Thanks to all of you, Advances in Neonatal Care is thriving! Our impact factor has been rising steadily over the past 5 years. We are quite pleased that our content is being noticed and cited in the neonatal world and beyond. Our readership both inside and outside neonatal nursing is also thriving, as is the growing number of manuscript submissions. Manuscripts are currently being authored by nurses, physicians, and other interdisciplinary collaborators who work together to optimize care for infants and their families in the neonatal intensive care unit (NICU). We are also seeing an increasing number of submissions from international authors. This increased participation is all good news; we are grateful to our readership and the National Association of Neonatal Nurses for their support. However, recently, we noticed that an increasing number of our submissions are coming to us without nurse authors. We had a spirited discussion in our Editorial Board meeting about how best to address this issue. Advances in Neonatal Care is the official journal of the National Association of Neonatal Nurses. As such, we believe it is the premiere journal for neonatal nursing. In addition, we believe Advances in Neonatal Care takes a unique and dynamic approach to the original research and clinical practice articles it publishes. Our focus is on addressing nursing practice issues and sharing research findings that will assist neonatal nurses caring for low birth-weight infants in level II and level III NICUs around the globe. The journal promotes evidence-based care and improved outcomes for the tiniest patients and their families. Our vision is that Advances in Neonatal Care is the FIRST place neonatal nurses and neonatal care providers go to for the best evidence to support caregiving of NICU infants and families. Thus, our guiding purpose for Advances in Neonatal Care is to provide content that supports a foundation and direction for neonatal nurses in Increased Awareness, Education/Professional Development, Setting the Standard of Care, and Leadership, as well as the basis for an interface to the greater Community that supports neonatal intensive care. To that end, our author guidelines have been updated and beginning in 2022 we will no longer accept manuscript submissions for review where there is not at least one nurse author. The nurse author could be from a variety of practice roles such as bedside nurse, clinical nurse specialist, neonatal nurse practitioner, or nurse researcher. Manuscripts already under review or in the revisions process will not be affected by this change in our editorial practice. We do realize this decision could decrease our submissions or could lead to some “tokenism” where a nurse author is included on the draft manuscript just for the sake of being able to submit to our journal. Tokenism occurs when an individual is included as author even when their role might not meet the true definition for authorship. According to COPE (Committee on Publication Ethics; https://publicationethics.org), authors of manuscripts must meet several criteria. Specifically, all authors must make substantial contributions to the work including conception or design of the work; or acquisition, analysis, or interpretation of data; as well as drafting the manuscript and critically reviewing the work before submission. This includes review and final approval of the manuscript submission by all authors. In short, all authors should be able to defend and answer questions about all aspects and sections of the manuscript with accuracy and integrity. We do ask all authors of manuscripts submitted to Advances in Neonatal Care to answer questions about authorship and conflict of interest during the submission process. While we don't yet publish how authors contribute as a note within the manuscript, some journals are beginning to include this information with the publication of an article. In summary, we believe that inclusion of a nurse as an author has the potential for many good outcomes. First and foremost, we believe this change in journal practices promotes neonatal nurses and our national association. It also promotes the importance of the role of neonatal nursing in optimizing outcomes for infants and families who must traverse the NICU. We already ask for nursing implications to be addressed in all manuscripts; this change in our editorial practices will strengthen the application of those nursing implications. Again, we thank you to our readership and for your submissions to Advances in Neonatal Care. Jacqueline M. McGrath, PhD, RN, FNAP, FAAN Co-Editor in Chief; Advances in Neonatal Care [email protected] Debra Brandon, PhD, RN, CNS, FAAN Co-Editor in Chief; Advances in Neonatal Care [email protected]
Healthy parent-infant interaction is crucial for the growth and development of the infant. Specifically, parental holding has substantial health benefits for both the infant and parent. Exploration of practices for parental holding related to common care, equipment, and procedures in neonatal intensive care units (NICUs). A survey was developed and distributed through the American Academy of Pediatrics (AAP) Section on Neonatal Perinatal Medicine (SoNPM) to physicians and advanced practice providers. Data were analyzed using descriptive statistics and thematic analysis. Peripherally inserted central catheters and conventional ventilators had the highest reports of allowing parental holding (86% and 41% reporting "always," respectively) and no reports of "never." Parental holding was infrequently permitted during therapeutic hypothermia, with chest tubes in place and receiving high-frequency ventilation (43%, 25%, and 20% reporting "never," respectively). In the free-text responses, a variety of factors were identified as barriers to parental holding, including equipment limitations, infant clinical instability, and unit culture and staffing. Despite the known benefits of parental holding, wide variability in NICU holding practices exists. Importantly, no medical intervention in this study was unanimously associated with restricting parental holding, suggesting that safe and feasible approaches to holding exist across clinical contexts. This highlights the critical need to document and disseminate these practices to inform and advance standards of care. The development of national standardized holding guidelines is a viable pathway forward to eliminate variability in individual perceived safety barriers and provide a pathway to improving family-centered care in the NICU.
