High-Frequency, Low-Dose Education to Improve Neonatal Outcomes in Low-Resource Settings: A Cluster Randomized Controlled Trial.

BACKGROUND: Annually 2.5 million infants die in the first 28 days of life, with a significant regional distribution disparity. An estimated 80% of those could be saved if neonatal resuscitation were correctly and promptly initiated. A barrier to achieving the target is the knowledge and skills of healthcare workers. PURPOSE: The objective of this cluster randomized trial was to assess the improvement and retention of resuscitation skills of nurses, midwives, and birth attendants in 2 birth centers serving 60 villages in rural India using high-frequency, low-dose training. RESULTS: There was a significant difference ( P < .05) between the groups in the rate of resuscitation, with 18% needing resuscitation in the control group and 6% in the intervention group. The posttest scores for knowledge retention at the final 8-month evaluation were significantly better in the intervention group than in the control group (intervention group mean rank 19.4 vs control group mean rank 10.3; P < .05). The success rate of resuscitation was not significantly different among the groups. IMPLICATIONS FOR PRACTICE: Improved knowledge retention at 8 months and the lower need for resuscitation in the intervention group support the efficacy of the high-frequency, low-dose education model of teaching in this setting. IMPLICATIONS FOR RESEARCH: Replication of these findings in other settings with a larger population cohort is needed to study the impact of such intervention on birth outcomes in low-resource settings.

Apremilast with Add-On Calcipotriene/Betamethasone Dipropionate for Treating Moderate to Severe Plaque Psoriasis.

BACKGROUND: About 20% of patients taking apremilast alone obtain PASI 75 by week 8. This single-center, pilot study aimed to determine whether add-on topical therapy with calcipotriene/betamethasone dipropionate (C/BD) could improve responses of partial apremilast responders by week 12. METHODS: Adults (≥18 years of age) with moderate to severe plaque psoriasis (baseline PGA ≥3, BSA affected ≥10%, PASI ≥12) took oral apremilast (30 mg twice daily) for 8 weeks. Patients who achieved between PASI 25–74 at week 8 used add-on, daily topical C/BD (.005%/.064%) foam up to week 12; those with <PASI 25 at week 8 were discontinued. RESULTS: Of 50 patients enrolled, 26 achieved PASI 25−74 and 8 PASI 75 at week 8. At week 12, 29 achieved PASI 75, and 24 at week 16. Of the week-8 partial responders, 21/26 achieved PASI 75 at week 12 on combination therapy and 15 maintained PASI 75 through week 16 on apremilast alone (4 did not maintain; 2 lost to follow up). In partial responders, mean PGA and BSA affected improved by 30% and 33% on apremilast, respectively, and by 67% and 86% at week 12 on the combination therapy, respectively. The most commonly reported adverse events (AEs; >5% occurrence) were headache (14%), diarrhea (10%), and nausea (8%); majority were mild. No related serious AEs occurred. CONCLUSION: We show that most week-8 partial apremilast responders can achieve PASI 75 at week 12 with combination C/BD topical therapy, and maintain PASI 75 through week 16 with apremilast monotherapy. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5435.

A Triplication of 6q24 and Meconium Pseudocyst: A Case Report.

With the rise in genetic screening both pre- and postnatally, new variances in genes are being recognized. Some are of unknown significance, while other known genetic expressions have obvious phenotypical expressions. Transient neonatal diabetes mellitus is a result of the duplication of chromosome 6q24, but little is known about the phenotypic expression of a triplication of chromosome 6q24. This case study presents an infant with a postnatally diagnosed triplication of chromosome 6q24, meconium pseudocyst, and multiple congenital anomalies with unknown genetic significance.

Improving Neonatal Outcomes Through Global Professional Development.

