Profile of Back-Referrals to Special Newborn Care Units

Objective: To study the outcomes of neonates back-referred from a tertiary care centre to special newborn care units (SNCUs) for step-down care. Methods: This prospective cohort study was conducted at a tertiary care neonatal unit and SNCUs in neighbouring states. We studied preterm and term neonates back-referred to district SNCUs from September, 2018 to April, 2019. The infants were followed up till 3 months corrected age, for mortality, re-hospitalization, emergency visits and unscheduled outpatient visits. Preterm inborn neonates <32 weeks gestation discharged directly to home formed the controls. Results: 201 back-referred neonates (study cohort) and 55 preterm neonates discharged to home (controls) were followed up till 3 months corrected age. Amongst the back-referred neonates, 5% died, 7% required re-hospitalization, 11% made emergency visits, and 24% made unscheduled outpatient visits. These outcomes were similar to the controls. Conclusion: Back-referral of convalescing neonates is a safe method of utilizing the limited healthcare resources in tertiary care centers in developing country settings.

Bubble continuous positive airway pressure therapy for neonatal respiratory distress at birth in level III newborn unit in Chengalpattu Medical College Hospital: a prospective observational study

Background: Bubble continuous positive airway pressure (bCPAP), a non-invasive respiratory device provides continuous pressure that helps recruitment of more alveoli, increases the lungs, functional residual capacity and decreases the work of breathing in newborns admitted with respiratory distress. Bubble continuous positive airway pressure (bCPAP) is the most important respiratory support in different types of respiratory conditions in level III. In this observational study, author reported this research using bCPAP therapy as the primary respiratory support in level III unit in tertiary care centre in Chengalpattu, Tamil Nadu, India. Despite reporting their indications, duration of use and adverse effects we tried to search for further improvement in other areas of CPAP therapy in level III newborn unit.Methods: This prospective observational study included 250 babies delivered in obstetric unit and admitted with respiratory distress within 6 hours of birth at level III care. They were treated according to level III newborn unit protocol. Those data were collected and entered in the proforma. Newborns were followed up till discharge.Results: A total of 250 babies satisfying the inclusion criteria delivered in Chengalpattu Medical College Hospital, Tamil Nadu, India (mean gestational age 36'2 weeks, mean birth weight 2.5'1.2 kg were included. All newborns were given bCPAP as the primary support. The most common underlying cause of respiratory distress was transient tachypnea of newborn (44%), followed by respiratory distress syndrome (24%) and prolonged respiratory transition (18%). The therapy success rate was 86%. Only 35 newborns failed to respond to CPAP. The most common adverse effect was eye puffiness (19%).Conclusions: Bubble continuous positive airway pressure (b CPAP) therapy use is being well established in level III unit for various respiratory conditions with minimal failure and adverse effects. Its use in extreme preterms and initiation after 6 hours is controversial.

A equipe de enfermagem frente aos acionamentos de alarmes em unidade de terapia intensiva neonatal / El equipo de enfermería antes de los disparadores de la alarma en la unidad de cuidados intensivos neonatales / The nursing team before alarm triggering in the neonatal intensive care unit

Describing and discussing the conduct of nurses before the triggering of the alarms by the electrical equipment. Methods: this is a descriptive, exploratory study with a qualitative analysis. Results: the professionals present good qualification, but act in a complex scenario that requires a differentiated staff sizing and that was not respected, a fact that may have interfered with service after the alarm was triggered. Conclusion: given the facts above, it is perceived that the training of nursing professionals and the stimulus to updating knowledge and to the compliance with the technical and operational standards of the profession are presented as well suited solution to the needs of the individual and the company and/or hospital unit, since the ultimate goal is to provide quality care and safety to the patient...

Descrever e discutir as condutas dos profissionais de enfermagem diante dos alarmes disparados pelos equipamentos eletromédicos. Métodos: trata-se de um estudo descritivo, exploratório e com análise qualitativa. Resultados: os profissionais apresentam uma boa qualificação, porém atuam num cenário complexo que exige um dimensionamento de pessoal diferenciado e que não foi respeitado, fato que pode ter interferido no atendimento ao alarme acionado. Conclusão: diante dos fatos mencionados, percebe-se que a capacitação dos profissionais de enfermagem e o estímulo à atualização de conhecimentos e ao cumprimento das normas técnicas e operacionais da profissão apresentam-se como solução bem adequada às necessidades do individuo e da empresa e/ou unidade hospitalar, visto que o objetivo final é aprestação de uma assistência de qualidade e a segurança do paciente...

