Program - Unifying Neonatal Nurses Globally

Transcription

THE COUNCIL OF INTERNATIONAL NEONATAL NURSES:
8TH INTERNATIONAL NEONATAL NURSING CONFERENCE 2013
NEW KNOWLEDGE,
NEW CARE
FINAL
PROGRAMME
AND BOOK OF
ABSTRACTS
5th - 8th September, 2013 • The Waterfront, Belfast, Northern Ireland, UK
THE COUNCIL OF
INTERNATIONAL
NEONATAL NURSES:
8TH INTERNATIONAL
NEONATAL NURSING
CONFERENCE 2013
The Waterfront, Belfast,
Northern Ireland, UK
5th - 8th September, 2013
www.coinn2013.com
Contents
Welcome Letter...................................................................................................................................................................... 2
Committee................................................................................................................................................................................. 3
Acknowledgements............................................................................................................................................................ 4
Conference Information................................................................................................................................................... 5
Venue Floorplan..................................................................................................................................................................... 9
Information for Oral Presenters...............................................................................................................................12
Information for Poster Presenters..........................................................................................................................13
Subsidiary Meetings........................................................................................................................................................14
Biographies: Invited Speakers..................................................................................................................................15
Pre-Conference Workshops........................................................................................................................................24
Programme at a Glance................................................................................................................................................27
Scientific Programme
Friday, 6 September 2013......................................................................................................................31
Saturday, 7 September 2013................................................................................................................40
Sunday, 8 September 2013...................................................................................................................47
Abstracts: Free Paper Presentations....................................................................................................................50
Abstracts: Posters..........................................................................................................................................................103
Exhibition Floorplan.......................................................................................................................................................145
Alphabetical List of Exhibitors and Sponsors..............................................................................................146
Directory of Exhibitors and Sponsors...............................................................................................................147
Delegate List......................................................................................................................................................................153
Notes.......................................................................................................................................................................................161
www.coinn2013.com1
Welcome
On behalf of the organising committee we welcome you to the 8th International
Neonatal Nursing Conference Belfast 2013. The conference is auspiced by the Council
of International Neonatal Nurses; with a mission to promote excellence in neonatal
nursing and health outcomes for infants and families and to act as an international
leader in the development and revision of professional standards of neonatal nursing.
Delegates are coming from all over the world to share their knowledge and expertise.
The Programme promises an exciting blend of clinical, research, management and
education topics. The pre-conference workshops offer opportunities to learn new skills,
understand the science behind new ways of delivering care, and enhance the quality of
the evidence base of the care you deliver.
As well as the pre-conference workshops, keynote and plenary sessions, we have
Poster Walks scheduled in the Programme and we encourage you to take the
opportunity to discuss with authors and presenters.
You can already see for yourselves what Belfast has to offer. Whether you are interested
in culture, eating out, touring the countryside or sport of all kinds, we have it all here.
The Visit Belfast team will do everything they can to ensure you have an enjoyable time
and get the most out of your stay.
We are so glad you have chosen to come and contribute to the theme of New Knowledge:
New Care and we know there’s plenty of craic to follow in these next few days.
Linda Johnston
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Tina Pollard
5 – 8 September, 2013
Committee
Professor Linda Johnston
COINN 2013 Conference Chair
Head of the School of Nursing and
Midwifery, Queens University Belfast,
United Kingdom
Ms Tina Pollard
COINN 2013 Co-Convener
Chair, Neonatal Nurses Association,
United Kingdom
Dr Margo Anne Pritchard
COINN 2013 Scientific
Programme Chair
Perinatal Research, Women’s and Newborn
Services, Royal Brisbane Women’s Hospital
and The University of Queensland Centre for
Clinical Research, Australia
Ms Agnes van den Hoogen
COINN 2013 Scientific Programme
Co-Chair
Research, Wilhelmina’s Children
Hospital, Utrecht, The Netherlands
Ms Sharon Nurse
COINN 2013 Social Programme Chair
Senior Teaching Fellow, Midwifery
& Neonatology, School of Nursing &
Midwifery, Queens University Belfast,
United Kingdom
Dr Karen New
COINN 2013 Committee
President of COINN, Nurse Researcher
and Clinical Nurse, Royal Brisbane &
Women’s Hospital, Brisbane, Australia
Dr Breidge Boyle
The Institute of Nursing and Health
Research, Ulster, United Kingdom
Dr Merryl Harvey
Senior Academic, Department of Child
Health, School of Nursing & Women’s
Health, Birmingham, United Kingdom
Ms Madge E Buus-Frank
Neonatal Nurse Practitioner,
The Children’s Hospital at Dartmouth,
New Hampshire, Canada
Dr David G Sweet
Regional Neonatal Unit, Royal Maternity
Hospital, Belfast, United Kingdom
Ms Philomena Farrell
Senior Midwife Manager, Belfast Trust,
Belfast, United Kingdom
www.coinn2013.com3
Acknowledgements
The 8th International Neonatal Nursing Conference 2013 kindly acknowledges
the generous support from the following companies:
SILVER SPONSOR
EXHIBITORS
european foundation for
the care of newborn infants
BREAKFAST SATELLITE SYMPOSIUM – Friday 6th September
Sponsored Free Paper Presentation Award
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Conference Information
Dates
The 8th International Neonatal Nursing Conference 2013 takes place from
Thursday, 5 September 2013 to Sunday, 8 September 2013
Venue
Belfast Waterfront
2 Lanyon Place
Belfast, County Antrim BT1 3WH
Tel: 028 9033 4400
www.waterfront.co.uk
Important Times:
Registration
The on-site registration desk will be located in the foyer of the Belfast Waterfront and will remain open during
the following hours:
Thursday, 5 September 2013
17:30 – 20:00
Friday, 6 September 2013
07:00 – 17:10
Saturday, 7 September 2013 07:00 – 16:10
Sunday, 8 September 2013
08:30 – 12:40
Speaker Preview Room
Located in the Canberra Room, the opening times are as follows:
07:00 – 16:00
Saturday, 7 September 2013 07:00 – 16:00
08:30 – 11:30
Exhibition & Poster Viewing
The poster viewing area is located in Bar Level 1. Exhibition & Catering on Gallery Level 1 & 2.
The official opening hours are as follows:
Thursday 5 September 2013: 18.30 – 20.00 (Exhibition only for welcome reception)
Friday, 6 September 2013: 10:30 – 15.10
Saturday, 7 September 2013: 09:30 – 15.00
Sunday, 8 September 2013: 11:00 – 12.40
*Please remove your poster by 11:30 hours (end of last coffee break) at the latest on Sunday, 8 September, 2013.
Evaluation & Certificates of Attendance
Delegates are asked to fill in the Conference evaluation form onsite and once this is completed, to give this to
the staff behind the registration desk, who will print their Certificate of Attendance.
www.coinn2013.com5
Badges
Please wear your registration badge at all times. All participants are required to wear identification badges when
attending sessions and when entering the exhibition. If you lose your badge, please go to the registration desk
where a new badge will be made for you.
Language
The official language of the Conference is English.
Liability & Insurance
The organisers are not able to take any responsibility whatsoever for injury or damage involving persons and
property during the Conference. Delegates are advised to take out their own personal insurance to cover travel,
accommodation, cancellation and personal effects.
Lunches and Refreshments
Coffee, tea and lunch will be served during the official breaks within the Exhibition & Catering area on
Gallery Level 1 & 2.
Mail/Messages/Medical Assistance/Lost & Found
Please go to the COINN 2013 Conference registration desk.
Mobile Phones
As a courtesy to speakers and other participants, all mobile phones and pagers must be silenced before
entering the scientific sessions.
Posters
Please refer to the full instructions on page 13.
You may set up your poster from 07:00 hours on Friday 6 September, 2013. Your poster will be on display
from 10:30 (the first coffee break) on Friday 6 September until 11:30 hours (end of last coffee break) on
Sunday, 8 September 2013.
All poster presenters should please ensure that they mount their poster by the correct poster number and be
present to deliver a 2 minute presentation about their poster during their designated Poster Walk. Poster presenters
should refer to the list of poster presentations included in this final programme for their board numbers.
Delegates are encouraged to view the posters during the official tea/coffee and lunch breaks.
Please note that the Organising Committee, The Belfast Waterfront or Kenes UK will not be responsible for any
posters that are not removed by 11:30 hours (end of last coffee break) at the latest on Sunday 8 September, 2013.
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Poster Walks
Every abstract accepted for Poster Display is accompanied by a slot during a lunchtime Poster Walk and presenting
authors will to deliver a 2 minute presentation with 1 minute to answer questions. The Chairs will be strict on time
keeping, so please adhere to this.
Friday 6th September 2013: 12:40 – 13:20hrs
• 01-09: Clinical Issues: Acute
• 10-21: Retrieval & Transport Stabilisation, APN & Workplace Management
• 22-29: Global Health Issues and Health & Developmental Outcomes
Saturday 7th September 2013: 12:20 – 13:00hrs
• 30-40: Fathers, Parenting & Developmental Care, Palliative Care and Bereavement
• 41-53: Quality, Infection & Pain and Education
• 54-61: Feeding & GIT Issues
Prizes
The Council of International Neonatal Nurses (COINN) and Save the Children’s Saving Newborn Lives
Programme are recognizing and encouraging excellence in neonatal nursing by presenting the second
International Neonatal Nursing Excellence Awards to nurses working in newborn care in low-resource settings.
Two winners and one runner up have been selected among nominations from across the world to receive this
year’s recognition, for their commitment to working on the frontlines of newborn care in resource-challenged
countries, where the majority of newborn deaths occur. These extraordinary nurses fully embrace the mission to
help newborns survive the most dangerous moments of life, while cultivating an environment of support, trust
and competency among health workers and families alike.
This year’s winners and runner up will be honoured during the prize-giving at the Conference from 10:10-10:30
on Friday, 6 September 2013 in the Auditorium.
Elsevier have kindly supported the award for the best Free Paper Presentation at the Conference. All free paper
oral presenters will be automatically entered for the best Free Paper Presentation award of £200. The winning
abstracts will also be published in the official journal of the Neonatal Nurses Association. Winners will be
announced at the closing of the Conference at 12:10 on Sunday, 8 September 2013 in the Auditorium.
Speakers, Chairpersons & Free Paper presenters
Please refer to the full instructions on page 12.
All Speakers must visit the Speaker Preview Room located in the Canberra room to confirm audiovisual
requirements at least 2 hours prior to the start of the session.
Please ensure that you are available in your presentation room at least 10 minutes before the start of the session.
www.coinn2013.com7
Social Events
Welcome Reception
18:30 – 20:00hrs
Exhibition Area at the Belfast Waterfront
Gala Dinner
Saturday, 7 September 2013
18:30 (for tour of Titanic Exhibition), Gala Dinner from 19:30 – 00:00hrs
The Titanic Belfast, 1 Olympic Way, Queen’s Road, Titanic Quarter, Belfast, Northern Ireland, BT3 9EP
Tel: +44 28 9076 6399
Gala Dinner tickets can be bought at the Onsite Registration Desk for £60 (including VAT). Please note that we
have limited tickets left and they will be sold on a first come first served basis.
Please make sure that you have your Gala Dinner ticket with you and are ready to take the coach at 18:00.
