Lateral kangaroo position for thermal stability of extremely preterm: Non-inferiority randomized controlled trial.

BACKGROUND: Kangaroo care (KC) is an evidence-based best practice that can prevent major health complications in preterm infants. However, there is a lack of evidence on the feasibility and safety of placing extremely preterm infants under 28 weeks gestational age in KC position. AIM: To compare thermal stability 60 min after the first KC session in the lateral versus prone position in extremely preterm infants under 28 weeks gestational age. STUDY DESIGN: This is a single-centre, randomized, non-inferiority, parallel clinical trial. The patients were extremely preterm infants during their first 5 days of life. Infants in the intervention group received KC in the lateral position while those in the control group received KC in the prone position. All infants receiving KC were inside their polyethylene bags but maintained skin-to-skin contact. The primary outcome was the axillary temperature of the infants, and the secondary outcome was the development of intraventricular haemorrhage. RESULTS: Seventy infants were randomized (35 per group). The mean gestational age was 26 +1(1+1) in both groups. In the first KC session, the infant temperature at 60 minutes was 36.79°C (0.43) in lateral KC position, and 36.78°C (0.38) in prone KC position (p = .022). In lateral KC position, 7.69% (2) of the children who, according to the cranial ultrasound performed before the first session, had no haemorrhage presented with intraventricular haemorrhage after the first session. In prone KC position, new haemorrhages appeared after the first session in 29.17% (7) (p = .08). CONCLUSIONS: The lateral KC position is an alternative to the conventional prone KC position and maintains normothermia in infants under 28 weeks gestational age. RELEVANCE TO CLINICAL PRACTICE: Extremely preterm infants are candidates for KC. Lateral KC position is an evidence-based best practice that can be applied to preterm infants under 28 weeks GA. This evidence is particularly useful in performing umbilical catheterization on these patients.

Content Validity of the Spanish Adaptation of the Premature Infant Pain Profile Revised.

BACKGROUND: To the best of our knowledge, there are no validated neonatal pain assessment scales in Spanish. Given the need for such a scale, a study was undertaken to adapt and validate the Premature Infant Pain Profile-Revised (PIPP-R) scale. After translation and back-translation, content validity was addressed, a crucial phase in validation studies, in which researchers examine whether the items that make up the scale represent the content that the scale is intended to assess. AIMS: The aim was to provide evidence for the content validity of the Spanish adaptation of the PIPP-R scale. METHOD: The study used the Delphi technique with 10 experts. Data collection was anonymous and was conducted through an online platform. It was an ad hoc survey consisting of four questions, with a five-point Likert scale for each item on the scale and for the instruction table. An item-content validity index (I-CVI) and a scale-content validity index (S-CVI) were calculated for the analysis. RESULTS: After two rounds of the survey, all items exceeded an I-CVI of 0.9. The S-CVI value was 0.98 (±0.03) for the scale, and 1 for its instruction table. The kappa index yielded values indicating an excellent degree of agreement. CONCLUSIONS: The Spanish version of the PIPP-R obtained a high degree of content validity according to the expert group and the Delphi technique.

XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support.

AIM: This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC). METHODS: The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation. RESULTS: Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability. CONCLUSION: Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.

Cultural Adaptation and Validation of the Premature Infant Pain Profile-Revised (PIPP-R) Pain Measurement Scale: Research Protocol.

INTRODUCTION: The main objective of this study is to validate the PIPP-R scale (Premature Infant Pain Profile-Revised) for measuring neonatal pain in the Spanish hospital setting. MATERIALS AND METHODS: The original scale will be translated from English into Spanish and a consensus translation will be prepared by the research team, which will be back-translated from Spanish into English. The content validity of the Spanish version of the scale will be measured using the Delphi method. Subsequently, a multicenter observational study will be conducted to assess construct validity, internal consistency, and intra-observer and inter-observer agreement. Pain will be assessed by comparing scores for a specific non-painful procedure with those for a specific painful procedure. The sample will include 300 subjects in intensive care and intermediate care units, who will be equally distributed among the participating hospitals. The subjects will be stratified into three groups by gestational age. DISCUSSION: The original version of the PIPP-R scale is useful for objectively assessing neonatal acute and procedural pain from a gestational age of 25 weeks and over. It is important to culturally adapt the original validated scale and to test its validity and reliability in the Spanish healthcare context. The results of this study may represent significant progress in pain management.

