Reducing The Risk Of Hypothermia In Neonatal Infants, Monika Klett-Dunbar

Master's Projects and Capstones

Abstract

Global Aim: To improve infant thermoregulation within the first 24 hours of life of the high risk preterm and very low birth weight (VLBW) infant population in the NICU, thereby reducing rates of morbidity and mortality due to complications influenced by infant hypothermia. Project Aim: To reduce the rate of hypothermia at one hour and the first 24 hours of life in the target population of preterm neonates weighing less than 1500 grams with a gestational age less than 32 weeks from 9.5% to < 5% through the consistent use of a specific bundle of interventions applied in the labor and delivery setting, by December 2017. The aim of the current initiative is also to build on the success of the pilot program launched in 2015 by adding to the preliminary bundle of initiatives, and sustaining hard-won achievements by reinforcing education measures to the nursing and medical teams involved in the infant delivery and NICU admission process. Background: Hypothermia is a major factor in morbidity and mortality of low-birth-weight premature infants, …

Safe Sleep In The Nicu Environment For Sids Prevention, Renee J. Aumua

Master's Projects and Capstones

Abstract

Sudden Infant Death Syndrome(SIDS) remains a leading cause of death for infants less than one year of age. Historically, Neonatal Intensive Care units have been exempt from following SIDS safe sleep guidelines recommended by the American Academy of Pediatrics(AAP) for SIDS prevention due to patient medical status and environment. However, in 2011 these guidelines were updated by the AAP to include NICU specific recommendations. This is a very important change due to this patient population being at a higher risk for SIDS than the term, well newborn. The Safe Sleep project was conducted in a 35 bed, tertiary care …

The Benefits Of Breastfeeding, Annagrace E. Anderson

Senior Honors Theses

Breast milk is the gold standard for infant nutrition. In the past, infant formula was promoted as equal or superior to breast milk. However, research has shown that breastfeeding is the superior form of infant nutrition except in rare circumstances. Breast milk provides for all of a newborn’s caloric needs and has the correct balance of nutrients to promote proper development. In addition, breast milk provides protection against illnesses, supports an infant’s immune system, and promotes life-long health for the newborn. Mothers also experience personal benefits by breastfeeding such as decreased cancer risks, bonding with their babies, and faster postpartum …

Opioid Abuse In Pregnancy: A Systematic Review, Emily Sebunia, Colleen Fearon

Williams Honors College, Honors Research Projects

Prenatal opioid abuse is a serious public health concern and linked with numerous health consequences for both mothers and children. Despite research describing negative outcomes of drug use during pregnancy, it is still a prevalent problem in the United States, with researchers finding that women are at highest risk for substance abuse during their reproductive years. Opioid abuse during pregnancy is common, including opioids such as hydrocodone, oxycodone, morphine, and heroin. Use of these drugs results in both short and long term side effects for the mother and child. Therefore, the prevalence of this problem should not be underestimated. …

Influence Of A Palliative Care Protocol On Nurses' Perceived Barriers To Palliative Care And Moral Distress, Christina Cavinder

Evidence-Based Practice Project Reports

The World Health Organization (2013) states palliative care for children should begin at diagnosis which may even occur prenatally. Neonatal palliative care is variable due to the high technological, curative environment in the newborn intensive care unit, and the uncertain prognoses of infants born at the edge of viability. The purpose of this EBP project was to determine the influence of establishing a neonatal palliative care protocol on nurses’ perceived barriers to palliative care and moral distress. Corley’s Moral Distress theory and Stetler’s Model were used as guides for the framework of the project. The protocol, based on guidelines supported …

Infant Pain Management, Breanne Ziraldo

Senior Honors Theses

Emphasis on infant pain management has recently become prominent in the medical field. Though it was once thought that infants do not feel pain or remember pain, this thinking has changed due to recent research on the subject. This research has found that infants’ underdeveloped nervous systems actually leads to increased pain rather than decreased pain as previously thought. Research has also found that there are long-term developmental risks associated with prolonged or unmanaged pain in infancy. However, this has not been applied to clinical practice. Studies show that infants are still being under-medicated, if medicated at all, for painful …

Maternal And Neonatal Outcomes By Labor Onset Type And Gestational Age, Jennifer L Bailit, Kimberly D Gregory, Uma M Reddy, Victor H Gonzalez-Quintero, Judith U Hibbard, Mildred M Ramirez, D Ware Branch, Ronald Burkman, Shoshana Haberman, Christos G Hatjis, Matthew K Hoffman, Michelle Kominiarek, Helain J Landy, Lee A Learman, James Troendle, Paul Van Veldhuisen, Isabelle Wilkins, Liping Sun, Jun Zhang

Faculty, Staff and Student Publications

OBJECTIVE: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.

STUDY DESIGN: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.

RESULTS: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor.

CONCLUSION: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction …

Aggressive Vs Conservative Phototherapy For Infants With Extremely Low Birth Weight, Brenda H Morris, William Oh, Jon E Tyson, David K Stevenson, Dale L Phelps, T Michael O'Shea, Georgia E Mcdavid, Rebecca L Perritt, Krisa P Van Meurs, Betty R Vohr, Cathy Grisby, Qing Yao, Claudia Pedroza, Abhik Das, W Kenneth Poole, Waldemar A Carlo, Shahnaz Duara, Abbot R Laptook, Walid A Salhab, Seetha Shankaran, Brenda B Poindexter, Avroy A Fanaroff, Michele C Walsh, Maynard R Rasmussen, Barbara J Stoll, C Michael Cotten, Edward F Donovan, Richard A Ehrenkranz, Ronnie Guillet, Rosemary D Higgins

Faculty, Staff and Student Publications

BACKGROUND: It is unclear whether aggressive phototherapy to prevent neurotoxic effects of bilirubin benefits or harms infants with extremely low birth weight (1000 g or less).

METHODS: We randomly assigned 1974 infants with extremely low birth weight at 12 to 36 hours of age to undergo either aggressive or conservative phototherapy. The primary outcome was a composite of death or neurodevelopmental impairment determined for 91% of the infants by investigators who were unaware of the treatment assignments.

RESULTS: Aggressive phototherapy, as compared with conservative phototherapy, significantly reduced the mean peak serum bilirubin level (7.0 vs. 9.8 mg per deciliter [120 …

Intensive Care For Extreme Prematurity--Moving Beyond Gestational Age, Jon E Tyson, Nehal A Parikh, John Langer, Charles Green, Rosemary D Higgins

Faculty, Staff and Student Publications

BACKGROUND: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients.

METHODS: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to …