Parental impact during and after neonatal intensive care admission.

Parents play a pivotal role in neurodevelopmental outcomes of their children in the neonatal intensive care unit (NICU) and beyond. Integration of parents in clinical care and research is synergistic. Engaged parents yield more comprehensive clinical care and more robust and meaningful research products. Subsequently, successful clinical and research efforts improve outcomes for children. We review strategies for parental integration into NICU clinical care and research, including parental involvement in therapeutic interventions and neurodevelopmental care, and effective communication strategies for clinicians and researchers. We discuss challenges in neonatal trials and emphasize the need for building a culture of research, collaborative partnerships with patient advocacy organizations, and ongoing support beyond the NICU. Overall, we call for recognizing and fostering the impactful role of parents as teammates with clinicians and researchers in optimizing neurodevelopmental outcomes in the NICU and beyond.

Neuromonitoring in neonatal intensive care units-an important need towards individualized neuroprotective care.

Neuromonitoring has been widely accepted as an important part in neonatal care. Amplitude-integrated EEG (aEEG) and near-infrared spectroscopy (NIRS) are often mentioned in this context, though being only a part of the fully array of methods and examinations that could be considered neuromonitoring. Within the broad array of medical conditions that could be encountered in a neonatal patient, it is important to be aware of the indications for neuromonitoring and especially which neuromonitoring technique to use best for the individual condition. aEEG is now a widely accepted neuromonitor in neonatology with its value in hypoxic events and seizures only rarely questioned. Other methods like NIRS still have to prove themselves in the future. The SafeBoosC-III trial showed that it still remains difficult for some of these methods to prove their value for the improvement of outcome. Bute future developments such as multimodal neuromonitoring with data integration and artificial intelligence analysis could improve the value of these methods.

Music therapy in tertiary neonatal intensive care: A matter of unlikely allies?

Over the past decades, music therapy in the neonatal intensive care unit (NICU) has been proven effective in physiological and psychological outcomes, including sucking, behaviour, stress reduction, neurodevelopment and promoting emotional bonding. However, not every NICU administers music therapy in their ward. Research on music therapy for neonates and their caregivers has lately accumulated, increasing the evidence of health benefits on brain development and across a variety of NICU-related pathologies, including neurological, cardiological, pulmonary and gastrointestinal problems. Conclusively, we will present the studied methods of music therapy for clinical benefits in neonatal intensive care.

How is bioelectrical impedance used in neonatal intensive care? A scoping review.

Poor growth and nutrition management in the neonatal period can have a negative impact upon both the short- and long-term outcomes for the infant. Improvements in bioelectrical impedance technology and accompanying licencing agreements now make this enhanced device available for use in infants as small as 23 weeks gestational age. An exploration of this technology and its use is now timely. The aim of the scoping review was to answer the following question: in preterm and sick term infants in the neonatal intensive care unit, how is bioelectrical impedance being utilized, in what situations, and when? The scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Methodol 8(1):19-32, 2005) framework. Forty-nine papers were initially identified and 16 were included in the scoping review. Three studies were experimental designs, and 13 were observational studies. The review found that BIA was used in neonatal intensive care in three main ways, for, (1) fluid status evaluation, (2) as a measure of adequate nutrition and growth, (3) to validate the technology as an outcome measure in neonates. CONCLUSION: There is a paucity of recent robust research papers which investigate the use of bioelectrical impedance in preterm neonates. Available evidence spans a range of 30 years, with technological advancement reducing the application of older studies to the modern neonatal setting. Although this technology may be helpful for decision-making around fluid management and nutrition, in preterm infants, robust evidence is needed to demonstrate the clinical benefit of bioelectrical impedance beyond that of usual care. WHAT IS KNOWN: • Clinical decisions regarding neonatal nutrition and fluid management are currently based upon the interpretation of vital signs, fluid balance, weight trend, biochemical markers, and physical examination. • Bioelectrical Impedance Analysis (BIA) is a non-invasive method of assessing body composition which is now available to be used in infants as small as 23 weeks gestation. WHAT IS NEW: • Bioelectrical Impedance has been used in three main ways in the NICU, for fluid status evaluation, for measuring nutrition and growth and to validate BIA as an outcome. • There is a lack of recent robust research data to support the use of the device within clinical decision making in neonatal intensive care.

Using the providers' perspective on video review of neonatal procedures to create a roadmap: a qualitative study.

OBJECTIVE: To examine the providers' perceptions and experiences on implementation of video review (VR) of procedures in the neonatal intensive care unit (NICU). DESIGN: Qualitative study using semi-structured interviews with neonatal care providers about their experiences with VR. Interviews were audio-recorded, transcribed and thematically analysed using the data analysis software Atlas.ti V.22.2. SETTING: Providers working in the NICU of the Leiden University Medical Center were interviewed during implementation of VR. RESULTS: In total, 28 NICU staff members were interviewed. The interviewed providers appreciated VR and valued the focus on a safe learning environment. Five overarching themes were identified: (1) added value: providers reported that VR is a powerful tool for reflection on daily practice and serves as a magnifying glass on practice, provides a helicopter view and VR with nursing and medical staff together led to new insights and was seen as highly valuable; (2) preconditions and considerations: the existing culture of trust on the NICU positively influenced providers' perception; (3) adjustment: it was recommended to first let providers attend a VR session, before being recorded; (4) experiences with VR: suggestions were made by the providers regarding the preparation and organisation of VR and the role of the chair; (5) embedding VR: providers considered how to embed VR on the long-term while maintaining a safe learning environment and provided suggestions for expanding. CONCLUSION: Neonatal care providers appreciated the use of VR and provided viewpoints on how to implement VR successfully, which were used to develop a roadmap with recommendations.

