Technology – Considerations for the NICU of the Future

An mHealth Intervention to Support Psychosocial Well-Being of Racial and Ethnically Diverse Families in the Neonatal Intensive Care Unit

OBJECTIVE

To assess the effectiveness of an mHealth neonatal intensive care unit (NICU) parent support smartphone application to improve psychosocial well-being, specifically reduced stress and anxiety, increased parenting competence, and improved social support among a diverse group of parents with infants born preterm in 3 Chicago-area NICUs.

STUDY DESIGN

A time-lapsed, quasiexperimental design in which control participants were enrolled and then intervention participants enrolled. Data collection occurred at 3 timepoints: NICU admission (AD), discharge (DC), and 30 days post-DC (DC+30). Validated outcome measures included parenting sense of competence, stress, anxiety, and social support.

RESULTS

Intention-to-treat analyses included 400 participants (156 intervention; 244 control). After covariate adjustment, a significant increase in parenting sense of competence (AD-DC, DC+30), decrease in stress (AD-DC+30), decrease in anxiety (AD-DC, DC+30), and increase in social support (AD-DC) were noted but did not differ by study arm. However, secondary analysis of parents with infants born at <32 weeks of gestational age (156 participants) showed decrease in stress (AD-DC+30) that was greater in intervention vs control group (P = .03). Among intervention participants who were Black, a significant increase in social support (AD-DC) total score (P = .01), and 2 subscales of emotional/informational support (P = .02) and positive social interaction (P = .02) were found.

CONCLUSIONS

This novel mHealth intervention shows evidence of reduced stress and anxiety while increasing social support among some subsets of parents at high risk of negative psychosocial experiences in the NICU, potentially enhancing outcomes for infants born preterm by ensuring that parents are less stressed and better supported.

The Relationship Between Neonatal Nurses' e-Health Literacy Levels and Care Behaviours: A Cross-Sectional Study

AIM

The study aims to determine the relationship between e-health literacy level and the care behaviour of neonatal nurses.

BACKGROUND

E-health literacy is becoming increasingly important, as health-related information can be obtained easily and quickly from electronic sources.

DESIGN

The study is a cross-sectional study.

METHODS

The sample of the study consists of 384 neonatal nurses working in different hospitals in Türkiye. An introductory form, the E-Health Literacy Scale (eHEALS), and the Care Behaviours Inventory-24 (CBI-24) were used for data collection. The data collection forms were created using Google Forms.

RESULT

eHEALS 4.32 ± 0.551, CBI-24 5.58 ± 0.567, CBS-24 sub-dimension: Assurance 5.58 ± 0.591, CBS-24 sub-dimension: Knowledge-Skills 5.64 ± 0.561, CBI-24 sub-dimension: Respect 5.56 ± 0.565, CBI-24 sub-dimension: Connectedness 5.52 ± 0.637 was found. It was determined that there was a very weak positive relationship between eHEALS, CBI-24 and sub-dimension scores (p < 0.001). A significant relationship was found between the eHEALS and the independent variables age, female, living in the Southeastern Anatolia region, working in a public hospital, using the internet for their profession, and CBI-24 sub-dimension: assurance (F = 6.111; p < 0.001).

CONCLUSION(S)

The relationship between e-health literacy and care behaviours of neonatal nurses was examined. Neonatal nurses' was found eHEALS, CBI-24, and sub-dimension scores had a high and very weak positive relationship. A significant relationship was found between the eHEALS level and age, female, Southeastern Anatolia region, state hospital, using the internet for their profession, and assurance sub-dimension.

IMPACT

Study determines the eHEALS of neonatal nurses and provides information about this field. Interventions aimed at eHEALS should be developed and implemented at both the institutional and individual levels.

REPORTING

STROBE, No Patient or Public Contribution.

Identifying characteristics associated with genetic testing in the NICU

Genetic testing is an integral part of Neonatal Intensive Care Unit (NICU) care. There are reported disparities in both NICU care and genetic testing related to race and language spoken. Identifying characteristics associated with genetic testing in NICUs could help detect patients who may benefit from genetic testing, as well as any current disparities. We sought to analyze characteristics of NICU admits who had genetic testing in general and specific test categories. Characteristics were requested from the Children's Hospital Neonatal Consortium database for patients admitted to Primary Children's Hospital's NICU in 2022. Statistical analysis was performed to determine if characteristics were more likely to result in genetic testing and if differences between those with genetic testing and those without were significant. All genetic test types were more likely ordered with genetic consultations. Cytogenetic testing was more likely in patients with a cardiology consult or who were Spanish-speaking. Patients who were of Hispanic origin were more likely to have molecular testing ordered. The average number of specialty consults for a patient was higher for those with genetic testing. Premature and low birthweight infants had longer time to genetic test ordering. No disparities were identified, which could be due to a small, homogenous sample. The differences with Spanish-speaking patients and those with mothers of Hispanic origin could be due to many factors, including consenting practices. It may be difficult to identify infants who might need genetic testing when they are low birthweight and/or premature. It is important to continue monitoring for differences in ordering practice for this vulnerable population.

