Mothers' Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care.

BACKGROUND: Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. PURPOSE: The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago. METHODS: In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant's birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis. RESULTS: Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother-nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving. IMPLICATIONS FOR PRACTICE: Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance. IMPLICATIONS FOR RESEARCH: Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers.

Non-operative advances: what has happened in the last 50 years in paediatric surgery?

Paediatric surgeons remain paediatric clinicians who have the unique skill set to treat children with surgical problems that may require operative intervention. Many of the advances in paediatric surgical care have occurred outside the operating theatre and have involved significant input from medical, nursing and allied health colleagues. The establishment of neonatal intensive care units, especially those focusing on the care of surgical infants, has greatly enhanced the survival rates and long-term outcomes of those infants with major congenital anomalies requiring surgical repair. Educational initiatives such as the advanced trauma life support and emergency management of severe burns courses have facilitated improved understanding and clinical care. Paediatric surgeons have led with the non-operative management of solid organ injury following blunt abdominal trauma. Nano-crystalline burn wound dressings have enabled a reduced frequency of painful dressing changes in addition to effective antimicrobial efficacy and enhanced burn wound healing. Burns care has evolved so that many children may now be treated almost exclusively in an ambulatory care setting or as day case-only patients, with novel technologies allowing accurate prediction of burn would outcome and planning of elective operative intervention to achieve burn wound closure.

[THE VALLEY IS A DREAM"--ON THE HISTORY OF THE NEONATAL INTENSIVE CARE UNIT IN THE HA'EMEK MEDICAL CENTER].

The establishment of the Cooperative Merhavia in 1910 marked the beginning of the settlement in the Jezreel Valley. The medical services started to develop almost simultaneously, with a small number of physicians and nurses who came in the wake of the first settlers and set up infirmaries in the region's communities mainly to treat malaria and other infectious diseases. The Ha'Emek Medical Center, which celebrates 90 years since its foundation, was the first hospital of Kupat Holim. It started out in a few temporary buildings in Kibbutz Ein Harod and was then transferred to its present location in Afula. Records of treatment of preterm babies go as far back as the 1950s. The Neonatal Intensive Care Unit in Afula was one of the first in Israel and, for many years, served as a referral center for hospitals in the North and Sharon regions, until similar departments were gradually founded. The history of the Neonatal Department of the Ha'Emek Medical Center is described, on the background of the development of the medical services, since the earliest settlement in the Jezreel Valley and the foundation of the hospital in Afula.

From intensive care to critical care medicine: a historical perspective.

The evolution of Critical Care Medicine is traced in relationship to its predecessors, namely Intensive Care and Intensive Therapy. This commentary documents the initial physical care rendered by professional nurses in hospitals of the 19th century in locations close to the nursing stations. The development of incubators for newborns and life-support devices to support ventilation and renal function or to reverse fatal arrhythmias characterized Intensive Therapy of the early 20th century. In the most recent 50 years, Critical Care evolved for comprehensive, largely electronic monitoring and automated laboratory measurements to guide intensive therapy of multiorgan failures by critical care physicians and nurse specialists, pharmacists, and respiratory therapists using multiple life-support methodologies and devices.

Dr Mary Crosse, OBE, MD (1900-1972) and the premature baby.

On behalf of Birmingham's Department of Public Health, Dr Crosse developed the Sorrento Premature Baby Unit in 1931 and pioneered the modern care of these small newborn infants in Britain.

Premature Infant Care in the Early 20th Century.

The complex early history of infant incubators provides insight into challenges faced by medical professionals as they promoted care for premature infants in the early 20th century. Despite their absence from the narrative to date, nurses played vital roles in the development of neonatal care. Working in many different settings, from incubator-baby shows to the first hospital unit designed specifically for premature infants, nurses administered quality care and promoted advanced treatment for these newborns.

Evolution of neonatal and pediatric critical care in India.

During the last decade, the disciplines of neonatal and pediatric critical care have rapidly progressed in India. The growth of Neonatal Intensive Care has paced the growth of Pediatric Critical Care. The substantial growth of discipline and the positive improvements in neonatal outcomes are the results of the concerted efforts of the National Neonatal Forum and commitment of expatriate physicians residing in the United States. This article provides the background information regarding perinatal, neonatal, and infant mortalities in India. It also describes the maternal child health care delivery system in the Indian subcontinent.

Historical perspectives of neonatal transport.

A personalized view of the growth and development of neonatal transport is presented. The public display of premature infants in France and Germany and the beginning of the transport incubators in Chicago are explained. How the policy of regionalization was developed and diluted during the readjustment phase is discussed.

The role of the French midwives in establishing the first special care units for sick newborns.

At the end of the 19th century, under Dr. Tarnier's direction, the first trials of incubators were performed at the Paris Maternity. The success led to the construction of a special pavilion for sick newborns. The midwife-in-chief, Mrs. Henry, raised the funds for the construction. The results of the initial trial are reported. In 1892, the successor of Dr. Tarnier, Dr. Budin, the Chair of Obstetrics, did not approve of the condition of the nursery. Mrs. Henry left abruptly. The unit was placed under medical direction in order to bring a scientific approach to the care of the sick newborns. Stepdown units called pouponnieres were created to assure the transition of the infants to the home and decrease neonatal mortality.

