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PubMed1981

[A 5-year review of neonatal intensive care at the kinderklinik der stadt wien - glanzing, neonatal intensive care centre (author's transl)].

This study deals with clinical results obtained at the neonatal intensive care unit of the Kinderklinik der Stadt Wien - Glanzing since its inception in 1974. An analysis of our newborn cases-admitted from 14 obstetric departments in Vienna and some obstetric departments in Lower Austria and Burgenland soon after birth-points to the fact that prematurity is still the most important risk factor in neonatal mortality. The results show that the prognosis of high-risk newborn infants depends very much on condition in the delivery room following primary resuscitation, the neonatal mortality increases with immaturity, hyaline membrane disease is the most important indication for artificial ventilation of premature infants, 30% of all patients requiring artificial ventilation are fullterm infants; 45% of them suffer from cerebral respiratory dysfunction, the mortality rate in mechanically-ventilated infants could not be significantly decreased over the past years. The consequences are discussed.

Austria↗
PubMed1996

Integrating family-centered developmental assessment and intervention into routine care in the neonatal intensive care unit.

Incorporating developmental intervention into routine practices requires time available during caregiving for continued infant assessment and intervention and requires time after and between caregiving for relief of infant distress. In an era of health-care reform, reorganization, and restructuring, this added caregiver time appears unavailable. However, nurses need to work together in meeting the developmental challenges of the NICU. Further research needs to be done to validate which interventions are appropriate for which babies and with what medical procedures. In addition, collaboration and sharing of responsibilities and resources with all care providers needs to be investigated. Moreover, research needs to be done that acknowledges that the environment of the NICU is also a world in which many adults work and live a large portion of their daily life. This environment must be supportive of their social needs as well as the needs of the high-risk infant. There are many pieces to the puzzle of providing developmentally supportive caregiving in the NICU. The number of different issues increases the complexity of changing the standard of care: Infant, family, environment. Each has its own challenges. However, with sensitivity, a collaborative approach, and a sincere effort to change, neonatal health-care professionals can integrate developmental practices into the NICU.

Child Development↗
PubMed1994

Caring in a neonatal intensive care unit: perspectives of providers and consumers.

Neonatal intensive care units have continually grown in number and complexity in their short history. The care given to infants and families in these units is done, in large part, by nursing. This article discusses the development of a scale that will explore the perceptions of this care by both consumers and providers. The perceptions of each group will be compared to determine if care that is thought and intended to be caring for providers is indeed perceived as such by consumers. This is of significant importance to the developing body of knowledge related to caring in nursing, and it will also promote care that is family centered.

Attitude of Health Personnel↗
PubMed2005

[Skin care and transcutaneous monitoring in neonatal intensive care unit].

Newborn skin, particularly in preterm infants, is exposed to iatrogenic complications resulting from lesions provoked by diagnosis and therapeutic devices. This paper reviews some principles of skin care in neonatal intensive care units and focuses on iatrogenic lesions and the proposed methods to prevent them.

Humans↗
PubMed1997

A philosophy of care for a neonatal intensive care unit. Operationalization of a nursing model.

Crisis reactions, a stressful environment, infant care practices, and nurse behavior may cause difficulties in entering the natural parental role for parents of infants who are admitted to a neonatal intensive care unit (NICU). In connection with discussions in the Uppsala NICU on what constitutes good care, a philosophy of care, based on Callista Roy's adaptation model, was formulated for the purpose of providing developmentally supportive, family-centered care, and for defining good care and the professional nurse role. The philosophy describes the infant's needs and environment. Caring activities focus on support of the infant's and his parent's roles and self-concept in their progress towards independence from professional assistance. The philosophy is an essential component in the introductory program which integrates newly recruited personnel from different disciplines into the unit. It is presented as a suggestion of how a model-based philosophy of care can be formulated by operationalization of the theoretical concepts of a nursing model.

Adaptation, Physiological↗
PubMedDate not supplied

Spiritual and religious components of patient care in the neonatal intensive care unit: sacred themes in a secular setting.

