Newborn Screening Knowledge and Attitudes Among Midwives and Out-of-Hospital-Birth Parents.

Midwifery and nursing are collaborative partners in both education and practice. Understanding needs and barriers to clinical services such as newborn screening is essential. This study examined knowledge and attitudes of midwives and out-of-hospital-birth parents about newborn blood spot screening (NBS). Descriptive and cross-sectional surveys were distributed to midwives and out-of-hospital-birth parents from birth center registries and the Utah Health Department of Vital Records. Seventeen midwife surveys (response rate: 17%) and 113 parent surveys (response rate: 31%) were returned. Most midwives and out-of-hospital-birth parents reported satisfactory knowledge scores about NBS. Only 5% of parents (n = 6) did not participate in NBS. Most midwives reported that NBS is important and encouraged patients to consider undergoing NBS. Some concerns included the lack of education for both midwives and out-of-hospital patients and the trauma and accuracy of the heel prick soon after birth. Both midwives and out-of-hospital-birth parents expressed a need for improved NBS education. Additional studies are needed to ascertain whether this trend is seen with similar populations throughout the United States, to further elucidate the factors that drive NBS nonparticipation, and to develop educational resources for midwives and their patients.

Early access to biological neonatal screening: coordination among child care action programs.

OBJECTIVE: To verify factors associated with early newborn access to biological neonatal screening. METHOD: A cross-sectional quantitative study was carried out with all newborns who underwent tests in healthcare units, hospitals, and laboratories of a city in the state of São Paulo, Brazil, with programs linking healthcare information. The following variables were investigated: child's age at collection (dependent); place of collection; date of collection; and type of user (independent). Descriptive and inferential statistics were applied. RESULTS: Records of 15,652 screenings were found in the two years analyzed. In the first year analyzed, 7,955 births and 7,640 (96.0%) tests were recorded, of which 5,586 (73.1%) were undertaken with newborns between three and five days old. In the next year analyzed, 8,316 births and 8,012 (96.3%) screenings were recorded, of which 7,025 (87.6%) were undertaken with newborns in the same age group. A statistically significant association was found between the variables "child's age" and "type of user" in one year, and between the variables "child's age" and "place of collection" in both years. CONCLUSION: Early access to these tests enables the screening of diseases and referral for treatment. The present study contributes to the management of child care programs by presenting strategies linking data and actions to improve access to biological neonatal screening.

Lessons learnt from implementing change in newborn bloodspot screening processes over more than a decade: Midwives, genetics and education.

OBJECTIVE: To explore midwives' roles and education requirements in newborn bloodspot screening (NBS) for genetic conditions, as programs and supporting education evolve over time. BACKGROUND: NBS processes are evolving and will continue to evolve with new genetic and genomic technologies. Midwives have a critical role in facilitating NBS, as they are the primary healthcare professional to interact with parents at the time of collecting the bloodspot. As new consent processes and genomic technologies are incorporated into NBS, midwives need to stay up-to-date with these changes, so that parents can make an informed decision about having the test and future use of the DNA sample. RESEARCH DESIGN/SETTING: We used a cross-sectional approach to analyse midwives' knowledge and behaviour in 2005/6 and 2016, with changes in NBS processes and education introduced in 2011. FINDINGS: We found midwives' NBS knowledge improved in 8/18 areas after a 10-year period, mostly related to process changes, but there was also an increase in misconceptions regarding which conditions are screened. Areas of significant improvement were not consistently explained by participation in continuing professional development (CPD). We found midwives used official brochures and NBS collection cards to guide discussions with families. Changes to the NBS collection cards, together with the content of CPD materials, aligned with the significant improvements and deficits we observed. When considering potential changes to future maternity care that incorporates emerging genomic technologies, midwives indicated the main barrier was their lack of knowledge; the majority (60.3%) reported supervision support to attend genomics CPD. KEY CONCLUSIONS: Changes in NBS practice should be implemented through multifaceted programs that include education sessions and procedural prompts. The NBS collection card should be seen not just as a legal consent document but also as an educational tool. IMPLICATIONS FOR PRACTICE: As NBS programs evolve through the addition of conditions screened for or changes to technology or consent processes, multiple strategies should be applied to upskill midwives to ensure they can best support parents to make informed choices.

