This presentation compares the development and implementation of competency checklists for orienting and mentoring practitioner that supports the needs of management, patients and NICU therapist's. Competencies from four NICUs across the US were compared by three neonatal physical therapists via a coding system. After coding, themes arose which described similarities which were then referenced back to the published physical therapy competencies. This varied between hospitals, depending on specific rehabilitation professionals employed, the evolution of NICU status and the complexity of the patient. The neonatal therapist has a unique opportunity to utilize the information from this study to bridge the gap between the operational management and the educational demands of the rehabilitation therapist in the NICU team.

In Part 2 of this 2 part sequence, use of abstinence assessment tools to rate NAS scores will be discussed to guide understanding of withdrawal symptoms commonly observed. Abstinence tools will be compared and contrasted against infant assessments commonly used by therapist to guide neurodevelopmental implications of symptoms. Guided by NAS assessments non-pharmological management will be addressed including environmental adaptations, state regulation, rest and sleep (use of swaddling, nonnutritive sucking, rocking, positioning), feeding (formula and breastfeeding). Applied examples of the therapist role in NICU along with treatment interventions for infants and their families will be discussed. Once the caregivers within the NICU are better to understand the scope of the problem, this knowledge will translate into improved developmentally supportive and age appropriate care. A through understanding of infants with NAS and their families will lead to more responsive care for their infants during and after their hospital stay.

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No description available.

In 2012 the American Academy of Pediatrics (AAP) revised its recommendations regarding neonatal male circumcision, transitioning from a recommendation against it to endorsing the practice. The current recommendations are based on the findings of three studies performed in Sub-Saharan Africa. In those studies, the researchers suggested that circumcision may result is reduced rates of Human Immunodeficiency Virus (HIV) transmission via heterosexual intercourse. In addition to the above studies there are several studies suggesting that circumcision can have benefits in reducing the rates of penile cancer, human papilloma virus transmission, and urinary tract infections. Based on the AAP recommendations some third-party payers have revised their policies regarding reimbursement procedures. While circumcision practices are a topic of debate in the United States, non-therapeutic circumcision is not recommended by the European Academy of Paediatrics and is not reimbursed by third-party payers. For instance, the National Health Service in Great Britain discontinued the practice of routine non-therapeutic circumcision in the mid twentieth century. This presentation will give a thorough review of the existing body of knowledge regarding the practices of non-therapeutic male infant circumcision. Existing studies regarding HIV risk reduction will be discussed in detail. At the same time, the generalizability and transferability of the above studies to the US health care system will be discussed. Finally, third-party reimbursement practices, costs associated with circumcision, and ethical issues related to this issue will be discussed.

This study was designed to investigate the effects of acute eticlopride (0.02 mg/kg, D2 antagonist) treatment, given immediately before training, in rats neonatally treated with quinpirole, which has been shown to produce long-term D2 receptor supersensitization. Rats were given quinpirole (1mg/kg) or saline treatment from P1-21. Beginning on P22, rats were administered eticlopride or saline (i.p.) fifteen mins before each of seven days of training. Rats were tested on the Morris water task (MWT). For the first three consecutive days, rats were tested on the place version of the MWT with a stationary platform. Animals were given 24 training trials followed by a probe trial, and swim patterns were analyzed with platform removed. The next day, animals began testing on the match-to-place version for four consecutive days and two daily trials were given with the platform moved to a new location each day. On both the search time and target visit measures of the probe trial, animals neonatally treated with quinpirole demonstrated a deficit, and eticlopride eliminated this deficit. Interestingly, animals neonatally treated with saline but given eticlopride before training also demonstrated a deficit on both measures. On the match-to-place version, the difference in latency to locate the platform between the two daily trials served as the dependent measure. Similar to the MWT place version, eticlopride treatment eliminated deficits produced by neonatal quinpirole treatment on this task, and eticlopride produced a deficit in saline controls. This study demonstrates that in a model of dopamine D2 supersensitivity, it appears that the increased sensitivity of the D2 receptor is important for cognitive function.

