Class of 2012 Abstract / Specific Aims: The objective of this study is to evaluate and compare clinical outcomes and economic impact involved with the use of beractant (B) compared to poractant (P) for the treatment of respiratory distress syndrome (RDS) in premature neonates admitted to a neonatal intensive care unit. Methods: Patients were included if they were less than 35 weeks gestational age at birth, survived at least 48 hours, and admitted to the neonatal intensive care unit and treated with P or B for RDS. The primary outcome of this study is the change in the fraction of inspired oxygen (FiO2) over the first 48 hours after surfactant administration. Secondary outcomes were the change in oxygen saturation, time spent on mechanical ventilation and continuous positive airway pressure (CPAP), complication occurrence and mortality of the neonates. Main Results: There were a total of 40 neonates whose charts were reviewed (n= 13 and n=27 in the P and B groups respectively). The mean gestational age of the neonates were 29.2+/-2.9 and 28.8+/-2.9 weeks in the P and B groups respectively. The FiO2 was found to not be lower between the P and B groups (35.5+/-22.2 and 42.4+/-24.2, respectively; p=0.379), as well as the O2 saturation (94.6+/-4.6 and 92.3+/-6.1; p=0.194). Significance was also not found for the other clinical or economic outcomes assessed in this study. Conclusions: There was not a significant difference between poractant and beractant in FiO2, O2 saturation, or in the other clinical outcomes evaluated in this study.

Titel: En omvälvande erfarenhet för föräldrar- en litteraturstudie om att få ett för tidigt fött barn. Bakgrund: Cirka 5 % av alla barn som föds årligen i Sverige är för tidigt födda. Flera studiers resultat visar att det är påfrestande för föräldrar till för tidigt födda barn att vistas på en neonatalavdelning. Trots att detta ämne är väl beforskat visar nutida studier att det finns delar i omvårdnaden som kan förbättras. Syfte: Syftet med litteraturstudien var att beskriva föräldrars erfarenheter av tiden på en neonatalavdelning med deras förtidigt födda eller lågviktiga barn. Metod: En litteraturstudie genomförd med tolv artiklar med kvalitativt resultat. Resultat: Tre huvudkategorier och sex underkategorier identifierades. Huvudkategorierna innefattar: att få vara nära sitt barn, föräldrars behov av information, kommunikation och stöd och föräldrars erfarenhet av miljön på neonatalavdelningar. Konklusion: Sjuksköterskor har stor inverkan på hur föräldrar upplever tiden på neonatalavdelningen. En viktig uppgift för dem är att involvera föräldrar i vården och se dem som en del av deras barns vårdteam. Inte enbart för föräldrars skull utan även för barnens välmående.   Nyckelord: Föräldrar, neonatalavdelning, erfarenheter, prematur. / Title: A transformative experience for parents- a literature study about having a prematurely born infant. Background: Approximately 5 % out of all children born annually in Sweden are born prematurely. Several studies' results show that it is stressful for parents of premature infants to stay at a neonatal unit. Although this topic is well researched, recent studies show that there are parts of the care that could be improved. Aim: The aim of this study was to describe parents' experiences of the time spent at a neonatal unit with their premature or low birth weight infants. Methods: A literature study was conducted from twelve articles with a qualitative result. Results: Three main categories and six subcategories were identified. The main categories included: being allowed to be close to ones child, parents need of information, communication and support and parents experience of the enviorment at the neonatal unit. Conclusion: Nurses have a major impact on how parents perceive their time at the neonatal ward. An important task for them is to involve parents in the care and to see them as part of their child's healthcare team. Not only for the parents sake but also for the infant's well-being.   Keywords: Parents, NICU, experiences, premature.

With over 400,000 infants being hospitalized in the NICU annually, it is important to understand adjustment in their mothers. Taylor’s cognitive theory of adaptation asserts that three factors, meaning making, control, and self-enhancement, influence positive adjustment in a crisis situation such as a NICU hospitalization. Since it has never been examined, the purpose of the current study was to test the utility of Taylor’s model in mothers with an infant in the NICU. Data was collected from mothers with an infant in the NICU (N = 181) and the main hypothesis was that meaning making, control, and self-enhancement would explain a significant portion of variance in depression scores in mothers with an infant in the NICU. Results from this study did not support this hypothesis. Still, this study is important in guiding future research to better understand the adjustment process of mothers with an infant in the NICU.