Use of topical sevoflurane in pressure ulcer treatment in a double-lung transplant patient.

Pain caused by wounds of different etiology is usually treated with oral analgesics. New topical use of products such as the ether anesthetic sevoflurane shows good results for pain control and has additional benefits. Pressure ulcers are painful and patients may benefit from the use of sevoflurane. We present the case of a double-lung transplant patient with a long-standing sacral pressure ulcer with poor pain control, for which sevoflurane dressings were used. The number of pain-free hours after application, the amount of daily analgesics and the size of the wound were monitored with the mobile wound application MOWA. After several days of sevoflurane application, the patient reduced analgesic consumption, remained longer free of pain, and the size of the wound decreased. Unfortunately, the patient had serious complications due to multiple comorbidities and died before the wound healed completely. Topical use of sevoflurane in pressure ulcers may be a good option to treat pain and improve patient quality of life.

Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT.

INTRODUCTION: This study aims to assess the efficacy of the modified kangaroo care lateral position on the thermal stability of preterm neonates versus conventional kangaroo care prone position. MATERIAL AND METHODS: A non-inferiority randomized parallel clinical trial. Kangaroo care will be performed in a lateral position for the experimental group and in a prone position for the control group preterm. The study will take place at the neonatal intensive care unit (NICU) of a University Hospital. The participants will be extremely premature infants (under 28 weeks of gestational age) along the first five days of life, hemodynamically stable, with mother or father willing to do kangaroo care and give their written consent to participate in the study. The sample size calculated was 35 participants in each group. When the premature infant is hemodynamically stable and one of the parents stays in the NICU, the patient will be randomized into two groups: an experimental group or a control group. The primary outcome is premature infant axillary temperature. Neonatal pain level and intraventricular hemorrhage are secondary outcomes. DISCUSSION: There is no scientific evidence on modified kangaroo care lateral position. Furthermore, there is little evidence of increased intraventricular hemorrhage association with the lateral head position necessary in conventional or prone kangaroo care in extremely premature newborns. Kangaroo care is a priority intervention in neonatal units increasing the time of use more and more, making postural changes necessary to optimize comfort and minimize risks with kangaroo care lateral position as an alternative to conventional prone position kangaroo care. Meanwhile, it is essential to ensure that the conventional kangaroo care prone position, which requires the head to lay sideways, is a safe position in terms of preventing intraventricular hemorrhage in the first five days of life of children under 28 weeks of gestational age. Trial registration at clinicaltrials.gov: NCT03990116.

[Improving patient safety: Usefulness of safety checklists in a neonatal unit]. / Mejorando la seguridad del paciente: utilidad de las listas de verificación de seguridad en una unidad neonatal.

INTRODUCTION: Due to the complexity and characteristics of their patients, neonatal units are risk areas for the development of adverse events (AE). For this reason, there is a need to introduce and implement some tools and strategies that will help to improve the safety of the neonatal patient. Safety check-lists have shown to be a useful tool in other health areas but they are not sufficiently developed in Neonatal Units. MATERIAL AND METHODS: A quasi-experimental prospective study was conducted on the design and implementation of the use of a checklist and evaluation of its usefulness for detecting incidents. The satisfaction of the health professionals on using the checklist tool was also assessed. RESULTS: The compliance rate in the neonatal intensive care unit (NICU) was 56.5%, with 4.03 incidents per patient being detected. One incident was detected for every 5.3 checklists used. The most frequent detected incidents were those related to medication, followed by inadequate alarm thresholds, adjustments of the monitors, and medication pumps. The large majority (75%) of the NICU health professionals considered the checklist useful or very useful, and 68.75% considered that its use had managed to avoid an AE. The overall satisfaction was 83.33% for the professionals with less than 5 years working experience, and 44.4% of the professionals with more than 5 years of experience were pleased or very pleased. CONCLUSION: The checklists have shown to be a useful tool for the detection of incidents, especially in NICU, with a positive assessment from the health professionals of the unit.

