Improving perinatal regionalization for preterm deliveries in a Medicaid covered population: initial impact of the Arkansas ANGELS intervention

Objective. To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001–2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice. Data Sources. A dataset of linked Medicaid claims and birth certificates for the time period by clustering Medicaid claims by pregnancy episode. Pregnancy episodes were linked to residential county‐level demographic and medical resource characteristics. Deliveries occurring before 35 weeks gestation (n=5,150) were used for analysis. Study Design. Logistic regression analysis was used to examine time trends and individual, county, and intervention characteristics associated with delivery at hospitals with NICU, and delivery at the academic medical center. Principal Findings. Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting. Conclusion. Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.     

NICU中早产儿的医院感染控制

早产儿是指孕周满28足周至不满37足周（196～258d）,体最1000～2 500g,身长＜45cm,身体各器官发育尚未成熟着,定义为早产儿[1].国内于近年来,早产儿发生率有上升趋势,NICU中收治的早产儿也是逐渐增多,国内早产儿总病死率为12.7%～20.8%[1],感染是严重威胁早产儿生命的危险因素.现就我科早产儿护理工作中的感染控制总结如下.     

Practice developments supporting change implementation in Wellington,New Zealand (NZ) for ‘continuity of care when transitioning complex preterm infants from NICU to home’

The discussion paper will focus on continuity of care relating to previous NZ research, specifically to transitioning complex preterm infants from NICU to home based on parent experiences, and on the practice developments that have occurred, to ensure optimal health outcomes. Previous NZ research discovered parent desire a consistent service delivery for the entire transition journey from NICU and at home.An informative and comprehensive opportunity has occurred for reflective professional practice, evaluation, development and implementation which have transpired in positive change through innovative practice developments and support change implementation in Wellington, NZ. This has resulted in the articulation of a model of care that has both embraced and integrated parental desires for a continuity of care process for complex preterm infants. This has been achieved by having the same Discharge Facilitator/Key Case Manager present within the NICU and external to the NICU for Home-based infants for the entire transition journey.The paper will focus and emphasis additional practice development changes and furthermore, will present a real purpose, for other countries to learn of such practice developments that have exemplified a celebratory success for families of Wellington, NZ.     

Neonatal nurses’ perceptions of using live streaming video cameras to view infants in a regional NICU

Tertiary hospital services have introduced live streaming video cameras into Neonatal units with the aim of reducing distress and enhancing bonding and attachment between infants and parents during hospitalisation. However, there is a paucity of research exploring the impact of using live streaming video cameras in the neonatal unit. The aim of this study was to describe staff perceptions of using a live streaming video camera in a neonatal context. Quantitative and qualitative data were collected via an online questionnaire. While staff reported benefits for parents, concerns regarding increased workload and difficulties in using the technology were also reported. For this technology to be implemented as standard care, and to ensure nurses confidence in using it, it will be important to address these concerns. Working in collaboration with nurses who have daily and ongoing experience with the cameras in clinical practice is key to finding effective solutions for implementing live web streaming cameras into standard care.     

A service evaluation of the fathers’ peer support group on a neonatal intensive care unit (NICU)

The following study evaluates a fathers' peer support group facilitated on a tertiary neonatal intensive care unit (NICU). Within the group, the experiences of fathers with an infant on the NICU was explored. Data was collected from eight fathers and analysed using thematic analysis. Four key themes emerged: (1) the “ups and downs” of the NICU journey, (2) the “balance between two worlds”; juggling NICU and life outside, (3) being “an important member of the family”; feeling seen, included and cared for and (4) “I'm not alone”; the benefits of the shared experience. The study concluded that the peer group was a valued form of support during which fathers were facilitated to meet other NICU dads, share their NICU journey and learn from the experiences of others. Recommendations for setting up a NICU fathers' peer support group are provided.     

Facilitators and barriers to developmentally supportive care for preterm infants in low and middle-income countries: A scoping review

BackgroundPreterm birth and its associated complications are a major cause of neonatal mortality worldwide. Approximately 15 million preterm infants are born annually, most births occurring in Sub-Saharan Africa and South Asia. However, Developmentally Supportive Care—an evidence-based intervention reported to improve the survival of preterm infants, is under utilized in Low and Middle-Income Countries. This review focuses on examining the barriers to, and facilitators of, Kangaroo Mother Care, positioning (nesting and swaddling), and control of the external neonatal intensive care environment in low- and middle-income countries.MethodsSix databases were systematically searched between January 2000 to April 2020. A search of the grey literature was also conducted. Two independent reviewers screened the citations of the retrieved papers and abstracted data for included studies based on predetermined inclusion/exclusion criteria.ResultsA total of 15853 articles were retrieved from the search. A full-text review was conducted on 155 articles. Thirty-two papers were identified and included in the review. Thirty papers focussed on KMC, two papers focused on noise control. No studies were identified on positioning and light control in the NICU. Barriers identified included lack of knowledge of DSC practices in both health care workers and family caregivers, existing cultural norms, and the absence of protocols and guidelines for practice. Facilitators included; healthcare worker training, leadership and support from health care facility managers to family caregivers, and available infrastructure.ConclusionFurther studies that comprehensively examine DSC implementation in Low-Middle-Income countries are required in order to improve sustained DSC practices.