Nursing Care in the Neonatal Intensive Care Unit

The field of neonatal care has evolved into a specialty brimming with technological advances, accompanied by expanded nursing roles and responsibilities. In light of this, the impact that thermoregulation, noise pollution, and disruptive care planning can have upon the progress of a sick newborn is discussed. Suggestions are made for evaluation of problem areas and for redirection of patient care plans to include attention to these vital aspects.     

Family Mental Health Care in the Neonatal Intensive Care Unit

The potential role of the neonatal intensive care nurse in mental health promotion is explored. The focus is upon assessment and intervention of families who are at risk for child abuse and future dysfunction. The importance of support systems during a crisis period is emphasized.     

Estimated Breastfeeding to Support Breastfeeding in the Neonatal Intensive Care Unit

ObjectiveTo evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members’ experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding.DesignA mixed method evaluation.SettingNeonatal Intensive Care Unit (NICU) in Sweden.ParticipantsThe study included 365 preterm (25^th–36^th gestational weeks) infants and 45 nurses or nurse assistants.MethodsA retrospective comparative medical record study was used to assess infant outcomes during a period of test weighing (196 infants) and again after the implementation of estimated breastfeeding (169 infants). A qualitative survey was conducted to explore the staff experiences of estimated breastfeeding.ResultsNo differences were found between groups regarding duration of tube feeding, length of hospital stay, gestational age, weight at discharge, and rate of any breastfeeding. Infants in the estimated breastfeeding group had a higher risk of not being exclusively breast milk fed than infants in the test‐weighing group (OR = 2.76, CI [1.5, 5.1]). Staff perceived estimated breastfeeding as a more facilitative and less stressful method for mothers than test weighing. Some staff had difficulty following guidelines while simultaneously providing person‐centered care.ConclusionsEstimated breastfeeding is a nonintrusive and feasible method for assessing and supporting the transition from tube feeding to breastfeeding among preterm infants in a NICU. However, the increased risk for not being exclusively breastfed is of concern. Additional research is needed to assess whether this method is appropriate and feasible in varying contexts and cultures.     

Placental Pathology and Clinical Outcomes in a Cohort of Infants Admitted to a Neonatal Intensive Care Unit

BackgroundPlacental pathology predicts persistent neurological impairment, even in normally grown infants. However, few studies have linked placental pathology with neonatal outcomes in a large population.MethodsWe matched the clinical outcomes of a cohort of neonates admitted to a neonatal intensive care unit (NICU) with placental pathology, where available, and examined (by multivariable logistic regression) the relationship between placental pathologies and these outcomes. The outcomes included neonatal death, necrotizing enterocolitis, and intraventricular hemorrhage ≥ grade 3. A forward selection model (10% significance level for entry) was used after adjusting for confounding factors.ResultsA detailed gross and microscopic pathological report was available for 1296 eligible infants (64%). Specific placental features were associated with specific neonatal outcomes. The Canadian Neonatal Network has previously determined that specific changes in the pattern of neonatal care can alter the incidence and severity of these outcomes. In the placentas from pregnancies delivering small for gestational age infants who were subsequently admitted to NICU, two different patterns of placental pathologies were found, one ischemic and the other inflammatory.ConclusionFrozen section examination of placentas may facilitate more timely delivery of tailored neonatal therapy.     

Maternal Perceptions of Infant Exercise in the Neonatal Intensive Care Unit

Objective: To identify important factors that influence mothers' perceptions of engaging in exercise with their preterm infants.
Design: Qualitative, semistructured individual interviews.
Setting: Neonatal Intensive Care Unit.
Participants: Thirteen mothers of preterm infants who were in the Neonatal Intensive Care Unit.
Methods: Two researchers conducted interviews with mothers in English or Spanish. Interviews were recorded, transcribed, and analyzed.
Results: Mothers tended to view infant exercise as beneficial but feared for the safety of their infants. They perceived nurses as experts who could safely exercise their infants but feared that they themselves might harm their infants. Factors that influenced their beliefs included previous experiences with infant exercise and views regarding the fragility or the strength of their own infants. Mothers identified nurses, doctors, family members, and research studies as trusted sources of information on exercise efficacy and safety.
Conclusion: Understanding and addressing mothers' perceptions is a crucial component of a nursing intervention that teaches parents to do assisted exercises at home with their preterm infants.