Neonatal Network
September/October 2008
Vol. 27, No. 5

ABSTRACTS

Transition to an Individual-Room NICU Design:
Process and Outcome Measures
Cheryl A. Milford, EdS
Barbara J. Zapalo, EdD
Glenda Davis, RNC, MPM

Redesign of a neonatal intensive care unit is a major budget undertaking, demanding accountability for its equipment and feasibility of design. It must be philosophically based and driven by research supporting best practice. The NICU at the Magee-Womens Hospital of the University of Pittsburgh Medical Center, a Level III, 74-bed unit, has made the change from a ward design to an individual-room design suitable for family-centered, developmentally supportive care. This article presents the design process as it occurred. Unique to this process are the involvement of NICU-graduate families and the use of transition teams. Guidelines and recommendations are offered to others interested in designing and practicing in an individual-room NICU. Outcome data demonstrate staff adjustment to the new design and practice model. A comparison of this NICU design is made with the Recommended Standards for Newborn ICU Design.

A Case Presentation of Early Intervention with Dolichocephaly in the NICU: Collaboration Between the Primary Nursing Team and the Developmental Care Specialist
Beth M. McManus, PT, MS, MPH, PCS
Philip S. Capistran, RN, BSN

Dolichocephaly, narrow width and long anterior-posterior cranial distance, is more commonly seen in preterm than in term infants. It seems to persist after NICU discharge and may be a marker for adverse neurodevelopment. This article reports a case of cranial molding in one extremely low birth weight infant. He was placed on a viscoelastic mattress and a twice weekly developmental care program. Cranial molding was measured using the cranial index (CI), a ratio of width to length. Initially, the patient presented with dolichocephaly (CI = 72 percent). By week 2, CI measurements approached normal limits (CI = 75 percent). When placed on continuous positive airway pressure, the infant presented with substantial dolichocephaly (CI = 66.7 percent). following position changes to midline, CI measurements continued to improve and remained within normal limits until discharge. This dual-element program was feasible, acceptable to parents and staff, and may be effective for identifying and managing dolichocephaly.

Music as a Nursing Intervention for Preterm Infants in the NICU
Diane O. Neal, MS, RN
Linda L. Lindeke, PhD, RN

Although there is general agreement that noise in the neonatal intensive care unit should be reduced, there is controversy about the use of music as a developmental care strategy with preterm infants. Much literature supports using music with preterm infants, indicating that it enhances physiologic and neurobehavioral functioning, but some experts worry that music is overstimulating. This article presents evidence supporting the use of music with preterm infants as well as criticism of same. Recommendations for music interventions with preterm infants are discussed, although further research is needed before specific guidelines can be established.

2007 Manuscript of Exceptional Merit Excellence in Writing Award Winner
Cerebral Monitoring of the Term Infant
Shelly V. Lavery, RN, BaHSc
Kathi S. Randall, RN, MSN, CNS, NNP-BC

Continuously monitoring brain function at the bedside in the NICU for term infants at risk of brain injury has become part of routine clinical practice in many countries. These monitors offer invaluable information about the sick infant’s neurologic status by providing real-time measurements of the brain’s electrical activity and identifying or confirming seizure activity. With the increasing availability of bedside electroencephalogram technology, it is essential for neonatal intensive care nursing staff to understand the rationale for its use, as well as the fundamentals of application and interpretation of this new technology.