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2017-03-31
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HotTopics inNeonatalNursingMATSERIKSSON,SPECIALISTNURSE,PROFESSOR
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Disclosure
Researchfunding:Lillabarnetsfond,RFR
Employer:ÖrebroUniversity
Consulting:AbbVie
Officeinprofessional organisations:Treasures&webmasterSwedishPaediatric PainSociety
Courtesy of some pictures:Marsha Campbell-Yeo,KJSAnand,RicardoCarbajal
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Who isMatsEriksson?Neonatalnursefor33years(staffnurse,headnurse,IT-nurse,night-nurse…)StillworkingclinicallyPhD2004AssociateProfessor2011Professor2016– nursingsciencewithspecialfocusonpaediatricnursing
FAMN- Thechild,thefamily,thecaring system,thesociety
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What are we goingtotalkabout?Where are thenurses?Controversies andchallengesNetworking
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Where are thenurses?OpeningceremonyatEuropeanAcademyofPaediatricSocieties20166distinguishedspeakers
=6whitemalemiddle-agedphysicians
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What does anurse looklike?
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StereotypesinnewSwedishTV-show
Wants tobeaphysician
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What does aNICU-nurse looklike?
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Andthen comes thedoctor
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Fromhierarchytoteamwork– arewethereyet?
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Isnursing only anurses’concern?
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Development of neonatalintensivecare
WorldExhibition Buffalo1901
19831990N
IDCAP
2000KangarooMother Care
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We know breastfeeding issuperior– yet itisdecreasing
Ericsonetal.2016
n=29.445
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Aturn towards partialbreastfeeding
Ericsonetal.2016
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Controversy #1KFC– KangarooFather Carevs.breastfeeding
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Isthere aprice topay forequality?
Infantswhose fathers did nottakepaternity leave during theinfant’s firstyear were significantly lesslikely tobebreastfed at2(p<0.001),4(p<0.001),and6months (p<0.001)
/Flacking etal.2010
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Controversy #2Singlepatient/familyroomsvs.breastfeeding
Lactation roomFamily roomOpen bay NICUdesign
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18month follow-up
Kangarooandmaternal care predicted better Bayley Cognitive andLanguage scoresInfantswith ≥1symptomof autismwere more likely tobeintheopen-bay low maternalinvolvement group vstheSFRhigh maternal involvement group
High maternal involvement isassociated with improved 18-monthneurodevelopmental outcome,especially ininfantscared forinaSFR-NICU
/Lesteretal.2016
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Controversy #3Earlyhome-going/homecarevs.breastfeeding
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Controversy #4Fortification of breastmilk vs.breastfeeding
Focusonquality of milkratherthan quality of contact
AlanLucas
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Isfocusing (too much?)onnutrtional content thereason?
Ericsonetal.2016
n=29.445
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Samepainexperience asadults?
Goksan eLife 2015;4:e06356
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PainfulproceduresinneonatesadmittedtoNICUs
*during the first 14 days of admission (Epippain Region of Paris)Carbajal et al, JAMA 2008;300:60-70
N 4 9 23 28 32 23 40 39 29 20 25 28 11 30 22 22 23 21 1 430
Num
ber o
f pai
nful
pro
cedu
res
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Why ispainassessment sohardtoimplement?
Gradin2010
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EUROPAIN:Painassessment inneonates inthetrachealventilationgroup
27
56,9
84,2
22,3
92,7
48
22,9
94,2
0
0
85,5
10,3
13,8
90,3
5,8
70,6
0
43,2
63,6
58,5
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
UK(n=713)
Sweden(n=38)
Spain(n=202)
Portugal(n=55)
Poland(n=50)
Norway(n=35)
Netherlands(n=69)
Malta(n=5)
Lithuania(n=23)
Italy(n=131)
Greece(n=126)
Germany(n=29)
France(n=493)
Finland(n=52)
Estonia(n=17)
Cyprus(n=41)
Belgium(n=37)
Austria(n=22)
TOTAL(n=2138)
PainassessmentNopainassessment
Carbajal2015
EUROPAIN:Painassessment tools
EDIN 42.3%
COMFORT-B 14.7%
N-PASS 9.8%
COMFPRT 7.5%
PIPP 4.9%
NIPS 4.0%
PAT 3.6%
CRIES 1.6%
Others <1%
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Finding theobjective painometer –are we searching fortheHoly Graal?
