Web Camera Use in the Neonatal Intensive Care Unit: Impact on Nursing Workflow.

BACKGROUND: Many neonatal intensive care units (NICU) are using web camera systems to allow virtual visitation of the infant by family members. Generally, families appreciate the web camera and utilize this service. However, no one has looked into the change on nursing workload after implementation of a web camera. OBJECTIVE: This study was designed to explore the perception of nurses and their workflow and identify determinants that may disrupt or facilitate the use of a commercially available camera service. Our primary goal was to see if the camera system interferes with the nursing care. STUDY DESIGN: This was a prospective, questionnaire-based study conducted between March and September 2014. Parents were offered the camera service and signed a consent form before use. Parents who refused the camera were the group designated as "off camera." There were two infant groups; one cared for using the cameras and the other not. The camera service was used continuously during the study period, except during procedures, baby care, and feedings. Demographic information on nursing staff and neonates was collected weekly. Questionnaires were placed at each bedside for nurses to complete on each shift for each infant once weekly. The questionnaires for infants off-camera did not have questions regarding the camera. However, the rest of the questions were similar regarding time spent interacting with family members, face to face, or on the phone. Data on time spent manipulating the camera per shift were also obtained. RESULTS: Surveys for 623 on-camera and 130 off-camera infants were completed by 42 nursing staff. Findings showed that caring for multiple infants while using the web camera increased nurses' workload and stress, which they perceived as having an adverse effect on the ability to provide quality care. Family decisions not to utilize the camera service were mainly cultural, and noted among Mennonite, Amish, and Hmong families. Some families residing close to the hospital also preferred visiting the baby personally rather than using the camera service. CONCLUSION: Parents and nurses perceived web cameras as beneficial in the NICU setting. However, nurses spent significant time manipulating cameras and addressing parental concerns over the phone, causing disruption in their workflow, which had the potential to decrease quality of care for infants. To compensate for these disruptions, we recommend increasing awareness of the potential issues with both cameras and families and providing multiple training sessions to nursing staff before systems are implemented.

Congenital Aphallia: Review of Pathogenesis and Current Treatment Guidelines.

Congenital aphallia is an extremely rare disorder with <100 cases reported globally. We report on an 11-month-old infant with aphallia and associated syrinx formation. We also review the pathogenesis, associated malformations, and current treatment guidelines for penile agenesis.

A case report of meningococcal disease in a neonate.

Neonatal meningococcal meningitis (NMM) is rare, although early onset and late onset forms of meningococcal sepsis in neonates have been reported. The outcome of meningococcal disease can be fatal and depends on the innate immune system, age, serogroups, pre-existing antibodies, and other unknown host factors. The presentation of NMM differs from that in children and adolescents and may present with fever, poor feeding, decreased activity, seizures, altered consciousness, respiratory distress, or rash. Prompt identification and initiation of antibiotics is critical to survival. In the literature, very few cases of neonatal meningococcal disease have been reported in the United States. The average annual incidence of meningococcal meningitis in neonates is very low compared to the incidence of group B streptococcal meningitis. We present the youngest documented case (to the best of our knowledge) of neonatal meningococcal meningitis in the United States. We also present a review of the existing literature.