Continuous non-invasive measurement of cardiac output in neonatal intensive care using regional impedance cardiography: a prospective observational study.

OBJECTIVES: To compare agreement between echocardiography and regional impedance cardiography (RIC)-derived cardiac output (CO), and to construct indicative normative ranges of CO for gestational age groups. DESIGN, SETTING AND PARTICIPANTS: Prospective cohort observational study performed in a tertiary centre in London, UK, including neonates born between 25 and 42 weeks' gestational age. EXPOSURES: Neonates on the postnatal ward had 2 hours of RIC monitoring; neonates in intensive care had RIC monitoring for the first 72 hours, then weekly for 2 hours, with concomitant echocardiography measures. MAIN OUTCOMES AND MEASURES: RIC was used to measure CO continuously. Statistical analyses were performed using R (V.4.2.2; R Core Team 2022). RIC-derived CO and echocardiography-derived CO were compared using Pearson's correlations and Bland-Altman analyses. Differences in RIC-derived CO between infants born extremely, very and late preterm were assessed using analyses of variance and mixed-effects modelling. RESULTS: 127 neonates (22 extremely, 46 very, 29 late preterm and 30 term) were included. RIC and echocardiography-measured weight-adjusted CO were correlated (r=0.62, p<0.001) with a Bland-Altman bias of -31 mL/min/kg (limits of agreement -322 to 261 mL/min/kg). The RIC-derived CO fell over 12 hours, then increased until 72 hours after birth. The 72-hour weight-adjusted mean CO was higher in extremely preterm (424±158 mL/min/kg) compared with very (325±131 mL/min/kg, p<0.001) and late preterm (237±81 mL/min/kg, p<0.001) neonates; this difference disappeared by 2-3 weeks of age. CONCLUSIONS: RIC is valid for continuous, non-invasive CO measurement in neonates. Indicative normative CO ranges could help clinicians to make more informed haemodynamic management decisions, which should be explored in future studies. TRIAL REGISTRATION NUMBER: NCT04064177.

Beneficios del masaje infantil en recién nacidos prematuros. Revisión bibliográfica / Benefits of infant massage in premature newborns. A bibliographic review

Objetivo: Conocer los efectos beneficiosos de la aplicación de masaje infantil en los recién nacidos prematuros estables en cuidados intensivos neonatales. Metodología y diseño: Revisión bibliográfica según directrices de la declaración PRISMA, realizada en febrero del 2021, en las bases de datos: Pubmed, Scielo, Elsevier y Dialnet. Los criterios de inclusión considerados fueron artículos con contenido sobre masaje terapéutico en niños como tratamiento en el medio hospitalario, idioma inglés / castellano, publicados 2016-2021 y, acceso a texto completo gratuito o accesibles desde recursos institucionales. Se evaluó nivel de evidencia y grado de recomendación y la calidad metodológica con criterios CASPE. Se identifica información de cada artículo: año de publicación, diseño, participantes y resultados de la intervención. Resultados: Se incluyeron 11 artículos con calidad metodológica entre 5-10 puntos según instrumento de evaluación de revisión sistemática o ensayo clínico aleatorio respectivamente. En los resultados se consideran 12 áreas temáticas: técnica de masaje y tiempo de duración; aplicación de aceites; neurodesarrollo; sistema inmunológico; gastrointestinal; peso; función visual; sueño; estrés; dolor; apego; estancia hospitalaria. La mayor parte de los estudios informaron de beneficios tanto fisiológicos como conductuales. Los beneficios referidos en los estudios hacen relación a mejora de la actividad gastrointestinal, mejor tolerancia al dolor, disminución de la estancia hospitalaria, mejor neurodesarrollo, aumento de peso, mejora en el sistema inmune e incremento en la función visual además de favorecer el apego y la disminución de los niveles de estrés. (AU)

Objectives: To know the beneficial effects of the application of infant massage in stable premature newborns in the NICU. Methodology and design: Systematic review that follows the guidelines of the PRISMA declaration. Bibliographic research was realized in February 2021 in the databases of Pubmed, Scielo, Elsevier and Dialnet. The inclusion criteria were articles relationated with therapeutic massage as treatment in the hospitalary area, In English or Spanish, between 2016-2021 as the year of publication and full free text or accessible through institutional resources. Results: 11 articles with methodological quality between 5-10 points according to the systematic review evaluation instrument or randomized clinical trial, respectively, are included. The results consider 12 thematic areas: massage technique and time; oil application; neurodevelopment; waterproof system; gastrointestinal; weight; visual function; sleep; stress; pain; attachment; hospital stay. Most studies report both physiological and behavioral benefits. The benefits referred to in the studies are related to improved gastrointestinal activity, better pain tolerance, shorter hospital stay, better neurodevelopment, weight gain, improved immune system and increased visual function, in addition to promoting attachment and the decrease in stress levels. (AU)

