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BACKGROUND: The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery. PURPOSE: The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health. METHODS: We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities. DISCUSSION: This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse. CONCLUSION: In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.
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BACKGROUND: Very preterm infants (less than 32 weeks gestational age) experience acute morbidity during their stay in a neonatal intensive care unit. Because of their prematurity and frequent laboratory testing, they experience anemia, requiring correction with packed red blood cell (PRBC) transfusion(s). PRBC transfusions have been linked to neonatal morbidity, such as necrotizing enterocolitis, but never signs and symptoms of physiological stability. OBJECTIVE: The secondary data analysis aimed to examine very preterm infants' physiological stability before, during, and after PRBC transfusions. METHODS: A within-case, mixed-methods design was used in a secondary data analysis for 16 transfusion cases from 13 very preterm infants. RESULTS: The findings showed very preterm infants with physiological variables falling within defined limits based on gestational age during the transfusion. Two contrasting case exemplars will be presented. DISCUSSION: PRBC transfusions are necessary and prevent morbidity in very preterm infants. Observing instability during transfusions and prospectively studying hypothermia, cardiac instability, and thermal gradients is essential to design interventions to decrease morbidity associated with PRBC transfusions.
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Anemia Neonatal , Enfermedades del Prematuro , Recién Nacido , Humanos , Lactante , Recien Nacido Prematuro , Transfusión de Eritrocitos/efectos adversos , Anemia Neonatal/prevención & control , Anemia Neonatal/complicaciones , Recién Nacido de muy Bajo Peso , Edad Gestacional , Enfermedades del Prematuro/terapiaRESUMEN
BACKGROUND: The coronavirus pandemic disrupted normal clinical operations and research. Nurse scientists conducting research studies in the neonatal intensive care unit experienced significant challenges to continuing their research studies amid national lockdowns and hospital visitation restrictions. OBJECTIVES: The purpose of this article is to describe the challenges encountered by nurse scientists conducting research studies in the neonatal intensive care unit during the pandemic, the creative solutions devised to overcome these barriers, and the lessons learned during this unprecedented time. METHODS: Using our pandemic area studies as exemplars, we highlight the barriers encountered in continuing our research in the intense environment of the neonatal intensive care unit. RESULTS: Visitor restrictions limited the presence of parents and researchers in the neonatal intensive care unit during the pandemic, causing disruptions to participant recruitment and data collection. Laboratory closures further limited research activities during the pandemic. Strategies to overcome these barriers include building formal collaborations among researchers and clinicians, creating the infrastructure to support virtual recruitment and electronic consent, and developing contingency plans for studies involving the analysis of biological samples. DISCUSSION: The neonatal intensive care unit is a unique environment because of vulnerable patient population and need for researchers to interact with parents to recruit study participants. Implementing the strategies developed during the coronavirus pandemic may allow for the continuation of research activities during future public health crises.
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Unidades de Cuidado Intensivo Neonatal , Pandemias , Humanos , Recién Nacido , PadresRESUMEN
BACKGROUND: Neonatal sepsis causes morbidity and mortality in preterm infants. Clinicians need a predictive tool for the onset of neonatal infection to expedite treatment and prevent morbidity. Abnormal thermal gradients, a central-peripheral temperature difference (CPtd) of >2°C or <0°C, and elevated heart rate characteristic (HRC) scores are associated with infection. OBJECTIVE: This article presents the protocol for the Predictive Analysis Using Temperature and Heart Rate Study. METHODS: This observational trial will enroll 440 very preterm infants to measure abdominal temperature and foot temperature every minute and HRC scores hourly for 28 days to compare infection data. Time with abnormal thermal gradients (Model 1) and elevated HRC scores (Model 2) will be compared to the onset of infections. For data analysis, CPtd (abdominal temperature - foot temperature) will be investigated as two derived variables, high CPtd (number/percentage of minutes with CPtd of >2°C) and low CPtd (number/percentage of minutes with CPtd of <0°C). In the infant-level model, the outcome yi will be an indicator of whether the infant was diagnosed with an infection in the first 28 days of life, and the high CPtd and low CPtd variables will be the average over the entire observation period, logit(yi) = ß0 + xiß1 + ziγ. For the day-level model, the outcome yit will be an indicator of whether the ith infant was diagnosed with an infection on the tth day from t = 4 through t = 28 or the day that infection is diagnosed (25 possible repeated measures), logit(yit) = ß0 + xitß1 + zitγ. It will be determined whether a model with only high CPtd or only low CPtd is superior in predicting infection. Also, the correlation of abnormal HRC scores with high CPtd and low CPtd values will be assessed. DISCUSSION: Study results will inform the design of an interventional study using temperatures and/or heart rate as a predictive tool to alert clinicians of cardiac and autonomic instability present with infection.