Nursing Diagnosis of Neonatal Jaundice: Study of Clinical Indicators.

PURPOSE: This study aimed to identify the defining characteristics of, and examine their association with, the nursing diagnosis (ND) of Neonatal Jaundice (00194) in sample of hospitalized newborns. DESIGN AND METHODS: A cross-sectional study developed with 100 newborns aged between 24h and ten days. Data collection was performed in a public hospital of tertiary health care between March and June of 2016. RESULTS: The ND of Neonatal jaundice was present in 31% of the sample. The most frequent defining characteristics were yellow-orange skin color (65%) and abnormal blood profile (75%). Yellow mucous membranes, yellow-orange skin color and bruised skin showed statistically significant sensitivity and specificity. Yellow mucous membranes, yellow sclera and yellow-orange skin color were statistically associated with Neonatal jaundice. Yellow mucous membranes showed the best diagnostic accuracy measurements. CONCLUSIONS: The clinical indicators that best predicted and increased the probability of developing jaundice were identified. PRACTICE IMPLICATIONS: These clinical indicators increase the ability of nurses to clinically infer nursing diagnoses. This allows nurses to identify signs and symptoms of health conditions in a sensible and definitive manner, decreasing the possibility of errors.

Confort neonatal del recién nacido pre-término / Neonatal comfort of preterm infant

Justificación: la clarificación de conceptos es un elemento primordial en el desarrollo científico, estos son explicativos y permiten caracterizar los fenómenos de interés disciplinar. Propósito: clarificar el significado de confort neonatal, para desarrollar una definición operacional que permita comprender mejor las necesidades de los recién nacidos pre-término. Metodología: se realizó un análisis de concepto bajo la metodología de Walker y Avant. Resultado: una definición teórica actual y operacional para su uso en intervenciones de enfermería del cuidado neonatal. Conclusión: el introducir nuevos conceptos en la disciplina, permite al profesional de enfermería desarrollar habilidades para resolver problemas propios de la práctica diaria

Justification: clarification of concepts is a key factor in scientific development; they are explanatory and enable the characterization of disciplinary interest phenomena. Objective: to clarify the meaning of neonatal comfort, in order to develop an operational definition that enables a better understanding of the needs of preterm infants. Method: a concept analysis under Walker and Avant's methodology was performed. Results: a current theoretical and operational definition for its use in nursing interventions of neonatal care. Conclusions: introducing new concepts to the discipline enables the nursing professionals to develop skills to solve problems related to everyday practice

Intraamniotic Infection and the Term Neonate.

Intraamniotic infection (IAI) may occur when the amniotic membranes are ruptured >18 hours prior to birth. The term neonate is at risk for early onset sepsis. This article describes the pathophysiology of IAI and the role of the mother-baby nurse during the anticipated birth and the ongoing assessment of the neonate.

Diagnóstico precoz y proceso de atención en enfermería en pacientes pediátricos con fibrosis quística / Early diagnosis and nursing process of care in pediatric patients with cystic fibrosis