Overview There are numerous studies in the current literature focusing on the intense emotions experienced by parents, following the birth of a preterm infant, (i.e., born prior to 37 weeks gestational age [GA]). Research findings have helped us understand the fear and anxiety they feel while attempting to navigate the neonatal intensive care unit (NICU) environment. What happens in those early weeks and months at home after discharge, however, is surprisingly absent from the literature. It is well known that preterm infants are readmitted to the hospital during the first few months after discharge at a rate of 10% - 35%, for an average 4.7 - 11.7 day stay and a cost of approximately $376 million (Underwood, 2007; Escobar, et al., 2005). The most common reasons for readmission are respiratory, feeding and jaundice problems (Spicer, et al., 2008; Underwood, 2007; Escobar, et al., 2005; Brissaud, et al., 2005). What we don’t yet know is what transpired during those early days and weeks at home and how mothers established their day-to-day routines. This missing information could foster a better understanding of family needs and promote the development of strategies to share with mothers prior to discharge, with the result being healthier transitions for both mothers and infants and a possible reduction in the inflated readmission rates for this cohort. The purpose of this research was to help bridge the gaps in the literature on the topic of transitioning a preterm infant to home following NICU discharge. Eight mothers who met the criteria of having a preterm infant born between 24 and 34 weeks GA, admitted to a NICU for a week or more, and who had been discharged to home for 6 months or less, were purposefully chosen from a convenience sample. Each mother was interviewed and asked to describe those first few months at home, e.g., how she met her infant’s needs, what she learned, and how she learned it. Two follow up questions were included and asked the mother what she would like us (HCPs) to know about her experience, and what she would say to other mothers whose infants were still in the NICU. Most mothers spoke at length of the fear they felt when bringing their infants home, and how inadequate they felt trying to provide care that had heretofore been provided by a team of specialists. They described the 2 difficulty and confusion associated with getting their infants to sleep in a quiet home environment until they thought to duplicate the noises of the NICU, and how the monitors, which all infants wore home from the NICU, were both friend and foe, alerting them to potential problems, but awakening the entire household in the process. Each mother also spoke of her determination to do whatever was necessary to ensure that her infant was not rehospitalized, and how thankful she was that her infant had made it to this point. Although each mother described a different approach to meeting the challenges associated with her infant, there was a consistency in the overall challenges each mother experienced. Most mothers wanted HCPs to know they were thankful for the part each had played in saving their infant’s life but they also wanted to impart their parental wisdom on the best ways to give information to a parent, the need for uniformity in what they called the “rules” of the NICU, and how a little encouragement from any HCP was sorely needed by most parents. These mothers were excited to be taking part in this study. They wanted to feel that something they saw, felt or did would make a difference for another mother with an infant in the NICU. Each thanked me for allowing them to share their experiences with me. The references for this document will appear at the end of each section.

Thesis advisor: Catherine Read / The purpose of this paper is to identify and examine the sources of paternal stress related to the NICU experience and the supports currently available. Once identified, the possible sources of stress will be incorporated into a checklist that will allow NICU staff to assess barriers to bonding and further personalize the interventions to facilitate the relationship between the parent and infant. / Thesis (BS) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: College Honors Program. / Discipline: Connell School of Nursing.

Background: Losing an infant is difficult for parents to face. To improve EOL care for dying neonates and their families, NICU nurses need to overcome obstacles and implement supportive behaviors. Understanding the size of obstacles and supportive behaviors will better enable NICU nurses to provide quality EOL care. Objectives: To determine the largest obstacles and supportive behaviors in NICU EOL care. Methods: A descriptive quantitative study of a random national sample of 1058 NICU nurses who were members of NANN (National Association of Neonatal Nurses). The National Survey of NICU Nurses' Perceptions of End-of-Life Care questionnaire was mailed twice yielding 234 usable questionnaires for a response rate of 26%. Results: Three themes emerged in the top rated obstacles: (a) obstacles related to families, (b) obstacles regarding language and communication, and (c) obstacles concerning ethical dilemmas. The lowest rated obstacles were nurses believing that life-saving measures/treatments were prematurely discontinued and unit visiting hours being too liberal. The top eight supportive behaviors included helping families cope with the infant's death and those involving helpful physician behaviors. Lowest rated supportive behaviors were those related to the nurses' own family death experience and behaviors promoting nurse convenience. Conclusions: Obstacles and supportive behaviors for NICU EOL care have been identified. Issues regarding families, communication, and ethical dilemmas need to be addressed. Efforts should be made to more quickly align the plan of care with the projected outcome to limit both infant suffering and nurse distress from inappropriate use of life-extending measures.

