scholarly journals From Neonatal Intensive Care to Neurocritical Care: Is It Still a Mirage? The Sicilian Multicenter Project

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Raffaele Falsaperla ◽  
Laura Mauceri ◽  
Milena Motta ◽  
Ettore Piro ◽  
Gabriella D’Angelo ◽  
...  
Keyword(s):  
At Risk ◽  
Intensive Care ◽  
Critically Ill ◽  
Neonatal Intensive Care ◽  
Neurocritical Care ◽  
Brain Protection ◽  
Model Of Care ◽  
Newborn Brain ◽  
Critically Ill Neonates

Background. Neonatal brain injury (NBI) can lead to a significant neurological disability or even death. After decades of intense efforts to improve neonatal intensive care and survival of critically ill newborns, the focus today is an improved long-term neurological outcome through brain-focused care. The goal of neuroprotection in the neonatal intensive care unit (NICU) is the prevention of new or worsening NBI in premature and term newborns. As a result, the neonatal neurocritical care unit (NNCU) has been emerging as a model of care to decrease NBI and improve the long-term neurodevelopment in critically ill neonates. Purpose. Neurocritical care (NCC) Sicilian project includes three academic sites with NICU in Sicily (Catania, Messina, and Palermo), and its primary goal is to develop neurocritical neonatal care unit (NNCU). Methods. In 2018, the three NICUs created a dedicated space for neonates with primary neurological diagnosis or at risk for neurological injuries—NNCU. Admission criteria for eligible patients and treatment protocols were created. Contact with parents, environmental protection, basic monitoring, brain monitoring, pharmacological therapy, and organization of the staff were protocolized. Results. Evaluation of the efforts to establish NNCU within existing NICU, current protocols, and encountered problems are shown. Implications for Practice. Our outcome confirmed the need for dedicated NNCU for neuroprotection of critically ill neonates at risk for a neurological injury. Although the literature on neonatal neurocritical care is still scarce, we see the value of such targeted approach to newborn brain protection and therefore we will continue developing our NNCU, even though there have been problems encountered. The project of building NNCU will continue to be closely monitored. Conclusions. The development of our neonatal neurocritical model of care is far from being completed. Although it is currently limited to the Sicilian area only, the goal of this paper is to share the development of this multicenter interdisciplinary project focused on a newborn brain protection. After evaluating our outcome, we strongly believe that a combined expertise in neonatal neurology and neonatal critical care can lead to an improved neurodevelopmental outcome for critically ill neonates, from the extremely preterm to those with brain injuries.

Development of a NeuroNICU with a Broader Focus on All Newborns at Risk of Brain Injury: The First 2 Years

2018 ◽  
Vol 35 (12) ◽  
pp. 1197-1205 ◽  
Author(s):  
Elisabeth Yan ◽  
Kathi Randall ◽  
Valerie Chock ◽  
Alexis Davis ◽  
Cecelia Glennon ◽  
...  
Keyword(s):  
At Risk ◽  
Intensive Care ◽  
Brain Injury ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Neurologic Injury ◽  
Medical Diagnoses ◽  
Critically Ill Neonates ◽  
Video Eeg

Objective Many critically ill neonates have an existing brain injury or are at risk of neurologic injury. We developed a “NeuroNICU” (neurologic neonatal intensive care unit) to better provide neurologically focused intensive care. Study Design Demographic and clinical variables, services delivered, and patient outcomes were recorded in a prospective database for all neonates admitted to the NeuroNICU between April 23, 2013, and June 25, 2015. Results In total, 546 neonates were admitted to the NeuroNICU representing 32% of all NICU admissions. The most common admission diagnoses were congenital heart disease (30%), extreme prematurity (18%), seizures (10%), and hypoxic–ischemic encephalopathy (9%). Neuromonitoring was common, with near-infrared spectroscopy used in 69%, amplitude-integrated electroencephalography (EEG) in 45%, and continuous video EEG in 35%. Overall, 43% received neurology or neurosurgery consultation. Death prior to hospital discharge occurred in 11%. Among survivors, 87% were referred for developmental follow-up, and among those with a primary neurologic diagnosis 57% were referred for neurology or neurosurgical follow-up. Conclusion The NeuroNICU-admitted newborns with or at risk of brain injury comprise a high percentage of NICU volume; 38% had primary neurologic diagnoses, whereas 62% had medical diagnoses. We found many opportunities to provide brain focused intensive care, impacting a substantial proportion of newborns in our NICU.

scholarly journals Organization and management of nursing services in NICU, levels of transport

