An international study on implementation and facilitators and barriers for parent‐infant closeness in neonatal units

Importance

Parent‐infant closeness and active parent participation in neonatal care are important for parent and infant health.

Objective

To give an overview of current neonatal settings and gain an in‐depth understanding of facilitators and barriers to parent‐infant closeness, zero‐separation, in 19 countries.

Methods

Neonatal intensive care unit (NICU) professionals, representing 45 NICUs from a range of geographic regions in Europe and Canada, were purposefully selected and interviewed June–December 2018. Thematic analysis was conducted to identify, analyze and report patterns (themes) for parent‐infant closeness across the entire series of interviews.

Results

Parent‐infant separation during infant and/or maternity care is very common (42/45 units, 93%), despite the implementation of family integrated care (FICare) practices, including parent participation in medical rounds (17/45, 38%), structured education sessions for parents (16/45, 36%) and structured training for healthcare professionals (22/45, 49%). NICU professionals encountered four main themes with facilitators and barriers for parent‐infant closeness on and between the hospital, unit, staff, and family level: Culture (jointly held characteristics, values, thinking and behaviors about parental presence and participation in the unit), Collaboration (the act of working together between and within different levels), Capacities (resources and policies), and Coaching (education to acquire and transfer knowledge and skills).

Interpretation

Implementing parent‐infant closeness in the NICU is still challenging for healthcare professionals. Further optimization in neonatal care towards zero‐separation and parent‐infant closeness can be achieved by enforcing the ‘four Cs for Closeness’: Culture, Collaboration, Capacities, and Coaching.

[Whole body hypothermia for the treatment of hypoxic-ischaemic encephalopathy in term infants--a safety study in Hungary]

Hypoxic-ischaemic encephalopathy is a major cause of long-term morbidity and mortality in term infants. Prolonged systemic hypothermia is a promising new approach for reducing brain damage in neonates.

OBJECTIVE

The aim of the open cohort-series clinical study was to collect data about the safety and technical feasibility of the hypothermia treatment in Hungary before joining to a randomised efficacy trial.

METHODS

The authors treated 28 asphyxiated term neonates with hypothermia between 2003 and 2005. Hypothermia (rectal temperature 33-34 degrees C) was maintained for 72 hours during continuous morphine analgesia. For historical control group 23 asphyxiated neonates were selected treated with standard therapy between 1996 and 2002. Entry criteria were the following: a 5-minute Apgar score 5 or less, the evidence of serious metabolic acidosis in the first hour of life (a BE of 15 mmol/l) and clinical sign of encephalopathy at the same time. Routine laboratory measurements of liver enzymes, renal functions, blood cell count, head ultrasound were performed daily.

RESULTS

The anthropometric and clinical parameters (Apgar, pH, BE, neurological signs of encephalopathy) of the hypothermia and control infants were similar. There were no significant differences between the mortality of the hypothermia (10/28 36%) and the control (10/21 48%) groups. The clinical parameters (laboratory values, abnormality on the head ultrasound, incidence of serious hypotension, hypoglycaemia, bleeding, need for cardiovascular support, oliguria) and the neurological outcome after 1.5-2 year follow-up were also similar.

CONCLUSIONS

This study demonstrated that prolonged whole body hypothermia of the asphyxiated neonate is safe and not associated with increased mortality and morbidity up to 18 month of age.

Changes in laboratory parameters indicating cell necrosis and organ dysfunction in asphyxiated neonates on moderate systemic hypothermia

AIM

Asphyxia is a major cause of morbidity and mortality in term infants. In addition to cerebral injury other organs are also distressed due to hypoxic-ischaemic insult. Systemic hypothermia has a beneficial effect on brain injury. We tested the impact of hypothermia on hypoxic damage of other internal organs.

METHODS

Asphyxiated term neonates (n = 21) were randomised to groups treated with hypothermia (n = 12) and normothermia (n = 9). Hypothermia (33-34 degrees C) was initiated within 6 h of life, and maintained for 72 h. We determined serum transaminase, lactate dehydrogenase, creatine kinase, uric acid, creatinine levels and diuresis during 6, 24, 48 and 72 postnatal hours.

RESULTS

Area under curve values of aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH), uric acid and creatinine during the investigated period and alanine aminotransferase (ALAT) value at 72 h were lower in neonates on hypothermia than in those on normothermia. Renal failure and liver impairment affected less hypothermic than normothermic neonates (3/12 vs. 7/9, p = 0.03, 3/12 vs. 6/9 p = 0.08, respectively). Four of the 12 hypothermic and 6 of the 9 normothermic neonates developed multiorgan failure.

CONCLUSIONS

These results suggest that systemic hypothermia may protect against cell necrosis and tissue dysfunction of internal organs after neonatal asphyxia.

238U, 226Ra, 210Po concentrations of bottled mineral waters in Hungary and their committed effective dose

Nowadays the consumption of bottled mineral waters has become very popular. The average consumption of these is 0.36 l d(-1) per person in Europe. A considerable segment of the population drinks almost only mineral water as drinking water, which is about 1 l d(-1). As is known, some kinds of mineral waters contain naturally occurring radionuclides in higher concentration than the usual drinking (tap) water. The WHO (1993) legislation concerning the drinking waters does not include the mineral waters. In our work, the concentrations of (226)Ra, (238)U and (210)Po were determined in mineral waters available in Hungary. To determine the (226)Ra concentration the emanation method was used. The (238)U and (210)Po concentrations were determined by alpha spectrometry using semiconductor detector. The dose contribution was calculated using the radionuclide concentrations and the dose conversion factors from the Basic Safety Standard IAEA (1995), for 1 l d(-1) mineral water consumption. In some cases the calculated doses were considerable higher than the limit for drinking waters. Especially for children the doses can be remarkably high.

Concentration of 226Ra in Hungarian bottled mineral water

Concentration of the radionuclide 226Ra was determined in almost every type of bottled mineral water commercially available in Hungary. Determination of the radon coming from the radium dissolved in the water was used for activity measurement. As the results show, the 226Ra concentrations exceed the level of 100 mBq l(-1) in six cases out of the 28 types of mineral water investigated. In one case 3 Bq l(-1) was measured, which provides 0.3 mSv year(-1) committed effective dose for adults in the case of a consumption rate of 1 l day(-1). In soft drinks produced from mineral water a concentration of 2.6 Bq l(-1) was determined, which means 1.4 mSv year(-1) effective dose in the age group 12-17 years in the case of permanent daily drinking of 1 l of these beverages.