...her pregnancy and her parenting skills. Mother did not attend. The pre – birth conference attended by the CDAT key worker, safeguarding midwife, health visitor, GP, social worker. The pre – birth conference took place as mum was concealing her pregnancy and that she was heavily * * DAY 1 Jack was born by caesarean section because they were concerns with the Zoe. Zoe was unwell – she had a heart valve problem. Jack was admitted to the intensive care unit, needing ventilation support for six hours 12pm * Safeguarding midwife aware that Jack been born, states that all people who needed to be aware of baby being born are. Informed us that her current partner and father of baby are not allowed to visit. Security, front desk at the main entrance of unit and nurses made aware * Urine virology/toxicology sent * Morphine started as Jack was Ventilated due to the respiratory distress 15pm * Out of hours social worker called inquiring about baby and mum 1630pm * Maternity support worker visited unit, updated on baby’s condition. Mum had her surgery – she will go and update mum 1830pm * Nurse looking after mum on ITU informed us on mum’s condition. Nurse informed us of name of mum’s current partner who is aware baby is born – nurse said he sounded concerned DAY 2 15pm * No signs of withdrawal DAY 3 14pm * Duty social worker given us the details of named social worker who is aware baby is born. Asked how long baby is expected to be an...
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...charge of such cases are called neonatologists, and I aspire to become one among the current 3,688 board-certified and board-eligible neonatologists in the United States. As with other medical professionals, these physicians are placed in the lives of their patients to improve their health and to utilize a series of diagnoses to treat their specific health deficits. Although the road through medical school, board exams, and residency is long and difficult—the resulting career is worth it. Previous to my research, I knew the basics about the career field of...
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...Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality Webster J, Pritchard MA Background - Methods - Results - Characteristics of Included Studies - References - Data Tables and Graphs [pic] Dates Date edited: 19/05/2006 Date of last substantive update: 31/01/2003 Date of last minor update: 05/04/2006 Date next stage expected 31/05/2006 Protocol first published: Issue 2, 2002 Review first published: Issue 3, 2003 Contact reviewer Joan Webster Nursing Director, Research Teaching and Research Royal Brisbane and Royal Women's Hospital and Health Service Districts Level 6, Ned Hanlon Building Butterfield Street Herston QLD AUSTRALIA 4029 Telephone 1: +61 7 3636 8590 Telephone 2: +61 7 3636 3140 Facsimile: +61 7 3636 2123 E-mail: joan_webster@health.qld.gov.au Contribution of reviewers Internal sources of support None External sources of support Centre for Clinical Studies - Women's and Children's Health, Mater Hospital, Sth Brisbane, Queensland, AUSTRALIA Department of Health and Ageing, Commonwealth Government, Canberra ACT, AUSTRALIA What's new This review updates the existing review of "Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality" which was published in The Cochrane Library Issue 2, 2003 (Webster 2003). No new trials were identified as a result of this updated search. The conclusions of the review are...
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...ADMISSION CARDIOTOCOGRAPHS In the United Kingdom (UK), there is well documented evidence that labour care is dominated by technology interventions (Davis-Floyd & Dumit 1998, Sinclair 2001). One of the most common interventions is the use of Cardiotocographs. The Cardiotocograph (CTG) is one form of fetal assessment that simultaneously records fetal heart rate (FHR), fetal movements and uterine contraction patterns (Nielson & Mistry 2000). Spencer (1992) also describes cardiotocography (CTG) as a composite record of fetal heart rate and uterine activity, which act as a diagnostic test of fetal condition whenever acute or chronic complications arise. Monitoring of fetal heart rate became a widespread practice during the 1970s and has remained an accepted technique for assessing fetal well being in labour until relatively recently (Gauge & Henderson 2005). However, MacLennan (1999) and Thacker et al (2001) argue that the widespread use of CTG in the clinical practice has not been supported by substantial evidence. The introduction of the Electronic Fetal Monitoring (EFM) ‘has been accompanied by confusion and difficulties with interpretation’ (Saling 1996) and ‘despite the fact that no clear evidence exists for its efficacy, especially in low-risk women’ (Murphy et al 1990) it has been integrated into maternity care, and uncertainty about its value remains (Neilson & Mistry 2000). Nevertheless, the aim of the introduction of CTG is to reduce the incidence of cerebral...
