Neonatal Hypoglycemia.

Neonatal hypoglycemia (NH) is broadly defined as a low plasma glucose concentration that elicits hypoglycemia-induced impaired brain function. To date, no universally accepted threshold (reference range) for plasma glucose levels in newborns has been published, as data consistently indicate that neurologic responses to hypoglycemia differ at various plasma glucose concentrations. Infants at risk for NH include infants of diabetic mothers, small or large for gestational age, and premature infants. Common manifestations include jitteriness, poor feeding, irritability, and encephalopathy. Neurodevelopmental morbidities associated with NH include cognitive and motor delays, cerebral palsy, vision and hearing impairment, and poor school performance. This article offers a timely discussion of the state of the science of NH and recommendations for neonatal providers focused on early identification and disease prevention.

Equity Matters: Introduction to a New Column.

"Equity Matters" is a new column for Neonatal Network designed to further explore and apply the concept of health equity as it relates to supporting neonatal health and family well-being. In this initial column, an overview of health equity and determinants of health is provided. Two frameworks-the Healthy People 2030 strategy (U.S. Department of Health and Human Services) and the American Hospital Association equity roadmap and health equity transformation model-are introduced. Five domains of determinants will be explored in future columns: economic stability, education, social and community context, health and health care, and neighborhood and built environment. The domains of each determinant will be described to provide theoretical and practical approaches to support integration into nursing practice. Neonatal nurses are positioned to recognize health inequities for new families, critically analyze their relationship with the determinants of health, and advocate for strategies to promote health and well-being.

The Evidence-Based Practice Process Steps 4, 5, and 6: Integration, Evaluation, and Dissemination.

This is the final column in a series of columns that began with the January/February 2021 issue of Neonatal Network, describing the evidence-based practice (EBP) project. The series has taken the reader through sparking the spirit of inquiry, asking a compelling question, and searching and critically appraising the literature. This column will briefly describe the final three steps: step 4, the integration of evidence with clinical expertise and patient/family preferences; step 5, the evaluation of outcomes of practice changes based on evidence; and step 6, the dissemination of the outcomes of the EBP change.

Baby Date: a mobile application for teaching nursing care to newborns in primary care.

OBJECTIVE: to develop and validate a mobile application for teaching undergraduates about the first nursing visit to a newborn in primary care. METHOD: methodological study with an Instructional Design framework; content drawn up from scientific documents on caring for newborns and their families, supported by the results of an integrative review on the subject. The Integrated Development Environment Android Studio 4.0.1 tool and the IntelliJ IDEA platform were used to build the digital technology. Experts validated content and students evaluated navigability. RESULTS: the final version of the mobile application contains 67 screens grouped into 12 sections with random access. The device is presented on the introductory screen; this is followed by content on the physical examination, neonatal screening, nutrition, oral health, the vaccination calendar, growth, development, danger signs, and accident prevention; at the end, there is a fact sheet and references. Audiovisual resources (texts, images, and videos) complement the application; experts presented a Content Validity Index (CVI) = 1.00; for nursing students all the items had a CVI = 1.00; only the item "layout and presentation" had a CVI = 0.95. CONCLUSION: the digital technology received a satisfactory evaluation from experts and students. It is innovative in child health care, with the potential to be used in the teaching-learning process of nursing students. BACKGROUND: (1) The mobile application provides content for newborn care in primary care. (2) The mobile application directs the nurse's consultation through evidence of care. (3) The mobile application can be used offline, offering knowledge at any time and place. (4) Navigation does not require a specific order, which gives the user freedom. (5) The mobile application promotes quality care in the first consultation with the newborn in primary care.

Performance Evaluation of a Supervised Machine Learning Pain Classification Model Developed by Neonatal Nurses.

BACKGROUND: Early-life pain is associated with adverse neurodevelopmental consequences; and current pain assessment practices are discontinuous, inconsistent, and highly dependent on nurses' availability. Furthermore, facial expressions in commonly used pain assessment tools are not associated with brain-based evidence of pain. PURPOSE: To develop and validate a machine learning (ML) model to classify pain. METHODS: In this retrospective validation study, using a human-centered design for Embedded Machine Learning Solutions approach and the Neonatal Facial Coding System (NFCS), 6 experienced neonatal intensive care unit (NICU) nurses labeled data from randomly assigned iCOPEvid (infant Classification Of Pain Expression video) sequences of 49 neonates undergoing heel lance. NFCS is the only observational pain assessment tool associated with brain-based evidence of pain. A standard 70% training and 30% testing split of the data was used to train and test several ML models. NICU nurses' interrater reliability was evaluated, and NICU nurses' area under the receiver operating characteristic curve (AUC) was compared with the ML models' AUC. RESULTS: Nurses weighted mean interrater reliability was 68% (63%-79%) for NFCS tasks, 77.7% (74%-83%) for pain intensity, and 48.6% (15%-59%) for frame and 78.4% (64%-100%) for video pain classification, with AUC of 0.68. The best performing ML model had 97.7% precision, 98% accuracy, 98.5% recall, and AUC of 0.98. IMPLICATIONS FOR PRACTICE AND RESEARCH: The pain classification ML model AUC far exceeded that of NICU nurses for identifying neonatal pain. These findings will inform the development of a continuous, unbiased, brain-based, nurse-in-the-loop Pain Recognition Automated Monitoring System (PRAMS) for neonates and infants.