Cash bar open all night
18:00 & 18:30Coach transfers leave from the roundabout next to the Belfast Waterfront and the Europa
Hotel to the Titanic Belfast
18:30 Tour of the Titanic Exhibition
19:30 Sit down for dinner
20:00 Traditional entertainment with a break for speeches and thank you notes at 21:30
23.00 Disco
23:30 & 00:00Coach Transfers leave from the Titanic Belfast and return to the Europa and to the
roundabout next to the Belfast Waterfront.
Wifi
Wifi will be available throughout the Belfast Waterfront.
Wifi Network: COINN
Passcode: COINN2013
Conference Secretariat
Kenes UK
The Euston Office, One Euston Square, 40 Melton Street London NW1 2FD
Tel: +44 (0) 207 383 8030
Email: Registration, Accommodation and General Enquires: [email protected]
Email: Abstract and Scientific Programme Queries: [email protected]
Website: www.kenes.com/uk
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Venue Floorplan - Ground Floor
www.coinn2013.com9
Venue Floorplan - First Floor
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Venue Floorplan - Second Floor
www.coinn2013.com11
Information for Oral Presenters
All presenters must register at the registration desk on arrival and check in at the Speakers’ preview room.
Please check the programme to confirm the date and time of your presentation. Speakers must report to the
Speakers’ Preview in the Canberra Room at least 2 hours before their session.
You may review your PowerPoint presentation in this room: Please pass your memory stick to the dedicated
technician who will then upload the presentation and check for viruses (We can read PowerPoint 2007 and
earlier versions. Any embedded movies or sound files should also be included on the stick as separate files,
(for back-up purposes). If you wish to present directly from your laptop, please inform the technicians in the
Speakers’ Preview Room
Please;
• Assemble in your session room at least 10 minutes before the beginning of the session.
• Ensure that you sit near the front of the room with easy access to the stage.
• Ensure that you keep to the time allocated to you, as it will cause disruption to sessions if you run over your
allotted time.
If there are any changes or corrections required to the presentation details in the programme, please let a
technician know as possible. A VGA (15 pin HDD) and audio (mini-jack) connector cables are provided.
If you are planning on presenting directly from your laptop/notebook/Mac, this can be done from the stage
lectern but please pre-advise the technician in the Speakers’ Preview Room.
Speaker Preview Room opening hours:
There will always be a technician available to assist you with any queries you may have in the Speakers’
Preview Room, located in the Canberra Room. There will be signs to guide you.
The opening times are as follows:
Saturday, 7 September 2013 Sunday, 8 September 2013
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07:00 – 16:00
07:00 – 16:00
08:30 – 11:30
Information for Poster Presenters
The posters will be viewed during the official Conference coffee and lunch breaks on Friday 6, Saturday 7
and Sunday, 8 September 2013.
Poster Walks
We kindly ask that you stand by your poster during the official tea, coffee and lunch breaks.
Every abstract accepted for Poster Display is accompanied by a slot during a lunchtime Poster Walk to talk
about your poster. You will be required to deliver a 2 minute presentation and will have 1 minute to answer
questions. The Chairs will be strict on time keeping, so please adhere to this.
Friday 6th September 2013: 12:40 – 13:20hrs
• 01-09: Clinical Issues: Acute
• 10-21: Retrieval & Transport Stabilisation, APN & Workplace Management
• 22-29: Global Health Issues and Health & Developmental Outcomes
Saturday 7th September 2013: 12:20 – 13:00hrs
• 30-40: Fathers, Parenting & Developmental Care, Palliative Care and Bereavement
• 41-53: Quality, Infection & Pain and Education
• 54-61: Feeding & GIT Issues
Equipment for Poster Display
Presenters will be provided with materials to fix posters to the boards in Bar Level One.
Poster Installation
You may set up your poster from 07:00hrs on Friday, 6 September 2013.
Your poster will be on display from 10:30hrs (the first coffee break) on Friday, 6 September until 11:30hrs
(end of last coffee break) on Sunday, 8 September 2013.
Please report to the Conference Registration Desk when you arrive at The Waterfront, where you will be given
your poster number and directed to your poster board.
Poster Removal
Posters must be removed by 11:30hrs (end of last coffee break) at the latest on Sunday, 8 September 2013.
Should they not be removed by this time, the Conference staff will take them down and no responsibility can be
taken for their safe return.
www.coinn2013.com13
SUBSIDIARY MEETINGS
Open meetings for all delegates to attend:
Research Fathers Network Meeting
12.20-13.20 in The Arc
This meeting will be a forum for delegates with an interest in supporting fathers in the perinatal period. It will
be an opportunity to review practice, share strategies to engage and involve fathers, network and consider
research opportunities.
Neonatal Nurses Association (NNA) AGM
12.20-13.20 in The Studio
Open to Neonatal Nurses Association members
Council of International Neonatal Nurses (COINN) AGM
12.00-13.00 in The Arc
Open to all delegates
Closed meetings (by invitation only):
Workforce Database Focus Group
17.20-18.20 in The Arc
Hosted by Carole Kenner & Wakako Eklund
Elsevier Editorial Board Meeting
17.30-19.00 in The Studio
Hosted by Sarah Davies
COINN 2016 Conference Committee Meeting
12.40-13.40 in the Canberra Room
Hosted by Karen New
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Biographies
Invited
Speakers
Biographies: Invited Speakers
Dr Fiona Alderdice
Chair in Perinatal Health and Well-being, School of Nursing and Midwifery, Queens University Belfast,
United Kingdom
Fiona joined the School of Nursing and Midwifery at Queens in 2002, became Director of Research
in 2004 and was promoted to a Chair in Perinatal Health and Well-being in 2010. A psychologist by
background she leads the research theme on maternal and child health. Fiona’s work in maternal and
child health research dates back to 1992 when she worked at the National Perinatal Epidemiology Unit
(NPEU) in Oxford. She was later awarded a MRC HSR training fellowship in 1998 to support her work on
complex pregnancy. Fiona has a sustained contribution to research activity through personal grant income
and collaborative research groups in the order of £5.8 million; £882,000 as a PI and £4.95 million
co-PI as part of multi-disciplinary research groups. Her current research programme is focussed on the
development of psychosocial interventions for women experiencing stress in pregnancy and measuring
well-being in pregnancy. Fiona is a member of the British Psychological Society, a committee member of
the Society of Reproductive and Infant Psychology ,Fellow of the Higher Education Academy and an invite
member of the MRC Steering Committee for the UK Stem Cell Bank. She was an Honorary Visiting Fellow
to the UK Cochrane Centre in Oxford in recognition of her role in developing the strategy for the Cochrane
Collaborations network in Ireland and she continues to review, train and conduct methodological research
with the Cochrane Collaboration.
Professor Geraldine Boylan
Professor of Neonatal Physiology, Paediatrics & Child Health, University College Cork, Ireland
Geraldine Boylan is Professor of Neonatal Physiology in the Department of Paediatrics & Child Health,
University College Cork (UCC), Ireland. She is co-director of the Science Foundation Ireland funded Irish
Centre for Fetal and Neonatal Translational Research (INFANT) www.infantcentre.ie.
INFANT aims to develop innovative technologies in perinatal healthcare that will improve outcomes for the
most vulnerable members of society- mothers and their babies.
Geraldine is co-Principal Investigator for the NEMO study, Europe’s first randomised controlled trial of
anticonvulsants in neonates http://www.nemo-europe.com . She is also a Principal Investigator for the
ANSeR study (Algorithm for Neonatal Seizure Recognition) funded by a Strategic Translational Award from
the Wellcome Trust that evaluates an automated seizure detection algorithm for neonates in intensive
care. More details about this algorithm are detailed on http://www.medscinet.net/anser/
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Professor Mike Clarke
Director, All-Ireland Hub for Trials Methodology Research, Centre for Public Health, Queens University
Belfast, United Kingdom
Prof Clarke has more than 23 years experience of the conduct and oversight of randomised trials,
systematic reviews and other types of prospective research. His work on systematic reviews includes
the central collection of individual participant data from hundreds of randomised trials of treatments for
women with breast cancer, leading to internationally-renowned reports that influence the care of women
worldwide. This research, his other systematic reviews, his role in assessing tens of thousands of reports
for the Cochrane Central Register of Controlled Trials and his many years of teaching about randomised
trials and systematic reviews have provided him with unique insights into the conduct of a vast number
of randomised trials. He is building on this experience when designing and conductinging research into
the methods of evaluations of health and social care. He has been actively involved in the design, conduct,
monitoring and reporting of several randomised trials that have recruited more than 1000 participants, in
breast cancer, maternity care, poisoning and sub-arachnoid haemorrhage.
Prof Clarke is the inaugural Director of the All Ireland Hub for Trials Methodology Research, where he
is expanding his existing portfolio of methodology research to meet the overarching aim of the Hub to
strengthen clinical trial methodology on the island of Ireland. This includes the development of beacons of
excellence in specific areas of methodology research relating to trials, reviews and public health, including
the use of evidence synthesis in clinical trials and the development of methods to keep clinical trials
simple, pragmatic and relevant to a wide range of practitioners, patients, the public and policy makers.
Prof Clarke has been a leading proponent of the importance of using systematic reviews in the design
and reporting of clinical trials for some time, and his work on core outcome sets (as part of the COMET
Initiative) also serves to improve the quality and usefulness of trials and reviews. His research reflects
his strong interest in increasing the capacity for reviews and trials, and in improving their accessibility, in
particular in low- and middle-income countries. He is Podcast and Journal Club Editor for The Cochrane
Library and is a founder of Evidence Aid, seeking to make it easier to use evidence from reviews in natural
disasters and other humanitarian emergencies.
Dr Stanley Craig
Consultant Neonatologist, Royal Maternity Hospital, Belfast, United Kingdom
Head of Postgraduate School of Paediatrics, N.Ireland Medical & Dental Training Agency, United Kingdom
Current Appointment: Appointed in 2002 as a Consultant Neonatologist in Regional Neonatal Unit, Royal
Maternity Hospital, Belfast.
Medical Qualifications: Graduated with MB ChB from University of Aberdeen in 1989; Graduated with
MD from Queen’s University Belfast in 2001, having undertaken research in neonatal nutrition and gut
motility; Elected as a Fellow of the Royal College of Paediatrics & Child Health in 2002; Graduated with
MSc from Queen’s University Belfast in 2013, having undertaken research in postgraduate paediatric
medical education.
Current Professional Roles: Head of School of Paediatrics for the Northern Ireland Medical & Dental
Training Agency; Chairman of the Neonatal Intensive Care Outcomes, Research & Evaluation Group.
(NICORE)
Current Professional Interests: Quality improvement in neonatal intensive care; Neonatal infection
particularly Gp B Streptococcus and nosocomial infections; Neonatal nutrition & NEC; Postgraduate
medical education
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Dr Jennifer A Dawson
Deputy Director Centre for Newborn Research, The Royal Women’s Hospital, Victoria, Australia
Dr Jennifer Dawson joined The Royal Women’s Hospital as a neonatal research nurse in November
2005. She trained as a nurse in Canberra and as a midwife in Scotland. She completed a MN
(Research) at the University of Sydney in 2003, and a PhD at the University of Melbourne in 2010. Her
research has led to over 40 publications with many incorporated in resuscitation guidelines for delivery
room management of newly born infants. Her current work is around the use of pulse oximetry in the
delivery room, and how this technology can help us. Her post doctoral work is supported by a four
year National Health and Medical Research Council fellowship and by the Murdoch Childrens Research
Institute. Jennifer is currently Deputy Director of the Department of Neonatal Research and enjoys
mentoring the next generation of medical and nursing researchers. Ms Odile Frauenfelder
Nursing president ESPNIC and member of the EFCNI Scientific Advisory Board, The Netherlands
After graduate as a general nurse in 1982 Odile has been graduated several nursing applications.