O recém-nascido hospitalizado em unidade de terapia intensiva neonatal e o posicionamento no leito / The newborn hospitalized in a neonatal intensive care unit and bed positioning: systematic review / El recién nacido hospitalizado en la unidad de cuidados intensivos neonatales y el posicionamiento en la cama: revisión sistemática

Objetivo: identificar quais os posicionamentos e produtos auxiliares mais indicados para o recém-nascido hospitalizado em Unidade de Terapia Intensiva Neonatal. Método: caracteriza-se como básica, de caráter exploratório e quanto aos procedimentos técnicos é uma revisão sistemática da literatura. A busca teve como bases a Biblioteca Virtual em Saúde, Plataforma Capes e Unique, limitando as publicações realizadas entre 2011 e 2021. Obteve-se 85 resultados, sendo a análise e discussão dos dados realizada com 7 estudos. Resultados: verificou-se que existem diversos posicionamentos que podem ser utilizados nesses pacientes, como os decúbitos dorsal, ventral e lateral, sendo o ventral o mais indicado. Ademais, identificaram-se diversos produtos que podem ser utilizados para auxiliar no posicionamento dos recém-nascidos e que podem facilitar os cuidados de enfermagem. Considerações finais: observou-se que poucos estudos trouxeram um padrão e/ou um método de posicionamento vinculado com os produtos auxiliares.

Objective: to identify which are the most suitable positioning and auxiliary products for the newborn hospitalized in Neonatal Intensive Care Units. Method: this is characterized as basic, exploratory, and as to the technical procedures, it is a systematic literature review. The search was based on the Biblioteca Virtual em Saúde, Plataforma Capes and Unique, limiting publications between 2011 and 2021. A total of 85 results were obtained, and the analysis and discussion of the data was carried out with 7 studies. Results: it was found that there are several positions that can be used in these patients, such as dorsal, ventral, and lateral decubitus, with the ventral position being the most indicated. Furthermore, several products were identified that can be used to assist in positioning the newborns and that can facilitate nursing care. Final considerations: it was observed that few studies brought a standard and/or a positioning method linked to the auxiliary products.

Objetivo: identificar cuáles son los posicionamientos y productos auxiliares más adecuados para los recién nacidos hospitalizados en una Unidad de Cuidados Intensivos Neonatales. Método: se caracteriza como básico, de carácter exploratorio y en cuanto a los procedimientos técnicos es una revisión sistemática de la literatura. La búsqueda se basó en la Biblioteca Virtual em Saúde, Plataforma Capes y Unique, limitando las publicaciones entre 2011 y 2021. Se obtuvieron 85 resultados, siendo el análisis y la discusión de los datos realizados con 7 estudios. Resultados: Se ha comprobado que hay varias posiciones que pueden utilizarse en estos pacientes, como el decúbito dorsal, ventral y lateral, siendo la ventral la más adecuada. Además, se identificaron varios productos que pueden utilizarse para ayudar a colocar a los recién nacidos y que pueden facilitar los cuidados de enfermería. Consideraciones finales: se observó que pocos estudios trajeron un patrón y/o un método de posicionamiento vinculado a los productos auxiliares.

Perfil de los recién nacidos de riesgo relacionados con la termorregulación en una Unidad de Cuidados Intensivos Neonatales / Perfil de recém-nascidos de risco relacionado à termorregulação em Unidade de Terapia Intensiva Neonatal / Profile of risky newborns related to thermoregulation in a Neonatal Intensive Care Unit

OBJETIVO: Analizar el patrón de temperatura de recién nacidos de bajo peso al nacer ingresados en una Unidad de Cuidados Intensivos Neonatales. METODOLOGÍA: Este es un estudio transversal y cuantitativo realizado en una Unidad de Cuidados Intensivos Neonatales en un hospital de maternidad en el noreste de Brasil. La muestra consistió en 45 niños de bajo peso al nacer, muy bajo peso al nacer o extremadamente bajo peso al nacer ingresados ​​en la unidad. RESULTADOS: Al ingreso se obtuvo una temperatura axilar promedio de 34.98ºC con una desviación estándar de 1.12. La tasa de hipotermia al ingreso fue considerablemente severa, por lo que en la primera hora, con seis horas y con 12 horas de hospitalización, el porcentaje de recién nacidos hipotérmicos (<36.5ºC) fue respectivamente: 93.33%, 73.33 % y 57.78%. CONCLUSIÓN: Hubo fallas en los procesos cuando se trata de termorregulación, dado que casi toda la muestra llega con potencial estrés por frío