[Hospitalized children's parents' anxiety in critical care units]. / Ansiedad en padres de niños hospitalizados en unidades críticas.

UNLABELLED: Child hospitalization is a potentially stressful process that affects both patients and family members. OBJECTIVE: Describe the anxiety that the parents of admitted children at a Intensive Care Units, Pediatric (PICU) and/or Neonatal (NICU) during the first week of hospitalization. MATERIAL AND METHOD: Observational study descriptive, transversal conducted at the Gregorio Marañón Hospital, in PICU and NICU. The inclusion criteria were: patients who didn't exceed the week admitted but they were at hospital more than one day, patients whose therapeutic effort wasn't limited and spanish-speaker parents. The sample size was 60 parents. We designed a questionnaire to measure sociodemographic variables and others related with the social support. The resulting variable, anxiety like State Anxiety (SA) and Trait Anxiety (TA) were determined by the STAI inventory. RESULTS: All the parents showed anxiety the average females SA was 44.59 (+/- 8.02) while the average of men was 44.32 (+/- 6.69). The results show a TA average of 34.73 (+/- 4.09) in woman and 34.95 (+/- 4.93) in men. 83% of the parents of the sample participated in their child caring, having this variable relationship with level of SA (p<0.05). Moreover 98% of parents understood the information given and were satisfied with it. CONCLUSION: All the parents presented anxiety, both SA and TA. They felt informed and supported by nurse. All these actions are directed towards an integral attention taking into account the family as the unit.

Ansiedad en padres de niños hospitalizados en unidades críticas / Hospitalized children's parents' anxiety in critical care units

La hospitalización infantil es un proceso potencialmente estresante que afecta al paciente y su familia. Objetivo: describir la ansiedad de padres de pacientes ingresados en Unidades de Cuidados Intensivos Pediátricas (UCIP) y/o Neonatales (UCIN), durante la primera semana de hospitalización. Material y método: estudio observacional descriptivo transversal desarrollado en el Hospital Universitario Gregorio Marañón, en UCIP y UCIN. Los criterios de inclusión fueron: padres de pacientes que no excedieran de una semana ingresados pero que lo estuvieran más de un día, de pacientes sin esfuerzo terapéutico limitado y padres hispano hablantes. La muestra consta de 60 padres. A través de un cuestionario de elaboración propia se midieron variables sociodemográficas y relacionadas con el apoyo social. La variable resultado ansiedad, como ansiedad estado (AE) y rasgo (AR) se determinó con el cuestionario STAI. Resultados: toda la muestra presentó ansiedad, la media en mujeres indicó AE 44,59 ('b18,02), y en hombres de 44,32('b16,69). La AR en mujeres supuso 34,73 ('b14,09) y en hombres de 34,95('b14,93). El 83% de los padres participó en el cuidado de su hijo, teniendo esta relación variable con la AE (p<0,05). Además un 98% entendió la información y se sintió satisfecha con ella. Conclusión: todos los padres presentan ansiedad, tanto AE como AR. Destacamos que se sintieron informados y apoyados por el personal de enfermería. Todas estas acciones nos encaminan hacia una atención integral, teniendo en cuenta a la familia como unidad asistencial(AU)

