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transitional care neonates

Tara Follett, Sara Calderon-Crossman, Denise Clarke, Marcia Ergezinger, Christene Evanochko, Krystal Johnson, Natalie Mercy, Barbara Taylor
BACKGROUND: A level 1 community hospital with a labor, delivery, recovery, and postpartum (LDRP) unit delivering over 2800 babies per year was operating without dedicated neonatal resuscitation and stabilization support. PURPOSE: With lack of funding and space to provide an onsite level 2 neonatal intensive care unit (NICU), a position was created to provide neonatal nurse practitioner (NNP) coverage to support the LDRP unit. METHOD: The article describes the innovative solution of having an NNP team rotate from a regional neonatal intensive care program to a busy community LDRP unit...
October 4, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Sezin Unal, Ebru Ergenekon, Selma Aktas, Serdar Beken, Nilgun Altuntas, Ebru Kazanci, Ferit Kulali, Ibrahim M Hirfanoglu, Esra Onal, Canan Turkyilmaz, Esin Koc, Yildiz Atalay
BACKGROUND: Perfusion index (PI) is becoming a part of clinical practice in neonatology to monitor peripheral perfusion noninvasively. Hemodynamic and respiratory changes occur in newborns during the transition period after birth in which peripheral perfusion may be affected. Tachypnea is a frequent symptom during this period. While some tachypneic newborns get well in less than 6 h and diagnosed as "delayed transition", others get admitted to intensive care unit which transient tachypnea of newborn (TTN) being the most common diagnosis among them...
October 7, 2016: BMC Pediatrics
R Sahni, X Ameer, K Ohira-Kist, J-T Wung
OBJECTIVES: Inhaled nitric oxide (iNO) is effective in conjunction with tracheal intubation (TI) and mechanical ventilation (MV) for treating arterial pulmonary hypertension and hypoxemic respiratory failure (HRF) in near-term and term newborns. Non-invasive respiratory support with nasal continuous positive airway pressure (CPAP) is increasingly used to avoid morbidity associated with TI and MV, yet the effectiveness of iNO delivery via nasal CPAP remains unknown. To evaluate the effectiveness of iNO delivered via the bubble nasal CPAP system in term and preterm newborns with HRF...
October 6, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
Julia Petty
BACKGROUND: Storytelling is an increasingly well recognised and valued platform to learn about the human experience within healthcare. Little is known however about how stories can enhance understanding in neonatal care, a specialised field offering rich opportunities for learning. This study focuses on the creation of stories based on the experiences of student nurses to inform teaching and learning strategies in the neonatal field. OBJECTIVES: The study aimed to create stories from the narratives of student nurses working within the neonatal field and identify what key themes for learning emerged in order to develop a storytelling resource to share experiences with their peers...
September 25, 2016: Nurse Education Today
Sophie Geoghegan, Kate Oulton, Catherine Bull, Joe Brierley, Mark Peters, Jo Wray
OBJECTIVE: Meeting the needs of parents of critically ill children is increasingly being recognized as an important factor in the child's clinical outcome as well as the implications it has for future parenting. Little is specifically known about the experience of parents who have a child in the ICU for a prolonged period. Our objective was to understand the experiences of this group to assist in the identification of mechanisms for providing support. DESIGN: Qualitative study based on semistructured interviews...
September 19, 2016: Pediatric Critical Care Medicine
Emily C Atwood, Grace Sollender, Erica Hsu, Christine Arsnow, Victoria Flanagan, Joanna Celenza, Bonny Whalen, Alison V Holmes
BACKGROUND AND OBJECTIVES: Although the incidence of neonatal abstinence syndrome (NAS) in the United States quintupled between 2000 and 2012, little is known about the family perspective of the hospital stay. We interviewed families to understand their experiences during the newborn hospitalization for NAS and to improve family-centered care. METHODS: A multidisciplinary team from 3 hospital units composed open-ended interview questions based on a literature review, clinical experience, and an internal iterative process...