OBJECTIVE: We hypothesized that spiritual distress was a common, unrecognized theme for neonatal intensive care unit (NICU) care providers. STUDY DESIGN: An anonymous questionnaire form assigned to a data table in a relational database was designed. RESULTS: Surveys were completed by 66% of NICU staff. All respondents viewed a family's spiritual and religious concerns as having a place in patient care. Eighty-three percent reported praying for babies privately. Asked what theological sense they made of suffering of NICU babies, 2% replied that children do not suffer in the NICU. Regarding psychological suffering of families, the majority felt God could prevent this, with parents differing (p = 0.039) from nonparents. CONCLUSION: There exists a strong undercurrent of spirituality and religiosity in the study NICU. These data document actual religious and spiritual attitudes and practices and support a need for pastoral resources for both families and care providers. NICU care providers approach difficulties of their work potentially within a religious and spiritual rather than a uniquely secular framework.

Adult↗
PubMed2005

Withholding treatment, withdrawing treatment, and palliative care in the neonatal intensive care unit.

Advances in pharmacology and technology have sharply reduced mortality of extremely preterm infants at the expense of an increasing number of survivors with handicaps and disabilities. The EURONIC study among neonatal intensive care units across Europe demonstrates that treatment of infants born at the limits of viability raises challenging ethical, moral, legal, and emotional dilemmas among neonatologists, nurses, and parents alike. When is it wise to withhold or withdraw intensive care and, if so, what are the needs of the nonviable or dying infant, family, and neonatal staff to provide a humane and compassionate death? This process begins with a thorough determination of diagnosis and prognosis, followed by decision making on the basis of futility of treatment or quality-of-life issues, and counseling of parents. Withholding or withdrawing of intensive care should be synonymous with palliative care. Perinatal audit and after-care of the family complete the process. The Dutch viewpoint and practice guidelines on withholding and withdrawing of neonatal intensive care are presented.

Counseling↗
PubMed1998

Satisfaction with obstetric care: relation to neonatal intensive care.

OBJECTIVE: To examine the relationship between admitting children to a neonatal intensive care unit (NICU) and mothers' satisfaction with obstetric care. METHODS: Mothers of live-born infants who are now normal were interviewed about their perceptions of the interpersonal, organizational, and technical care they and their babies received during pregnancy, delivery, and the neonatal period, and their and their infants' health. Comparisons between the responses of mothers whose babies were admitted to the normal nursery (n = 595) and those whose babies were sent to an NICU (n = 72) were made by chi2 analysis (1 df) and Wilcoxon rank sum tests. RESULTS: Mothers whose babies were admitted to an NICU were more likely to complain that their obstetricians did not explain things in terms they could understand (P < .05); did not give them the right amount of information about what to expect during pregnancy (P < .05); hid something from them before delivery (P < .001); did not explain the reasons for tests performed during delivery (P < .05); misled them about their child's prognosis (P < .001); failed to treat properly a problem during delivery (P < .05); and did not know the latest medical developments (P < .05). CONCLUSION: Even when children do well, admission of newborns to an NICU is associated with greater maternal dissatisfaction with obstetric care.

Adult↗
PubMed1996

Postmortem examinations in a statewide audit of neonatal intensive care unit admissions in Australia in 1992. New South Wales Neonatal Intensive Care Unit Study Group.

The objectives of the investigation were (i) to study infants registered in a statewide audit of tertiary neonatal intensive care units in New South Wales, Australia in 1992 and who died, and (ii) to examine postmortem rates, quality of postmortem reports and compare clinical cause of death with postmortem report. Death rates, data on clinical cause of death and postmortem status were collected prospectively as part of the routine audit. Postmortem reports were examined by LS. Fifteen percent of the cohort died and 43% had a postmortem examination. The postmortem rate was highest in the 28-36 week gestation group and in babies dying of pulmonary haemorrhage, intracranial haemorrhage or sudden infant death syndrome. Fewer than 50% of babies with a major congenital anomaly had a postmortem. The postmortem changed the major diagnosis in 10% of cases and added useful information in 17%. We conclude that postmortem examination should be an essential part of any audit of neonatal intensive care unit outcomes.