BACKGROUND: Globally, stillbirths account for 2.7 million infant deaths each year, with the vast majority occurring in sub-Saharan Africa and South Asia. Approximately 900,000 infants die due to birth asphyxia. The focus of the Helping Babies Breathe (HBB) program is to help the nonbreathing infant to breathe within the first minute of life, termed the "Golden Minute." PURPOSE: To present a multinational interprofessional development program utilizing the train-the-trainer methodology for HBB to address neonatal morbidity and mortality. Involving nursing students in collaboration with established global partners provided an innovative method of professional development. Lessons learned and challenges will be shared to enhance success of future efforts. PROJECT IMPLEMENTATION: HBB train-the-trainer workshops were held to provide professional development for nurses and nursing students in 5 locations in 4 countries including Ethiopia, India, Vietnam, and Zambia. Workshop participants and the trainers participated in discussions and informal conversation to assess impact on professional development. RESULTS: HBB training and train-the-trainer workshops were implemented in 4 counties. Equipment and supplies were provided in these countries through several internal university grants. All 145 participants demonstrated increased knowledge and skills at the end of the workshops through the HBB check off. Collaborative teaching and cross-cultural professional skills were enhanced in student and faculty trainers. IMPLICATIONS FOR PRACTICE: Nurses, midwives, and advance practice nurses can engage globally and contribute to closing this gap in knowledge and skills by providing train-the-trainer workshops. IMPLICATIONS FOR RESEARCH: Developing systems to integrate the HBB program within each country's existing healthcare infrastructure promotes in-country ownership. Joining the global effort to save the lives of neonates can be a meaningful opportunity for innovative professional development projects. While HBB education has been shown to save lives, a 1-time training is insufficient. Determining how often HBB updates or refreshers are required to maintain skills is an important next step. Another direction for research is to implement this project within prelicensure nursing programs.

Case Study: Cystic Fibrosis in the Newborn.

Cystic fibrosis (CF) is considered one of the most commonly occurring fatal genetic disorders. This disorder is associated with pancreatic insufficiency and pulmonary complications. However, at birth the initial complications are associated with bowel obstruction. Cystic fibrosis management warrants an interdisciplinary team because this disorder affects various organ systems. Effective management of the newborn with CF assists in improving the child's overall prognosis. Family support is critical throughout the prenatal and postnatal periods. The case presented reviews a child born with suspected CF and the clinical course within the NICU.

Bacterial sepsis in the neonate.

Neonatal bacterial infections leading to sepsis occur frequently in the first few days or weeks of life. NPs must be able to recognize the early signs of sepsis and understand the need for rapid evaluation and treatment. This article discusses antibiotic treatments for various types and locations of bacterial infections and sepsis in the neonate.

The Pad Project: A Global Initiative Uniting Women.

The Pad Project is a women's health program used to educate women on their monthly menstrual cycles. Through this ministry, women who do not have access to menstrual hygiene products are given sustainable hygienic kits to promote menstrual health. This unique health education program also integrates stories from the gospel to illustrate Christ's love and caring commitment toward women and women's health.

Staphylococcal Scalded Skin Syndrome: A Case Review.

Staphylococcal scalded skin syndrome (SSSS) is a rare yet well-known exfoliative skin syndrome. It involves extensive desquamated areas caused by an exfoliative toxin from Staphylococcus aureus. The typical presentation of SSSS allows for early diagnosis and treatment of the disease. Knowing and understanding the prevalence, pathophysiology, risk factors, and diagnosis of SSSS will ensure that infants being treated and cared for by neonatal nurses and neonatal nurse practitioners will receive appropriate, comprehensive, and multidisciplinary care while in the NICU. The purpose of this case review is to inform neonatal nurses and practitioners of the current literature that focuses on the diagnosis and management of SSSS.

Septo-Optic Dysplasia: A Case Study.

Septo-optic dysplasia (SOD) is a rare congenital heterogeneous malformation. SOD was formerly known as de Morsier syndrome, which associated a midline brain defect such as an absent septum pellucidum with optic nerve hypoplasia. The diagnosis of SOD is made when there are two or more characteristics of the classic triad. The triad consists of optic nerve hypoplasia, pituitary hormone abnormalities, and midline brain defects, although it can vary in the severity of clinical presentation and phenotype. The purpose of this article is to review a case and analyze the literature regarding prevalence, etiology, clinical presentation, diagnosis, and management of SOD.

Management of Epidermolytic Ichthyosis in the Newborn.

