Oral Care in Critically Ill Infants and the Potential Effect on Infant Health: An Integrative Review.

BACKGROUND: Critically ill infants admitted to the neonatal intensive care unit are at risk for ventilator-associated pneumonia and abnormal oral colonization. Adherence to evidence-based guidelines for oral care in critically ill adults is associated with improved short- and long-term health outcomes. However, oral care guidelines for critically ill infants admitted to the neonatal intensive care unit have not been established, possibly increasing their risk of ventilator-associated pneumonia and other health complications. OBJECTIVE: To describe and summarize the evidence regarding oral care for critically ill infants admitted to the neonatal intensive care unit and to identify gaps needing further investigation. METHODS: The MEDLINE (through PubMed) and CINAHL databases were searched for observational studies and randomized controlled trials investigating the effect of oral care on oral colonization, ventilator-associated pneumonia, and health outcomes of infants in the neonatal intensive care unit. RESULTS: This review of 5 studies yielded evidence that oral care may promote a more commensal oral and endotracheal tube aspirate microbiome. It may also reduce the risk of ventilator-associated pneumonia and length of stay in the neonatal intensive care unit. However, the paucity of research regarding oral care in this population and differences in oral care procedures, elements used, and timing greatly limit any possible conclusions. CONCLUSIONS: Oral care in critically ill infants may be especially important because of their suppressed immunity and physiological immaturity. Further appropriately powered studies that control for potential covariates, monitor for adverse events, and use recommended definitions of ventilator-associated pneumonia are needed to make clinical recommendations.

Neonatal intensive care unit sound levels before and after structural reconstruction.

PURPOSE: This study compared sound levels before and after structural reconstruction within an NICU. STUDY DESIGN AND METHODS: Using a descriptive design, sound level recordings (in decibels, A-weighted scale) of the Leq, L10, and Lmax were measured continuously for 8 hours (0600-1400) before and after reconstruction in an NICU located in north central Florida. RESULTS: Levels before reconstruction were Leq M = 60.44 dB, L10 M = 59.26 dB, and Lmax M = 78.39 dB. The average overall sound levels after reconstruction were Leq M = 56.4 dB, L10 M = 60.6 dB, and LmaxM = 90.6 dB. Although an approximate 4-decibel decrease in the Leq sound level after reconstruction was noted, a similar decrease in the L10 and Lmax did not occur. Furthermore, sound levels after reconstruction in the NICU still exceeded recommended levels (Leq < 50 dB, L10 < 55 dB, and Lmax < 70 dB). CLINICAL IMPLICATIONS: Findings from this study demonstrated the positive impact that reconstruction can have on sound levels (4 dB Leq decrease); however, additional interventions may be needed to meet the current standards for noise reduction in an NICU.