Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: a cross-sectional survey

Purpose: This study aimed to explore the knowledge of and attitude toward breastfeeding among medical staff working in the neonatal intensive care unit and obstetric unit.Methods: A cross-sectional survey design was used. The questionnaire focused on participants’ knowledge of and attitude toward breastfeeding and their characteristics. A total of 123 participants, including nurses and physicians working in the neonatal intensive care unit and obstetric unit, completed the questionnaire. Data were analyzed using descriptive statistics, chi-square test, Fisher exact test, and Spearman correlation coefficient.Results: One-third the of participants reported that they had obtained formal education related to breastfeeding within the last year, 44% of participants obtained information related to breastfeeding from books, while 30.9% of participants learned from coworkers. Over 93% of the participants reported a need for formal breastfeeding education. The rate of correct answers for breastfeeding knowledge was 59.2%, and there were no significant differences between the nurse and physician groups. Breastfeeding attitude was positive with a score of 60.0, and nurses working in the obstetric unit scored higher than other nurse or physician groups (p=0.014). A significant correlation between knowledge of and attitude toward breastfeeding was found in medical staff attending to preterm infant mothers (p<0.001).Conclusion: Consistent information and positive support regarding breastfeeding need to be provided to medical staff so that they can help preterm mothers initiate and continue breastfeeding. Further study is needed to develop an interprofessional education program to increase breastfeeding knowledge and enhance positive attitude of medical staff attending to preterm mothers.

Download Full-text

Characteristics of Neonatal Intensive Care Unit Patients in North Carolina: A Cross-Sectional Survey

PEDIATRICS ◽

10.1542/peds.87.6.904 ◽

1991 ◽

Vol 87 (6) ◽

pp. 904-908

Author(s):

Alan D. Stiles ◽

Karen Metzguer ◽

Ann O'Hale ◽

Robert C. Cefalo

Keyword(s):

Intensive Care Unit ◽

North Carolina ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Chronic Care ◽

Neonatal Intensive Care Units ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Care Facilities

A shortage of neonatal intensive care facilities has been encountered in some areas of the country including North Carolina. To examine possible solutions to this health care delivery problem, a cross-sectional survey of all the neonatal intensive care units in North Carolina was performed to examine characteristics of patients occupying the beds in these facilities. It was found that a substantial amount of chronic care is now occurring in neonatal intensive care beds, with 38% of occupants of neonatal intensive care beds being 31 days of age or older and 3% being mechanically ventilated at 91 days of age or older. In addition, according to criteria established for this study, a substantial number of "convalescent" patients (32%) were occupying beds in neonatal intensive care units. It is concluded that an increase in both intermediate/convalescent care beds and establishment of chronic care facilities in North Carolina, rather than an increase in intensive care beds in these units, would alleviate the shortage of neonatal intensive care facilities. Further, the characteristics of the population occupying neonatal intensive care unit beds should be considered by health planners in addition to occupancy rate, when new facilities are being established.

Download Full-text

Using a behavior analytics approach to change nursing care of extremely premature infants: A pilot study

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n5p14 ◽

2018 ◽

Vol 9 (5) ◽

pp. 14

Author(s):

Jenn Gonya ◽

Jessica Niski ◽

Nicole Cistone

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pilot Study ◽

Neonatal Intensive Care Unit ◽

Premature Infant ◽

Premature Infants ◽

Nursing Care ◽

Neonatal Intensive Care ◽

Extremely Premature Infant

The neonatal intensive care unit (NICU) is, inherently, a trauma environment for the extremely premature infant. This trauma is often exacerbated by nurse caregiving practices that can be modified and still remain effective. Our study explored how behavior analytics could be used to implement an intervention known as Care by Cues and how the intervention might, ultimately, impact infant physiologic stability.

Download Full-text

Level and Noise Sources in the Neonatal Intensive Care Unit of a Reference Hospital

Investigación y Educación en Enfermería ◽

10.17533/udea.iee.v38n3e13 ◽

2020 ◽

Vol 38 (3) ◽

Author(s):

Alma Damaris Hernández-Salazar ◽

Josefina Gallegos-Martínez ◽

Jaime Reyes-Hernández

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Environmental Noise ◽

Sound Level ◽

Noise Sources ◽

Cross Sectional ◽

Reference Hospital ◽

And Shifts

Objective. Determine the level of environmental and periauricular noise in preterm babies and identify the sources generating noise in the Neonatal Intensive Care Unit -NICU- of a reference hospital in San Luis Potosí, Mexico. Methods. Cross-sectional and analytic study of the measurement of the level of environmental noise in five critical areas of the NICU, according with the method of measurement of noise from fixed sources by the Mexican Official Norm and periauricular at 20 cm from the preterm patient’s pinna. The measurements were carried out during three representative days of a week,morning, evening and nocturnal shifts. A STEREN 400 sound level meter was used with 30 to 130 dB range of measurement and a rate of 0.5 s. Results. The average level of periauricular noise (64.5±1.91dB) was higher than the environmental noise (63.3±1.74 dB) during the days and shifts evaluated. The principal noise sources were activities carried out by the staff, like the nursing change of shift and conversations by the staff, which raised the level continuously or intermittently, operation of vital support equipment (alarms) and incidences (clashing of baby bottles and moving furnishings) producedsudden rises of noise. Conclusions. Environmental and periauricular noise in NICU exceeds by two and almost three times the 45 dB during the day and 35 dB at night from the norm in hospitals. It is necessary to implement permanent noise reduction programs to prevent sequelae in the preterm infant and professional burnout in the nursing staff.