Background: About five percent of the infants being born in Sweden are cared for in a neonatal unit because of their prematurity. Breastfeeding and breast milk is considered to be the best nutrition for infants in general and for premature infants in particular. The premature infant, depending on how premature, may not be able to breastfeed effectively due to their immaturity. Stress, anxiety and fatigue are factors that affect breast milk production in a negative direction and these feelings are common in the neonatal unit. Aim: To illuminate mothers’ experiences of breastfeeding the premature infant in the neonatal unit. Method: A literature review of eight studies with a qualitative research approach, published between the year 2000 and 2012 was conducted. The studies have been analysed through a content analysis. Result: The findings showed that mothers perceived breastfeeding as a marker of motherhood and they felt guilt and began to question themselves as good mothers if it did not work. The mothers experienced lack of understanding, from the staff, concerning difficulties with breastfeeding, moreover the nurses where the ones who decided when and for how long the mothers should breastfeed. It also appeared that excessively focus on breastfeeding and breast milk by the staff resulted in objectification and the mothers would rather see breastfeeding as a natural process. Some mothers felt support and encouragement from the staff, while some mothers felt that the staff was constant present, which resulted in insecurity. Conclusion: Breastfeeding support for mothers of premature infants during their hospital stay is not satisfying and nurses’ actions have a major impact on mothers’ experiences. Therefore, nurses need to pay attention to mother’s individual needs of support and be aware of how her actions affect the mothers. Nurses also need to strength the mothers in their parent role so that they believe in their own ability to make breastfeeding work.

Sound levels in the neonatal intensive care unit often exceed the recommended level of 45 dBA. Various sounds contribute to the extraneous noise that envelops this fragile environment. Increase in noise and high levels of sound can be detrimental to the health of premature infants, which can cause both short and long-term developmental delays and negative physiologic responses. Music therapy interventions in the NICU have addressed numerous needs of this population, with a positive effect on development, physiologic responses, and hospital stay. The purpose of this study was to investigate the effect of music therapy on decreasing the sound levels in the NICU. Two different pods in a 66-bed NICU were used to measure sound levels for four consecutive days, alternating between days of baseline and music therapy intervention. A dosimeter was used to collect data, which was later analyzed to determine Lmin, and Lmax, and Leq. Results indicated an overall decrease in the sound levels average when music therapy intervention was present. Future studies should use multiple settings and collect data for an extended amount of time to further examine the sound levels of the NICU environment and any additional effects music therapy can have.

Infants born prior to 37 weeks gestation are at risk for countless medical problems and developmental delays. In order to help minimize these delays and improve the child’s potential, the Individuals with Disabilities Education Act, Part C, funds Early Intervention (EI) Services. These services may include speech, physical therapy, occupational therapy, or developmental therapy, among others. Purpose and Objective: While numerous studies show the benefits of EI therapies, little is known about barriers to EI participation, what the parents of these children who participate in EI think, or how to improve EI services. This study attempts to answer these questions. Methods: Surveys regarding EI were posted to three preemie parent organizations social media pages, and 140 surveys were returned. These surveys were analyzed for both quantitative and qualitative answers. Qualitative answers were coded and themes were garnered. Results: A total of 148 participants took the survey, and 76% had children that had participated or currently participate in EI. Of the parents who answered their child did not attend EI, most state there was no EI services near them, their child did not qualify, or the EI services were of poor quality. Of the EI parent surveys, most parents (73%) were happy with their child’s EI and their child’s progress, and would recommend EI to others. Most children had EI therapy at least weekly, and were referred to EI prior to leaving the NICU. Parents felt as though their child benefitted in nearly all domains. In addition to the benefits to their child, EI parents also felt as though therapy helped decrease their stress level, gave them a benchmark to measure their child’s progress and connected them with other professionals for their child. Some parents also provided recommendations to improve EI: decrease eligibility requirements, improve communication with parents, provide continuity of care, and create a bridge program for children three and up until they reach school age. Conclusions: With these suggestions, providers can help improve current EI services. Primary care providers should ensure children who are at risk for delays are referred, and EI services should improve communication with parents and enhance continuity of care.

Neonatal Intensive Care Unit (NICU) patients present unique patient identification challenges. Prospective hazard analysis (PHA) assesses safety by identifying hazards before an adverse event occurs. This project analyzes a barcoded feeding process in one NICU, and conducts a preliminary evaluation of PHA methods. Observations were conducted to quantify patient identification methods used in one NICU; the unit’s barcoded feeding process was examined for potential failures. The process underwent PHA with two methods, Global Hazard Ratings (GHR), a simplified method developed for this project, and Failure Modes and Effects Analysis (FMEA). FMEA showed greater interrater reliability; there was poor agreement between methods. A list of 21 hazards was developed for the clinical team from the FMEA results. Recommendations are for the unit to formulate and implement mitigation strategies for the identified hazards. Future work involves a more in depth look at FMEA interrater reliability and reliability comparison with other PHA methods.