Sleep in the neonatal intensive care unit

Recent experimental data suggest a strong role for sleep in brain development. As sleep is the predominant behavioral state in the term and especially the preterm newborn, these data underline the importance of respecting sleep duration and organization within the different sleep states. Polysomnography is the preferred technique used for identification of sleep state; however, behavioral observations-under the condition that the observer is well trained-may prove as efficient. Newborns hospitalized in the neonatal intensive care unit are exposed to many stimuli and care activities that disrupt their sleep organization and may have irreversible effects on their brain development. In order to improve the long-term neurobehavioral outcome of these high-risk subjects, a consistent care approach is proposed. Application of the Neonatal Individualized Developmental Care and Assessment Program decreases environmental stressful events and promotes harmonious well-being behaviors, based on an individual approach. This strategy has encouraging results, showing an increase in sleep duration under Neonatal Individualized Developmental Care and Assessment Program conditions, but further studies are needed to assess its long-term neurobehavioral impact.     

循征医学在新生儿重症监护病房感染控制中的应用

目的 应用循征医学的方法建立新生儿重症监护病房（NICU）感染控制流程.方法 通过对NICU感染控制相关资料的调查,确定存在的问题,利用医学文献数据库（Medline）等相关医学网站检索相关文献,进行评价整合证据,以系统科学的方法建立NICU感染控制流程.结果 对照组和观察组对比：奶瓶奶嘴清洁消毒合格率,空气、物体表面、保温箱湿化水监测以及两组医护人员洗手依从性,各项监测指标差异均具有统计学意义（P＜0.05或P＜0.01）.结论 应用循征医学的方法建立NICU感染控制流程,是科学、有效的方法.     

Nosocomial sepsis in the neonatal intensive care unit

During a 12-month study of the causes of and risk factors for nosocomial sepsis in a neonatal intensive care unit (NICU), we detected 23 episodes of nosocomial sepsis in 20 of the 155 infants at risk who were hospitalized in the NICU for at least one week. The associated mortality was 20%. Gram-positive organisms accounted for 15 (65%) of the episodes. Low birth weight, multiple gestation, and prolonged hospitalization were significant risk factors for nosocomial sepsis by univariate analysis; together, these three factors correctly predicted 80% of the infants with sepsis and 82% of the control subjects. By logistic regression analysis, however, length of stay was not a significant risk factor, but rather a confounding variable that was highly associated with birth weight. Analysis of risk factors for nosocomial sepsis showed that previous antibiotic therapy placed an infant at risk for candidemia; assisted ventilation was a risk factor for sepsis caused by group D Streptococcus and Candida albicans. Sepsis was related to infected or malfunctioning intravascular catheters in nine of the 20 infants with sepsis. Further investigation to determine strategies for preventing nosocomial septicemia in the low birth weight infant is warranted.     

Ethical issues in the neonatal intensive care unit

The case of Baby Y presented a difficult and complex ethical dilemma for the family and the staff involved. The issues of religious beliefs and law, up-holding these beliefs in the center of a religious community, financial concerns, and health care workers disagreeing about carrying out treatments made this case one that few will forget. When asked after Baby Y died how they felt, many members of the staff answered that it should not have gone on as long as it did and that they learned a lot from the family and the experience. Palliative care has been well associated with the adult cancer population in the form of hospice care. It is the hope that this well-integrated aspect of care crosses over to the NICU population. Many of the patients in the types of cases mentioned previously stay in the NICU for extended periods of time until a decision is made clear or the infant expires on his own time. The hustle and bustle of a busy, open, and not-so-private NICU is not the place for this to take place. The NICU should have a designated place where these infants can be cared for better in a more family-centered and staff-friendly environment. Pain management is another important aspect of palliative care. Comfort of the infant is of utmost importance, as it helps the family believe the suffering is under control. During the last few days or weeks of life, the family should have time that is peaceful and restful, and, eventually, the infant should have a pain-free death.Lastly, a part of the palliative care philosophy and approach includes providing treatments that may ap-pear to prolong the inevitable but in fact help the process along to resolution. In the case of Baby Y, surgery to repair some of the defects may have allowed her to go home with her family and spend her short life with them. This was the wish of the mother,especially, and it never happened. It may well be the"what if" she continues to ask for the rest of her life.     

Social support in the neonatal intensive care unit

That having a baby in hospital undergoing intensive care is a stressful experience is beyond dispute. Every parent, no matter how well-developed their own personal resources, depends to some extent on the support of others within their social system to cope with this stress. Grandparents occupy a special place in support networks and their role was studied in families with a very low birthweight baby. Both professional and lay perspectives were investigated and 93 families participated. Questionnaires were sent to family members 1 month after the baby's birth and 1 month after discharge home. There was a general consensus that the principal role of grandparents was to provide emotional support. Many practical forms of help were seen to be expressions of their care and concern. There were, however, discrepancies between professional and parental expectations where both protection from problems and obtaining information on behalf of the parents were concerned. More was expected of grandmothers than of grandfathers and maternal grandmothers in particular were key figures. There were a number of areas of potential conflict of needs and rights and a recommendation has been made to give parents a greater voice on who they choose to support them.     

