A System-Wide Approach to Prevention of In-Hospital Newborn Falls.

Background: The Centers for Disease Control and Prevention lists accidents (unintentional injuries) as the fifth leading cause of infant mortality. Data analysis from a multihospital system of inpatient family birth centers revealed fluctuations in newborn birth admission falls rates at times above the benchmark reported in the literature.

Purpose: We describe a multipronged approach to address an identified safety concern.

Using Dextrose (Glucose) Gel to Reverse Neonatal Hypoglycemia.

Hospitals are challenged to implement measures to improve health outcomes, decrease costly interventions, and increase patient satisfaction. By following a nurse-driven protocol, our institution has successfully met these three challenges in our treatment of newborns diagnosed with neonatal hypoglycemia (NH). Based on results of a randomized clinical trial, a multidisciplinary team trialed glucose gel as a standard treatment for NH.

Postpartum Mood Disorders Screening in the NICU.

Maternal depression is increasingly recognized as the leading complication of childbearing. A mother's mental health impacts the well-being and long-term outcomes of her children. This column will discuss a systematic approach to screening for maternal postpartum mood disorders (PPMDs) and referring women to resources according to an established algorithm.

Neonatal Pressure Ulcer Prevention.

The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic, physiologic, and developmental factors place ill and preterm newborns at risk for skin breakdown. Two case studies illustrate these factors, and best practices for pressure ulcer prevention are described.

Telemedicine for neonatal resuscitation.

Maintaining high levels of readiness for neonatal resuscitation in low-risk maternity settings is challenging. The neonatal resuscitation program (NRP) algorithm is a community standard in the United States; yet training is biannual, and exposure to enough critical events to be proficient at timely implementation of the algorithm and the advanced procedures is rare. Evidence supports hands-free leadership to help prevent task saturation and communication to promote patient safety.

Delayed cord clamping: a collaborative practice to improve outcomes.

Delayed cord clamping is a collaboration between the obstetric team and the neonatal team. Although the optimal timing for clamping the umbilical cord after birth continues to be subject to study, delaying clamping for at least 30-60 seconds, with the newborn held at or below the level of the uterus/placenta supports normal physiology and has proven benefits. Practical issues such as thermoregulation and equipment can be overcome with team collaboration and prebriefing planning.

Subcutaneous fat necrosis: a complication of neuroprotective cooling.

Because neuroprotective cooling for hypoxic ischemic encephalopathy (HIE ) becomes more commonplace in NICU s, health care providers should be familiar with the complications of this therapy. Therapeutic cooling improves neurodevelopmental outcomes and has relatively few side effects. One unexpected outcome that has been reported is subcutaneous fat necrosis (SCFN).

The role of magnesium sulfate in the prevention of cerebral palsy.

Magnesium sulfate (MgSO4) has been widely used in the perinatal arena for many decades. It has been used for tocolysis in the U.S.

Is your nursery full of MDROs?

Multidrug-resistant organisms (MDROs) or multiresistant organisms are a significant and growing concern to all of us. Late-onset methicillin-resistant Staphylococcus aureus (MRSA) infections in the NICU are reported to have increased by 308 percent from 1995 to 2004.1 The Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Advisory Committee considers the prevention and control of MDROs a national priority, one that requires administrative and scientific leadership.