The experience of having newborn admitted to the neonatal intensive care unit (NICU) is one that can be incredibly challenging for parents, particularly mothers. To assess the effectiveness of supportive nursing interventions defined as structured emotional support, informational counseling, and parent‑education sessions delivered by NICU nursing staff on anxiety, depression, and stress among mothers of NICU infants. We systematically reviewed 22 studies, encompassing 1877 participants, that reported on the effects of supportive nursing interventions for stress reduction among mothers with infants in NICU. Pooled standard mean differences (SMDs) were calculated using random-effects models. Heterogeneity was assessed using the Cochran Q statistic and I2 index. Subgroup analyses were conducted based on study design and type of intervention. Supportive nursing interventions produced a significant reduction in maternal NICU‑related stress (SMD = -1.285, 95% CI: -1.766 to -0.804; P < .001), indicating that mothers receiving these interventions experienced lower stress than controls. However, substantial heterogeneity was observed ( I2  = 95.2%), reflecting variations in intervention format, measurement scales, and clinical settings. Subgroup analyses indicated a larger effect in nonrandomized trials (SMD = -2.16) versus randomized controlled trials (SMD = -0.99), and educational support interventions produced greater stress reduction (SMD = -1.61) than other forms of support (SMD = -0.83). Supportive nursing interventions significantly reduce stress among mothers with infants in NICU. Tailored personalized support interventions, considering individual and cultural nuances, may further enhance the efficacy of these interventions. Future research should focus on identifying the most effective components of these interventions and ensuring their broader implementation in NICU settings.
Mothers with infants in intensive care face the challenge of adapting to an unfamiliar environment. They often experience fear for their babies' survival while hoping that both their needs and those of their infants will be met. This study aims to examine the effect of religious attitudes on the parenting beliefs of mothers whose newborns are receiving care in the neonatal intensive care unit (NICU). This cross-sectional and correlational study was conducted from May 2023 to March 2024. The study population consisted of 252 mothers whose babies were hospitalized in the NICU of a hospital in a province in northern Türkiye. A Sociodemographic Data Form, the Ok-Religious Attitude Scale (OK-RAS), and the NICU Parental Beliefs Scale (NICU-PBS) were used to collect the data. The mothers' mean scores were 33.37 ± 3.66 on the OK-RAS and 69.29 ± 2.99 on the NICU-PBS. A moderate positive correlation was found between the two scales ( r = .668, P < .05). This result indicates that higher maternal religious attitude scores are associated with higher NICU parental belief scores. The OK-RAS score had a significant positive effect on the NICU-PBS (β = .373, t = 4.362, P < .001). The results of this study reveal that religious attitudes significantly affect mothers' parenting beliefs. It is recommended that nurses adopt a holistic support approach when caring for newborns in the NICU, taking into account the religious and emotional needs of mothers.
