Car seat safety for premature and/or high risk infants

What measures does your NICU take to assure the safe and proper use of car seats at discharge of premie or high-risk infants?
Does your unit recommend an individualized car seat evaluation for all premie and high risk infants?
Does your unit have an checklist for parental education on car seat safety?
Does your unit educate parents by use of videotapes, pamphlets, or referring them to websites?

For all of us who work in the Neonatal ICU, car seat safety is of paramount importance since we are discharging smaller and smaller premature and high risk infants. Some of these babies are going home with monitors and oxygen. These infants are susceptible to episodes of apnea, bradycardia and desaturation especially if they are not properly fitted and fastened in to their car seats.
The American Academy of Pediatrics has issued the following guidelines and recommendations regarding the transportation of infants at possible risk of respiratory problems:
1. Current information suggests that each preterm infant born at less than 37 weeks' gestation should have a period of observation in a car safety seat before hospital discharge to monitor for possible apnea, bradycardia, or oxygen desaturation. An appropriate hospital staff person should conduct the observation. Hospitals should develop policies to include this evaluation in their discharge planning process. An Academy endorsed video " Special Delivery: Safe Transportation of Premature and Small Infants, " contains additional information on this topic.
2. Families should minimize travel for infants at risk of respiratory compromise.
3. Infants with documented desaturation, apnea or bradycardia in a semiupright position should travel in a supine or prone position in an alternative safety device. The use of other upright equipment, including infant swings, infant seats, and infant carriers, should be avoided.
Alternative child restraint devices are available for infants who must travel in a prone, supine, or semiupright position. Specific information regarding currently available restraint systems can be obtained from the American Academy of Pediatrics brochure, "Family Shopping Guide to Car Seats."
If a semiupright position can be maintained safely by the infant, a conventional car safety seat that allows for proper positioning of the low birth weight infant should be selected. Better observation of the infant is possible when the child is in a rear- facing car safety seat adjacent to an adult rather than in a car bed.
4. Infants for whom home cardiac and apnea monitors are prescribed should use this monitoring equipment during travel and have portable, self-contained power available for twice the duration of the expected transport time.
5. Because commercially available securement systems for all portable medical equipment such as monitors and oxygen tanks are limited and not designed for use in motor vehicles, such equipment should be wedged on the floor or under the vehicle seat to prevent it from becoming a dangerous projectile in the event of a crash or sudden stop.
This information was retrieved from:
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;97/5/758.pdf
Please review this article for the complete recommendations on this topic.
Also review the article titled "Car Seat Safety for High-Risk Infants" by Kimberly D. Howard-Salsman in the March/April 2006 issue of Neonatal Network. Visit Neonatal Network on the web:
http://www.neonatalnetwork.com

David Kolb and experiential learning

Have you ever heard of experiential learning??
Experiential learners are those who learn best by hands on experience.
David Kolb created the theory on this type of learning.
Currently I am taking a required computer course in nursing education for my master's degree.
I avidly agree that it is crucial to have hands on learning particularly with the computer.
Those of us who are or will be involved in any type of education, from nursery school to post- graduate need to appreciate David Kolb's theory on experiential learning.

Here is an excerpt form the web:
Many of us engaged in professional learning have a broad understanding of the work of David Kolb. His highly influential book entitled 'Experiential Learning: Experience as the source of learning and development' was first published in 1984 since when his ideas have had a dramatic impact on the design and development of lifelong learning models. Of course, David Kolb's work can be traced back to that famous dictum of Confucius around 450 BC:
"Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand."
This article aims to help you explore the development of experiential learning from its original proposal into some of its current refinements and applications today, using the World Wide Web (the Internet) as a vast reference library...
A useful place to start this online exploration is David Kolb's own website. Here you need to be careful. There is another and different David Kolb, a professor of philosophy at Bates College, who is a prolific author. The man we seek is the professor of organisational behaviour at Weatherhead School of Management. David A Kolb describes himself as a "contemporary advocate of Experiential Learning". His own professional webpage [now at http://reviewing.co.uk/research/experiential.learning.htm#26] where you can find information about his background, current work and most well known publications - including references to his most well-known subject - experiential learning and learning styles.
The concept of experiential learning explores the cyclical pattern of all learning from Experience through Reflection and Conceptualising to Action and on to further Experience. One of the sites which explores the model and its practical application is http://www.learningandteaching.info/learning/experience.htm. This is a very well-known model which now forms the heart of many training and learning events. It also describes the process for recording continuous professional development, through taking time to capture, record and implement learning in our daily work. There are many adaptations and uses of the model. A fascinating one is provided on the Natural Learning website where analogy between this model of learning and organic growth in the plant and gardening worlds is well made: http://www.humanoptions.com/learning.html.

