Prevalence, Severity Patterns and Risk Factors of Bronchopulmonary Dysplasia in Preterm Infants Younger than 32 Weeks of Gestation in a Tertiary Centre in Oman.

Objectives: This study aimed to determine the rate and severity patterns of bronchopulmonary dysplasia (BPD) and identify antenatal and postnatal factors associated with BPD in preterm infants <32 weeks of gestational age (GA). Methods: This retrospective observational study included preterm neonates <32 weeks of gestation admitted into the neonatal intensive care unit between January 2010 and December 2017 at Sultan Qaboos University Hospital, Muscat, Oman. A data set of antenatal and perinatal factors were collected. BPD was defined as the need for oxygen and/or respiratory support at 36 weeks post-menstrual age (PMA). Infants with and without BPD were compared in their antenatal and perinatal factors. Results: A total of 589 preterm infants <32 weeks were admitted. Among them, 505 (85.7%) survived to 36 weeks' PMA and 90 (17.8%) had BPD. The combined BPD and mortality rate was 28.4%. Grades 1, 2 and 3 BPD constituted 77.8%, 7.8% and 14.4%, respectively. BPD was associated with lower GA, lower birth weight, need for intubation at resuscitation, lower Apgar scores, longer duration of ventilation, surfactant therapy and higher rates of neonatal morbidities. On binary logistic regression analysis, predictors of BPD were longer duration of ventilation, intraventricular haemorrhage (IVH) and necrotising enterocolitis (NEC). Conclusion: In an Omani centre, 17.8% of preterm infants (<32 weeks GA) developed BPD. Various perinatal and neonatal factors were associated with BPD. However, longer duration of ventilation, IVH grades 1 and 2 and NEC stages II and III were significant predictors. Future multicentre research is necessary to provide the overall prevalence of BPD in Oman to help optimise the resources for BPD prevention and management in preterm infants.

Parental barriers to implementing family-centred care in a neonatal intensive care unit in Islamic Republic of Iran.

Background: Studies have shown short-term and long-term positive effects of family-centred care interventions on neonatal and maternal health, and developmental outcomes in neonatal intensive care units. However, some challenges and barriers limit implementation of family-centred care. Aim: To investigate parental barriers to implementing family-centred care in a neonatal intensive care unit in Islamic Republic of Iran. Methods: A conventional content analysis was conducted at a neonatal intensive care unit in Tehran, Islamic Republic of Iran from 2020 to 2021. Twenty semi-structured interviews and 9 field notes were conducted. The interview data were analysed using the Graneheim and Lundman method and the demographic data were analysed using SPSS version 21. Findings: Two themes emerged from the data analysis. The first theme was "inefficiency of playing the parental role", with 2 main categories of "face unpleasant feelings" and "inappropriate presence and participation". The second theme was "ineffective involvement of parents in the care", with 3 main categories of "lack of effective communication with personnel", "interference of parents in the treatment process", and "given insufficient information by parents". Conclusion: Parental barriers to the provision of family-centred care featured prominently in the study. Therefore, to improve neonatal and family health, there is a need for involvement, coordination and effective communication between the medical teams and parents to create a supportive and friendly environment in neonatal intensive care units.

Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit.

INTRODUCTION: Sick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was 30 events per 1000 adhesive application days in our unit. AIMS AND OBJECTIVES: We aimed to reduce the median MARSI rate from the existing 30 per 1000 MARSI days to <5 per 1000 MARSI over 5 months from June 2023 to October 2023. MATERIAL & METHODS: With the point-of-care quality improvement (QI) approach, a prospective study was planned to reduce the incidence of MARSI among sick very preterm newborns (<32 weeks gestational age) and eventually improve overall skin condition during hospital stay. Sequential Plan-Do-Study-Act cycles were implemented based on the identified risk factors recognised during recurring team discussions. RESULTS: We demonstrated a reduction in the MARSI rate from 30 events per 1000 adhesive applications (during baseline assessment) to zero events per 1000 adhesive applications at the end of the study period. It was temporally related to the assessment of skin risk stratification at admission using a validated tool, regular assessment of neonatal skin condition score based on the skin risk stratification, and reinforcement of MARSI prevention bundle by application of barrier spray. Awareness regarding 'skin injury prevention' bundles was continually generated among healthcare professionals. The MARSI rate remained <5 events per adhesive application in the sustenance phase over 6 months. CONCLUSION: Implementing evidence-based skin care practices resulted in a significant reduction in iatrogenic cutaneous injury events in very preterm neonates.