OBJETIVO: Analisar o padrão de temperatura dos recém-nascidos de baixo peso internados em uma Unidade de Terapia Intensiva Neonatal. METODOLOGIA: Trata-se de um estudo transversal e quantitativo realizado numa Unidade de Terapia Intensiva Neonatal de uma maternidade no Nordeste do Brasil. A amostra foi constituída de 45 recém-nascidos de baixo peso, muito baixo peso ou extremo baixo peso admitidos na unidade. RESULTADOS: Na admissão obteve-se uma média de temperatura axilar de 34,98ºC com desvio padrão de 1,12. A taxa de hipotermia na admissão foi consideravelmente grave, de forma que na primeira hora, com seis horas e com 12 horas de internação a porcentagem de recém-nascidos hipotérmicos (<36,5ºC) foi respectivamente: 93,33%, 73,33% e 57,78%. CONCLUSÃO: Verificou-se falhas nos processos quando se trata de termorregulação, haja vista que quase a totalidade da amostra chega com potencial estresse ao frio

OBJECTIVE: To analyze the temperature pattern of low birth weight newborns admitted to a Neonatal Intensive Care Unit METHODOLOGY: This is a cross-sectional and quantitative study conducted in a Neonatal Intensive Care Unit of a maternity hospital in Northeastern Brazil. The sample consisted of 45 low birth weight, very low birth weight or extremely low birth weight newborns admitted to the unit. RESULTS: At admission, we obtained an axillary temperature average of 34.98ºC with a standard deviation of 1.12. The hypothermia rate at the time of admission was considerably severe, so that in the first hour, with 06 hours and with 12 hours of hospitalization, the percentages of hypothermic newborns (<36.5ºC) were respectively: 93.33%, 73.33 % and 57.78%. CONCLUSION: We found flaws in the processes when it comes to thermoregulation, given that almost the entire sample arrives with potential cold stress

Variables asociadas a eventos adversos en neonatos con catéter venoso central de inserción periférica / Variables associated with adverse events in neonates with peripherally inserted central catheters / Variáveis associadas a eventos adversos em neonatos com cateter central de inserção periférica

OBJETIVO: Identificar los factores asociados con la aparición de eventos adversos en el catéter de inserción central periférica en recién nacidos. MÉTODOS: Un estudio transversal con un enfoque cuantitativo realizado en una Unidad de Cuidados Intensivos Neonatales de un hospital de maternidad de referencia en atención materna e infantil de alto riesgo en el noreste de Brasil. Muestra de 108 neonatos recolectados de febrero a noviembre de 2016. RESULTADOS: La prevalencia de eventos adversos en los recién nacidos fue del 53,70%, asociada a las siguientes variables: sexo masculino (p = 0,033), peso inferior a 2500 gramos (p = 0,003), inserción después de 48 horas (p = 0,027), más de tres intentos de punción (p = 0,024), dificultad de progresión del catéter (p = 0,040), presencia de intercurrencias durante la inserción del catéter (p = 0,027), sobre dos cambios de apósito = 0.009) y ubicación no central del dispositivo (p = 0.042). CONCLUSIÓN: Los resultados indican la necesidad de estrategias para la prevención de eventos adversos, con énfasis en la educación continua y el mejoramiento de habilidades en la gestión de este dispositivo

OBJECTIVE: To identify the factors associated with the occurrence of adverse events by a peripherally inserted central catheter in newborns. METHODS: A quantitative, cross-sectional study carried out in the Neonatal Intensive Care Unit of a reference maternity hospital in high-risk maternal and child care in Northeast Brazil. The sample of 108 neonates was collected from February to November 2016. RESULTS: The prevalence of adverse events in newborns was 53.70%, associated with the following variables: male gender (p = 0.033), weight below 2500 grams (p = 0.003), insertion performed after 48 hours of life (p = 0.027), more than three puncture attempts (p = 0.024), difficulty in inserting the catheter (p = 0.040), intercurrence during catheter insertion (p = 0.027), over two dressing changes (p = 0.009), and non-central position of the device (p = 0.042). CONCLUSION: The results indicate the need for strategies to prevent adverse events, with emphasis on continuing education and on the improvement of skills regarding the use of this device

OBJETIVO: Identificar os fatores associados à ocorrência de eventos adversos por cateter central de inserção periférica em recém-nascidos. MÉTODOS: Estudo transversal, com abordagem quantitativa, realizado em Unidade de Terapia Intensiva Neonatal de uma maternidade referência no atendimento materno-infantil de alto risco no Nordeste do Brasil. Amostra de 108 neonatos coletada no período de fevereiro a novembro de 2016. RESULTADOS: A prevalência de eventos adversos em recém-nascidos foi de 53,70%, associados às seguintes variáveis: sexo masculino (p = 0,033), peso menor que 2500 gramas (p = 0,003), inserção realizada após 48 horas de vida (p = 0,027), mais de três tentativas de punção (p = 0,024), dificuldade de progressão do cateter (p = 0,040), presença de intercorrência durante a inserção do cateter (p = 0,027), acima de duas trocas de curativos (p = 0,009) e localização não central do dispositivo (p = 0,042). CONCLUSÃO: Os resultados indicam a necessidade de estratégias de prevenção de eventos adversos, destacando-se a educação continuada e aprimoramento de habilidades quanto ao manejo desse dispositivo

Factores de riesgo para el desarrollo de hiponatremia precoz en el prematuro. Revisión de nuestra práctica en administración de sodio en los primeros días de vida / Risk factors for the development of early hyponatraemia in the premature infant. A review of the practice of giving sodium in the first days of life

