Gestión del capital venoso de los recién nacidos hospitalizados: catéter de línea media (CM) con técnica adaptada. Servicio de Neonatología, Hospital Público de Chile / Venous capital management of hospitalized newborns: midline catheter (MC) with adapted technique. Neonatology Service, Chilean public hospital

INTRODUCCIÓN: El catéter midline o de línea media (CM) es un dispositivo de acceso vascular que mide de 6 a 20cm, con la punta del dispositivo ubicado en venas basílica, braquial o cefálica debajo del pliegue axilar. El catéter de línea media se caracteriza por ser un acceso confiable y proporcionar menores complicaciones que un catéter intravenoso periférico corto. Este tipo de dispositivo vascular se ha utilizado ampliamente en adultos, pero faltan estudios desarrollados en el área neonatal. OBJETIVO: fue describir las características de la utilización de catéter midline con técnica adaptada en recién nacidos hospitalizados con necesidad de terapia intravascular en un hospital público de Chile, durante 2 años de seguimiento. METODOLOGÍA: Investigación descriptiva y retrospectiva, estuvo orientada a la identificación de las variables relacionadas a: tiempo de permanencia, características de la terapia intravascular, sitio de inserción, complicaciones y causa de retiro. RESULTADOS: La muestra estuvo conformada por 163 usuarios entre 24 y 41 semanas de edad gestacional, peso de nacimiento en un rango de 500 y 4880 gramos. El 87,7% se retiró por término de tratamiento intravascular, mientras que el 12,3% del total de los CM presentó complicaciones. El promedio de rendimiento del CM fue de 7,99 días, el sitio de inserción más frecuente correspondió a extremidad superior derecha, mientras que su utilización estuvo dada principalmente para fleboterapia, antibióticos y nutrición parenteral periférica. CONCLUSIÓN: Se concluye que el CM con técnica adaptada en usuarios neonatales presenta una alta tasa de éxito para completar la terapia intravascular periférica y bajo porcentaje de complicaciones.

INTRODUCTION: The midline catheter (MC) is a vascular access device measuring 6 to 20cm, with the tip of the device located in the basilic, brachial or cephalic veins below the axillary crease. The midline catheter is characterized as a reliable access and provides fewer complications than a short peripheral intravenous catheter. This type of vascular device has been widely used in adults, but studies developed in the neonatal area are lacking. OBJECTIVE: to describe the characteristics of the use of midline catheter with adapted technique in hospitalized newborns in need of intravascular therapy in a public hospital in Chile, during 2 years of follow-up. METHODOLOGY: Descriptive and retrospective research was oriented to the identification of variables related to: length of stay, characteristics of intravascular therapy, site of insertion, complications and cause of withdrawal. RESULTS: The sample consisted of 163 users between 24 and 41 weeks of gestational age, birth weight in the range of 500 and 4880 grams. Eighty-seven point seven percent were withdrawn due to the end of intravascular treatment, while 12.3% of the total MC presented complications. The average MC performance was 7.99 days, the most frequent insertion site corresponded to the right upper extremity, while its use was mainly for phlebotherapy, antibiotics and peripheral parenteral parenteral nutrition. CONCLUSION: The MC with adapted technique in neonatal users presents a high success rate to complete peripheral intravascular therapy and a low percentage of complications.

Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU.

BACKGROUND: Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms. PURPOSE: To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol. METHODS: A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation. RESULTS: The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03). IMPLICATIONS FOR PRACTICE AND RESEARCH: Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.

Boas práticas no cuidado ao recém-nascido com boa vitalidade na sala de parto: revisão integrativa / Good practices in caring for a newborn with good vitality in the delivery room: integrative review / Buenas prácticas en el cuidado de un recién nacido con buena vitalidad en la sala de entrega: revisión integrativa

Objetivo: analisar a produção científica brasileira sobre boas práticas relacionadas ao cuidado do recém-nascido com boa vitalidade na sala de parto. Métodos: revisão integrativa realizada em cinco recursos informacionais, mediante associação dos descritores: recém-nascido; assistência perinatal; e, parto humanizado, em português, inglês e espanhol. Resultados: 12 publicações compuseram a análise interpretativa, nas quais contato pele a pele imediato mãe-bebê, aleitamento materno precoce e clampeamento oportuno do cordão umbilical são reconhecidos como boas práticas ao recém-nascido na sala de parto. A adesão ou não a essas condutas associam-se a fatores como tipo de parto, presença de acompanhante, vínculo com a equipe de saúde, infraestrutura, disponibilidade de recursos e hospital intitulado Amigo da Criança. Conclusão: é necessária uma mudança de paradigma vislumbrando o fortalecimento do vínculo entre mãe e bebê, logo, são necessários profissionais capacitados e sensibilizados para a humanização das condutas na sala de parto