Building a NICU quality & safety infrastructure.

The American Academy of Pediatrics (AAP) Standards for Levels of Neonatal Care, published in 2023, highlights key components of a Neonatal Patient Safety and Quality Improvement Program (NPSQIP). A comprehensive Neonatal Intensive Care Unit (NICU) quality and safety infrastructure (QSI) is based on four foundational domains: quality improvement, quality assurance, safety culture, and clinical guidelines. This paper serves as an operational guide for NICU clinical leaders and quality champions to navigate these domains and develop their local QSI to include the AAP NPSQIP standards.

Quality improvement initiative: implementing and redefining video review of real-time neonatal procedures using action research.

Video review (VR) of procedures in the medical environment can be used to drive quality improvement. However, first it has to be implemented in a safe and effective way. Our primary objective was to (re)define a guideline for implementing interprofessional VR in a neonatal intensive care unit (NICU). Our secondary objective was to determine the rate of acceptance by providers attending VR. For 9 months, VR sessions were evaluated with a study group, consisting of different stakeholders. A questionnaire was embedded at the end of each session to obtain feedback from providers on the session and on the safe learning environment. In consensus meetings, success factors and preconditions were identified and divided into different factors that influenced the rate of adoption of VR. The number of providers who recorded procedures and attended VR sessions was determined. A total of 18 VR sessions could be organised, with an equal distribution of medical and nursing staff. After the 9-month period, 101/125 (81%) of all providers working on the NICU attended at least 1 session and 80/125 (64%) of all providers recorded their performance of a procedure at least 1 time. In total, 179/297 (61%) providers completed the questionnaire. Almost all providers (99%) reported to have a positive opinion about the review sessions. Preconditions and success factors related to implementation were identified and addressed, including improving the pathway for obtaining consent, preparation of VR, defining the role of the chair during the session and building a safe learning environment. Different strategies were developed to ensure findings from sessions were used for quality improvement. VR was successfully implemented on our NICU and we redefined our guideline with various preconditions and success factors. The adjusted guideline can be helpful for implementation of VR in emergency care settings.

Barriers to the Implementation of Infant- and Family-Centered Developmental Care From Focus Groups With Neonatal Care Providers.

AIM: Although infant- and family-centered developmental care (IFCDC) is scientifically grounded and offered in many hospitals to some extent, it has not yet been universally implemented as the standard of care. In this article, we aim to identify barriers to the implementation of IFCDC in Belgian neonatal care from the perspective of neonatal care providers. METHODS: We conducted 8 online focus groups with 40 healthcare providers working in neonatal care services. An inductive thematic analysis was carried out by means of Nvivo. RESULTS: The focus groups revealed barriers related to contextual, hospital, and neonatal unit characteristics. Barriers found in the hospital and neonatal unit were related to financing, staffing, infrastructure, access to knowledge/information and learning climate, leadership engagement, and relative priority of IFCDC. Contextual barriers were related to peer pressure and partnerships, newborn/parent needs and resources, external policy, and budgetary incentives. CONCLUSION: Three main barriers to IFCDC implementation have been identified. Resources (staffing, financing, and infrastructure) must be available and aligned with IFCDC standards, knowledge and information have to be accessible and continuously updated, and hospital management should support IFCDC implementation to create an enabling climate, including compatibility with the existing workflow, learning opportunities, and priority setting.

Baby and Family-Centered Care in the Neonatal Intensive Care Unit: Changing Perspective.

