Phillips R, Solomon J, Dixon L
… +1 more, Altimier L
Crit Care Nurs Clin North Am
· 2024 Jun · PMID 38705686
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Caring for extremely preterm infants in the neonatal intensive care unit (NICU) is a multidisciplinary team effort. A clear understanding of roles for each member of the delivery team, anticipation of challenges, and sta...Caring for extremely preterm infants in the neonatal intensive care unit (NICU) is a multidisciplinary team effort. A clear understanding of roles for each member of the delivery team, anticipation of challenges, and standardized checklists support improved outcomes for this population. Physicians and nursing leaders are responsible for being role models and holding staff accountable for creating a unit culture of Neuroprotective Infant and Family-Centered Developmental Care. It is essential for parents to be included as part of the care team and babies to be acknowledged for their efforts in coping with the developmentally unexpected NICU environment.
Crit Care Nurs Clin North Am
· 2024 Jun · PMID 38705685
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Bonding and attachment are known to be critically important for the well-being of infants and children. Both bonding and attachment can begin before birth, which impacts fetal and infant brain development and may improve...Bonding and attachment are known to be critically important for the well-being of infants and children. Both bonding and attachment can begin before birth, which impacts fetal and infant brain development and may improve birth outcomes. Babies in the womb and preterm babies in the neonatal intensive care unit (NICU) can hear and respond to maternal voices with positive effects on physiologic stability, brain development, and language development. Supporting emotional connections before and after birth is the responsibility and the privilege of health-care providers who care for pregnant mothers and babies in the NICU.
Dagle JM, Hunter SK, Colaizy TT
… +4 more, McElroy SJ, Harmon HM, McNamara PJ, Klein JM
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296373
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The clinical care of infants born at 22 weeks' gestation must be well-designed and standardized if optimal results are to be expected. Although several approaches to care in this vulnerable population are possible, proto...The clinical care of infants born at 22 weeks' gestation must be well-designed and standardized if optimal results are to be expected. Although several approaches to care in this vulnerable population are possible, protocols should be neither random nor inconsistent. We describe the approach taken at the University of Iowa Stead Family Children's Hospital neonatal intensive care unit with respect to preterm infants born at 22 weeks' gestation. We have chosen to present our standardize care plan with respect to prenatal, neurologic, nutritional, gastrointestinal, and skin management. Respiratory and cardiopulmonary care will be briefly reviewed, as these strategies have been published previously.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296369
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Neonates admitted to the neonatal intensive care unit (NICU) are a unique population who most often begin life acutely or critically ill. Venous access is required by most acutely/critically ill neonates, especially thos...Neonates admitted to the neonatal intensive care unit (NICU) are a unique population who most often begin life acutely or critically ill. Venous access is required by most acutely/critically ill neonates, especially those born preterm. Access is required for implementing management strategies such as stabilization, medications, fluids, nutrition, and transfusion of blood products. However, achieving and maintaining venous access in these neonates can be difficult, especially in preterm infants due to a myriad of contributing factors. Peripheral intravenous (PIV) catheters and peripherally inserted central catheters (PICC) are 2 common vascular access approaches used in the NICU and have traditionally been the most studied in the neonatal literature. Both options offer advantages and disadvantages. An alternative to PIVs and PICCs is the midline peripheral catheter (MPC), which in the literature may also be referred to as extended dwell peripheral intravenous catheters. Depending on the intended use, the MPC offers a venous access approach between a PIV and PICC. Usage of MPCs in the NICU is slowly increasing with the limited published evidence suggesting they are viable option when considering the need for vascular access. The purpose of this article is to present the advantages and disadvantages of MPCs as an alternative approach for venous access in neonates when appropriate.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296378
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Pulse oximetry screening (POS) was first described over 20 years ago. However, in recent years, major clinical trials have demonstrated consistent test accuracy for the detection of critical congenital heart defects (CCH...Pulse oximetry screening (POS) was first described over 20 years ago. However, in recent years, major clinical trials have demonstrated consistent test accuracy for the detection of critical congenital heart defects (CCHD). International uptake of POS has progressed well over the last 10 years with most major high-income countries now recommending screening. This review describes the evidence base which has led to this, the current debate regarding choice of screening algorithm, and the future areas for further research.