Download Full-text

Invasive candidiasis in a Brazilian neonatal intensive care unit

Revista Brasileira de Saúde Materno Infantil ◽

10.1590/1806-93042021000200011 ◽

2021 ◽

Vol 21 (2) ◽

pp. 547-552

Author(s):

Henrique Yuji Watanabe Silva ◽

Felipe Teixeira de Mello Freitas

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Neonatal Intensive Care Unit ◽

Invasive Candidiasis ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Cross Sectional ◽

Antibiotics Use ◽

Elbw Neonates

Abstract Objectives: to describe the epidemiology of invasive candidiasis in a neonatal intensive care unit. Methods: cross-sectional study that included all neonates with invasive candidiasis confirmed by blood culture from April 2015 to June 2018. Demographic, clinical and microbiological data were analyzed, comparing neonates with extreme low birth weight (ELBW) with neonates ≥ 1000g birth weight, considering a p <0.05 as statistically significant. Results: there were 38 cases of invasive candidiasis, resulting in an overall incidence of 2.5%. Twelve (32%) were ELBW neonates and 26 (68%) neonates ≥ 1000g birth weight, an incidence of 4.4% and 2.0%, respectively. Abdominal surgery was more frequent among neonates with birth weight ≥ 1000g compared to ELBW neonates (85% vs. 17%; p <0.01), as well as the median in days of antibiotics use (18 vs. 10.5; p = 0.04). The median in days of mechanical ventilation was more frequent among ELBW neonates (10 vs. 5.5; p = 0.04). The majority of Candida species were non-albicans (64%). Fatality rate was 32%. Conclusions: the incidence of invasive candidiasis among neonates with birth weight ≥ 1000g was higher than that found in the literature. This group has a higher proportion of gastrointestinal malformations that require surgery. Thus, fluconazole prophylaxis may be necessary for a broader group of neonates.

Download Full-text

Each Additional Day of Antibiotics Is Associated With Lower Gut Anaerobes in Neonatal Intensive Care Unit Patients

Clinical Infectious Diseases ◽

10.1093/cid/ciz698 ◽

2019 ◽

Vol 70 (12) ◽

pp. 2553-2560

Author(s):

Ashley M Rooney ◽

Kathryn Timberlake ◽

Kevin A Brown ◽

Saumya Bansal ◽

Christopher Tomlinson ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Taxonomic Composition ◽

Term Infants ◽

Cross Sectional ◽

Adjusted Risk ◽

Treatment Regimens

Abstract Background Discontinuation of inappropriate antimicrobial therapy is an important target for stewardship intervention. The drug and duration-dependent effects of antibiotics on the developing neonatal gut microbiota needs to be precisely quantified. Methods In this retrospective, cross-sectional study, we performed 16S rRNA sequencing on stool swab samples collected from neonatal intensive care unit patients within 7 days of discontinuation of therapy who received ampicillin and tobramycin (AT), ampicillin and cefotaxime (AC), or ampicillin, tobramycin, and metronidazole (ATM). We compared taxonomic composition within term and preterm infant groups between treatment regimens. We calculated adjusted effect estimates for antibiotic type and duration of therapy on the richness of obligate anaerobes and known butyrate-producers in all infants. Results A total of 72 infants were included in the study. Term infants received AT (20/28; 71%) or AC (8/28; 29%) with median durations of 3 and 3.5 days, respectively. Preterm infants received AT (32/44; 73%) or ATM (12/44; 27%) with median durations of 4 and 7 days, respectively. Compositional analyses of 67 stool swab samples demonstrated low diversity and dominance by potential pathogens. Within 1 week of discontinuation of therapy, each additional day of antibiotics was associated with lower richness of obligate anaerobes (adjusted risk ratio [aRR], 0.84; 95% confidence interval [CI], .73–.95) and butyrate-producers (aRR, 0.82; 95% CI, .67–.97). Conclusions Each additional day of antibiotics was associated with lower richness of anaerobes and butyrate-producers within 1 week after therapy. A longitudinally sampled cohort with preexposure sampling is needed to validate our results.

Download Full-text

Negative Consequences of Providing Nursing Care in the Neonatal Intensive Care Unit

Nursing Outlook ◽

10.1016/j.outlook.2018.08.004 ◽

2018 ◽

Vol 66 (6) ◽

pp. 576-585 ◽

Cited By ~ 1

Author(s):

Riko Sano ◽

Rachel F. Schiffman ◽

Kotaro Shoji ◽

Kathleen J. Sawin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Nursing Care ◽

Neonatal Intensive Care ◽

Negative Consequences

Download Full-text

Nosocomial Sepsis and its Risk Factors: A Cross-Sectional Study in a Neonatal Intensive Care Unit

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v2i1.24970 ◽

2019 ◽

Vol 2 (1) ◽

pp. 52-59

Author(s):

Sunil Kumar Yadav ◽

SP Yadav ◽

P Kanodia ◽

N K Bhatta ◽

R R Singh ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Nosocomial Sepsis

Introduction: Nosocomial sepsis is a common and serious infection of neonates who are admitted in intensive care unit. They lead to significant morbidity and mortality in both developed and resource limited countries. The neonatal intensive care unit (NICU) is a suitable environment for disseminating the infections and, hence, needs preventive intervention. The study was carried out to determine the risk factors for nosocomial sepsis in neonatal intensive care unit. Material and Methods: This was a cross-sectional study conducted in a seven bedded teaching and referral hospital NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Nosocomial sepsis was diagnosed according to the CDC criteria. Risk factors for nosocomial sepsis were analyzed with Chi-square test and Logistic regression model. P-value of <0.05 was considered significant. Results: Low birth weight (both preterm and IUGR) and mechanical ventilation were found to be related with nosocomial sepsis. Conclusions: Low birth weight and mechanical ventilation were the most important risk factors fornosocomial sepsis.

Download Full-text