Moral Distress and Burnout in NICU Nurses

The objectives of this study were to factor analyze the Moral Distress Scale–Revised (MDS-R) in NICU nurses and to evaluate the relationships among dimensions of the MDS-R and the demoralization, exhaustion, and loss of motive dimensions of the Burnout Measure (BM). A total of 142 NICU nurses completed modified pen-and-paper versions of the MDS-R and BM. Exploratory and confirmatory factor analyses showed that the MDS-R-14 was a relatively good fit for the data. The compromised care dimension predicted BM demoralization (β = 0.24) and exhaustion (β = 0.22), the futile care dimension predicted BM exhaustion (β = 0.18), and the untruthful care dimension predicted BM demoralization (β = .25). Strategies to mitigate moral distress and resulting burnout in NICU nurses should address futile care, compromised care, and untruthful care.     

PS联合CPAP治疗新生儿呼吸窘迫综合征临床研究

目的通过研究肺表面活性物质(PS)结合持续气道正压通气(CPAP)治疗新生儿呼吸窘迫综合征(NRDS)的治疗效果,进一步指导NRDS的临床治疗。方法选取于2017年4月-2018年10月间在本院收治的80例确诊为新生儿呼吸窘迫综合征的患儿作为研究对象,随机将患儿分为试验组和对照组,对照组给予持续气道正压通气治疗,试验组在对照组的基础上联合使用PS治疗。结果试验组对于呼吸窘迫缓解的有效率明显高于对照组,在气管插管内滴入PS治疗后试验组的血气情况明显优于对照组,且试验组患儿副作用发生率明显低于对照组,以上指标差异具有统计学意义,P <0.05。结论 PS结合CPAP在新生儿呼吸窘迫综合征的治疗中疗效很好。     

The infantile cutaneous microbiome: A review

Recent focus on the neonatal intestinal microbiome has advanced our knowledge of the complex interplay between the intestinal barrier, the developing immune system, and commensal and pathogenic organisms. Despite the parallel role of the infant skin in serving as both a barrier and an interface for priming the immune system, large gaps exist in our understanding of the infantile cutaneous microbiome. The skin microbiome changes and matures throughout infancy, becoming more diverse and developing the site specificity known to exist in adults. Delivery method initially determines the composition of the cutaneous microbiome, though this impact appears transient. Cutaneous microbes play a critical role in immune system development, particularly during the neonatal period, and microbes and immune cells have closely intertwined, reciprocal effects. The unique structure of newborn skin influences cutaneous microbial colonization and the development of dermatologic pathology. The development of the infantile skin barrier and cutaneous microbiome contributes to future skin pathology. Atopic dermatitis flares and seborrheic dermatitis have been linked to dysbiosis, while erythema toxicum neonatorum is an immune response to the establishment of normal bacterial skin flora. Physicians who care for infants should be aware of the impact of the infantile skin microbiome and its role in the development of pathology. A better understanding of the origin and evolution of the skin microbiome will lead to more effective prevention and treatment of pediatric skin disease.     

Time-Driven Activity-Based Cost Comparison of Three Imaging Pathways for Suspected Midgut Volvulus in Children

ObjectiveTo use time-driven activity-based costing to compare the costs of pathways for evaluating suspected pediatric midgut volvulus using either fluoroscopic upper gastrointestinal examination (UGI) or focused abdominal ultrasound (US).MethodsProcess maps were created through patient shadowing, medical record review, and frontline staff interviews. Using time-driven activity-based costing methodology, practical capacity cost rates were calculated for personnel, equipment, and facility costs. Supply costs were included at institutional purchase prices. The cost of each process substep was determined by multiplying step-specific capacity costs by the median time required for each step, and substep costs were summed to generate total pathway cost. Multivariate sensitivity analyses were performed applying minimum and maximum labor costs. Assuming UGI would be used to troubleshoot nondiagnostic US, a break-even analysis was performed to determine the cost impact of varying frequencies of UGI on the total cost of the US-based pathway.ResultsProcess maps were created from 105 (48 girls, 57 boys) patient encounters. Base case pathway times were 90 min (UGI) and 55 min (US). Base case cost for UGI was $282.74 (range: $170.86-$800.82) when performed by a radiology practitioner assistant and $545.66 (range: $260.97-$1,974.06) when performed by a radiologist. Base case cost for US was $155.67 (range: $122.94-$432.29) when performed by a sonographer and $242.64 (range: $147.46-$1,330.05) when performed by a radiologist. For a US-based pathway, the total cost break-even pathway mix (percent UGI required for troubleshooting) was 57%.ConclusionUS can be a faster and less costly alternative to UGI in pediatric patients with suspected midgut volvulus.     

新生儿重症监护病房中重症肺炎多种菌感染相关因素分析

目的分析新生儿重症监护病房(NICU)中重症肺炎新生儿多种菌感染危险因素。方法回顾分析2014年1月至2019年5月收入NICU的1 057例重症细菌肺炎新生儿的临床资料,分析其多种菌感染的危险因素。结果单因素分析显示,胎龄(37周)、出生体质量(2 500 g)、发病日龄(7 d)、羊水污染(Ⅱ、Ⅲ度)、感染类型(医院感染)、住院时间(≥14天)、机械通气、Apagar评分(7分)、胎膜早破、抗菌药物使用天数(≥10天)、更换抗菌药物(≥3种)、联合使用抗菌药物(≥3种)12个因素是NICU中重症肺炎新生儿多种菌感染的危险因素,差异有统计学意义(P均0.05)。多因素分析显示,更换抗菌药物(≥3种)、Apagar评分(7分)、感染类型(医院感染)、机械通气、羊水污染(Ⅱ、Ⅲ度)是NICU中重症肺炎新生儿多种菌感染的独立危险因素(P0.05)。结论临床应针对主要危险因素采取综合防控措施,减少NICU新生儿重症肺炎多种菌感染。