October 2016: Hospital Pediatrics
Zelda Greene, Colm Pf O'Donnell, Margaret Walshe
BACKGROUND: Preterm infants (< 37 weeks' postmenstrual age) are often delayed in attaining oral feeding. Normal oral feeding is suggested as an important outcome for the timing of discharge from the hospital and can be an early indicator of neuromotor integrity and developmental outcomes. A range of oral stimulation interventions may help infants to develop sucking and oromotor co-ordination, promoting earlier oral feeding and earlier hospital discharge. OBJECTIVES: To determine the effectiveness of oral stimulation interventions for attainment of oral feeding in preterm infants born before 37 weeks' postmenstrual age (PMA)...
September 20, 2016: Cochrane Database of Systematic Reviews
Media Esser
BACKGROUND/INTRODUCTION TO CASE: Neonatal wound care is challenging due to the fragility and vulnerable skin structure. Neonates are often left susceptible to the forces of their environment, leaving them open to infection when skin injury occurs. Leptospermum honey has been used successfully in adult patients, with evidence lacking in the neonatal population. This case demonstrates the management of a difficult-to-heal wound in a 23-week gestation infant. PURPOSE: Selecting the proper treatment and products for wound healing is challenging, with little evidence-based research available for the treatment of neonatal wounds...
September 8, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Nathan Batchelder, Tsz-Yin So
Osteomyelitis is a bone infection that requires prolonged antibiotic treatment and potential surgical intervention. If left untreated, acute osteomyelitis can lead to chronic osteomyelitis and overwhelming sepsis. Early treatment is necessary to prevent complications, and the standard of care is progressing to a shorter duration of intravenous (IV) antibiotics and transitioning to oral therapy for the rest of the treatment course. We systematically reviewed the current literature on pediatric patients with acute osteomyelitis to determine when and how to transition to oral antibiotics from a short IV course...
August 8, 2016: World Journal of Clinical Pediatrics
Lori Feldman-Winter, Jay P Goldsmith
Skin-to-skin care (SSC) and rooming-in have become common practice in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as delineated in the World Health Organization's "Ten Steps to Successful Breastfeeding." SSC and rooming-in are supported by evidence that indicates that the implementation of these practices increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep...
September 2016: Pediatrics
Malki Miller, Keyur Donda, Alok Bhutada, Deepa Rastogi, Shantanu Rastogi
BACKGROUND: Growth in preterm infants is compromised during the transition phase of nutrition, when parenteral nutrition (PN) volumes are weaned with advancing enteral nutrition (EN) feeds, likely due to suboptimal nutrient intakes during this time. We implemented new PN guidelines designed to maintain optimal nutrient intakes during the transition phase and compared growth outcomes of this cohort with a control group. MATERIALS AND METHODS: A chart review was conducted on infants born <32 weeks' gestation, before (control group) and after (study group) a new transition PN protocol was implemented in the neonatal intensive care unit...
August 18, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Margaret Broom, Anne Gardner, Zsuzsoka Kecskes, Sue Kildea
STUDY OBJECTIVE: To facilitate staff transition from an open plan to a two cot Neonatal Intensive Care Unit (NICU) design. BACKGROUND: In 2012, an Australian regional NICU transitioned from an open plan to a two cot NICU design. Research has reported single and small room NICU design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such NICUs...
August 17, 2016: Journal of Clinical Nursing
Sousan Heydarpour, Zohre Keshavarz, Maryam Bakhtiari
AIM: To explore factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit. BACKGROUND: Transition to motherhood often causes significant issues in terms of adaptation to the role of motherhood. The main factors leading to parental stress, especially in the neonatal intensive care unit, have shown that the greatest source of stress is the loss of women's role as mothers. DESIGN: It was a qualitative study with content analysis approach...