Retrieved from:
http://reviewing.co.uk/research/experiential.learning.htm#1

Noise in the NICU

What do the staff in your unit do to reduce noise levels in your NICU?

Many of us who practice nursing in the NICU forget that the noise levels in the units are very damaging to the babies especially premature infants and infants who spend many days under the radiant warmers. It has been found that most units' sound levels exceed recommended levels. Many studies have been done that indicate that excessive exposure of the premie to noise contributes to undesirable physiological and behaviorable effects. These effects include disruption of sleep, apnea, bradycardia, desaturation. cochlear damage, speech and hearing problems, intracranial bleeding and more. Excessive sound may also mask meaningful sounds such as the parent's voice.

There are certain areas of the NICU, times of day, and behavoirs of staff that contribute to excessive noise. Entrances, sink areas, and staff computer areas are the noisiest. Sound levels are the highest during nursing shift changes and during rounds.

What can we do to reduce sound levels and thereby protect our premies from damage??
1. Simply make a concerted and continued effort to keep our voices low.
2. Educate all staff to promote awareness of this problem.
3. Move nurse to nurse reporting to an area outside the unit.
4. Abolish the use of loudspeakers or turn down the volume.
5. Use lights rather than ringers to signify phone calls.
6. Move social phone calls to outside the unit.
7. Limit the use of music for staff enjoyment.
8. Lower the lights which seems to promote a quieter environment.
9. Move premies to incubators as soon as possible.

Remember we, as nurses, can have a definite impact on the sources of noise in our units.
Although it will be a challenge to maintain safe levels of sound, the benefits to our babies will be great.

Please provide any comments and suggestions on measures your NICU has taken to reduce sound. Thank You!!

Reference:

Krueger C, Nealis R, Parker L, and Wall S. 2005. Elevated sound levels within a busy NICU. Neonatal Network 24(6):33-37.
http://www.neonatalnetwork.com/

Carolyn

Kangaroo Care

Does your NICU support the use of Kangaroo care?

Kangaroo Care is a practice that originated in Colombia in the late 1970s that has been adopted worldwide because of the advantages for premature babies. Kangaroo Care means holding a NICU baby skin-to-skin (against the parent's chest) for varying lengths of time. Premature and sick babies that "kangaroo" appear to relax and become content. Numerous studies have shown that Kangaroo Care has many health benefits that include the following:
higher blood oxygen levels
improved sleep
improved breastfeeding
improved weight gain
Kangaroo Care also helps parents feel close to their baby, and gives them confidence in their ability to meet their baby's needs. Mothers who "kangaroo" also show improved breast milk production.
Retrieved from: http://wo-pub2.med.cornell.edu/cgi-bin/WebObjects/PublicPediatrics.woa/14/wa/viewContent?contentID=2414



My unit practices the use of Kangaroo Care but not on a consistent basis. I would definitely like to see it being done frequently and have both mother and father participate. As these photos show, many nurses advocate for using Kangaroo care even for tiny intubated premies. I enjoy, as part of my routine practice, having mothers utilize Kangaroo care.



Pictures retrieved from: http://www.godstinyangels.org/kangaroo.jpg
http://www.godstinyangels.org/Me%20holding%20Dominique.JPG

Welcome to my blog on neonatal nursing

Hello neonatal nurses and any nurse interested in sharing information and comments on neonatal nursing.
This is my first time creating my own blog and I am quite interested in reading your comments on topics related to neonatal nursing.