NICU中早产儿母乳喂养的实施体会

总结了NICU中早产儿母乳喂养的实施经验。通过对702例早产儿成功实施母乳喂养,认为通过对患儿家属的健康教育,使其认识母乳喂养的重要性,遵循规范的方法,指导乳母正确收集母乳,合理储存及运送母乳,经由NICU中的专人接收、储存并喂养早产儿,是安全且可行的。未发生母乳相关性医院感染。     

Feeding Outcomes in Preterm Infants After Discharge From the Neonatal Intensive Care Unit (NICU): A Systematic Review

Optimal growth and successful feeding in the neonatal intensive care unit (NICU) are difficult to achieve, and data indicate premature infants continue to struggle after discharge. The purpose of this systematic review was to identify growth and feeding outcomes in the NICU published within the last 10 years. Available evidence suggests weight-for-age decreases between birth and discharge from the NICU, and continues to lag behind expectations after discharge. Prevalence rates of breastfeeding differ across countries, with declining rates after discharge from the NICU. Interventions focused on increasing breastfeeding rates are effective. Most healthy preterm infants successfully nipple feed at a gestational age ≥ 36 weeks, but infants may be discharged prior to achieving full oral feeding, or eating with poor coordination. Earlier born preterm infants are later at achieving full oral feedings. After discharge, preterm infants are slower to develop eating skills, parental reports of feeding problems are prevalent, and parents introduce solids to their infants earlier than recommended. This review enhances professionals’ understanding of the difficulties of feeding and growth in preterm born infants that are faced by parents.     

Growth Outcomes of Preterm Infants in the Neonatal Intensive Care Unit: Long-term Considerations

Promoting growth is an important aspect of the management of preterm infants in the neonatal intensive care unit. However, this proves to be a difficult challenge. Most preterm infants have discharge weights less than the 10th percentile resulting in extrauterine growth retardation. Growth during the neonatal intensive care unit stay is associated with long-term outcomes. Slow growth velocity is associated with altered neurodevelopmental outcomes. There is increasing concern that strategies to improve growth are resulting in altered fat mass deposition and placing the infant at increased risk for the later development of clinical indications of metabolic syndrome. The minimal evidence available lends support to this hypothesis. Future research is needed to develop strategies that improve growth and neurodevelopmental outcomes while limiting the risk of metabolic syndrome.     

A Philosophy of Care for a Neonatal Intensive Care Unit

Crisis reactions, a stressful environment, infant care practices, and nurse behavior may cause difficulties in entering the natural parental role for parents of infants who are admitted to a neonatal intensive care unit (NICU). In connection with discussions in the Uppsala NICU on what constitutes good care, a philosophy of care, based on Callista Roy's adaptation model, was formulated for the purpose of providing developmentally supportive, family-centered care, and for defining good care and the professional nurse role. The philosophy describes the infant's needs and environment. Caring activities focus on support of the infant's and his parent's roles and self-concept in their progress towards independence from professional assistance. The philosophy is an essential component in the introductory program which integrates newly recruited personnel from different disciplines into the unit. It is presented as a suggestion of how a model-based philosophy of care can be formulated by operationalization of the theoretical concepts of a nursing model.     

Addressing the Needs of Mothers with Infants in the Neonatal Intensive Care Unit: A Qualitative Secondary Analysis

PurposeMothers of infants hospitalized in neonatal intensive care units (NICUs) need to be recognized as essential partners of the care team as their presence and involvement are key to infants' health and developmental outcomes. Addressing mothers' perceived needs is beneficial for the improvement of supportive nursing care; however, little qualitative research on their unmet needs has been conducted in South Korea. This study assessed mothers' perspectives on their NICU experiences and their unmet needs within the South Korean cultural context.MethodA cross-sectional, multicentered, secondary analysis study was conducted using the written responses to an open-ended questionnaire. Of the 344 NICU-experienced mothers, 232 throughout South Korea (seven cities and five provinces) voluntarily completed the questionnaire via smartphone-based or web-based surveys. Their narrative responses were analyzed using thematic content analysis guided by the critical incident technique.ResultsFour themes emerged. NICU-experienced mothers of preterm infants referred to the “family-friendly environment” (16.4%) as a positive experience. The greatest unmet need was “relationship-based support” (58.2%), followed by “information and education-based support” (20.0%) and “system-level challenges” (5.4%).ConclusionThe importance of creating a family-friendly NICU environment should be emphasized by ensuring 24-hour unrestricted access and encouraging active parental involvement in infant care, as well as actively supporting NICU families through supportive words and actions. The assurance of antiinfection management and better staffing levels should be fundamentally guaranteed to NICU staff.     