HeartRateVariability– HRVGalvanc SkinResponse/SkinConductance– GSRCerebralhaemodynamics – NearInfraredSpectrocscopy –NIRSCryacoustics– SoundspectrogramComputerisedfacialmovementsNewandimprovedassessmentscales
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118 days in the NICU
1152 procedures
528 hours of fentanyl exposure
852 exposures to 24% sucrose
2 general anesthesia
1960 hours of extreme lighting
2296 hours of excessive noise
2346 hours of maternal separation
JACK, 24 W GA WAS EXPOSED TO:
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Prolonged Maternal Separation
Less mature motor development Reynold 2013
Poorer ability to regulate stress Vinall 2013
Higher reactivity Jahromi 2004
Higher mortality Ray 2012
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Skin-to-skin care for procedural pain in neonates
Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R
January 2014
36 Reviewed
19 Included Studies
1544 Infants
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Skin-to-skincontact forpainrelief
-2
0
2
4
6
8
10
Glucose Tourniqe Disinfection Skinpunctionorsham
Standardcare:Sham
Incubator:Skinpunction
Skin-to-skin:Sham
Skin-to-skin:Skinpunction
Olssonetal.2015
NearInfraredSpectroscopy–changes inHbO2onthecontralateralside
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Ismother bestforSSC-painrelief?
Johnston,2012
Johnston,2011
Premature InfantPainProfile
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www.pearl.direct0" 50" 100" 150" 200"
Standard Care- Heelstick!
Cobedding - Heelstick!
TIME TO RECOVERY
** P<.001 95% CI 25.6 to 103.4
Skin-to-skinw.siblings
Campbell-Yeo 2012
0.36%0.28%
0.43%0.5%
0%
0.1%
0.2%
0.3%
0.4%
0.5%
0.6%
Pre! Post!
Co-bedding Standard
Pre
Post
Sal
ivar
y C
ortis
ol u
g/dl
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0
20
40
60
80
100
120
Heel prick Venepuncture
GlucoseNo glucose
Cryi
ng t
ime,
sec
Eriksson 1999
Alwaysusesweetsolution
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Carbajal 1999
Succrose orglucose?
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Redefining PCA>Parent ControlledAnalgesia
Parents asprimary caregivers –including painmanagementCommunicationinstead of distraction
Photo:Ann
-CathrineBe
rg
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Infant-directed
lullaby
singing
aspainrelief
Ullsten etal.2016
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Parentsroleinpainmanagement- accordingtoparents
NoneBeinformed
Bepresent
Providecomfort
InformantforNICUstaff
Activedecisionmaker
Advocateforinfant
Figure1.RolesparentshavedescribedthemselvesininfantpaincareintheNICU(Francketal.2012).
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Parentsroleinpainmanagement- accordingtonurses
Axelinetal.2015
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Figure 2
Current Biology DOI: (10.1016/j.cub.2017.02.036)
Touching isgoodEvent-related potentials(ERP)
Premature infantshave weaker response tolight touchthan full-term
But if they have had ”supportive touch”-skin-to-skin-careandbreastfeeding they responded more likethefull-terminfants
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Controversy #5
IsSkin-to-Skincontact /KangarooMother Carealwayspositive?
WHO guidelines
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Anderzen-Carlsson2015
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Societiesandnetworks
28thAnnual MeetingJune6-92017,Lisbon,Portugal
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Societiesandnetworks
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EFCNI– strongvoiceof parents
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WorldPrematurityDayNov.17
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Building asix-language web-site
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ForParents
Our Research
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Take home message:Tobeing aneonatalnurse istobeing anequal partofamultiprofessional teamParents are theprimary caregiversDoresearch– readresearch– useresearch