Introducción. La fibrosis quística (FQ) o mucoviscidosis, considerada una enfermedad extraña, hoy día se diagnostica a un número creciente de niños en todo el mundo y la cantidad de niños aquejados de esta enfermedad que llegan a la adolescencia y a la adultez es cada vez mayor. Objetivos. Facilitar aspectos importantes que tener en cuenta por parte del personal de enfermería en la detección precoz de la fibrosis quística y desarrollar un Plan de Cuidados de Enfermería estandarizado con los diagnósticos más frecuentes en estos pacientes. Método. Revisión bibliográfica. Se utilizaron bases de datos como EBSCO, SciELO y Medline bajo descriptores como «enfermería », «cuidadores» y «fibrosis quística». Conclusiones. El diagnostico precoz es fundamental para lograr una mejor calidad de vida y disminuir la mortalidad y el Proceso de Atención de Enfermería (PAE) se encarga de identificar los problemas reales y potenciales, siendo el documento guía que utiliza el personal de enfermería para trabajar las expectativas que cada paciente ha de lograr. En el nuevo PAE confeccionado se formularon 11 diagnósticos de enfermería, 11 expectativas y 63 acciones, que solucionan total o parcialmente los problemas y necesidades de estos pacientes (AU)

Introduction. An increasing amount of children worldwide are currently diagnosed with cystic fibrosis (CF), or mucoviscidosis, still considered a rare disease. The number of children suffering from this disease reaching adolescence and adulthood is likewise increasing. Objectives. To present important aspects to be considered by nursing staff in the early detection of cystic fibrosis and develop a standarized Nursing Care Plan for these patients’ most common diagnoses. Method. Literature review using databases such as EBSCO, SciELO and Medline using searching keawords including nursing, caregivers and cystic fibrosis. Conclusions. Early diagnosis is crucial to achieve a better life quality and reduce mortality. Nursing Care Plan (NCP) is responsible for identifying actual and potential problems and is the guiding document used by the nursing staff to work out the achievement of each patient’s expected evolution. The resulting new NCP developed included 11 nursing diagnoses, 11 expected evolutions and 63 actions that fully and / or partially address patients’ problems and needs (AU)

Evaluación del desarrollo y cuidado individualizado del RN (NIDCAP) / Evaluation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Objetivo: mostrar la evidencia científica sobre los resultados de la aplicación del Programa de Evaluación y Cuidado Individualizado del Desarrollo del Recién Nacido (NIDCAP) y sus potenciales beneficios clínicos en recién nacidos prematuros. Método: se llevó a cabo una revisión de la literatura, haciendo una búsqueda avanzada a través de PubMed, Cuiden, Scielo y Biblioteca Cochrane Plus, Google Académico y UpToDate. Dicha búsqueda se limitó a los idiomas inglés y español. El periodo de búsqueda fue el comprendido entre los años 2004 al 2016. Resultados: de los 281 documentos encontrados, fueron seleccionados 18. NIDCAP tiene el potencial de mejorar el desarrollo mental y psicomotor clínico. Los enfermeros, en comparación con el personal médico, tenían una actitud más positiva, mayor control conductual y una percepción de un mayor impacto positivo de NIDCAP en condiciones de UCIN. Las deficiencias en el diseño y métodos en los estudios revisados obstaculizan demandas de largo alcance sobre la eficacia del método. Los fundamentos científicos de los efectos del NIDCAP serían sustancialmente mejorados con estudios exhaustivos con seguimiento prolongado. Conclusiones: a pesar de los resultados esperanzadores en el desarrollo motor y cognitivo, y su valor de humanización, la evidencia científica sobre los efectos del NIDCAP es limitada al no demostrar que aporte mejorías clínicas significativas en el bebé prematuro. La evaluación de esta intervención integral, de alta complejidad, está cargada de una serie de problemas metodológicos. Las principales debilidades de los estudios están en los seguimientos a corto plazo y deficiencias metodológica, por lo que se necesitan estudios a largo plazo y con diseño centrado en objetivos concretos (AU)