Autopsy↗
PubMed1995

CRIB (clinical risk index for babies), mortality, and impairment after neonatal intensive care. Scottish Neonatal Consultants' Collaborative Study Group and the International Neonatal Network.

Risk-adjustment may overcome the disadvantages of birthweight-specific comparisons of neonatal units. Risk-adjusted rates of death or impairment after 18 months were compared in five tertiary and three non-tertiary neonatal units for 695 high-risk infants. CRIB (clinical risk index for babies) was more closely related than birthweight to death or impairment. After adjustment for risk with CRIB, deaths remained more likely after non-tertiary than tertiary care (odds ratio 1.90, 95% CI 1.1-3.3) but rates of impairment in survivors were nearly identical (0.97, 0.5-2.1). To improve performance further, risk-adjusted rates of death and impairment should be monitored for all neonatal units.

Birth Weight↗
PubMed2004

A simple automatized audit system for following and managing practices of platelet and plasma transfusions in a neonatal intensive care unit.

During neonatal intensive care, blood components are often used in clinical situations where both their efficacy and safety lack solid justification. A practical system to continuously analyse actual transfusion practices is a prerequisite for improvements of quality in transfusion therapy. We hypothesized that such a system would reveal inappropriate variations in clinical decision making and offer a means for staff education and quality improvement and assurance. The study consisted of three 120-152-day periods (P I, P II and P III) between January 2000 and October 2001 and involved 543 new patient admissions (141 patients with birth weight < 1501 g) and 6227 days of patient care at a single tertiary level NICU. P I was a control with no intervention, P II was after technically introducing the computer system and, the last period, P III was after presenting and discussing the results of P I and P II at a staff meeting. Upon an order of platelet or fresh frozen plasma (FFP) unit from the blood bank, a computer-based audit system compared the last platelet count or prothrombin time [expressed as percentage of normal clotting activity, prothrombin time (PT-%)] to predefined criteria. In the case of exceeding the preset thresholds, the system required additional information and recorded the pretransfusion laboratory values for later analysis. Thirty-two per cent of platelet transfusions were given with pretransfusion platelet count >49 x 10(9) L(-1), and 60% of these transfusions (19% of all platelet transfusions) could not be clinically justified in retrospective chart review. There was no significant change in this practice from P II to P III. FFP transfusions were given with significantly different pretransfusion PT-% values during P II and P III. The proportions of FFP transfusions with pretransfusion PT-% > 49% were 7.8% and 0.9% during P II and P III, respectively (P < 0.0001). In chart review, none of the FFP transfusions with pretransfusion PT-% > 49% could be justified by clinical grounds. Inappropriate transfusions of both platelets and plasma remain a significant challenge for quality assurance of neonatal intensive care. Automated recording of pretransfusion platelet count and prothrombin time reliably identified the poorly justified transfusions and thus offered a practical resource-saving tool for quality assurance of transfusion in the NICU. A significant shift towards more appropriate use of plasma was demonstrated after implementation of the audit system.

Automation↗
PubMed1993

Development of a pharmaceutical care system in a neonatal intensive care satellite pharmacy.

The development of a pharmaceutical care system for a neonatal intensive care unit satellite pharmacy from existing integrated clinical, distributive, and quality assurance activities is described. Components of practice already in place included pharmacotherapeutic monitoring, evaluations for childhood immunizations, monthly medication summaries, and daily follow-up on scheduled doses returned in the unit dose exchange carts. Pharmacists documented patient drug therapy consultations on a standard form. New elements of practice emphasized organization of patients' clinical data by problem, development of specific outcome-oriented standards of care for common neonatal conditions and disease states, and quality improvement activities that evaluated the appropriateness of patient monitoring and patient outcomes. Written standards of care for specific disease states improved clinical decision-making, documentation of pharmacists' performance, and communication about patient care with other health care professionals. Elements of pharmacy practice already in place may provide a good foundation for a structured pharmaceutical care system.

Documentation↗
PubMed1998

Caring for the graduate from the neonatal intensive care unit. At home, in the office, and in the community.

