Neonatal Network
March/April 2007
Vol. 26, No. 2

ABSTRACTS

An Evidence-Based Approach to Nipple Feeding in a Level III NICU: Nurse Autonomy, Developmental Care, and Teamwork
Catherine S. Shaker, MS/CCC-SLP, BRS-S
Amy Marie Werner Woida, RN, BSN

Historically, nipple feeding in the NICU has been initiated and advanced by physician order based on nursing observation and suggestions. The growing evidence base regarding nipple feeding readiness and progression, contingent caregiving, and nurse autonomy in decision making prompted our Level III NICU to reconsider our process. A literature review and discussions resulted in new protocols for initiating and advancing nipple feedings for three distinct groups: healthy preterm infants, preterm infants with complicated medical courses, and sick term or postterm infants. Through incorporating contingent caregiving, greater autonomy for the bedside nurse, developmental support, and collaboration, we expect to improve outcomes, communication, and problem solving.

Newborn Screening: A Literature Review
Allyson Kayton, RN, MSN, NNP

Newborn screening is the largest genetic testing effort for newborns in the U.S. Its purpose is to identify newborns who are at risk for metabolic, endocrine, or hematologic disorders. A review of the literature was conducted to determine the benefits of newborn screening; specimen collection timing and handling; ethical considerations of screening; as well as current practices regarding consent, notification of results, and follow-up procedures. The use of tandem mass spectrometry for expanded newborn screening and postmortem diagnosis of unexplained infant death was also reviewed. This article is intended to educate health care providers in the areas of controversy that surround the U.S. newborn screening program, with the hope of encouraging further research in this important area of newborn care.

The Chasm in Neonatal Outcomes in Relation to Time of Birth in Lebanon
Lina Kurdahi Badr, RN, DNSc, FAAN
Bahia Abdallah, RN, MPH
Sossi Balian, RN, MPH
Hala Tamim, MPH, PhD
Mirvat Hawari, RN

Purpose: The purpose of this study was to investigate the relationship between the time of birth and the mortality and morbidity of infants admitted to neonatal intensive care units.

Design: This prospective, cohort study examined the records of women and infants admitted to the NICUs of four hospitals in Beirut, Lebanon, between July 1, 2002, and June 30, 2003. The hospitals selected were university affiliated and had a large number of deliveries (5,152 total for the year 2002-2003).

Main Outcome Variables: Neonatal mortality and morbidity for infants admitted to the NICU were evaluated in relation to time of birth.

Results: For the whole sample, mortality was higher for infants born during the night shift than for those born during the day shift. Mortality, morbidity, and brain asphyxia rates were also higher for infants born during the night shift and admitted to the NICU. Maternal risk factors and delivery complications were not consistently higher on the night shift.

Retained Central Venous Lines in the Newborn: Report of One Case and Systemic Review of the Literature
Mercedes Serrano, MD
Alfredo Garcia-Alix, MD, MPH
Juan-Carlos Lopez, MD, MPH
Jesus Perez, MD, MPH
Jose Quero, MD, MPH

The use of percutaneously inserted central catheters (PICCs) is an established practice in most NICUs. With the widespread use of these catheters, an increasing number of PICC complications has been reported in neonates. We present one case of a PICC retained and tethered in the vein in a very low birth weight infant, as well as a systematic review of PICC retention cases. Ten previous cases of PICC retention in neonates were found. Among those cases, the most common associated factors were coagulase-negative staphylococcus catheter colonization/bacteremia and long duration of catheterization. Occlusion was not a useful sign for predicting catheter retention. Once retention was established, heparin or urokinase instillations were ineffective. Although surgical exploration was sometimes required, firm, continuous traction applied to the catheter over several hours or intermittent, moderately strong pulling maneuvers were successful in 44.4 percent of the cases in which they were performed. Traction did not show major side effects. Our case provides additional support for use of traction as the initial approach in the management of this rare complication.

Building a Case for Neonatal Palliative Care
Tricia L. Romesberg, MSN, CNNP

The concept of palliative care, well recognized in the adult population, has not been fully implemented in the pediatric population. Yet there is an urgent need to define and provide excellence in end-of-life care for infants and their families. Beneficent end-of-life care for the dying neonate includes efforts directed at comfort care, assistance with end-of-life decision making, and bereavement support. Through research and education, the challenges to implementing neonatal palliative care programs can be overcome. This article describes the components of neonatal palliative care, identifies the challenges associated with the implementation of such programs, and proposes strategies for addressing these challenges.