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Abstrakt Bakgrund: Sverige är idag världsledande gällande överlevnaden hos extremt underburna barn. Den högspecialiserade vården i Sverige är centraliserad till regionsjukhus vilket leder till att flertalet av dessa barn behöver transporteras från hemsjukhus till regionsjukhus för fortsatt vård. Motiv: Föräldrars känslor i samband med att deras barn behöver neonatal intensivvård är väl studerat i tidigare forskning både internationellt och nationellt. Då det finns begränsat med kunskap angående dessa föräldrars behov av stöd i samband med flytt av deras extremt underburna barn till annat sjukhus finns det möjligheter till förbättring inom området. Syfte: Syftet med studien var att belysa vilket stöd föräldrar till extremt underburna barn önskade när deras barn behövde flyttas till en annan neonatalavdelning på ett annat sjukhus.Metod: Studien genomfördes som en kvalitativ enkätstudie med öppna frågor med empirisk design. Enkäterna analyserades via en kvalitativ innehållsanalys med induktiv ansats av Elo & Kyngnäs. Föräldrarna (n=63) rekryterades via ett strategiskt urval från hela Sverige. Resultat: Resultatet delas in i två huvudkategorier; ”Föräldrars behov av förberedelser inför flytt till annat sjukhus” samt ”Föräldrars behov av emotionellt och personligt stöd”. Resultatet visar att det finns ett stort behov av stöd hos föräldrarna för att minimera de negativa upplevelser som kan uppstå då deras extremt underburna barn behöver flyttas till en annan neonatalavdelning. Föräldrarna beskriver att de önskar få information om avdelningen de flyttar till avseende rutiner och faciliteter samt när flytt förväntas ske och att denna information idag är bristfällig. Föräldrarna beskriver även att deras känslor och upplevelser behöver bli bekräftade av personalen och att behovet av en kontaktperson är stort. Konklusion: Resultatet belyser vilket stöd föräldrar efterfrågar i samband med flytt av sitt extremt underburna barn vilket skapar möjligheter för en framtida utveckling av neonatalvården. Implementering av stödjande vårdrutiner samt förbättrat samarbete mellan sjukhusen skulle öka möjligheterna för en förbättrad föräldraupplevelse och därmed minskad psykisk ohälsa. / AbstractBackground: Sweden is world-leading when it comes to survival rates among extremely preterm infants. Highly specialized care units are centralized to regional hospitals, resulting in that many extremely preterm infants need to be moved from their home hospital to a regional hospital for additional care. Motive: Parents' emotions when their extremely preterm infant requires neonatal intensive care is a well-studied area in both national and international studies. The authors therefore believe that there is a reason for further research regarding parents’ need for support in connection to the relocation of their extremely preterm infant to another hospital. Since there is limited research regarding the needs of these parents, there are opportunities for improvement in the area.Aim: The purpose of this study was to illustrate what support parents of extremely preterm infants need when their infant needs to be moved to another neonatal unit at another hospital. Methods: The study was conducted as a qualitative questionnaire study with open questions with empirical design. The questionnaires were analysed using a qualitative content analysis with an inductive approach by Elo & Kyngnäs. The parents (n=63) were recruited via a strategic selection from all over Sweden.Result: The result is divided into two main categories; “Parents’ need for preparation when moving to another hospital” and “Parents’ need for emotional and personal support”. The result shows that there is a great need for support among parents to minimize the negative experiences that can occur when their extremely preterm infant needs to be moved to another neonatal unit. The parents describe that they wish to receive more information about routines and facilities at the unit they are moving to, and then the move is expected to take place. The parents also describe that their feelings and experiences could be further confirmed by the staff and that they have a need for establishing a relation with a contact person. Conclusion: The result highlights what support parents request in relation to transportation of their extremely preterm infant, creating opportunities for further improvements in neonatal care. Implementation of supportive care routines and improved collaboration between hospitals could increase the opportunities for an improved parental experience and by that reduced mental illness.

Bakgrund: I Sverige har ca 10% av de nyfödda barnen behov av neonatalvård där vanligaste dödsorsaken är asfyxi, infektioner, underburenhet samt fosterskador. Oavsett ålder ska välbefinnandet främjas till livets slut. Familjecentrerad Vård (FCV) är en arbetsmodell kring ett sjukt barn och dennes familj där vården planeras efter hela familjens behov i samråd med familjen för hela familjens bästa. Syfte: Undersöka föräldrars upplevelser av vårdtiden då deras barn vårdats i livets slut på en neonatal intensivvårdsavdelning ur ett familjecentrerat perspektiv. Metod: Kvalitativ litteraturöversikt med systematisk ansats med riktad innehållsanalys. Resultat: Resultatet visar att det var viktigt att få spendera tid med sitt barn både före och efter döden. Föräldrarna önskade få ge normal omsorg som att hålla om, mata och trösta. Det fanns ett stort behov av information och kommunikation kring barnets situation. I efterhand värdesatte de högt att de fått hjälp att insamla minnessaker. Föräldrarna menade på att vårdtiden var svår men värdefull. Slutsats: FCV kan vara ett verktyg som får föräldrarna att spendera mer tid med sitt barn vilket kan leda till minskad prevalens av depression efter barnets död. Det är av stor vikt att se varje familjs individuella behov för en så bra vårdtid som möjligt för familjen.

The incidences of maternal opioid use and neonatal opioid withdrawal syndrome (NOWS) have increased by nearly 400% over the past decade. Isemann and colleagues (2017) developed prediction tools (TiTE/TiTE2) to differentiate, within the first two days of life, between infants who will require pharmacotherapy for NOWS from those infants who will not require pharmacotherapy for NOWS. The goal of the current experiment was to replicate and extend their prediction model. The present experiments successfully replicated Isemann et al., (2017) results and also established alternative cutoff values for requiring treatment that provide better balance between all four metrics. Moreover, new prediction models (TEN/TEN2) were proposed based on a factor analysis of modified Finnegan scores across the first 48 hours of life. Area Under the Curve-Receiver Operating Characteristic curve analyses indicated that the TEN2 was the best prediction model compared to the TiTE2 and the TEN.