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...were comparable. Use of occlusive polyethylene wrap resulted in higher admission temperatures for infants less than 27 weeks gestation. There was no statistically significant improvement in admission temperatures for 27-29 week infants. The rate of hypothermia on admission was lower in the intervention group, but more infants recorded temperatures exceeding 37.2 degrees C during the first 12 hours. There were no other adverse effects noted. Use of occlusive polyethylene wrap improved admission temperatures for infants less than 27 weeks gestation. This intervention is easy to implement and does not interfere with resuscitation. However, removal of the wrap should be considered following admission to a closed care system in the neonatal intensive care unit because, in the intervention group, hyperthermia in the...
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...into glucose (sugar) for energy The pancreas makes insulin (a hormone) to help glucose get into the cells of our body When someone has diabetes their body either doesn’t make any/enough or can’t use its own insulin as it should Glucose begins to build up in the blood Prevalence: WHO estimate in: 2000 = 177 million diabetic people 2025 = 300 million diabetic people = 9% global population IDF (international diabetes federation): 2 million diabetic people in UK with over 750,000 undiagnosed NICE: 650,000 women give birth in England & Wale each year and 2-5% (13,000-32,500) involves women with diabetes, of these: * 87.5% are Gestational Diabetes (GD) * 7.5% are Type 1 * 5% are Type 2 From 1997-2003 there was 74% rise in new cases in the UK with the West Midlands being one of the highest areas (News, 2009) Treatment: Aim: to maintain glycaemic control – regular monitoring is required Lifestyle: diet, exercise Medication – tablet or injection e.g. Insulin, rapid acting insulin analogues (Aspart, Lispro) and/or hypoglycaemic agents (Metformin and Glibenclamide) Diabetes health complications: Hypoglycaemia: Too much insulin; which can cause low blood sugar Symptoms: Paleness, shaking, hunger, sweating Specialist will advise what to do e.g. consume sugary soft drink Occasionally can cause loss of consciousness – an injection will be needed Diabetic Ketoacidosis (DKA)/Hyperglycaemia: A life-threatening complication. Near complete deficiency...
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...I scampered through the hallways at Dartmouth Hospital searching for a sign to direct me towards the neonatal intensive care unit (NICU). My heart was racing knowing that I was walking into the experience completely empty handed. When I found the unit, I walked into a huddle of nurses going over the day’s census. I was assigned to a nurse who had the most severe and critical case on the unit. This was a full term baby, 40 weeks and 1 day. Though the charting from the hospital where he was born was not completely clear, it is said that the fetus was experiencing bradycardia for 17 minutes at 50bpm. This otherwise known low-risk pregnancy quickly turned into a STAT C-section. When the baby was delivered its ABGAR scores were 0, 0, and 3. The baby was intubated, put on a cardiac and brain monitor, and rushed to the Dartmouth NICU. An umbilical line and a venous line were all drawn to gain access to the circulation to hydrate and nourish. An arterial line was drawn because frequent blood gases were needed. As you can imagine, like I had, this baby looked like an experimental nursing tool. When I first saw him he looked as though he was fake. He had lines and tubes going in and coming out of every possible place on the body. He was hooked up to the EEG monitor to record his brain waves because it had been showing signs of abscence seizures. The baby had no swallowing reflex so frequent suctioning was crucial. When I arrived I was told that the baby would be going down to get an...
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...Research Critique of a Quantitative Study The purpose of this research critique is to inform the reader of a randomized clinical study regarding the treatment of Neonatal Abstinence Syndrome (NAS). This writer is interested in the treatment of drug exposed infants and the goals of reducing babies’ hospitalization in the Neonatal Intensive Care Unit (NICU). The study researches the adjunct therapy for treatment of NAS. The study will be broken down into the following units: protection of human participants, type of data collection utilized in the study, data management and analysis, findings and interpretation of these findings and finally the conclusion of the study and its findings. Protection of Human Participants This study’s goal is to differentiate the efficacy of clonidine versus phenobarbital in adjunct therapy with morphine sulfate in the treatment of NAS. One of the benefits of this study is the importance of standardization of a weaning protocol. The weaning protocol did not change from day to day and provider to provider as can be the case outside of the study. Another benefit is the predefined measures for each study group that were considered adverse events. These measures worked as a safety net to ensure the study was done safely and not causing harm to the babies. One noted concern/risk noted by the author was the potential for prolonged exposure to phenobarbital on a baby’s developing brain. The concern is the phenobarbital may cause behavioral compromises...