This article focuses on recent progress in the understanding of optimal care for the neonatal intensive care unit (NICU) graduate in three domains that have relevance to primary care pediatricians: the concept of developmentally supportive care for the immature central nervous system of fragile premature infants; an understanding of the function and systems of community-based early intervention available for medically complex, developmentally challenged and at-risk infants; and the management of technology-dependent children at home.

Aftercare↗
PubMed1999

Developmental care teams in the neonatal intensive care unit: survey on current status.

Developmental Care Teams (DCT) have evolved in Neonatal Intensive Care Units (NICUs) in response to mounting evidence that developmental care is cost-effective and improves outcomes of critically ill newborns. Lack of national practice guidelines and standardized roles for DCT members prompted formulation and distribution of a questionnaire to obtain information regarding staff membership of DCTs, budgeting for DCTs, utilization of developmental care in practice, and education and developmental training of NICU staff. Questionnaires were sent to 50 NICUs in 30 states, with a return rate of 62% (31 of 50), representing 18 different states. Of those who responded, 64% had a DCT, and an additional 24% were in various phases of starting a team. Forty-three percent of the teams meeting on a regular basis did so monthly. Only 30% of those with a DCT had a dedicated budget to cover operating costs of their developmental program. Fifty-two percent of respondents had Neonatal Individualized Developmental Care and Assessment Program (NIDCAP)-certified staff at their institutions; however, nine other types of developmental specialists were also listed. Only four respondents indicated utilization of set criteria for initiation of a DCT consult, and 74% of those with DCTs initiated consults "when the need arises." NIDCAP assessments were used for parent teaching (54%), care plans (69%), care recommendations (46%), and at caregiver "discretion" (39%). The results of the survey validated an intense interest in developmental care. Approach to developmental care is variable between NICUs and implementation as outlined by NIDCAP is unusual. Practical guidelines for utilization and funding of DCTs are needed.

Child Development↗
PubMed2002

Expanding the infection control team: development of the infection control liaison position for the neonatal intensive care unit.

Neonatal survival has risen progressively during the past 30 years. As the limits of viability continue to decline, the challenges of providing care to infants at the lowest extremes of gestational age and birth weight continually increase. Nosocomial infections in this very fragile population can be devastating. The complexity of care of these premature infants requires specialized knowledge of the neonate, infectious disease processes, and methods to reduce infection risks in the neonatal intensive care unit. The role of infection control liaison has been established in our institution as an adjunct to meeting this challenge by providing a line of communication between staff, neonatologists, and the infection control team. This article describes the role of the infection control liaison and its overall impact on the infection control program in an 87-bed level II, III, and IV neonatal intensive care unit from 1995 to 1999.

Cross Infection↗
PubMed1990

Effects of birth weight and sociodemographic variables on mental development of neonatal intensive care unit survivors.

Neonatal intensive care unit survivors (N = 494) from 10 tertiary care centers were evaluated over the first 4 to 5 years of life to determine the relative contributions of birth weight and sociodemographic factors to mental development. Six sociodemographic factors were studied: sex, race, family income, and mother's marital status, age, and educational level; the last five factors also are known to be associated with premature birth. Mental development was measured with the Bayley Scales of Infant Development (12 to 24 months) and the Stanford Binet Intelligence Test (4 to 5 years). Each factor's influence was assessed by multivariate analysis. Birth weight had limited long-term implications; at 4 to 5 years, only infants with birth weights less than 1000 gm had significantly lower scores than those in other birth weight categories. Sociodemographic variables had a greater impact on mental development, with age-dependent differences found between nonwhite and white children and between children with mothers of low, medium, and high educational levels.

Adult↗
PubMed2006

[Neurosensory visual development of the foetus and newborn and neonatal intensive care units].

In neonatal intensive care units, newborn can be exposed to stress, which can damage the early development of his visual function. Being aware of the different processes of the complex visual system (embryogenesis, neuronal organization, neurosensory visual development) enables to propose practical recommendations to prevent early injures on the development of foetus and newborn visual system to limit the use of drugs that produce central nervous system depression, to respect sleep and cyclization of the light (darkness periods), to reduce strong stimuli (bright light, intense noise, pain), and to stimulate visual experience with various objects in the central visual field.

Embryonic Development↗