Epidermolytic ichthyosis (EI) is a rare autosomal dominant genodermatosis that presents at birth as a bullous disease, followed by a lifelong ichthyotic skin disorder. Essentially, it is a defective keratinization caused by mutations of keratin 1 (KRT1) or keratin 10 (KRT10) genes, which lead to skin fragility, blistering, and eventually hyperkeratosis. Successful management of EI in the newborn period can be achieved through a thoughtful, directed, and interdisciplinary or multidisciplinary approach that encompasses family support. This condition requires meticulous care to avoid associated morbidities such as infection and dehydration. A better understanding of the disrupted barrier protection of the skin in these patients provides a basis for management with daily bathing, liberal emollients, pain control, and proper nutrition as the mainstays of treatment. In addition, this case presentation will include discussions on the pathophysiology, complications, differential diagnosis, and psychosocial and ethical issues.

Trisomy 13: Changing Perspectives.

The diagnosis of trisomy 13 has been considered incompatible with life. Trisomy 13 is associated with a pattern of congenital anomalies and mental disabilities that make caring for these infants a challenge for both the family and health care professionals. The clinical management of trisomy 13 varies based on the organ systems involved. The current standard of care has been withholding intensive support and providing comfort care. Recent literature suggests there are improved outcomes in infants who receive intensive care at birth. In addition, case reports evaluating older children with trisomy 13 report that, although there are significant intellectual and psychomotor disabilities, these children do meet developmental milestones such as smiling in response to parents, sitting unassisted, and walking with a walker. This case review will include a discussion of the clinical course of an infant born with mosaic trisomy 13 where the parents requested intensive care.

Travel as a Transformational Spiritual Event.

There is a philosophical connection between elements of travel and elements of spirituality. Nurses can develop spiritual intelligence, hone transcultural skills, and develop cultural humility through travel. Concepts of spiritual intelligence are incorporated to distinguish spirituality from religion. This discussion is to describe the spiritual attributes of travel through exploration of unique cultural sameness and differences, stepping out of one's routine, experiences of solitude, and the application to nursing. Venues such as study abroad, mission trips, cultural exchange opportunities, and service learning projects all can provide meaningful times of transformation, spiritual growth, learning new ways of doing things, and of being in the world. Nurses who integrate these practices into the care they provide daily will be enriched personally and rewarded with improved outcomes.

Supporting Families of Children With Disabilities.

Advanced technology combined with improvements in neonatal care have increased the survival rates of low-birth-weight infants and infants born with severe birth defects. These infants are at greater risk for long-term health and developmental problems. The effect of having a child with a disability on the family is described, and emerging interventions and resources available for these families are provided.

Antenatal corticosteroids at the beginning of the 21st century.

Corticosteroids administered to women in preterm labor are the standard of care for reducing neonatal morbidity and mortality associated with prematurity. These agents promote lung development and reduce the incidence of neonatal intraventricular hemorrhage. Several studies have investigated the method by which fetal lung fluid is cleared after birth. This exploration resulted in the elucidation of the Starling equation or the hypothesis that fluid filtration through capillary membranes is dependent on the balance between the pressure blood places on the capillary membranes and the osmotic pressure of the membranes. The clinical observation that a neonate experiences a vaginal squeeze during a vaginal birth may be important, but it can account for only a small percentage of the lung fluid absorbed. Perhaps more importantly, amiloride-sensitive sodium transport channels (ENaCs) have emerged as key factors in the movement of alveolar fluid from the lung into the vascular system. Several potential clinical applications have been developed from this new knowledge about the physiology of lung fluid clearance at birth. Neonates born late preterm or at term by elective cesarean before the onset of labor are more likely to develop respiratory distress than those born vaginally. Based on the mechanism of action of antenatal corticosteroids, these drugs may be beneficial in the clearance of fetal lung fluid in this population. This article reviews how fetal lung fluid is cleared; the pharmacologic effects of corticosteroids on the fetus; and the risks, benefits, and controversies associated with corticosteroid use.

Volume-guaranteed ventilation.

Pressure-limited, time-cycled ventilation has been the primary mode of ventilation for neonates for several decades. But the realization that volume rather than pressure causes ventilator-induced lung injury has led to the development of new strategies for ventilation. Volume guarantee is a mode of ventilation that automatically adjusts the inspiratory pressure to achieve a set tidal volume according to changes in lung compliance or resistance or the patient's respiratory drive. Volume-guaranteed ventilation delivers a specific, preset volume of gas, and inspiration ends when it has been delivered. This mode of ventilation requires careful attention to the infant and to ventilator settings.