Cuidados al final de la vida en unidades de cuidado intensivo neonatal de Iberoamérica: una mirada desde la perspectiva de enfermería / End-of-life care in neonatal intensive care units in Iberoamerica: A look from the nursing perspective

Introducción: Los cuidados al final de la vida (CFV) son una parte fundamental de la asistencia al recién nacido ingresado en una unidad de cuidados intensivos neonatal (UCIN). El objetivo de este estudio fue explorar cómo se implementan los CFV en UCIN de Iberoamérica. Métodos: Estudio transversal realizado en 2022 mediante encuesta vía correo electrónico y redes oficiales de SIBEN a profesionales de enfermería de UCIN de países de Iberoamérica, sobre aspectos relacionados con los CFV. Recolección y análisis de datos con REDCap y STATA 14.0. Resultados: Obtuvimos 400 respuestas de enfermeros/as de 11 países, el 73% procedentes de hospitales terciarios. El 86% de los respondedores eran responsables directos de brindar CFV, si bien un 48% dijeron no haber recibido formación. Solo 67 (17%) afirmaron que la UCIN en la que trabajan cuenta con un protocolo. Las acciones que se implementan durante los CFV fueron infrecuentes (≤50%) en todos los ítems explorados y muy poco frecuentes (<20%) en permitir el acceso libre de familiares, contar con privacidad, brindar asistencia psicológica, registrar el proceso en la historia clínica, asistir con los procesos burocráticos u otorgar un plan de seguimiento para el duelo. Conclusión: La mayoría de los profesionales de enfermería encuestados eran responsables directos de proveer CFV, pero no contaban con protocolos, no habían recibido capacitación y consideraron que los CFV podrían mejorarse significativamente. Las estrategias para los CFV en la región iberoamericana requieren ser optimizadas.(AU)

Introduction: End-of-life care (ELC) represents a quality milestone in neonatal intensive care units (NICU). The objective of this study was to explore how ELC are carried out in NICUs in Iberoamerica. Methods: Cross-sectional study, carried out in 2022 through the administration of an anonymous survey sent to neonatal nursing professionals. The survey included general data and work activity data; existence and contents of ELC protocols in the NICU and training received. The survey was distributed by email and published on official SIBEN social networks. REDCap and STATA 14.0 software were used for data collection and analysis. Results: We obtained 400 responses from nurses from 11 countries, 73% working in third level hospitals. A percentage of 86 of the respondents are directly responsible for providing ELC, although 48% of them said they had not received training on this subject. Only 67 (17%) state that the NICU in which they work has a protocol that establishes a strategy for performing the ELC. Finally, the actions that are implemented during the ELC are globally infrequent (≤50%) in all the items explored and very infrequent (<20%) in relation to allowing free access to family members, having privacy, providing psychological assistance, register the process in the medical record, assist with bureaucratic processes or grant a follow-up plan for grief. Conclusion: Most of the nursing professionals surveyed are directly responsible for this care, do not have protocols, have not received training, and consider that the ELC could be significantly improved. Strategies for ELCs in the Ibero-American region need to be optimized.(AU)

End-of-life care in neonatal intensive care units in Iberoamerica: A look from the nursing perspective.

INTRODUCTION: End-of-life care (ELC) represents a quality milestone in neonatal intensive care units (NICU). The objective of this study was to explore how ELC are carried out in NICUs in Iberoamerica. METHODS: Cross-sectional study, through the administration of an anonymous survey sent to neonatal nursing professionals. The survey included general data and work activity data; existence and contents of ELC protocols in the NICU and training received. The survey was distributed by email and published on official SIBEN social networks. REDCap and STATA 14.0 software were used for data collection and analysis. RESULTS: We obtained 400 responses from nurses from 11 countries in the Ibero-American region. 86% of the respondents are directly responsible for providing ELC, although 48% of them said they had not received training on this subject. Only 67 (17%) state that the NICU in which they work has a protocol that establishes a strategy for performing the ELC. Finally, the actions that are implemented during the ELC are globally infrequent (≤50%) in all the items explored and very infrequent (<20%) in relation to allowing free access to family members, having privacy, providing psychological assistance, register the process in the medical record, assist with bureaucratic processes or grant a follow-up plan for grief. CONCLUSION: Most of the nursing professionals surveyed are directly responsible for this care, do not have protocols, have not received training, and consider that the ELC could be significantly improved. Strategies for ELCs in the Ibero-American region need to be optimized.

Acceso de las familias a las unidades de internación de Neonatología en Iberoamérica: una realidad a mejorar / Family access to Neonatal Intensive Care Units in Latin America: A reality to improve

INTRODUCCIÓN: El ingreso de la familia en UCIN trae beneficios al RN y su familia, como eje de la atención humanizada. OBJETIVO: Conocer el estado actual sobre acceso de padres y familias en UCIN de Iberoamérica. MÉTODOS: Estudio transversal en 15 países de Iberoamérica. Dos cuestionarios: 1) para enfermeros jefes con tareas de gestión y conducción, y 2) para enfermeros en tarea asistencial. Se exploró sobre características y modalidades de funcionamiento; uso de guías de acceso, opinión personal sobre derecho a ingresar, riesgos, interferencias o colaboración relacionadas al ingreso, y papel de enfermería en las decisiones. Líderes de enfermería de cada país identificaron contactos y obtuvieron autorización según regulaciones de cada país. Las repuestas fueron analizadas en forma centralizada sin identificación del participante. RESULTADOS: Seiscientos cuarenta cuestionarios; respuesta en 226 (35%). Entre 52 UCIN, el 63% dispone de lugar para estancia de madres (solo el 27% durante la noche); en el 31 (60%) existen carteles que indican sobre horarios fijos para «visitas» de padres. El ingreso irrestricto existe en solo 19 UCIN (36%); para hermanos y abuelos es más restringido (en el 29% no es posible). Entre las 174 enfermeras, el 76% considera que las madres deben acceder siempre, pero estos porcentajes disminuyen para padres, hermanos y abuelos; el 77% opina que enfermería favorece y el 35% que dificulta el acceso. Adicionalmente, el 48% opina que el ingreso interfiere con tareas de enfermería. CONCLUSIÓN: Es necesario un cambio cultural en las UCIN de Iberoamérica para que se respeten los derechos de los RN y sus familias durante la internación