An Exaggeration? Reality?: Can ChatGPT Be Used in Neonatal Nursing?

Artificial intelligence (AI) represents a system endowed with the ability to derive meaningful inferences from a diverse array of datasets. Rooted in the advancements of machine learning models, AI has spawned various transformative technologies such as deep learning, natural language processing, computer vision, and robotics. This technological evolution is poised to witness a broadened spectrum of applications across diverse domains, with a particular focus on revolutionizing healthcare services. Noteworthy among these innovations is OpenAI's creation, ChatGPT, which stands out for its profound capabilities in intricate analysis, primarily facilitated through extensive language modeling. In the realm of healthcare, AI applications, including ChatGPT, have showcased promising outcomes, especially in the domain of neonatal nursing. Areas such as pain assessment, feeding processes, and patient status determination have witnessed substantial enhancements through the integration of AI technologies. However, it is crucial to approach the deployment of such applications with a judicious mindset. The accuracy of the underlying data must undergo rigorous validation, and any results lacking a solid foundation in scientific insights should be approached with skepticism. The paramount consideration remains patient safety, necessitating that AI applications, like ChatGPT, undergo thorough scrutiny through controlled and evidence-based studies. Only through such meticulous evaluation can the transformative potential of AI be harnessed responsibly, ensuring its alignment with the highest standards of healthcare practice.

Barriers to the Implementation of Infant- and Family-Centered Developmental Care From Focus Groups With Neonatal Care Providers.

AIM: Although infant- and family-centered developmental care (IFCDC) is scientifically grounded and offered in many hospitals to some extent, it has not yet been universally implemented as the standard of care. In this article, we aim to identify barriers to the implementation of IFCDC in Belgian neonatal care from the perspective of neonatal care providers. METHODS: We conducted 8 online focus groups with 40 healthcare providers working in neonatal care services. An inductive thematic analysis was carried out by means of Nvivo. RESULTS: The focus groups revealed barriers related to contextual, hospital, and neonatal unit characteristics. Barriers found in the hospital and neonatal unit were related to financing, staffing, infrastructure, access to knowledge/information and learning climate, leadership engagement, and relative priority of IFCDC. Contextual barriers were related to peer pressure and partnerships, newborn/parent needs and resources, external policy, and budgetary incentives. CONCLUSION: Three main barriers to IFCDC implementation have been identified. Resources (staffing, financing, and infrastructure) must be available and aligned with IFCDC standards, knowledge and information have to be accessible and continuously updated, and hospital management should support IFCDC implementation to create an enabling climate, including compatibility with the existing workflow, learning opportunities, and priority setting.

An evaluation of the capabilities of language models and nurses in providing neonatal clinical decision support.

AIM: To assess the clinical reasoning capabilities of two large language models, ChatGPT-4 and Claude-2.0, compared to those of neonatal nurses during neonatal care scenarios. DESIGN: A cross-sectional study with a comparative evaluation using a survey instrument that included six neonatal intensive care unit clinical scenarios. PARTICIPANTS: 32 neonatal intensive care nurses with 5-10 years of experience working in the neonatal intensive care units of three medical centers. METHODS: Participants responded to 6 written clinical scenarios. Simultaneously, we asked ChatGPT-4 and Claude-2.0 to provide initial assessments and treatment recommendations for the same scenarios. The responses from ChatGPT-4 and Claude-2.0 were then scored by certified neonatal nurse practitioners for accuracy, completeness, and response time. RESULTS: Both models demonstrated capabilities in clinical reasoning for neonatal care, with Claude-2.0 significantly outperforming ChatGPT-4 in clinical accuracy and speed. However, limitations were identified across the cases in diagnostic precision, treatment specificity, and response lag. CONCLUSIONS: While showing promise, current limitations reinforce the need for deep refinement before ChatGPT-4 and Claude-2.0 can be considered for integration into clinical practice. Additional validation of these tools is important to safely leverage this Artificial Intelligence technology for enhancing clinical decision-making. IMPACT: The study provides an understanding of the reasoning accuracy of new Artificial Intelligence models in neonatal clinical care. The current accuracy gaps of ChatGPT-4 and Claude-2.0 need to be addressed prior to clinical usage.

Newborn Screening Has Moved Way Beyond PKU.

Nurses need to understand how clinical genetic and genomic applications affect newborn screening and advocate for parents and newborns.

Compassionate Care: Listening Visits Provided by Neonatal Intensive Care Unit Nurses.

PURPOSE: Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences. STUDY DESIGN AND METHODS: This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity. RESULTS: Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU. CLINICAL IMPLICATIONS: For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences.