The goal of baby and family-centered care in the neonatal intensive care unit (NICU) is to recognize the baby's needs exhibited through the baby's individual behavior and communication and support parent education, engagement, and interaction with the baby to build a nurturing relationship. Health care providers and caregivers must guide rather than control the role of the parents from birth through NICU care, transition to home, and continuing care at home. Parents are health care team members, primary caregivers, and shared decision-makers in caring for their babies.

Neuroprotective Infant and Family-Centered Developmental Care for the Tiniest Babies: Perspectives from Key Members of the Neonatal Intensive Care Unit Small Baby Team.

Caring for extremely preterm infants in the neonatal intensive care unit (NICU) is a multidisciplinary team effort. A clear understanding of roles for each member of the delivery team, anticipation of challenges, and standardized checklists support improved outcomes for this population. Physicians and nursing leaders are responsible for being role models and holding staff accountable for creating a unit culture of Neuroprotective Infant and Family-Centered Developmental Care. It is essential for parents to be included as part of the care team and babies to be acknowledged for their efforts in coping with the developmentally unexpected NICU environment.

Best Practices to Support Maternal Mental Health During the Transition from Neonatal Intensive Care Unit to Home: A Scoping Review.

Mothers with an infant hospitalized in the neonatal intensive care unit (NICU) are at an increased risk of mental health concerns, including depression and anxiety. Successful mental health support during the critical time of transition from hospital to home requires careful consideration of the mothers' mental health beginning during the NICU stay. Major themes from a scoping review to identify best practices to support maternal mental health include (1) comprehensive evaluation of needs and continuity of care, (2) key role of in-person support, and (3) the potential to use technology-based support to increase mental health support.

Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial.

OBJECTIVE: To examine the effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit. DESIGN: Prospective randomized controlled parallel-group clinical trial. SETTING: Maternal and Child Health Hospital, Fujian, China. METHODS: The control group received routine neonatal intensive care unit care, while the intervention group received a web neonatal intensive care unit diary based on routine care. Outcomes, including anxiety, depression, and post-traumatic stress disorder symptoms, quality of life, sleep quality, care ability, and cortisol and melatonin levels, were evaluated at T1 (Time 1, before the intervention), T2 (Time 2, immediately after the intervention), and T3 (Time 3, 1 month after the intervention). RESULTS: Seventy pairs of parents of preterm infants in the neonatal intensive care unit were randomly allocated to two groups: intervention (n = 35) and control (n = 35). The anxiety scores in the intervention group were significantly lower at T2 and T3 than those in the control group (P < 0.001). The care ability scores in the intervention group were significantly higher at T2 and T3 (P < 0.001). The prevalence of post-traumatic stress disorder at T3 was significantly different between the groups (P = 0.040). No significant differences were observed in the quality of life or sleep quality between the groups at T2 and T3 (P > 0.05). No significant differences were observed in cortisol and melatonin levels between the groups (P > 0.05). CONCLUSIONS: Web neonatal intensive care unit diaries effectively relieved anxiety symptoms, reduced the prevalence of post-traumatic stress disorder, and enhanced the care abilities of parents of preterm infants in the neonatal intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE: Web neonatal intensive care unit diary can be considered in clinical practice as a convenient psychological intervention method, especially among parents of preterm infants in the neonatal intensive care unit.

Implementation of Listening Visits with Parents of Preterm Infants in an Italian Neonatal Intensive Care Unit.

