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1.
Eur J Pediatr ; 183(4): 1759-1763, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38240763

RESUMO

Initial discharge from a neonatal intensive care unit (NICU) to home is a crucial milestone that impacts preterm infants, their families, and NICUs. Standardized discharge programs individualized for family needs can ensure a safe transfer of care to parents, decrease the length of stay and hospital costs, and improve parents' satisfaction. To assess the degree of variability in the current discharge criteria of preterm infants less than 34 weeks' gestation among Canadian NICUs, explore different institution-specific guidelines and degree of adherence to the Canadian Paediatric Society (CPS) guidelines. A clinical representative of each of the 117 level 2-4 Canadian NICUs was contacted via email to participate in an anonymous survey link regarding the discharge criteria of preterm infants. Responders from ninety-eight NICUs (84%), representing all Canadian provinces, completed the survey. Most were nurse practitioners (43%) and neonatologists (31%) with > 5 years of experience (87%). Level 3 and 4 NICUs represented 63% of responses. Units varied widely in many discharge criteria and in their adherence to CPS guidelines. Most of the units (81%) lack written discharge guidelines; 60% do not have a dedicated discharge coordinator, and 45% do not have a post-discharge clinic. Only 25% routinely teach parents CPR and only half of the surveyed units provide parental support programs.   Conclusion: There is a significant heterogeneity in discharge practices of preterm infants among Canadian NICUs. This survey provides a basis for benchmarking and knowledge sharing. What is Known: • Discharging preterm infants from the NICU impacts preterm infants, their families, and NICUs. • All efforts should ensure a safe transfer of care to parents, decrease the length of stay, better utilize resources, and improve parents' satisfaction. What is New: • The discharge criteria of preterm infants vary widely among NICUs. • This survey provides benchmark information and exposes the need to better standardize discharge practices and the subsequent support for infants and parents.


Assuntos
Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Lactente , Recém-Nascido , Humanos , Criança , Alta do Paciente , Assistência ao Convalescente , Canadá
2.
Am J Perinatol ; 36(2): 141-147, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29945280

RESUMO

OBJECTIVE: This article assesses the degree of variability in the current practice of skin antiseptics used in Canadian neonatal intensive care units (NICUs) and different experiences related to each antiseptic used. METHODS: An anonymous survey was distributed to a clinical representative of each of the 124 Canadian level II and level III NICUs. RESULTS: One hundred and two respondents (82.2%), representing all Canadian provinces, completed the survey. Chlorhexidine gluconate with/without alcohol was the antiseptic most used (96%) and the antiseptic with the highest reported adverse effects (68% reported skin burns/breakdown). Other antiseptics used include povidone-iodine (35%) and isopropyl alcohol (22%). Specific guidelines for antiseptic use were available in only 50% of the units with many NICUs lacking gestational and/or chronological age restrictions. Only 23% of responders believed that there was awareness among health care providers of the adverse effects of antiseptics used. Less than half (43%) were completely satisfied with the antiseptics used in their units. CONCLUSION: Chlorhexidine gluconate is the most commonly used antiseptic in Canadian NICUs. The high number of associated adverse effects and the lack of guidelines regulating antiseptic use are of concern. Large clinical trials are urgently needed to guide practice and improve the safety of antiseptics.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Unidades de Terapia Intensiva Neonatal , Padrões de Prática Médica , 2-Propanol/efeitos adversos , 2-Propanol/uso terapêutico , Anti-Infecciosos Locais/efeitos adversos , Canadá , Clorexidina/efeitos adversos , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Estudos Transversais , Idade Gestacional , Pesquisas sobre Atenção à Saúde , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Corpo Clínico Hospitalar , Recursos Humanos de Enfermagem Hospitalar , Política Organizacional , Povidona-Iodo/efeitos adversos , Povidona-Iodo/uso terapêutico , Guias de Prática Clínica como Assunto
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