Objective: to show the scientific evidence of the outcomes of the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) and its potential clinical benefits for pre-term newborns. Method: a literature review was conducted, through an advanced search in PubMed, Cuiden, Scielo and the Cochrane Plus Library, Academic Google and UpToDate. Said search was limited to English and Spanish. The search period included the years from 2004 to 2016. Results: eighteen (18) documents were selected of the 218 documents found. NIDCAP has the potential to improve mental and clinical psychomotor development. Compared with the medical staff, nurses had a more positive attitude, higher behavioural control, and a perception of a higher positive impact of NIDCAP in the NICU setting. The design and method deficiencies in the studies reviewed represent a barrier for long-term demands on the method efficacy. The scientific basis of NIDCAP effects would be significantly improved with comprehensive studies of prolonged follow-up. Conclusions: despite the hopeful outcomes on motor and cognitive development, and its humanization values, there is limited scientific evidence about NIDCAP effects, because it has not been demonstrated to offer significant clinical improvements in pre-term babies. The assessment of this comprehensive and high-complexity intervention is burdened by a series of methodological problems. The main weaknesses of the studies consist in their short-term follow-up and methodological problems. The main weaknesses of the studies consist in their short-term follow-up and methodological deficiencies; therefore, long-term studies are required, with a design focused on specific objectives (AU)

Genome Sequencing Technologies and Nursing: What Are the Roles of Nurses and Nurse Scientists?

BACKGROUND: Advances in DNA sequencing technology have resulted in an abundance of personalized data with challenging clinical utility and meaning for clinicians. This wealth of data has potential to dramatically impact the quality of healthcare. Nurses are at the focal point in educating patients regarding relevant healthcare needs; therefore, an understanding of sequencing technology and utilizing these data are critical. AIM: The objective of this study was to explicate the role of nurses and nurse scientists as integral members of healthcare teams in improving understanding of DNA sequencing data and translational genomics for patients. APPROACH: A history of the nurse role in newborn screening is used as an exemplar. DISCUSSION: This study serves as an exemplar on how genome sequencing has been utilized in nursing science and incorporates linkages of other omics approaches used by nurses that are included in this special issue. This special issue showcased nurse scientists conducting multi-omic research from various methods, including targeted candidate genes, pharmacogenomics, proteomics, epigenomics, and the microbiome. From this vantage point, we provide an overview of the roles of nurse scientists in genome sequencing research and provide recommendations for the best utilization of nurses and nurse scientists related to genome sequencing.

Apego en el postparto precoz: comparación entre madres de neonatos ingresados en el Servicio de Obstetricia y en la Unidad de Cuidados Intensivos Neonatales / Attachment in early postpartum: comparison between mothers of infants admitted to the Obstetric Service and the Neonatal Intensive Care Unit

Introducción: el apego materno es el conjunto de conductas y vínculos que la madre establece en torno al recién nacido. El ingreso en la Unidad de Cuidados Intensivos Neonatales supone una barrera en el establecimiento de estos primeros lazos. Objetivo: el principal objetivo del presente estudio es comparar el grado de apego valorando dicha separación, así como identificar aquellas variables que podrían influir en su establecimiento. Material y métodos: un total de 82 madres, divididas en dos grupos (O-U), participaron en este estudio ex postfacto comparativo causal mediante la cumplimentación del cuestionario Maternal Attachment Inventory, la entrevista y la revisión de la historia clínica. Resultados: se encontraron diferencias estadísticamente significativas en la puntuación MAI entre madres del Grupo Obstetricia (99’67) y del Grupo UCIN (91’64), del mismo modo se señaló la edad gestacional y la alimentación como factores influyentes. Discusión y conclusión: la separación tras el ingreso en la Unidad de Cuidados Intensivos Neonatales dificulta el establecimiento de los primeros vínculos maternos. Es necesario valorar los diferentes factores que influyen en esta situación y realizar futuras intervenciones para mejorar la relación materno-filial (AU)

Introduction: Maternal attachment is the set of behaviors and links established around to the mother and the newborn. Admission to the Neonatal Intensive Care Unit (NICU) is a barrier in establishing these early ties. Objective: The main objective of this study is compare the degree of maternal attachment in the Neonatal Intensive Care Unit, and it identify the variables that could influence on his establishment. Material and methods: 82 mothers, divided into two groups, participated in this causal comparative study by carry out the questionnaire Maternal Attachment Inventory (MAI), the interview and review of medical history. Results: There are significant differences in MAI scores between mothers of Obstetrics Group (99'67) and NICU Group (91'64). Gestational age and feeding are influential factors. Discussion and conclusion: Separation hinders the establishment of the first maternal ties. It is necessary to assess the factors that influence in this situation and it plan future interventions to improve maternal-child relationship (AU)

Support for families.