Describir y discutir la conducta de las enfermeras ante las alarmas activadas por el equipo eléctrico. Métodos: se realizó un estudio descriptivo, exploratorio, con análisis cualitativo. Resultados: los profesionales tienen una buena calificación, pero actúan en un escenario complejo que requiere un dimensionamiento de personal característico y que no se observó, lo que puede haber interferido con alarma de servicio activado. Conclusión: teniendo en cuenta los hechos anteriores, se percibe que la capacitación de los profesionales de enfermería y el estímulo a la actualización de conocimientos y al cumplimiento de las normas técnicas y operativas de la profesión se presentan como una solución muy adecuada para las necesidades del individuo y la empresa y/o unidad hospitalaria, ya que el objetivo final es proporcionar una atención de calidad y seguridad al paciente...

Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit.

Background: The most frequently isolated fungi in patients using TPN belongs to the Candida genus. Various infections including venous catheter infections, fungemia, endocarditis and ophthalmitis may be encountered. Objective: Upon growth of Candida in the blood cultures from the pediatric (neonatal) unit of our hospital, a surveillance was performed in this unit and involving the health care workers. Clonal relationships of the isolates were investigated with molecular tests. Methods: Blood samples obtained from the patients in pediatric neonatal unit were studied with automatized blood culture [BacT/Alert (Bio Mérioux, France)]. Yeast isolates from environmental surveillance cultures (TPN solutions, hands of healthcare personnel, étagère, etc) and patients were identified as C. albicans with conventional methods and ID 32 C and ATBTM Fungus 3 (Biomerieux, France) kits. Clonal similarity was determined by using AP-PCR as initial method and we have also typified all strains by the method of REP-PCR (diversilab system,bioMérieux). Finally; Pulsed Field Gel Electrophoresis (PFGE) was used for confirmation. Results: C. albicans was isolated in blood cultures of seven patients. Similar antifungal susceptibility patterns were observed in all isolates. AP-PCR and REP-PCR showed that the C. albicans isolates grown in the TPN solution and from the patients’ blood cultures were clonally same strains. PFGE analysis further confirmed this clonality. Conclusion: According to results of the molecular methods, we thought that a C. albicans outbreak had occurred in the neonatal pediatric unit, due to contamination of TPN solution.

Equipe de saúde: negociações e limites da autonomia, pertencimento e reconhecimento do outro / Health team: negotiations and limits of autonomy, belonging and the acknowledgement of others

ResumoBuscamos desvelar o significado do trabalho em equipe dentro da complexidade de uma Unidade Neonatal. As técnicas utilizadas para coleta de dados foram a análise documental, a observação participante e a entrevista. Foram entrevistados 24 profissionais que atuam numa Unidade Neonatal pública e de alta complexidade do município do Rio de Janeiro. Os dados foram desenvolvidos conforme a técnica de análise de conteúdo, na modalidade temática, com base em bibliografia sobre humanização, ergologia e processo de trabalho em saúde e em equipe. Concluímos que, mesmo no ambiente neonatal, a construção do trabalho em equipe se efetiva quando o modo de atendimento está voltado para a lógica orientada pelas necessidades de saúde dos sujeitos, considerando os bebês e suas famílias, perpassando pelas negociações, os limites da autonomia, as noções de pertencimento e o reconhecimento do outro.

AbstractThe scope of this paper was to establish the significance of teamwork within the complex interaction in a Neonatal Unit. The techniques used for data collection were document analysis, participant observation and interviews. Twenty-four professionals working in a public and highly complex Neonatal Unit in the city of Rio de Janeiro were interviewed. The data were analyzed using the thematic approach of the content analysis technique, based on the literature on humanization, health work processes, teamwork and ergology. The conclusion drawn is that even in the neonatal environment, the construction of teamwork is established when the care model is geared to the logic responding to the health needs of individuals, taking into consideration the babies and their families, encompassing negotiations, limits of autonomy and notions of belonging and the recognition of others.