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Temperatura Corporal/fisiología , Recien Nacido Extremadamente Prematuro/fisiología , Enfermedades del Prematuro/diagnóstico , Sepsis Neonatal/diagnóstico , Ensayos Clínicos como Asunto , Humanos , Recién Nacido , Enfermedades del Prematuro/prevención & control , Unidades de Cuidado Intensivo Neonatal , Monitoreo Fisiológico/métodos , Sepsis Neonatal/prevención & control , Estudios Observacionales como Asunto , Equilibrio Hidroelectrolítico/fisiologíaRESUMEN
BACKGROUND: Previously, we recorded periods of time with foot higher than abdominal temperatures in association with infection in preterm infants. Monitoring dual temperatures may be an important tool to assess infant instability. Currently, incubators cannot measure and display dual temperatures in servo-control mode. PURPOSE: To examine the usability of GE Healthcare's Giraffe OmniBed with research software to measure, display, and record dual temperatures, and their differences while in servo-control. In addition, nurses' perceptions of the use and display of dual temperatures and differences were evaluated. METHODS: A multiple-case, mixed-methods design. Abdominal and foot temperatures were measured, displayed, and stored for 28 days for 14 preterm infants. Nurses were surveyed for satisfaction and preferences with the dual temperature display. Nurses noted abnormal temperature differences and infant condition in bedside journals. RESULTS: Study infants were 26 to 31 weeks of gestational age and 670 to 1410 g. Abdominal, foot, and the abdominal-foot temperature difference was measured, recorded, and downloaded successfully in all infants over all days. Nurses liked using dual temperature display with the abdominal-foot temperature difference. Surveys indicated preferences for larger displays and alarms for abnormal values. Thermal instability, stimulation, and thermistor detachment were associated with abnormal thermal gradients. Two exemplar cases are presented. IMPLICATIONS FOR PRACTICE: Monitoring dual temperatures adds information to the clinical assessment. IMPLICATIONS FOR RESEARCH: Studies are needed to examine relationships between abnormal thermal gradients and infections, infant stability, and nursing care along with the underlying physiologic mechanisms. Studies are needed for wireless dual temperature monitoring.
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Incubadoras para Lactantes , Recien Nacido Prematuro , Temperatura Corporal , Regulación de la Temperatura Corporal , Edad Gestacional , Humanos , Recién Nacido , TemperaturaRESUMEN
BACKGROUND: Very low birth weight (VLBW) infant thermal instability upon neonatal intensive care unit admission has been associated with respiratory morbidity; however, the association between ongoing thermal instability and respiratory morbidity remains unclear. METHODS: A longitudinal data analysis was conducted on 12 VLBW infants. Chronic respiratory morbidity risk was defined as supplemental oxygen requirement (FiO2) or scheduled diuretic dosing at 36 weeks post-menstrual age. Acute respiratory morbidity was quantified as desaturations (SpO2<90%), bradycardia with desaturations (HR<100 and SpO2<90%), apnea, increase in FiO2 requirement, or increase in respiratory support. Multi-level, mixed-effects models and regression analysis examined the relationships between body temperature over the first 14 days of life and respiratory morbidities. RESULTS: Body temperature was not associated with chronic respiratory morbidity risk (p=0.2765). Desaturations, bradycardia with desaturations, increased FiO2 requirement, and increased respiratory support were associated with decreased body temperature (p<0.05). Apnea was associated with increased body temperature (p<0.05). The covariate-adjusted risk of desaturations (aOR=1.3), bradycardia with desaturations (aOR=2.2), increase in FiO2 requirement (aOR=1.2), and increase in respiratory support (aOR=1.2) were significantly greater during episodes of hypothermia. CONCLUSION: VLBW infants are dependent on a neutral thermal environment for optimal growth and development. Therefore, the significant associations between hypothermia and symptoms of acute respiratory morbidity require further study to delineate if these are causal relationships that could be attenuated with clinical practice changes, or if these are concurrent symptoms that cluster during episodes of physiological instability.