INTRODUCCIÓN: Estudio retrospectivo en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel sobre la incidencia de hiponatremia precoz (primeras 48 horas de vida) en prematuros. Buscamos factores de riesgo y de protección para esa alteración, como punto de partida para un cambio en la actuación médica al prescribir fluidos intravenosos. MATERIAL Y MÉTODOS: Muestra de 256 prematuros (edad gestacional: 235-366) ingresados en la unidad de cuidados intensivos neonatales de nuestro hospital, entre enero de 2016 y junio de 2018. Se determinó qué pacientes recibieron aportes intravenosos de sodio en distintos intervalos de las primeras 48 horas de vida y cuántos padecieron hiponatremia de cualquier tipo (< 135 mmol/l) y moderada-grave (< 130 mmol/l). Se estudió la relación entre hiponatremia precoz y peso/edad gestacional, administración de corticoides prenatales, enfermedad respiratoria, sepsis precoz y asfixia perinatal. RESULTADOS: Padecieron hiponatremia 81 pacientes, 31,64% del total (hasta un 50% en < 30 semanas de edad gestacional), siendo moderada-grave (< 130 mmol/l) en un 17,3% de los casos. El periodo de tiempo con más casos de hiponatremia fue el de las primeras 12 horas de vida (22,64%). Demostraron ser factores de riesgo el peso (p = 0,034), la edad gestacional (p < 0,001) y el padecimiento de enfermedad respiratoria (p < 0,001) y, en el análisis multivariable, este último se mostró relacionado de forma independiente con la hiponatremia precoz (p < 0,01; OR = 5,24; IC 95%: 2,79-9,84). La administración de betametasona prenatal no demostró proteger. CONCLUSIÓN: Según nuestros resultados creemos conveniente aportar sodio en los fluidos intravenosos prescritos los primeros días de vida, particularmente en prematuros de menos edad gestacional y en afectos de enfermedad respiratoria

INTRODUCTION: A retrospective study was conducted in the Neonatal Intensive Care Unit of a tertiary hospital to determine the incidence of early hyponatraemia (first 48hours of life) in preterm infants. Risk and protection factors in this condition were also examined as a starting point for a change in the medical action when prescribing intravenous fluids. MATERIAL AND METHODS: The study included a sample of 256 premature babies (gestational age: 235-366) admitted to the Neonatal Intensive Care Unit of a tertiary hospital between January 2016 and June 2018. The number of patients receiving intravenous sodium in different intervals during the first 48hours of life was determined, as well as the number of those with hyponatraemia of any type (< 135 mmol/l), and moderate-severe (< 130 mmol / l). An analysis was made of the relationship between early hyponatraemia and weight / gestational age, antenatal steroids exposure, respiratory pathology, early sepsis, and perinatal asphyxia. RESULTS: Hyponatraemia occurred in 81 patients, 31.64% of the total (up to 50% in < 30 weeks of gestational age), and was moderate-severe (< 130 mmol / l) in 17.3% of the cases. The period of time with the most cases of hyponatraemia was in the first 12hours of life (22.64%). Weight (P=.034), gestational age (P < .001) and respiratory disease (P < .001) were found to be risk factors and, in a multivariate analysis, the latter was independently related to early hyponatremia (P < .01, OR = 5.24, 95% CI: 2.79-9.84). Antenatal betamethasone exposure did not show to be a protection factor. CONCLUSION: According to the results of this study, it is considered an advantage to provide sodium in the intravenous fluids prescribed during the first days of life, particularly in preterm infants of lower gestational age and with respiratory disease involvement

Procesos dolorosos, evaluación y tratamiento en unidades de cuidados intensivos neonatales: revisión de la literatura científica / Painful procedures, assesment and treatment in neonatal intensive care units: a scientific literature review

INTRODUCCIÓN: Los recién nacidos ingresados en las Unidades de Cuidados Intensivos Neonatales (UCIN) están expuestos a numerosos procedimientos diagnósticos y terapéuticos. Estos procesos causan dolor y estrés, que a su vez pueden provocar consecuencias futuras para el neonato. Las escalas de valoración del dolor se crearon para poder evaluarlo y tratarlo adecuadamente. Actualmente la inexistencia de consenso y protocolos de ámbito internacional provoca una evaluación y consecuentemente un tratamiento irregular. El objetivo de este trabajo es dar a conocer los procedimientos invasivos más frecuentes, las escalas que se utilizan en las UCIN para valorar el dolor producido durante estos procedimientos y las estrategias que se utilizan para disminuir el dolor y estrés de los neonatos. METODOLOGÍA: Estudio documental mediante revisión por publicaciones en bases de datos de ciencias de la salud (PubMed/Medline), siguiendo las recomendaciones PRISMA. Se utilizaron los descriptores MeSH: pain assessment tools. El intervalo de publicación revisado fue de 1999 a 2017. Un total de 72 artículos cumplieron los criterios de inclusión. RESULTADOS: El procedimiento invasivo más frecuente en las UCIN es la punción con lanceta (32,8%). La escala de valoración más utilizada es la PIPP (51,8%). El tratamiento no farmacológico más común para la disminución del dolor y estrés fue la administración de soluciones glucosadas orales (59%). CONCLUSIONES: Existen más de 16 herramientas de evaluación del dolor en los neonatos. Cada UCIN utiliza las escalas de valoración del dolor en torno a la naturaleza propia de la unidad. La falta de homogeneidad y consenso provoca que no se obtenga una valoración regular y uniforme

