Validação de tecnologia educacional sobre fototerapia para orientar familiares de neonatos ictéricos / Validation of educational technology on phototherapy to guide family members of icteric neonates / Validación de tecnología educativa sobre fototerapia para orientar a familiares de neonatos ictéricos

Objetivo: validar tecnologia educacional sobre fototerapia para orientar familiares de neonatos ictéricos. Método: estudo de desenvolvimento metodológico, realizado em 2012, com nove juízes especialistas, 11 enfermeiros assistenciais e 11 familiares, mediante aplicação de questionários submetidos à análise estatística. Foi realizado em uma maternidade pública estadual no município de Manaus, Brasil. Resultados: a tecnologia a ser validada foi do tipo álbum seriado, com dupla face, intitulado A luz que cura, a mão que cuida. O Índice de Validade de Conteúdo (IVC) foi de 79,7%. O Índice de Concordância (IC) na validação de aparência foi de 96,1% entre enfermeiros e 97,2% entre familiares. Conclusão:a tecnologia educacional mostrou-se válida quanto ao conteúdo e aparência, com potencial para orientar familiares de neonatos ictéricos por enfermeiros que atuam na área neonatal e maternidade.

Objective: to validate an educational technology on phototherapy designed to guide family members of icteric neonates. Method: a methodological study carried out in 2012 with 9 specialist, 11 nursing assistants and 11 family members, through the application of questionnaires later submitted to statistical analysis. The study was conducted in a state public maternity hospital in the city of Manaus, Brazil. Results: the technology that was to be validated was a double-sided flip chart called The light that heals, the hand that cares. The Content Validity Index was 79.7%. The Concordance Index for the validation of appearance was 96.1% among nurses and 97.2% among family members. Conclusion: the educational technology was validated for content and appearance and demonstrated potential for orientations of family members of icteric neonates conducted by nurses who work in the neonatal and maternity areas.

Objetivo: validar tecnología educativa sobre fototerapia para orientar a familiares de neonatos ictéricos. Método: estudio de desarrollo metodológico, realizado en 2012, con 9 jueces especialistas, 11 enfermeros asistenciales y 11 familiares, mediante aplicación de cuestionarios sometidos al análisis estadístico. Se realizó en una maternidad pública estadual en el municipio de Manaus, AM, Brasil. Resultados: la tecnología validada fue del tipo álbum seriado, con doble cara, titulado La luz que cura, la mano que cuida. El Índice de Validez de Contenido fue del 79,7%. El Índice de Concordancia en la validación de apariencia fue del 96,1% entre enfermeros y el 97,2% entre familiares. Conclusión: la tecnología educativa se mostró válida en cuanto al contenido y apariencia, con potencial para orientar a familiares de neonatos ictéricos por enfermeros que actúan en el área neonatal y maternidad.

Neonatal jaundice.

Essential facts The National Institute for Health and Care Excellence (NICE) first published guidelines on jaundice in newborn babies in 2010 and updated them in May. Jaundice is caused by raised bilirubin levels when red blood cells are broken down.

Maternal satisfaction with a novel filtered-sunlight phototherapy for newborn jaundice in Southwest Nigeria.

