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 Towards a safer and more efficient neonatal transfer system in South Africa: A qualitative inquiry with advanced life support paramedics

2021 ◽  
Vol 18 ◽  
Author(s):  
Pradeep Ashokcoomar ◽  
Raisuyah Bhagwan
Keyword(s):  
South Africa ◽  
Critically Ill ◽  
Transfer Process ◽  
Life Support ◽  
Advanced Life Support ◽  
Qualitative Inquiry ◽  
Research Approach ◽  
Western Cape ◽  
Group Discussions ◽  
Kwazulu Natal

Introduction The inter-healthcare transfer of the critically ill neonate is a critical aspect of larger neonatal intensive care, as it influences the safe transport of neonates from the receiving to the referring hospital. It is crucial then that the transfer process be safe and efficient so as not to compromise the already fragile condition of the neonate. The aim of the study was to understand the challenges advanced life support (ALS) paramedics face during neonatal transfers and to understand how the process could be made safer and more efficient. The objectives related to understanding the transfer process, the challenges linked to the critically ill neonate and the difficulties associated with the ambulance vehicle and equipment. Methods Using a qualitative research approach we sought the views of ALS paramedics at the forefront of transfers nationally. In-depth interviews were held with eight paramedics in KwaZulu-Natal and four focus group discussions with ALS paramedics in KwaZulu-Natal, Gauteng, Free State and the Western Cape in South Africa. A total of 35 ALS paramedics were involved in these group discussions. Results The study uncovered several challenges that paramedics face related to poor organisational preparation for transfer of the critically ill neonate, and other crucial issues that compromise the transfer such as inadequate or defective equipment. Conclusion There is a need for greater scrutiny of the transfer process and a commitment from stakeholders to begin addressing the challenges confronting the safe transfer of critically ill neonates.

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 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 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.

Use of Predictive Modeling to Plan for Special Event Medical Care During Mass Gathering Events

2019 ◽  
Vol 13 (5-6) ◽  
pp. 874-879
Author(s):  
Rachel L. Allgaier ◽  
Nina Shaafi-Kabiri ◽  
Carla A. Romney ◽  
Lee A. Wallis ◽  
John Joseph Burke ◽  
...  
Keyword(s):  
South Africa ◽  
Resource Allocation ◽  
Life Support ◽  
Advanced Life Support ◽  
Western Cape ◽  
Mass Gathering ◽  
World Cup ◽  
Mass Gathering Medicine ◽  
Number Of Patients ◽  
Patient Presentation

ABSTRACTObjectives:In 2010, South Africa (SA) hosted the Fédération Internationale de Football Association (FIFA) World Cup (soccer). Emergency Medical Services (EMS) used the SA mass gathering medicine (MGM) resource model to predict resource allocation. This study analyzed data from the World Cup and compared them with the resource allocation predicted by the SA mass gathering model.Methods:Prospectively, data were collected from patient contacts at 9 venues across the Western Cape province of South Africa. Required resources were based on the number of patients seeking basic life support (BLS), intermediate life support (ILS), and advanced life support (ALS). Overall patient presentation rates (PPRs) and transport to hospital rates (TTHRs) were also calculated.Results:BLS services were required for 78.4% (n = 1279) of patients and were consistently overestimated using the SA mass gathering model. ILS services were required for 14.0% (n = 228), and ALS services were required for 3.1% (n = 51) of patients. Both ILS and ALS services, and TTHR were underestimated at smaller venues.Conclusions:The MGM predictive model overestimated BLS requirements and inconsistently predicted ILS and ALS requirements. MGM resource models, which are heavily based on predicted attendance levels, have inherent limitations, which may be improved by using research-based outcomes.

NRP Versus PALS for Infants Outside the Delivery Room: Not If, but When?

2021 ◽  
Vol 41 (6) ◽  
pp. 22-27
Author(s):  
Jaime Esbensen Doroba
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Delivery Room ◽  
Background Information ◽  
Neonatal Resuscitation Program ◽  
Support Guidelines

Background Both the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines can be used for infants requiring cardiopulmonary resuscitation outside the delivery room. Each set of guidelines has supporting algorithms for resuscitation; however, there are no current recommendations for transitioning older infants outside the delivery room. Objective To provide background information on the algorithms in the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines and to discuss the role that nurses and advanced practice nurses play in advancing scientific research on resuscitation. Content Covered Summaries of both sets of guidelines, differences in practices, and recommendations for practice changes will be discussed. Discussion Provider preference and unit practice determine which guidelines are used for infants outside the delivery room. Providers in pediatric intensive care units and pediatric cardiac intensive care units often use the Pediatric Advanced Life Support guidelines, whereas providers in neonatal intensive care units use the Neonatal Resuscitation Program guidelines for infants of the same age. The variation in resuscitation practices for infants outside the delivery room can negatively affect resuscitation outcomes.

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.

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