The experiences of families in the intensive care unit can positively or negatively influence lactation. Mothers with infants in the neonatal intensive care unit should be provided with care that will increase the amount of human milk and duration of lactation. The aim of this study is to examine the effects of Lactation Management Model (LMM)-based care on maternal anxiety, human milk volume, breastfeeding duration, and exclusive breastfeeding among mothers of infants in the neonatal intensive care unit. It is a randomized controlled trial study. Prior to education, participants filled out an introductory form and informed consent form. The experiment group received care technique according to the LMM for 3 days. The content of the LMM includes skin-to-skin contact, warm compress application to the breast, relaxation, breast massage, and process monitoring. All mothers were followed up face-to-face by researchers for the first 3 days and then daily until the infant's discharge, by telephone follow-up at 1, 2, and 3 months after discharge. The anxiety level of the experiment group (39.8 ± 5.45) was found to be higher. Infant Milk Intake Assessment Form score at the first (8.15 ± 2.21), second (9.90 ± 0.38), and third months (9.68 ± 0.47) were higher in the experiment group. It was observed that the change in weight of infants in the experiment group at the first (3562.00 ± 669.70), second (4573.75 ± 520.35), and third months (5818.75 ± 534.30) was greater compared to the control group. Expanding care based on the LMM positively affects exclusive lactation and lactation rates.
Palliative care is underutilized in the neonatal intensive care unit (NICU). Many patients who qualify for palliative care in the NICU are not being referred. The project's purpose was to promote the integration of palliative care in the NICU by increasing the number of palliative care consultations through a diagnosis trigger list. The project director conducted a literature review and created and implemented a facility-specific diagnosis trigger list and educational module. Retrospective chart reviews were conducted from June 2023 through August 2023 to gather baseline data and from June 2024 through August 2024 to assess the project's impact. The Neonatal Palliative Care Questionnaire for Nurses (NPCQN) and the Neonatal Palliative Care Attitude Scale (NiPCAS) were administered to neonatal nurse practitioners at the facility by pre- and post-tests before and after receiving the module. The percentage of palliative care consultations placed improved from 4% to 13%. The NPCQN showed statistically significant improvement in knowledge with a P  < .001. The NiPCAS showed statistically significant improvement in attitude concerning 2 of 26 questions, with values of P = .016 and P = .047. The implementation of a neonatal palliative care trigger list can increase the number of consultations placed. A palliative care trigger list can be generalized to other populations.
Retinopathy of Prematurity (ROP) examination is a procedure associated with pain, discomfort, and physiological changes in premature newborns. Explore effects of exposure to different types of auditory stimulation during ROP examination on pain, comfort, and physiological parameters of premature infants. The study was conducted in the neonatal intensive care unit between January 2023 and June 2024. A stratified randomization method was used for sample selection, and a total of 75 premature infants participated. Intervention comparisons included a rain stick (n = 25), white noise (n = 25), and control (n = 25). The sound of a rain stick is often considered musical. Premature infants in the intervention groups were exposed to the rain stick or white noise 3 minutes before, during the entire ROP examination, and 3 minutes after. The infants in the control group underwent routine ROP examination and nursing care. Neonatal Pain Agitation and Sedation Scale and comfort scores were significant in the rain stick group than in the white noise and control groups before, during, and after the examination. In both the rain stick and white noise groups, mean SpO2 and peak heart rate differed significantly between during- and post-procedure measurements (P < .05). Musical stimulation, as a noninvasive and accessible intervention, can be used in neonatal intensive care unit care to reduce pain and enhance infant comfort. Neonatal nurses may safely integrate gentle auditory stimuli into routine care. Future studies should determine optimal music types, durations, and methods, and evaluate their long-term and cross-cultural effects to support standardized neonatal music therapy practices.
