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.

Nursing Diagnosis of Neonatal Jaundice: Study of Clinical Indicators.

PURPOSE: This study aimed to identify the defining characteristics of, and examine their association with, the nursing diagnosis (ND) of Neonatal Jaundice (00194) in sample of hospitalized newborns. DESIGN AND METHODS: A cross-sectional study developed with 100 newborns aged between 24h and ten days. Data collection was performed in a public hospital of tertiary health care between March and June of 2016. RESULTS: The ND of Neonatal jaundice was present in 31% of the sample. The most frequent defining characteristics were yellow-orange skin color (65%) and abnormal blood profile (75%). Yellow mucous membranes, yellow-orange skin color and bruised skin showed statistically significant sensitivity and specificity. Yellow mucous membranes, yellow sclera and yellow-orange skin color were statistically associated with Neonatal jaundice. Yellow mucous membranes showed the best diagnostic accuracy measurements. CONCLUSIONS: The clinical indicators that best predicted and increased the probability of developing jaundice were identified. PRACTICE IMPLICATIONS: These clinical indicators increase the ability of nurses to clinically infer nursing diagnoses. This allows nurses to identify signs and symptoms of health conditions in a sensible and definitive manner, decreasing the possibility of errors.

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.

Comparison of two transcutaneous bilirubinometers in term and near-term neonates.

PURPOSE: Determination of bilirubin levels is performed for many newborns in the first days of life, and several different transcutaneous bilirubinometers are available. We aimed to determine whether transcutaneous bilirubin measurement, as performed using Jaundice Detector JH20-1C, a new device, correlates with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. DESIGN AND SAMPLE: The study was performed on term or near-term newborn infants who underwent transcutaneous bilirubin measurements as part of their normal care. The study group consisted of 585 newborn infants with gestational ages ranging from 35 to 42 weeks, coming from an uneventful pregnancy. In this prospective study, bilirubin concentrations were determined with two different transcutaneous bilirubinometers. MAIN OUTCOME VARIABLE: In 585 infants, the correlation coefficient for Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was .965 (p < .0001). The mean (± standard deviation) difference between the Jaundice Detector JH20-1C versus Minolta Air-Shields Jaundice Meter model JM-103 was 0.26 ± 0.95 mg/dL. Results showed the Jaundice Detector JH20-1C to have an acceptable level of intradevice imprecision (r = .978, p < .0001, mean differences .0158 ± .871 mg/dL). RESULTS: Jaundice Detector JH20-1C showed the good performances of intradevice and interdevice imprecision in comparison with Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. Jaundice Detector JH20-1C may be suitable for screening term or near-term newborn infants for jaundice in the well-baby nursery or maternity ward.

Delayed cord clamping: a collaborative practice to improve outcomes.

Delayed cord clamping is a collaboration between the obstetric team and the neonatal team. Although the optimal timing for clamping the umbilical cord after birth continues to be subject to study, delaying clamping for at least 30-60 seconds, with the newborn held at or below the level of the uterus/placenta supports normal physiology and has proven benefits. Practical issues such as thermoregulation and equipment can be overcome with team collaboration and prebriefing planning. Neonatal nurses who attend deliveries are perfectly poised to influence this practice and improve short- and long-term outcomes for their patients.

Clinical update: understanding jaundice in the breastfed infant.

Breastfed infants are more likely to be jaundiced than infants who are formula fed. Community practitioners need to understand the physiology of jaundice and the issues associated with breastfeeding so that they can support parents. Visible jaundice is a result of hyperbilirubinaemia and, in most cases, is harmless and caused by normal physiological processes. It does, however, require detection monitoring and sometimes treatment to prevent rare but serious health complications. Although some debate remains over the association between breastfeeding and jaundice, the literature suggests that in the breastfed infant, early onset jaundice may be a result of insufficient intake of breast milk and prolonged jaundice may be related to a constituent of breast milk itself (breast milk jaundice). Early breastfeeding support to promote good positioning, attachment and baby-led feeding may help prevent early onset jaundice. Management of jaundice in the breastfed infant involves referral to local services to determine bilirubin levels and exclude pathologies.

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.

Maternal experience with neonatal jaundice.

PURPOSE: To describe the lived experience of mothers having an infant with neonatal jaundice. STUDY DESIGN AND METHODS: A descriptive phenomenological design with 6 mothers who had infants with neonatal jaundice. Streubert's method of phenomenology guided the collection, organization, and analysis of data to abstract themes. RESULTS: Eight major themes emerged relating to the lived experience: (1) physical and emotional exhaustion, (2) feeling robbed, (3) distressed by infant's physical appearance, (4) loss of control, (5) maternal vigilance, (6) feeling discounted but only for so long, (7) family impact, and (8) supportive environment. Three major themes emerged relating to the mother's educational experience: (1) everyone has a different opinion, and therefore no one really knows for sure; (2) feeling defensive and at fault; and (3) knowing now what I would do differently if I had another baby. Mothers reported receiving infant care advice contrary to guidelines from multiple healthcare providers. CLINICAL IMPLICATIONS: In this study the physical, emotional, and learning needs of the mothers were rarely met. Nurses are the healthcare professionals who have the most contact with new mothers, and therefore must remain current with the evidence for appropriate care. Much needs to be done to help mothers who have infants with neonatal jaundice. Additional studies about how nurses and other healthcare providers interact with families facing this problem are warranted.

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.

Neonatal hematologic disorders.

Neonatal hematology is a complex subspecialty of pediatric hematology, combining the unique aspects of the maternal/fetal relationship, the delicate balance of coagulation factors, and the distinctive physiologic conditions of the newborn period. The objective of this article is to briefly review specific hematologic disorders that commonly present in the newborn period. Alloimmune cytopenias, polycythemia, thrombosis and bleeding associated with vitamin K deficiency will be discussed through a focus on pathophysiology, signs and symptoms, current treatment strategies, and implications for nursing care.