The Effect of Contingent Singing on Infants with Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit.

A significant component of care for infants with bronchopulmonary dysplasia (BPD) is providing an optimal environment for supporting neurodevelopment and growth. Interventions that support the behavioral and physiologic stability of this population may play an important role in improving overall outcomes. Contingent singing is a music intervention that allows the caregiver to tailor certain musical elements, such as rhythm and tempo, to match behavioral and physiologic cues and support the infant in achieving optimal stabilization. A randomized crossover design was used to study the effect of contingent singing on the behavioral state and physiologic measures compared to standard care practices in the neonatal intensive care unit (NICU). Data were collected on a sample of 37 infants diagnosed with BPD. There were no significant differences in the physiologic measures or behavioral states of infants in the contingent singing sessions compared to control sessions. Parents and staff reported favorable views of music therapy in the NICU, and there were no adverse responses from infants during contingent singing. Further research is needed to determine the effectiveness of this intervention on the physiologic stability of infants with BPD.

Comparison of Psychological and Physiological Stress in NICU Nurses: Effects of Unit Design and Shift.

BACKGROUND: Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied. PURPOSE: To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift. METHODS: Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models. RESULTS: NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001). IMPLICATIONS FOR PRACTICE: Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress. IMPLICATIONS FOR RESEARCH: Strategies are needed for reducing stress in NICU nurses who work night shift.

Optimum Detection of Ureaplasma in Premature Infants.

BACKGROUND: Ureaplasma spp. is a known risk factor for bronchopulmonary dysplasia in premature infants. Emerging research suggests treatment with azithromycin or clarithromycin in the first days of life (DOLs) reduces bronchopulmonary dysplasia in Ureaplasma spp. positive infants. Side effects of these antibiotics make it imperative to optimize reliable noninvasive screening procedures to identify infants who would benefit from treatment. METHODS: The aim of this study was to determine the best site and time to screen for Ureaplasma spp. in 24- to 34-week premature infants. Oral, nasal, gastric and tracheal cultures were collected and placed immediately in 10B broth media. Polymerase chain reaction verified culture results and identified the Ureaplasma spp. RESULTS: Cultures yielded a Ureaplasma spp. incidence of 80/168 = 47.6% [95% confidence interval (CI): 40-56]. Nasal cultures had greater sensitivity to detect Ureaplasma spp. than oral cultures (P = 0.008): however, a significant proportion of infants with Ureaplasma spp. would have been missed (12/79 = 15.2%, 95% CI: 8%-25%, P < 0.001) if oral cultures were not obtained. For all sites, the collection at DOL 7-10 were more likely to be positive than the collection at DOL 1-2: however, a significant proportion (5/77 = 6.5%, 95% CI: 2-15, P < 0.001) of infants with Ureaplasma spp. would have been missed if the DOL 1-2 cultures were not obtained. CONCLUSIONS: For optimal Ureaplasma spp. detection in 24- to 34-week premature infants, cultures need to be taken both early and late in the first 10 DOLs both from nasal and oral secretions.

Care of 500-1500 Gram Premature Infants in Hybrid Incubators.

BACKGROUND: Although technological advances have improved devices used to maintain the temperatures of 500- to 1500-g infants, managing the thermal environment remains challenging. PURPOSE: To evaluate the effects of 2 methods of thermal support provided by a hybrid incubator during routine care in the first week of life. METHODS: This descriptive, comparative study evaluates changes in temperature, humidity, heart rate, and oxygen saturation in the incubator versus radiant warmer (canopy) modes of hybrid warmers using data downloaded from the incubator and the monitor. The impact of the Boost Curtain on temperature when opening the portholes during the incubator mode was also examined. Mixed-effects linear models and the log-rank test were used to analyze patient data to determine the effect of thermal support on temperature and humidity changes during care, as well as during the postcare period. RESULTS: Entering the incubator through the portholes improved temperature control compared with using the canopy mode. The Boost Curtain resulted in an overall temperature stability and heat gain. IMPLICATIONS FOR PRACTICE: Nurses caring for premature infants in hybrid incubators should minimize incubator openings and utilize portholes rather than the canopy whenever practical. The Boost Curtain should be used when opening the portholes during the incubator mode. IMPLICATIONS FOR RESEARCH: Comparing time, accuracy, and tolerance of procedures in the canopy versus incubator modes would improve nurses' ability to determine the best approach for different clinical scenarios.

Improving communication between obstetric and neonatology teams for high-risk deliveries: a quality improvement project.

Summoning is a key component of communication between obstetrics and neonatal resuscitation team (NRT) in advance of deliveries. A paging system is a commonly used summoning tool. The timeliness and information contained in the page help NRT to optimally prepare for postdelivery infant care. Our aim was to increase the frequency that summoning pages contained gestational age and reason for NRT attendance to >90%. At baseline, 8% of pages contained gestational age and 33% of pages contained a reason for NRT attendance. Sequential Plan-Do-Study-Act cycles were used as our model for quality improvement. During the 8-month improvement period, the per cent of pages increased to 97% for gestational age and 97% for reason for NRT attendance. Measures of page timeliness, our balancing measure, did not change. Summoning communication between obstetric and NRT is crucial for optimal perinatal outcomes. The active involvement of all stakeholders throughout the project resulted in the development of a standardised paging tool and a more informative paging process, which is a key communication tool used in many centres.

Journey to Becoming a Neonatal Nurse Practitioner: Making the Decision to Enter Graduate School.