Since 1993 Odile is working at the neonatology ward in the Sophia Children’s Hospital Erasmus MC
Rotterdam.
In 2003 Odile graduated as Master in Advanced Nursing Practice and she is working as a neonatal
nurse-practitioner since then. Beside her clinical work Odile is also the president of the Dutch
association for nurse practitioners (V&VN VS), nursing president elect of the European Society of
paediatric and Neonatal Intensive Care (ESPNIC) and a member of the scientific board of the European
Foundation for the Care of the Newborn infants (EFCNI). Odile is an editorial board member of the online
magazine treatment in paediatrics.
Professor Henry L Halliday
Retired Honorary Professor of Child Health, Queen’s University Belfast, United Kingdom
Henry L. Halliday, is a retired consultant neonatologist, having worked at Royal Maternity Hospital in
Belfast, Northern Ireland for almost 30 years. He is currently an honorary professor of Child Health at
Queen’s University of Belfast where he studied medicine in the 1960s. Following a paediatric residency
in Belfast, Dr Halliday completed fellowships at Rainbow Babies & Children’s Hospital at University
Hospital’s Case Medical Centre in Cleveland and the Cardiovascular Research Institute at the University
of California, San Francisco. After being appointed as a consultant paediatrician with a special interest
in neonatology at Royal Maternity Hospital, he earned his MD at Queen’s University Belfast in 1981. He
served as an honorary lecturer at the University before being promoted to honorary professor in 1992.
Dr Halliday has been on the cutting edge of surfactant therapy research for more than 25 years. His
neonatal unit in Belfast joined the European network that in the mid-1980s organized a number of
ground-breaking large studies focusing on surfactant therapy for infants with RDS. In 1984, he was
first author of a paper in The Lancet describing clinical experience with a new artificial surfactant
made from dipalmitoylphosphatidylcholine and high-density lipoprotein. His research interests include
general neonatology, perinatal medicine, acute respiratory disease in the newborn including surfactant
replacement therapy, evolution and treatment of chronic lung disease, conducting systematic reviews,
and coordinating multicenter randomized clinical trials. Dr. Halliday is currently president of the
European Association of Perinatal Medicine, and has published more than 275 original articles in
peer-reviewed journals, nearly 100 book chapters, and more than 300 abstracts and letters.
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Professor Inger Hallström
Head of the Department of Health Sciences, Faculty of Medicine, Lund University, The Netherlands
Inger Hallstrom is currently Professor in paediatric nursing at Lund University, Sweden where she also
received her basic education in nursing in 1977. With the experience of working as paediatric nurse,
head nurse, care developer and clinical lecturer for twenty years at the University Children’s Hospital
in Lund Professor Hallstrom is the leader for research and education in Child, Family & Reproductive
Health at Lund University since 2002. She is an active researcher with a primary interest in family
centred care and how illness in childhood affects the family in a longitudinal perspective. Her research
includes both qualitative and quantitative studies and her research provides knowledge for the
construction of shaping policies aiming at enhancing child health care and the participation of the
family in care and decisions, and to the understanding of the health related behaviour of the family.
She is currently the Head of the Department of Health Sciences, Faculty of Medicine, Lund University,
Sweden.
Dr Denise Harrison
Chair in Nursing Care of Children, Youth and Families, Children’s Hospital of Eastern Ontario (CHEO) and
University of Ottawa, Ontario, Canada
Dr Denise Harrison began her research career with a single clinical question; “how can we reduce
pain during painful procedures in sick babies?” This came after working for many years in neonatal
intensive care, where infants are exposed to large numbers of painful procedure during their care,
most of which used to occur with no pain relief. Denise completed a Master’s of Nursing, then a PhD
at the School of Nursing, University of Melbourne, Australia, then a post-doctoral research fellowship
with Dr Bonnie Stevens at the Hospital for Sick Children, Toronto, Canada within Dr Steven’s CIHR Team
in Children’s Pain. Her current role is the Chair in Nursing Care of Children, Youth and Families at the
Children’s Hospital of Eastern Ontario and the University of Ottawa.
Denise’s research programme focuses on exploring effective methods to manage pain in infants and
knowledge translation of effective pain management strategies in settings where painful procedures
take place. Denise has long been aware of the need to effectively communicate research information
through venues other than nursing and medical journals and conferences. She underwent media
training during her doctoral studies, co-convened a Pain in Child Health (PICH) institute which focused
on media training for PICH trainees and faculty and ran Café Scientifiques in Ottawa as a way to
present research in an engaging way to the public.
www.coinn2013.com19
Professor Carole Kenner
Executive Director COINN
Dean/Professor, Northeastern University, School of Nursing & Associate Dean Bouve College of Health
Sciences, Boston, USA
Dr. Carole Kenner is the Dean in the School of Nursing and Associate Dean Bouvé College of Health Sciences,
Northeastern University. Dr. Kenner received a Bachelor’s of Science in Nursing from the University of
Cincinnati and her master’s and doctorate in nursing from Indiana University. She specialized in neonatal/
perinatal nursing for her master’s and obtained a minor in higher education for her doctorate. She has
almost 30 years’ experience in teaching with 20 of those years in higher education administration. She
has served as a Chiron Mentor for nurses through Sigma Theta Tau International, a nursing honor society.
She also has served as a mentor for new deans and assistant deans through the American Association of
Colleges of Nursing. She has authored more than 100 journal articles and 20 textbooks.
Her career is dedicated to nursing education and to the health of neonates and their families, as well
as educational and professional development of healthcare practices in neonatology. Her dedication
includes providing a healthcare standard for educating neonatal nurses nationally and internationally.
Her passion led her to begin the journal Newborn and Infant Nursing Reviews, which she now serves as
international column editor. She serves on the Consensus Committee of Neonatal Intensive Care Design
Standards, which sets recommendations for Neonatal Intensive Care Unit designs and serves on the
March of Dimes Nursing Advisory Committee. She is a fellow of the American Academy of Nursing
(FAAN), past president of the National Association of Neonatal Nurses (NANN) and founding President
of the Council of International Neonatal Nurses (COINN), the first international organization representing
neonatal nursing. She is the 2011 recipient of the Audrey Hepburn Award for Contributions to the
Health and Welfare of Children internationally. Her book “Developmental Care of Newborns & Infants”
2nd edition co-edited with Dr. Jacqueline McGrath just won the American Journal of Nursing Book of
the Year Award. She co-authored the book “Teaching the IOM” with Anita Finkelman, now in its second
edition won an award for merit from the Society for Technical Communication, Washington DC. She
was one of the founders of the 501C Institute for Oklahoma Nursing Education (IONE) which addresses
building capacity in the workforce in the state of Oklahoma. She has been involved in genetics her
entire career having headed one of the first master’s degree in nursing programmes that had a minor
in genetics at the University of Cincinnati. She represented the National Association of Neonatal Nurses
to the National Coalition of Health Professions Education in Genetics (NCHPEG) for more over 10 years.
She also helped develop the nursing competencies in genetics.
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Professor Shoo K. Lee
Scientific Director, Institute of Human Development, Child and Youth Health, Canadian Institutes of
Health Research: Professor of Paediatrics, Obstetrics & Gynaecology and Public Health, University of
Toronto, Canada: Paediatrician-in-Chief and Director, Maternal-Infant Care (MICare) Research Centre,
Mount Sinai Hospital, Canada
Dr Shoo Lee is a neonatologist and health economist. He is the Scientific Director of the Institute of
Human Development, Child and Youth Health at the Canadian Institutes of Health Research; Professor of
Paediatrics, Obstetrics & Gynaecology, and Public Health at the University of Toronto; and Paediatricianin-Chief and Director of the Maternal-Infant Care (MICare) Research Centre at Mt Sinai Hospital. He
founded the Canadian Neonatal NetworkTM, and is the Director of the Canadian Institutes of Health
Research Team in Maternal-Infant Care. His research focuses on improving quality of care, patient
outcomes and health care services delivery. He has received many awards for his work, including the
Knowledge Translation Award from the Canadian Institutes of Health Research, the Aventis Pasteur
Research Award and the Distinguished Neonatologist Award from the Canadian Paediatric Society,
the Premier Member of Honour Award from the Sociedad Iberoamericana de Neonatologia, and the
Magnolia Award from the Shanghai government.
Dr Marsha Campbell-Yeo
Professor, Nursing and Paediatrics, Dalhousie University, Halifax, Canada
Dr. Marsha Campbell-Yeo is an assistant professor at the School of Nursing, Dalhousie University and
a certified neonatal nurse practitioner and clinician scientist in the Department of Pediatrics, IWK
Health Centre, Halifax, Nova Scotia Canada. She completed her Bachelor and Masters of Nursing from
Dalhousie University and requirements for certification as a Neonatal Nurse Practitioner from State
University of New York. She graduated with a Doctorate of Philosophy in Nursing from McGill University
in Feb. 2012.
Marsha’s passion for improving neonatal outcomes arose from her almost 25 years of caring
for critically ill newborns and their families as a clinician, educator and researcher. Her primary
area of research interest involves the investigation of maternal driven interventions and parental
involvement to improve outcomes of medically at risk newborns specifically related to pain, stress and
neurodevelopment. In addition, optimizing the uptake of these interventions into clinical practice.
Marsha is a past recipient of a Canadian Institutes of Clinical Research Doctoral Fellowship and
currently holds operating grants from regional and national bodies.
www.coinn2013.com21
Dr Silke Mader
Silke Mader, Chairwoman of the Executive Board EFCNI, Member of the Directors Board NIDCAP, Germany
Silke Mader founded EFCNI in 2008 together with experts and stakeholders. In 1997, her twins were
born in 25 week of pregnancy, lacking totally the appropriate care. Unfortunately, one of them died a few
days after birth, leaving the parents and the sibling. Her professional background lies in the elementary
educational theory with main focus on linguistic support of migration children and remedial educational
theory. During her time in hospital and afterwards, she was faced with the non-existence of support of
any kind, the absence of public awareness and the lack of information and education for parents during
pregnancy. She felt that no parents should ever undergo such awful experience. Therefore, in 1999, she
decided to actively participate in the Munich-based local parent group, which she headed from 2001 on.