A history of neonatal medicine in Iran.

Neonatal medicine was officially initiated in the United States of America in 1973, and in the same year, the American Board of Pediatrics held the first subspecialty examination in the field of neonatal-perinatal medicine. The first Newborn Intensive Care Unit (NICU) in Tehran began its work with great efforts of Prof. Hadi Samaee at Ali-Asghar Children's Hospital, approved by the Ministry of Health as the first standard center for training neonatologists. Hence, the first neonatology fellowship program began in 1986 and two years later (1988) its graduate started work at Ali-Asghar Children's Hospital. Afterwards, more NICUs were built all over the country and equipped gradually. The Iranian Association of Neonatology and Perinatology were founded in 1998 and 2003, respectively. These two scientific associations jointly made recommendations to health officials to develop consistent educational programs for neonatal and maternal health promotion in Iran. Regionalization of maternal-neonatal health services was also another recommendation which has now been presented to the Ministry of Health as a national program to promote neonatal and maternal health status. Thanks to the measures taken so far over the last few years, the index of neonatal mortality has declined from 26 per 1,000 live births in 1990 to 11 per 1,000 live births in 2012.

Early neonatal special care units and their scientific achievements.

Treatment of sick neonates originated in maternity and foundling hospitals in the 19th century. Nosocomial infections and difficult logistics of wet-nursing prevented admission of neonates in most children's hospitals well into the 20th century. In this article, 31 hospitals are described, all located in large cities, in which preterm and sick neonates were treated before the Great Depression. Even though mostly initiated by private charity, these institutions performed research right from the start. Topics included warming and feeding preterm infants, collecting and distributing human milk, developing and storing breast milk substitutes, prevention of rickets and nosocomial infections, maternal and public education regarding infection control, pathoanatomic characterisation of diseases and malformations and epidemiologic studies of infant mortality. These pioneering hospitals, their founding dates, researchers and classic publications are presented in a table.

The changing role of parents in neonatal care: a historical review.

Over the past century, improvements in technology and neonatal care techniques have dramatically reduced infant mortality rates. While this progress continues, a growing body of literature supports the significant role that parents play in the development of infants, particularly within the hospital setting. Throughout much of the twentieth century, various barriers prevented many parents from participating in thc care of their neonates, negatively influencing infant outcomes. Today parental involvement in neonatal carc has become a key part of a larger family-centered care model. This historical review describes how past neonatal care practices affected the roles of parents, from absence or indirect involvemcnt to the important involved roles of today. Understanding current trends in relation to these past experiences may encourage the formulation of family-centered care practices now and in the friture.

[Ivo Nasso: infection medicine specialist and founder of neonatal intensive care]. / Ivo Nasso: infettivologo e fondatore della terapia intensiva neonatale.

Ivo Nasso (1892-1976), graduated in medicine in 1919, dedicated his work to the study of infectious diseases and was responsible for promoting the study of medicine for preterm and small for age patients and neonatal intensive care in Italy. Nasso developed one of the first pilot centres for immature infants. In fact, in the 1950s in Milan the mortality rate for immature infants in their first year of life was approximately 50%, whereas in the United States the figure was around 20-25% and in France around 35%. The installation of an immature infants' unit in Milan signaled a decrease in infant mortality down to 30%. The pilot centre for immature infants of the University of Milan was composed of 2 visiting rooms with wide glass doors, allowing the relatives to see the babies, an area for sterilisation, a milk bar and 4 hospitalisation rooms; one with incubators and one without, the room for babies in pre-discharging stages and one for isolated confinement. Thermostatic and thermo-electric cots were used. During the planning of the pilot centre Nasso arranged the isolated confinement area in such a way as to be able to identify the infections which he held to be of fundamental importance in the care of low weight babies. Particular importance was allotted to the pre-discharging area, which was comprised of a large area in the style of a veranda, enabling easier acclimatization.

Prematurity as a public health problem: US policy from the 1920s to the 1960s.

During the 1920s and 1930s, a number of physicians created model premature infant stations in select hospitals, arguing that medicine could successfully treat premature infants, most of whom could be expected to live normal lives. Most hospitals and doctors, however, remained indifferent to the special medical needs of premature infants. Subsequently, public health officials, beginning in Chicago, took up the cause of the medical management of newborn premature infants, defining the problem and finding the resources for a community-wide solution. The latter included multiple, high-quality premature nurseries, infant transport, regionalization, and public financing. The "Chicago model" was adapted by many state and municipal departments of health, particularly after World War II, to create community-based programs, the largest of which was in New York City. As premature infant care became of greater interest to pediatricians and hospitals, in part because of the success achieved by public health officials, the earlier, prominent role of the latter was increasingly diminished and historically forgotten.