Sola A, Leslie Altimier, Teresa Montes Bueno M
… +1 more, Muñoz CE
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296377
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Oxygen (O2) is a drug frequently used in newborn care. Adverse effects of hypoxia are well known but the damaging effects of excess oxygen administration and oxidative stress have only been studied in the last 2 decades....Oxygen (O2) is a drug frequently used in newborn care. Adverse effects of hypoxia are well known but the damaging effects of excess oxygen administration and oxidative stress have only been studied in the last 2 decades. Many negative effects have been described, including retinopathy of prematurity . Noninvasive pulse oximetry (SpO2) is useful to detect hypoxemia but requires careful evaluation and understanding of the frequently changing relationship between O2 and hemoglobin to prevent hyperoxemia. Intention to treat SpO2 ranges should be individualized for every newborn receiving supplemental O2, according to gestational age, post-natal age, and clinical condition.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296376
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Systematic Reviews and Randomized clinical trials have shown that the use of noninvasive ventilation (NIV) compared to invasive mechanical ventilation reduces the risk of bronchopulmonary dysplasia and or mortality. Most...Systematic Reviews and Randomized clinical trials have shown that the use of noninvasive ventilation (NIV) compared to invasive mechanical ventilation reduces the risk of bronchopulmonary dysplasia and or mortality. Most commonly used NIV modes include nasal continuous positive airway pressure, bi-phasic modes, such as, bi-level positive airway pressure, nasal intermittent positive pressure ventilation, high flow nasal cannula, noninvasive neurally adjusted ventilatory assist, and nasal high frequency ventilation are discussed in this review.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296375
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Near-infrared spectroscopy (NIRS) is a novel technology that uses infrared light to noninvasively and continuously measure regional oxygen extraction in real time at the bedside. Neonatal research using this device suppo...Near-infrared spectroscopy (NIRS) is a novel technology that uses infrared light to noninvasively and continuously measure regional oxygen extraction in real time at the bedside. Neonatal research using this device supports its use as an adjunct to routine cardiovascular monitoring because NIRS serves as a surrogate marker for end-organ perfusion and can detect minute changes in cerebral, intestinal, and kidney tissue beds. Multiple conditions affecting premature infants are frequently associated with hypoperfusion; therefore, methods to detect early tissue-specific perfusion alterations may substantially improve the clinician's ability to intervene and prevent further deterioration.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296374
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Couplet care of mother and newborn intensive care unit (NICU) baby in the same room is a new, rapidly evolving option for the care of NICU babies. This change has structural and operational challenges that require carefu...Couplet care of mother and newborn intensive care unit (NICU) baby in the same room is a new, rapidly evolving option for the care of NICU babies. This change has structural and operational challenges that require careful planning but its successful implementation is likely to drive enhanced family participation in the care of their baby throughout the NICU stay as well as improve collaboration between obstetric and neonatal providers.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296372
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Neonatal nurses play an essential role in small and sick newborn care. In the last few years, especially during the pandemic, neonatal mortality stayed relatively static. Recognition is growing that neonatal nurses repre...Neonatal nurses play an essential role in small and sick newborn care. In the last few years, especially during the pandemic, neonatal mortality stayed relatively static. Recognition is growing that neonatal nurses represent a specialty that requires unique, consistent, competency-based training and education to provide the best possible care. The Council of International Neonatal Nurses, Inc collaborates with many global stakeholders to raise the standards of neonatal nursing care, especially in Africa.
Sarik DA, Matsuda Y, Garber K
… +2 more, Hernandez M, Terrell EA
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296371
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Telehealth has proven to be a valuable approach to providing care to the neonatal population, including supporting families during the transition to home, facilitating remote monitoring of fragile neonates, and connectin...Telehealth has proven to be a valuable approach to providing care to the neonatal population, including supporting families during the transition to home, facilitating remote monitoring of fragile neonates, and connecting neonatal experts with infants and caregivers in underserved or remote communities. Clinicians engaging in telehealth need to be aware of policies and regulations that govern practice as well as the potential health equity issues that may present themselves.
