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Lee, Hanna, Da-Jung Kim, and Jeong-Won Han. "Developing Nursing Standard Guidelines for Nurses in a Neonatal Intensive Care Unit: A Delphi Study." Healthcare 8, no. 3 (September 4, 2020): 320. http://dx.doi.org/10.3390/healthcare8030320.
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The purpose of this study is to develop nursing standard guidelines for nurses in a neonatal intensive care unit. The Delphi method was used in this study to elicit expert consensus. Thirteen experts who were nurses and pediatric adolescent specialists working in the neonatal intensive care unit participated in the study. In this study, 178 items were developed based on 5 nursing practice standards and 7 standards of professional practice. An additional 10 items were included based on observation in the neonatal intensive care unit. After expert validation, a final total of 184 items was developed. The standard guidelines for high-risk neonatal care developed in this study for practical clinical education in nursing are significant because they reflect the nursing practice standards in Korea and characteristics of nursing practice in the neonatal intensive unit.
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Azzizadeh Forouzi, Mansooreh, Marjan Banazadeh, Jila Soltan Ahmadi, and Farideh Razban. "Barriers of Palliative Care in Neonatal Intensive Care Units." American Journal of Hospice and Palliative Medicine® 34, no. 3 (July 11, 2016): 205–11. http://dx.doi.org/10.1177/1049909115616597.
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Objective: Neonatal nurses face numerous barriers in providing end-of-life (EOL) care for neonates and their families. Addressing neonatal nurses’ attitudes could provide insight into barriers that impede neonatal palliative care (NPC). This study thus conducted to examine neonatal nurses’ attitude toward barriers in providing NPC in Southeast Iran. Method: In this cross-sectional study, a translated modified version of Neonatal Palliative Care Attitude Scale was used to examine attitudes of 70 nurses toward barriers of palliative care in 3 neonatal intensive care units in Southeast Iran. Results: Findings indicated that overall 42.63% of nurses were strongly agreed or agreed with the proposed barriers in NPC. Among all categories, the highest and the lowest scores belonged to the categories of “insufficient resources” (3.42 ± 0.65) and “inappropriate personal and social attitudes” (2.33 ± 0.48), respectively. Neonatal nurses who had less education and study regarding NPC reported the presence of more barriers to NPC in the categories of “inappropriate organizational culture” and/or “inadequate nursing proficiency.” Also, younger nurses had more positive attitudes toward the category of inappropriate organizational culture as being a barrier to provision of NPC (4.62). Conclusion: The findings suggest that developing a context-based instrument is required to represent the barrier more precisely. Neonatal palliative care can be improved by establishing a special environment to focus on infants’ EOL care. This establishment requires standard palliative care guidelines and adequate NPC-trained nurses.
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Purdy, Isabell, and Rita Wadhwani. "Embracing Bioethics in Neonatal Intensive Care, Part II: Case Histories in Neonatal Ethics." Neonatal Network 25, no. 1 (January 2006): 43–53. http://dx.doi.org/10.1891/0730-0832.25.1.43.
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Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced-based medicine have often superseded standards in evidence-based ethics. Neonatal nurses attain a more in-depth understanding of the clinical significance of the four principles of bioethics: autonomy, nonmaleficence, beneficence, and justice. Case studies illustrate the principles discussed.
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Richardson, Douglas K., and William O. Tarnow-Mordi. "Measuring Illness Severity in Newborn Intensive Care." Journal of Intensive Care Medicine 9, no. 1 (January 1994): 20–33. http://dx.doi.org/10.1177/088506669400900104.
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Measurement of illness severity has found increasing use in adult and pediatric intensive care research over the past decade. The development of illness severity indices for neonatal intensive care has lagged because birth weight has served as an excellent proxy for illness severity. However, a number of recent studies have shown marked variation in survival and morbidity among neonatal intensive care units (NICUs) despite birth weight adjustment, making clear the need for neonatal illness severity scoring. We discuss advantages and disadvantages of the 4 types of scoring systems used in adult intensive care—diagnosis, risk-factor, therapeutic, and physiological—and review their applications in adult and pediatric ICU research. Criteria for score design, as well as standards for validation and performance, are enumerated. The 30 neonatal scores fall in 5 major categories: obstetric risk, general use pediatric scores, predictors of developmental outcome, bronchopulmonary dysplasia risk, and acute mortality risk. Few have been adequately validated on large, concurrent independent samples. The most promising scores are those that measure acute physiological derangement on admission. Potential applications for these new illness severity scores are discussed.
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Purdy, Isabell. "Embracing Bioethics in Neonatal Intensive Care, Part I: Evolving Toward Neonatal Evidence-Based Ethics." Neonatal Network 25, no. 1 (January 2006): 33–42. http://dx.doi.org/10.1891/0730-0832.25.1.33.
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Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced-based medicine have often superseded standards in evidence-based ethics. Part I of this article presents a historical review of neonatal care and an overview of cases that have set precedents in neonatal ethical debate. It also includes recommendations for enhancing the skills of neonatal nurses as patient advocates in NICU ethical issues, an area that is, at times, controversial and baffling to clinicians.
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Flores, Cindy J., Anil Lakkundi, Joanne McIntosh, Peter Freeman, Amanda Thomson, Ben Saxon, Justine Parsons, Tracey Spigiel, Sarah Milton, and Bryony Ross. "Embedding best transfusion practice and blood management in neonatal intensive care." BMJ Open Quality 9, no. 1 (January 2020): e000694. http://dx.doi.org/10.1136/bmjoq-2019-000694.
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BackgroundTransfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best transfusion principles in the neonatal intensive care unit (NICU) by aligning local policies, providing targeted education and partnering with parents.MethodsPractice-based evidence for clinical practice improvement (PBE-CPI) methodology was used. Previous hospital accreditation audits were reviewed and a neonate-specific transfusion audit was developed. Audit was performed at baseline and repeated following the intervention period. NICU clinicians received targeted education in obtaining informed consent, prescription and safe administration of blood components during a ‘Blood Month’ awareness period. A neonate-specific parent handout about transfusion was developed in partnership with parents. A pilot video demonstrating a shared consent discussion was also developed to assist in the consent process. Parents’ knowledge, concerns and feedback regarding transfusion practice was sought at baseline (survey) and on project completion (experience trackers).ResultsNeonate-specific baseline transfusion audit showed inconsistent consent, monitoring and documentation processes in neonatal transfusions. Post-targeted education audit showed improvement in these parameters. The targeted PBM and transfusion-related education delivered during ‘Blood Month’ was well-received by staff. Parents’ feedback about the NICU transfusion consenting process was consistently positive. NICU medical and nursing clinicians (n=25) surveyed agreed that the parent handout was well set out, easy to understand and recommended that it be used to complement practice.ConclusionPBE-CPI tools aligned with Australian PBM guidelines for clinicians and parents were well-accepted by clinical stakeholders and were associated with practice improvement in PBM awareness and transfusion consent processes. This PBE-CPI project developed NICU-specific consent information, not previously available, by partnering with parents to ensure quality of care in transfusion practice. Adoption of this also helps to meet accreditation for Australian Blood Management Standards. These strategies and tools translate readily into other NICUs to embed and support best PBM and transfusion practice.
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Raza, Syed M., Mohamed M. Sheta, Suzan S. Gad, Nermine Elmaraghy, Ahmed S. Hussein, Shaimaa Sahmoud, and Abeer I. Al-Khalafawi. "Effect of Educational Intervention on Implementation of Neonatal Safety Standards." Journal of Child Science 10, no. 01 (January 2020): e93-e96. http://dx.doi.org/10.1055/s-0040-1716376.
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Abstract Background and Aim Patient safety in the neonatal intensive care unit (NICU) is one of the highest priority issues on the health care quality agenda worldwide. Efforts are needed to improve neonatal safety in NICU. The present study evaluated the effect of educational intervention on neonatal safety. Materials and Methods Quasi-experimental study was conducted in three major hospitals, including the health care workers in their NICU during the period of study from May 2016 to May 2018. Neonatal safety standards were evaluated using an observational checklist after its validation by a pilot study. An intervention educational program was conducted in the three hospitals, followed by a reevaluation of the standards. All staff members (58 physicians and 69 nurses) participated in the three stages of the study. Results The interventional program resulted in significant improvement of the health care workers implementation of the general (90.6 ± 15.1 vs. 127.6 ± 7.02, p = 0.016) and specific (50.6 ± 17.1 vs. 96.1 ± 13.2, p = 0.04) Egyptian Neonatal Safety Standards. Conclusion Training and increasing the awareness of health care workers of the neonatal safety standards can significantly increase the fulfilment of these standards in both secondary and tertiary care neonatal units.
