Advances in neonatal care : official journal of the National Association of Neonatal Nurses
-
3 Despite the 1999 American Academy of Pediatrics (AAP) policy statement indicating that routine neonatal circumcision is not medically necessary, circumcision continues to be the most frequently performed surgical procedure in the newborn period in the United States. Further, many health care practitioners routinely perform this procedure without the use of any or with inadequate or ineffective analgesia and anesthesia. ⋯ This article synthesizes these studies and highlights their significance for current clinical practice. The article provides a detailed pictorial and video guide to circumcision with an emphasis on the use of multimodal strategies to ensure adequate anesthesia, analgesia, and infant comfort before, during, and after the procedure.
-
Review
The role of C-reactive protein in the evaluation and management of infants with suspected sepsis.
C-reactive protein (CRP) is a nonspecific, acute-phase protein that rises in response to infectious and noninfectious inflammatory processes. Good evidence exists to support the use of CRP measurements in conjunction with other established diagnostic tests (such as a white blood cell (WBC) count with differential and blood culture) to establish or exclude the diagnosis of sepsis in full-term or near-term infants. This article reviews the immunologic function of CRP and the history of CRP testing. ⋯ Quantitative serial CRP levels, obtained 24 hours after the onset of signs and symptoms of infection, with serial measurements 12 to 24 hours apart, offer the most sensitive and reliable information. At least 2 CRP levels, obtained 24 hours apart, with levels < or = 10 mg/L, are needed to identify infants unlikely to be infected. The use of CRP to exclude infection may allow clinicians to discontinue antibiotics at 48 hours in select infants, limiting extended unnecessary antibiotic exposure.
-
This is a prospective audit to determine the frequency of resuscitation interventions in the clinical setting and to compare self-reports of clinical performance with the existing Neonatal Resuscitation Program (NRP) and Canadian National Guidelines for Neonatal Resuscitation. ⋯ Clear differences between the NRP guidelines and actual clinical practice were shown. A high rate of unanticipated resuscitations, delivery room medications, and chest compressions was described. Postresuscitation hypothermia or hyperthermia were common. Improved sequencing was noted when the entire resuscitation team was NRP certified. Certification in NRP does not assure competency, nor does it ensure compliance with established standards of care.
-
To determine whether developmental care interventions reduce neurodevelopmental delay, poor weight gain, length of hospital stay, length of mechanical ventilation, physiologic stress, and other clinically relevant adverse outcomes in preterm infants. ⋯ In most studies, the inclusion of multiple interventions made the determination of the effect of any single intervention difficult. Although there is evidence of some benefit of developmental care interventions overall and no major harmful effects reported, there were a large number of outcomes for which no or conflicting effects were shown. The single trials that did show a significant effect of an intervention on a major clinical outcome were based on small sample sizes, and the findings often were not supported in other small trials. Before a clear direction for practice can be supported, evidence showing more consistent effects of developmental care interventions on important short- and long-term clinical outcomes is needed. The economic impact of the implementation and maintenance of developmental care practices should be considered by individual institutions.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of two microenvironments and nurse caregiving on thermal stability of ELBW infants.
This study tested a novel bioinstrumented radiant warmer (RW), designed to provide a reduced-intervention nursing caregiving environment (RINCE) on the ambient and body surface temperature stability of extremely low birth-weight (ELBW) infants (< 1,000 g) during caregiver disruptions. The RINCE was compared with a control bed consisting of a standard RW, modified with a Plexiglas hood (Rohm and Haas, Philadelphia, PA) and an external humidity source. ⋯ This study identified the extreme inter-dependence of the ELBW infant's temperature and the ambient environment. The RINCE significantly improved ambient temperature variability, RH variability, and the infant's peripheral and delta temperature (delta T) stability, particularly during and after caregiver disruptions.