BACKGROUND: Neonatal nurse practitioners (NNPs) play an important role in caring for premature and ill infants. Currently, there is a shortage of NNPs to fill open positions. Understanding how nurses decide to become NNPs will help practicing nurse practitioners, managers, and faculty encourage and support nurses in considering the NNP role as a career choice. PURPOSE: To describe how nurses decide to enter graduate school to become nurse practitioners. METHODS: A qualitative study using semistructured interviews to explore how 11 neonatal intensive care unit nurses decided to enter graduate school to become NNPs. RESULTS: Key elements of specialization, discovery, career decision, and readiness were identified. Conditions leading to choosing the NNP role include working in a neonatal intensive care unit and deciding to stay in the neonatal area, discovering the NNP role, deciding to become an NNP, and readiness to enter graduate school. Important aspects of readiness are developing professional self-confidence and managing home, work, and financial obligations and selecting the NNP program. IMPLICATIONS FOR PRACTICE: Neonatal nurse practitioners are both positive role models and mentors to nurses considering the role. Unit managers are obligated to provide nurses with opportunities to obtain leadership skills. Faculty of NNP programs must be aware of the impact NNP students and graduates have on choices of career and schools. IMPLICATIONS FOR RESEARCH: Exploring the decision to become an NNP in more geographically diverse populations will enhance understanding how neonatal intensive care unit nurses decide to become NNPs.

Wolff-Parkinson-White Syndrome in a Term Infant Presenting With Cardiopulmonary Arrest.

BACKGROUND: Wolff-Parkinson-White syndrome is a congenital abnormality of the cardiac conduction system caused by the presence of an abnormal accessory electrical pathway between the atria and the ventricles. This can result in intermittent tachyarrhythmias such as supraventricular tachycardia. In rare occasions, sudden death may occur from atrial fibrillation with rapid ventricular conduction. Supraventricular tachycardia typically has a sudden onset and offset, classified as a paroxysmal arrhythmia. Because of the variable occurrence, Wolff-Parkinson-White syndrome may go undiagnosed in the immediate newborn period. PURPOSE: To highlight arrhythmia as a possible cause of sudden decompensation in infants. CASE FINDINGS/RESULTS: The clinical presentation of this infant is complex and a number of potential diagnoses were considered. Preexcitation on electrocardiogram resulted in the diagnosis of Wolff-Parkinson-White syndrome. IMPLICATIONS FOR PRACTICE: Nurses caring for infants should be alert to tachycardia and irregularities of the heart rate, including those in the prenatal history, and should report them for evaluation. While all parents should be taught to watch for signs of illness, parents of infants with Wolff-Parkinson-White have additional learning needs, including recognizing early signs and symptoms of heart failure.

Examination of the newborn with congenital scoliosis: focus on the physical.

Although scoliosis at birth is rare, conditions at birth and in the newborn period predispose newborns to the development of scoliosis in later life. Scoliosis is congenital when associated with abnormal vertebral segmentation regardless of the age of diagnosis. Other conditions may predispose neonates to vertebral damage or the development of sustained uneven forces on the developing spine. Although it is difficult to know which newborns will progress to developing scoliosis, it is important to be aware of risk factors to provide anticipatory education for parents and to arrange appropriate follow-up after discharge. This article reviews the embryology of vertebral formation and risk factors for the development of scoliosis. The discussion includes the incidence, risk factors, genetics, associated problems, physical examination, and nursing implications of the infant with congenital scoliosis.

Part 3: examination of the newborn with closed spinal dysraphism.

Spinal dysraphism, an incomplete closure of the neural tube, can be open, exposing the neural elements to the environment, or can be closed, covered with skin. Abnormal development of the spine occurs early in life and also interferes with usual development of the skin. This often creates cutaneous markers or stigmata over the area. Cutaneous markers may include a subcutaneous mass, abnormal hair growth, skin dimple, tag or sinus, or unusual pigmentation. Recognizing these markers is important because, although many closed spinal dysraphisms are asymptomatic at birth, neurological sequelae can occur. The sequelae are insidious and often permanent. This article, Part 3 in a series of articles devoted to spinal assessment, reviews closed spinal dysraphisms. The article emphasizes identification of various cutaneous markers associated with closed spinal dysraphisms. Early detection and follow-up may prevent neurologic sequelae for the infant later in life.

Examining the newborn with an open spinal dysraphism.

Spinal dysraphism includes a constellation of frequent and potentially complex malformations of the spine and spinal cord. Open spinal dysraphisms, the majority of which are myelomeningoceles, have a number of associated morbidities that require both immediate and lifelong medical care. The role of the neonatal nurse includes the immediate stabilization of the affected infant, systematic examination of the malformation, and implementation of evidence-based protocols to ameliorate the associated medical problems. Coordination of care and communication and support of the family are essential aspects of care. This article reviews the embryology of open spinal dysraphisms and the steps needed to stabilize and evaluate affected infants.

Part 1: recognizing neonatal spinal cord injury.

Neonatal spinal cord injury can occur in utero, as well as after either a difficult delivery or a nontraumatic delivery. Spinal cord injury can also be related to invasive nursery procedures or underlying neonatal pathology. Early clinical signs of spinal cord injury that has occurred in utero or at delivery includes severe respiratory compromise and profound hypotonia. Knowledge of risk factors and awareness of symptoms is required for early recognition and appropriate treatment. This article reviews the embryological development of the spinal column highlighting mechanisms of injury and identifying underlying factors that increase the risk of spinal cord injury in newborns. Signs and symptoms of injury, cervical spine immobilization, and the differential diagnosis are discussed. Nursing implications, general prognosis, and research in spinal cord injury are provided.