INTRODUCTION: New-borns that are hospitalized in Neonatal Intensive Care Units (NICU) are subjected to numerous diagnostics and therapeutic procedures. These procedures cause pain and distress that they can produce futures consequences. Pain assessment tools were created to assess and to treat appropriately. Currently there are not an international consensus and protocols to assess the pain in new-borns, for this reason there is an irregular value and treatment. The aim of this review is to let know the invasive procedures most frequently applicate in NICU, the pain assessment tools most utilized and the different strategies to reduce pain and distress of new-borns. METHODS: Documental study through published reviews in Health Sciences databases (PubMed/Medline). PRISMA recommendations were followed. Mesh terms «pain assessment tools» were utilised. The interval of years reviewed was from 1999 to 2017.72 articles were met the inclusion criteria. RESULTS: The most invasive procedure in NICU was the heel lancet (32.8%). The pain assessment tool most utilised was PIPP (51.8%). The pharmacological treatment most applicate to reduce pain and distress of new-born was the oral glucose solutions (59%). CONCLUSIONS: There are more than 16 pain assessment tools to assess newborns' pain. Each NICU use the most tool concerned by the specific nature of the unit. There are not consensus and homogeneity to assess pain in new-borns. In fact, this makes an irregular a uniformity value

Promoción del sueño en unidades de cuidados intensivos neonatales: scoping review / Promoção do sono em unidades de cuidados intensivos neonatais: scoping review / Sleep promotion in neonatal intensive care units: scoping review

El sueño desempeña un papel fundamental en el crecimiento y desarrollo de los recién nacidos, su privación presenta numerosos efectos negativos. El ambiente de las unidades de cuidados intensivos neonatales (UCIN) se presenta como perturbador y nocivo del sueño neonatal. OBJETIVO: Mapear la evidencia científica existente en cuanto a las estrategias promotoras del sueño de los recién nacidos en contexto de UCIN. Metodología: Scoping review basada en la metodología propuesta por el Joanna Briggs Institute, utilizando los siguientes motores de búsqueda y bases de datos: MEDLINE via PubMed, CINHAL Plus with Full Text e Nursing & Allied Health Collection: Comprehensive via EBSCO-HOST, Academic Search Complete, ScienceDirect e Directory of Open Access Journals via B-ON, LILACS, RCAAP e SciELO. Definido como limitadores artículos publicados en los últimos 5 años (hasta febrero de 2019), disponibles en portugués o inglés y en texto completo. RESULTADOS: Se localizaron 186 registros, y la muestra final incluyó 9 estudios que respondieron al objetivo de la revisión sobre la base de los criterios de inclusión definidos. Las estrategias promotoras del sueño identificadas remiten a la gestión del ambiente en la UCIN, concentración de los cuidados de enfermería respetando el ciclo de sueño / vigilia de los recién nacidos, posicionamiento adecuado, contención, succión no nutritiva, técnica de Yakson, toque humano suave, canguro materno, masaje, estímulos auditivos tranquilos y colchón modelador. Conclusión: Dada la importancia del sueño en el desarrollo de los recién nacidos, es fundamental el papel del Enfermero a través de la adopción de estrategias protectoras y promotoras de éste, especialmente en contexto de UCIN

O sono tem um papel fundamental no crescimento e desenvolvimento dos recém-nascidos, com a sua privação a apresentar inúmeros efeitos negativos. O ambiente das unidades de cuidados intensivos neonatais (UCIN) apresenta-se como perturbador e nocivo do sono neonatal. OBJETIVO: Mapear a evidência científica existente quanto às estratégias promotoras do sono do recém-nascido em contexto de UCIN. Método: Scoping review baseada na metodologia proposta pelo Joanna Briggs Institute, com recurso aos seguintes motores de busca e bases de dados: MEDLINE via PubMed, CINHAL Plus with Full Text e Nursing & Allied Health Collection: Comprehensive via EBSCO-HOST, Academic Search Complete, ScienceDirect e Directory of Open Access Journals via B-ON, LILACS, RCAAP e SciELO. Definidos como limitadores artigos publicados nos últimos 5 anos (até fevereiro de 2019), disponíveis em português ou inglês e em texto integral. RESULTADOS: Foram localizados 186 registos, tendo a amostra final incluído 9 estudos que responderam ao objetivo da revisão com base nos critérios de inclusão definidos. As estratégias promotoras do sono identificadas remetem para a gestão do ambiente na UCIN, concentração dos cuidados de Enfermagem respeitando o ciclo de sono-vigília dos recém-nascidos, posicionamento adequado, contenção, sucção não-nutritiva, técnica de Yakson, toque humano suave, canguru materno, massagem, estímulos auditivos calmos e colchão modelador. Conclusão: Dada a importância do sono no desenvolvimento dos recém-nascidos, é fulcral o papel do Enfermeiro através da adoção de estratégias protetoras e promotoras deste, especialmente em contexto de UCIN

