Neonatal Network
May/June 2006
Vol. 25, No. 3

ABSTRACTS

Ventilator-Induced Airway Injury: A Critical Consideration During Mechanical Ventilation of the Infant
Jay S. Greenspan, MD
Thomas H. Shaffer, PhD

The clinical management of respiratory failure in the newborn often focuses on lung parenchymal stiffness due to immaturity, surfactant deficiency, infiltrates, and other causes. However, health care personnel should also consider the airway, which plays an important role in gas exchange and lung mechanics. The airway can be easily injured, and an injured airway can significantly alter both the acute and chronic course of lung disease in infants. Further, there are developmental changes that affect the susceptibility of the neonatal airway to injury. Recognizing and preventing causes of airway injury can help to ensure optimal outcomes for the critically ill neonate.

Nursing Care of the Premature Infant with Severe Combined Immunodeficiency Disease
Brigit M. Carter, RN, MSN, CCRN

Diagnosis and treatment of severe combined immunodeficiency disease (SCID) is documented in fetuses, term infants, and older children; however, there is very little information on its diagnosis and treatment in premature infants. When Duke University Medical Center's first preterm infant with a known SCID history was delivered, in June 1999, there was no defined protocol for the infant's nursing care. Although many of the guidelines for nursing care of the premature infant population (less than or equal to 36 weeks) apply, there are important considerations for preterm infants with an SCID diagnosis. This article provides background on SCID and identifies those special considerations-namely, multidisciplinary communication, infection prevention, thorough physical assessments, and parental support.

Using Developmental Assessments in the NICU to Empower Families
Linda B. Lowman, MEd
Linda L. Stone, PhD
Jean Gardner Cole, MS

NICU nurses and developmental specialists have a unique opportunity to facilitate the beginning of a meaningful parent/infant relationship in the NICU setting. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS) is one tool that can be utilized to support this process. When parents observe this assessment, they learn to recognize and understand infant cues and gain confidence for everyday routines such as diapering, feeding, general caregiving, and even taking that first trip with the baby to the grocery store. Parents become empowered when they discover not only their baby's amazing competencies, but also their own. In addition, the BNBAS provides a framework through which parents can effectively communicate and advocate for their baby.

Midline Catheter Use in the Intensive Care Nursery
Mary Kay Leick-Rude, RNC, MSN, PCNS
Barbara Haney, RNC, MSN, CPNP

Purpose: To describe the use of midline catheters in a Level IV, 48-bed NICU over a four-and-a-half-year period.Design: Nonrandomized prospective review of data obtained for quality assurance monitoring.Sample: 1,130 catheters inserted in 858 patients ranging in age at insertion from 1 to 249 days, 360-8,000 gm in weight, and 23-42 weeks gestational age at birth.Outcome Variables: Catheter outcome data related to dwell times; patient characteristics; insertion site; and reason for removal, including failure related to infiltration, leaking, occlusion, dislodgment, infection, phlebitis, or malposition.Results: There was no significant statistical difference in median catheter survival times related to weight or postconceptional age. Overall mean catheter dwell time was 8.7 days. Scalp was the most common insertion site (49 percent), and the site with the longest dwell time was the saphenous vein at the knee, which lasted a mean of 12.9 days. Elective removal represented 43 percent of all removals. Incidence of positive blood culture was 3.5 percent (0.41/1,000 catheter days), with the risk significantly higher if a central line was also in place.