Can an EPR support the concept of family-centred, individualized developmental care of premature infants and newborns?

At the University Children's Hospital Heidelberg the concept of 'Developmental, Family-Centred, Individual Care of Premature Infants and Newborns' was introduced to support optimal growth of premature infants. This interdisciplinary concept requires cooperation of different specialists. A well operating communication is a precondition for such cooperation. As a patient's record is not only used for storing information but also for exchanging information, the question was if a complete electronic patient record (EPR), in contrast to the existing patient's record, could sensibly support this new concept of care. To answer this question the whole communication of the staff in the infants ward was analysed using different observation methods. These observations delivered several issues which showed that an EPR could improve communication and workflow. Therefore an EPR for the neonatology at the University Children's Hospital Heidelberg can now be designed on the basis of our communication concept.

Introducing an innovative, multidisciplinary concept of care - communication problems and possible solutions.

Introducing an innovative, multidisciplinary concept of care means the change of existing structures both in work and communication flows which often involves problems. In this paper we describe exemplary the communication problems which arose during the introduction of the multidisciplinary concept of Family-Centred, Individualized Developmental Care of Premature Infants and Newborns at the Children's Hospital Heidelberg. We suggest workflow adaptations to achieve timeliness of information and present ideas to prevent communication problems e.g. caused by inadequate knowledge of staff. We used interviews, analyzed video-recordings and modified the Communication Observation Method [7] to analyze the present state of communication flows and structures.

Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland.

BACKGROUND: Painful invasive procedures are frequently performed on preterm infants admitted to a neonatal intensive care unit (NICU). The aim of the present study was to investigate current pain management in Austrian, German and Swiss NICU and to identify factors associated with improved pain management in preterm infants. METHODS: A questionnaire was sent to all Austrian, German and Swiss pediatric hospitals with an NICU (n = 370). Pain assessment and documentation, use of analgesics for 13 painful procedures, presence of written guidelines for pain management and the use of 12 analgesics and sedatives were examined. RESULTS: A total of 225 units responded (61%). Pain assessment and documentation and frequent analgesic therapy for painful procedures were performed more often in units using written guidelines for pain management and in those treating >50 preterm infants at <32 weeks of gestation per year. This was also the case for the use of opioid analgesics and sucrose solution. Non-opioid analgesics were used more often in smaller units and in units with written guidelines. There was a broad variation in dosage of analgesics and sedatives within all groups. CONCLUSION: Pain assessment, documentation of pain and analgesic therapy are more frequently performed in NICU with written guidelines for pain management and in larger units with more than 50 preterm infants at <32 weeks of gestation per year.

[Individual developmental care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)]. / Individuelle, entwicklungsfördernde Pflege basierend auf dem Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

The number of preterm deliveries is increasing. Major advances in neonatology now enable even infants with a very low gestational age to survive. These infants have to spend months in the intensive care unit, while they have to deal with a lot of painful medical procedures, nursing care units, excessive noise and light, all differing from the normal uterine environment. The immature preterm infant nervous system is in a vulnerable phase of development. Early exposure to stress, or the mismatch of the preterm infant brain with the unphysiologic intensive care environment, may be linked to long-term developmental impairments reported in these children. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is a systematic method of assessing the individual needs of preterm newborns. In an attempt to mimic uterine environment, care according to the NIDCAP principles is reducing infant distress and in the same way supporting the individual aibilities. Thus NIDCAP may have an effect on the preterm infant neurodevelopmental outcome.

The AMPA receptor subunits GluR-A and GluR-B reciprocally modulate spinal synaptic plasticity and inflammatory pain.

Ca(2+)-permeable AMPA receptors are densely expressed in the spinal dorsal horn, but their functional significance in pain processing is not understood. By disrupting the genes encoding GluR-A or GluR-B, we generated mice exhibiting increased or decreased numbers of Ca(2+)-permeable AMPA receptors, respectively. Here, we demonstrate that AMPA receptors are critical determinants of nociceptive plasticity and inflammatory pain. A reduction in the number of Ca(2+)-permeable AMPA receptors and density of AMPA channel currents in spinal neurons of GluR-A-deficient mice is accompanied by a loss of nociceptive plasticity in vitro and a reduction in acute inflammatory hyperalgesia in vivo. In contrast, an increase in spinal Ca(2+)-permeable AMPA receptors in GluR-B-deficient mice facilitated nociceptive plasticity and enhanced long-lasting inflammatory hyperalgesia. Thus, AMPA receptors are not mere determinants of fast synaptic transmission underlying basal pain sensitivity as previously thought, but are critically involved in activity-dependent changes in synaptic processing of nociceptive inputs.