Two years later, she became Chairwoman of the German umbrella organisation “The preterm born child
e. V.” Together with experts, Silke developed declarations, guidelines and information material for parents
with preterm children. As the situation throughout Europe is distressingly similar and preterm children
urgently need a voice not only within Europe – but also worldwide, she decided to give up her job as a
teacher and to assume chair functions in the Foundation Board of EFCNI
Professor Bernadette Mazurek Melnyk
Associate Vice President for Health Promotion, University Chief Wellness Officer, Dean and Professor,
College of Nursing and Professor of Pediatrics & Psychiatry, College of Medicine, The Ohio State
University, USA
Bernadette Mazurek Melnyk is the Associate Vice President for Health Promotion, University Chief Wellness
Officer, and Professor and Dean of the College of Nursing at The Ohio State University. She also is a
professor of pediatrics and psychiatry at Ohio State’s College of Medicine. Dr. Melnyk is a pediatric and
psychiatric mental health nurse practitioner, and is an internationally recognized expert in evidence-based
practice, intervention research and child and adolescent mental health. Dr. Melnyk is a frequent keynote
speaker at national/international conferences, and has consulted with hundreds of healthcare systems
and colleges throughout the globe on implementing and sustaining evidence-based practice.
Her record includes over 19 million dollars of sponsored funding from federal agencies as principal
investigator and over 180 publications. Dr. Melnyk is co-editor of four books, including Evidence-based
Practice in Nursing & Healthcare: A Guide to Best Practice. She is an elected fellow of the American
Academy of Nursing and the National Academies of Practice, and served a four-year term as one of
only two nurses on the 16-member United States Preventive Services Task Force. In addition, she
serves on the National Quality Forum’s (NQF) Behavioral Health Steering Committee and the Centers for
Disease Control and Prevention’s Laboratory Best Practices Workgroup. Dr. Melnyk is co-editor of the
journal, Worldviews on Evidence-based Nursing. She has received numerous national and international
awards, and has twice been recognized as an Edge Runner by the American Academy of Nursing. Dr.
Melnyk also was recently inducted into Sigma Theta Tau International’s Research Hall of Fame.
22
Dr David Millar
Consultant Neonatologist, Royal Maternity Hospital, Belfast, United Kingdom
I trained in Neonatal Medicine in Northern Ireland, Scotland and Canada. In McMaster University,
Canada, I developed an interest in Evidence-based Medicine and specifically Health Research
Methodology. I am a co-investigator for the Canadian Institute for Health Research-funded NIPPV trial:
which is the largest trial for preterm infants comparing two modalities of non-invasive respiratory
support. I have a keen interest in neonatal pulmonology and quality improvement. I teach nationally on
Evidence-based Medicine courses. Away from work I have two young children, who keep me busy.
Dr David G Sweet
Consultant Neonatologist, Regional Neonatal Unit, Royal Maternity Hospital, Belfast, United Kingdom
David Sweet graduated from Queen’s University Belfast in 1990 and trained in Paediatrics and Neonatal
Medicine in Northern Ireland and Western Australia. He was appointed as a consultant Neonatologist
in the Regional Neonatal Unit in the Royal Maternity Hospital in Belfast in 2003 and Honorary Clinical
Lecturer for the Dept of Child Health, Queen’s University in 2007. He has 26 peer reviewed publications
and review articles to date, mostly related to the evolution of neonatal bronchopulmonary dysplasia.
David is the Northern Ireland Co-ordinator of several multicentre trials and maintains an active interest
in Perinatal Research and Evidence-based medicine
Ms Agnes van den Hoogen
Past Nursing President ESPNIC
Neonatal Nurse, Wilhelmina Childrens Hospital, UMC Utrecht, The Netherlands
Current professional situation: Post Doc research in health care dept of Neonatology at Wilhelmina
Children’s Hospital, University Medical Centre, The Netherlands.
Thesis: Infections in Neonatal Intensive: Care Prevalence, Prevention and Antibiotic use.
Clinical Interest: Neonatal infections: Its prevalence and prevention, Management of central venous and
arterial catheters in newborn infants, Ethics and Epidemiology.
Other Activities: Member of the Dutch National group ‘Innovation and Research’, Since 2004 member
of the Scientific Committee of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC),
since 2007 president of the SC. President of ESPNIC nursing since 2011.
Dr Joke Wielenga
Academic Medical Center/Emma Children’s Hospital, Amsterdam, The Netherlands
Joke joined the IC Neonatology of the EMMA Children’s Hospital/Academic Medical Centre in
Amsterdam, the Netherlands as a nurse (RN) in 1983. Joke became a scientist after graduating the
Masters study of Health Sciences in 1995. Joke received in 2008 a PhD with her thesis based on
stress in the care of preterm infants; a study on the COMFORT scale and Newborn Individualized
Developmental Care and Assessment Programme (NIDCAP). Her current research programme is
focussed on pain, stress and discomfort in care for preterm infants and their families as well as on
Evidence Based Practice (EBP) in the neonatal intensive care. Joke is the chair of the Dutch Innovation
and Research group, active member of the Dutch NIDCAP Forum and Dutch Association on Pain in
NICU´s. Joke has been a member of the nursing scientific committee of ESPNIC for several years.
Joke is also actively involved in the association of parents with a preterm or sick newborn infant in the
Netherlands.
www.coinn2013.com23
PreConference
Workshops
Thursday,
5 September
2013
Pre-Conference Workshops
All workshops will be held at the Europa Hotel, Great Victoria Street, Belfast, BT2 7AP
Telephone: 028 9027 1066
Workshop 1 - in Copenhagen 1
aEEG and EEG in the NICU
08:00 – 12:00 and 13:00 – 17:00
Geraldine Boylan, University College Cork, Ireland
EEG measures tiny electrical signals form the brain and is particularly useful in monitoring neurological function
of neonates in the intensive care unit. In the intensive care unit it is essential for detecting seizures on neonates
and monitoring the efficacy of treatment strategies. Since the introduction of therapeutic hypothermia in
neonates with Hypoxic Ischemic Encephalopathy (HIE) EEG monitoring is now approaching standard of care in
the NICU.
Covering the basics of neonatal aEEG/EEG in the NICU this workshop will serve as an introduction to the correct
set up of both preterm and term neonatal aEEG/EEG. Common issues and problem solving will be covered and
discussed. A section of this course will be practical and case studies will be used to demonstrate various aEEG/
EEG findings.
Topics covered:
• Neonatal aEEG/EEG recording
• Electrodes
• Montage
• Recording parameters
• Artefacts biological/non-biological
• Common Patterns in neonatal aEEG/EEG
• Normal Term patterns
• Normal Preterm patterns
• Seizure patterns
• Patterns in HIE
www.coinn2013.com25
Pre-Conference Workshops
Workshop 2 - in Copenhagen 2
Cochrane Systematic Reviews
13:00 – 17:00
Fiona Alderdice, School of Nursing and Midwifery, Queens University Belfast, United Kingdom
and Mike Clarke, Queens University Belfast, United Kingdom
Systematic reviews are widely recognised as key elements in evidence based decision making, and in the
design and interpretation of new research. This workshop will take participants through the various steps
in conducting or appraising a systematic review. It will be interactive with the facilitators encouraging the
participants to consider and tackles issues relating to question formulation; eligibility criteria; finding, appraising
and summarising studies, and reporting the review. There will also be an introduction to the statistical aspects
of meta-analyses, and information on how to conduct a review within The Cochrane Collaboration.
Workshop 3 - in Dublin 1
Practical tips for using oxygen saturation monitoring in the delivery room and how to use the
reference range
08:00 – 12:00 and 13:00 – 17:00
Jennifer Dawson, The Royal Women’s Hospital, Victoria, Australia
The aim of this workshop is to discuss how to use pulse oximetry in the delivery room. Additionally, we will
discuss how to use a published reference range for delivery room oxygen saturation measurements to inform
managment of supplemental oxygen in the delivery room.
Workshop 4 - in Dublin 2
Pain management in infants –the evidence and utilization in clinical practice
13:00 – 17:00
Denise Harrison, Children’s Hospital of Eastern Ontario, University of Ottawa, Canada and
Marsha Campbell-Yeo, Dalhousie University, Canada
Evidence from systematic reviews and meta-analyses of pain management strategies for newborn and
older infants including breastfeeding, skin-to- skin care and sweet solutions will be presented. Knowledge
translation activities to date and effectiveness of the implementation strategies will be debated. The workshop
will conclude with current research gaps; research to practice gaps; challenges in clinical applications; current
debates and recommendations for future research directions relating to the management of pain in infants.