Child hospitalization is a potentially stressful process that affects both patients and family members. Objective: Describe the anxiety that the parents of admitted children at a Intensive Care Units, Pediatric (PICU) and/or Neonatal (NICU) during the first week of hospitalization. Material and method: Observational study, descriptive, transversal conducted at the Gregorio Marañón Hospital, in PICU and NICU. The inclusion criteria were: patients who didn’t exceed the week admitted but they were at hospital more than one day, patients whose therapeutic effort wasn’t limited and spanish-speaker parents. The sample size was 60 parents. We designed a questionnaire to measure sociodemographic variables and others related with the social support. The resulting variable, anxiety, like State Anxiety (SA) and Trait Anxiety (TA) were determined by the STAI inventory. Results: All the parents showed anxiety, the average females SA was 44.59 ('b18.02) while the average of men was 44.32('b16.69). The results show a TA average of 34.73 ('b14.09) in woman and 34.95('b14.93) in men. 83% of the parents of the sample participated in their child caring, having this variable relationship with level of SA (p<0.05). Moreover, 98% of parents understood the information given and were satisfied with it. Conclusion: All the parents presented anxiety, both SA and TA. They felt informed and supported by nurse. All these actions are directed towards an integral attention taking into account the family as the unit(AU)

[Assessing the impact of kangaroo care on preterm infant stress]. / Impacto del cuidado canguro en el estrés del neonato prematuro.

OBJECTIVE: To assess the efficacy of Kangaroo Care (KC) in decreasing stress in newborns of 29-34 weeks' post-menstrual age (PMA). METHODS: Quasi-experimental pre-post without control group analytical study conducted in the Gregorio Marañón University Hospital Neonatal Unit. The inclusion criteria were: infants 29 to 34 weeks' PMA, in an incubator, did not have neurological pathology, were not post-surgical, and with a Spanish-speaking mother and/or father. The sample size was fifty-one premature infants. The study variables selected were: clinical variables (additional oxygen and pathology), socio-demographical variables (PMA, KC duration) and the outcome variable, premature infant stress, which consisted of two variables: the physiological stress signal and the behavioural stress response. The variables were collected at three different times: basal stress, during KC and after KC completion, making a comparison analysis between the basal stress and after KC. RESULTS: The response rate was 100%, without registering any loss. The stress variables that changed after the intervention (statistically significant) were: irregular breathing, trunk arching or hyperextension, very open fingers, contraction of the face muscles, apnea, irritability and exaggerated and sustained extension of arms and legs. O(2) saturation was 94.73%±3.05% before KC and 95.92%±2.97% after the intervention. The heart rate (HR) ranged from 158.14±17.48 bpm (beats per minute) before the KC to 151.47±4.47 bpm after it. CONCLUSIONS: KC is related to the decrease in the occurrence of neonatal variables of stress, helping to organize motor and physiological systems to achieve a state of tranquility.

Impacto del cuidado canguro en el estrés del neonato prematuro / Assessing the impact of kangaroo care on preterm infant stress

Objetivo. Evaluar la eficacia del cuidado canguro (CC) en la reducción del estrés del neonato de 29-34 semanas de edad posmenstrual (EPM). Método. Estudio analítico cuasiexperimental pre-post sin grupo control, realizado en la Unidad de Neonatología del Hospital Universitario Gregorio Marañón. Los criterios de inclusión fueron: neonatos de 29-34 EPM, que no padeciesen afección neurológica y/o estuviesen en periodo posquirúrgico, que permaneciesen en incubadora y con madre y/o padre hispanohablante. La muestra consta de 51 pretérminos. Las variables del estudio fueron: clínicas (oxígeno adicional y enfermedad), sociodemográficas (EPM, duración del CC) y variable resultado, estrés del neonato, que comprende dos variables: signos de estrés fisiológicos y respuestas conductuales de estrés. Las variables se recogieron en tres momentos: estrés basal, durante el CC y tras la realización del CC, realizando un análisis de comparación entre la determinación basal de estrés y tras realizar CC. Resultados. La tasa de respuesta fue del 100%, sin registrarse ninguna pérdida. Las variables de estrés disminuidas tras CC (diferencias estadísticamente significativas) son: respiración irregular, bostezos, hiperextensión o arqueamiento del tronco, dedos bien abiertos, contracción de los músculos de la cara, irritabilidad, apnea, extensión exagerada y mantenida de los brazos y piernas. La saturación de O2 (SatO2) antes del CC fue del 94,73%±3,05% y tras la intervención, del 95,92%±2,97%. La frecuencia cardíaca (FC) varió de 158,14±17,48 lpm antes del CC a 151,47±4,47 lpm después. Conclusiones. El CC está relacionado con la disminución de la aparición de variables de estrés del neonato, ayudándole a organizar su sistema motor y fisiológico para alcanzar un estado de tranquilidad (AU)