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Temperatura Corporal , Recién Nacido de muy Bajo Peso , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Estudios Longitudinales , MorbilidadRESUMEN
The purpose of this study is to identify the most supportive and restrictive factors contributing to students' ability to persist through nursing program course completion as perceived by 59 nontraditional students enrolled in a nursing associate degree program. The Student Perception Appraisal-Revised tool was used. Results include that encouragement by friends within school is the top supportive factor, while financial status was found to be the most restrictive factor. Students' perceptions of why they are not successful in staying in school may help nurse educators to plan and implement changes for improvement based on changing student needs.
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Graduación en Auxiliar de Enfermería/organización & administración , Abandono Escolar/estadística & datos numéricos , Estudiantes de Enfermería/psicología , Humanos , Investigación en Educación de Enfermería , Factores de Riesgo , Estudiantes de Enfermería/estadística & datos numéricosRESUMEN
BACKGROUND: Maintaining a productive research enterprise within a college of nursing is multifaceted and complex. It is especially challenging when a college's mission transitions to address other priorities, and later attempts to re-emerge in the competitive funding environment and re-establish a productive research portfolio. PURPOSE: To describe how a college is rebuilding the research enterprise to meet the established research mission after a decade of marginal research productivity. STRATEGIES: Targeted multi-level strategies at the university, college, and individual levels are being implemented to enhance the research infrastructure and faculty capacity to increase research productivity. IMPACT: In the past five years, compared to the previous five years, annual faculty publications have doubled, annual extramural funding per tenure track faculty increased by 72%, and the College's average extramural sponsored award funding per year increased 118%. National Institutes for Research rankings moved from no ranking (2013) to top 31 (2017). DISCUSSION: Early results are positive and efforts to maintain and further grow the research enterprise will require sustained effort to meet ongoing challenges.
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Investigación Biomédica/historia , Investigación Biomédica/organización & administración , Facultades de Enfermería/historia , Facultades de Enfermería/organización & administración , Universidades/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , South CarolinaRESUMEN
BACKGROUND: Approximately half of the 55,000 very low birth-weight infants (<1500 g) born in the United States each year develop bronchopulmonary dysplasia (BPD). Many etiologies have been associated with the development of BPD, including aberrant temperature/humidity levels of artificial ventilation. PURPOSE: The purpose of this literature review is to explore what is known regarding inspired air temperature/humidity levels from artificial ventilation in very premature infants, focusing on what levels these infants actually receive, and what factors impact these levels. METHODS/SEARCH STRATEGY: PubMed, CINAHL, Scopus, and Web of Science were searched. Of the 830 articles retrieved, 23 were synthesized for study purpose, sample/study design, and temperature/humidity findings. FINDINGS/RESULTS: Heating and humidification practices studied in neonatal ventilation did not maintain recommended levels. In addition, human neonatal studies and noninvasive neonatal ventilation research were limited. Furthermore, ventilation settings, environmental temperatures, and mouth position (in noninvasive ventilation) were found to impact temperature/humidity levels. IMPLICATIONS FOR PRACTICE: Environmental temperatures and ventilatory settings merit consideration during artificial ventilation. In addition, aberrant temperature/humidity levels may impact infant body temperature stability; thus, employing measures to ensure adequate thermoregulation while receiving artificial ventilation must be a priority. IMPLICATIONS FOR RESEARCH: This review underscores the need for further research into current warming and humidification techniques for invasive and noninvasive neonatal ventilation. A focus on human studies and the impact of aberrant levels on infant body temperature are needed. Future research may provide management options for achieving and maintaining target temperature/humidity parameters, thus preventing the aberrant levels associated with BPD.
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Displasia Broncopulmonar/terapia , Calor/uso terapéutico , Humedad , Respiración Artificial/métodos , Respiración Artificial/normas , Ventiladores Mecánicos/normas , Humanos , Humedad/normas , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Ventilación no Invasiva/métodos , TemperaturaRESUMEN
BACKGROUND: Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants. PURPOSE: To evaluate the effectiveness of a Golden Hour protocol for infants born at less than 32 weeks' gestation on improving the admission process in a military care facility. Specific aims focused on temperature, time to initiation of intravenous (IV) fluids, time to administration of antibiotics, and time to close of the incubator top. METHODS: A pre-/postdesign was used to compare outcomes from preimplementation to postimplementation. Predata were collected using electronic health record chart review and postdata were collected from the Neonatal Intensive Care Unit admission worksheet. RESULTS: Although we did not find statistical significance, we found that more infants had a temperature greater than 36.5°C within 1 hour of birth and decrease in time to initiation of IV fluids and antibiotics from preimplementation to postimplementation, which is clinically significant. Time to close of the incubator top remained greater than 1 hour. IMPLICATIONS FOR PRACTICE: Implementation of a Golden Hour protocol provides a guide to caring for preterm infants during the first hour of life to improve patient outcomes. Involvement of key stakeholders and staff education are key to successful implementation. IMPLICATIONS FOR RESEARCH: Researchers should examine long-term outcomes related to implementation of a Golden Hour protocol in future studies. Future quality improvement projects should include the effectiveness of similar protocols and address possible barriers.
