[Nursing Experience Caring for a Premature Infant With Bronchopulmonary Dysplasia].

A nursing experience supporting parents experiencing anxiety related to their 26+2 weeks preterm infant on continued ventilator assistance at home due to bronchopulmonary dysplasia is described in this article. Data were collected from March 21st to June 1st, 2021 via observation, interviews, clinical care, medical record reviews, and discharge preparation services. A holistic nursing assessment identified the main health issues as: gas exchange disorder, inefficient infant feeding patterns, and caregiver role stress. The parents were encouraged to participate in care activities, create individualized discharge plans, and view health education videos and caregiving skill demonstrations. Kangaroo care, comfortable positioning and soothing techniques were used to stabilize the emotions of the infant and to strengthen the parent-child bond. Psychological support was provided to alleviate parental anxiety and to enhance parenting ability and confidence. This experience supports the importance of tailoring clinical care to individual needs, adopting a family-centered approach, assessing family interactions, and making early preparations to obtain appropriate continuous care after discharge to ensure proper continuum of care.

Bronchopulmonary Dysplasia Within and Beyond the Neonatal Unit.

BACKGROUND: Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of prematurity or chronic neonatal lung disease, is a major cause of respiratory illness in premature babies. Newborn babies survive at gestational ages of 23 to 26 weeks, earlier than when BPD was first described. New mechanisms of lung injury have therefore emerged and the clinical and pathological characteristics of pulmonary involvement have changed. PURPOSE: Improved neonatal intensive care unit modalities have increased survival rates; the overall prevalence of the condition, however, has not changed. Management of evolving BPD aims at minimizing lung injury. Management of established, especially severe BPD, still poses significant clinical challenge as these babies need long-term oxygen therapy (LTOT) for variable length of time. We aim to give an overview of management of established BPD with particular focus on weaning home oxygen therapy at our local center in the United Kingdom. SEARCH AND RESULTS: On the basis of most recent evidence, we concluded that an integrated pathway for managing babies on LTOT is very important after discharge from neonatal unit. IMPLICATIONS FOR PRACTICE: A structured weaning pathway for premature babies on home oxygen improves outcome. IMPLICATIONS FOR RESEARCH: The management of severe BPD and related complications, particularly during the first 2 years of life, remains a continuing challenge for parents and healthcare providers. The most beneficial respiratory support strategy to minimize lung injury and/or promote lung healing remains unclear and requires further investigation.

Caring for children with complex needs.

This article describes the role of the community neonatal nurse in the discharge of infants with chronic lung disease (CLD), or bronchopulmonary dysplasia. It also explores the use of a common assessment framework in the assessment of such children and development of a nursing care plan. The article includes a case study to illustrate the link between CLD and other diseases, and emphasises the importance of focusing on holistic care from admission, in the neonatal unit and at discharge.

Educating neonatal nurses in Brazil: a before-and-after study with interrupted time series analysis.

BACKGROUND: Preterm birth contributes significantly to infant mortality and morbidity, including blindness from retinopathy of prematurity (ROP). Access to intensive neonatal care is expanding in many countries, but care is not always optimal, one factor being that nursing is often by inadequately trained nurse assistants. OBJECTIVE: The aim of this study was to evaluate whether an educational package for nurses improves a range of outcomes including survival rates and severe ROP in 5 neonatal units in Rio de Janeiro, Brazil. METHODS: The study design included an uncontrolled before-and-after study in 5 units, with interrupted time series analysis. Participatory approaches were used to develop a self-administered educational package for control of pain, oxygenation, infection, nutrition, and temperature and to improve supportive care ('POINTS of Care'). Educational materials and DVD clips were developed and training skills of nurse tutors were enhanced. There were two 1-year periods of data collection before and after a 3-month period of self-administration of the education package. RESULTS: Overall, 74% of 401 nurses and nurse assistants were trained. A total of 679 and 563 infants were included in the pre- and post-training periods, respectively. Despite improvement in knowledge and nursing practices, such as the delivery and monitoring of oxygen, there was no change in survival (pre-training 80%, post-training 78.2%), severe ROP (1.6 vs. 2.8%), sepsis (11.3 vs. 12.3 cases per 1,000 infant days) or other outcomes. Outcomes worsened over the pre-intervention period but the change to an improvement after the intervention was not statistically significant. During the study period many trained staff left the units, but few were replaced. CONCLUSIONS: Future studies need to focus on barriers to implementation, team building, leadership and governance, as well as the acquisition of knowledge and skills.

Saberes e práticas das mães sobre o uso de broncodilatador em crianças com displasia broncopulmonar no domicílio: subsídios para a enfermagem pediátrica / Knowledge and practices of mothers of bronchodilator use in children with bronchopulmonary dysplasia at home: subsidies for pediatric nursing