August 10, 2016: Journal of Advanced Nursing
Katheleen Hawes, Elisabeth McGowan, Melissa O'Donnell, Richard Tucker, Betty Vohr
OBJECTIVE: To examine the association of maternal mental health, perceptions of readiness at neonatal intensive care unit (NICU) discharge, and social risk factors with depressive symptoms 1 month postdischarge in mothers of early (<32 weeks), moderate (32-33 weeks), and late (34-36 weeks) preterm infants. A secondary objective was to compare depressive symptoms among mothers in all preterm groups. STUDY DESIGN: Mothers (n = 734) of preterm infants cared for >5 days in the NICU and participating in a Transition Home Program completed the Fragile Infant Parent Readiness Evaluation prior to discharge for perceptions of NICU staff support, infant well-being, maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant)...
August 5, 2016: Journal of Pediatrics
Marina Boykova
When the day of discharge from a neonatal intensive care unit (NICU) comes for the parents of newborn infants, they are filled with long-awaited joy and happiness. They go home feeling as parents, away from scheduled routines of the hospital, monitor alarms, clinical rounds, numerous tests, and so on. What do we know about what happens after these little patients and their families leave the NICU? What happens from the point of leaving the hospital until when things get settled and life becomes perceived as normal? This article presents a short summary of research conducted with the vulnerable population of high-risk and preterm infants and their families postdischarge...
July 2016: Journal of Perinatal & Neonatal Nursing
Helen Christou, Maria Lv Dizon, Kathryn N Farrow, Sudarshan R Jadcherla, Kristen T Leeman, Akhil Maheshwari, Lewis P Rubin, Brian K Stansfield, David H Rowitch
Understanding mechanisms of childhood disease and development of rational therapeutics are fundamental to progress in pediatric intensive care specialties. However, Division Chiefs and Department Chairs face unique challenges when building effective laboratory-based research programs in Neonatal and Pediatric Intensive Care, owing to high clinical demands necessary to maintain competence as well as financial pressures arising from fund flow models and the current extramural funding climate. Given these factors, the role of institutional support that could facilitate successful transition of promising junior faculty to independent research careers is ever more important...
July 19, 2016: Pediatric Research
Jason R Moore, David J Varricchio
Diapsids show an extremely wide range of reproductive strategies. Offspring may receive no parental care, care from only one sex, care from both parents, or care under more complex regimes. Young may vary from independent, super-precocial hatchlings to altricial neonates needing much care before leaving the nest. Parents can invest heavily in a few young, or less so in a larger number. Here we examine the evolution of these traits across a composite phylogeny spanning the extant diapsids and including the limited number of extinct taxa for which reproductive strategies can be well constrained...
2016: PloS One
Gil Wernovsky, Stacey L Lihn, Melissa M Olen
Over the past 20 years, the successes of neonatal and infant surgery have resulted in dramatically changed demographics in ambulatory cardiology. These school-aged children and young adults have complex and, in some cases, previously unexpected cardiac and non-cardiac consequences of their surgical and/or transcatheter procedures. There is a growing need for additional cardiac and non-cardiac subspecialists, and coordination of care may be quite challenging. In contrast to hospital-based care, where inpatient care protocols are common, and perioperative expectations are more or less predictable for most children, ambulatory cardiologists have evolved strategies of care more or less independently, based on their education, training, experience, and individual styles, resulting in highly variable follow-up strategies...
July 4, 2016: Cardiology in the Young
Michelle Paliwoda, Karen New, Fiona Bogossian
BACKGROUND: All newborns are at risk of deterioration as a result of failing to make the transition to extra uterine life. Signs of deterioration can be subtle and easily missed. It has been postulated that the use of an Early Warning Tool may assist clinicians in recognising and responding to signs of deterioration earlier in neonates, thereby preventing a serious adverse event. OBJECTIVE: To examine whether observations from a Standard Observation Tool, applied to three neonatal Early Warning Tools, would hypothetically trigger an escalation of care more frequently than actual escalation of care using the Standard Observation Tool...
September 2016: International Journal of Nursing Studies
Valerie Boebel Toly, Carol M Musil, Amy Bieda, Kimberly Barnett, Donna A Dowling, Abdus Sattar
BACKGROUND: Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization...
July 13, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
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