Culture Clash: Transitioning from the Neonatal Intensive Care Unit to the Pediatric Intensive Care Unit

The hospitalization of a child is one of the most traumatic episodes of parenthood. The fear, frustration, anger, and loss of control can be overwhelming to the parents of the critically ill child. Acute care hospitalizations such as those that occur in the neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) are especially distressing to every member of the family. Unfortunately, families subjected to both NICU and PICU admissions experience two distinctive cultures with very different philosophies and goals. In spite of the best intentions of health care providers, the obvious cultural differences between the NICU and PICU potentially aggravate the stress suffered by families. Unfortunately, most NICU and PICU staff members are unfamiliar with the contrasting cultures. Utilizing specific examples from Phoenix area facilities, the purpose of this article is to describe the many factors that shape and influence the NICU and PICU experience for families.     

Ethical Considerations in the Neonatal Intensive Care Unit

Advances in treatment and technology capabilities, coupled with the ability to care for younger, smaller, and sicker neonates contribute to ethical conflicts in the neonatal intensive care unit (NICU). Although the ethical approach to care is sometimes inconsistent, it is important for clinicians to develop and adopt a framework for ethical decision-making in the NICU. Providers need to understand the four ethical principles of autonomy, beneficence, nonmaleficence, and justice and apply these principles to clinical decision-making about care in the NICU. Ethical decision-making must be family-centered and respectful of cultural differences. Providers must comply with professional ethical guidelines as well as government and legal mandates. Adopting ethical frameworks for neonatal care ensures a more holistic approach to care in the highly technical environment of the NICU.     

Family-Centered Rounds in the Neonatal Intensive Care Unit

Promotion of family‐centered care is common in neonatal intensive care units (NICUs) across the nation. Yet, true collaboration and shared decision‐making with families in the care of their baby is not the standard of care. Family‐centered rounds can provide the opportunity for this level of collaboration, but care must be taken to overcome barriers to family‐centered rounds.     

Three Years' Experience with a Patient Data Management System at a Neonatal Intensive Care Unit

We report about our experience with the patient data management system (PDMS) Hewlett Packard CareVue 9000 at two neonatal ICUs. We describe our PDMS configuration (hard- and software), local adjustments and enhancements such as knowledge based systems for calculating the parenteral nutrition of newborn infants (VIE-PNN), for advising medication (VIE-Nmed), and for managing mechanical ventilation (VIE-VENT), and the results of a structured interview with our staff members about the acceptance of the system. Despite some criticism nearly all collaborators liked the system, especially because of its time saving automated documentation of vital data and mechanical ventilation parameters. More than 2/3 preferred the computer assisted documentation to charting by hand, only 1/41 would have liked to return to paper documentation. All staff members possessed excellent (15/39) or good (24/39) knowledge of the system. Main points of critique were the system's therapy planning facilities (medication administration records), the restrictive facilities for documenting patient care and the yet unsolved problems of data evaluation and export.PDM systems have to be constantly adapted to the user's needs and to the changing clinical environment. Living with the system asks for an intensive dialog with the system and its functionalities, for creativity and well defined ideas about the future system development.     

A Protocol for Swaddled Bathing in the Neonatal Intensive Care Unit

A review of the literature revealed a lack of consensus concerning the type of bath, water temperature, and the length of the bath. Because our neonatal intensive care unit had already transitioned to swaddle bathing, the aim of this Performance Improvement project was to determine preferred initial water temperature and the length of the bath in the neonatal intensive care unit. Results of the Performance Improvement project indicated that above 101°F, the higher the initial water temperature, the higher the baby's temperature during the bath. Therefore, it was determined that the initial bath water temperature should be between 100° and 101° F and the average length of bath should be 8 minutes. Results of the chart review indicated that by 5 minutes after the bath, the initial water temperature had no lasting effect on the baby and the baby self-regulated his/her own body temperature. There was no difference in baby temperature after bath with a warmed blanket.     

Cue-based Co-regulated Feeding in the Neonatal Intensive Care Unit: Supporting Parents in Learning to Feed Their Preterm Infant

Feeding preterm infants may be considered by some a routine task rather than a critical component of neonatal intensive care unit care. The technology of the neonatal intensive care unit, attention to numbers rather than infant behaviors, and nonindividualized ways in which care may be delivered can affect the culture of feeding. The importance of the feeding relationship and the infant's positive learning experiences may get lost in “the numbers” when the parents’ focus is primarily on “emptying the bottle” to get the infant home. The developmental nature of learning to feed may be overshadowed by well-intentioned professional caregivers who describe feeding as a “light bulb phenomenon” (the infant all of a sudden “figures it out” and therefore “knows how to feed”) vs a developmental process that requires carefully titrated support. Providing parents with skills to co-regulate with their infant during feeding can support parent-infant attachment, reduce stress, and improve intake.