Effectiveness of a Novel Feeding Algorithm for Oral Feeding Transition of Infants Born Prematurely

BACKGROUND

Feeding skill acquisition is commonly a limiting factor determining when an infant born prematurely can be discharged.

PURPOSE

This study aimed to determine if the addition of a novel feeding progression algorithm (combination of objective data from a suck measurement device and slow flow/low variability nipples) to current neonatal intensive care unit (NICU) standards could decrease feeding-related length of stay (primary outcome). We hypothesized that by timing the initiation of oral feedings to coincide with adequate sensory-motor skill development, feeding-related length of stay may be decreased.

METHODS

This was a prospective intervention study, with a historical control cohort, of infants born less than 30 weeks' gestational age without comorbidities affecting feeding skill acquisition at a Regional Level III-S NICU at a women and infant's hospital in Louisiana. A novel feeding progression algorithm utilized objective assessment of sucking to determine progression in nipple flow rates with slow flow/low variability nipples (flow rates from 0 to 9 mL/min) for infants receiving intervention (n = 18). Thirty-six controls who did not receive the feeding progression algorithm were identified via electronic medical record retrospective chart review.

RESULTS

Eighteen completed the study. Compared to the control group, infants receiving feeding interventions had delayed sequencing initiation, extended time between initially off positive pressure ventilation and initiation of sequencing, and decreased feeding-related length of stay, with similar total length of stay.

IMPLICATIONS FOR PRACTICE AND RESEARCH

This study adds to existing research supporting the effectiveness of novel feeding progression algorithms and interventions to support the health and outcomes of infants born prematurely. Future research should focus on implementation studies for feeding progression algorithm integration into standard NICU care.

ATTENTIV: Instrumented Peripheral Catheter for the Detection of Catheter Dislodgement in IV Infiltration

Intravenous (IV) infiltration is a common problem associated with IV infusion therapy in clinical practice. A multitude of factors can cause the leakage of IV fluids into the surrounding tissues, resulting in symptoms ranging from temporary swelling to permanent tissue damage. Severe infiltration outcomes can be avoided or minimized if the patient's care provider is alerted of the infiltration at its earliest onset. However, there is a lack of real-time, continuous infiltration monitoring solutions, especially those suited for clinical use for critically ill patients. Our design of the sensor-integrated ATTENTIV catheter allows direct detection of catheter dislodgement, a root cause of IV infiltration. We verify two detection methods: blood-tissue differentiation with a support vector machine and signal peak identification with a thresholding algorithm. We present promising preliminary testing results on biological and phantom models that utilize bioimpedance as the sensing modality. Clinical relevance- The sensor-embedded ATTENTIV catheter demonstrates potential to automate IV infiltration detection in lieu of using traditional infusion catheters and manual detection methods.

Neonatal Care Provider Tasks in the NICU and Delivery Room

BACKGROUND

Decreased availability of pediatric residents in neonatal intensive care units (NICUs) has created demand for other neonatal medical care providers. No recent publications exist about how to approach the organization of tasks involved in that care.

PURPOSE

The purpose of this article is to present a structure and resources to guide the organization of tasks in the care of sick and premature infants in the NICU.

METHODS

The methods included a literature review to develop evidenced-based practice resources. The literature was reviewed regarding the relevant history and resources to support task organization during patient rounds and care in the NICU, and for delivery attendance by skilled providers. The goal, to establish a reference to support education about these approaches, is based upon evidence, which appears to be rooted in tradition.

FINDINGS

Evidence-based resources include documentation templates, problem list in order of systems, and provider tasks for NICU and delivery attendance.

IMPLICATION FOR RESEARCH

Future studies can measure mentor or learner perceptions of the value of these resources, critical thinking improvement, safety, and clinical outcomes.

IMPLICATION FOR PRACTICE

These resources may provide structure for learners and providers who have studied the physiology, pathophysiology, and problem management concepts, but need to learn how to execute their responsibilities in these busy environments.

Technology integration in complex healthcare environments: A systematic literature review

To support safety and efficient care, effective integration of technology into the timepressured, high-risk healthcare environments is critical. This systematic literature review aimed to highlight the impact of technology on the physical environment as well as the facilitators for and barriers to technology integration into complex healthcare settings, including operating rooms and trauma rooms. PsycINFO, Web of Science, and PubMed databases were utilized, along with a hand search. PRISMA and MMAT guidelines were used for reporting and quality appraisal. Out of 1,001 articles, 20 were eligible. Identified categories included hybrid and integrated environments, technological ambiance, and information technologies. Technology integration has implications for direct patient care, efficiency, throughput, patient safety, teamwork, communication, and the perception of care. The facilitators for and barriers to technology integration included layout design, equipment positioning, and decluttering. The physical environment can improve the impact of technology on factors such as patient safety and efficiency.