BACKGROUND: In many resource-limited settings, the availability of effective phototherapy for jaundiced infants is frequently hampered by lack of, or inadequate resources to acquire and maintain conventional electric-powered phototherapy devices. This study set out to ascertain maternal experience and satisfaction with a novel treatment of infants with significant hyperbilirubinemia using filtered sunlight phototherapy (FSPT) in a tropical setting with irregular access to effective conventional phototherapy. METHODS: A cross-sectional satisfaction survey was conducted among mothers of jaundiced infants treated with FSPT in an inner-city maternity hospital in Lagos, Nigeria from November 2013 to March 2014. Mothers' experience during treatment was elicited with a pretested questionnaire consisting of closed and open-ended items. Satisfaction was rated on a five-point Likert scale. Correlates of overall maternal satisfaction were explored with descriptive and inferential non-parametric statistics. RESULTS: A total of 191 mothers were surveyed, 77 (40%) of whom had no prior knowledge of neonatal jaundice. Maternal satisfaction was highest for quality of nursing care received (mean: 4.72 ± 0.55, median: 5[IQR: 5-5]) and lowest for physical state of the test environment (mean: 3.85 ± 0.74, median: 4[IQR: 3-4]). The overall rating (mean: 4.17 ± 0.58, median: 4[IQR: 4-5]) and the observed effect of FSPT on the babies (mean: 4.34 ± 0.58, 4[IQR: 4-5]) were quite satisfactory. FSPT experience was significantly correlated with the adequacy of information received (p < 0.0005), test environment (p = 0.002) and the observed effect of FSPT on the child (p < 0.0005). Almost all mothers (98.4%) indicated willingness to use FSPT in future or recommend it to others, although some (30 or 15.7%) disliked the idea of exposing newborns to sunlight. CONCLUSIONS: Mothers of jaundiced newborns in this population are likely to be satisfied with FSPT where it is inevitable as an alternative to conventional electric-powered phototherapy. Adequate information, good test environment and friendly nursing care must be ensured for satisfactory maternal experience.

Management of neonates with hyperbilirubinemia: improving timeliness of care using a clinical pathway.

BACKGROUND: Neonatal hyperbilirubinemia is a common reason for neonates to present to the emergency department (ED). Although clinical practice guidelines provide recommendations for evaluation and therapy, few studies have evaluated ways to apply them effectively in the ED setting. The primary objective of this study was to compare time to phototherapy in neonates presenting to the ED with jaundice before and after implementation of a nursing-initiated clinical pathway. Secondary outcomes included time to bilirubin result and ED length of stay in neonates. METHODS: We performed a retrospective historical control study comparing neonates presenting to the ED with jaundice during 9-month periods before and after initiation of the pathway. Charts were abstracted for times of assessment and treatment and final disposition. RESULTS: Three hundred neonates were included in this study: 149 before and 151 after pathway implementation. Median time to phototherapy (historical control: 128 minutes vs postintervention group: 52 minutes; P < .001), median time to bilirubin result (157 vs 99; P < .001), and median ED length of stay (268 minutes vs 195 minutes; P < .001) were shorter for neonates treated after the implementation of the clinical pathway. No complications were reported during the study period. CONCLUSIONS: After implementation of a clinical pathway for the management of neonates with jaundice in the ED, we observed a reduction in time to phototherapy, time to bilirubin measurement, and overall length of stay.

Prolonged jaundice in neonates.

Jaundice is common in neonates and is often the reason for a parent to consult a community midwife or health visitor. It is known that up to 40 per cent of breastfed infants are jaundiced at 14 days of age and a proportion of these infants are referred to paediatric services for assessment and blood investigations. Most often the investigations reveal a high bilirubin level but otherwise normal liver function results, leading to a diagnosis of breastfeeding jaundice, with no treatment required other than reassurance to the parents and monitoring. A recent clinical audit is presented which evaluates current clinical practice and the results reflect breast feeding as the main reason for prolonged jaundice. This is followed by some guidance for the community health practitioners with the aim of reducing referral of otherwise well neonates with jaundice and reducing invasive investigations.

Percepções maternas sobre o neonato em uso de fototerapia / Maternal perceptions about the newborn in use of phototherapy

A fototerapia é o tratamento inicial da icterícia neonatal. Objetivamos conhecer a percepção da mãe acerca da fototerapia e identificar as suas dificuldades, relacionadas ao tratamento fototerápico. Estudo descritivo com abordagem qualitativa, realizado no Alojamento Conjunto (AC) de um hospital público em Fortaleza-CE, com 8 puérperas na faixa etária entre 13 e 25 anos. Os dados foram coletados em maio e junho/2006, mediante entrevista com duas questões de pesquisa: O que representa para a senhora ver o seu filho sob fototerapia; quais são as dificuldades enfrentadas em relação aos cuidados com o seu bebê na fototerapia? Na análise das falas, identificamos as categorias: percepção da mãe com relação ao cuidado com o bebê sob a fototerapia, dificuldades enfrentadas pela mãe com seu filho em fototerapia, e a mãe após as orientações recebidas. Concluímos que existe a necessidade de repensar as orientações e assumir autenticamente os cuidados de enfermagem ao binômio mãe-filho.