2022 ◽  
Vol 4 (4) ◽  
pp. 151-153
Author(s):  
Onaisa Aalia Mushtaq ◽  
Javaid Ahmad Mir ◽  
Bushra Mushtaq
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Nursing Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Respiratory Support ◽  
Organization And Management ◽  
Nursing Services ◽  
Intensive Care Nursery ◽  
Critically Ill Neonates

Neonatal Intensive Care is defined as, “care for medically unstable and critically ill newborns requiring constant nursing, complicated surgical procedures, continual respiratory support, or other intensive interventions.” A NICU is a unit that provides high quality skilled care to critically ill neonates by offering facilities for continuous clinical, biochemical and radio logical monitoring and use of life support systems with the aim of improving survival of these babies. Intermediate care includes care of ill infants requiring less constant nursing care, but does not exclude respiratory support. Care of ill infants requiring less constant nursing care, but does not exclude respiratory support. When an intensive care nursery is available, the intermediate nursery serves as a “step down unit” from the intensive care area.

scholarly journals Nucleated Red Blood Cells: Could They Be Indicator Markers of Illness Severity for Neonatal Intensive Care Unit Patients?

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 197
Author(s):  
Rozeta Sokou ◽  
Georgios Ioakeimidis ◽  
Maria Lampridou ◽  
Abraham Pouliakis ◽  
Andreas G. Tsantes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Roc Curve ◽  
Blood Cells ◽  
Neonatal Intensive Care ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Nucleated Red Blood Cells ◽  
Critically Ill Neonates

Background: We aimed to assess whether nucleated red blood cells (NRBCs) count could serve as a diagnostic and prognostic biomarker for morbidity and mortality in critically ill neonates. Methods: The association between NRBCs count and neonatal morbidity and mortality was evaluated in an observational cohort of critically ill neonates hospitalized in our neonatal intensive care unit over a period of 69 months. The discriminative ability of NRBCs count as diagnostic and prognostic biomarkers was evaluated by performing the Receiver Operating Characteristics (ROC) curve analysis. Results: Among 467 critically ill neonates included in the study, 45 (9.6%) of them experienced in-hospital mortality. No statistically significant difference was found with regards to NRBCs count between survivors and non-survivors, although the median value for NRBCs was sometimes higher for non-survivors. ROC curve analysis showed that NRBCs is a good discriminator marker for the diagnosis of perinatal hypoxia in neonates with area under the curve (AUC) [AUC 0.710; 95% confidence interval (CI), 0.660–0.759] and predominantly in preterm neonates (AUC 0.921 (95% CI, 0.0849–0.0993)) by using a cut-off value of ≥11.2%, with 80% sensitivity and 88.7% specificity. NRBCs also revealed significant prognostic power for mortality in septic neonates (AUC 0.760 (95% CI, 0.631–0.888)) and especially in preterms with sepsis (AUC 0.816 (95% CI, 0.681–0.951)), with cut-off value ≥ 1%, resulting in 81.6% sensitivity and 78.1% specificity. Conclusion: NRBCs count may be included among the early diagnostic and prognostic markers for sick neonates.

scholarly journals Preparedness of Western Cape advanced life support providers to provide clinical stabilisation and intensive care for neonatal interfacility transfers

2020 ◽  
Vol 17 ◽  
Author(s):  
Erefaan Ismail ◽  
Raveen Naidoo ◽  
Dorcas Rosaley Prakaschandra
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Critically Ill ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Practical Training ◽  
Western Cape ◽  
Chi Square ◽  
Critically Ill Neonates

Introduction The Western Cape is a province in South Africa – known for the port city of Cape Town – surrounded by the Indian and Atlantic oceans. The transport of high-risk neonates between neonatal intensive care units in the Western Cape of South Africa is performed by advanced life support (ALS) providers.The implications of this practice have not been documented. This study will evaluate the preparedness of ALS providers to undertake intensive care of critically ill neonates during interfacility transfers.MethodsData collection was performed using a questionnaire with a response rate of 81% (n=145). The data analysis encompassed descriptive statistics using tables and figures. Inferential statistics was done using the chi-square test with a significance reported for p<0.05. Reliability was determined using Cronbach’s alpha.ResultsThe respondents highlighted that their initial ALS training was not adequate to prepare them for managing critically ill neonates. This view was expressed by the greater majority (n=63, 43.4%) when asked about their combined neonatal theory and practical training notional hours of their curriculum which focussed on managing critically ill neonates. ConclusionThere is an urgent need to improve the training programs of ALS providers with regards to neonatology. Numerous factors affecting the preparedness of ALS providers to manage critically ill neonates have been highlighted.