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Shrivastava, Ajit Kumar, Prema Ram Choudhary, and Santosh Kumar Roy. "Bacteriological profile of neonatal and pediatrics sepsis in intensive care unit at a tertiary care hospital in western India." International Journal of Contemporary Pediatrics 8, no. 3 (February 23, 2021): 460. http://dx.doi.org/10.18203/2349-3291.ijcp20210521.
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Background: Neonatal and pediatrics sepsis are one of the main causes of mortality in neonatal and pediatric intensive care units of developing countries. This study was conducted to determine bacteriological profile of neonatal and pediatrics sepsis in the intensive care unit. Methods: A prospective cross-sectional study was conducted in the neonatal and pediatric intensive care unit, for the period of two years. All 400 neonates and pediatrics patients admitted with suspected clinical sepsis were included. Sepsis screens and cultures were sent under aseptic conditions. Isolation of microorganisms and their identification was done according to standard microbiological techniques bacteriological profile was analyzed with descriptive statistics.Results: Incidence of septicemia is 35.34% in neonates, 9.83% in post neonates and 22.95% in older children. Most common associated factor in neonates were preterm 41.46% in neonates, fever of unknown origin 50% and 78.57% in post neonates and children respectively. Out of 232 suspected cases on neonates in 36.07% cases bacterial pathogen were isolated, 62 suspected cases on post neonates in 9.83% cases bacterial were isolated and 106 suspected cases of older children in 22.95% cases bacterial pathogen were isolated. Common bacterial species isolated were Klebsiella sp. 39.02% in neonates, S. aureus 50% and 35.71% in post neonates and older children respectively.Conclusions: There is entail prevention of infection control measures and rational antibiotic strategy to decrease the economic burden of hospital and community.
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Sampathkumar, P. Sampathkumar, and S. Gobinathan. "A study on status of neonatal transport to a level III neonatal intensive care unit." International Journal of Contemporary Pediatrics 5, no. 3 (April 20, 2018): 1040. http://dx.doi.org/10.18203/2349-3291.ijcp20181538.
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Background: In the past decade, great advancements in Neonatal care contributed to a fall in IMR. A further fall in IMR can only be achieved by improving the neonatal transport facilities. Hence to assess the current status of neonatal transport we undertook this study.Methods: This is a cross-sectional study of 75 neonates transported to our NICU. For all the babies, data regarding the place of birth, mode of delivery, mode of transport, etc. were collected. On admission parameters like blood glucose, temperature, CRT, SPO2, the presence of cyanosis, shock was assessed.Results: In the present study 64% of neonates came to our NICU on their conveyance. 67% of referrals from PHCs did not utilize ambulance facility. 30% of neonates had hypothermia on arrival. 35%had hypoglycemia on arrival. 15% had a low oxygen saturation on arrival. 15% had prolonged CRT on arrival. Only 8% of neonates received prior treatment. 11% babies did not have any referral slip. Only a very few had complete and proper referral advice.Conclusions: To further reduce the neonatal mortality rate, the neonatal transport facilities should be upgraded. A standard protocol should be formulated for interfacility transport. A separate fleet of neonatal ambulances well equipped and manned by trained personnel is the need of the hour.
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Milette, Isabelle, Marie-Josée Martel, Margarida Ribeiro da Silva, and Mary Coughlin McNeil. "Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the Neonatal Intensive Care Unit. Part A." Canadian Journal of Nursing Research 49, no. 2 (May 17, 2017): 46–62. http://dx.doi.org/10.1177/0844562117706882.
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The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the “universe of developmental care” conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission’s requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.
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Elie, Valery, Virginia Neyro, Phuong Ha, Beate Aurich, Stephanie Leroux, and Evelyne Jacqz-Aigrain. "Capacities and Competences for Drug Evaluation in European Neonatal Intensive Care Units: A Survey and Key Issues for Improvement." American Journal of Perinatology 35, no. 06 (April 25, 2018): 589–98. http://dx.doi.org/10.1055/s-0038-1637766.
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Background Multicenter neonatal clinical trials aim to provide evidence-based drug evaluation, but recruiting neonates requires collaboration, standard procedures, and trained neonatologists. Methods A questionnaire based on a previous Delphi study was sent to European neonatal intensive care units (NICUs) to collect their research experience and identify areas for improvement. Results Of 247 NICUs,79 (32%) responded: 69 were level III units and 10 were level II units. In level III centers, 62% had medical staff dedicated to research and 65% conducted regular in-house audits. Similarities were observed in the median number of trials per year (level II: 2; level III: 5), Good Clinical Practice training (level II: 78%; level III: 66%), and standard operating procedures (level II: 63%; level III: 71%). Most NICUs had access to scientific advice for trial design, conduct, data management, and regulatory aspects. Involvement of patient advocacy groups was more common in level II units (level II: 75%; level III: 59%). A “quality” score of 34 “quality” research items was calculated for all centers (mean: 23.2 ± 6.2; range: 6–34). Conclusion Research experience and processes vary across Europe. Harmonizing research practices and setting standards will allow building a European neonatal network for effective, safe, and quality neonatal drug development.
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Ingale, Hemangi D., Vaishali A. Kongre, and Renu S. Bharadwaj. "A study of infections in neonatal intensive care unit at a tertiary care hospital." International Journal of Contemporary Pediatrics 4, no. 4 (June 21, 2017): 1349. http://dx.doi.org/10.18203/2349-3291.ijcp20172664.
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Background: As infection is a major cause of morbidity and mortality in neonates, early diagnosis and prompt treatment can prevent its serious consequences. The present study was conducted to determine the prevalence of infections in neonatal intensive care unit (NICU) of a tertiary care hospital and to study their risk factors, causative organisms and antimicrobial susceptibility pattern.Methods: Appropriate samples were collected from all neonates with clinical signs and symptoms of infections. Isolation of microorganisms, their identification and antimicrobial susceptibility was done according to standard microbiological techniques.Results: Among 1210 neonates admitted in the NICU, 393 (32.4%) were clinically suspected infections. The prevalence of Septicemia, Pneumonia, and Meningitis were 6%, 1.5%, 0.7% respectively. The predominant organisms causing neonatal infection were Gram negative bacteria followed by fungi and Gram positive bacteria. Among Gram negative bacteria, the antimicrobial resistance was highest for third generation Cephalosporins [Ceftazidime (81.1%), Cefotaxime (60.3%)]. In Gram positive bacteria highest resistance was observed for Penicillin and Ampicillin (91.3%). Methicillin resistance was observed in 91.6% of Coagulase negative Staphylococci (CoNS). All isolates of Candida parapsilosis were sensitive to Fluconazole, Voriconazole but resistant to Amphotericin B. Predominant risk factors were low birth weight (87.7%) and prematurity (75%). Maternal risk factors were pregnancy induced hypertension (13.4%) and premature rupture of membranes (PROM) (10.1%). The case fatality rate was 20.7%.Conclusions: There is a need of strict infection control measures and rational antibiotic policy to reduce the economic burden of hospital and community due to neonatal infections.
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Vaghela, Jayeshkumar P., and Anupama Sukhlecha. "Drug utilization study in neonatal intensive care unit of a tertiary care teaching hospital." International Journal of Basic & Clinical Pharmacology 6, no. 10 (September 23, 2017): 2510. http://dx.doi.org/10.18203/2319-2003.ijbcp20174386.
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Background: Sick and pre-term neonates are admitted in neonatal intensive care units (NICU) and treated. A great care needs to be taken to use drugs in neonates due to the immaturity of their body functions. There is a lack of standard drug prescribing guideline in children, especially neonates because; safety and efficacy for a majority of drugs have not been established in them. The objectives of the study were to evaluate the drug utilization pattern in NICU of a teaching hospital and to identify problems in drug utilization and suggest measures, if needed.Methods: A prospective, observational study was carried out in NICU for duration of one year. Demographic details like age, sex, birth weight, duration of hospitalization was recorded from the case files of neonates. The morbid condition, treatment with drugs and other supportive modalities were recorded. The outcome of treatment was also noted. WHO drug utilization core indicators were also evaluated.Results: Out of 623 admissions in NICU, 56% were males. There were 56% of neonates who were born pre-term. The maximum used drugs were Vitamin K (73%) and antibiotics (64%). The antibiotics were mainly from penicillin and aminoglycoside groups. Respiratory distress syndrome (19%) and neonatal sepsis (16%) were the most common causes for admission. Out of total admissions, 64% were discharged following recovery, while, 12% had expired.Conclusions: Drugs usage in neonates should be minimal and should be prescribed from essential drug list. Antibiotic policy needs to be formulated for hospitals to minimize antibiotic usage and prevent development of resistance.