Eventos adversos em Unidade de Terapia Intensiva Neonatal / Adverse events in a Neonatal Intensive Care Unit / Eventos adversos en Unidad de Cuidados Intensivos Neonatales

Estudo observacional, prospectivo, para determinar a incidência de eventos adversos (EAs) em Unidade de Terapia Intensiva Neonatal (UTIN). Utilizou-se um "instrumento" específico, adaptado do modelo americano utilizado pela Rede Vermont-Oxford. Dos 218 recém-nascidos, 183 (84%) apresentaram EAs, correspondendo a 2,6 EA/paciente. Distúrbios da termorregulação (29%), distúrbios da glicemia (17,1%) e Infecção Relacionada à Assistência à Saúde (IRAS) de origem hospitalar (13,5%) foram os mais frequentes. Alguns EAs apresentaram associação com peso de nascimento (p < 0,05). O percentual de IRAS e a extubação não programada foi diretamente proporcional ao tempo de internamento. A incidência de EAs em UTIN é elevada entre os recém-nascidos de muito baixo peso. A qualidade da assistência torna-se primordial na elaboração das estratégias preventivas.

This was a prospective, observational study conducted in a neonatal intensive care unit to determine the incidence of adverse events. A specific trigger tool instrument was used, based on the one from Vermont-Oxford Network. A total of 218 neonates were followed and AEs were detected in 183 (84%) of them, with a rate of 2,6 AE/patient. Thermoregulation disorders (29%), disorders of glycemic control (17,1%) and nosocomial infections (13,5%) were the most frequent. Some AE were associated with birth weight (p<0.05). The accidental extubations and nosocomial infections were associated with hospital days. The incidence of AEs is high, especially among neonates with very low birth weight. Best practices regarding preventive strategies are necessary to improve quality of health care for these infants.

Estudio observacional, prospectivo para determinar la incidencia de eventos adversos (EAs) en la Unidad Neonatal de Cuidados Intensivos (UNCI). Fue utilizado un instrumento específico adaptado del modelo americano Vermont-Oxford. De los 218 recién nacidos, el 84% presentaron EA, lo que corresponde a 2,6 EA / paciente. Trastornos de la termorregulación (29%), trastornos de la glicemia (17,1%) e infección relacionada con el cuidado de la salud (IRCS) nosocomiales (13,5%) fueron los más frecuentes. Algunos presentaron asociación con el peso al nacer (p<0,05). El porcentaje de IRCS y la extubación no programada fue directamente proporcional a la duración de la estancia hospitalaria. La incidencia de EAs en la UNCI es alta entre los recién nacidos de muy bajo peso al nacer. La calidad de la asistencia es fundamental en el desarrollo de estrategias de prevención.

Dimensão relacional da atividade de cuidado e condições de trabalho de auxiliares de enfermagem em uma unidade neonatal / The relational dimension of the care activity and the working conditions in a neonatal unit

Este artigo analisa as condições de trabalho de auxiliares de enfermagem que atuam em Unidade Neonatal, considerando a dimensão relacional da atividade de cuidado. Tendo como principais referências epistemológicas a concepção canguilhemiana de saúde e a perspectiva ergológica, a pesquisa se pautou em abordagens clínicas do trabalhar, incluindo métodos diretos (observações), indiretos (conversas e encontros sobre o trabalho com as auxiliares) e análise de documentos relativos às normas antecedentes desse trabalho. Analisou-se fundamentalmente a produção linguageira dos coletivos. Entre os resultados encontrados, destacam-se: o desenvolvimento dessa atividade de cuidado implica intensa mobilização das trabalhadoras; a possibilidade de não atender às mães que chegam para ter seus bebês parece ser mais nocivo à saúde dessas profissionais do que trabalhar com um número excessivo de pacientes. Concluiu-se que as condições precárias de trabalho são potencialmente produtoras de sofrimento patogênico, uma vez que a realização prazerosa e bem-sucedida dessa atividade é dificultada.

This paper focuses on the working conditions of nursing technicians of Neonatal Units, considering the relational dimension of the care activity. Having as main epistemological references Canguilhem's concept of health of and the Ergological perspective, the research was based on the clinical approaches of work, including the following methods: direct (observations) and indirect (talks and meetings about work with the technicians); analysis of documents on the previous norms concerning this work. The analysis dealt basically with the groups' language production. Some results can be highlighted: the development of this care activity implies intense mobilization of workers; the possibility of not assisting the mothers who arrive to have their babies seems to be more noxious to these technicians than to work with an overload of patients; the precarious conditions of work are producers of pathogenic suffering, once the pleasant and well-succeeded realization of this activity is hindered.