Esta pesquisa teve como objeto de estudo os saberes e práticas das mães sobre o uso de broncodilatador em crianças com displasia broncopulmonar, e como objetivos: desvelar os saberes e práticas das mães sobre o uso de broncodilatador em seus filhos com displasia broncopulmonar no domicílio; conhecer os cuidados realizados pelas mães no uso do broncodilatador em seu filho com displasia broncopulmonar no domicílio e descrever as reações percebidas pelas mães em seus filhos após o uso da medicação. Trata-se de um estudo descritivo com abordagem qualitativa. O cenário foi um ambulatório de pneumologia localizado no Município do Rio de Janeiro e os sujeitos, 14 mães de crianças portadoras de displasia broncopulmonar, com idades entre 0 e 2 anos. A coleta dos dados foi realizada através da entrevista semiestruturada, no mês de julho de 2014. Utilizada a análise de conteúdo de Bardin. Como resultados, emergiram duas categorias: os saberes e medos das mães sobre o uso do broncodilatador eas práticas de cuidado da mãe na administração do broncodilatador na criança. A primeira categoria compreende quatro subcategorias: conhecimento das mães sobre a ação do medicamento; sinais de alerta percebidos pelas mães para o uso do medicamento na criança; os efeitos percebidos pelas mães após o uso do medicamento na criança e os medos relacionados ao uso do broncodilatador. A segunda categoria abrange três subcategorias: cuidados com o posicionamento da criança; cuidados com a higiene da criança e cuidados com o espaçador. A maioria das mães consegue identificar a partir dos seus saberes e de seu universo vocabular as principais ações dos broncodilatadores, no entanto podem-se evidenciar alguns relatos com informações inconsistentes, o que nos faz supor a ausência de orientações por parte dos profissionais junto a essa clientela. O esforço respiratório configura-se como sinal de alerta para que as mães utilizem a medicação para tentar evitar a crise respiratória...

This research studied the knowledge and practices of mothers on the use of bronchodilators in children with bronchopulmonary dysplasia, and had the following objectives: to reveal the knowledge and practices of mothers of bronchodilator use in their children with bronchopulmonary dysplasia at home; to understand the care provided by mothers in bronchodilator use in your child with bronchopulmonary dysplasia at home and to describe the reactions perceived by mothers in their children after using the medication. This is a descriptive qualitative study. The scenario was a pulmonology clinic located in the city of Rio de Janeiro and had as subjects, 14 mothers of children with bronchopulmonary dysplasia, aged between 0 and 2 years old. Data collection was conducted through a semi-structured interview on July 2014. It was used Bardin's content analysis. As a result, two categories emerged: the mothers' knowledge and fears about the bronchodilator use and the mothers' care practices in the bronchodilator administration on their children. The first category comprises four subcategories: the mothers' knowledge of the action of the drug; the warning signs perceived by mothers leading to the use of the drug in their children; the effects noticed by the mothers after the use of the medicine in their children and the fears related to the use of bronchodilators. The second category includes three subcategories: the positioning of the child; the child hygiene and the care of the spacer. Most mothers were able to explain based on their knowledge and using their own words, the main actions of bronchodilators. However, there were some inconsistent information, which makes us realize the absence of a clear guidance from the professionals and this clientele. The respiratory effort appears as a warning sign for mothers leading to the use of the drug intending to prevent a respiratory crisis...

Transition from gavage to nipple feeding for preterm infants with bronchopulmonary dysplasia.

BACKGROUND: The transition from gavage to nipple feeding is difficult for preterm infants with bronchopulmonary dysplasia because of tachypnea and hypoxemia from chronic respiratory distress. OBJECTIVE: The aim of this study was to test the hypothesis that preterm infants with bronchopulmonary dysplasia who transitioned from gavage to nipple feeding with the semidemand method would achieve nipple feeding sooner and be discharged from hospital sooner than control infants who received standard care. METHODS: Forty-two infants were randomized to the control condition and 44 to the experimental protocol. Mean gestational ages and birth weights were 25 ± 1.5 weeks and 784 g for controls and 25 ± 1.4 weeks and 787 g for experimental infants. Control infants received standard care that included gradual increases in the number of nipple to gavage feedings per day. Experimental infants received the semidemand method that used infant behavioral and cardiorespiratory signs to regulate frequency, length, and volume of nipple feedings. General linear model procedures were used to compare study groups. RESULTS: Experimental infants achieved nipple feeding at M = 5.9 ± 0.7 days compared with control infants, M = 12.3 ± 0.8 (p < .0001). Length of hospitalization was not significantly different between groups. DISCUSSION: The semidemand method significantly shortened the time for infants to attain nipple feeding in a manner taking their respiratory distress into consideration.

Decreasing accidental mortality of ventilator-dependent children at home: a call to action.

An estimated 8,000 children in the United States are dependent on mechanical ventilation at home. Despite technological advances for home monitoring of ventilated patients, the preventable death rate among these children has not changed significantly during the last 2 decades. Analysis of the data indicate that the primary causes of preventable death in ventilator-dependent children at home are inadequate training, improper response, and a lack of vigilance by the clinicians who care for them.

Tracheostomy in infants: parent education for home care.

Children with tracheostomies are increasingly discharged home for continued care by their parents. Nurses are responsible for providing these parents with the extensive education required for a smooth and successful transition to home care. This article is intended to help neonatal and pediatric nurses to effectively prepare the parents of an infant with a tracheostomy to provide safe, quality care to their child after being discharged from an acute care setting to their home. This article discusses the knowledge, attitudes, and skills the parents are required to acquire prior to the infant's discharge. Home ventilation, airway management, suctioning, tracheostomy care, emergency management, safe home environment, equipment for continuous or intermittent ventilation, and supplies necessary for care are some of the topics discussed.

Techniques of early respiratory management of very low and extremely low birth weight infants.

The generalized anatomic and physiologic immaturity of preterm infants of very low birth weight (VLBW) (

Gently caring: supporting the first few critical hours of life for the extremely low birth weight infant.

Caring for the extremely low birth weight infant in the first days of life is complex and challenging, yet rewarding. It is the experienced health care provider who will be best prepared to meet the needs of these fragile infants and their concerned/frightened parents. Understanding how to minimize stress and support body functions will enable us to better care for these infants in the first few days of life. We should strive to partner with parents, even in the resuscitative and stabilization phases of care, particularly when an infant may not survive. Nursing plays an essential role in providing this minute-to-minute support. It is not always what we do, but how we do it, that may matter most.