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Buraniqi, Ersida, Arnold J. Sansevere, Kush Kapur, Ann M. Bergin, Phillip L. Pearl, and Tobias Loddenkemper. "Electrographic Seizures in Preterm Neonates in the Neonatal Intensive Care Unit." Journal of Child Neurology 32, no. 10 (July 9, 2017): 880–85. http://dx.doi.org/10.1177/0883073817713918.
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Objective: Characterize clinical and electroencephalography (EEG) characteristics of preterm neonates undergoing continuous EEG in the neonatal intensive care unit. Methods: Retrospective study of preterm neonates born less than 37 weeks’ gestational age undergoing continuous EEG in the neonatal intensive care unit at Boston Children’s Hospital over a 2-year period. Results: Fifty-two preterms (46% male) had a mean gestational age of 32.8 weeks (standard deviation = 4.17). Seizures were detected in 12/52 (23%), with EEG seizures detected in 4/12 (33%). The median time from EEG to the first seizure was 0.5 hours (interquartile range 0.24-4). Factors associated with seizures were male gender (odds ratio = 4.65 [95% confidence interval = 1.02-21.24], P = .047) and lack of EEG state change (odds ratio = 0.043 [95% confidence interval = 0.005-0.377], P = .04). Conclusion: Twenty-three percent of preterms undergoing continuous EEG had EEG seizures or electrographic seizures with no clear clinical correlate. This confirms recent American Clinical Neurophysiology Society guidelines suggesting that preterm neonates are at high risk for seizures.
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Hennessy, Sandra C. "Developing standard concentrations in the neonatal intensive care unit." American Journal of Health-System Pharmacy 64, no. 1 (January 1, 2007): 28–30. http://dx.doi.org/10.2146/ajhp060180.
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HEFFERMAN, PAM, and STEVE HEILIG. "Giving “Moral Distress” a Voice: Ethical Concerns among Neonatal Intensive Care Unit Personnel." Cambridge Quarterly of Healthcare Ethics 8, no. 2 (April 1999): 173–78. http://dx.doi.org/10.1017/s0963180199802060.
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Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the “gray area” gestation period of approximately 23–25 weeks may result in situations where various people involved in such cases may feel “held hostage” to technological imperatives. Legal decisions and standards have evolved that are discordant with the views of many clinicians most familiar with the treatment of such patients. Increasing concerns regarding such scenarios have fueled much academic and professional debate about the need for consensus about ethical limits to clinical interventions with high probability of nonbeneficial impact. While at least some clinicians and ethicists may be inching toward consensus regarding limits to such treatment, the voices of some bedside personnel, particularly neonatal intensive care unit (NICU) nurses, have been relatively muted in this debate. At least one previous survey of clinicians, which included nurses, indicated that many nurses experienced a high level of “moral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of futility.
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Placencia, Frank X., and Laurence B. McCullough. "The History of Ethical Decision Making in Neonatal Intensive Care." Journal of Intensive Care Medicine 26, no. 6 (May 23, 2011): 368–84. http://dx.doi.org/10.1177/0885066610393315.
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Neonatal ethics has focused on 2 questions: is withholding potentially live-saving treatment from neonates ethically justified? and if so, who has the authority to decide? This article details how these questions developed and provides a description of the possible answers. In the first section, we review a selection of seminal articles by noted authors in the fields of ethics, medicine, and law. The second section provides a detailed account of the development of the Baby Doe Regulations and the impact they had on neonatal ethics, with particular attention to the emergence of the Best Interest Standard as a guideline for decision making. In the last section, we review the landmark position statements by the American Academy of Pediatric (AAP), and the focus on evidence-based decision making. We conclude that forgoing life-saving treatment is ethically justified. However, this requires a rigorous evidence-based process and is limited by the Best Interest Standard. The second question is more difficult to answer, but we feel that in light of legal limitations, physicians acting as both the infant advocate and a proxy for the state, decide what falls in the range of acceptable treatment options, with the parents free to choose within that range.
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Robinson, Christine A., Anita Siu, Rachel Meyers, Ben H. Lee, and Jared Cash. "Standard Dose Development for Medications Commonly Used in the Neonatal Intensive Care Unit." Journal of Pediatric Pharmacology and Therapeutics 19, no. 2 (June 1, 2014): 118–26. http://dx.doi.org/10.5863/1551-6776-19.2.118.
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OBJECTIVES: To establish standardized, rounded doses of medications for neonates in the neonatal intensive care unit (NICU) through a multi-institutional peer-reviewed process. METHODS: Pediatric faculty and pediatric pharmacy residents from the Ernest Mario School of Pharmacy (Piscataway, NJ) conducted a systematic review of rounded, weight-based medication information for neonatal patients from September 2010 to April 2011. After initial review, an expanded workgroup of expert neonatal pharmacy clinicians from academic institutions throughout the United States were invited to conduct a final review. The workgroup identified 74 medications or indications in the NICU. Recommended standardized doses were established for discrete weight categories at workgroup consensus web meetings conducted from June to December 2011. Workgroup recommendations were cross-referenced with published neonatal pharmacology resources. Consensus was obtained when references provided insufficient information on medication information. RESULTS: Seventeen weight categories of increasing ranges were used, from 40 g for the lowest weights (e.g., 410–450 g) to 840 g for the highest weights (e.g., 3660–4500 g). Medications were divided into 3 categories of administration routes: oral (n = 4), intermittent intravenous (n = 64), and other (e.g., intramuscular; n=6). A significant majority of standardized doses (84%) were within 15% of their corresponding weight-calculated dose. CONCLUSIONS: Establishment of a portfolio of standardized, rounded doses of medications commonly used in the NICU was feasibly established by a multi-institutional peer review process, with the great majority of standardized doses being within clinically acceptable ranges of administration. Use of standardized, rounded doses for reduction in dosing errors may be feasible on a systematic level.
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Schmalenberg, Claudia, and Marlene Kramer. "Types of Intensive Care Units With the Healthiest, Most Productive Work Environments." American Journal of Critical Care 16, no. 5 (September 1, 2007): 458–68. http://dx.doi.org/10.4037/ajcc2007.16.5.458.
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Background The quality of nurses’ work environments in hospitals is of great concern. The American Association of Critical-Care Nurses has specified 6 standards essential to a healthy (ie, satisfying and productive) work environment. These standards are sufficiently aligned to the Essentials of Magnetism processes to make this tool suitable for measuring healthy work environments. Objectives To identify differences in staff nurses’ perceptions of the work environment by type of intensive care unit. Methods A cross-sectional descriptive design with strategic sampling was used in this secondary analysis of data from 698 staff nurses working in 34 intensive care units in 8 magnet hospitals. Intensive care units were grouped into 4 types: medical, including coronary care; surgical, including trauma and cardiovascular; neonatal and pediatric; and medical-surgical. All nurses completed the Essentials of Magnetism instrument. Analysis of variance was used to identify initial differences; multivariate analysis of variance was used to control for covariates. Results The intensive care nurses and units scored above the National Magnet Hospital Profile mean on process variables and on the Essentials of Magnetism outcome variables. Neonatal and pediatric units scored significantly higher than did the other types of intensive care units sampled. Conclusions Intensive care unit structures supported care processes and relationships that resulted in job satisfaction among nurses and high-quality care for patients in this strategic sample. Systematic study of the structures and processes present in units reporting a healthy work environment can be used to assist other clinical units in improving work environments.
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Pasarón, Raquel. "Neonatal Bioethical Perspectives: Practice Considerations." Neonatal Network 32, no. 3 (2013): 184–92. http://dx.doi.org/10.1891/0730-0832.32.3.184.
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Over the past 30 years, there has been a modest improvement in the survival rates of U.S. infants. The public health impact of associated economic and technological advances raises questions regarding neonatal care and end-of-life decisions for those caring for this population. Nurses have an obligation to remain abreast of neonatal ethical standards because they are intimately involved in caring for these patients. Therefore, the aim of this article is to (a) summarize the extant neonatal bioethical literature to appreciate the complex ethical issues that translate into practice challenges, (b) present a framework that guides the assessment of the benefits and burdens of neonatal intensive care in the clinical setting to solicit and provoke dialogue, and (c) provide examples that advocate for educational training for neonatal health care providers in support of ethically sound care to affected families and infants.
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Merenstein, G. B. "Individualized developmental care. An emerging new standard for neonatal intensive care units?" JAMA: The Journal of the American Medical Association 272, no. 11 (September 21, 1994): 890–91. http://dx.doi.org/10.1001/jama.272.11.890.