Sleep plays a fundamental role in the growth and development of newborns, with their deprivation having many negative effects. The environment of the neonatal intensive care units (NICU) presents itself as disturbing and harmful for the neonatal sleep. OBJECTIVE: Map the existing scientific evidence regarding the strategies promoting newborn's sleep in the NICU setting. Methodology: Scoping review based on the methodology proposed by the Joanna Briggs Institute, using the following search engines and databases: MEDLINE via PubMed, CINHAL Plus with Full Text and Nursing & Allied Health Collection: Comprehensive via EBSCO-HOST, Academic Search Complete, ScienceDirect and Directory of Open Access Journals via B-ON, LILACS, RCAAP and SciELO. As search limiters, there were defined articles published in the last 5 years (until February 2019), available in Portuguese or in English and in full text. RESULTS: A total of 186 results were listed, and the final sample included 9 studies that responded to the review objective based on the selected inclusion criteria. The sleep-promoting strategies identified refer to the management of the environment in the NICU, the concentration of Nursing care respecting the newborn's sleep-wake cycle, and non-pharmacological interventions such as proper positioning, physical restraint, non-nutritive sucking, Yakson technique, gentle human touch, kangaroo mother care, massage, calm auditory stimuli and remolding mattress. Conclusion: Given the importance of sleep in the newborn's development, the nurse's role is crucial through the implementation of protective and promoting sleep strategies, especially in the NICU

Técnicas seguras en neonatología, ¿podemos mejorar? / Safe techniques in neonatology. Can we improve?

Los eventos adversos secundarios al uso de técnicas y procedimientos en las Unidades de Cuidados Intensivos Neonatales son una causa frecuente de error potencialmente grave en el período neonatal. La disminución en el número de procedimientos invasivos que se realizan en la práctica clínica habitual se ha propuesto como un posible factor causante de este hecho. En el presente artículo discutiremos las estrategias de prevención de estos incidentes en neonatología, analizando específicamente el valor del entrenamiento simulado para adquirir competencias en la realización de procedimientos invasivos, así como la aplicación de paquetes globales de cuidados neonatales que utilicen otras técnicas de mejora de calidad con el objetivo de efectuar una asistencia más segura a los recién nacidos ingresados en nuestras unidades

Adverse events due of the use of techniques and procedures in Neonatal Intensive Care Units are a frequent cause of potentially serious error in the neonatal period. A decrease in the number of invasive procedures performed in routine clinical practice has been proposed as a possible factor. In this article, we will discuss prevention strategies for these incidents in neonatology, specifically the value of simulated training to acquire competencies in the performance of invasive procedures, as well as the application of global neonatal bundles of care using other quality improvement techniques, with the objective of providing a more safety assistance to new born admitted to our units

Deshidratación hipernatrémica grave neonatal por fallo en la instauración de la lactancia materna: estudio de incidencia y factores asociados / Severe neonatal hypernatremic dehydratation in the initiation of the breastfeeding: study of incidence and associated factors

Introducción: la deshidratación hipernatrémica neonatal asociada al fallo en la instauración de la lactancia materna puede provocar importantes complicaciones e incluso la muerte. Existen pocos datos acerca de su magnitud en nuestro medio. Objetivos: conocer la incidencia y describir las características clínico-epidemiológicas asociadas. Material y métodos: estudio observacional retrospectivo en recién nacidos con diagnóstico de deshidratación hipernatrémica con Na>150 mEq/l que necesitaron ingreso hospitalario entre 2011 y 2017 en nuestra área sanitaria. Se excluyeron casos con patología de base o infección concomitante. Se recogieron datos demográficos, clínicos, analíticos, terapéuticos y evolutivos mediante revisión de historias clínicas y se realizó análisis estadístico posterior. Resultados: la población susceptible estimada fue de 41 084 recién nacidos. Cumplieron criterios 20 casos. Alimentación con lactancia materna exclusiva 19/20, primer hijo en 14/20 familias, con mediana de edad materna 34 años (rango intercuartílico: 31-37). Los motivos de consulta más frecuentes fueron pérdida de peso, ictericia e irritabilidad. La mediana de edad al ingreso fue de 5,5 días (rango intercuartílico: 3,3-9,8), con porcentaje de peso perdido 14,4% (rango intercuartílico: 10-17) y natremia mediana 157,25 mEq/L (rango intercuartílico: 152-157,8). La estancia media fue de 6,5 días (rango intercuartílico: 4-8,75), 2/20 precisaron cuidados intensivos. No registramos fallecimientos o complicaciones graves. Conclusiones: la incidencia global de la deshidratación hipernatrémica fue de 0,5 por cada 1000 recién nacidos/año en la población estudiada. Se relacionó con lactancia materna exclusiva, primiparidad y mayor edad materna. Con estos resultados, parece una medida oportuna informar sobre signos de alarma al alta de maternidad, así como realizar la primera revisión del bebé de forma precoz