Objective: to analyze the Brazilian scientific production on good practices related to the care of newborns with good vitality in the delivery room. Method: integrative review carried out on five information resources, using the association of descriptors: newborn; perinatal care; and humanized birth, in Portuguese, English and Spanish. Results: 12 publications comprised the interpretative analysis, in which mother-infant immediate skin-to-skin contact, early breastfeeding, and timely umbilical cord clamping are recognized as good practices for the newborn in the delivery room. Adherence or not to these behaviors is associated with factors such as type of delivery, presence of companion, bond with the health team, infrastructure, availability of resources and hospital called Child Friendly

Objetivo: analizar la producción científica brasileña sobre buenas prácticas relacionadas con el cuidado de recién nacidos con buena vitalidad en la sala de partos. Método: revisión integradora en cinco recursos de información, utilizando la asociación de descriptores: recién nacido; cuidado perinatal; y nacimiento humanizado, en portugués, inglés y español. Resultados: 12 publicaciones comprendieron el análisis interpretativo, en el cual el contacto inmediato piel a piel de la madre y el bebé, la lactancia temprana y el pinzamiento oportuno del cordón umbilical se reconocen como buenas prácticas. El cumplimiento de estas se asocia a tipo de parto, presencia de acompañante, vínculo con equipo de salud, infraestructura, disponibilidad de recursos y hospital llamado Child Friendly. Conclusión: se necesita un cambio de paradigma para prever el fortalecimiento del vínculo entre la madre y el bebé, por lo tanto, se necesitan profesionales capacitados y sensibilizados para humanizar la conducta en la sala de partos

WebPalestra: consulta de enfermagem à mulher, à criança e à família em processo de amamentação

Resolução COFEN 358/2009; objetivos do processo de enfermagem; fases do processo de enfermagem; terminologia em enfermagem; diagnósticos prevalentes na assistência de enfermagem durante a amamentação.

The Effects of an Infant Calming Intervention on Mothers' Parenting Self-Efficacy and Satisfaction During the Postpartum Period: A Randomized Controlled Trial.

The aim of this study was to evaluate the effects of a behavioral infant calming technique to support mothers' parenting self-efficacy and parenting satisfaction. The methods of this randomized controlled trial are based on the CONSORT guidelines. Data were collected during March 1 to May 20, 2019, from 3 postpartum units in 1 university-level hospital in Finland. A total of 250 mothers agreed to participate, of which 120 were randomly allocated to the intervention group and 130 to the control group. All mothers completed a baseline questionnaire before randomization. Mothers in the intervention group were taught the 5 S's infant calming technique. The control group received standard care. Follow-up data were collected 6 to 8 weeks postpartum. The primary outcome measure was the change in parenting self-efficacy and parenting satisfaction scores over the follow-up period. The intervention group showed significantly larger improvements in parenting self-efficacy scores. There were no statistically significant differences in median improvements in parenting satisfaction. The 5 S's infant calming technique is feasible. These study findings may assist midwifery and neonatal nursing staff to support mothers and families during the postpartum period, whether the infants are fussy or not.

Comfort With Touch and Influencing Factors Among Chinese Midwives: A Cross-sectional Survey.