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Kim, Janice, Hilary Rosen, Kristen Angel, Azarnoush Maroufi, Samantha Tweeten, Jacqueline Lui, John Crandall, Tracy Lanier, Jane Siegel, and Akiko Kimura. "Transmission of Listeriosis in a Neonatal Intensive Care Unit Supported by Whole-Genome Sequencing." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s53. http://dx.doi.org/10.1017/ice.2020.536.
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Background: Listeriosis is a rare but serious infectious disease caused by Listeria monocytogenes (LM) and predominantly transmitted through contaminated food. Moreover, 15% of listeriosis cases in the United States are pregnancy associated; nosocomial neonatal transmission in hospitals is extremely rare. In July 2018, the California Department of Public Health (CDPH) was notified of 4 patients, a mother–neonate pair and twin neonates, with listeriosis at the same hospital. The CDPH and San Diego County Health and Human Services Agency initiated an investigation to determine transmission and prevent additional infections. Methods: We reviewed medical records of the neonates and their mothers, interviewed the mothers with a detailed food exposure questionnaire, interviewed healthcare personnel (HCP), and performed an infection control assessment of the neonatal intensive care unit (NICU). CDPH performed whole-genome sequencing (WGS) on LM isolates that were then analyzed by whole-genome multilocus sequence typing (wgMLST) by the Centers for Diseases Control and Prevention (CDC) to assess relatedness in PulseNet, a public health laboratory database. The CDC also performed testing for LM on formalin-fixed placentas from the mother of the twins. Results: During a 1-week period, 4 patients with LM were identified at the hospital. A mother was admitted at 31 weeks gestation with acute abdominal and back pain that progressed with precipitous vaginal delivery and postpartum sepsis. Her neonate was resuscitated, transported to the NICU, underwent a sepsis evaluation, received antibiotics, and was transferred to another hospital within 6 hours. Maternal blood, placenta, and neonatal blood cultures grew LM. Twin neonates, born to an asymptomatic mother and present in the NICU during the index neonate’s stay, developed acute infection 4 and 6 days after the index neonate’s transfer; blood cultures confirmed LM. The LM isolates from the 4 patients were indistinguishable by wgMLST and were not related to other PulseNet isolates. LM was not detected in the twin placentas. There were no common food exposures between the mothers. At least 1 common HCP cared for all 3 neonates. Infection control lapses included lack of proper hand hygiene during the index neonate’s resuscitation and potentially after cleaning and disinfection of the neonate’s incubator. Conclusions: This report provides supportive evidence that nosocomial transmission of LM can occur during a brief NICU stay due to lapses in infection control practices. Strict adherence to standard precautions in the delivery room and NICU is imperative to prevent cross transmission.Disclosures: NoneFunding: None
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James, Danielle, and Laura A. Talbot. "Neonatal Aeromedical Evacuation During COVID-19: An Interview With Captain Danielle James." Military Medicine 186, Supplement_2 (September 1, 2021): 74–80. http://dx.doi.org/10.1093/milmed/usab250.
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ABSTRACT During the coronavirus-19 pandemic, limited information existed about the risks and consequences of severe acute respiratory syndrome coronavirus 2 infection associated with maternal transmission to neonates. With rapidly evolving evidence, Air Force Neonatal Intensive Care Unit nurses at U.S. Naval Hospital Okinawa, Japan, adapted their standard operating procedures to safeguard their at-risk neonatal patients. This interview describes an Air Force NICU nurse’s view of neonatal transport and nursing care during the coronavirus-19 pandemic.
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Mokhnach, Larisa, Marilyn Anderson, Rachelle Glorioso, Katie Loeffler, Kelly Shinabarger, Lauren Thorngate, Marna Yates, et al. "NICU Procedures Are Getting Sweeter: Development of a Sucrose Protocol for Neonatal Procedural Pain." Neonatal Network 29, no. 5 (September 2010): 271–79. http://dx.doi.org/10.1891/0730-0832.29.5.271.
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Neonates in the neonatal intensive care nursery experience multiple, painful, tissue-damaging procedures daily. Pain among neonates is often underestimated and untreated, producing untoward consequences. A literature review established strong evidence supporting the use of sucrose as an analgesic for minor procedural pain among neonates. A review of unit practices and nurses’ experiential evidence initiated the production of a standardized protocol in our unit at the University of Washington Medical Center NICU in Seattle.Nursing practices surrounding sucrose use differed widely in dose, timing, and patient application. We carefully evaluated evidence documenting the effectiveness as well as the safety of sucrose administration and wrote a protocol and practice standards for our primarily premature patient population. This article describes the development and execution of a standardized, nurse-implemented, sucrose protocol to reduce procedural pain.
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Morgan, C., S. Keady, A. Ozzard, and B. Chauhan. "A standard aqueous parenteral nutrition formulation for neonatal intensive care." Clinical Nutrition 22 (August 2003): S70. http://dx.doi.org/10.1016/s0261-5614(03)80260-1.
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Vetter, E., LD Felice, and GL Ingersoll. "Self-scheduling and staff incentives: meeting patient care needs in a neonatal intensive care unit." Critical Care Nurse 21, no. 4 (August 1, 2001): 52–59. http://dx.doi.org/10.4037/ccn2001.21.4.52.
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Nursing staff and leadership in a resource-intensive NICU identified an innovative process for covering the unit's scheduling needs. Early concerns about the feasibility of achieving self-scheduling with a large staff were unwarranted. The use of a unit-based committee and the support of the nurse manager allowed us to develop a process that met the needs of the staff members and maintained the staffing standards of the unit. Contributing to the success of the self-scheduling is a mechanism for recognizing and rewarding staff members who adjust their work schedules to meet the needs of the unit. Satisfaction among staff members with self-scheduling is high, and new employees cite the opportunity for self-scheduling as a contributing factor in their decisions to work in the NICU.
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Rahman, Tania, Md Anisur Rahman, Kamrunnahar Alo, Momtaz Begum, Sharmin Sarwar, and Sharmeen Sultana Nila. "Distribution of Microorganisms in Neonatal Sepsis and Possible Outbreak of Enterobacter spp. in Neonatal Intensive Care Unit." KYAMC Journal 11, no. 1 (May 17, 2020): 14–20. http://dx.doi.org/10.3329/kyamcj.v11i1.47145.
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Background: Neonatal sepsis is one of the leading causes of neonatal mortality and morbidity globally, more in developing countries. Frequent monitoring of changing pattern of pathogens causing neonatal sepsis is mandatory for effective treatment.
Objectives: This study was done to isolate and identify different organisms of sepsis and to compare different types of organisms between early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS).
Materials and Methods: This cross sectional descriptive study was conducted in Department of Microbiology in collaboration with Department of Neonatology, (DMCH) Dhaka. Blood sample was collected from 106 clinically suspected septicemic neonates and isolation and identification of organism was done by automated blood culture and standard microbiological protocol. Data was collected from attendants by filling a predesigned questionnaire.
Results: Among 106 samples, 76 (71.69%) were bloodculture positive. Prevalence of (LONS) was higher 42 (55.26%) in comparison to (EONS) 34 (44.74%). Male neonates were affected more 42 (55.26%) than female 34 (44.74%). Among the isolated organisms, Enterobacter spp. was the predominant organism 20 (26.31%) followed by Klebsiella pneumoniae 18 (23.68%) and Candida spp. 12 (15.79%).
Conclusion: Gram-negative organisms play the leading role for causing neonatal sepsis and Enterobacter outbreak should be concerned. Therefore, regular surveillance of organism profile causing neonatal sepsis is of utmost necessity.
KYAMC Journal Vol. 11, No.-1, April 2020, Page 14-20
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Khadka, Sanu Bhai, Badri Thapa, and Kishori Mahat. "Nosocomial Citrobacter Infection in Neonatal Intensive Care Unit in a Hospital of Nepal." Journal of Nepal Paediatric Society 31, no. 2 (May 6, 2011): 105–9. http://dx.doi.org/10.3126/jnps.v31i2.4094.
