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LaRonde MP, Connor JA, Cerrato B, Chiloyan A, Lisanti AJ. Individualized Family-Centered Developmental Care for Infants With Congenital Heart Disease in the Intensive Care Unit. Am J Crit Care 2022; 31:e10-e19. [PMID: 34972853 DOI: 10.4037/ajcc2022124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Individualized family-centered developmental care (IFDC) is considered the standard of care for premature/medically fragile newborns and their families in intensive care units (ICUs). Such care for infants with congenital heart disease (CHD) varies. OBJECTIVE The Consortium for Congenital Cardiac Care- Measurement of Nursing Practice (C4-MNP) was surveyed to determine the state of IFDC for infants younger than 6 months with CHD in ICUs. METHODS An electronic survey was disseminated to 1 nurse at each participating center. The survey included questions on IFDC-related nursing practice, organized in 4 sections: demographics, nursing practice, interdisciplinary practice, and parent support. Data were summarized by using descriptive statistics. Differences in IFDC practices and IFDC-related education were assessed, and practices were compared across 3 clinical scenarios of varying infant acuity by using the χ2 test. RESULTS The response rate was 66% (25 centers). Most respondents (72%) did not have IFDC guidelines; 63% incorporated IFDC interventions and 67% documented IFDC practices. Only 29% reported that their ICU had a neurodevelopmental team. Significant differences were reported across the 3 clinical scenarios for 11 of 14 IFDC practices. Skin-to-skin holding was provided least often across all levels of acuity. Nurse education related to IFDC was associated with more use of IFDC (P < .05). CONCLUSION Practices related to IFDC vary among ICUs. Opportunities exist to develop IFDC guidelines for infants with CHD to inform clinical practice and nurse education. Next steps include convening a C4-MNP group to develop guidelines and implement IFDC initiatives for collaborative evaluation.
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Affiliation(s)
- Meena P. LaRonde
- Meena P. LaRonde is a staff nurse III, Cardiovascular Intensive Care Unit, Boston Children’s Hospital, Boston, Massachusetts
| | - Jean A. Connor
- Jean A. Connor is the director of nursing research, Cardiovascular and Critical Care Patient Services, Boston Children’s Hospital and an assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Cerrato
- Benjamin Cerrato is a project coordinator, Cardiovascular and Critical Care Patient Services, Boston Children’s Hospital
| | - Araz Chiloyan
- Araz Chiloyan is a quality improvement consultant, Department of Cardiology, Boston Children’s Hospital
| | - Amy Jo Lisanti
- Amy Jo Lisanti is a research assistant professor at the University of Pennsylvania School of Nursing, Department of Family and Community Health and a primary investigator at the Research Institute and Children’s Hospital of Philadelphia
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de Oliveira Tobinaga WC, de Lima Marinho C, Abelenda VL, de Sá PM, Lopes AJ. Short-Term Effects of Hydrokinesiotherapy in Hospitalized Preterm Newborns. Rehabil Res Pract 2016; 2016:9285056. [PMID: 27672453 DOI: 10.1155/2016/9285056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background. In the neonatal intensive care unit (NICU) environment, preterm newborns are subject to environmental stress and numerous painful interventions. It is known that hydrokinesiotherapy promotes comfort and reduces stress because of the physiological properties of water. Objective. To evaluate the short-term effects of hydrokinesiotherapy on reducing stress in preterm newborns admitted to the NICU. Materials and Methods. Fifteen preterm newborns underwent salivary cortisol measurement, pain evaluation using the Neonatal Infant Pain Scale (NIPS), and heart rate, respiratory rate, and peripheral oxygen saturation measurements before and after the application of hydrokinesiotherapy. Results. The mean gestational age of the newborns was 34.2 ± 1.66 weeks, and the mean weight was 1823.3 ± 437.4 g. Immediately after application of hydrokinesiotherapy, a significant reduction was observed in salivary cortisol (p = 0.004), heart rate (p = 0.003), and respiratory rate (p = 0.004) and a significant increase was observed in peripheral oxygen saturation (p = 0.002). However, no significant difference was observed in the NIPS score (p > 0.05). Conclusion. In the present study, neonatal hydrotherapy promoted short-term relief from feelings of stress. Neonatal hydrokinesiotherapy may be a therapeutic alternative. However, this therapy needs to be studied in randomized, crossover, and blinded trials. This trial is registered with NCT02707731.
