Families as partners in neonatal neuro-critical care programs.

Parents of neonates with neurologic conditions face a specific breadth of emotional, logistical, and social challenges, including difficulties coping with prognostic uncertainty, the need to make complex medical decisions, and navigating new hopes and fears. These challenges place parents in a vulnerable position and at risk of developing mental health issues, which can interfere with bonding and caring for their neonate, as well as compromise their neonate's long-term neurodevelopment. To optimize neurologic and developmental outcomes, emerging neonatal neuro-critical care (NNCC) programs must concurrently attend to the unique needs of the developing newborn brain and of his/her parents. This can only be accomplished by embracing a family-centered care environment-one which prioritizes effective parent-clinician communication, longitudinal parent support, and parents as equitable partners in clinical care. NNCC programs offer a multifaceted approach to critical care for neonates at-risk for neurodevelopmental impairments, integrating expertise in neonatology and neurology. This review highlights evidence-based strategies to guide NNCC programs in developing a family-partnered approach to care, including primary staffing models; staff communication, implicit bias, and cultural competency trainings; comprehensive and tailored caregiver training; single-family rooms; flexible visitation policies; colocalized neonatal and maternal care; uniform mental health screenings; follow-up care referrals; and connections to peer support. IMPACT: Parents of neonates with neurologic conditions are at high-risk for experiencing mental health issues, which can adversely impact the parent-neonate relationship and long-term neurodevelopmental outcomes of their neonates. While guidelines to promote families as partners in the neonatal intensive care unit (NICU) have been developed, no protocols integrate the unique needs of parents in neonatal neurologic populations. A holistic approach that makes families true partners in the care of their neonate with a neurologic condition in the NICU has the potential to improve mental and physical well-being for both parents and neonates.

Neuroprotección mediante hipotermia moderada en recién nacidos con encefalopatía hipóxico-isquémica / Neuroprotection by mild hypothermia in newborn with hypoxic-ischemic encephalopathy

En la mayoría de los países desarrollados el tratamiento con la hipotermia se ha convertido en un pilar fundamental para la neuroprotección del recién nacido con encefalopatía hipóxico-isquémica (EHI). En la unidad de cuidados intensivos neonatales de la universidad de Duke, la hipotermia moderada se aplica desde el 2005. El tratamiento con hipotermia es muy limitado en otros países porque en adición a un equipamiento especializado, requiere de manejo detallado de las disfunciones multiorgánicas, documentación meticulosa de la información clínica con cuidados y control del paciente en forma protocolizada. Como punto de partida, y para facilitar la introducción de la hipotermia en las unidades de cuidados intensivos neonatales en Uruguay, se presenta la evolución de cinco pacientes internados en la unidad de cuidados intensivos del centro hospitalario de Duke (Carolina del Norte, EE.UU.), evaluando la respuesta al tratamiento con hipotermia moderada y su evolución clínica