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Introduction: Neonatal Citrobacter infection is either acquired horizontally or vertically as a nosocomial infection. The source of nosocomial Citrobacter is either hands of medical staff or the innate objects. Objective: The aim of this study was to study nosocomial Citrobacter infection in neonates admitted in Neonatal Intensive Care Unit (NICU) and trace the source of infection. Methods: The study was conducted in NICU in a hospital in Kathmandu, Nepal during a period of January to March 2010. Specimens were collected from neonates, hands of medical staff and innate objects and were processed using a standard microbiological method. Results: The prevalence of neonatal nosocomial infection was 32.6% (29/89). Citrobacter spp. was isolated in 11 neonates admitted in NICU with the prevalence rate of 37.9% (11/29) among other pathogens. Umbilical cord infection was most common (n=8). These isolates were grouped into five antibiotypes (I, 4; II, 3; III, 2; IV, I; V, 1). All of these isolates were multi-drug resistant showing susceptibility towards quinolones. The isolate of Citrobacter spp. was also recovered from a nasal prong which was grouped with 4 other clinical strains. Conclusion: Multi-drug resistant nosocomial Citrobacter spp. was inflicting neonates in NICU and the source of this pathogen was traced to nasal prong. Nosocomial Citrobacter infection is a common problem of neonates in NICU. This will lead to increase neonatal mortality if infection prevention and control practices are not initiated. Key words: Neonates; Citrobacter spp.; nasal prong; infection control; Nepal DOI: 10.3126/jnps.v31i2.4094 J Nep Paedtr Soc 2010;31(2):105-109
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Marzoog, Ahmed Salih, Hussein Naeem Mohammed, and Kholod Dhaher Habib. "Effectiveness of conventional phototherapy, intensive phototherapy and exchange transfusion in treating neonatal jaundice at Fatima Al-Zahra Hospital for maternity and children in Baghdad." AL-Kindy College Medical Journal 16, no. 2 (December 30, 2020): 25–29. http://dx.doi.org/10.47723/kcmj.v16i2.262.
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Background: Neonatal hyperbilirubinemia is a common disease in neonates especially in early days of birth that requires a good and successful treatment for reducing the severity and its complications that can produce important and irreversible effects.
Objectives: To evaluate the effectiveness of conventional phototherapy, intensive phototherapy and exchange transfusion on outcomes of neonatal jaundice at Fatima Al-Zahra Hospital for maternity and child care in Baghdad.
Patients & Methods: A retrospective study was carried out using medical records of neonates with diagnosis of unconjugated jaundice, admitted in the septic neonatal care unit of Fatima Al-Zahra hospital over 6 months period between 1st May till 31st October 2018. The total serum bilirubin, fractionations and blood group were done in all cases. They treated with conventional phototherapy, intensive phototherapy and exchange transfusion according to the severity of jaundice.
Results: Total neonates admitted from 1st may to 31st October 2018 in septic neonatal care unit were 1254, among them 432 (35%) were diagnosed as unconjugated neonatal jaundice “indirect hyperbilirubinemia”. Male: Female ratio (1.4:1), males 256(59.3%), females 176(40.7%). Physiological jaundice was the most common cause 129(29.9%) cases. Prematurity in 104(24.1%) and ABO incompatibility 59(13.7%) while Rh incompatibility 14(3.2%), sepsis 8(1.9%) and unknown causes of jaundice were 118(27.3%) because lack of lab facilities. Conventional phototherapy was the most common kind of treatment in 237(55%) while intensive phototherapy used in 175(40.3%) cases with successful reduction in T.S.B level and the rate of improvement without need for exchange transfusion (92%) (161/175).Only 20(4.5%) cases were treated with exchange transfusion especially for ABO incompatibility 8 (42.1%) cases and Rh incompatibility 4 (21.1%) cases. Most of neonates 429 (99.3%) discharged with complete improvement and only 2 (0.5%) neonates suffered from kernicterus and one death (0.2%).
Conclusion: Conventional phototherapy is still the standard treatment of mild to moderate indirect hyperbilirubinemia. Use of intensive phototherapy in the treatment of unconjugated neonatal hyperbilirubinemia is effective in reducing T.S.B level, need for exchange transfusion and hospital staying.
Recommendations: provide aseptic neonatal care unit in the hospital with further number of intensive phototherapy devices as it is so effective in treating unconjugated neonatal jaundice and reduces need for exchange transfusion as it is proven in the study.
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Vain, Nestor E. "Nosocomial Respiratory Viral Infection in the Neonatal Intensive Care Unit." American Journal of Perinatology 37, S 02 (September 2020): S22—S25. http://dx.doi.org/10.1055/s-0040-1714081.
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Infections caused by respiratory viruses in neonates during their stay in the neonatal intensive care unit (NICU) are more frequent than generally suspected. Respiratory syncytial virus (RSV), a highly contagious pathogen, is the most common etiologic agent, and it carries a high risk of nosocomial spread. During the RSV season, overcrowding of the NICU, shortage of staff, and unrestricted visitors are factors predisposing outbreaks. Since signs and symptoms of RSV infections are no specific, a high index of suspicion is essential to prevent or limit epidemics. The etiologic agent should be confirmed and polymerase chain reaction (PCR) is the gold-standard test. Shedding of the virus by infected preterm infants is prolonged and RSV lasts for several hours on countertops and other surfaces. The first case should be isolated and strict cohorting must be instituted. Compliance with hand washing must be warranted. Wearing gowns and gloves may help. The severity of nosocomial RSV infections tends to be higher than that of those community acquired. There is no uniform recommendation to start palivizumab during hospital stay of premature and high-risk infants. The use of this monoclonal antibody to stop or limit the spread of outbreaks is controversial. It is recommended by some professional organizations and not by others but its use during large outbreaks in infants at risk who share the room with infected neonates is not uncommon. Key Points
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Nabat ul Hassan, Saeeda, Ghulam Asghar Bhutta, and Khushbu Farva. "Frequencies, sensitivity pattern and molecular characterization of bacterial isolates in blood in neonatal sepsis." Professional Medical Journal 28, no. 7 (July 1, 2021): 987–92. http://dx.doi.org/10.29309/tpmj/2021.28.07.5902.
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Objective: To determine frequency, molecular characterization and sensitivity of bacterial isolates against commonly used antibiotics in neonatal sepsis. Study Design: Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: October 2019 to March 2020. Material & Methods: Neonates admitted in neonatal intensive care unit (NICU) of study institution having signs and symptoms of neonatal symptoms such as fever, irritability, seizures, anorexia and lethargy, were included in the study using consecutive sampling technique. Blood sample from all study patients taken and sent for culture to determine bacterial isolates and antibiotic sensitivity against commonly used antibiotics for neonatal sepsis. Bacterial isolates identification was done using standard bacteriological technique performed by modified Kirby & Bauer disc diffuse method as per Clinical and Laboratory standards institute (CLSI) guidelines. Results: Total 200 cases were studied having neonatal sepsis and admitted in NICU including 58% female and 42% male children. Bacterial growth occurred in 10.5% samples and in 89.5% samples no bacterial growth seen. There were 1% samples with gram positive and 9.5% samples with gram negative bacterial isolates. Klebsiella was the commonest organism isolated in 38.1% cases out of total positive isolates. There were 72.5% neonates having age 1-14 days and 27.5% neonates having age 15-28 days. Conclusion: Gram negative bacteria are common cause of neonatal sepsis, out of which Klebsiella is the commonest organism. Antimicrobial drug resistance in different infections is a serious emerging issue.
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Piccotti, Lucia, Barbara Voigtman, Rebecca Vongsa, Emma M. Nellhaus, Karien J. Rodriguez, Todd H. Davies, and Stephen Quirk. "Neonatal Opioid Withdrawal Syndrome: A Developmental Care Approach." Neonatal Network 38, no. 3 (May 1, 2019): 160–69. http://dx.doi.org/10.1891/0730-0832.38.3.160.
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Tens of thousands of infants are impacted yearly by prenatal opioid exposure. The term neonatal opioid withdrawal syndrome (NOWS) is now replacing the more familiar term neonatal abstinence syndrome (NAS). Ongoing debate continues related to standard regimens for treatment of this oftentimes perplexing condition. Historically, treatment has focused on pharmacologic interventions. However, there is limited research that points to nonpharmacologic methods of treatment as viable options, whether alone or in addition to pharmacologic interventions. This article, utilizing a review of pertinent literature, outlines the physical aspects of NOWS, including its pathophysiology and the resulting physical clinical signs. In addition, we present an overview of how age-appropriate, nonpharmacologic interventions, centered on developmental care, may be a valuable approach to organize and prioritize routine care for these infants, their families, and the health care team facing the challenges of NOWS. Finally, the need for further research to better define evidence-based standards of care for these infants and their families is discussed.
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Banerjee, Shailendra N., Lisa A. Grohskopf, Ronda L. Sinkowitz-Cochran, and William R. Jarvis. "Incidence of Pediatric and Neonatal Intensive Care Unit–Acquired Infections." Infection Control & Hospital Epidemiology 27, no. 6 (June 2006): 561–70. http://dx.doi.org/10.1086/503337.