Parker LA, Koernere R, Fordham K
… +4 more, Bubshait H, Eugene A, Gefre A, Bendixen M
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296370
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Mother's own milk (MOM) is known to decrease complications in preterm infants and when unavailable, it is recommended that preterm very low-birth weight infants be fed donor human milk (DHM). Due to the pasteurization, p...Mother's own milk (MOM) is known to decrease complications in preterm infants and when unavailable, it is recommended that preterm very low-birth weight infants be fed donor human milk (DHM). Due to the pasteurization, processing, and lactation stage of donors, DHM does not contain the same nutritional, immunologic, and microbial components as MOM. This review summarizes the differences between MOM and DHM, the potential effects on health outcomes, and the clinical implications of these differences. Finally, implications for research and clinical practice are discussed.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296368
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The history of racism in the United States was established with slavery, and the carry-over effect continues to impact health care through structural and institutional racism. Racial segregation and redlining have impact...The history of racism in the United States was established with slavery, and the carry-over effect continues to impact health care through structural and institutional racism. Racial segregation and redlining have impacted access to quality health care, thereby impacting prematurity and infant mortality rates. Health disparities also impact neonatal morbidities such as intraventricular hemorrhage and necrotizing enterocolitis and the family care experience including the establishment of breastfeeding and health care provider interactions.
Crit Care Nurs Clin North Am
· 2024 Mar · PMID 38296367
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Neonatology has been a rapidly growing specialty, starting in the early 1900s with premature infants displayed in incubator shows, to today with complex disease processes treated in state-of-the-art neonatal intensive ca...Neonatology has been a rapidly growing specialty, starting in the early 1900s with premature infants displayed in incubator shows, to today with complex disease processes treated in state-of-the-art neonatal intensive care units. Along the way evolving knowledge, medications, and technology provided opportunities to learn from mistakes and misguided treatments. The ability to learn from past mistakes improves our care now and illustrates the need for humility and vigilance in everything we do. This article explores errors made in the past as we look forward to the future.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838423
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Care models for older adults have been studied for more than 30 years. Several models of care for older adults were created in the acute care setting to prevent hospital-acquired disability and decline-a phenomenon frequ...Care models for older adults have been studied for more than 30 years. Several models of care for older adults were created in the acute care setting to prevent hospital-acquired disability and decline-a phenomenon frequently observed among older patients admitted in the acute care setting. The Acute Care for Elders (ACE) model and the Nurses Improving Care for Health System Elders program were 2 such models that sought to improve the quality of care for older adults and reduce their cost for care. Where are they today? Are we still using these care models in the acute care setting?
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838422
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The cardiovascular geriatric population requiring intensive or critical care is a group vulnerable to adverse outcomes because of age, the critical care environment, geriatric syndromes, and multiple chronic conditions....The cardiovascular geriatric population requiring intensive or critical care is a group vulnerable to adverse outcomes because of age, the critical care environment, geriatric syndromes, and multiple chronic conditions. Polypharmacy increases the risk of adverse events in this group. Several tools and aids are available to guide the clinical practice of appropriate prescribing and deprescribing. To optimize the care of the cardiovascular geriatric population, evidence-based prescribing, and deprescribing tools can be implemented by the interprofessional team consisting of the patient, their support system, critical care nurses, advanced practice clinicians, physicians, and allied health professionals.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838421
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Hospitals are always looking to improve the quality of patient care and avoid hospital-acquired conditions such as ventilator-associated pneumonia (VAP). Currently, there are no set standards regarding interventions to p...Hospitals are always looking to improve the quality of patient care and avoid hospital-acquired conditions such as ventilator-associated pneumonia (VAP). Currently, there are no set standards regarding interventions to prevent VAP, and there is not a single element that has a direct impact on VAP prevention. By creating an interprofessional team to work together, the quality improvement project was able to evaluate current practice compared with evidence-based practice in the literature to develop a critical care VAP bundle practice, which demonstrated improvement in compliance.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838420
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Mental illnesses among critically ill patients are approximately 2.5 times that of the general population. Although older adults with physical-mental multimorbidity represent more than 50% of critical care admissions, he...Mental illnesses among critically ill patients are approximately 2.5 times that of the general population. Although older adults with physical-mental multimorbidity represent more than 50% of critical care admissions, health-care professionals caring for geriatric patients are not adequately educated to effectively recognize and treat serious mental illness. Additionally, critical care nurses feel vulnerable, unsupported, and unable to provide the best and safest possible patient-centered care for patients with mental illness. Hospitals can reduce these burdens by creating critical care policies and practices that are inclusive of geriatric and mental health concepts, care, and continuing education to those providing care.