Preterm infants experience physiological instability and mothers often experience heightened anxiety in the neonatal intensive care unit (NICU), prompting growing interest in combining kangaroo mother care (KMC) with auditory interventions such as lullaby singing to enhance maternal-infant well-being. This study aimed to examine the added effect of maternal lullaby singing during KMC on maternal state anxiety and the physiological parameters of mothers and their preterm infants. This randomized controlled trial was conducted with 61 mother-preterm infant dyads in the NICU of a state hospital in southern Türkiye. Participants were allocated to either the KMC-only group (n = 31) or the KMC + lullaby group (n = 30). Maternal state anxiety was assessed at baseline and after the intervention period. Maternal and infant physiological parameters were monitored for 3 consecutive days. The study was registered at ClinicalTrials.gov (NCT06964204). Maternal state anxiety decreased significantly over time in the KMC + lullaby group compared with the KMC-only group (P < .05). Among infants, time-dependent significant differences were observed in respiratory rate and oxygen saturation. For mothers, significant between-group and time effects were found in heart rate, respiratory rate, and oxygen saturation (P < .05). Given their low cost and feasibility, incorporating lullaby singing into routine KMC may enhance both psychological and physiological outcomes for mothers and preterm infants. Integration of this combined approach into NICU care protocols is recommended, alongside further research to validate these additive effects.
Family-centered care (FCC) is a core approach in neonatal intensive care units (NICUs), yet culturally adapted measurement tools remain limited. This study evaluated the validity and reliability of the Family-Centered Care Scale for Neonatal Intensive Care Units (FCCS-NICU) in Iranian NICUs. A methodological study was conducted in 2025 across 11 NICUs in Shiraz, Iran. The adaptation process involved translation, back-translation, and pilot testing with 40 mothers. The final version of the scale was administered to 500 mothers. Content validity was examined using the Content Validity Index. Construct validity was assessed through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Reliability was evaluated using Cronbach alpha, item-total correlations, and test-retest reliability with intraclass correlation coefficients. EFA revealed a four-factor structure-dignity and respect, information sharing, participation in care, and family collaboration-explaining 68.34% of the total variance. CFA confirmed this structure, with all path coefficients statistically significant (P < 0.05). Internal consistency was excellent (Cronbach alpha = 0.865-0.933 for subscales; 0.941 overall). Test-retest reliability showed high stability (99.6%), and item-total correlations ranged from 0.215 to 0.802, indicating strong reliability. The consistency between EFA and CFA further supported the robustness of the factor structure. The validated FCC-NICU scale provides healthcare professionals with a reliable and practical tool to measure FCC in Iranian NICUs. Its application can guide strategies to enhance family involvement, strengthen collaboration between families and providers, and improve overall satisfaction with neonatal care.
Failure to meet cue-based feeding and delay in developing oral feeding skills may cause long-term problems for premature infants. The aim of this study was to determine the effects of oropharyngeal colostrum administration to premature infants on readiness for oral feeding and the transition time to full oral feeding. A randomized controlled trial comprised 60 premature neonates, aged 26 0 to 33 6/7 weeks of gestation, divided into oral colostrum (OC) n =30 and control groups (n = 30). The OC group received 0.2 mL of maternal colostrum while the control group did not. Both groups received routine care. The infants' feeding skills measured by the Early Feeding Skills Assessment Tool (EFS-Turkish) and the transition time to oral feeding were evaluated for 7 days. The groups were similar in terms of demographic and clinical characteristics. While there was no significant difference between the groups in the mean EFS-Turkish scores before the intervention, the mean scores of the OC group after the intervention were found to be significantly higher than those of the control group ( P < .001). OC administration, in addition to time (90.2%), explained 20% of the variation between the mean EFS-Turkish score measurements. When the difference between the total weight gains of the groups before the intervention and on the seventh day was compared, the OC group gained significantly more weight than the control group ( P = .022). OC administration may be an effective non-pharmacological method that can positively contribute to the development of early feeding skills of premature infants.