scholarly journals The Neurointensive Care Nursery and Evolving Roles for Nursing

2016 ◽  
Vol 35 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Susan Peloquin ◽  
Annette Carley ◽  
Sonia L. Bonifacio ◽  
Hannah C. Glass
Keyword(s):  
At Risk ◽  
Critical Care ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Neurocritical Care ◽  
Team Approach ◽  
Pediatric Practice ◽  
Neurologic Status ◽  
Intensive Care Nursery

AbstractNeonatal neurocritical care is an emerging subspecialty that combines the expertise of critical care medicine and neurology with that of nursing and other providers in an interprofessional team approach to care.1,2 Neurocritical care of the neonate has roots in adult and pediatric practice. It has been demonstrated that adults with acute neurologic conditions who are treated in a specialized neurocritical care unit have reduced morbidity and mortality, as well as decreased length of stay, lower costs, and reduced need for neurosurgical procedures. In pediatrics, neurocritical care has focused on various primary and secondary neurologic conditions complicating critical care that also contribute to mortality, morbidity, and duration of hospitalization. However, the concept of neurocritical care as a subspecialty in pediatric practice is still evolving, and evidence demonstrating improved outcomes is lacking.3–5 In the neonatal intensive care nursery, neurocritical care is also evolving as a subspecialty concept to address both supportive and preventive care and optimize neurologic outcomes for an at-risk neonatal patient population. To enhance effectiveness of this care approach, nurses must be prepared to appropriately recognize acute changes in neurologic status, implement protocols that specifically address neurologic conditions, and carefully monitor neurologic status to help prevent secondary injury. The complexity of this team approach to brain-focused care has led to the development of a specialized role: the neurocritical care nurse (neonatal intensive care nursery [NICN] nurse). This article will review key concepts related to neonatal neurocritical care and the essential role of nursing. It will also explore the emerging role of the NICN nurse in supporting early recognition and management of at-risk infants in this neonatal subspecialty practice.

scholarly journals Preparedness of Western Cape ALS providers to provide clinical stabilisation and intensive care for neonates during the patient journey

2018 ◽  
Author(s):  
◽  
Erefaan Ismail
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Neonatal Intensive Care ◽  
Improve Patient Safety ◽  
External Support ◽  
Hospital Environment ◽  
Western Cape ◽  
Patient Journey ◽  
Critically Ill Neonates ◽  
Training Programmes

The management and intensive care of neonates is inherently prone to adverse events, particularly as such management often involves pre-term neonates in distress – this means they have been born too early and their frail bodies require external support in order to survive. In the Western Cape high-risk neonates who are being referred from one neonatal intensive care unit (NICU) to another such unit or from primary and secondary hospitals to NICU are transported by ALS providers. However, there is a paucity of evidence relating to the preparedness of these ALS providers for the management and continuum care of these critically ill neonates. This study showed the general lack of neonatal exposure as the clinical management of critically ill neonates ranged from once in six months (n = 17, 11.7%) to a group of 6.9% (n = 6) who indicated that they had never managed critically ill neonates. The lack of frequency of employing the critical ALS skills of neonatal intubation (n = 62, 42.8%) and neonatal CPR (n = 49, 33.8%) cited, reflected the lack of opportunity to use such skills frequently in the pre- hospital environment. Only 9.7% (n = 14) of the respondents indicated they had the necessary specialised monitoring equipment to safely transfer neonates and only 14.5% (n = 21) of the respondents felt “well-prepared” to manage critically ill neonates. There is an urgent need to standardise both the theory and the practicum components for all ALS provider neonatal training programmes. The ideal would be the establishment of a mentorship programme, supervised by neonatologists. Additional neonatal short course/refresher training is also needed which includes the design of Continued Professional Development (CPD) accredited activities. In order to improve patient safety, the procurement of sufficient specialised neonatal intensive care equipment and disposables, especially for the rural ALS providers, should be prioritised. Elements before, during and after the inter-facility transfer of a critically ill neonate by ALS providers were explored. This study suggests that these factors may impact on the emotional and mental preparedness of the ALS providers, possibly hampering their ability to provide optimum care.

scholarly journals Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Johanna Helmersson-Karlqvist ◽  
Miklos Lipcsey ◽  
Johan Ärnlöv ◽  
Max Bell ◽  
Bo Ravn ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Risk Prediction ◽  
Cystatin C ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Sample Tube ◽  
Long Term Mortality

AbstractDecreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.

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