Hot Topics in neonatal nursing - pearl.direct

1 2017-03- Topicsin neonatal NursingMATS ERIKSSON, SPECIALIST NURSE, funding: Lilla barnets fond, RFRE mployer: rebro UniversityConsulting: AbbVieOffice in professionalorganisations: Treasures & webmaster Swedish PaediatricPain SocietyCourtesyof somepictures: MarshaCampbell-Yeo, KJS Anand, Ricardo Carbajal2017-03- Mats Eriksson? neonatal nurse for 33 years (staff nurse, head nurse, IT-nurse, )Still working clinicallyPhD 2004 Associate Professor 2011 Professor 2016 nursing science with special focus on paediatric nursingFAMN - The child, the family, the caringsystem, the we going to talk about?Wherearethe nurses?Controversiesand challengesNetworking2017-03- the nurses?Opening ceremony at European Academy of Paediatric Societies 20166 distinguished speakers= 6 white male middle-aged nurselook like?

2 2017-03- in new Swedish TV-showWantsto be a NICU-nurselook like?2017-03- thencomesthe hierarchy to teamwork are we there yet?2017-03- nursingonlya nurses concern? neonatal intensive careWorld ExhibitionBuffalo 190119831990 NIDCAP2000 Kangaroo MotherCare2017-03- knowbreastfeedingis superior yet it is decreasingEricson et al. 2016n= turntowardspartial breastfeedingEricson et al. 20162017-03- #1 KFC Kangaroo FatherCare vs. therea priceto pay for equality?Infants whosefathersdidnot takepaternityleaveduringthe infant sfirstyearweresignificantlyless likelyto be breastfedat 2 (p < ), 4 (p < ), and 6 months(p < )/Flackinget al. 20102017-03- #2 Single patient / family rooms vs. breastfeedingLactationroomFamilyroomOpen bayNICU monthfollow-upKangaroo and maternalcarepredictedbetterBayleyCogniti veand Languagescores Infants with 1 symptom ofautism weremorelikelyto be in the open-baylowmaternalinvolvementgroupvs the SFR highmaternalinvolvementgroupHighmaternal involvementis associatedwithimproved18- month neurodevelopmentaloutcome, especiallyin infants caredfor in a SFR-NICU /Lester et al.

3 20162017-03- #3 Early home-going / home care vs. #4 Fortificationof breastmilkvs. breastfeedingFocus on qualityof milk ratherthanqualityof contactAlan Lucas2017-03- focusing(too much?) on nutrtionalcontentthe reason?Ericson et al. 2016n= pain experienceas adults?GoksaneLife2015;4:e06356 2017-03- procedures in neonates admitted to NICUs*duringthe first 14 daysof admission (EpippainRegionof Paris)Carbajalet al, JAMA 2008;300:60-70N 4 9 23 28 32 23 40 39 29 20 25 28 11 30 22 22 23 21 1 430 Number of painful pain assessmentso hard to implement?Gradin 20102017-03- : Pain assessmentin neonatesin the trachealventilation group 2756,984,222,392,74822,994,20085,510,313 ,890,35,870,6043,263,658,50%10%20%30%40% 50%60%70%80%90%100%UK (n=713)Sweden (n=38)Spain (n=202)Portugal (n=55)Poland (n=50)Norway (n=35)Netherlands (n=69)Malta (n=5)Lithuania (n=23)Italy (n=131)Greece (n=126)Germany (n=29)France (n=493)Finland (n=52)Estonia (n=17)Cyprus (n=41)Belgium (n=37)Austria (n=22)TOTAL (n=2138)Pain assessmentNo pain assessmentCarbajal2015 EUROPAIN: Pain <1% objectivepainometer are we searchingfor the Holy Graal?

4 Heart Rate Variability HRVG alvancSkin Response / Skin Conductance GSRC erebral haemodynamics Near Infrared Spectrocscopy NIRSCry acoustics Sound spectrogramComputerised facial movements New and improved assessment scales2017-03- days in the NICU 1152 procedures528 hours of fentanyl exposure 852 exposures to 24% sucrose2 general anesthesia 1960 hours of extreme lighting 2296 hours of excessive noise2346 hours of maternal separationJACK, 24 WGA Maternal SeparationLess mature motor development Reynold2013 Poorer ability to regulate stress Vinall2013 Higher reactivity Jahromi2004 Higher mortality Ray 20122017-03- -to-skin care for procedural pain in neonatesJohnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee RJanuary 201436 Reviewed19 Included Studies1544 Infants2017-03- to-skin contactfor pain relief-2 0246810 GlucoseTourniqeDisinfectionSkin punction or shamStandard care: ShamIncubator: Skin punctionSkin-to-skin: ShamSkin-to-skin: Skin punctionOlsson et al.

5 2015 Near Infrared Spectroscopy changesin HbO2 on the motherbest for SSC-pain relief?Johnston, 2012 Johnston, 2011 PrematureInfant Pain Profile2017-03- "50"100"150"200"Standard Care- Heelstick!Cobedding - Heelstick!TIMETORECOVERY** P<.001 95% CI to -to-skin w. !Post!Co-bedding Standard Pre Post Salivary Cortisol glucoseCrying time, secEriksson 1999 Always use sweet solution2017-03- 1999 Succroseor glucose? > ParentControlledAnalgesiaParentsas primarycaregivers includingpain managementCommunication insteadof distractionPhoto: Ann-Cathrine Berg2017-03- pain reliefUllstenet al. role in pain management- according to parentsNoneBe informedBe presentProvide comfortInformant for NICU staffActive decision makerAdvocate for infantFigure 1. Roles parents have described themselves in infant pain care in the NICU (Franck et al.)

6 2012). 2017-03- role in pain management- according to nursesAxelin et al. Current BiologyDOI: ( ) Touchingis goodEvent-relatedpotentials (ERP)Prematureinfants haveweakerresponseto lighttouch thanfull -termButif theyhavehad supportivetouch -skin-to -skin-careand breastfeedingtheyrespondedmorelike the # 5Is Skin-to-Skin contact/ Kangaroo MotherCare alwayspositive?WHO guidelines2017-03- !Anderzen-Carlsson and networks28th AnnualMeeting June 6-9 2017, Lisbon, Portugal2017-03- and strong voice of parents2017-03- Prematurity Day Nov. six -languageweb -site2017-03- 3126 For ParentsOur :To beinga neonatal nurseis to beingan equalpart ofa multiprofessionalteam Parentsarethe primarycaregiversDo research read research use research