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...Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection Barbara C.C. Lam, Josephine Lee and Y.L. Lau Pediatrics 2004;114;e565; originally published online October 18, 2004; DOI: 10.1542/peds.2004-1107 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/114/5/e565.full.html PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2004 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from pediatrics.aappublications.org at University of Southern Queensland Library on August 5, 2014 Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection Barbara C.C. Lam, MBBS, FRCP(Edin, Lond.), FRCPCH(UK), FHKCPaed; Josephine Lee, RN, MSN; and Y.L. Lau, MD (Hons), FRCP(Edin, Glasg. Lond.) FRCPCH(UK) ABSTRACT. Objective. Health care–associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However...
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...Pain Assessment and Management G u i d e l i n e f o r Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP P r a c t i c e , 2 n d E d i t i o n Pain Assessment and Management Guideline for Practice, 2nd Edition This guideline is an outline of the pain assessment and management practices that currently are accepted and documented by experts in the field of neonatal care. In addition, it summarizes and recommends pain assessment and management practices based on the best evidence for the nursing care of infants. This guideline does not preclude the use of manufacturers’ recommendations or other acceptable methods of assessing and managing pain in infants. The use of other practices known to improve the quality of neonatal care is encouraged and not restricted by this document. The National Association of Neonatal Nurses (NANN) developed this guideline in response to members’ requests. Broad in scope, it can provide a foundation for specific nursing protocols, policies, and procedures developed by individual institutions. Authors Marlene Walden, PhD RNC NNP CCNS Sharyn Gibbins, PhD RN NNP Reviewers Daniel Batton, MD, American Academy of Pediatrics Sandra Sundquist Beauman, MSN RNC Jim Couto, MA, American Academy of Pediatrics Mary Ann Gibbons, BSN RN Melinda Porter, RNC CNS NNP Ann Stark, MD FAAP, Chair of AAP Committee on Fetus and Newborn Carol Wallman, RNC NNP MS, NANN/AWHONN Liaison to AAP Committee on Fetus and...
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...in Orlando, FL is one of the busiest and most respected hospitals for the medical treatment of children and women in the United States Since its opening on golfing legend Arnold Palmer’s birthday September 10, 1989, more than 1.5 million children and women have passed through its doors. It is the fourth busiest labor and delivery hospital in the United States and the largest neonatal intensive care unit in the Southeast, and APH ranks fifth out of 5,000 hospitals nationwide in patient satisfaction. “Part of the reason for APH’s success,” says Executive Director Kathy Swanson, “ is the our continuous improvement process. Our goal is 100% patient satisfaction. But getting there means constantly examing and reexaming everything we do, from patient flow, to cleanliness, to layout spaces, to colors on the walls, to speed of medication delivery from pharmacy to patient. Continuous improvements is a huge and never ending task.”. One of the tools the process flow chart. Staffer Diane Bowles, who carries the “Clinical Practice Improvement Consultant” charts scores of processes. Bowles’s flowcharts help study ways to improve the turnaround of a vacated room (especially important in a hospital that has operated at 130% of capacity for years), speed up the admission process, and deliver warm meals warm. Lately, APH has been examining the flow of maternity patients (and their paperwork) from the moment they enter the hospital until they are discharged, hopefully with their healthy...
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...every day, despite that there are neonatal patients suffering from painful life limiting medical conditions that have no treatment or cure. “Advances in medical technology make it possible to extend life, at times, the focus on ‘cure at all costs’ overshadows the obligation to provide dignified, humane, and compassionate care” (Rushton, 2005). In an effort to provide legal, humane and compassionate end-of-life care to infants, the Dutch developed the Groningen Protocol in 2003. Developed in collaboration with the prosecutor’s office, the Groningen Protocol was designed to guide a transparent medical and legal decision making process for parents and their doctors considering neonatal euthanasia (Catlin, 2008; Petrou, 2005). Neonatal euthanasia is the practice of hastening the death of a terminal ill newborn in an effort to relive their suffering. Most countries current laws make it illegal for the neonatal population to benefit from euthanasia. Research is suggestive that albeit in secret neonatal euthanasia maybe disguised and illegally practiced around the world. Legalizing neonatal euthanasia would not only allow transparency in end-of-life treatment options, but assist in the development of practice guidelines. In addition to the regulation of practice, transparency would authorize medical professionals to openly discuss the option for euthanasia with their patient’s parents along with the rest of the medical team. Active neonatal euthanasia is a form of euthanasia...