Is my baby yellow?

In July 2004, The American Academy of Pediatrics (AAP) summarized the latest medical research regarding newborn jaundice and updated the current clinical guidelines. The AAP recommends that clinicians 1) promote breastfeeding and not routinely supplement newborns with water; 2) assess the risk of severe hyperbilirubinemia before discharge; 3) provide follow-up visits after discharge to assess jaundice; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and kernicterus. This article summarizes the new guidelines.

Randomized controlled trial of compact fluorescent lamp versus standard phototherapy for the treatment of neonatal hyperbilirubinemia.

BACKGROUND: Special blue tube lights of standard length are used in most neonatal units to deliver phototherapy. Of late, special blue compact fluorescent lamp phototherapy equipments have been introduced in India, which are claimed to be better than standard tube lights. AIM: To compare special blue compact fluorescent lamp (CFL) phototherapy with special blue standard-length tube lights (STL). METHODS: This randomized, controlled trial was conducted in a level III NICU. Neonates, otherwise healthy, of gestation greater than 34 weeks with hyperbilirubinemia requiring phototherapy, were included. Rh iso-immunized babies, those who underwent prior exchange transfusion and whose parents declined to consent were excluded. By stratified block randomization, babies were allocated to receive phototherapy by CFL or STL. CFL and STL were both special blue lights with irradiance maintained above 15 microWatts/nm/cm2. Total serum bilirubin (TSB) was measured 12 hourly till phototherapy was stopped or an exchange transfusion was done. Temperature and clinical and laboratory parameters of dehydration were recorded 12 hourly till 72 hrs. Nursing staff answered an objectivized proforma about the disadvantageous effects on nurses. RESULTS: Fifty babies were enrolled in each group. Baseline characteristics, causes of jaundice, hemolysis, baseline TSB and irradiance were similar in both groups. Mean duration of phototherapy (P = 0.98) was similar in both groups. Kaplan-Meier analysis of phototherapy duration showed no difference in the survival curves of the 2 groups (P = 0.6). Axillary temperature was similar in both groups and no baby was dehydrated. Nursing staff reported no significant differences between CFL and STL visavis glare hurting the eyes, giddiness and headache. CONCLUSIONS: CFL phototherapy has no superiority over STL phototherapy in terms of efficacy and adverse effects on the neonate and effects on nursing staff.

Significado de ser mãe de um recém-nascido sob fototerapia: uma abordagem humanística

A icterícia caracterizada pela coloração amarelada da pele e outros órgãos, continua sendo importante causa de enfermidade no período neonatal. Pode ter muitas causas, mas na maioria dos casos é fisiológica, cedendo nos primeiros dias após o nascimento; contudo quando isto não ocorre, ou suspeita-se que seja patológica o neonato é submetido ao tratamento inicial da icterícia neonatal, a fototerapia. Este estudo, orientado por uma abordagem de cunho humanístico teve por objetivo desvelar o significado de ser mãe do recém-nascido em uso de fototerapia. A pesquisa foi realizada em uma Maternidade-Escola pública de grande porte, localizada em Fortaleza-CE, onde exercem os nossas funções de enfermeira assistencial da Unidade de Internação Neonatal (UIN).Os sujeitos foram dez mães de recém-nascidos internados em UIN de alto, médio e baixo risco, submetidos a tratamento fototerápico. O período de coleta de dados ficou com preendido entre maio a julho de 2002. Utilizamos como estratégias a observação participante e o Grupo de Encontro de Saúde com influência das concepções teóricas de Carl Rogers. Como instrumentos utilizamos o diário de campo e um gravador para registrar os diálogos....