The aim of this study was to identify comfort with touch (CT) and influencing factors among Chinese midwives. Midwives (N = 252) from 7 hospitals in Guangdong, China, were asked to complete a self-report questionnaire between November 2018 and April 2019. The questionnaire included the Nurses' Comfort with Touch Scale (NCTS), the Nurses' Perceived Professional Benefits (NPPB) Scale, the Maslach Burnout Inventory-General Survey (MBI-GS), and a self-designed demographic questionnaire. Multivariate linear regression was used to identify influencing factors for CT. Mean NCTS total score was 88.90 ± 14.40, and the mean item score was 5.23 ± 0.91, which indicated a respectable score. Within the NCTS, CT was highest in the comfort support category (5.32 ± 0.29) whereas CT was lowest in the physical comfort category (4.28 ± 0.28). Multivariate regression analysis demonstrated that CT among Chinese midwives was associated with positive experiences or feelings surrounding the patient-nurse relationship (B = 3.239, P < .001), perceived professional benefit (PPB, positive professional identity) (B = 0.240, P < .001), emotional exhaustion (B = -0.414, P < .001), depersonalization (negative attitude toward the work setting) (B = -0.773, P < .001), and personal accomplishment (evaluation of self-worth) (B = 0.170, P = .015). Touch training and educational programs are recommended for Chinese midwives to enhance awareness and acceptance of touch care. In addition, promoting positive patient-nurse relationships, improving PPB, and reducing burnout are recommended to enhance CT among Chinese midwives. Because of the size and racial homogeneity of the sample, further studies are recommended to identify CT and influencing factors in a larger, more diverse population of midwives worldwide.

The Value of Using an Acuity Score for Neonatal Nursing Research.

The Score for Neonatal Acute Physiology (SNAP) is a physiological-based illness severity tool developed in 1993, and since that time, it has been revised to include SNAP-II Perinatal Extension (SNAPPE-II) for mortality risk assessment and SNAP-II to assess severity of illness. The purpose of this methodologically based article is to provide an overview of SNAP methodology and then to critically evaluate the feasibility and utility of SNAP-II in neonatal nursing research. The SNAP-II scoring measure is parsimonious and has been utilized in a variety of retrospective and prospective medical research with good results; yet, it is not often employed in nursing studies. For research purposes, the required data are readily obtainable from medical records, calculations can be performed via computer to reduce errors, and the resultant score is parsimonious and reproducible. SNAP-II has some limitations, however, and additional research is needed to further refine the scoring system. This methodological article outlines the strengths and limitations of SNAP-II and recommends the use of a severity score to better describe research samples for clinical benchmarking and comparative research. There is extensive interest in validating acuity scores for appropriate patient assignments. Rather than having established ratios, often established by law, nurses are interested in measuring patient acuity and appropriately assigning ratios based on patient needs.

Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Cuidados de la placenta y seguridad del recién nacido en el nacimiento Lotus / Placenta care and newborn safety in Lotus Birth

OBJETIVO: revisar la evidencia científica referente a los cuidados de la placenta y a la seguridad del recién nacido en el nacimiento Lotus. MÉTODO: revisión narrativa. Se llevaron a cabo diferentes estrategias de búsqueda en las siguientes bases de datos y plataformas: Pubmed, Cochrane, Ovid, Scielo, Cuiden, Clinical key, BMJ, Metas de Enfermería y Google Scholar. Palabras usadas: Lotus birth, umbilical non severance, cord clamping, care, safety, nacimiento Lotus. Filtros: 2016-2020, sobre cuidados placenta y seguridad recién nacido, estudios epidemiológicos. RESULTADOS: se localizaron 169 documentos. Se seleccionaron seis artículos. En dos artículos se trataban los cuidados de la placenta que eran lavadas con agua tibia en las primeras horas, secadas y envueltas en paños de tejidos naturales, usando sales y hierbas aromáticas para acelerar el proceso de secado, y dejándola a la altura del recién nacido. En los otros cuatro documentos se describían seis casos de complicaciones infecciosas que se resolvieron con antibioterapia, en madres que habían presentado bolsa rota prolongada, cultivos vaginales positivos y ausencia de antibioterapia periparto. DISCUSIÓN: el Lotus birth es una práctica infrecuente, asociada tradicionalmente al parto domiciliario, que se va introduciendo en el medio hospitalario. Es escasa la evidencia disponible sobre los cuidados de la placenta en el nacimiento Lotus y la seguridad de esta práctica para los recién nacidos

OBJECTIVE: to review the scientific evidence regarding placenta care and newborn safety in Lotus Birth. METHODS: a narrative review. Different search strategies were conducted in the following databases and platforms: Pubmed, Cochrane, Ovid, Scielo, Cuiden, Clinical key, BMJ, Metas de Enfermería and Google Scholar. Terms used: Lotus Birth, umbilical non severance, cord clamping, care, safety, nacimiento lotus. Filters: 2016-2020, on placenta care and newborn safety, epidemiological studies. RESULTS: in total. 169 documents were located. Six articles were selected. Two articles discussed placenta care: they were washed with warm water during the first hours, dried and wrapped in natural fabric cloths, using salts and aromatic plants to accelerate the drying process, and placed at the same height as the newborn. The other four documents described six cases of infectious complications, which were solved with antibiotic therapy, in mothers who had presented prolonged broken sac, positive vaginal cultures, and lack of peripartal antibiotic therapy. DISCUSSION: Lotus Birth is a rare practice, traditionally associated with home births, which has been increasingly introduced in the hospital setting. There is limited evidence available about placenta care in Lotus Birth, and the safety of this practice for newborns