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Abstract
Pain assessment and measurement are the cornerstones of pain management. Pain assessment connotes a comprehensive multidimensional description. Conversely, pain measurement provides a numeric quantitative description of each factor illustrating pain qualities. Pain scales provide a composite score used to guide practice and research. The type of infant pain instrument chosen is a significant factor in guiding pain management practice. The purpose of this review was to summarize current infant pain measures by introducing a conceptual framework for pain measurement. Although more than 40 infant pain instruments exist, many were devised solely for research purposes; several of the newly developed instruments largely overlap with existing instruments. Integration of pain management into daily practice remains problematic. Understanding how each instrument measures infant pain allows clinicians to make better decisions about what instrument to use with which infant and in what circumstances. In addition, novel new measurement techniques need further testing.
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Abstract
AIM Chloral hydrate is generally considered a safe and effective single dosing procedural sedative for neonates in the clinical setting. However, its safety profile as a repetitive dosing maintenance sedative is largely unknown. This study aimed to document current administration practices of chloral hydrate in the Neonatal Unit, Royal Children's Hospital, Melbourne, Australia, over a 6-month period. METHODS Patients who had been prescribed chloral hydrate during the specified audit period were recruited into the study and prospectively followed for a period of 28 days, or until they were discharged from the unit. Demographic data were collected on recruitment, and daily documentation of chloral hydrate administration was recorded. RESULTS A total of 238 doses of chloral hydrate were administered to a cohort of 32 patients during the study period. The majority of the audited doses (84%) were ordered as repeating doses. Doses were more likely to be given at night than during the day, and the median dosage for repetitive dosing was found to be above the study site's recommended dosing range. Pre-dose and/or post-dose assessment of distress/agitation accompanied dosage approximately half of the time. The audit did not reveal any recognisable pattern of sedation maintenance or weaning process for patients who received multiple doses. CONCLUSIONS Health-care professionals caring for hospitalised infants should be made aware of the potential risks of chloral hydrate as a repetitive dosing sedative, and of the importance of systematically evaluating the appropriateness and effectiveness of utilising such pharmacological intervention for managing and treating distress.
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Affiliation(s)
- Sharon Cruise
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Island, UK
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Collados-Gómez L, Aragonés-Corral B, Contreras-Olivares I, García-Feced E, Vila-Piqueras ME. [Assessing the impact of kangaroo care on preterm infant stress]. Enferm Clin 2011; 21:69-74. [PMID: 21458343 DOI: 10.1016/j.enfcli.2010.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 12/22/2010] [Accepted: 12/23/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy of Kangaroo Care (KC) in decreasing stress in newborns of 29-34 weeks' post-menstrual age (PMA). METHODS Quasi-experimental pre-post without control group analytical study conducted in the Gregorio Marañón University Hospital Neonatal Unit. The inclusion criteria were: infants 29 to 34 weeks' PMA, in an incubator, did not have neurological pathology, were not post-surgical, and with a Spanish-speaking mother and/or father. The sample size was fifty-one premature infants. The study variables selected were: clinical variables (additional oxygen and pathology), socio-demographical variables (PMA, KC duration) and the outcome variable, premature infant stress, which consisted of two variables: the physiological stress signal and the behavioural stress response. The variables were collected at three different times: basal stress, during KC and after KC completion, making a comparison analysis between the basal stress and after KC. RESULTS The response rate was 100%, without registering any loss. The stress variables that changed after the intervention (statistically significant) were: irregular breathing, trunk arching or hyperextension, very open fingers, contraction of the face muscles, apnea, irritability and exaggerated and sustained extension of arms and legs. O(2) saturation was 94.73%±3.05% before KC and 95.92%±2.97% after the intervention. The heart rate (HR) ranged from 158.14±17.48 bpm (beats per minute) before the KC to 151.47±4.47 bpm after it. CONCLUSIONS KC is related to the decrease in the occurrence of neonatal variables of stress, helping to organize motor and physiological systems to achieve a state of tranquility.
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Affiliation(s)
- Laura Collados-Gómez
- Unidad de Cuidados Medios de Neonatología, Hospital Universitario Gregorio Marañón, Madrid, Spain.
