Neonatal Intensive Care: Principles and Guidelines

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Most of the participants Their mean age was 34 years, and their mean work experience was 9. Ninety-one percent of the respondents were female and 6. The results of the quality of clinical guideline evaluation have been presented in Table 6. In the final evaluation, Total mean score of clinical guideline was 80 from Protocol of end-of-life neonatal palliative care, designed by Catlin and Carter, is a modern model for neonatal palliative care, which has appropriate number, combination, and variation of care, and is counted as the richest model.

This protocol has been adopted in all articles and neonatal palliative clinical guidelines. Due to its good ability, this model was used as the primary core of the guideline designed in the present study. The major difference between the above clinical guideline and the one used in our study is that it contains the sections of introduction domain, goal, and definition , background, different aspects of neonatal palliative care, and home care.

We also completed the guideline in other fields based on already published guidelines in valid centers and explained the philosophy, mission, goal general goals, specific goals, and expected results , domain type of clinical guideline, target population, and clinical guideline nurses , definition and importance of the subject, and guideline development method, all in the section of introduction.

Background section was replaced by general points which included ethical and legal considerations of neonatal palliative care, based on national regulations and religious and general principles of neonatal palliative care.

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The third section is associated with the components of neonatal palliative care. The section of home care in the above guideline was not used, as it did not address our target population. Several studies are in line with the process of our research, including Toman et al. They firstly reviewed the related literature about CHF patients, and then extracted educational programs from them. Next, they investigated the association between education and clinical evidences and, finally, performed that.

We handed the primary draft of clinical guideline to the nominal group based on localization approach, and surveyed the rank and applicability of care. Sadeq Tabrizi and Gharibi suggested a national accreditation model via Delphi technique in their article in which both standards of rank and applicability had been surveyed, which is consistent with the present study. Meanwhile, in their study, a nine-point scale was adopted for scoring the recommendations, instead of a four-point scale used in our study.

They also used acceptance, deletion, and combination or modification of the standards in their Delphi technique. We also used deletion, acceptance, and combination of the recommendations in designing our clinical guideline.

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Rolley et al. Their strategy included a vast literature review about the patients undergoing cardiac invasive interventions. At this stage, literature review was conducted by an evidence-based process, in which lesser number of studies was a limitation. In the next stage, a panel of experts was formed, and then, modification of care was conducted based on Delphi technique. Meanwhile, we used a nominal group and formed a focus group.

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So, these two studies are not consistent with the present study. Therefore, nominal group was adopted in the present study. Albert, in her article, suggested evidence-based nursing care in cardiac failure patients.

Neonatal Intensive Care: Principles and Guidelines

She selected the studies conducted between and using an evidence-based pyramid. She defined the care providers and receivers, and recommended evaluation of the guidelines suggested to the wards.

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They firstly collected guidelines from 11 countries and separately investigated them with experts. Then, the primary tool was modified, and three guidelines from each country were selected and investigated by 70 other experts.

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Chen et al. In four clinical guidelines, the quality of applicability was less than the other sections, which is consistent with our study. Based on Chen et al. High number of questions in the second section of the questionnaire and high volume of clinical guideline in the third section were among the limitations of the present study, which led to delayed or no response of some experts.

As neonatal palliative care is a new issue in Iran, the researchers faced shortage of experienced and adequately knowledgeable experts to be selected in the panel of experts. Nurses need a clinical guideline to support the neonates and their parents concerning end-of-life palliative care. With regard to increasing importance of palliative care, the present clinical guideline can fill the existing gap in the context of neonatal palliative care. This article was derived from a master thesis of Zoafa A. Conflict of Interest: None declared. National Center for Biotechnology Information , U.

Iran J Nurs Midwifery Res. Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Ms. E-mail: ri. Received May 17; Accepted Oct This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Background: Clinical guidelines are important instruments for increasing the quality of clinical practice in the treatment team. Materials and Methods: This study was conducted with multistage comparative strategies with localization in Isfahan in Conclusions: The compilation of the guideline can play an effective role in provision of neonatal care in nursing.

Keywords: Clinical guideline, end-of-life care, neonatal intensive care unit, neonatal palliative care.

Table 1 Combination of key words used in systematic research. Open in a separate window. Table 2 Research database. Table 4 Grades of recommendations. Modified from American Academy of Pediatrics and Joint Committee on Infant Hearing, Year Position Statement: Principles and guidelines for early hearing detection and intervention programs, Pediatrics 4 , Arrangements for follow-up examinations should be made before discharge.

Current research indicates that the risk to visual development in preterm infants does not end when the risk for ROP has passed. The most common form of damage and the leading cause of chronic neurologic morbidity is periventricular white matter injury. A recent Cochrane review indicates that early intervention can improve cognitive outcomes up to preschool age. When immunizations have been declined by parents, this should be clearly indicated in the discharge summary, along with follow-up recommendations. For qualifying infants, RSV prophylaxis should be initiated with intramuscular palivizumab before discharge into the community setting during RSV season.

RSV infection prophylaxis should be coordinated with the follow-up pediatrician for subsequent monthly injections. Discharge of smaller infants results in the use of car seat restraint devices that were designed for 7- to 8-pound term infants. In these devices, preterm infants may experience oxygen desaturations and apnea and bradycardia caused by head slouching and airway obstruction.

Although this is a recommended practice, limitations have been identified. First, little objective evidence supports the ability of this challenge to absolutely confirm safe travel for an infant. VLBW children who have low weight gain in early years of life have a higher probability of cognitive deficits; conversely, those with excessive weight gain had a higher likelihood of obesity, cardiovascular disease, and diabetes.

For these infants, early evaluation of their functional neurologic status may facilitate referrals to early intervention services soon after discharge. Technology-Dependent Infants Infants who rely on long-term technologic support are being discharged home in increasing numbers. In the past, children who were ventilator dependent, who had tracheostomies, gastrostomies, or jejunostomies, and even those who required long-term intravenous IV access for medications or parenteral nutrition would remain hospitalized, separated from their families and susceptible to other morbidities associated with long hospital stays e.

With this increase of technology-dependent children discharged into the community comes a greater need for support services for the parents, providers, and the infants themselves. Carnevale et al described the experiences of 12 families with technology-dependent children at home. Rooming in with their infant for one or more nights is an important safety net to evaluate their abilities and confidence in caring for their child.

Communication and care coordination among the subspecialties following these infants are crucial. The following are the primary objectives of follow-up care:. Courtesy Angel Carter, Brian S.

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Carter, and Donna K.