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MedTech Outlook | Monday, May 22, 2023
Effective nursing care contributes to declining global mortality rates among preterm infants.
As survival rates at the lowest gestations improve, more preterm infants are being cared for, requiring a clinical care approach that considers their specific characteristics. There is a risk of iatrogenic injury, immature organ function, and parental and familial strain due to a high degree of uncertainty, the separation of the infant from the mother, and a long stay in the hospital. Neonatal care for preterm infants can influence the current global population's short-term and long-term outcomes, despite the challenges associated with providing nursing care to infants. It is important to streamline nursing care provided to infants born at the very lowest gestations and their families, focusing on doing less harm by establishing an adequate care environment, actively promoting parental closeness and caregiving, and infant skin care.
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Medical treatments and procedures integrated with specific nursing aspects and details in bedside nursing impact outcomes as much as medical management. The management of intravenous lines has provided impressive results in improving the quality of care and reducing rates of late-onset sepsis and patient outcomes.
Considering the following best practices in neonatal care for deficient gestational-age infants is essential.
Minimize pain and stress: There is a greater risk of inadequate brain development and long-term neurodevelopment among infants exposed to pain and stress during their first 14 days.
As infants experience many sensory stimuli at a crucial time in their development, initiatives that aim to create a less harmful environment should be beneficial. Clear evidence for its effectiveness is lacking. Adapting the environment and challenging existing routines regarding care intervals, procedures, and blood collection are effective ways to reduce noxious stimuli and environmental stress.
Care planning, handling, and positioning: Performing routine caregiving tasks such as changing diapers can cause cerebral circulatory fluctuations and cardiac instability, particularly when sleep disruption is involved. Studies suggest that grouping caregiving activities around a single caregiving event promote neurodevelopment by allowing more uninterrupted sleep and rest.
On the other hand, providing complicated care imposes a greater magnitude of hemodynamic changes and must be stopped when the infant shows signs of stress. According to studies, an interval between diaper changes, repositioning, and monitoring of four to six hours is an appropriate compromise. Visually observing vital signs is also beneficial in most clinical settings.
IVH prevention bundles have been introduced in many centers to reduce intraventricular bleeding during the first few days of an infant's life. Caregiving should be divided between two people so that one, ideally a parent, can provide comfort and positioning to the infant by flexing the nest.
Nursing research and quality improvement: In the intensive care unit, a preterm infant exposes itself to stimuli that are entirely different from the stimuli in the womb, causing them to mature, develop, and grow differently from when they were in the womb. Standardized nursing protocols that integrate with medical management are necessary for optimal outcomes, and these protocols should minimize harm and encourage parental involvement. To reduce the number of interventions and care, clinicians must clarify and express every detail of the nursing procedures to qualified staff members.
There remains a lack of clarity regarding best practices regarding timing, positioning, space organization, and ergonomics of care for the preterm infant, despite noninvasive methods such as skin-to-skin care being likely to provide useful benefits to this group of infants. A conservative approach towards ointments, dressings and adhesive removers is important while awaiting evidence from clinical trials about how best to care for and treat immature skin. Without data from randomized controlled trials covering all aspects of nursing care, sharing experiences and comparing care approaches across centers may yield results.
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