Objective: To assess the efficacy of Kangaroo Care (KC) in decreasing stress in newborns of 29-34 weeks’ post-menstrual age (PMA). Methods: Quasi-experimental pre-post without control group analytical study conducted in the Gregorio Marañón University Hospital Neonatal Unit. The inclusion criteria were: infants 29 to 34 weeks’ PMA, in an incubator, did not have neurological pathology, were not post-surgical, and with a Spanish-speaking mother and/or father. The sample size was fifty-one premature infants. The study variables selected were: clinical variables (additional oxygen and pathology), socio-demographical variables (PMA, KC duration) and the outcome variable, premature infant stress, which consisted of two variables: the physiological stress signal and the behavioural stress response. The variables were collected at three different times: basal stress, during KCand after KC completion, making a comparison analysis between the basal stress and after KC. Results: The response rate was 100%, without registering any loss. The stress variables that changed after the intervention (statistically significant) were: irregular breathing, trunk archingor hyperextension, very open fingers, contraction of the face muscles, apnea, irritability and exaggerated and sustained extension of arms and legs. O2 saturation was 94.73%±3.05% before KC and 95.92%±2.97% after the intervention. The heart rate (HR) ranged from 158.14±17.48bpm (beats per minute) before the KC to 151.47±4.47 bpm after it. Conclusions: KC is related to the decrease in the occurrence of neonatal variables of stress, helping to organize motor and physiological systems to achieve a state of tranquillity (AU)

Tratamiento de la artrosis. Intervención enfermera / Arthrosis treatment. Nursing intervention

Este artículo presenta el caso de una paciente con artrosis que reside en un centro de mayores, y que está siendo tratada, principalmente, con fármacos. Debido a su incapacidad se propone una intervención enfermera integral en la que se ha realizado una valoración de la agencia, el déficit, la demanda y los requisitos de autocuidado, y se desarrolla un plan de cuidados integrado básicamente por acciones educativas. El referente teórico que enmarca todo el proceso de cuidado es la Teoría de Autocuidado de Orem. Mediante esta intervención se pretende mejorar la calidad de vida de este tipo de pacientes y destacar la importancia que las acciones de apoyo educativo tienen en el cuidado(AU)

This article presents the case of a patient suffering from arthrosis residing in an elderly home and who is being treated mainly with pharmaceuticals. Due to that patient’s incapacity, an integral nursing intervention plan was proposed; for this plan, an evaluation was carried out by the agency, the deficit, the self-care needs and requirements, and a treatment plan integrated basically of educational action plans was developed. The theoretical reference which provides the framework for this entire process is Orem’s Theory of Self-Care. By means of this intervention, medical professionals hope to improve the life quality for this kind of patient and to highlight the importance that educational action plans have in the treatment of patients(AU)

[Arthrosis treatment. Nursing intervention]. / Tratamiento de la artosis. Intervención enfermera.

This article presents the case of a patient suffering from arthrosis residing in an elderly home and who is being treated mainly with pharmaceuticals. Due to that patient's incapacity an integral nursing intervention plan was proposed; for this plan, an evaluation was carried out by the agency, the deficit, the self-care needs and requirements, and a treatment plan integrated basically of educational action plans was developed. The theoretical reference which provides the framework for this entire process is Orem's Theory of Self-Care. By means of this intervention, medical professionals hope to improve the life quality for this kind of patient and to highlight the importance that educational action plans have in the treatment of patients.