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Objective.To compare the cumulative incidence of infections acquired in the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU).Design.Estimation of the cumulative incidence of infections with data obtained from the Pediatric Prevention Network (PPN) point-prevalence survey and observed rates from the National Nosocomial Infections Surveillance (NNIS) system.Setting.Ten hospitals participated in both the PPN survey and NNIS system.Participants.All patients present on the PPN survey dates (August 4, 1999, or February 1, 2000) in the NICUs or PICUs of the PPN hospitals were included in the survey. Point prevalences for PICU-acquired and for NICU-acquired infections at these hospitals were calculated from the survey data. The cumulative incidence rates were estimated from the point prevalence rates using a standard formula and a standard method for calculating the time to recovery (ie, on the basis of the assumption that discontinuance of antimicrobial therapy indicates recovery from infection); alternate methods to judge the time to recovery from infection were also explored.Results.The average cumulative incidence of intensive care unit-acquired infection for NICUs and PICUs combined (all units), as measured by NNIS, was 14.1 cases per 100 patients; in comparison, the prevalence was 14.06 cases for 100 patients (median difference, —0.95 cases per 100 patients; 95% confidence interval, —4.6 to 5.0 cases per 100 patients), and the estimated cumulative incidence using the standard method of calculating the time to recovery was 13.8 cases per 100 patients (median difference, —1.5 cases per 100 patients; 95% confidence interval, —9.1 to 2.9 cases per 100 patients). Estimates of cumulative incidence using alternate methods for calculation of time to recovery did not perform as well (range, 4.9-100.9 cases per 100 patients). The average incidence density for all units, as measured by the NNIS system, was 6.8 cases per 1,000 patient-days, and the estimate of incidence density using the standard method of calculating the time to recovery was 3.6 cases per 1,000 patient-days (median difference, 4.3 cases per 1,000 patient-days; 95% confidence interval, 0.9 to 9.2 cases per 1,000 patient-days). Estimated incidence densities using alternate methods for determining recovery time correlated closely with observed incidence densities.Conclusions.In this patient population, the simple point prevalence provided the best estimate of cumulative incidence, followed by use of a standard formula and a standard method of calculating the time to recovery. Estimation of incidence density using alternate methods performed well. The standard formula and method may provide an even better estimate of cumulative incidence than does simple prevalence in general populations.
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Souza, Renata Rangel Birindiba de, Valdecyr Herdy Alves, Diego Pereira Rodrigues, Louise José Pereira Dames, Flávia do Valle Andrade Medeiros, and Eny Dórea Paiva. "O conhecimento do enfermeiro sobre cateter central de inserção periférica: estudo descritivo." Online Brazilian Journal of Nursing 15, no. 1 (April 16, 2016): 21. http://dx.doi.org/10.17665/1676-4285.20165298.
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Aim: to analyze the knowledge of nurses in the Neonatal Intensive Care Unit on the entry, handling, maintenance and withdrawal of the peripherally inserted central catheter. Method: This is a descriptive, exploratory, and qualitative study involving nine nurses from the Neonatal intensive care unit of the Antonio Pedro University Hospital, Fluminense Federal University, interviewed based on a semi-structured script. The data submitted to content analysis have originated thematic categories. Results: knowledge of nurses regarding the statement, insertion, maintenance and removal of the catheter, standards and protocols and professional training for the care process are decisive for the safety of care to the newborn. Conclusion: The use of the peripherally inserted central catheter (PICC) is important in neonatology for its benefits to the infant. However, nurses need to deepen their knowledge so that the care process in the NICU is guided by ethics and based on nursing protocols aiming to base and legitimize such assistance.
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Van Enk, Richard A., and Florence Steinberg. "Comparison of Private Room with Multiple-Bed Ward Neonatal Intensive Care Unit Environments." HERD: Health Environments Research & Design Journal 5, no. 1 (October 2011): 52–63. http://dx.doi.org/10.1177/193758671100500105.
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Objective: This study determined whether a private room or open ward design better met optimal environmental conditions for a neonatal intensive care unit with regard to sound level, light level, temperature and humidity. Background: Multiple-bed designs for hospital neonatal intensive care units were the standard until recently. Now, private room designs promise to provide better conditions for neonate development and patient care quality. Methods: The study compared an eight-bed open ward design with a private room design of a 45-bed neonatal intensive care unit, measuring the environmental parameters of sound, light, temperature, and humidity before and after the construction and occupation of a new private room unit. Results: Average light levels were higher in the private room design because of the increased number of windows, but both designs were within the recommended levels. Mean temperature readings were two degrees cooler in the private room environment, and readings were more stable. Mean humidity readings in the two environments were the same, but humidity levels in the private room design were more stable. Median sound level in the private room design was lower than the open ward design, but the range was similar. Conclusion: The private room design allows for a more controlled patient care environment that can be maintained within a smaller range of variation nearer optimal environmental conditions.
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Rahman, Tania, Sharmeen Sultana, Taslima Akber Happy, Kamrunnahar Alo, and Momtaz Begum. "Alarming Pattern of Antimicrobial Resistance in Neonatal Sepsis Observed in Neonatal Intensive Care Unit of a Tertiary Care Hospital in Bangladesh." KYAMC Journal 12, no. 1 (May 8, 2021): 3–7. http://dx.doi.org/10.3329/kyamcj.v12i1.53359.
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Background: Resistance of micro-organisms to multiple broad-spectrum antimicrobial agents is a major problem in treating neonatal sepsis. It is a matter of utmost importance to have knowledge of trends in changing pattern of antimicrobial resistance.
Objective: This study was done to observe antimicrobial resistance of gram-positive and gram-negative bacteria isolated from cases of neonatal sepsis
Material and Methods: This cross sectional descriptive study was conducted in Department of Microbiology in collaboration with Department of Neonatology, Dhaka Medical College Hospital, Dhaka. Antimicrobial resistance of all the isolated bacteria was performed by Modified Kirby-bauer disk diffusion method following standard guideline after isolation and identification of bacteria from blood samples of suspected septicemic neonates by automated blood culture and standard microbiological protocol.
Results: All of the isolated Staphylococcus aureus, Coagulase negative Staphylococcus, Group-B Streptococcus and Micrococcus showed 100% resistance to ceftriaxone, cefotaxime and ceftazidime. Among the isolated gram-negative bacteria, all of Enterobacter spp., Pseudomonas aeruginosa and Citrobacter spp. showed 100% resistance to amoxiclav, amikacin, ceftriaxone, cefixime, ceftazidime.
Conclusion: Majority of the gram-positive and gram-negative bacteria are developing resistance to multiple antimicrobial agents and surveillance is necessary to tackle this alarming situation.
KYAMC Journal.2021;12(01): 03-07
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Subhani, Muhammad T., and Ifrah Kanwal. "Digital Scrapbooking as a Standard of Care in Neonatal Intensive Care Units: Initial Experience." Neonatal Network 31, no. 3 (2012): 162–68. http://dx.doi.org/10.1891/0730-0832.31.3.162.
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In this article, we describe a digital photo scrapbooking project as a standard of care for the parents of infants admitted in a neonatal intensive care unit (NICU). Photographs were taken from birth until discharge or expiry at special moments during the infant’s hospitalization and used to create a digital scrapbook with daily notes by the parents. The scrapbook and original photos were provided on a CD at discharge or at expiry. Parents and their families unanimously appreciated the photos and the opportunity to record their thoughts, and considered the CDs as a lifetime treasure. Digital photo journaling could be implemented as a standard of care at other institutions with a commitment from the nursing and ancillary staff of the NICU and labor and delivery department, with possible support from volunteers.
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Rangelova, Vanya, Ralitsa Raycheva, Ani Kevorkyan, Maya Krasteva, and Tihomir Dermendzhiev. "Surveillance of Nosocomial Infections in a Bulgarian Neonatal Intensive Care Unit." Folia Medica 62, no. 4 (December 31, 2020): 753–61. http://dx.doi.org/10.3897/folmed.62.e50437.
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Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care units (NICU) which result in high morbidity and mortality. Aim: To determine and analyze the incidence, risk factors and etiologic agents of NI in newborns admitted in the NICU to help plan-ning future surveillance and prevention strategies. Materials and methods: A prospective cohort study was carried out at the NICU of St George University Hospital, Plovdiv, Bul-garia from January 1, 2017 to June 31, 2018. The number of neonates included in the study was 507. Descriptive statistics such as count, percent, mean and standard deviation was used. Chi-square test was performed to prove associations. Odds ratios, with 95% confidence intervals, were computed from the results of the binominal logistic regression analyses. Results: Of the 507 hospitalized newborns in NICU, 48 presented with 54 NI. The incidence and the density incidence rates were 9.5% and 7.67 per 1,000 patient-days, respectively. Nosocomial infections were detected in neonates from all birth weight (BW) classes, but it was low BW and premature neonates that were at major risk to acquire them. The most common infection sites were ventilator-asso-ciated pneumonia (VAP) (67.27%), bloodstream infection (23.64%) and conjunctivitis (9.09%). Major pathogens were Gram-negative such as Klebsiella pneumoniae, E. coli, Pseudomonas aeruginosa and Acinetobacter baumannii. In the multivariate logistic regression analysis NIs were strongly associated with intubation, presence of a venous catheter, the duration of antibiotic treatment and increased CRP> 10 mg/l. Conclusions: This report highlights the burden of NIs, identifies the major focus for future NI control and prevention programs.