Neonatal Nurse Practitioner Use of Ultrasonography to Verify Umbilical Venous Catheter Placement in the Neonatal Intensive Care Unit.

BACKGROUND: Literature dating back to 1982 supports the use of ultrasound to confirm UVC position as a more reliable method compared to x-ray. The use of ultrasound to confirm UVC position remains infrequent in the NICU. PURPOSE: To determine the feasibility of training an NNP in the acquisition and interpretation of a parasternal short-axis (PSAX) image of the heart to confirm UVC position. METHODS: A retrospective review of 48 charts evaluated descriptive data using standard technique of an x-ray to confirm UVC placement. An NNP was trained to acquire and interpret a parasternal short-axis (PSAX) cardiac view by a pediatric cardiologist. The NNP independently and prospectively evaluated 21 neonates and determined whether the UVC was in satisfactory or unsatisfactory position. The same image was blindly over-read by the pediatric cardiologist. Agreement between the NNP and pediatric cardiologist interpretations as well as the pediatric cardiologist and radiologist interpretations was evaluated using the κ-test. RESULTS: Initial pediatric cardiology interpretation of UVC position showed the UVC to be malpositioned in 66% of neonates (n = 14). NNP and pediatric cardiology interpretations in UVC position had 86% agreement (κ-0.667). Pediatric cardiology (ultrasound) and radiology interpretations (x-ray) in UVC position had 86% agreement (κ-0.69). IMPLICATIONS FOR PRACTICE: It is feasible to train NNPs to perform and accurately interpret a single PSAX ultrasound image to determine satisfactory UVC position. IMPLICATIONS FOR RESEARCH: Increasing the use of ultrasound to determine satisfactory position of UVCs in the NICU can reduce unnecessary exposure to ionizing radiation in neonates.

Grief among Neonatal Intensive Care Nurses.

BACKGROUND: Nurses working in the high-stress environment of the neonatal intensive care unit (NICU) are at high risk of experiencing grief after death of a baby. DESIGN: Using a quantitative cross-sectional design, a convenience sample of nurses working in a Level IV NICU in Northern California, United States completed online surveys. Level of grief among NICU nurses, perceptions of grief support available at their institution, and past and future grief coping methods were assessed. PARTICIPANTS: A diverse sample of 55 NICU nurses, mean age 45.5 (SD = 11.7) years. SETTING: A high-acuity NICU in one large Northern California hospital. METHODS: Participant demographic data and the Revised Grief Experience Inventory were completed online. RESULTS: Total grief scores ranged between 22 and 82 with a mean of 46.9 (SD = 17.4). Sixty percent (n = 33) moderately/strongly disagreed on adequacy of current grief support services at their institution and 81% (n = 45) reported hospital staff could benefit from additional grief support. Nurses' past grief support included family, friends, and church. Future grief resources would include family, friends, and co-workers. Participants indicated need for debriefing and additional nurse staffing resources at the time of a patient death. CONCLUSIONS: Neonatal intensive care unit nurses in our study reported experiencing grief. Debriefing and bereavement support may be helpful for nurses working in high-stress environments where there is a higher likelihood of patient death.

Variables asociadas a eventos adversos en neonatos con catéter venoso central de inserción periférica / Variables associated with adverse events in neonates with peripherally inserted central catheters / Variáveis associadas a eventos adversos em neonatos com cateter central de inserção periférica

