7 Advancements in Neonatal Care
More babies, including extremely preterm infants, are surviving stays in neonatal intensive care units (NICUs), due to recent advancements in neonatal care.
“Babies have earlier viability,” said Jaylee Hilliard, MSN, RN, NEA-BC, CPXP, senior director of clinical strategy at AngelEye Health in Nashville, explaining that 23 weeks was the earliest NICU teams would resuscitate a baby, but now that has dropped to 22 weeks. “It’s just phenomenal we have the technology and know-how to do that, not just to keep them alive but the long-term outcomes.”
Hilliard indicated technology plays a major role in successful outcomes, along with skilled neonatal nurses and physicians.
“The very first minute, hours and days of these babies lives sets the tone for the rest of their lifetime,” Hilliard said.
7 Trends in Neonatal Care to Watch
Here are several key trends and advancements in neonatal care that staff and travel NICU nurses will want to be aware of in the coming months:
Trends in Preterm Births and NICU Admissions
The rate of U.S. preterm births, defined as babies with less than 37 weeks gestation, recently declined for the first time in six years, moving from 10.2 percent in 2019 to 10.1 percent in 2020, according to a March of Dimes report card. Infant mortality also has decreased from 5.7 deaths per 1,000 live births in 2018 to 5.6 deaths per 1,000 live births.
A study at Kaiser Permanente Southern California found a decrease in the risk-adjusted NICU admission rate and days spent in the NICU, according to an article in JAMA Network Open. The reductions were not associated with higher rates of readmissions or deaths.
Parents play a critical role in the outcomes of their tiny babies receiving neonatal care, but work, distance and other factors often become barriers to providing optimal care, Hilliard said.
“The literature tells us the parents more educated and engaged in the care of their child have better long-term outcomes for their child, and they are less likely to readmitted,” Hilliard said.
AngelEye features an app with a bedside camera, allowing the parents to see their babies at any time, reducing parental anxiety. Parents average spending 3.5 minutes per virtual visit and log in on average five times per day.
The AngelEye system also provides online family resources and education; a HIPAA-compliant and secure text, photo and video messaging feature “Patient Connect;” and “MilkTracker,” an inventory and scanning technology for safe feedings of that baby’s breastmilk.
“Body cooling treatment for neonatal encephalopathy has significantly improved outcomes from a neurological perspective and is now the standard of care,” said Sheila Kaseman, MS, RNC-NIC, clinical manager of the neonatal intensive care unit at Children’s Hospital Colorado in Aurora.
Whole body cooling, also referred to as newborn therapeutic hypothermia, slowly lowers the baby’s body temperature, using a water-filled cooling blanket, to 92 degrees. The infant usually remains lying on the blanket for three days. The treatment reduces the severity of brain injuries.
Multiple studies have shown that human milk provides ideal nutrition for preterm babies. New mothers of infants in the NICU often require encouragement and support to pump milk for their infants.
Kristen Halstead, BSN, MBA, clinical program manager for Lactation Support Services at Children’s Hospital Colorado, indicated the hospital uses a “human milk analyzer system to analyze each individual mom’s milk – the first of its kind in Colorado.”
Milk analysis systems can measure fat, protein, and total carbohydrate content and determine told solids and energy content, according to an article in JAMA. The analysis can help identify deficiencies in protein or energy levels in the mother’s milk of infants with increased need for the nutrients, and then clinicians can fortify the milk if needed.
Children’s Hospital Colorado also uses “a centrifuge for defatting milk for babies with chylothorax,” Halstead said.
Chylothorax refers to an accumulation of lymphatic fluid in the pleural space. Limited research exists as to the effectiveness of using a modified-fat breastmilk in these children, but a study in Breastfeeding Medicine reported that “using fat-free human milk may be a beneficial dietary strategy to facilitate resolution of chylothoraces in infants.”
Ex Utero Intrapartum Treatments (EXIT)
“EXIT procedures are used more frequently to deliver babies who need immediate surgical intervention at birth while remaining attached to the placenta,” Kaseman said.
During EXIT procedures, surgeons operate on the infant while he or she is still connected to the umbilical cord to intervene and treat babies with immediate, critical problems post-delivery and unable to breathe or transition safely to human life.
To improve outcomes, Children’s Hospital Colorado uses telemedicine for complex discharges either to a NICU closer to the family’s home or to a primary care provider, Kaseman reported. The NICU team can give the receiving “team a baseline assessment and more effective team hand off.”
The teledischarges are in addition to traditional written discharge summaries and offer the receiving team an opportunity to view a baseline exam and any procedures the patient needs, plus ask questions from the hospital’s neonatal experts. The neonatal nurses and infant’s family also participates in the televisit.
Extreme COVID Visitation Precautions
Like everywhere else, COVID-19 has changed the NICU as well, Kasman said.
“Parents and team members are always masked,” she said. “There are also significant restrictions limiting visitors during NICU stays. In some cases, siblings of newborns have gone months without meeting [the newborn] in person. The Child Life team has gotten creative with technology so families can still ‘meet’ the newborn in the NICU.”
The Global Alliance for Newborn Care launched a “Zero separation. Together for better care!” campaign to encourage parental involvement during the COVID-19 pandemic.
NICU nurses can do better in keeping parents engaged during the pandemic. The extreme restrictions can possibly have long-term outcomes for the infant and family, Hilliard said. The AngelEye technology with its camera system and parent engagement features can help reduce the challenges.
“Due to the pandemic and the visitation restrictions, this technology is more important than ever before,” Hilliard said. “In the future, I believe this bedside technology will be a standard of care.”
Many advances in neonatal care by NICU nurses have led to better outcomes for the tiny babies.To learn more about NICU travel nursing positions, contact an AMN Healthcare career advisor.