Racial, Ethnic, and Gender Composition Among Neonatal Nurse Practitioner Faculty Ranks.

BACKGROUND: Despite increases in nursing faculty diversity, representation is lacking in positions of higher faculty rank. Challenges for minority faculty include decreased awareness of promotion standards, less mentoring, and increased stress from being the sole representative of their respective underrepresented population. METHODS: The purpose of this study was to determine the racial, ethnic, and gender composition of neonatal nurse practitioner (NNP) faculty in the United States. A nonexperimental survey was sent to all accredited NNP programs to describe demographics of NNP faculty in the United State. RESULTS: Of the 128 survey participants, 84% self-identified as White. Forty-eight of the participants ranked Professor or Associate professor were White. In contrast, all other races only had 8 respondents who were of the higher faculty ranks. There were only 2 male participants; one identified as full professor and one as associate professor. CONCLUSION: Limitations of this project included a small sample size leading to an inability to determine statistical significance. Previous evidence supports decreased diversity in higher faculty rank in other healthcare providers and the results of this study add to that body of literature. Barriers to increased diversification need to be rectified to ensure health equity to all patients.

Qualitative Study of Nurses' Experiences as They Learned to Provide Neonatal Palliative Care.

OBJECTIVE: To describe the experiences of nurses as they learned to provide palliative care in the NICU. DESIGN: Interpretive description. SETTING: Four NICUs in three Canadian provinces, including one rural center and three tertiary centers. PARTICIPANTS: Nine NICU nurses with 3 to 21 years of experience who provided neonatal palliative care. METHODS: We collected data using online interviews that we recorded and transcribed. We analyzed data using immersion, inductive coding, reflective memoing, and thematic analysis. RESULTS: Participants received little or no formal education in neonatal palliative care and instead learned to provide this care through observation and experience. Participants said it was important to find meaning in their work, which contributed to their motivation to learn to provide high-quality neonatal palliative care. Participants described challenges, including unit cultures in which early palliative care was not embraced. We identified three overarching themes that represented the participants' experiences: Meaning-Making in Neonatal Palliative Care, Challenges in Providing Neonatal Palliative Care, and Ill-Prepared to Provide Neonatal Palliative Care. CONCLUSION: Standardized education may improve the quality of care and nurses' experiences with neonatal palliative care. We recommend designing and evaluating a standardized curriculum on neonatal palliative care.

Maintaining Safe Breastfeeding Practices During the COVID-19 Pandemic: An Overview of the Evidence to Inform Clinical Guidelines.

The impact of the COVID-19 pandemic upon the health care landscape has prompted many organizations to revise policies in response to ever-changing guidelines and recommendations regarding safe breastfeeding practices. The application of these professional guidelines into clinical practice is fraught with barriers, inconsistencies, and often-minimal evidential support. Key concerns for health care providers and patients include antenatal versus postnatal transmission, milk transmission, and separation care versus rooming-in, including the subsequent impacts upon breastfeeding and bonding. While SARS-CoV-2 is a novel virus, the volume of literature to support best practice for couplet care continues to be developed at a rapid pace. The benefits of breastfeeding are steeped in evidence and outweigh the potential risk of transmission of COVID-19 from mother to newborn. Health care organizations must continue to seek guidance for policy revision within the ever-growing body of evidence for best practice and evaluate current practices for feasibility during and after hospitalization.

A Case of Vertical Transmission of COVID-19.

Coronavirus disease 2019 (COVID-19), which is caused by SARS-CoV-2, has overwhelmed health care systems in 2020, affecting millions of lives worldwide. There have, however, been few reports of the effect this virus has on the newborn population. This case study presents an infant with a vertical transmission of COVID-19, including symptoms, diagnosis, and management, to help inform care for the COVID-19-positive infant.

Skin-to-Skin Contact (Kangaroo Care) During the COVID-19 Pandemic.

Early recommendations to separate mothers from their newborns during the coronavirus disease 2019 (COVID-19) pandemic have created a detrimental separation practice. This article presents a review of the latest information regarding the (1) 3 modes of transmission of the virus to the neonate; (2) incidence, clinical signs, and severity of COVID-19 in the neonate; (3) factors to be considered to balance risk and benefits of separation and skin-to-skin contact (SSC) when conducting shared decision making; and (4) compendium of published SSC guidelines; and concludes with recommendations for safe practice of SSC to prevent and/or restrict COVID-19 infection in neonates.

SARS CoV-2 (COVID-19) Current Pharmacotherapy for Mother and Infant.

The novel coronavirus disease 2019 (COVID-19), appeared in the United States over 1 year ago. This virus has a wide range of presentations, from being asymptomatic to causing severe acute respiratory syndrome, which can lead to death. It has led to a worldwide effort to find effective treatments, from repurposed medications to new discoveries, as well as the push to develop effective vaccines. As the race to fight this pandemic unfolds, this column provides what is currently available to combat this virus, how it has been utilized in the pregnant population, and what data have been made available about how these treatments affect fetal development and the neonate.