The problems of moderate preterm infants.

Moderate preterm infants are the largest group of preterm infants but are an understudied population. Care practices are adapted from studies of full term infants or extremely preterm infants. Studies are needed to tailor treatments for this vulnerable population. The NRN began investigation in this population with a registry of characteristics, and neonatal outcomes of these infants. This work compares outcomes of MPR with those of full term infants reported in the literature.

Neonatal Resuscitation Training: Implications of Course Construct and Discipline Compartmentalization on Role Confusion and Role Ambiguity.

BACKGROUND: The Neonatal Resuscitation Program's (NRP's) Sixth Edition introduced simulation-based training (SBT) into neonatal life support training. SBT offers neonatal emergency response teams a safe, secure environment to rehearse coordinated neonatal resuscitations. Teamwork and communication training can reduce tension and anxiety during neonatal medical emergencies. PURPOSE: To discuss the implications of variability in number and type of simulation scenario, number and type of learners who comprise a course, and their influence upon scope of practice, role confusion, and role ambiguity. METHODS: Relevant articles from MEDLINE, CINAHL, EMBASE, Google Scholar, the World Health Organization, the American Heart Association, and NRP were included in this integrative review of the literature. FINDINGS/RESULTS: Purposeful synergy of optimal SBT course construct with teamwork and communication can resist discipline compartmentalization, role confusion, and role ambiguity. Five key themes were identified and coined the "5 Rights" of NRP SBT. These "5 Rights" can guide healthcare institutions with planning, implementation, and evaluation of NRP SBT courses. IMPLICATIONS FOR PRACTICE: NRP SBT can facilitate optimal team function and reduce errors when teams of learners and varied scenarios are woven into the course construct. The simulated environment must be realistic and fully equipped to encourage knowledge transfer and attainment of the NRP's key behavioral outcomes. IMPLICATIONS FOR RESEARCH: Investigation of teamwork and communication training with NRP SBT, course construct, discipline compartmentalization, and behavioral and clinical outcomes is indicated. Investigation of outcomes of SBT using a team-teaching model, combining basic and advanced practice NRP instructors, is indicated.

Quality initiatives related to moderately preterm, late preterm, and early term births.

Most premature infants born in the United States each year are classified as either moderately preterm (MPT) or late preterm (LPT) infants. Unnecessary variation in care and lack of evidence-based practices may contribute to the morbidities of prematurity. Quality-improvement (QI) initiatives designed for neonates have primarily focused on extremely low-gestational-age newborns. However, the lessons learned in this group of infants could be applied to decreasing unnecessary variation among MPT and LPT infants. Practice variation in the timing of nonindicated preterm deliveries, the use of progesterone, respiratory care practices, feeding management, and discharge planning are particularly in need of QI.