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Dombrecht, Laure, Joachim Cohen, Filip Cools, Luc Deliens, Linde Goossens, Gunnar Naulaers, Kim Beernaert, et al. "Psychological support in end-of-life decision-making in neonatal intensive care units: Full population survey among neonatologists and neonatal nurses." Palliative Medicine 34, no. 3 (November 19, 2019): 430–34. http://dx.doi.org/10.1177/0269216319888986.
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Background: Moral distress and burnout related to end-of-life decisions in neonates is common in neonatologists and nurses working in neonatal intensive care units. Attention to their emotional burden and psychological support in research is lacking. Aim: To evaluate perceived psychological support in relation to end-of-life decisions of neonatologists and nurses working in Flemish neonatal intensive care units and to analyse whether or not this support is sufficient. Design/participants: A self-administered questionnaire was sent to all neonatologists and neonatal nurses of all eight Flemish neonatal intensive care units (Belgium) in May 2017. The response rate was 63% (52/83) for neonatologists and 46% (250/527) for nurses. Respondents indicated their level of agreement (5-point Likert-type scale) with seven statements regarding psychological support. Results: About 70% of neonatologists and nurses reported experiencing more stress than normal when confronted with an end-of-life decision; 86% of neonatologists feel supported by their colleagues when they make end-of-life decisions, 45% of nurses feel that the treating physician listens to their opinion when end-of-life decisions are made. About 60% of both neonatologists and nurses would like more psychological support offered by their department when confronted with end-of-life decisions, and 41% of neonatologists and 50% of nurses stated they did not have enough psychological support from their department when a patient died. Demographic groups did not differ in terms of perceived lack of sufficient support. Conclusion: Even though neonatal intensive care unit colleagues generally support each other in difficult end-of-life decisions, the psychological support provided by their department is currently not sufficient. Professional ad hoc counselling or standard debriefings could substantially improve this perceived lack of support.
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Porta, Roser, Vicente Molina, Mª Teresa Gomez, Clara González, Montserrat Roca, Cristina Berenguer, and Beatriz Ibáñez. "Is the privacy of information protected in a neonatal intensive care unit?" JAHR 10, no. 1 (June 28, 2019): 203–9. http://dx.doi.org/10.21860/j.10.1.11.
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Respecting patients’ intimacy and confidentiality can be a challenge in the neonatal intensive care units (NICUs) designed according to traditional standards (e.g. a single big room with a number of cots and incubators located close one to another). Concerned about this topic, two members of the team designed a study to check the quality of the confidentiality in the NICU area, and identify opportunities for improvement. This is an observational study performed for a period of one month. The observed team was not aware of being observed. During observation time, a total of 147 hours, 25 confidentiality violation situations were encountered. Twelve (48%) were comments, spoken with a loud voice, about the patients in the NICU area or in adjacent areas, 24% (6/25) were related to the privacy issues due to leaving medical documentation or computer screens available for anybody to see or informing parents in a way that could be heard by parents of other babies, 12% (3/25) were phone conversations about patients in a loud voice, 4% (1/25) were answering questions to parents or relatives about other babies. The medical and personal information of the patients in the NICU is often exposed and shared with parents of other patients and non-related professionals. The architectural design of the traditional NICUs, some socio-cultural issues in South European countries, and the difficulties in changing attitudes are the critical points to focus on to start a quality educational project to protect the right to intimacy and confidentiality of vulnerable children and parents admitted to the NICUs.
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Mitsiakos, G., E. Papadakis, O. Vrani, H. Chatziionnids, M. Braimi, and N. Nikolaides. "P47 An appealing alternative to standard PT/INR measurement in Neonatal Intensive Care Unit neonate." Thrombosis Research 123 (January 2009): S153. http://dx.doi.org/10.1016/s0049-3848(09)70092-1.
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Kashyap, Rashmi, Surinder Kaur, and Aarti Sareen. "Ascertainment of risk factors and clinical course for neonates with early onset sepsis in a tertiary care hospital, rural area, Punjab." International Journal Of Community Medicine And Public Health 5, no. 3 (February 24, 2018): 1185. http://dx.doi.org/10.18203/2394-6040.ijcmph20180782.
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Background: Neonatal sepsis is the most common cause for neonatal mortality and morbidity. Despite advances in neonatal care, the impact of neonatal sepsis remains marked in developing countries. Thus identifying the risk factors is crucial for optimizing neonatal care.Methods: A prospective study was conducted among inborn and outborn neonates with risk factors or clinical features of Early Onset Neonatal Sepsis admitted in nursery and Neonatal intensive care unit, GSMCH, Banur, Distt Patiala, Punjab during the period from August 2014 to January 2015. Outcome variables were the association of neonatal, maternal and environmental factors with Early Onset Neonatal Sepsis (EONS). Overall clinical course in terms of survival/death, Short term outcome of those who survived based on clinical improvement and culture sensitivity report. Analysis was done using percentage, range, mean, standard deviation. Chi square test and multivariate regression analysis was done for comparison between various risk factors and EONS.Results: A total of 85 neonates were enrolled in the study. There were 71 (83.42%) inborn neonates and 14 (16.47%) neonates were outborn. Based on Haematological System Score of >3, sepsis among the inborn neonates was present in 29(40.84%), while in outborn babies sepsis was present in 13 (92.85%) neonates which was statistically significant (p=0.000). Comparison of risk factors like birth asphyxia and unclean vaginal examination showed statistically significant difference (p=0.002; 0.002) between neonates with sepsis and those without sepsis.Conclusions: Neonatal sepsis is a major cause of mortality and morbidity. The study concludes that birth asphyxia and unclean vaginal examination are strong risk factors for early onset neonatal sepsis.
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Tavasoli, Atoosa, Golbahar Akhoundzadeh, and Hamid Hojjati. "The Effect of Narrative Writing of Mothers on Their Stress With Care in the Neonatal Intensive Care Unit." Complementary Medicine Journal 10, no. 3 (October 1, 2020): 196–205. http://dx.doi.org/10.32598/cmja.10.3.332.4.
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Objective: Premature birth and hospitalization in the intensive care unit cause many crises and stresses for mothers. In the meantime, narration writing is a method of counseling to reduce mothers' stress. Therefore, we aimed to study the effect of maternal narration on the stress of mothers of premature infants admitted to the neonatal intensive care unit. Methods: This experimental study was performed on mothers of neonates admitted to the intensive care units. The experimental and control groups were selected by simple random sampling method. In the experimental group, based on the instructions given, the mothers recorded their daily events 3 times a day. The obtained data were analyzed in SPSS V. 21 with descriptive statistics (mean and standard deviation) and inferential statistics (paired t-test, independent t-test, ANCOVA test). Results: The Mean±SD score of stress was 97.43±2.66 in the experimental group and 95.26±5.76 in the control group before the intervention. The stress level of mothers was 84.9±5.35 in the experimental group after the intervention and 87.1±5.25 in the control group. The covariance test showed a significant difference between the experimental and control groups (P=0.03 and Eta= 0.07) so that 7% of stress reduction changes are related to mothers' narration. Conclusion: This study showed that narrative writing as an effective supportive intervention has a vital role in reducing stress in mothers of neonates admitted to the intensive care unit.
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Shettigar, Chandrashekar G., and Sanchita Shettigar. "Non albicans Candidemia: an emerging menace in neonatal intensive care unit." International Journal of Contemporary Pediatrics 5, no. 2 (February 22, 2018): 436. http://dx.doi.org/10.18203/2349-3291.ijcp20180531.
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Background: Candidemia has become an increasingly major problem in neonatal intensive care unit (NICU) which is associated with high mortality and morbidity. In this study we evaluated the epidemiology of Candidemia in neonates who were admitted to NICU and their in vitro susceptibility to commonly used antifungal drugs.Methods: This was a retrospective study of candidemia in NICU from October 2014 to September 2017. The isolates were identified as per standard mycological techniques and antifungal susceptibility was determined by disk diffusion method.Results: Out of 563 blood culture analyzed, 54(9.59%) culture yielded Candida in their blood. The non albicans Candida (NAC) species were the predominant organism for candidemia in neonates, accounting for 35 (64.81%) and the remaining 19 (35.18%) isolates were of C. albicans. Among the NAC species, the maximum isolates were of C. krusei (31.48%) followed by C. glabrata (22.22%). Non albican Candida were more resistant to azole group of antifungal, especially commonly used antifungal like fluconazole (51.43%). Among NAC species, C. glabrata was most resistant and C. tropicalis was least resistant organism. Prematurity <34 weeks, very low birth weight (<1500gm), prolonged use of broad spectrum antibiotic therapy, prolonged use of central venous catheter, mechanical ventilation, parenteral nutrition, prolonged NICU stays and concomitant bacterial sepsis were significantly associated with Candida infection in blood stream. NAC species were also associated with high mortality rate.Conclusions: Increased incidences of candidemia along with emergence of NAC species have become an important health care issue. Therefore, knowledge of local epidemiological data on candidemia is essential which will guide on therapeutic decision making.