Infection control in the neonatal intensive care unit

Healthcare-associated infection (HCAI), also known as nosocomial infection, is one of the main causes of adverse events in the neonate. Despite current infection control policies and practices and ongoing education programmes for healthcare workers, HCAI infection rates within the neonatal intensive care unit (NICU) continue to increase, often with devastating results. This review of the literature aims to increase awareness of some of the many issues that contribute to high HCAI rates in the NICU, thereby highlighting many more interventions that can be carried out by the healthcare worker to reduce these rates. This literature review is limited because it considers only the contribution that healthcare workers make to HCAI rates.     

新生儿重症监护病房医院感染的原因分析及对策

[目的]探讨新生儿重症监护病房医院感染的原因及对策.[方法]采用回顾性调查研究的方法,对2006年1月-2007年12月我院新生儿重症监护病房收治的1 058例患儿病例资料进行统计.[结果]发生医院感染24例,感染率2.27%,感染部位以呼吸道为主,其次为皮肤黏膜、血液、胃肠道等,病原体以肺炎克雷伯菌、表皮葡萄球菌、金黄色葡萄球菌为主.[结论]采取相应措施可减少新生儿医院感染的发生.     

新生儿重症监护病房医院感染的因素探讨及防控对策

目的探讨新生儿重症监护病房医院感染的原因及对策。方法采用回顾性调查研究的方法,对2007年1月至2008年12月我院新生儿重症监护病房收治的981例患儿的病例资料进行统计学分析。结果发生医院感染23例,感染率2.33%,感染部位以胃肠道为主,其次为呼吸道、皮肤黏膜、口腔、其他等,病原体以肺炎克雷伯菌、表皮葡萄球菌、金黄色葡萄球菌为主。结论采取严格的消毒隔离制度,合理使用抗生素,尽量缩短住院时间等相应措施可有效减少新生儿医院感染的发生。     

新生儿重症监护病房多重耐药菌感染的特征和危险因素分析

目的分析新生儿重症监护病房(NICU)多重耐药菌(MDRO)感染的分布特征,并探讨NICU发生MDRO感染的危险因素,为减少MDRO感染提供临床依据。方法回顾性分析MDRO感染的患儿病历资料。根据《MDR、XDR、PDR多重耐药菌暂行标准定义——国际专家建议》,从NICU选出MDRO感染的151例患儿220株细菌,并以同期该病区非MDRO感染的272例患儿为对照。分析MDRO的分布情况,运用单因素及多因素logistic回归分析MDRO感染相关的影响因素。结果不同年份中,NICU检出的最为常见MDRO为大肠埃希菌、其次为葡萄球菌属。产前母亲使用抗生素、PICC置管、腰椎穿刺、低蛋白血症及淋巴细胞比值是NICU发生MDRO感染的影响因素(P均<0.05)。其中母亲产前1周内使用抗生素者相对于母亲产前1周内没有使用抗生素者感染MDRO的风险增加(OR=2.268,95%CI 1.095～4.700),有低蛋白血症者相对于无低蛋白血症者感染MDRO的风险增加(OR=4.999,95%CI 2.849～8.700),行腰椎穿刺者相对于没有行腰椎穿刺者感染MDRO的风险降低(OR=0.36...     

新生儿重症监护病房医院感染的原因分析及对策

[目的]探讨新生儿重症监护病房医院感染的原因及对策。[方法]采用回顾性调查研究的方法,对2006年1月-2007年12月我院新生儿重症监护病房收治的1058例患儿病例资料进行统计。[结果]发生医院感染24例,感染率2．27％,感染部位以呼吸道为主,其次为皮肤黏膜、血液、胃肠道等．病原体以肺炎克雷伯菌、表皮葡萄球菌、金黄色葡萄球菌为主。[结果]采取相应措施可减少新生儿医院感染的发生。     

Hearing outcomes in the neonatal intensive care unit graduate

Universal hearing screening is accepted as a standard of care in the United States. Infants in the neonatal intensive care unit are at increased risk of hearing loss. Delay in the diagnosis of hearing loss may delay language and communication skills that result in life-long challenges for these infants and their families. Types of hearing loss, methods of screening, and interventions are reviewed.     

Co-bedding of twins in the neonatal intensive care unit

The increased incidence of multiple gestations has raised many questions regarding the differences in the care of twins versus singletons. The concept of co-bedding twins in the neonatal intensive care unit (NICU) has drawn increased attention in recent years. A NICU in a children's hospital in the Mid-Atlantic region of the United States explored the benefits and risks to this practice, and developed a guideline for double bunking twins. The guideline provides health care professionals with a safe and efficient means to arrange a physical environment that will simulate the environment many parents will use at home. Research is needed to determine the potential physical, psychologic, or psychosocial benefits of co-bedding multiple-gestation infants.