Can the special care neonatal unit admission cut-off be lowered down to 1500g babies.

Objective. The study was conducted to find out whether there is any significant difference in outcome if low birth weight babies weighing between 1500g and 1800g are managed by keeping them with their mothers, i.e., without special care neonatal unit (SCNU) admission. Methods. It was a retrospective study for which data was collected from past medical record section of 6 months duration from 01.07.06 to 31.12.06, Medical College, Kolkata. The subject of the study was babies born with weight between 1500g and 2000g, divided into 2 groups. Group A representing babies born between weight 1500g and 1800g, groups B representing babies born between 1801g and 2000g. The groups were compared with regard to four variable namely average material age, sex of the babies, singleton or twin pregnancy, mode of delivery and gestational maturity. Test of one proportion was used for statistical analysis of outcome. Results. Total number of live born babies in group A were 198 and in group B 223. Two group were comparable with respect to average maternal age (23.7 yr), sex distribution, singleton or twin pregnancy and number of cesarian section or vaginal delivery and proportion of small for gestational age (SGA) babies. In both the group 13 babies required SCNU admission after being given to their mothers in the postnatal ward. No significant difference in outcome was observed between the groups. Conclusion. We conclude that the recommended guidelines for giving institutional care to babies below 1800g may be lowered down to 1500g. However, more babies should be evaluated prospectively, over a longer duration of time, before changing the standard guidelines.

Erros medicamentosos em unidade de terapia intensiva neonatal / Medication errors in a neonatal intensive care unit

OBJETIVO: Determinar a incidência e o tipo de erros médicos em uma unidade de terapia intensiva neonatal e a relação entre o erro e o estado clínico do paciente. MÉTODOS: Revisamos os prontuários médicos, durante os primeiros 7 dias de hospitalização, de todos os recém-nascidos de alto risco admitidos por um período de 3 meses. RESULTADOS: Setenta e três pacientes foram admitidos durante o período de estudo. A média de peso de nascimento foi de 2.140 g (640-5.020 g), e a idade gestacional média foi de 34 semanas (25-40 semanas). Dos 73 prontuários analisados, 40 (55 por cento) apresentaram um ou mais erros. Um total de 365 dias de hospitalização foi analisado, e 95 erros médicos foram detectados (um erro por 3,9 dias de hospitalização). O erro mais freqüente esteve associado com uso de medicamentos (84,2 por cento). Uso de procedimentos terapêuticos (medicamentos, fototerapia, etc.) sem prescrição adequada no prontuário do paciente (erro de comissão) representou 7,4 por cento dos erros, e a incidência de erros de omissão foi de 8,4 por cento. A incidência de erros médicos foi significativamente maior em recém-nascidos com idade gestacional menor. CONCLUSÕES: A incidência de erros no cuidado de recém-nascidos de alto risco é elevada. Deve-se incentivar estratégias para melhorar a educação de profissionais da saúde envolvidos no cuidado e o desenvolvimento da cultura local, divulgando algoritmos claros e acessíveis para orientar o comportamento quando há ocorrência de erros.

OBJECTIVE: To determine the incidence and type of medical errors in a newborn intensive care unit and the relationship between the error and the patient's clinical status. METHODS: We reviewed the medical charts, during the first 7 days of hospitalization, of all high-risk newborn infants admitted for a period of 3 months. RESULTS: Seventy-three patients were admitted during the study period. Their mean birth weight was 2,140 g (640-5,020 g) and mean gestational age was 34 weeks (25-40 weeks). Of 73 medical charts analyzed, 40 (55 percent) had one or more errors. A total of 365 days of hospitalization was analyzed and 95 medical errors were detected (one error per 3.9 days of hospitalization). The most frequent error was associated with medication use (84.2 percent). Use of therapeutic procedures (drugs, phototherapy, etc.) without proper prescription in the patient's chart (commission error) accounted for 7.4 percent of the errors, and incidence of omission errors was 8.4 percent. Incidence of medical errors was significantly higher in newborn infants with lower gestational age. CONCLUSION: Incidence of errors in the care of high-risk newborn infants is elevated. Strategies to improve education of health professionals involved in the care and development of local culture by disseminating clear, accessible algorithms to guide behavior when errors occur must be encouraged.