26
Programme
at a glance
07:00
Registration Opens
Auditorium
07:30-08:15
AbbVie Sponsored Satellite Symposium
08:30-08:40
Opening introduction
Linda Johnston, United Kingdom & Tina Pollard, United Kingdom
08:40-09:00
COINN: The Future Direction of Neonatal Nursing Globally Is In Our Hands
Carole Kenner, CEO, COINN
09:00-10:00
Child-Family Psychosocial Health
09:00-09:30
Improving healthcare quality, reliability and patient outcomes with EBP and ARCC
Bernadette Mazurek Melnyk, The Ohio State University College of Nursing, Columbus, USA
09:30-10:00
Neonatal Care Based upon the Families’ Needs
Inger Hallström, Lund University, Sweden
10:00-10:10
Opening Address
Edwin Poots MLA, Minister of Health, Social Services and Public Safety, Northern Ireland
10:10-10:30
International Neonatal Nurse Excellence Awards, COINN and Saving Newborn Lives, Save the Children
Award Winners, Joy Lawn, London School of Hygiene & Tropical Medicine and Save the Children, Carole Kenner
10:30-11:00
Coffee Break & Visit the Exhibition in Gallery Levels 1 & 2, Poster Viewing in Bar Level 1
Auditorium
Studio
The Arc
Fathers, Parenting & Developmental Care
Global Health Issues
Health & Developmental Outcomes
NNA AGM
Research Fathers Network Meeting
01-09: Clinical Issues: Acute
10-21: Retrieval & Transport
Stabilisation, APN & Workplace
Management
22-29: Global Health Issues and
13:20-14:40
Neonatal Retrieval & Transport Stabilisation
APN & Workplace Management
Feeding & GIT Issues
14:40-15:10
11:00-12:20
12:20-13:20
Lunch and Exhibition in Gallery Levels 1 & 2
Bar Level 1
Poster Walks
12:40
Auditorium
15:10-16:10
Models of Care
15:10-15:40
Improving quality of care, patient outcomes and health care services delivery, neonatal network
Shoo Lee, Canadian Institutes of Health Research, Toronto, Canada
15:40-16:10
Reducing NICU Length of Stay, Hospital Costs and Readmission Rates with COPE for Parents of Preterms
Auditorium
Studio
The Arc
16:10-17:20
Clinical Issues: Acute
Palliative Care & Bereavement
Quality
17:20
Close of meeting
28
07:00
Registration Opens
Auditorium
08:00-09:30
Networks
08:00-08:30
Changing the Paradigm for Neonatal Care
Shoo Lee, Canadian Institutes of Health Research, Toronto, Canda
08:30-09:00
Families' experiences when caring for a child born preterm
09:00-09:30
Caring for Tomorrow: The challenge to improve maternal and newborn health in Europe
Silke Mader, EFCNI, Munich, Germany
09:30-10:00
10:00-12:00
ESPNIC
10:00-10:30
Thirteen Years Advanced Nursing Practice at Dutch NICU’s, Where Do We Stand Today’
Odile Frauenfelder, Sophia’s Childrens Hospital, Erasmus University, Rotterdam, The Netherlands
10:30-11:00
ESPNIC Delphi Studies
Joke Wielenga, University Medical Center Amsterdam, The Netherlands
11:00-11:30
Scientific Nursing Research groups
Agnes van den Hoogen, Wilhelmin Childrens Hospital, University Medical Center Utrecht
11:30-12:00
Interactive Panel Discussion
12:00-13:00
COINN AGM in The Arc
Lunch and Exhibition in Gallery Levels 1 & 2
Bar Level 1
Poster Walks
12:20
30-40: Fathers, Parenting &
Developmental Care, Palliative Care
and Bereavement
41-53: Quality, Infection & Pain
and Education
54-61: Feeding & GIT Issues
Auditorium
13:00-14:30
Respiratory Health
13:00-13:30
Oxygen saturation monitoring in the delivery room, a help or just more numbers to worry about
Jennifer Dawson, Royal Women’s Hospital, Victoria, Australia
13:30-14:00
History of Surfactant
Henry Halliday, Queens University Belfast, United Kingdom
14:00-14:30
NIPPV - where are we now
David Millar, Royal Maternity Hospital, Belfast, United Kingdom
14:30-15:00
Auditorium
Studio
The Arc
15:00-16:10
Infection & Pain
Clinical Issues: Late Preterm Infants and
newborn health
Education
16:10
Close of meeting
18:00-23:00
Titanic Tour and Gala Dinner
www.coinn2013.com29
08:30
Registration Opens
Auditorium
09:30-10:30
Evidence in Care and Practice
09:30-10:00
Push versus gravity feeding
10:00-10:30
European Guidelines on the management of RDS
David Sweet, Royal Maternity Hospital, Belfast, United Kingdom
10:30-11:00
Quality improvement through Benchmarking
Stanley Craig, Royal Maternity Hospital, Belfast, United Kingdom
11:00-11:30
Coffee Break
Auditorium
Studio
11:30-12:10
Feeding & Research
Respiratory & Patient Decision Making
12:10-12:40
Elsevier Prize for Best Free Paper Presentation, 2016 Conference Presentation and Closing
Karen New, Australia
30
Day 1
Friday, 6
September
2013
FRIDAY, 6 SEPTEMBER 2013
INNER HALL
07:00-17:20Registration
AUDITORIUM
07:30-08:15 AbbVie Sponsored Satellite Symposium
Respiratory Syncytial Virus: Best Practices for Planning and Protecting
Barbara Whelan, Neonatal Clinical Midwife Specialist, Coombe Women & Infants University Hospital, Dublin, Ireland
Lisa Loczy, RSV Coordinator, Alberta Children’s Hospital, University of Calgary, Canada
08:30-08:40 Opening Introduction
Linda Johnston, United Kingdom & Tina Pollard, United Kingdom
08:40-09:00 COINN: The Future Direction of Neonatal Nursing Globally Is In Our Hands
Carole Kenner, CEO, COINN
09:00-10:00 Plenary Session
Child-Family psychosocial health
Chairs: Linda Johnston, United Kingdom & Tina Pollard, United Kingdom
09:00-09:30 Improving healthcare quality, reliability and patient outcomes with EBP and ARCC
09:30-10:00 Neonatal Care Based upon the Families’ Needs
10:00-10:10 Opening Address
Edwin Poots MLA, Minister of Health, Social Services and Public Safety, Northern Ireland
10:10-10:30 International Neonatal Nurse Excellence Awards, COINN and Saving Newborn Lives, Save the Children
Award Winners, Joy Lawn, London School of Hygiene & Tropical Medicine and Save the Children, Carole Kenner
GALLERY LEVELS 1 & 2, BAR LEVEL 1
10:30-11:00
Coffee Break, Visit the Exhibition & Poster Viewing
AUDITORIUM
11:00-12:20
Free Paper Session
Fathers, Parenting & Developmental Care
Chairs: Dee Beresford, United Kingdom & Merryl Harvey, United Kingdom
11:00-11:10
FP01: The Father at the Bedside: Patterns of Involvement in the NICU
Nancy Feeley, Canada
11:10-11:20
FP02: Being Judged And Judging Others: Insights Into The Relationships Between Fathers And Health
Professionals In A UK Neonatal Unit
Kevin Hugill, United Kingdom
32
11:20-11:30
FP03: NIDCAP: Observing Babies To Inform Practice: A Case Study
Kaye Spence, Australia
11:30-11:40
FP04: Skin-to-skin Provides Meaning To Fathers’ Experiences In The NICU
Declan Cooper, Australia
11:40-11:50
FP05: Establishing parenthood after birth of moderate or late preterm infant
Helle Haslund, Denmark
11:50-12:00
FP06: First-time Fathers Of Preterm Infants: The Pregnancy Narrative And Preterm Birth.
An Exploration Of The Concept In Neonatal Fatherhood Research
Liz Crathern, United Kingdom
12:00-12:20
Questions and Discussions
STUDIO
11:00-12:20
Free Paper Session
Global Health Issues
Chairs: Marie Hubbard, United Kingdom & Karen New, Australia
11:00-11:10
FP07: Who Are We? How Are We Trained? What Do We Do? Where Do We Practice? : The COINN Global
Neonatal Provider Database Initiative (CGNPD)
Wakako Eklund, USA
11:10-11:20
FP08: Does Imparting New Knowledge Improve Neonatal Care In The Developing World?
If Not, Why Not? Reflections On Working In A Rural Hospital In Uganda
11:20-11:30
FP09: Reasons Why the WHO/UNICEF 10 Steps to Successful Breastfeeding require Modification for
Application in Neonatal Wards
Kerstin H Nyqvist, Denmark
11:30-11:40
FP10: Global Health Issues: Neonatal Nurse Education In Developing Countries
Karien Mannering, New Zealand
11:40-11:50
FP11: Traditional Practices of Newborn Care in a Nepalese Village
Shobha Nepali, Australia
11:50-12:00
FP12: Stillbirths in Northern Ireland: what lessons can be learnt?
Dale Spence, United Kingdom
12:00-12:20
THE ARC
11:00-12:20
Free Paper Session
Chairs: Mary Beth Bodin, USA & Onno Helder, The Netherlands
11:00-11:10
FP13: The Survival Of The Neonate After Maternal Death, Time Series From 2006 To 2010, Florianópolis,
Santa Catarina, Brazil
Maria de Lourdes Souza, Brazil
11:10-11:20
FP14: Unexpected Birth Outcomes: The Pregnancy That Follows
Joann O’Leary, USA
11:20-11:30
FP15: An endeavour to reduce neonatal morbidity and mortality in Botswana
Ruth Maitshoko Rakata-Sejeso, South Africa
www.coinn2013.com33
11:30-11:40
FP16: Neonatal pain causes alteration in long-term developmental outcomes:- a systematic review
Susan J Ward-Smith, United Kingdom
11:40-11:50
FP17: M-CHAT And Follow-up Interview Screening And ADOS Diagnosis Of Autism In VPT Children
Attending A Developmental Follow-up Program
Margo Pritchard, Australia
11:50-12:00
FP18: Impact of neonatal intensive care admission on Late Preterm Infants: health outcomes and
family functioning at 3 years of age
Jennifer McGowan, United Kingdom
12:00-12:20
GALLERY LEVELS 1 & 2
12:20-13:20
Lunch & Visit the Exhibition
STUDIO
12:20-13:20
NNA AGM
Tina Pollard, United Kingdom
THE ARC
12:20-13:20
Research Network Meeting
Merryl Harvey, United Kingdom & Margo Pritchard, Australia
BAR LEVEL 1
12:40
Poster Walk
Clinical issues: Acute
Chair: Ruth Davidge, South Africa
12:41-12:44
P01: Nasal cannula flow rate, cannula size and generated airway pressure: an in-vitro study
Ann Schwoebel, USA
12:44-12:47
P02: Heat Loss Prevention In The Delivery Room And On Admission To The Intensive Care Nursery
Ann Schwoebel, USA
12:47-12:50
P03: Current Practices On Prevention Of Hypothermia, Temperature Taking And Neonatal Transport In
Neonatal Units Across Australia, NZ, Ireland & UK
Jacqueline Smith, Australia
12:49-12:52
P04: The application of a plastic wrap to improve NICU admission temperatures in infants born less
than 30 weeks gestation: A randomised controlled trial.
12:52-12:55
P05: Comprehensive Care For The Infant Experiencing Narcotic Abstinence Syndrome
Barbera Herzog Taft, USA
12:55-12:58
P06: Effect of quality improvement for reducing incidence of severe retinopathy of prematurity (ROP)
Somying Goonthon, Thailand
12:58-13:01
P07: Development of an algorithm for management of delayed meconium passage in extremely low
birth weight infant
Gil Castro Patricia, Spain
34
13:01-13:04
P08: An audit of Sucrose use, pre and post implementation of Sucrose Guidelines in a Neonatal Unit.
Sharon Nurse, United Kingdom
13:04-13:07
P09: Parent Feedback From A Neonatal Nurse Delivered Infant Basic Resuscitation Service
Barbara Hills, United Kingdom
BAR LEVEL 1
12:40
Poster Walk
Retrieval & Transport Stabilisation, APN & Workplace Management
Chair: Jacquie Koberstein, New Zealand
12:41-12:44
P10: The transfer of infants from tertiary NICUs to community SCNs: the perceptions and opinions of
health professionals on parents’ transfer experiences
Louisa Ramudu, Australia
12:44-12:47
P11: Subgaleal Haemorrhage in newborns: the challenges faced by medical retrieval teams
Jane Roxburgh, Australia
12:47-12:50
P12: From Vision to Practice: Using Telehealth as a catalyst for strengthening the Neonatal Care
Network in Manitoba
Michael Narvey, Canada
12:49-12:52
P13: The Effectiveness Of E-learning In Enhancing Neonatal Resuscitation Skills, Knowledge and
Confidence Of Undergraduate Nursing Students
Wafaa Elarousy, Saudi Arabia
12:52-12:55
P14: Examination of the role of advanced practice registered nurses in the NICU in the United States,
a model for global role expansion
Susan OConnor, USA
12:55-12:58
P15: Creating A Program Of Quality Improvement For A Group Of Advanced Practice Nurses
Tamara Wallace, USA
12:58-13:01
P16: Ethnography of Nursing Workplace Relations in an Australian NICU: A Review
Shobha Nepali, Australia
13:01-13:04
P17: Exploring The Power Of Neonatal Specific Education: The Impact On Practice, And The Nurses’
Attitudes Toward Professional Relationship
Miki Konishi, Japan
13:04-13:07
P18: Implementing An Educational Program To Improve Patient Outcomes By Improving The Success
Of PIV Insertion In A Large Multilevel NICU
Nancy O’Neill, Canada
13:07-13:10
P19: Neonatal simulation study days facilitated by advanced neonatal nurse practitioners
Denise Quinn, United Kingdom
13:10-13:13
P20: Perceptions of Doctors Working In Labour Wards of the Use of Cardiotocography as an
Intrapartum Monitoring Tool
Sindiwe James, South Africa
13:13-13:16
P21: The essential role of the Neonatal Nurse Research Coordinator - Need for position security
Rosslyn Lontis, Australia
www.coinn2013.com35
BAR LEVEL 1
12:40
Poster Walk
Global Health Issues and Health & Developmental Outcomes
Chair: Wakako Eklund, USA
12:41-12:44
P22: Obstacles in Providing Neonatal Care in Kurdistan, Iraq
Atiya Kareem, Iraq
12:44-12:47
P23: Retinopathy of prematurity in Northern Ireland: can we achieve 100% screening coverage?