Introduction: neonatal hypernatremic dehydration associated with failure in the establishment of breastfeeding instauration can cause significant complications and even death. There are few studies on its incidence in Spain. Objectives: our aim was to determine the incidence of this problem and describe the epidemiological and clinical features associated with it. Materials and methods: we conducted a retrospective observational study in newborns with a diagnosis of hypernatremic dehydration and serum sodium levels of more than 150 mEq/l that required hospitalization between 2011 and 2017 in our catchment area. We excluded patients with underlying conditions or concomitant infection. We collected data on epidemiological, clinical, laboratory, treatment and outcome variables through the review of health records, followed by their statistical analysis. Results: the estimated size of the susceptible population was 41 084 newborns. Twenty met the inclusion criteria. In this sample, 19/20 newborns were exclusively breastfed, 14/20 were the first-born child, and the median maternal age was 34 years (interquartile range: 31-37). The most frequent reasons for seeking care were weight loss, jaundice and irritability. The median age at admission was 5.5 days (interquartile range: 3.3-9.8), the percentage of birth weight lost was 14.4% (interquartile range: 10-17), and the median serum sodium level was 157.25 mEq/l (interquartile range: 152-157.8). The mean length of stay was 6.5 days (interquartile range: 4-8.75), and 2/20 newborns required intensive care. None of the patients died or had severe complications. Conclusions: we found an overall incidence of hypernatremic dehydration of 0.5 per 1000 live births per year in the population under study. We found an association with exclusive breastfeeding, primiparity and greater maternal age. In light of these results, it seems advisable to provide information on the warning signs at the time of discharge from the maternity ward, and to schedule the first checkup for the baby at an earlier time

Cuidados de Enfermería en el tratamiento con hipotermia en la encefalopatía hipóxico-isquémica del recién nacido / Nursing care in hypothermia treatment for newborns with hypoxic-ischemic encephalopathy

Objetivo: analizar la evidencia científica disponible sobre el tratamiento con hipotermia y los cuidados de Enfermería en la encefalopatía hipóxico-isquémica del recién nacido. Método: revisión narrativa de la literatura. Se realizó una búsqueda bibliográfica en diferentes bases de datos, plataformas, bibliotecas y repositorios, que incluían entre otras PubMed, Cochrane, Lilacs, Enfispo, Cuiden, Scielo, etc. Se usaron los términos combinados "hipoxia- isquemia encefálica", "hipotermia inducida", "recién nacido" y "atención de Enfermería". La búsqueda se limitó a artículos científicos de neonatología y pediatría, publicados entre 2006 y 2017, en castellano o inglés. Resultados: se identificaron 29 estudios que hacían referencia al tratamiento con hipotermia en la encefalopatía hipóxico-isquémica (EHI) del recién nacido, así como de los cuidados de Enfermería. Diversos estudios han demostrado que la hipotermia aplicada antes de las seis horas de vida y mantenida durante 72 horas, reduce la mortalidad y lesiones cerebrales. Existe controversia en su aplicación en la encefalopatía hipóxico-isquémica severa o moderada, pero en las dos se obtienen resultados favorables. No hay ninguna terapia que combinada con la hipotermia mejore su eficacia. El éxito de este tratamiento requiere del esfuerzo de un equipo multidisciplinar. La profesión enfermera tiene un papel fundamental en su aplicación y ha de incluir también la atención a los padres durante todo el proceso. Conclusiones: la evidencia disponible apoya que la hipotermia inducida reduce la mortalidad y las secuelas neurológicas en recién nacidos afectados. Queda pendiente un mayor control a lo largo de los años de estos neonatos. Son necesarias otras estrategias que combinadas con la hipotermia inducida reduzcan el impacto de la encefalopatía hipóxico-isquémica

Objective: to analyze the scientific evidence available about hypothermia treatment and Nursing care for newborns with hypoxic-ischemic encephalopathy. Method: a narrative review of literature. A bibliographic search was conducted in different databases, platforms, libraries and repositories, including PubMed, Cochrane, Lilacs, Enfispo, Cuiden, Scielo, etc. The following combined terms were used: "hipoxia- isquemia encefálica" (hypoxic-ischemic encephalopathy), "hipotermia inducida" (induced hypothermia), "recién nacido" (newborn) and "atención de Enfermería" (Nursing care). The search was limited to scientific articles on Neonatology and Paediatrics published between 2006 and 2017, in Spanish and English. Results: twenty-nine (29) studies were identified regarding hypothermia treatment for newborns with hypoxic-ischemic encephalopathy (HIE) as well as Nursing care. Different studies have demonstrated that applying hypothermia before the first 6 hours of life, and maintaining it for 72 hours, will reduce mortality and brain damage. There is some controversy regarding its application in severe or moderate hypoxic-ischemic encephalopathy, but favourable results are obtained in both. No therapy will improve the efficacy of hypothermia when used in combination. The success of this treatment requires the effort of a multidisciplinary team. Nurses as professionals will play an essential role in its application, with must also include care for parents during the entire process. Conclusions: the evidence available supports that induced hypothermia will reduce mortality and neurological consequences in newborns. Further follow-up over the years should be conducted in these newborns. Other strategies are required, to be used in combination with induced hypothermia, for a reduction in the impact of hypoxic-ischemic encephalopathy