PURPOSE: To assess the feasibility of implementing Listening Visits (LV) in an Italian neonatal intensive care unit (NICU). STUDY DESIGN AND METHODS: This feasibility implementation of LV included empathic listening and problem-solving sessions provided by a psychologist to 26 parents of hospitalized preterm newborns. Using the RE-AIM implementation framework, three facets of feasibility were assessed: reach, adoption, and implementation. RESULTS: It is feasible to integrate LV into the NICU: 76% of families were willing to try LV (reach). Listening Visits recipients reported high satisfaction. Twelve of the 16 families (75%) received six or more LV sessions (adoption), with mothers attending more sessions. Implementation fidelity, defined here as the percentage of LV recipients that received at least four sessions, was 94% among mothers and 30% among fathers. CLINICAL IMPLICATIONS: The LV intervention for parental support during the NICU stay is feasible and deemed helpful by parents. Parents were motivated to participate even though their levels of depression, stress, and anxiety were not high. In addition to the use of standardized screening questionnaires, parental requests and clinical team indications should be included in the decision-making for the provision of parental support services.

Improving Maternal Depression Screening in the Neonatal Intensive Care Unit.

PURPOSE: To examine whether self-perceived benefits of mental health treatment differed between mothers of babies in the neonatal intensive care unit with and without a positive screen for depression based on their Edinburgh Postnatal Depression score. STUDY DESIGN AND METHODS: Mothers were recruited in person pre-COVID-19 pandemic, and via phone call and online advertisement during the pandemic. Mothers completed a 10-item depression scale and whether they believed they would benefit from mental health treatment. A chi-square test determined the difference in perceived benefit between mothers who screened positively for depression and those who did not. RESULTS: This secondary analysis included 205 mothers, with an average age of 29. Of the 68 mothers who screened positively for depression, 12 believed that would not benefit from mental health intervention. Of the 137 who screened negatively for depression, 18 believed they would benefit from mental health intervention. Mothers who screened negatively for depression were significantly less likely to believe they would benefit from mental health intervention. CLINICAL IMPLICATIONS: Depression screening scales offer guidance on which mothers to flag for follow-up, but neither on how a mother will respond nor how to effectively approach a mother about her mental health. Nurses can improve identification and follow-up of depressed mothers in the neonatal intensive care unit by asking mothers about their perceived need for mental health treatment.

Improving Parental Knowledge of Medically Complex Neonates Through Scheduled Conferences.

Reports of parental dissatisfaction from incomplete or inconsistent information led to a quality improvement (QI) project to establish planned family conferences at 10 days and 1 month of life, for 50% of the medically complex neonates admitted to a neonatal intensive care unit within 1 year. A QI team instituted a system in which social workers scheduled family conferences and a neonatologist conducted the conferences. Team members tracked measures using statistical process control charts over 21 months. The QI team scheduled conferences for greater than 80% of eligible families, with an 86% completion rate on days 10 and 30, exceeding project goals of 50%. The majority of the families surveyed were satisfied with the meetings. Only 2% of parents surveyed found meetings burdensome, compared to 14% of physicians. A sustainable method for scheduling meetings and preparation for conferences, including the use of a template led to success.

Iatrogenic skin injuries in infants admitted to neonatal intensive care units: An investigation in 22 Chinese units.

OBJECTIVE: To investigate the incidence of iatrogenic skin injuries in neonates across 22 neonatal intensive care units (NICUs) in China. DESIGN: Prospective study. SETTING: 22 NICUs in China. PATIENTS: Infants admitted to NICU. INTERVENTIONS: None. MEASUREMENTS: The "Iatrogenic Skin Injuries Data Collection Form of infants" were used to collect the data during hospitalization. MAIN RESULTS: A total of 8126 neonates who were hospitalized in 22 tertiary hospitals across 15 provinces, cities, and autonomous regions of China between December 1, 2019 and January 31, 2020 were analyzed. Five hundred and twenty-one infants had iatrogenic skin injuries, including 250 with diaper dermatitis (47.98%), 70 with physicochemical factor-related skin lesions (PCFRSIs) (13.44%), 81 with medical device-related pressure injuries (MDRPIs) (15.55%), and 69 with medical adhesive-related skin injuries (MARSIs) (13.24%), accounting for 91% of the total number of iatrogenic injuries. Among these, diaper dermatitis was closely related to the skin and feeding status. Furthermore, the risk was higher among neonates who had skin damage upon admission or were already fully fed orally. The influencing factors of MDRPIs and MARSIs were similar. They were negatively associated with gestational age and birth weight, and were closely related to the presence of various tubes. CONCLUSIONS: Diaper dermatitis, PCFRSIs, MDRPIs, and MARSIs were the four common types of iatrogenic skin injuries in newborns. The various types of iatrogenic skin injuries were influenced by varying factors. Specialized nursing measurements can reduce the likelihood of these injuries.