Hiperbilirrubinemia neonatal: propostas de intervenções de enfermagem / Neonatal hiperbilirubinemia: proposal for nursing assessment

A hiperbilirrubinemia neonatal é um evento freqüentemente observado em recém-nascidos a termo e prematuros, resultante do aumento dos níveis séricos de bilirrubina total. Trata-se de um estudo de revisão bibliográfica, que tem como objetivos discurrer sobre a assistência de enfermagem ao recém-nascido (RN) portador de hiperbilirrubinemia e submetido a fototerapia e/ou exsangüíneotransfusão, além de propor intervenções de enfermagem adequadas a estes tratamentos. Quanto à fototerapia, a literatura enfatiza: cuidados com pele e temperatura, além do estímulo da interação do binômio mãe e filho. Na exsangüíneotransfusão ressalta-se: o preparo dos materiais necessários para o procedimento e eventuais complicações, monitorização cardiorrespiratória e de pressão arterial, proporcionar equilíbrio térmico, controle glicêmico durante e após o procedimento, promoção de conforto ao RN. Os resultados encontrados possibilitaram concluir que a assistência de enfermagem aplicada ao RN, quando realizada de forma sistematizada, assegura a qualidade desta assistência, promovendo uma melhor e mais rápida recuperação, além de menor incidência de complicações.

Tin-metalloporphyrins: an answer to neonatal jaundice?

Hyperbilirubinemia is a common problem, affecting 45-60 percent of term infants and up to 80 percent of premature neonates. Phototherapy, the standard treatment for neonatal hyperbilirubinemia, is effective but has the potential for adverse effects. Prevention of bilirubin formation, rather than dependence on therapeutic measures to remove excess bile pigment, is a logical alternative. Metalloporphyrins--specifically tin-protoporphyrin (SnPP) and tin-mesoporphyrin (SnMP)--are being used experimentally to prevent and treat neonatal hyperbilirubinemia. This article reports the findings of studies exploring the use of SnPP and SnMP.

Color me yellow: caring for the infant with hyperbilirubinemia.

When caring for the neonate with hyperbilirubinemia, discerning between physiologic jaundice and non-physiologic jaundice is important in determining the needed management techniques. The causes of neonatal jaundice are examined along with contributing factors. Based on these findings, management techniques are discussed including nutrition, fluid support, advice to the breast-feeding mother, and options for in-house or home care management.

Double surface phototherapy on a fluid bed.

Jaundice is a common neonatal problem with a higher incidence in premature infants. Phototherapy is an established treatment modality, effective and safer than exchange transfusion. Double surface phototherapy is more effective. The present methods have drawbacks, viz limited availability, high cost of equipment and difficulties in nursing infants during phototherapy. A modification to the technique which overcomes these difficulties made with equipment available in most neonatal units is described with three case reports of hyperbilirubinaemia successfully treated using this method.

Efficacy of "high-intensity" blue-light and "standard" daylight phototherapy for non-haemolytic hyperbilirubinaemia.

We report our clinical experience with phototherapy in 3802 infants; 3629 were exposed to "standard" daylight phototherapy and 173 to "high-intensity" blue-light phototherapy. High-intensity blue-light phototherapy was twice as effective as standard daylight phototherapy in decreasing bilirubin concentrations. No failures occurred with high-intensity phototherapy compared with an overall failure rate of 1.84/1000 with daylight lamps; these cases were transferred to high-intensity phototherapy with prompt response. Rebound after cessation of phototherapy was greater in those exposed to high-intensity blue light with a significantly greater number requiring a second exposure. However, the incidence was still low. No third exposure was required in any infant. Nursing of infants under high-intensity blue light was more difficult and inconvenient as was clinical monitoring. The light also caused more stress on the nursing and medical personnel. However, the infants tolerated both types of phototherapy equally well. High-intensity blue-light phototherapy would seem to be the treatment of choice for infants with rapidly increasing or very high bilirubin levels, as well as in those not responding adequately to daylight phototherapy.