Lindsay Fraser, United Kingdom
12:47-12:50
P24: Evaluation of neonatal care in public and private hospitals considering the objectives of the Stork
Network (Rede Cegonha)
Vera Tonete, Brazil
12:49-12:52
P25: Kangaroo Mother Care (KMC) among High-Risk Infants: Nurses Knowledge, Attitudes and Education
12:52-12:55
P26: Smoking load of Brazilian pregnant women and weight at birth
Cristina Parada, Brazil
12:55-12:58
P27: Does implementation of a Central Line Bundle reduce Central line associated blood stream
infection? -- A tertiary centre’s experience and outcome
Kwee Bee Lindrea, Australia
12:58-13:01
P28: «Halo» phenomenon (phenomenon “Stefanis”) in relation with antimicrobial copper
implementation
Zacharoula Manolidou, Greece
13:01-13:04
P29: The Role of Nursing in Implementing Helping Babies Breathe® in Countries with Limited
Resources: An Analysis of Critical Challenges
Glenn Barber, USA
AUDITORIUM
13:20-14:40
Free Paper Session
Neonatal Retrieval & Transport Stabilisation
Chairs: Donna Hovey, Australia & Linda Johnston, United Kingdom
13:20-13:30
FP19: Aeromedical Neonatal Nursing: Long distance repatriation of an extremely preterm infant
Lisa Moran, United Kingdom
13:30-13:40
FP20: Neonatal Nurse’s Perceptions And Experiences Of Neonatal Transport Services
Ann Kelly, Ireland
13:40-13.50
FP21: Successful Back Transfers in Victoria Australia are they a Myth?
Fay Presbury, Australia
13.50-14:00
FP22: An Innovative Lactation Support Intervention for Mothers of Premature Infants - A Pilot Study
Marjolaine Héon, Canada
14:00-14:10
FP23: An Evaluation of Cheshire and Merseyside Neonatal Network Transport Service Transfer Activity
to Paediatric Services
Carol Jackson, United Kingdom
14:10-14:20
FP24: Implementing Inter Facility, Ambulance KMC. Changing Atitudes, Saving Lives in South Africa
Vanessa Booysen, South Africa
14:20-14:40
36
STUDIO
13:20-14:40
Free Paper Session
APN & Workplace Management
Chairs: Trudi Mannix, Australia & Pat O’Flaherty, Canada
13.40-13:50
FP25: Competency Development In Neonatal Care In South Africa
Mariana Scheepers, South Africa
13:30-13:40
FP26: A NICU-based Nursing Research Fellowship Program For Staff Nurses: Empowered Nurses Lead
To Better Patient Outcomes
Nancy Rodriguez, USA
13.40-13:50
FP27: Profiling Neonatal Nurses’ Practice: Influences and Outcomes
Kaye Spence, Australia
13:50-14:00
FP28: The Value Of Bedside Learning Tools To Aid Clinical Decision Making In Neonatal Nursing Care:
Exploring The Needs Of Neonatal Nurses
Julia Petty, United Kingdom
14:00-14:10
FP29: Transformational Leadership In The Neonatal Intensive Care Unit: Implementing Change To
Support Best Practice
Angela Casey, Australia
14:10-14:20
FP30: Getting to a Better Place: Ethics Based Conflict Resolution in the Neonatal Intensive Care Unit (NICU)
Julie Cadogan, USA
14:20-14:40
THE ARC
13:20-14:40
Free Paper Session
Chairs: Carin Maree, South Africa & Joke Wielenga, The Netherlands
13:20-13:30
FP31: What Do We Know About The Care And Placement Of Feeding Tubes In Very Low Birth Weight Infants?
Tamara Wallace, USA
13:30-13:40
FP32: Clinical Indicators Of Oral Feeding Performance In Premature Infants With Bronchopulmonary Dysplasia
Yu-Wen Wang, Taiwan
13:40-13.50
FP33: Staff’s Sensitivity And Focus Of Care -- Influence On Feeding In NICUs In Sweden And England
Renée Flacking, United Kingdom
13.50-14:00
FP34: Comparative Study Of Orogastric Versus Nasogastric Tube Feeding In VLBW Neonates : An Open
Labelled Randomised Controlled Trial
Harmesh Singh, India
14:00-14:10
FP35: Factors Associated With Exclusive Breastfeeding Of Preterm Infants
Ragnhild Maastrup, Sweden
14:10-14:20
FP36: A Longitudinal Evaluation Of Kangaroo Care For Preterm Infants In Thailand
Trudi Mannix, Australia
14:20-14:40
www.coinn2013.com37
14:40-15:10
AUDITORIUM
15:10-16:10
Plenary Session
Models of Care
Chairs: Margo Pritchard, Australia & Agnes van den Hoogen, The Netherlands
15:10-15:40
Improving quality of care, patient outcomes and health care services delivery, neonatal network
Shoo Lee, Canadian Institutes of Health Research, Toronto, Canada
15:40-16:10
Reducing NICU Length of Stay, Hospital Costs and Readmission Rates with COPE for Parents of Preterms
AUDITORIUM
16:10-17:10
Free Paper Session
Clinical Issues: Acute
Chairs: Odile Frauenfelder, The Netherlands & Denise Evans, United Kingdom
16:10-16:20
FP37: Ten Years Of TOBY - A Cooling Journey
Brenda Strohm, United Kingdom
16:20-16:30
FP38: Hypothermia And Neonatal Mortality
Geralyn Prullage, Rwanda
16:30-16:40
FP39: Concordance of temperature measurements in the preterm and term neonate using three
thermometers
16:40-16:50
FP40: Establishment of inter-observer reliability using the Finnegan neonatal abstinence scoring tool
Karen D’Apolito, USA
16:50-17:10
38
STUDIO
16:10-17:10
Free Paper Session
Palliative Care & Bereavement
Chairs: Sharon Nurse, United Kingdom & Denise Kinross, Australia
16:10-16:20
FP41: Neonates And Infants With Neurodevelopmental Delay And End Of Life Care Needs -- What Care
Do We Provide At Home For These Children In Ireland?
Margaret Naughton, Ireland
16:20-16:30
FP42: Turkish Neonatology Nurses’ Problems and Quality of Life
Naime Altay, Turkey
16:30-16:40
FP43: Are NICU nurses apprehensive when providing care for dying infants
Gary Parker, USA
16:40-16:50
FP44: Rites Of Passage -- The Unexpected Transition From Pregnancy To Palliative Care
Jayne Price, United Kingdom
16:50-17:10
THE ARC
16:10-17:10
Free Paper Session
Quality
Chair: Kaye Spence, Australia
16:10-16:20
FP45: International collaboration for the translation of evidence into practice
Jann Foster, Australia
16:20-16:30
FP46: Analysis Of Unexpected Events In Presumed Well-appearing Neonates After The Implementation
Of A Newborn Rapid Response System - A 4 Year Experience
Rita Patnode, USA
16:30-16:40
FP47: Decreasing multiple neonatal peripheral IV sticks
Ann Schwoebel, USA
16:40-16:50
FP48: Development of the Neonatal Navigator Phone App as a supportive tool for parents on their
unexpected journey through the neonatal unit
Judy HItchcock, New Zealand
16:50-17:10
www.coinn2013.com39
Day 2
Saturday, 7
September
2013
SATURDAY, 7 SEPTEMBER 2013
INNER HALL
AUDITORIUM
08:00-09:30
Plenary Session
Networks
Chairs: Carole Kenner, USA & Kaye Spence, Australia
08:00-08:30
Changing the Paradigm for Neonatal Care
Shoo Lee, Canadian Institutes of Health Research, Toronto, Canda
08:30-09:00
Families’ experiences when caring for a child born preterm
09:00-09:30
Caring for Tomorrow: The challenge to improve maternal and newborn health in Europe
Silke Mader, EFCNI, Munich, Germany
09:30-10:00 Coffee Break, Visit the Exhibition & Poster Viewing
AUDITORIUM
10:00-12:00
Plenary Session
ESPNIC
Chair: Shoo Lee, Canada
10:00-10:30
Thirteen Years Advanced Nursing Practice at Dutch NICU’s, Where Do We Stand Today
Odile Frauenfelder, Sophia’s Childrens Hospital, Erasmus University, Rotterdam, The Netherlands
10:30-11:00
ESPNIC Delphi Studies
Joke Wielenga, University Medical Center Amsterdam, The Netherlands
11:00-11:30
Scientific Nursing Research groups
Agnes van den Hoogen, Wilhelmin Childrens Hospital, University Medical Center Utrecht
11:30-12:00
Interactive Panel Discussion
GALLERY LEVELS 1 & 2
12:00-13:00
Lunch & Visit the Exhibition
THE ARC
12:00-13:00 COINN AGM
www.coinn2013.com41
BAR LEVEL 1
12:20
Poster Walk
Fathers, Parenting & Developmental Care, Palliative Care and Bereavement
Chair: Debbie Aywlard, Canada
12:20-12:23
P30: A Parenting Intervention For Families With A Very Preterm Baby; Prem Baby Triple P
12:23-12:26
P31: Experiences Of Fathers Of Premature Infants And Their Feelings For Their Babies
Shigeka Higai, Japan
12:26-12:29
P32: The Relationship between Maternal Mental Health and Quality of Preterm Infant-Mother Interaction
12:29-12:32
P33: Fathers’ Perceptions Of The Barriers And Facilitators To Their Involvement With Their Newborn
Hospitalized In The Neonatal Intensive Care Unit
Nancy Feeley, Canada
12:32-12:35
P34: Implementing Family Integrated Care In A Neonatal Intensive Care Unit: The Importance Of
Providing Guided Parent Education To Facilitate Learning
Marianne Bracht, Canada
12:35-12:38
P35: Effects of cycled lighting versus near dark lighting on physiologic stability and motor activity level
of preterm infants
Valérie Lebel, Canada
12:38-12:41
P36: Maternal representations of the care for low birth weight preterm babies: collective subject
discourse
Cristina Parada, Brazil
12:41-12:44
P37: Developing An Advanced Neonatal Nurse Practitioner (ANNP) Programme That Is Fit For Purpose:
Mini Doctor, Maxi Nurse Or Something More Hybrid
12:44-12:47
P38: The sleep of preterm newborns admitted to a neonatal unit*
Eliana Moreira Pinheiro, Brazil
12:47-12:50
P39: Enhancing Bereavement Care In A Dublin Maternity Service
Brid Shine, Ireland
12:50-12:53
P40: Life Narrative Of Brazilian Mother-Women Which Child Born With No Current Curative Possibility
Ines Maria Meneses Santos, Brazil
42
BAR LEVEL 1
12:20
Poster Walk
Quality, Infection & Pain and Education
Chair: Denise Harrison, Canada
12:20-12:23
P41: Trauma Informed Age Appropriate Care - A New Paradigm For The Neonatal ICU
Mary Coughlin, USA
12:23-12:26
P42: A Neonatal ICU And Their Unseen Environmental Enemies
Darlene Mensinger, USA
12:26-12:29
P43: Determination of acute procedural pain responses in Extremely Low Gestational Age (ELGA)
infants over time: A case report
Bonnie Stevens, Canada
12:29-12:32
P44: Quality improvement initiative in reducing late onset sepsis
Sharon D Murray, United Kingdom
12:32-12:35
P45: Closing the link between practice and theory
Mary Goggin, United Kingdom
12:35-12:38
P46: Effect Of Reducing NICU Light And Noise During Kangaroo Mother Care on Preterm Infants’
And Mothers’ Outcomes: A Pilot Study
Marilyn Aita, Canada
12:38-12:41
P47: Educational Approaches To Inspire Neonatal Nurses -- But Is There An Impact On Care Delivery?