OBJETIVO: Identificar los factores asociados con la aparición de eventos adversos en el catéter de inserción central periférica en recién nacidos. MÉTODOS: Un estudio transversal con un enfoque cuantitativo realizado en una Unidad de Cuidados Intensivos Neonatales de un hospital de maternidad de referencia en atención materna e infantil de alto riesgo en el noreste de Brasil. Muestra de 108 neonatos recolectados de febrero a noviembre de 2016. RESULTADOS: La prevalencia de eventos adversos en los recién nacidos fue del 53,70%, asociada a las siguientes variables: sexo masculino (p = 0,033), peso inferior a 2500 gramos (p = 0,003), inserción después de 48 horas (p = 0,027), más de tres intentos de punción (p = 0,024), dificultad de progresión del catéter (p = 0,040), presencia de intercurrencias durante la inserción del catéter (p = 0,027), sobre dos cambios de apósito = 0.009) y ubicación no central del dispositivo (p = 0.042). CONCLUSIÓN: Los resultados indican la necesidad de estrategias para la prevención de eventos adversos, con énfasis en la educación continua y el mejoramiento de habilidades en la gestión de este dispositivo

OBJECTIVE: To identify the factors associated with the occurrence of adverse events by a peripherally inserted central catheter in newborns. METHODS: A quantitative, cross-sectional study carried out in the Neonatal Intensive Care Unit of a reference maternity hospital in high-risk maternal and child care in Northeast Brazil. The sample of 108 neonates was collected from February to November 2016. RESULTS: The prevalence of adverse events in newborns was 53.70%, associated with the following variables: male gender (p = 0.033), weight below 2500 grams (p = 0.003), insertion performed after 48 hours of life (p = 0.027), more than three puncture attempts (p = 0.024), difficulty in inserting the catheter (p = 0.040), intercurrence during catheter insertion (p = 0.027), over two dressing changes (p = 0.009), and non-central position of the device (p = 0.042). CONCLUSION: The results indicate the need for strategies to prevent adverse events, with emphasis on continuing education and on the improvement of skills regarding the use of this device

OBJETIVO: Identificar os fatores associados à ocorrência de eventos adversos por cateter central de inserção periférica em recém-nascidos. MÉTODOS: Estudo transversal, com abordagem quantitativa, realizado em Unidade de Terapia Intensiva Neonatal de uma maternidade referência no atendimento materno-infantil de alto risco no Nordeste do Brasil. Amostra de 108 neonatos coletada no período de fevereiro a novembro de 2016. RESULTADOS: A prevalência de eventos adversos em recém-nascidos foi de 53,70%, associados às seguintes variáveis: sexo masculino (p = 0,033), peso menor que 2500 gramas (p = 0,003), inserção realizada após 48 horas de vida (p = 0,027), mais de três tentativas de punção (p = 0,024), dificuldade de progressão do cateter (p = 0,040), presença de intercorrência durante a inserção do cateter (p = 0,027), acima de duas trocas de curativos (p = 0,009) e localização não central do dispositivo (p = 0,042). CONCLUSÃO: Os resultados indicam a necessidade de estratégias de prevenção de eventos adversos, destacando-se a educação continuada e aprimoramento de habilidades quanto ao manejo desse dispositivo

The State of the Science of Preterm Birth: Assessing Contemporary Screening and Preventive Strategies.

Preterm birth remains a leading cause of morbidity and mortality during the perinatal and neonatal periods. Now affecting approximately 1 in 10 births in the United States, preterm birth often occurs spontaneously and without a clear etiology. Careful assessment of risk factors, however, identifies vulnerable women allowing targeted interventions such as progestogen therapy and cerclage. This article is intended to highlight preterm birth risk factors and current predictive and preventive strategies for midwives, nurse practitioners, clinical nurse specialists, and perinatal nurses.

Periviability: A Review of Key Concepts and Management for Perinatal Nursing.

One of the most complex clinical problems in obstetrics and neonatology is caring for pregnant women at the threshold of viability. Births near viability boundaries are grave events that carry a high prevalence of neonatal death or an increased potential for severe lifelong complications and disabilities among those who survive. Compared with several decades ago, premature infants receiving neonatal care by today's standards have better outcomes than those born in other eras. However, preterm labor at periviability represents a more complex counseling and management challenge. Although preterm birth incidence between 20/7 and 25/7 weeks has remained unchanged, survival rates at earlier gestational ages have increased as perinatal and neonatal specialties have become more adept at caring for this at-risk population. Women face difficult choices about obstetric and neonatal interventions in light of uncertainties around survival and outcomes. This article reviews current neonatal statistics in reference to short- and long-term outcomes, key concepts in obstetric clinical management of an anticipated periviable birth, and counseling guidance to ensure shared-decision making.