Neonatal Network
September/October 2005
Vol. 24, No. 5

ABSTRACTS

Putting Babies "Back to Sleep": Can We Do Better?
Linda J. Levy Raydo, RNC, NNP, MS
Christine M. Reu-Donlon, RNC, NNP, MS

The American Academy of Pediatrics first recommended in 1992 that infants be places on their backs for sleep to reduce the risk for sudden infant death syndrome (SIDS). Since that time, there has been a national drop in the incidence of SIDS of more than 40 per cent. Unfortunately, many parents and other caregivers are still receiving inconsistent information and observing varying practices regarding infant sleep position.

This article emphasizes the role of the health care professional in both teaching and modeling these potentially lifesaving practices consistently and unambiguously. Available literature is reviewed regarding attitudes and beliefs about infant sleep positioning, and specific concerns are addressed in order to allow for better tailoring of educational programs.

Intravenous Immunoglobulin in the Management of Hemolytic Disease of the Newborn
Cynthia A. Mundy, RNC, MSN, NNP

Jaundice caused by hemolysis continues to challenge practitioners caring for infants in the NICU. Bilirubin levels can rise quickly in the first days of life, and interventions must be prompt to prevent side effects related to hyperbilirubinemia. Conventional treatments such as hydration and phototheraphy are common, but new studies suggest that use of intravenous immunoglobulin (IVIG) as an additional treatment may prevent the need for exchange transfusion in some babies. This article presents a case study of an infant with blood-type incompatibility treated successfully with multiple doses of IVIG, discusses the pathophysiology and clinical presentation of hemolytic jaundice, and reviews current management strategies for this disease.

A Concept Analysis of Family-Centered Care in the NICU
Sheila K. Malusky, RN, BSN

Family-centered care (FCC) has been implemented in many NICUs throughout the U.S. It is valuable in helping families whose infants require hospitalization cope with the stress, fear, and altered parenting roles that may accompany their child's condition and hospitalization. To employ such a significant philosophy of care, nurses must understand what the FCC concept signifies. A concept analysis can often aid understanding of abstract ideas such as FCC. This article utilizes a 1995 framework for concept analysis to clarify the meaning of FCC for the neonatal nurse. Incorporating FCC into daily professional practice can enable nurses to improve the emotional and physical well-being of each family member they encounter.

Elevated Sound Levels within a Busy NICU
Charlene Krueger, ARNP, PhD
Susan Wall, CNM, MSN
Leslie Parker, RNC, MSN, NNP
Rose Nealis, ARNP, PhD, CCM

Purpose: Elevated sound levels in the NICU may contribute to undesirable physiologic and behavioral effects in preterm infants. This study describes sound levels in a busy NICU in the southeastern U.S. and compares the findings with recommended NICU noise level standards.
Design: NICU sound levels were recorded continuously at nine different locations within the NICU. Hourly measurements of loudness equivalent (Leq) sound level, sound level exceeded 10 percent of the time (L10), and maximum sound level (Lmax) were determined.
Sample: Sound levels were sampled from nine different locations within the NICU.
Main Outcome Variable: Sound levels are described using the hourly, A-weighted Leq, L10, and Lmax.
Results: The overall average hourly Leq ( M = 60.44 dB, range = 55-68 dB), L10 (M = 59.26 dB, range = 55-66 dB), and Lmax (M = 78.39, range = 69-93 dB) were often above the recommended sound levels (hourly Leq <50 dB, L10 <55 dB, and 1-second Lmax <70 dB). In addition, certain times of the days, such as 6-7 am and 10 am-12 noon, were noisier than other times of day.