INTRODUCTION: Family access to NICUs has benefits for the newborn (NB) and family, as the main way of humanised care. OBJECTIVE: To determine the current state of parents and families access to NICUs in Latin America. METHODS: A cross-sectional study was conducted in 15 countries using two questionnaires: 1) directed at head nurses with management and supervision activities, and 2) nurses with care tasks. The features and modes of functioning were examined; the use access guides, personal opinion on the rights to enter, risks, interference, or collaboration as regards the patient, and nursing role in decisions. Nursing leaders of each country identified contacts and obtained authorisation under the regulations of each country. The responses were analysed centrally with the participants remaining anonymous. RESULTS: Out of 640 questionnaires issued, responses were received by 226 (35%). Among 52 NICU, 63% have a place for mothers to stay (only 27% overnight), and in 31 (60%) there are notices with fixed schedules for visiting the NB. Unrestricted access exists in only 19 NICU (36%), but for siblings and grandparents it is more restricted (it is not possible in 29%). Among the 174 nurses that responded, 76% feel that mothers should always have access, but these percentages decrease for fathers, siblings and grandparents. A large majority (77%) believe that nursing staff would favour access, and 35% would make it difficult. In addition, 48% believed that access interferes with nursing care. care. CONCLUSION: A cultural change is needed in the NICUs in Latin America in order to respect the rights of newborns and their families during hospitalization

[Family access to Neonatal Intensive Care Units in Latin America: A reality to improve]. / Acceso de las familias a las unidades de internación de Neonatología en Iberoamérica: una realidad a mejorar.

INTRODUCTION: Family access to NICUs has benefits for the newborn (NB) and family, as the main way of humanised care. OBJECTIVE: To determine the current state of parents and families access to NICUs in Latin America. METHODS: A cross-sectional study was conducted in 15 countries using two questionnaires: 1) directed at head nurses with management and supervision activities, and 2) nurses with care tasks. The features and modes of functioning were examined; the use access guides, personal opinion on the rights to enter, risks, interference, or collaboration as regards the patient, and nursing role in decisions. Nursing leaders of each country identified contacts and obtained authorisation under the regulations of each country. The responses were analysed centrally with the participants remaining anonymous. RESULTS: Out of 640 questionnaires issued, responses were received by 226 (35%). Among 52 NICU, 63% have a place for mothers to stay (only 27% overnight), and in 31 (60%) there are notices with fixed schedules for visiting the NB. Unrestricted access exists in only 19 NICU (36%), but for siblings and grandparents it is more restricted (it is not possible in 29%). Among the 174 nurses that responded, 76% feel that mothers should always have access, but these percentages decrease for fathers, siblings and grandparents. A large majority (77%) believe that nursing staff would favour access, and 35% would make it difficult. In addition, 48% believed that access interferes with nursing care. care. CONCLUSION: A cultural change is needed in the NICUs in Latin America in order to respect the rights of newborns and their families during hospitalisation.

Evaluation of cytomegalovirus infection in low-birth weight children by breast milk using a real-time polymerase chain reaction assay.

Human Cytomegalovirus (CMV) is the most common cause of intrauterine and perinatal infections worldwide. Postnatal CMV transmission has usually no consequences, but in some cases it may produce disease in preterm infants. Literature reports a broad range of breast milk-acquired CMV infections (5.7-58.6%), which depends on the study's design and the treatment of the milk. To evaluate CMV transmission via breast milk, a prospective study using a real-time PCR assay was performed. One hundred and thirty-one mothers (accounting for 160 children) accepted the participation in the study. Urine samples from the infants and breast milk samples from their mothers were collected at 3, 15, 30, 60, and 90 days after delivery. CMV-DNA in breast milk was analysed by quantitative real-time PCR assay Affigene® CMV Trender (Cepheid, Bromma, Sweden). The breast milk samples from 92 mothers (92 of 131, 70.2%) were positive for CMV by PCR. CMV infection was detected in thirteen children by PCR, and four of them (30.7%) had clinical symptoms. There were not significant differences in morbidity between symptomatic and non- symptomatic patients; nonetheless, the average length of hospitalization in symptomatic children was higher than that of non-symptomatic children (P < 0.05). The rtPCR technique is useful for detection of mothers with high viral loads of CMV-DNA in milk, and might be of help to decide whether to freeze the breast milk in preterm children less than 28 weeks.

Safe oxygen saturation targeting and monitoring in preterm infants: can we avoid hypoxia and hyperoxia?

UNLABELLED: Oxygen is a neonatal health hazard that should be avoided in clinical practice. In this review, an international team of neonatologists and nurses assessed oxygen saturation (SpO2 ) targeting in preterm infants and evaluated the potential weaknesses of randomised clinical trials. CONCLUSION: SpO2 of 85-89% can increase mortality and 91-95% can cause hyperoxia and ill effects. Neither of these ranges can be recommended, and wider intermediate targets, such as 87-94% or 88-94%, may be safer.