Barriers and Facilitators of Parent Presence in the Neonatal Intensive Care Unit.

PURPOSE: The purpose of this study was to describe system-level and personal factors influencing parent presence in the neonatal intensive care unit (NICU) and identify differences in factors by sociodemographic characteristics. STUDY DESIGN AND METHODS: In a cross-sectional national survey study using social media recruitment, participants rated the frequency of 13 potential barriers and 12 potential facilitators using a 5-point Likert scale. Experiences of discrimination and parent-staff engagement were also measured. RESULTS: Valid responses were analyzed from 152 participants. Uncomfortable facilities and home responsibilities were the most highly reported system-level and personal barriers, respectively. Encouragement to participate in caregiving and social support were the most highly reported system-level and personal facilitators, respectively. Participants reported low to moderate levels of discrimination and moderate levels of parent-staff engagement. Latent class analysis revealed three sociodemographic clusters. Differences in barriers, facilitators, discrimination, and engagement were found among clusters. CLINICAL IMPLICATIONS: NICU facilities are uncomfortable and may discourage parent presence. Allowing support persons to accompany parents, providing comfortable facilities, and engaging parents in caregiving may promote greater parent presence and improved parent and child outcomes. Studies of potential bias toward parents with lower education and income and effects on parent presence and infant outcomes are needed.

Compassionate Care: Listening Visits Provided by Neonatal Intensive Care Unit Nurses.

PURPOSE: Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences. STUDY DESIGN AND METHODS: This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity. RESULTS: Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU. CLINICAL IMPLICATIONS: For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences.

Encontro com Especialistas - Projetos arquitetônicos da Rede Cegonha: ambiência em unidades neonatais

Encontro com as especialistas Thalita Lellice Morais Campelo (arquiteta) e Zeni Lamy (médica neonatologista).

Assessment of Neonatal Intensive Care Unit Sound Exposure Using a Smartphone Application.

OBJECTIVE: This study aimed to determine the impact of neonatal intensive care unit (NICU) design and environmental factors on neonatal sound exposures. We hypothesized that monitoring with a smartphone application would identify modifiable environmental factors in different NICU design formats. STUDY DESIGN: Minimum, maximum, and peak decibel (dB) recordings were obtained using the Decibel X phone app, and the presence of noise sources was recorded in each patient space at three NICUs over a 6-month period (December 2017 to May 2018). Data were analyzed by Student's t-test and ANOVA with Bonferroni correction. Data were collected at the University of Maryland Medical Center single family room (SFR) level IV and St. Agnes Healthcare hybrid pod/single family room level III NICU, Baltimore, MD and at Prince George's Hospital Center open-pod design Level III NICU, Cheverly, MD. RESULTS: All recordings in the three NICUs exceeded the American Academy of Pediatrics (AAP) recommended <45 dB level. The maximum and peak dB were highest in the open pod format level III NICU. Conversations/music alone and combined with other factors contributed to increased sound exposure. Sound exposure varied by day/night shift, with higher day exposures at the level III hybrid and open pod NICUs and higher night exposures at the level IV SFR NICU. CONCLUSION: Although sound exposure varied by NICU design, all recordings exceeded the AAP recommendation due, in part, to potentially modifiable environmental factors. A smartphone application may be useful for auditing NICU sound exposure in quality improvements efforts to minimize environmental sound exposure. KEY POINTS: · Smartphone application was used to assess NICU sound exposure.. · All cases of sound exposure exceed recommendations.. · A smartphone application was used to identify modifiable factors..