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Antibacterianos/uso terapéutico , Temperatura Corporal , Fluidoterapia/métodos , Hipoglucemia/prevención & control , Hipotermia/prevención & control , Cuidado Intensivo Neonatal/métodos , Sepsis Neonatal/prevención & control , Mejoramiento de la Calidad , Glucemia/metabolismo , Protocolos Clínicos , Práctica Clínica Basada en la Evidencia , Femenino , Edad Gestacional , Glucosa/uso terapéutico , Hospitales Militares , Humanos , Hipoglucemia/metabolismo , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Masculino , Tiempo de TratamientoRESUMEN
BACKGROUND: Hypothermia is related to increased morbidity and mortality in very preterm infants; continuous temperature monitoring is necessary. Thermoregulation is limited in preterm infants. OBJECTIVES: The purpose of the research was to assess and describe negative temperature differential (NTD) and assess the associations of NTD with infant demographic characteristics, medical history, and clinical events. METHODS: An exploratory, case study design was used. Abdominal and foot temperature was measured every minute over the first 2 weeks of life in 22 preterm infants at less than 29 weeks gestational age. RESULTS: All infants experienced NTD. Daily NTD in all infants across all study days ranged from 0 to 70.7%; 2-week mean NTD over all infants ranged from 7.3% to 38.5%. Four infants treated for late onset of infection had a higher NTD than 18 infants without infection (M = 27.8%, SD = 9.52 vs. M = 16.4%, SD = 5.34, p < .05). Although not statistically significant, higher mean percentage of NTD was noted in infants having early onset infection (24.1% vs. 16.4%), African American race (20.0% vs. 15.3%), and/or being born to a mother who smoked during pregnancy (26.6% vs. 16.7%). DISCUSSION: A larger study is needed to examine associations between NTD and race, maternal smoking history, and infection. NTD might be used as a biomarker to guide acute clinical care and identify infants at risk for acute and chronic morbidity.
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Hipotermia/diagnóstico , Enfermedades del Prematuro/prevención & control , Recien Nacido Prematuro , Efectos Tardíos de la Exposición Prenatal/prevención & control , Temperatura Corporal , Femenino , Edad Gestacional , Humanos , Hipotermia/etiología , Hipotermia/prevención & control , Recién Nacido , Enfermedades del Prematuro/etiología , Unidades de Cuidado Intensivo Neonatal , Masculino , Embarazo , Efectos Tardíos de la Exposición Prenatal/etiología , Pronóstico , Fumar/epidemiologíaRESUMEN
BACKGROUND: Hypothermia is a problem for very premature infants after birth and leads to increased morbidity and mortality. Previously we found very premature infants exhibit abnormal thermal patterns, keeping foot temperatures warmer than abdominal temperatures for their first 12h of life. PURPOSE: We explored the utility of infrared thermography as a non-invasive method for measuring body temperature in premature infants in an attempt to regionally examine differential temperatures. RESULTS: Our use of infrared imaging to measure abdominal and foot temperature for extremely premature infants in heated, humid incubators was successful and in close agreement using Bland and Altman technique with temperatures measured by skin thermistors. CONCLUSIONS: Our study methods demonstrated that it was feasible to capture full body temperatures of extremely premature infants while they were resting in a heated, humid incubator using a Flir SC640 infrared camera. This technology offers researchers and clinicians a method to examine acute changes in perfusion differentials in premature infants which may lead to morbidity.