Unfinished Nursing Care (UNC) in Neonatal Intensive Care Units (NICUs) is a critical determinant of infant outcomes. The Neonatal Extent of Work Rationing Instrument (NEWRI) measures the frequency of UNC but not the underlying reasons. Integrating the NEWRI with the UNC Survey (UNCS) to capture these reasons may help prevent or mitigate UNC. To develop and validate a comprehensive tool for investigating UNC and related reasons in NICUs. A developmental and validation study was conducted in 2024 following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Part A of the NEWRI and Part B of the UNCS were integrated to develop the Italian version of the NEWRI with Reasons (NEWRI_IR). Nurses from 8 Italian NICUs (N = 342) were invited to participate. Descriptive and inferential analyses, Mokken Scale Analysis, and Confirmatory Factor Analyses were conducted. A total of 198 nurses (57.9%) participated. The NEWRI_IR comprises 2 sections: Part A (25 items, care interventions) and Part B (15 items, reasons). Part A demonstrates strong scalability (H = 0.743), indicating a hierarchical structure among items. Part B revealed a 5-factor structure: "Human resources and workflow predictability," "Communication issues," "Material resources," "Priority setting," and "Human resources issues." The most frequent UNC involved parental education and support, whereas inadequate nurse staffing and frequent interruptions were main reasons. The NEWRI_IR is a psychometrically validated instrument for assessing the frequency and reasons for UNC in NICUs, supporting monitoring of care quality and guiding organizational interventions.
Rates of bronchopulmonary dysplasia (BPD) continue to increase despite advances in healthcare. Various methods of delivering continuous positive airway pressure (CPAP) can be contributing factors that increase the risk of developing BPD. A recent increase in BPD rates at a local neonatal intensive care unit (NICU) prompted further investigation into potential preventative practices. The project's goal was to reduce rates of BPD in the NICU by 20% after transitioning to FlexiTrunk CPAP, as well as through education to increase nursing confidence, which will improve compliance with FlexiTrunk CPAP usage. A level IV NICU was targeted, including 242 infants on whom CPAP was being utilized. Interventions during the implementation of FlexiTrunk CPAP included staff education from the new device's representatives, posters displayed during a skills symposium, PowerPoint slides, and real-time education using algorithms. Nursing confidence levels, compliance rates on device usage, and BPD rates were assessed before and after the implementation of FlexiTrunk CPAP. After implementing FlexiTrunk CPAP, compliance with device usage in the level IV NICU improved to over 93% as nurse confidence improved. However, BPD rates remained the same during the study period in 2024. Education and enhanced understanding regarding transition to FlexiTrunk CPAP are crucial to its successful implementation and maintenance. Increasing and providing various methods of educating staff is also key to successful quality improvement initiatives. Further time and research are necessary to evaluate preventative strategies and outcomes for infants with BPD who are in or discharged from the NICU.
Neonates in the neonatal intensive care unit (NICU) frequently require medical adhesives for device fixation; yet, their immature skin makes them vulnerable to medical adhesive-related skin injuries (MARSIs). Research on the incidence of MARSI and clinical risk factors in this population remains limited. To investigate the incidence, characteristics, and clinical risk factors of MARSIs in neonates admitted to the NICU. A prospective observational study was conducted in a university hospital NICU, including 129 admitted neonates. The overall skin condition was evaluated using the neonatal skin condition scale, whereas the severity of MARSI was assessed using the Three-Item Severity score. The incidence, severity, and common sites of skin injuries were also investigated, and a logistic regression analysis was performed to identify the risk factors for such injuries. MARSIs occurred in 51.9% of neonates. The most affected site was the head and face region (60.3%), and gastric and endotracheal tube fixations were the leading causes. Among all cases, 18.1%, 75%, and 6.9% were mild, moderate, and severe, respectively. Total parenteral nutrition (TPN) was identified as an independent risk factor for MARSI (OR = 4.279; P = .020). The most common causes of MARSI were gastric and endotracheal tube fixation, and the use of TPN was identified as a significant risk factor. Nursing strategies to reduce MARSIs should be prioritized in infants receiving TPN and requiring fixation in the head and face areas.