Sara Morris, United Kingdom
12:41-12:44
P48: Development of the Neonatal Navigator Phone App as a supportive tool for parents on their
unexpected journey through the neonatal unit
Judy Hitchcock, New Zealand
12:44-12:47
P49: Neonatal Pain Causes Physiological Changes Affecting Long-Term Outcomes
Susan Ward-Smith, United Kingdom
12:47-12:50
P50: Determination of Knowledge and Skill Levels Of Neonatal Nurses about Peristomal Skin Care
Ebru Kılıçarslan Törüner, Turkey
12:50-12:53
P51: Implementation of antimicrobial copper in Neonatal Intensive Care Unit (NICU)
12:53-12:56
P52: Financial Benefits after the implementation of antimicrobial copper in Intensive Care Units (ICUs)
12:56-12:59
P53: Impaired Lung Function and Health Status in Adult Survivors of Bronchopulmonary Dysplasia
Aisling Gough, United Kingdom
www.coinn2013.com43
BAR LEVEL 1
12:20
Poster Walk
Chair: Carin Maree, South Africa
12:20-12:23
P54: The Role Of Complementary Applications in The Treatment Of Infantile Colic
Sibel Icke, Turkey
12:23-12:26
P55: IBCLC Counselling - Does It Help Mothers’ Experienced Breastfeeding Problems In A NICU?
Susanne Norby Bojesen, Denmark
12:26-12:29
P56: The Effectiveness Of Proactive Telephone Support Provided To Breastfeeding Mothers Of Preterm
Infants Study Protocol For A Randomized Controlled Trial
Jenny Ericson, Sweden
12:29-12:32
P57: Acceptability, Feasibility, And Estimated Effects Of Breast Milk Expression At The Preterm Infant’s
Bedside
12:32-12:35
P58: Preterm newborn sleep patterns before and after feeding and during nap time*
Eliana Moreira Pinheiro Pinheiro, Brazil
12:35-12:38
P59: The Impossibility Of Breastfeeding For Brazilian Hiv-Seropositive Women
Ines Maria Meneses Santos, Brazil
12:38-12:41
P60: Life Narratives Of Brazilian Women Who Breastfed Adoptive Children
Ines Maria Meneses Santos, Brazi
12:41-12:44
P61: Early vs late initiation of breast milk expression on lactation success and infant nutritional
outcomes among mothers of very low birth weight infants
Leslie Parker, USA
AUDITORIUM
13:00-14:30
Plenary Session
Respiratory health
Chairs: Pamela Boyd, United Kingdom & Merryl Harvey, United Kingdom
13:00-13:30
Oxygen saturation monitoring in the delivery room, a help or just more numbers to worry about
13:30-14:00
History of Surfactant
Henry Halliday, Queens University Belfast, United Kingdom
14:00-14:30
NIPPV - where are we now
David Millar, Royal Maternity Hospital, Belfast, United Kingdom
14:30-15:00
44
AUDITORIUM
15:00-16:10
Free Paper Session
Infection & Pain
Chairs: Karen New, Australia & Odile Frauenfelder, The Netherlands
15:00-15:10
FP49: The Use Of Own Mother’s Colostrum As A Potential Immune Therapy For Extremely Premature
Infants: State Of The Science
15:10-15:20
FP50: National clinical guideline on Pain Assesment in Denmark, - COMFORTneo
Helle Haslund, Denmark
15:20-15:30
FP51: Impact Of Kangaroo Mother Care On Deleterious Consequences Of Pain Due To Venipuncture In Neonates
Harmesh Singh, India
15:30-15:40
FP52: Nursing contributions in a multi-institutional and multidisciplinary collaborative reduces CLABSI rates
Susan L Moran, USA
15:40-15:50
FP53: Reduced nosocomial bloodstream infection rate among very low birth weight infants by
sequential hand hygiene promotion: a ten-year experience
Onno Helder, Netherlands
15:50-16:00
FP54: Enhanced bacterial enrichment in the diagnostics of blood cultures taken from neonatal patients
Jouni Pesola, Finland
16:00-16:10
STUDIO
15:00-16:10
Free Paper Session
Clinical Issues: Late Preterm Infants and newborn health
Chair: Jennifer Dawson, Australia
15:00-15:10
FP55: A systematic review of recent research in late preterm infants
Maryann Bozzette, USA
15:10-15:20
FP56: Factors influencing neonatal care admission of Late Preterm Infants born at 34-36 weeks
gestation in Northern Ireland
15:20-15:30
FP57: Implications of Maternal Obesity-Associated Inflammation for Newborn and Infant Health
Kathie Records, USA
15:30-15:40
FP58: The coping styles of parents following the down-transfer of their infants from tertiary NICUs to
community SCNs in Victoria, Australia
Louisa Ramudu, Australia
15:40-15:50
FP59: A Correlational Analysis Of A National Survey Of Neonatal Peripherally Inserted Central Catheter
(PICC) Practices: Demographics And Training
Elizabeth L Sharpe, USA
15:50-16:00
FP60: Term Neonates with Bilious Vomiting -Should they be considered as Time Critical Transfers to the
Surgical Centre?
16:00-16:10
www.coinn2013.com45
THE ARC
15:00-16:10
Free Paper Session
Education
Chairs: Ruth Davidge, South Africa & Donna Hovey, Australia
15:00-15:10
FP61: Development And Design Of An E Learning Portal To Assess And Address Neonatal Clinicians’
Breastfeeding Knowledge And Practice
Wendy Higman, United Kingdom
15:10-15:20
FP62: PEDALO Project: The Development And Testing Of An E-learning Platform To Promote Critical
Thinking And Clinical Reasoning Skills In Neonatal Intensive
Nadine Griffiths, Australia
15:20-15:30
FP63: An innovative approach to training neonatal nurses at the University of Cape Town, South Africa
Hilary Barlow, South Africa
15:30-15:40
FP64: Application of wholebrain learning in neonatal nursing education
Carin Maree, South Africa
15:40-15:50
FP65: Creating A Core Syllabus For Clinical Competency: Standardising The Education Of UK
Specialised Neonatal Nurses.
Sue Turrill, United Kingdom
15:50-16:10
TITANIC BELFAST
18:30-23:00
Gala Dinner
18:30 (for tour of Titanic Exhibition), Gala Dinner from 19:30 – 00:00hrs
The Titanic Belfast, 1 Olympic Way, Queen’s Road, Titanic Quarter, Belfast, Northern Ireland, BT3 9EP
Tel: +44 28 9076 6399
Gala Dinner tickets can be bought at the Onsite Registration Desk for £60 (including VAT).
Please note that we have limited tickets left and they will be sold on a first come first served basis.
Please make sure that you have your Gala Dinner ticket with you and are ready to take the coach at 18:00
Cash bar open all night
18:00 Coach transfers leave from the roundabout next to the Belfast Waterfront and the Europa
Hotel to the Titanic Belfast
18:30 Tour of the Titanic Exhibition
19:30 Sit down for dinner
20:00 – 22:45 Traditional entertainment with a break for speeches and thank you notes at 21:30
23.00 – 00:00 Disco
23:30 Coach Transfers leave from the Titanic Belfast and return to the Europa and to the
roundabout next to the Belfast Waterfront.
46
Day 3
Sunday, 8
September
2013
SUNDAY, 8 SEPTEMBER 2013
INNER HALL
AUDITORIUM
09:30-10:30
Plenary Session
Evidence in Care and Practice
Chairs: Trudi Mannix, Australia & Mary Beth Bodin, USA
09:30-10:00
Push versus gravity feeding
10:00-10:30
European Guidelines on the management of RDS
David Sweet, Royal Maternity Hospital, Belfast, United Kingdom
10:30-11:00
Quality improvement through Benchmarking
Stanley Craig, Royal Maternity Hospital, Belfast, United Kingdom
11:00-11:30
*Please remove your Poster by the end of the break
AUDITORIUM
11:30-12:10
Free Paper Session
Feeding & Research
Chair: Tina Pollard, United Kingdom
11:30-11:40
FP66: Service Evaluation Of Nursing Practice On The Use Of NNS During Tube Feeding Premature
Infants In The NICU; An Observational Study
Langley Donghong, United Kingdom
11:40-11:50
FP67: State of the Science: Immune Protection against Infection with Human Milk Feedings for
Premature Infants.
11:50-12:00
FP68: Acceptability and Feasibility Issues of Clinical Trials in a Context of Premature Birth
12:00-12:10
48
SUNDAY, 8 SEPTEMBER 2013
STUDIO
11:30-12:10
Free Paper Session
Respiratory & Patient Decision Making
Chair: Agnes van den Hoogen, The Netherlands
11:30-11:40
FP69: Trends in the prevalence and risk of multiple births with congenital anomaly: a registry based
study in 14 European countries 1984-2007
Breidge Boyle, United Kingdom
11:40-11:50
FP70: Non-invasive ventilation strategies in the extremely low birth weight infant.
Robyn Richards, Australia
11:50-12:00
FP71: Parent involvement in the research process: lip service or meaningful engagement?
Shared reflections of the experiences from one research project.
11:50-12:10
AUDITORIUM
12:10-12:40
Elsevier Prize for Best Free Paper Presentation, 2016 Conference Presentation and Closing
www.coinn2013.com49
ABSTRACTS
FREE PAPER
PRESENTATIONs
Abstracts: Free Paper Presentations
FATHERS, PARENTING & DEVELOPMENTAL CARE
FP01: The Father At The Bedside: Patterns Of Involvement In The NICU
Feeley, N1; Sherrard, K2; Waitzer, E3; Boisvert, L4
McGill University School of Nursing, Canada; 2Neonatal Intensive Care Unit, Jewish General Hospital, Canada; 3Jewish General
Hospital, Canada; 4McGill University Health Centre, Canada
1
Background: Many fathers want to be involved in infant caregiving during an NICU hospitalization and lack of involvement
is stressful. However not all do. Understanding how fathers are involved and why some are more involved is an important
avenue for research.
Methods: A multiple case study explored patterns of involvement. 18 fathers were interviewed. Interview, socio-demographic,
and medical data were used to create cases for cross-case analysis. Interviews were content analyzed and four themes
identified: types of involvement, paternal role, motivation, and special circumstances. Each case was then coded for these
variables. Next, summaries were reviewed, and then across cases to identify those sharing similar characteristics. Eight cases
were coded by staff not involved who confirmed the classification.