Families need support to understand the implications of screening results.

Prevalencia del Streptococcus agalactiae en la mujer embarazada en la ciudad autónoma de Melilla. ¿Es la cultura un factor determinante? / Prevalence of the Streptococus agalactiae in the pregnant woman from the autonomic city of Melilla: is culture a determinant factor?

Contexto. La infección neonatal por estreptococo grupo B es una de las principales causas de morbimortalidad neonatal. Por ello se realiza un cribado a todas las gestantes para detectar su presencia y, en tal caso, administrar un tratamiento antibiótico durante el trabajo de parto. El objetivo del estudio fue conocer la prevalencia de estreptococo en las gestantes de Melilla, así como sus diferencias en función de la cultura y la edad. Método. Estudio descriptivo trasversal con emplazamiento en el Hospital Comarcal de Melilla. Resultados. La muestra tomada está formada por 280 individuos; 194 son de cultura musulmana (69.3 %) y 68 son de cultura cristiana (24.3 %), con 18 individuos de cultura desconocida (6.4 %). Asimismo, se sabe que 78 tienen una edad menor o igual a 25 años (27.85 %), 158 individuos tienen una edad comprendida entre los 26 y 34 años (56.42 %) y 44 individuos tienen una edad igual o mayor a 35 años (15.71 %). Conclusiones. La prevalencia de colonización vagino-rectal por estreptococo grupo B en las gestantes de Melilla está dentro de las cifras estimadas a nivel nacional. Sin embargo, es diferente en función de si pertenecen a la cultura musulmana o cristiana, siendo mayor en la población musulmana. Ambas prevalencias se encuentran dentro de las estadísticas nacionales. Por otro lado, se observa que no existen diferencias en la prevalencia en función de la franja etárea (AU)

Background. The neonatal infection by Streptococcus group B is one of the main causes of neonatal morbi-mortality rate. For this reason a screening is made to each pregnant woman in order to detect its presence, and if it was the case, to apply an antibiotic treatment during labour. The aim of this study was to know the prevalence of this Streptococcus in the pregnant women from Melilla, as well as the differences according to culture and age. Method. A descriptive cross-sectional study located in the Hospital Comarcal from Melilla. Results. The sample is taken from 280 women: 194 are from Muslim culture (69.3 %), 68 are from Christian culture (24.3 %) and 18 women from unknown cultures (6.4 %). Also it is known that 78 of them are 25 years old or less (27.85 %), 158 are between 26 and 34 years old (56.42 %) and 44 are 35 years old or more (15.71 %). Conclusions. The prevalence of vagino-rectal colonization by Streptococcus group B in the pregnant women from Melilla is within the national estimated figures, however it is different if they are from Muslim or Christian culture, being higher in the Muslim population. On one hand both prevalences are within the national statistics, and on the other hand it is observed that there is not any difference according to age (AU)

Pulse Oximetry Screening for Critical Congenital Heart Disease: Bringing Evidence Into Practice.

Congenital heart disease is the most common and serious type of infant birth defect. Pulse oximetry screening has been supported in the literature as a valuable tool to aid in the prompt detection of critical defects. Pulse oximetry is easily accessible, inexpensive, and noninvasive, and can be readily performed by clinical nurses at the infant's bedside; however, it remains a technology that is underutilized in newborns. Nurses can be leaders in addressing the need to translate knowledge into practice to improve the morbidity and mortality rates in the newborn population.

Research and commentary.

Familial genetic information should be shared with children as a continuous process.