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Chung, Ha Uk, Bong Hoon Kim, Jong Yoon Lee, Jungyup Lee, Zhaoqian Xie, Erin M. Ibler, KunHyuck Lee, et al. "Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care." Science 363, no. 6430 (February 28, 2019): eaau0780. http://dx.doi.org/10.1126/science.aau0780.
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Existing vital sign monitoring systems in the neonatal intensive care unit (NICU) require multiple wires connected to rigid sensors with strongly adherent interfaces to the skin. We introduce a pair of ultrathin, soft, skin-like electronic devices whose coordinated, wireless operation reproduces the functionality of these traditional technologies but bypasses their intrinsic limitations. The enabling advances in engineering science include designs that support wireless, battery-free operation; real-time, in-sensor data analytics; time-synchronized, continuous data streaming; soft mechanics and gentle adhesive interfaces to the skin; and compatibility with visual inspection and with medical imaging techniques used in the NICU. Preliminary studies on neonates admitted to operating NICUs demonstrate performance comparable to the most advanced clinical-standard monitoring systems.
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Verma, Jyotsna, Shweta Anand, Nawal Kapoor, Sharad Gedam, and Umesh Patel. "Neonatal outcome in new-borns admitted in NICU of tertiary care hospital in central India: a 5-year study." International Journal of Contemporary Pediatrics 5, no. 4 (June 22, 2018): 1364. http://dx.doi.org/10.18203/2349-3291.ijcp20182512.
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Background: Neonatal mortality rate contributes significantly to under five mortality rates. Data obtained from pattern of admission and outcome may uncover various aspects and may contribute and help in managing resources, infrastructure, skilled hands for better outcome in future.Methods: This retrospective study was done on 1424 neonates who were admitted at LN Medical College and JK Hospital, Bhopal in neonatal intensive care unit (NICU) in the Department of Paediatrics from January 2013-December 2017.Results: 1424 newborns admitted within 24 hours of birth were included in the study. About 767 were male neonates, (Male: female1.16:1). The low birth weight babies were 54% in our study. Among the various causes of NICU admission, Respiratory distress was present in 555 (39%) of neonates, Respiratory distress syndrome (Hyaline membrane disease) being the most common cause of respiratory distress. Neonatal sepsis accounted for morbidity in 24% of neonates, with Klebsiella being the most common organism grown in the blood culture. The incidence of congenital anomalies was 2.5%. The neonatal mortality was found to be 11% in our study. Prematurity with Respiratory distress syndrome (Hyaline membrane disease) and perinatal asphyxia were the two most common causes of neonatal mortality in the study. Extremely low birth weight neonates had the highest case fatality rate in the study, which indicates the need to develop an efficient group of professionals in teaching hospitals who will provide highly specialized and focused care to this cohort of vulnerable neonates.Conclusions: Present study has shown respiratory distress, perinatal asphyxia, and sepsis as the predominant causes of neonatal morbidity. All three are preventable causes, and our health-care programs should be directed toward addressing the risk factors in the community responsible for the development of these three morbidities. The preterm and low birth weight babies had significantly high mortality even with standard intensive care; therefore, a strong and effective antenatal program with extensive coverage of all pregnant females specifically in outreach areas should be developed which will help in decreasing preterm deliveries and also lower the incidence of low birth weight babies.
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Bell, Catherine, Jennifer Jackson, and Hannah Shore. "P3 S.a.f.e. – the positive impact of ‘druggles’ on prescribing standards and patient safety within the neonatal intensive care environment." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e2.4-e2. http://dx.doi.org/10.1136/archdischild-2017-314585.12.
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IntroductionSituation Awareness For Everyone (S.A.F.E)1 is a two year programme led by the Royal College of Paediatrics and Child Health in partnership with NHS hospitals, to aid the development of a range of quality improvement techniques with the aim of reducing preventable deaths and errors occurring in the UK’s paediatric departments.The neonatal unit began daily safety huddles to identify ward risks and share learning points in September 2015. An NHS Trust piloted the ‘druggle’, a ‘ward-based safety huddle’ with ward pharmacist, doctors and nurses, as part of the S.A.F.E project, on their neonatal ward in July 2015.AimThe aims of the druggles are to increase communication between pharmacists, the medical team and nursing staff, and to educate all staff regarding specific drug related topics. They enable the team to receive feedback on anonymised errors in real time, draw attention to areas for improvement, encourage discussion and share learning points from them.MethodThe druggles were developed as drug related safety briefings. They are presented once a week as part of the daily huddle. The basic format of the sessions is a weekly ‘hot topic’, for example recent BNFc changes, an ‘error of the week’ and celebration of good prescribing practice. Themes are identified by members of staff and discussed at the druggles as they arise. This enables timely education and discussion of topics as they occur.The neonatal pharmacy team completed a baseline prescribing standards audit in February 2016 (after the induction of the new medical team) which will be repeated before the doctors rotate in August. This audit provided information about common prescribing errors and helped to identify possible ‘hot topics’ for discussion. A ‘zero tolerance’ audit of 5 randomly chosen prescription charts is completed weekly to assess prescribing standards in real time. A chart ‘fails’ when the first prescribing error, or deviation from prescribing standards, is picked up.ResultsThe baseline audit of all charts on the unit showed poor compliance with prescribing standards overall, particularly when transcribing or cancelling prescriptions. Subsequent weekly ‘zero tolerance’ audits have shown an improvement from 20% of prescription charts with no prescribing error to 65% with no errors over the first 12 weeks.ConclusionAn improvement of prescribing standards has been observed from the initial findings of the ‘zero tolerance’ audit. The druggles have encouraged more discussions, allowed the MDT to work together to improve the standards of prescribing and have proved to be an invaluable tool when implementing new processes. Developments have also been made to existing processes, such as the separation of babies’ drug charts from their mothers’ charts on the postnatal ward as a result of an error discussed at a druggle. The druggles have now begun to be implemented throughout the Children’s Hospital.ReferenceRoyal College of Paediatrics and Child Health. Situation awareness for everyone (S.A.F.E.) programme2016. http://www.rcpch.ac.uk/safe [Accessed: 6 July 2016].
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C. S., Neeta, and Shailender Singh. "Study of drug utilization in intensive care management of neonates at tertiary care hospital." International Journal of Basic & Clinical Pharmacology 6, no. 6 (May 23, 2017): 1530. http://dx.doi.org/10.18203/2319-2003.ijbcp20172255.
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Background: Newborn infants form a highly vulnerable group. Compared to adults they are more prone to adverse drug events. Exposure to multiple drugs is also known to be a leading factor in their well-being. Many advances have been made in this area, yet there is a paucity of information to guide rational prescribing in newborns. This study was conducted to evaluate the drug prescribing trends in a Neonatal Intensive Care Unit (NICU) of a tertiary care hospital in Bidar.Methods: A prospective study was undertaken, over a period of 3 months at the government teaching hospital, Bidar. Neonates of either sex admitted to NICU were included. Data collection was done by scrutinizing the inpatient case sheets and investigation reports.Results: A total of 100 neonates were admitted and 11 deaths were noted. Most common cause for admission was septicaemia. The total number of drugs prescribed was 488. The average number of drugs per prescription was 4.9. Antimicrobials were the commonest agents prescribed and intravenous route was the commonest route of drug administration. Most of the drugs were prescribed by generic names.Conclusions: In our study it was observed that polypharmacy is commonly observed practice in NICU patients. Most of the antibiotics were prescribed empirically. The dose and frequency of administration was mostly as per the standard guidelines.
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Gale, G., and LS Franck. "Toward a standard of care for parents of infants in the neonatal intensive care unit." Critical Care Nurse 18, no. 5 (October 1, 1998): 62–64. http://dx.doi.org/10.4037/ccn1998.18.5.62.
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Kingsmore, Stephen F. "Is Rapid Exome Sequencing Standard of Care in the Neonatal and Pediatric Intensive Care Units?" Journal of Pediatrics 226 (November 2020): 14–15. http://dx.doi.org/10.1016/j.jpeds.2020.08.006.
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