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...Abstract Red blood cells (RBCs) from cord blood contain fetal hemoglobin that is predominant in newborns and, therefore, may be more appropriate for neonatal transfusions than currently transfused adult RBCs. Post-collection, cord blood can be stored at room temperature for several days before it is processed for stem cells isolation, with little known about how these conditions affect currently discarded RBCs. The present study examined the effect of the duration cord blood spent at room temperature and other cord blood characteristics on cord RBC quality. RBCs were tested immediately after their isolation from cord blood using a broad panel of quality assays. No significant decrease in cord RBC quality was observed during the first 65 hours of storage at room temperature. The ratio of cord blood to anticoagulant was associated with RBC quality and needs to be optimized in future. This knowledge will assist in future development of cord RBC transfusion product. Go to: ------------------------------------------------- 1. Introduction Fetal and neonatal anemias are among the most serious complications of pregnancy and postnatal development. The causes of fetal anemia include immune haemolytic disease [1], defects in hemoglobin structure and synthesis, fetomaternal or twin-to-twin hemorrhages, and parvovirus B19 infections [2]. Neonatal anemia, on the other hand, can either result from fetal anemia or develop after birth as a result of hemorrhage due to obstetric accidents, frequent...
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...November 2000 EAST AFRICAN MEDICAL JOURNAL 599 East African Medical Journal Vol. 77 No. 11 November 2000 SAFE MOTHERHOOD INTERVENTION STUDIES IN AFRICA: A REVIEW M. Luck, DSc, Researcher, Centro de Malária e Outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, P-1300 Lisboa, Portugal SAFE MOTHERHOOD INTERVENTION STUDIES IN AFRICA: A REVIEW M. LUCK ABSTRACT Objective: To review the findings of safe motherhood intervention studies conducted in African settings. Data sources: Published literature regarding interventions designed to reduce maternal mortality in African settings. Study selection: Studies conducted in sub-Saharan Africa to assess the effects of interventions designed to reduce maternal mortality. Data extraction: Search of Medline database for the years 1988 to 1998 with additional manual search of references cited in Medline-referenced studies. Data synthesis: Few of the 34 intervention studies identified used a double-blind, randomized controlled trial design (4/34), or outcome measures directly related to maternal mortality or maternal health (7/34). Six of the studies produced reasonably convincing evidence of a positive effect on maternal health outcomes. Of these, three showed that changes in delivery practices brought about improved maternal outcomes, two found that a combined intervention consisting of upgrading of emergency obstetric services and community education increased the number of major obstetric...
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...up a 200-bed mutlispeciality hospital in the southern part of the city. To be set up at a cost of Rs 50 crores, the hospital will be completed in three phases. The first phase is likely to become operational without the oncology department within the next couple of months. Said Debashish Poddar, managing director, BP Poddar Hospital & Medical Research Limited, "It will not be a so called state-of-the-art hospital but a hospital, which will ensure healthcare deliver of international standards within the affordable limits of the common man. The hospital is the culmination of the dream of Arun Poddar, Chairman of the Group and his family to perpetuate the memory of his father Late BP Poddar, he added. Despite being a multispeciality unit, the focus area of the hospital will be oncology. All possible imaging facilities will be provided at the hospital. The management has applied for necessary regulatory clearances from Bhaba Atomic Research Centre (BARC) to start radiation therapy for treatment of cancer. According to Dr Subrata Das, medical director, BP Poddar Hospital & Medical Research Limited, "With a few dedicated hospitals in the region dedicated to oncology, the proposed hospital will take care of all the needs of the cancer patients. We are in the process of installing the latest equipment in the hospital to provide the best possible medical care." The management will be investing substantially on training of human resources. Said Shantanu Ray, a renowned academician...
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