Peripherally inserted central catheters (PICCs) have become universal in the care of neonatal patients. The use of an infant's length, weight, or post-menstrual age (PMA) may be an alternative method for measuring the depth of a PICC. The purpose of this study was to explore the relationships among neonatal length, weight, PMA, and PICC depth. Inpatient neonates admitted to a Nationwide Children's Hospital's Newborn Intensive Care Unit requiring placement of PICC were enrolled between January 2022 and April 2024. Standard PICC procedures were maintained. The research group corroborated appropriate PICC tip position of enrolled infants. Multivariable linear regression with robust standard errors was used to evaluate linear relationships between PICC insertion depth and current weight, current length, and PICC insertion site. Birth demographics of enrolled infants had gestational ages of 22 to 41 weeks, weights of 450to 4160 g, and lengths of 25.5 to 54.6 cm. Of the 182 infants enrolled, 72 underwent antecubital, 71 ankle, and 39 knee insertions. Three models were analyzed: current length, current weight, and PMA, demonstrating a significant association with PICC depth (P < .0001). Infant length proved to be the strongest predictor of PICC depth. This investigation provides an alternative method of measurement for estimating centimeter length of neonatal PICC depth. Further examination into the data by stratifying an infant's weight and length and/or gestational age may prove to be a more appropriate prediction model.
Kangaroo mother care (KMC) is an effective care practice for preterm infants, based on early and continuous skin-to-skin contact between mother and newborn, with benefits on physiological stability, reduction of mortality, and promotion of lactation. However, the optimal timing for early initiation of KMC is still under investigation. To explore the clinical and organizational implications of early initiation of KMC in preterm infants, with particular attention to the timing of initiation. Systematic review conducted in April 2025 on Medline (PubMed) and Cochrane Library. Studies published since 2016 in Italian or English were included. Articles prior to 2016, reviews and irrelevant studies were excluded. Four studies were selected for the final analysis. Two independent reviewers selected and analyzed the studies, extracting data on clinical context, timing of initiation, and main outcomes. Early KMC, started within 24 hours of birth in preterm or low birth-weight infants, promotes greater physiological stability; reduces mortality by up to 25%; and improves breastfeeding, growth, and neurodevelopment. Ultra-early initiation (within 1.3 hours) is effective even in newborns with moderate clinical instability. The nurse plays a central role in the promotion and management of early KMC. The integration of early KMC into routine care requires specific training, organizational support, and active involvement of families. Further studies are needed to consolidate the evidence and define universal protocols.
Pain management in newborns is important. White noise holds potential advantages as a safe, inexpensive, and easily implemented nonpharmacological intervention for alleviating pain during invasive procedures in newborns. This systematic review and meta-analysis critically examined the effects of white noise intervention on pain during invasive procedures in newborns, providing a reference for guiding clinical practice. Six electronic databases were systematically searched for relevant studies published up to 25 July 2025. Randomized controlled trials involving the effects of white noise intervention on invasive pain in newborns were enrolled. Two reviewers independently extracted data, assessed risk of bias, and performed statistical analysis using Rev Man software. Thirteen randomized controlled trials were conducted, involving a total of 721 participants. The results indicated that white noise significantly reduced pain scores during and after invasive procedures. It also helped stabilize heart rate and oxygen saturation levels in newborns during and after these procedures. Furthermore, white noise was found to be effective in decreasing crying time after invasive procedures and improving comfort in newborns. Our results indicate that white noise may have potential advantages in alleviating pain associated with invasive neonatal procedures. Furthermore, due to the limited number of studies, our confidence in interpreting the results regarding neonatal comfort levels is reduced. We therefore recommend that future studies conduct larger, multi-center studies to enrich the experimental findings.
Congenital hyperextension of the knee joint is a rare malformation with a variety of names, principally genu recurvatum of knee, backward bending of the knee, and dislocation of knee. Abnormal anterior hyperextension position and limitation of flexion of tibiofemoral joint are the classical clinical presentation in an infant at birth. The accurate etiology of the malformation is undetermined. Congenital genu recurvatum (CGR) can occur as an isolated entity or can present in association with other congenital abnormalities like talipes equinovarus, developmental dysplasia of the hip, hindfoot, and forefoot abnormalities. Two baby girls were born in our institution with abnormal position of the knees that one of them was isolated and the other associated with developmental dysplasia of hip. Based on clinical presentation and X-ray findings, diagnosis of CGR was proved for them. They were treated with early gentle manipulation, serial casting, and splinting at the first days of birth. Postnatal management of the CGR is conservative. Surgical treatment is the last option. Newborns with CGR should be evaluated to determine the cause and plan treatment. Symptoms include pain, joint instability, limb length difference, and cosmetic concerns. A full physical examination with bilateral comparison is essential. Radiology helps measure recurvatum in terms of bone and ligament involvement. Knowing the cause guides proper treatment.