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Sittig SE, Nesbitt JC, Krageschmidt DA, Sobczak SC, Johnson RV. Noise levels in a neonatal transport incubator in medically configured aircraft. Int J Pediatr Otorhinolaryngol 2011; 75:74-6. [PMID: 21074281 DOI: 10.1016/j.ijporl.2010.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate exposure of neonates to noise during air medical transport as few commercially available hearing protective devices exist for premature newborns during air medical transport. METHODS Sound pressure levels in an infant incubator during actual flight conditions in four common medically configured aircraft were measured. Three noise dosimeters measured time-weighted average noise exposure during flight in each aircraft. One dosimeter was placed in the infant incubator, and the remaining dosimeters recorded noise levels in various parts of the aircraft cabin. RESULTS The incubator provided a 6-dBA decrease in noise exposure from that in the crew cabin. The average noise level in the incubator in all aircraft was close to 80 dB, much higher than the proposed limits of 45 dB for neonatal intensive care unit noise exposure or 60 dB during transport. CONCLUSIONS Exposure of neonates to elevated noise levels during transport may be harmful, and steps should be taken to protect the hearing of this patient population.
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Affiliation(s)
- Steven E Sittig
- Division of Intensive Care and Respiratory Care, Mayo Clinic, Rochester, MN 55905, USA.
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Newnham CA, Inder TE, Milgrom J. Measuring preterm cumulative stressors within the NICU: the Neonatal Infant Stressor Scale. Early Hum Dev 2009; 85:549-55. [PMID: 19520525 DOI: 10.1016/j.earlhumdev.2009.05.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 05/01/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Stress experiences, while pervasive, are less likely than painful experiences to be managed in still-hospitalised preterm infants. AIM We aimed to quantify the severity of common stressors for preterm infants with a view to providing a tool to manage presumed accumulated infant stress. METHODS AND SUBJECTS Seventeen doctors and 130 nurses who work in Neonatal Intensive and Special Care Nurseries rated the perceived stress severity of 44 acute events and 24 chronic living conditions for preterm infants at three ages (<28 weeks, 28-32 weeks, >32 weeks post-conceptional age) and for themselves. Acute items (such as heel lance) were organised into nursing, peripheral venous access, peripheral arterial access, central vascular access, ventilation, nutrition, medical procedures, surgery, radiology and miscellaneous categories. Chronic living conditions included items such as receiving intranasal oxygen and having a systemic infection. RESULTS Doctors and nurses perceived nearly all items to be stressful to infants to some degree and to be equally stressful across ages. The degree of stress experienced by clinicians themselves was generally low and moderately correlated with presumed infant stress for the same items. Presumed infant stress was inversely related to clinician age. CONCLUSION Based on these results we developed the Neonatal Infant Stressor Scale to help track, measure and manage presumed accumulated stress in preterm neonates.
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Affiliation(s)
- C A Newnham
- Parent-Infant Research Institute, Clinical and Health Psychology, Austin Health, Melbourne, Australia.
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Abstract
PURPOSE The purpose of this study was to compare stress responses of infants born preterm during routine nursing assessments performed under two conditions. One condition incorporated a second caregiver supporting the infant in a facilitated tucked position, whereas the second condition did not. METHODS A convenience sample of 12 infants born preterm, ages 25 to 34 weeks postconceptual age on the day of testing (mean = 30.9 weeks), were evaluated using the Premature Infant Pain Profile (PIPP), during the two caregiving conditions. For each trial, the infant received a PIPP score. The level of significance was set at p = 0.05. RESULTS A significant difference (p = 0.013) existed between the two testing positions as measured by the PIPP. Nine of the 12 infants received a lower PIPP score with facilitated tucking during routine care assessments. CONCLUSIONS By incorporating facilitated tucking during routine care events, the stress level of the infants born preterm may be reduced. When the infants' stress levels are reduced, they may be better able to maintain stability in their autonomic, motor, and state systems.
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Affiliation(s)
- Sharon Hill
- Physical Therapy Program, St. Ambrose University, Davenport, IA, USA.