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Temperatura Corporal , Recien Nacido Prematuro/fisiología , Termografía/métodos , Regulación de la Temperatura Corporal , Femenino , Humanos , Recién Nacido , Rayos Infrarrojos , MasculinoRESUMEN
BACKGROUND: Very low birth-weight (<1500 g) infants are vulnerable to their environment during the first hour after birth. We designed an evidence-based golden hour protocol (GHP) with a goal to stabilize and perform admission procedures within 1 hour of birth at a level IIIB neonatal intensive care unit (NICU). PURPOSE: The aim of this quality improvement project was to ascertain whether an evidence-based GHP would improve care efficiency and short-term outcomes. METHODS: Rapid cycles of change using Plan Do Study Act were utilized to document progress and gain knowledge during the quality improvement project. Measures were plotted with statistical process control methods (SPC), which analyzed improvement over time. RESULTS: Both admission temperature and glucose-level means were within reference range throughout the project and predicted a stable process. We observed significantly decreased time to initiation of intravenous fluids and antibiotics. An upward trend of surfactant administration within the first 2 hours of life was also observed. IMPLICATIONS FOR PRACTICE: The use of a GHP provided an organized approach to admission procedures and care. By using a checklist and recording intervention times, NICU caregivers were more aware of time management for each intervention and were able to decrease time to initiation of intravenous fluids and antibiotics. IMPLICATIONS FOR RESEARCH: Future research should focus on establishing normal blood pressure ranges and safe pain management during the "golden hour" and beyond. Future quality improvement should focus on improving subsequent temperature and blood glucose levels after admission umbilical artery and venous catheter placement.
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Cuidado del Lactante/métodos , Recién Nacido de muy Bajo Peso , Cuidado Intensivo Neonatal/métodos , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad , Tiempo de Tratamiento , Antibacterianos/administración & dosificación , Glucemia , Temperatura Corporal , Protocolos Clínicos , Fluidoterapia , Humanos , Recién Nacido , Surfactantes Pulmonares/administración & dosificaciónRESUMEN
BACKGROUND: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. METHODS: 367 preterms born at <32 weeks gestational age (GA) between 2019-2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. RESULTS: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). CONCLUSIONS: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.
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Preterm infants have increased morbidity and mortality due to immature physiology and neonatal complications. Necrotizing enterocolitis (NEC) is a devastating gastrointestinal complication that affects morbidity and mortality in preterm infants. The authors present an adaptation of Neuman's systems model called the NEC systems model to explore intrinsic and extrinsic factors leading to NEC in preterm infants. The literature was searched for theoretical models to guide exploration of neonatal disease influenced by the environment. Neuman's Systems Model provides a holistic approach to care of the system, offering a foundation to develop frameworks to examine preterm infants in their environment with associated stressors.
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Enterocolitis Necrotizante , Enfermedades del Recién Nacido , Lactante , Recién Nacido , Humanos , Recien Nacido Prematuro , Teoría de SistemasRESUMEN
BACKGROUND: High-dose interleukin-2 is a therapy available for individuals with renal cell carcinoma; however, it can produce adverse effects, specifically depressive symptoms. There is limited information regarding the trajectory of depressive symptoms and measurement-based care assessment of depressive symptoms. OBJECTIVE: The purpose was to describe the trajectory of depressive symptoms and compare 2 depression measures. METHODS: A descriptive, mixed-method case study approach was used to describe the longitudinal trajectory of depressive symptoms The qualitative assessment included a journal entry and an interview. The quantitative depression symptom severity measures included the 8-item self-report Patient-Reported Outcomes Measurement Information System Depression and the 30-item Inventory of Depressive Symptomatology-Clinician Rated (IDS-C). RESULTS: Ten cases were enrolled. The maximum number of interleukin-2 doses that any patient received within a single hospitalization ranged from 4 to 12. Mean scores on the 8-item Patient-Reported Outcomes Measurement Information System Depression showed no changes in depressive symptoms from pretreatment to posttreatment, nor across hospitalizations. Mean total scores on the IDS-C increased from "normal" to "mild severity" depressive symptom range across all treatment cycles, suggesting transient depressive symptoms within hospitalizations. Qualitative data from the case supported the IDS-C increase, suggesting that the patient developed depressive symptoms pretreatment to posttreatment. CONCLUSIONS: Understanding the trajectory of depressive symptoms allows for the identification of critical time points when depressive symptoms present and change across treatment. It is critical to use measurement-based care using validated measures to assess for the presence and changes in depressive symptoms. IMPLICATIONS FOR PRACTICE: Validated self-report or clinician-rated depression symptom measures should be used to document the presence or absence of depressive symptoms in this population.