Kangaroo care (KC) is considered to be an effective intervention in establishing circadian rhythms and human milk hormone profiles in premature infants. This study protocol has 2 main objectives: to assess the effects of regular KC on circadian rhythm, growth, and physiological parameters in premature infants, and to evaluate human milk cortisol and melatonin levels as secondary outcomes. This trial is a parallel-group, single-blind, randomized controlled experimental study. Sample of the study will consist of 56 premature infants. The experimental group (n = 28) will receive KC for 1 hour, twice daily, during designated day and night intervals over 3 consecutive days. The control group (n = 28) will receive routine incubator/cot care. The daytime and nighttime circadian rhythms of both groups will be monitored. Human milk samples will be collected from both groups to determine cortisol and melatonin levels in human milk. Protocol results are expected to advance knowledge by providing the first integrated assessment of circadian rhythm development in neonatal intensive care unit infants using noninvasive neurophysiological measures and human milk cortisol and melatonin. By linking these indicators to KC and assessing growth and physiological stability, the study will provide evidence on whether KC supports circadian rhythm maturation. Research will guide clinicians in evaluating the effects of kangaroo care administered during daytime and nighttime intervals for 3 consecutive days on circadian rhythm, growth, physiological parameters, and human milk cortisol and melatonin levels, while also providing a foundation for future research.
Current neonatal resuscitation program standards recommend the use of real-time documentation completed by a designated scribe. Accurate documentation of resuscitation interventions after delivery is an important component of future care for the newborn. The purpose of this article was to review current practices in the documentation of neonatal resuscitation practices, how technology is currently used in this setting, and to discuss interventions for increasing accuracy and completion of documentation moving forward. A narrative literature review was performed with studies found on CINAHL, Scopus, and PubMed databases. The literature was reviewed for current documentation practices in the delivery room across different hospitals. Other studies assessing accuracy and technologic interventions for increasing accuracy were also included. Documentation differs immensely across institutions. Without the use of real-time recording, it is inaccurate, especially in providing a timeline of interventions. Real-time recording was the most accurate and can be technology supported through an app or video recording the resuscitation. Few studies exist assessing current practices across institutions for documenting neonatal resuscitations and how standardizing practices can improve care of neonates. Further research on this topic and potential interventions for practice improvement should be completed. Interventions such as tablet applications or video recordings, with or without the use of artificial intelligence, have been shown to improve documentation practices. Real-time recording should be prioritized in the delivery room setting aided by a designated recorder, video recording of the resuscitation, and a computer or tablet application.
Preterm infants (PTIs) are exposed to tremendous stressors within the neonatal intensive care unit (NICU), an environment that is supposed to be nurturing rather than disruptive. Toxic stress has yet to be defined as a concept relevant to premature and older infants. The lack of buffering support (a mother or another meaningful adult who provides physical/emotional support to minimize stressful events and promote resilience) triggers adverse childhood experiences leading to unfavorable-neurodevelopmental consequences. This article aims to clarify the concept of toxic stress in premature infants and infants younger than 2 years old. Walker and Avant's approach is the Wilsonian method, which is a systematic approach for clarifying and presenting a concept. The analysis focuses on infants aged 0 to 24 months in the NICU setting. Using the keywords related to toxic stress' physiologic and behavioral responses, databases including PubMed, CINAHL, and Google Scholar were searched to explore the toxic stress concept. Analysis of 33 English articles published in the last 20 years yielded an enhanced definition and empirical referents of toxic stress. The defining attributes, antecedents, consequences, and exemplar cases of the proposed concept were discussed. Clinical concerns are the uncommon use of the toxic stress concept in the NICU and the lack of physiologic and behavioral toxic stress assessment during routine care. Interventional studies are needed to test strategies to minimize/eliminate toxic stress and modify NICU practices. Mitigating the negative impacts of toxic stress often relies on high-quality nursing assessment and family-integrated care models incorporation.