Multiple birth babies requiring neonatal care

Twin pregnancy and neonatal care in England: a Tamba report | The Twins and Multiple Births Associations   (TAMBA)

This report includes information from neonatal networks for stillbirth rates, neonatal death rates, NICE compliance and neonatal admissions for twins.

Findings revealed that twins were 2.5 times more likely to result in a stillbirth and more than five times more likely to result in a neonatal death, in comparison to singleton pregnancies. The report is being submitted to the national review into neonatal services with a call to highlight where and how care should be delivered to multiple birth babies.

Full document available here

Additional link: Royal College of Midwives press release

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National Neonatal Audit 2016

National Neonatal Audit Programme (NNAP) 2017 annual report on 2016 data | The Royal College of Paediatrics and Child Health (RCPCH)  

This report highlights key findings and recommendations form the NNAP analysis of neonatal care data for over 95,000 babies during 2016.  The report is accompanied by case studies and a guide to the audit for parents and carers.

See also: Your Baby’s Care’ – A guide for parents and carers to the NNAP 2017 Annual Report on 2016 data

Additional link: RCPCH press release

Facilitators & barriers of palliative care in the neonatal unit

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Kilcullen, M. & Ireland, S. Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery. BMC Palliative Care | Published online: 11 May 2017

Background: Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit.

Conclusions: This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.

Read the full article here

Comparison of three different methods for risk adjustment in neonatal medicine

Adams, M. et al. BMC Pediatrics | Published online: 17 April 2017

Background: Quality improvement in health care requires identification of areas in need of improvement by comparing processes and patient outcomes within and between health care providers. It is critical to adjust for different case-mix and outcome risks of patient populations but it is currently unclear which approach has higher validity and how limitations need to be dealt with. Our aim was to compare 3 approaches towards risk adjustment for 7 different major quality indicators in neonatal intensive care (21 models).

Conclusions: All three approaches to risk adjustment revealed comparable results. The limited effect of risk adjustment on clinic comparisons indicates a small case-mix influence on observed outcomes, but also a limited ability to isolate quality improvement potential based on risk-adjustment models. Rather than relying on methodological approaches, we instead recommend that clinics build small collaboratives and compare their indicators both in risk-adjusted and unadjusted form together. This allows qualitatively investigating and discussing the residual risk-differences within networks. The predictive validity should be quantified and reported and stratification into risk groups should be more widely used to correct for confounding.

Read the full article here

Adaptation for life after birth: a review of neonatal physiology

Riviere, D. et al. Anaesthesia and Intensive Care Medicine. Published online: January 5 2017

Life as a fetus is very different from life after birth. The neonatal period (first 28 days of life or 44 weeks postconception age) is a period of dramatic and rapid physiological changes. These vary from the immediate adaptations to extrauterine life to a consequent gradual maturation of organ function. Questions still exist around this transition concerning the optimal oxygen concentration during resuscitation, methods of respiratory support, facilitation of cardiovascular changes, identification of at-risk infants for problems such as hypoglycaemia and hypothermia, and the role of therapeutic hypothermia. This article combines well established and contemporary information to summarize a systems-based approach to traditional neonatal physiology.

Read the full abstract here

Supporting Siblings of Neonatal Intensive Care Unit Patients

Morrison, A. & Gullón-Riveraemail, A.L. Journal of Pediatric Nursing. Published online: December 12 2016

life-862967_960_720.jpgHighlights:

  • The article discusses the benefit of a Social Story™ to support siblings as an intervention approach within the NICU.
  • The Social Story™ approach is unique and differs from the formats of current children’s books about NICU.
  • This article provides an example of a NICU Social Story™ ready to implement with siblings of NICU patients.
  • Child Life Specialists can utilize Social Stories™ as educational tool to provide sibling and family support.

Read the abstract here

The Effect of Early Feeding on Initial Glucose Concentrations in Term Newborns

Zhou, Y. et al. The Journal of Pediatrics. Published online: 3 November 2016

Objective: To evaluate the influence of early feeding on initial glucose concentrations in healthy term newborns who were not at risk for hypoglycemia.

Study design: This retrospective observational study was conducted at the University of Arkansas for Medical Sciences where universal early glucose screening was standard of care for newborn infants. Plasma glucose concentrations were compared in term infants born in 2008 who were not at risk for neonatal hypoglycemia and who were fed before (early feeders) and after (late feeders) their initial glucose screens. Multiple linear regression models were built to determine whether glucose concentrations differed significantly between early vs late feeders.

Results: In the 315 early and 572 late feeders, the mean (SD) age of first feeding was 0.9 (0.6) and 3.8 (2.0) hours, respectively. The age at initial glucose specimen collection was 2.2 (1.1) and 1.8 (0.8) hours, respectively. The initial glucose concentration was not higher in early vs late feeders (51.8 ± 11.9 vs 55.5 ± 13.3 mg/dL; P < .001). In linear regression analyses of all infants, the mean initial glucose concentration was 3.61 (95% CI 1.75-5.48) mg/dL lower in early vs late feeders.

Conclusions: Early feeding in otherwise healthy term newborns did not increase initial glucose concentrations compared with newborns who fed later (ie, fasted). Before direct evidence is available, these observations may be instructive for managing early asymptomatic hypoglycemia in at-risk newborns.

Read the abstract here