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Depresión , Neoplasias , Humanos , Depresión/epidemiología , Interleucina-2/efectos adversos , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológicoRESUMEN
Infants born preterm are at a significantly higher likelihood of having autism spectrum disorder (ASD). Preterm birth and ASD are both associated with neurological differences, notably autonomic nervous system (ANS) dysfunction, pointing to preterm ANS dysfunction as a potential pathway to ASD, particularly in VPT infants. In this study, a subset of very preterm (VPT) infants enrolled in a large, multisite clinical trial were enrolled in this study at birth (N=20). Continuous measures of minute-by-minute thermal gradients, defined by the difference between central and peripheral temperatures, and hour-by-hour abnormal heart rate characteristics (HRCs) were collected from birth-28 days (>40,000 samples/infant). Following NICU discharge, standardized measures of cognition, language, and motor skills were collected at adjusted ages 6, 9, and 12 months. At 12 months, assessments of social communication and early ASD symptoms were administered. Results suggest significant ASD concerns for half of the sample by 12 months of age. Neonatal abnormal HRCs were strongly associated with 12-month ASD symptoms (r=0.81, p<.01), as was birth gestational age (GA), birth weight (BW), and abnormal negative thermal gradients. ANS measures collected in the first month of neonatal life, more than a year prior to the ASD evaluation, were surprisingly strong predictors of ASD. This study highlights complementary ANS measures that describe how ANS dysfunction, likely resulting from an imbalance between the parasympathetic and sympathetic systems, may impact very early regulatory processes for neonates who later develop ASD. This finding offers a promising avenue for researching ANS-related etiological mechanisms and biomarkers of ASD.
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Neonatal hypothermia poses an increased risk of infection, hypoglycemia, metabolic dysfunction, and mortality, particularly in preterm or low birthweight (LBW) infants. However, early detection of hypothermia and prompt thermoregulation can mitigate these effects thus, the need for continuous neonatal temperature monitoring. The BEMPU TempWatch is a small bracelet designed for continuous temperature monitoring for neonates. When the body temperature falls below 36.5ËC, the bracelet generates an alarm sound and flashes an orange light, indicating hypothermia. This study aimed to assess the validity of the BEMPU TempWatch in detecting hypothermia in a clinical setting in Ghana using sensitivity and specificity. Additionally, the study sought to identify factors associated with misclassification using logistic regression analysis. A standardized questionnaire collected information about the mother, pregnancy, delivery, and neonate. The BEMPU TempWatch was placed on the wrist of the neonate, and over a 24-hour follow-up period, a nurse took 4-hourly axillary temperature readings using a digital thermometer. Whenever the device's alarm sounded, a nurse immediately checked and recorded the axillary temperature, undertook necessary clinical actions, and rechecked after 30 minutes. Among the 249 neonates included in the study, 57.0% were female, 12.5% were extremely LBW, and 13.7% were extremely preterm. Based on 1,973 temperature readings, the sensitivity of the BEMPU TempWatch in detecting hypothermia was 67.8%, and the specificity was 95.9%. The sensitivity was lower among neonates being treated in incubators (58.4%) compared to those not (82.7%). Sensitivity was higher among neonates with LBW (1,500-2,500g) (73.5%) than very or extremely LBW neonates (<1,500g) (62.8%). The results showed that the BEMPU TempWatch had significantly fewer misclassifications among neonates who were not treated in an incubator, received only breastmilk, and were not born extremely preterm. Further studies are warranted to evaluate the effectiveness of the BEMPU TempWatch on neonatal health outcomes.
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BACKGROUND: There is a need to facilitate research collaboration between PhD- and DNP-educated faculty at colleges and schools of nursing. Both types of doctoral-prepared faculty are hired, and their skills and expertise are often different yet complementary. Strengthening collaborations can contribute to new knowledge and the translation of research into practice. PURPOSE: The purpose of this study was to implement four strategies to foster research and scholarship productivity and evaluate the outcomes. METHOD: We implemented four strategies to foster collaboration. Two interactional strategies included Research Exchange (an annual event) and an enhanced matchmaking and mentoring plan. The two organizational strategies implemented were internal research pilot funds and writing clubs. RESULTS: All four approaches have been found to be effective in improving research collaboration and scholarship outcomes, including presentations, manuscripts, and proposals for external funding. Faculty have provided suggestions for further improvements. CONCLUSIONS: National trends indicate that there may be more DNP-prepared faculty than PhD-prepared faculty hired at colleges and schools of nursing. As such, it is useful to develop and purposefully offer approaches such as the four strategies described to enhance research productivity, facilitate career progression, and contribute to improved patient outcomes.