Simulating whole-body vibration for neonatal patients on a tire-coupled road simulator.

Exposure to excessive whole-body vibration is linked to health issues and may result in increased rates of mortality and morbidity in infants. Newborn infants requiring specialized treatment at neonatal intensive care units often require transportation by road ambulance to specialized care centers, exposing the infants to potentially harmful vibration and noise. A standardized Neonatal Patient Transport System (NPTS) has been deployed in Ontario, Canada, that provides life saving equipment to patients and safe operation for the clinical care staff. However, there is evidence that suggests patients may experience a higher amplitude of vibration at certain frequencies when compared with the vehicle vibration. In a multi-year collaborative project, we seek to create a standardized test procedure to evaluate the levels of vibration and the effectiveness of mitigation strategies. Previous studies have looked at laboratory vibration testing of a transport system or transport incubator and were limited to single degree of freedom excitation, neglecting the combined effects of rotational motion. This study considers laboratory testing of a full vehicle and patient transport system on an MTS Model 320 Tire-Coupled Road Simulator. The simulation of road profiles and discrete events on a tire-coupled road simulator allows for the evaluation of the vibration levels of the transport system and the exploration of mitigation strategies in a controlled setting. The tire-coupled simulator can excite six degrees-of-freedom motion of the transport system for vibration evaluation in three orthogonal directions including the contributions of the three rotational degrees of freedom. The vibration data measured on the transport system during the tire-coupled testing are compared to corresponding road test data to assess the accuracy of the vibration environment replication. Three runs of the same drive file were conducted during the laboratory testing, allowing the identification of anomalies and evaluation of the repeatability. The tire-coupled full vehicle testing revealed a high level of accuracy in re-creating the road sections and synthesized random profiles. The simulation of high amplitude discrete events, such as speed hump traverses, were highly repeatable, yet yielded less accurate results with respect to the peak amplitudes at the patient. The resulting accelerations collected at the input to the manikin (sensor located under the mattress) matched well between the real-world and road simulator. The sensors used during testing included series 3741B uni-axial and series 356A01 tri-axial accelerometers by PCB Piezotronics. These results indicate a tire-coupled road simulator can be used to accurately evaluate vibration levels and assess the benefits of future mitigation strategies in a controlled setting with a high level of repeatability.

Diagnosis Discordance and Neonatal Transport: A Single-Center Retrospective Chart Review.

INTRODUCTION: In Canada, more than 4,000 critically ill newborns per year require transfer. Transports are initially managed based on information conveyed by referral practitioners. OBJECTIVES: To identify the frequency of diagnostic discordance between the referring facility, transport team, and tertiary care center in our outborn neonatal population and to verify the association between discordance events (DEs), prolonged transport stabilization times, and potential risk factors to further inform and facilitate the development of future outreach education initiatives. STUDY DESIGN: In this retrospective chart review, we identified and categorized DEs for patients transported by our service in a 1-year period. Associations between DE, transport stabilization times, and patient variables were studied using univariate and multivariable approaches. RESULTS: From 233 eligible patients, 10.7% of patients had referral to discharge discordance events. No significant association was identified between stabilization time and DE. Birth weight and presence of a neurologic diagnosis were associated with DE. CONCLUSION: Diagnostic discordance was identified in 1 of every 10 neonates transported and found to be associated with patients with higher birth weight and the presence of neurologic diagnoses. Outreach initiatives will be developed and adapted accordingly, with a focus on this population.

Be Sweet to Babies During Painful Procedures: A Pilot Evaluation of a Parent-Targeted Video.

BACKGROUND: Breastfeeding (BF), skin-to-skin care (SSC), and sucrose effectively reduce babies' pain during newborn blood work, but these strategies are infrequently used. Our team developed a parent-targeted video intervention showing the effectiveness of the 3 pain management strategies. PURPOSE: To evaluate neonatal intensive care unit (NICU) parents' (1) baseline knowledge and previous use of BF, SSC, and sucrose for procedural pain management; (2) intention to advocate/use BF, SSC, or sucrose for their infants' future blood work after viewing the video; (3) intention to recommend the video to other parents; and (4) perceptions of the video and identify areas for improvement. METHODS: Cross-sectional survey of parents in an NICU. RESULTS: Fifty parents were enrolled: 33 mothers and 17 fathers. More than two-thirds (68%) of parents had prior knowledge of analgesic effects of sucrose; knowledge of SSC and BF as pain-reduction strategies was lower: 44% and 34%, respectively. Eighty-six percent of parents felt the video was the right length; 7 (14%) felt the video was too long. After viewing the video, 96% of parents intended to advocate for BF, SSC, or sucrose for pain management and 88% parents would recommend the video to other parents. IMPLICATIONS FOR PRACTICE: The video is acceptable to parents, is feasible to deliver to parents in an NICU, and has potential to increase parents' intent to advocate for pain management strategies for their infants. IMPLICATIONS FOR RESEARCH: Future studies are required to evaluate the effectiveness of this parent-targeted intervention on increasing actual use of pain management in clinical practice.

Pain Management During Newborn Screening: Using YouTube to Disseminate Effective Pain Management Strategies.

To assess the reach, acceptability, and effect of the BSweet2Babies video showing breast-feeding, skin-to-skin care, and sucrose during blood sampling on intention to recommend the video or advocate for use of the interventions. In July 2014, the video and an electronic survey were produced and posted. After 1 year, the online viewer survey responses and YouTube analytics were analyzed. One year after posting, the BSweet2Babies video had 10 879 views from 125 countries and 187 (1.7%) viewers completed the survey. Most respondents were aware of the analgesic effects of breast-feeding, skin-to-skin care, and sucrose. Nearly all respondents (n = 158, 92%) found the BSweet2Babies video to be a helpful resource and 146 (84%) answered that they would recommend the video to others. After viewing the video, 183 (98%) respondents answered that they would advocate for 1 or more of the interventions. The BSweet2Babies video showing effective pain treatment during blood sampling had a large reach but a very small response rate for the survey. Therefore, analysis of acceptability and effect on intention to recommend the video and advocate for the interventions depicted are limited. Further research is warranted to explore how to best evaluate videos delivered through social media and to determine the effect of the video to promote knowledge translation into clinical practice.