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Abstract
OBJECTIVE Individualized attention for premature infants was assessed from temporal patterns of caregiving at three very different regional NICUs. STUDY DESIGN Continuous time-lapse video recording of 95 premature infants under 1500 g was made over three 24-hour periods when they were 33 weeks' and 35 weeks' conceptional age. STATISTICAL ANALYSIS Analysis of variance was used to compare caregiving measures within and across hospitals. RESULTS The tapes were scored in 5-minute epochs for periods when the infants were in and out of the crib, and when intervention/caregiving was occurring. Despite other differences, the three hospitals did not differ with respect to demographic and risk characteristics of the infant subjects. In all three hospitals, there was more out-of-crib and more caregiving during the daytime than at night; caregiving time showed individual differences over day and night periods; developmental changes in caregiving were observed over the 2 weeks; and more caregiving time was devoted to infants who were at greater risk. CONCLUSION Temporal patterns of caregiving reliably indicate individual differences, with sensitive and responsive caregiving common to typical NICU nursing environments.
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Affiliation(s)
- Evelyn B Thoman
- Department of Psychology, University of Connecticut, Storrs, USA
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Abstract
Infant massage has been practiced for centuries by segments on the continents of Africa and South America and in the Far East. Infant massage is a relatively new modality in North America. Numerous studies support its use in preterm infants, who have exhibited decreased stress levels, increased weight gain, and improved motor function when compared with non-massaged controls. Research has recently turned to the benefits of massage in the cocaine-exposed population and in those with human immunodeficiency virus. Massage in ill preterms has been targeted for clinical testing.
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Affiliation(s)
- Rosalie O Mainous
- Graduate Program, School of Nursing, University of Louisville, Louisville, Kentucky, USA
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Chang YJ, Anderson GC, Lin CH. Effects of prone and supine positions on sleep state and stress responses in mechanically ventilated preterm infants during the first postnatal week. J Adv Nurs 2002; 40:161-9. [PMID: 12366646 DOI: 10.1046/j.1365-2648.2002.02358.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND/RATIONALE Preterm infants in mechanical ventilation are vulnerable and may manifest physiological instability and a disorganized behavioural state when responding to external stimuli. Adequate positioning strategies may play an important role in protecting infants from environmental stressor and assisting quality of sleep. However, no study has examined effects of prone and supine positions on behavioural state and stress signs including startle, tremor, and twitch responses for ventilated preterm infants during the critical first week postbirth. AIM OF THE STUDY The purpose of this study was to compare effects of prone and supine positions on behavioural state and stress responses in mechanically ventilated preterm infants. DESIGN/METHODS The infants were aged 25-36 weeks of gestation, < or = 7 days of age, and without sedation or congenital abnormalities. Using a crossover design, 28 infants were randomly assigned to supine/prone or prone/supine position sequence. Infants were placed in each position for 2 hours. A stabilization period of 10 minutes before observation of each position was allowed. During the protocol, care procedures were kept minimal and ventilator settings remained unchanged. Behavioural state and frequencies of stress signs including startle, tremor, and twitch were systemically recorded and analysed with repeated measures analysis of variance. FINDINGS Infants when prone compared with supine had (a) less crying, less active sleep, and more quiet sleep states, and (b) fewer stress responses of startle, tremor, and twitch. CONCLUSION Results indicate that prone positioning improves the quality of sleep and decreases stress for ventilated preterm infants during the first week postbirth. These may conserve energy and assist infants' extrauterine adaptation.
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Affiliation(s)
- Ying-Ju Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Abstract
This statement is intended for health care professionals caring for neonates (preterm to one month of age). The objectives of this statement are to: increase awareness that neonates experience pain; provide a physiological basis for neonatal pain and stress assessment and management by health care professionals; make recommendations for reduced exposure of the neonate to noxious stimuli and to minimize associated adverse outcomes; and recommend effective and safe interventions that relieve pain and stress.
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Abstract
Infant handling and disruptions in the neonatal intensive care unit are environmental stressors over which nurses have the most control. Two of the major goals of developmental care are individualizing care by decreasing infant disruptions and handling by caregivers, and modulating or attenuating infant responses to the care they receive. However, it has yet to be established to what extent these goals have been achieved. This article will provide a comparative review of selected literature to ascertain what effect, if any, the introduction of developmental care has had on infant handling or disruption in the neonatal intensive care unit.
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Affiliation(s)
- K L Peters
- Perinatal Research Centre, University of Alberta, Edmonton, Canada
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