Towards an architecture of flexibility

OBJECTIVE

Our objective was to explore the case for adoption of flexibility as a core value in the design process for Neonatal Intensive Care Units (NICUs).

METHODS

Guidelines for NICU design and care of NICU patients and families were examined to identify opportunities for building flexibility into NICU design to optimize function and experience.

RESULTS

Benefits of building flexibility into NICU design included the ability for units to adapt quickly and economically to unpredictable events and demographic changes. Further, by centering family presence as a design necessity, NICUs may better protect families from experiencing additional harm due to separation and interruption of restorative activities. We were able to highlight several examples of current NICUs, which have successfully adopted flexible design and operational models to provide optimal levels of clinical and family-centered care.

CONCLUSION

By intentionally incorporating flexibility into the design of an NICU, infants, families, and healthcare providers can be provided with an environment that can adapt to shifting needs to optimally support unit function and clinical outcomes.

Conceptualization of an ICU Infrastructure for Simulation Based Education in Medical Engineering & eHealth

The use of simulation-based training is gaining importance in medical as well as engineering related education. The complex environment of an intensive care unit is characterized by a high need of interaction between clinical as well as technical components and views. These diverse interactions and the connected requirements are the focus for the presented simulation infrastructure, enabling research, education and training. The presented concept of a modular and flexible intensive care environment provides a high degree of interoperability and flexibility for individual research questions and full support of connectivity for typical clinical workflows. The presented simulation and testing bed will allow both, education for engineering and medical students using patient simulation and simultaneous data transfer as well as research on medical workflows, infrastructural demands and connectivity conformance questions.

eHealth interventions for parents in neonatal intensive care units: a systematic review

BACKGROUND

As technology becomes increasingly more advanced, particularly video technology and interactive learning platforms, some neonatal intensive care units are embracing electronic health (eHealth) technologies to enhance and expand their family-centered care environments. Despite the emergence of eHealth, there has been a lack of systematic evaluation of its effectiveness thus far.

OBJECTIVES

To examine the effect of eHealth interventions used in neonatal intensive care units on parent-related and infant outcomes.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

This review considered studies that included parents or primary caregivers of infants requiring care in a neonatal intensive care unit.

TYPES OF INTERVENTION(S)

This review considered studies that evaluated any eHealth interventions in neonatal intensive care units, including education (e.g. web-based platforms, mobile applications); communication (e.g. videos, SMS or text messaging), or a combination of both. Comparators included no eHealth interventions and/or standard care.

TYPES OF STUDIES

Experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, and analytical cross sectional studies were considered.

OUTCOMES

This review considered studies that included parent-related outcomes (use and acceptance, stress/anxiety, confidence, financial impact, satisfaction and technical issues) and neonatal outcomes (length of stay, postmenstrual age at discharge, parental presence and visits).

SEARCH STRATEGY

A systematic search was undertaken across four databases to retrieve published studies in English from inception to November 18, 2016.

METHODOLOGICAL QUALITY

Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI).

DATA EXTRACTION

Quantitative data were extracted from included studies independently by two reviewers using the standardized data extraction tool from JBI-SUMARI.

DATA SYNTHESIS

A comprehensive meta-analysis for all outcomes was not possible and data has been reported narratively for all outcomes.

RESULTS

Eight studies met inclusion criteria and were included in the review. The majority of the studies were low to very low quality. The study design and type of eHealth technology examined varied greatly. There appears to be growing interest in the topic as over half of the included studies were published within the past two years. Primary findings suggest parent acceptance and use of eHealth interventions but an unclear impact on neonatal outcomes, particularly on length of stay, a commonly reported neonatal outcome. Due to the variation in eHealth interventions, and heterogeneity across studies, meta-analysis was not possible. Numerous single studies and small sample sizes limited the degree of adequate strength to determine statistical differences across outcomes.

CONCLUSIONS

While heterogeneity across studies precluded meta-analysis, consistent trends across all studies examining parental acceptance of eHealth interventions indicate that parents are willing to accept eHealth interventions as part of their neonatal intensive care, suggesting that the incorporation and evaluation of eHealth interventions in the neonatal intensive care unit setting is warranted. Further high quality studies are needed with larger sample sizes to detect changes in outcomes. As eHealth intervention studies move beyond feasibility and implementation, there is a demand for randomized control trials to examine the effect of eHealth interventions on parent and neonatal outcomes compared to usual care. Future studies should consider reporting of outcomes using standardized measures which would allow comparison across eHealth interventions in subsequent reviews.