Neonatal Network
May/June 2007
Vol. 26, No. 3

ABSTRACTS

Subdural and Primary Subarachnoid Hemorrhages: A Case Study
Catherine S. Shaker, MS/CCC-SLP, BRS-S
Stacie Barker, RN, MSN, NNP

Subdural hemorrhage (SDH) and primary subarachnoid hemorrhage (SAH) are two forms of intracranial bleeding that can be encountered in infants. These events can be life threatening to the infant and devastating to his family. Neonatal nurses need to have an understanding of these unfortunate, yet not uncommon, types of intracranial hemorrhage. This article explains the etiology, the diagnosis, and the treatment of SDH and SAH, concluding with a case study.

Evaluation of the Impact of the S.T.A.B.L.E. Program on the Pretransport Care of the Neonate
Nancy O'Neill, RN, MN, NNP
Alexandra A. Howlett, MD, FRCPC, FAAP

Purpose: To determine whether the S.T.A.B.L.E. Program increases health care providers' confidence and clinical abilities in pretransport stabilization and to assess the care of transported neonates before and after S.T.A.B.L.E. Program education.

Design: A descriptive design was used to evaluate health care providers' confidence about pretransport stabilization and to assess infant outcomes before and after S.T.A.B.L.E. education.

Sample: Sixty-four participants in the S.T.A.B.L.E. Program in Nova Scotia participated in this study over a 13-month period. The study evaluated the charts of all neonates transported to the IWK Health Centre over two one-year periods, before and after the S.T.A.B.L.E. Program.

Main Outcome Variable: Perceived confidence and incorporation of S.T.A.B.L.E. Program principles among regional health care providers and neonatal stability at time of transfer were measured.

Results: Ninety-six percent of participants indicated that the course was relevant and useful. Ninety percent indicated that they felt more confident about their ability to provide neonatal pretransport stabilization, and 86.5 percent reported adoption of the S.T.A.B.L.E. Program principles into their practice. There were no differences in infant outcomes between the pre- and post-S.T.A.B.L.E. time periods.

Use of the Six Sigma Methodology to Reduce Incidence of Breast Milk Administration Errors in the NICU
Douglas Drenckpohl, MS, RD, CNSD, LDN
Laura Bowers, BSN, RN
Hoa Cooper, MSHSA, RN

Breast milk is the optimal source of nutrition for infants. According to research, neonates fed breast milk have a reduced risk of sepsis, increased feeding tolerance, a decreased incidence of necrotizing enterocolitis, and better neurodevelopmental outcomes. Unfortunately, researchers have not identified practices to reduce or eliminate the risk for errors in breast milk administration. This article discusses the potential hazards of incorrect administration of breast milk. It then describes how the tertiary care center at Children's Hospital of Illinois implemented a policy utilizing six sigma quality improvement methodologies to improve breast milk administration. Since implementation of this policy, the NICU at our hospital has reduced the risk of breast milk administration errors to less than 3.4 mistakes per million opportunities.

Use of the Duotron Transporter High Frequency Ventilator During Neonatal Transport
Gina Honey, RN, BSN
Tammy Bleak, RN
Tracy Karp, RNC, MS, NNP
Amy MacRitchie, MD
Donald Null, Jr, MD

In the past, transport of neonates with severe respiratory failure was hampered by the lack of an appropriate transport ventilator capable of providing high frequency ventilation (HFV). This article reports on the experiences of the Intermountain Health Care Life Flight Program in selecting a high frequency ventilator and preparing the transport team members for its use. Once the use of the Duotron ventilator was initiated, pre- and posttransport data were collected for the first 134 neonates requiring HFV on transport. Analysis of the data determined that 96 percent of the infants were successfully transported using the Duotron ventilator. Inspired oxygen requirements stayed the same or improved in the majority of intubated patients for whom comparison data were available. Ventilation and acid-base balance improved. Although HFV has been a common therapy in neonatal care for some time, its adoption for use during transport required modification and considerable education for transport team members.