Results: Three patterns were identified: Equal to Mother, Mother is More Important, and Reluctant Involvement. Equal
to Mother fathers (6) perceived their involvement as being indistinguishable from that of mother. They believed they
played a critical role in child care, were intrinsically motivated, and described varied motives for involvement. All were on
paternity leave. They spent most of the day in the NICU, and were the only fathers to bathe or do skin to skin care. Mother
is More Important fathers (5) described their involvement as distinct from that of mother. They described indirect forms of
involvement. Some held or diapered the infant; but they believed that such activities should be performed by mother. None
were on leave. They visited briefly daily. Reluctant fathers (7) had few motives for being involved. Extrinsic sources dominated.
A major feature was their fear of handling the infant. Half were on leave. Some visited every day, others less.
Implications: Not all fathers wish to be involved to the same extent. Nurses need to assess preferences and facilitate
involvement to the extent that fathers feel comfortable.
FP02: Being Judged And Judging Others: Insights Into The Relationships Between
Fathers And Health Professionals In A UK Neonatal Unit
Hugill, Kevin
School of Health, University of Central Lancashire, Preston, United Kingdom
Background: providing effective care for parents in neonatal units necessitates an understanding of the factors that
contribute to the diversity of individual experience and how people responded to these often stressful events. For mothers,
their relationships with health professionals are known to be an important feature in determining their levels of stress and
satisfaction during their time on the neonatal unit. Less is known about how health professionals and fathers interact and how
this affects fathers overall experience. This presentation discusses findings from a PhD Study exploring the early experiences
of fathers in a UK neonatal unit and reports on the thematic area: ‘being judged and judging others’.
Method: an ethnographic study in a neonatal unit of a large NHS teaching hospital in England. Data was collected over 36
months through fieldwork observation, face-to-face semi-structured interviews with a purposive sample of consenting fathers
and an ethnographic survey with health professionals. Transcriptions of field notes, interviews and survey responses were
concurrently analysed thematically.
www.coinn2013.com51
Results: health professionals and fathers routinely made judgments about the behaviours and motivations of others. These
interactions were seemingly governed by a complex culturally mediated series of conventions and expectations. This
included aspects of prevailing organisational culture and individual assumptions about men and fatherhood. These opinions,
sometimes ill informed, on occasion prohibited greater involvement by fathers in the care of their infant. Some mothers and
nurses took steps to counter these obstacles and facilitate opportunities for greater inclusion of fathers in unit activities.
Conclusions: based on these findings health professionals need to be sensitised to the effects that their attitudes can have
upon fathers. Increased awareness about facets of father and health professional relationships could inform the development
of interventions and strategies to better meet the needs of fathers which would be potentially useful in clinical practice.
FP03: NIDCAP: Observing Babies To Inform Practice: A Case Study
Spence, Kaye
Grace Centre for Newborn Care, The Sydney Children’s Hospitals Network (Westmead), Westmead, Australia
Background: Infant behaviour can be observed through systematic and naturalistic observations in the neonatal nursery.
This methodology was developed as part of the Newborn Infant Developmental Care Assessment Program (NIDCAP®). The
observation enables a plan of care to be developed based on the robustness and competence of the infant in interacting with
their environment and care-giving. Studies have shown that early intervention programs that support the infant’s development
can be beneficial for the infant’s outcome and maternal interactions. NIDCAP as a model has been implemented extensively in
Europe across many neonatal settings including surgical NICU.
Method: A case study illustrates how observations can lead to care-planning and relationships between an infant
and his parents and care-givers. Regular observations, plans and consultation with parents were used throughout the
admission of a preterm infant with a long-gap oesophageal atresia. A series of video recordings were taken to assist in the
implementation of change in practice for the nursing and medical team.
Results: Over a 3 month period of the infant’s admission to the NICU a series of weekly observations were undertaken. A
total of 12 observations resulted in developing plans which identified the strengths, vulnerabilities and challenges for the
infant, family, staff and environment. A reflective process enabled improvements to be implemented as well as team-building
opportunities for the parents and staff. The infant was discharged home breastfeeding and follow-up assessment at 8 months
was competent on the Bayley neurodevelopmental assessment.
Conclusion: Using an early intervention program in the NICU can be beneficial for the infant and family as well as provide a
structured approach to meeting the infant’s developmental goals whilst in the NICU.
52
FP04: Skin-to-skin Provides Meaning To Fathers’ Experiences In The NICU
Cooper, Declan
University of Tasmania/ Royal Hospital for Women, Australia
Background: It is recognised that becoming a father is an extremely profound experience; however, these experiences are
not clearly understood. Historically neonatal care has put emphasis on the mother-infant interactions and her transition to
motherhood. These focuses seem to be compounded when fathers are suddenly and very unexpectedly propelled into the
neonatal environment because of a sick and or preterm infant at birth. What is known around father’s challenges, experiences
and transitioning to fatherhood within the NICU is often combined with the experiences of the mother resulting in the
uniqueness of these experiences had by fathers being lost.
Method: Families were recruited on a voluntary basis in a tertiary level NICU consisting of a level 3 and a level 2 nursery as
well as a special care nursery. All babies must have been stable for a minimum of 3 days. The families were randomly allocated
into either the treatment or the control group. The control group fathers attended to skin to skin care as per the unit policy. The
treatment group fathers committed to a minimum of 5 hours skin to skin care per week. Each week both groups of fathers
completed a quick survey of questions reflecting upon the previous week. All fathers recruited were followed up at 3 months post
discharge with an interview.
Results: The results were analysed in each group and themes identified. These themes were then compared between the groups
whereby similarities and differences were recognised. The themes in both groups were not dissimilar except in the areas of
information and understanding the “fathering role”. A similarity identified was that both groups feel “torn” between being there
for their partner and child, the expectations of their employment and other outside activities. On the three month follow up the
similarities were greater between the groups.
FP05: Establishing parenthood after birth of moderate or late preterm infant
Haslund, Helle
Nursing Research, NICU, Aalborg University Hospital, Denmark
Background and Aim: Danish studies show that premature-mothers develop PTSD symptoms more frequent than the rest of
the population. Little research has been conducted on family life the first year after birth of a moderate or late preterm infant
(GW 32--37). These are discharged to normalcy without specialized health care services.
Methods: PhD in anthropology is the research frame. I have done a 1,5 years fieldwork in Danish families after discharge
doing participant observation in everyday life and semi structured interviews. Fieldwork included health care nurse visits in
informant’s families as well as informant’s participation in peer groups of mothers.
Results: My findings show a heavy focus on monitoring child development and health in the Danish welfare state. Child
health and development is associated with good parenting. Furthermore moral processes point at parenting as not only about
doing right but actually is associated with being right as human beings. Parents are influenced by prematurity searching for
normalcy in the monitoring context in a modern western society as Denmark. Parenthood thus becomes a professionalized
and moral practice. In spite of an excessive amount of knowledge on baby care even on the internet parents experience
uncertainty in the multiple daily choices on sleep, stimulation, food etc. Premature birth with hospitalization and experiences
of risk, accentuates the insecurity as it is difficult to know if the child is normal. Peer Groups should provide recognition and
sharing, but can contribute to the stigma of premature families in the process of mutual assessment practiced in the groups.
Conclusion: Monitoring in Denmark contributes adversely to parental insecurity. Parents expect answers helping to guide
daily micro decisions in baby care. This parental knowledge however is not often scientific evidence but a trial and error
journey especially the first 4 month after discharge.
www.coinn2013.com53
FP06: First-time Fathers Of Preterm Infants: The Pregnancy Narrative And Preterm
Birth. An Exploration Of The Concept In Neonatal Fatherhood Research
Crathern, Liz
School of Nursing and Midwifery, University of Sheffield, LEEDS, United Kingdom
Background: Transition to fatherhood in neonatal intensive care (NIC) is challenging. Recent neonatal research has seen an
increase in neonatal studies that have focused on the experiences of fathers in NIC. Historically, neonatal research on fathers
has begun its enquiry at or around the time of birth. However, this paper extends that enquiry by presenting findings on
fathers’ lived experiences during the pregnancy, and the time leading up to the preterm birth.
Methodology, method and sample: The research was guided by Heideggerian phenomenological methodology. 8 fathers
consented to tape recorded interviews and these were conducted within the first week of their infants’ birth. 6 of the 8 fathers
consented to a follow up interview and these were conducted close to their infants’ discharge date. The infants’ gestational ages
ranged from 27 -- 35 weeks. Fathers were offered a transcript of their interviews, all the fathers requested personal copies.
Findings: This paper discusses a key theme that emerged from research findings on the experiences of first time fathers of preterm
infants. The open style of questioning, commensurate with the methodology, yielded rich thick narrative for analysis. Asking the question
‘can you tell me about your experiences leading up to the birth of your infant’ generated narrative on the men’s lived experience of
supporting their partners throughout the pregnancy, and their experience in delivery suite. The findings were captured within the theme:
Anticipatory fatherhood: the challenges of a preterm birth. It is hoped presenting the men’s narratives of their lived experiences will
challenge pre-existing ideas and stimulate new ways of thinking about how to improve family care to first time fathers in NIC.
Implications for practice, policy, education and research: This particular finding from the research adds to that emerging
body of new knowledge, suggesting implications for practice, policy, education and research.
54
GLOBAL HEALTH ISSUES
FP07: Who Are We? How Are We Trained? What Do We Do? Where Do We Practice?
: The COINN Global Neonatal Provider Database Initiative (CGNPD)
Eklund, W1; Karlsen, KA2; Boykova, M3; Fleck, PC1; Bugrara, K4; Damus, K1; Kenner, C1
School of Nursing, Northeastern University, USA; 2Author/Founder National Program Director, The S.T.A.B.L.E. Program, USA;
3
College of Nursing, University of Oklahoma, USA; 4Program Directorâ€¨Information Systemsâ€¨Graduate School of Engineering,
Northeastern University, USA
1
Background: Achieving the UN’s MDG#4, to reduce by 2015 two-thirds of the mortality for the population 5 and younger,
will require a major focus on improving neonatal outcomes since more than a third of these deaths occur in the neonatal
period.(WHO 2013). Reducing neonatal mortality will also impact MDG#5 to improve maternal health since the majority of
neonatal deaths are related to preterm births and major determinant is the health of pregnant women. Therefore, neonatal
nurses, who collectively form the largest workforce in neonatal healthcare, are integral to achieving both MDGs in developed
and developing nations, and a global database of who they are, where they work, how they are trained and what they do is
urgently needed as currently none exists.
Methods: In 2013 a COINN workgroup with input from an Advisory Council created a survey which will prospectively collect
profiles of neonatal nurses, expanding to include all neonatal providers worldwide, resulting in a global database of the
neonatal workforce. The survey explores the demographic characteristics, years of experience, scope of practice, work
environment, availability of neonatal specialty education, and other elements relevant to the neonatal nursing workforce
meeting the needs of the neonates in countries worldwide. This rich resource, housed on the COINN website, will be used for
planning and evaluation of neonatal workforce and practice issues such as training and the distribution of neonatal care. It
will also be analyzed in conjunction with global neonatal outcome data to better understand the gaps in neonatal care delivery
and training needs of healthcare workers within the vast diversity of international resources and healthcare delivery systems.
Results and Implications: The survey structure, results of the 2013 pilot, the planned global launch and a 5 year timeline of
this COINN initiatives will be presented. Its implications for the development of global neonatal and maternal policies will be
discussed.
World Health Organization (WHO). (2013). Millennium Development Goals.
http://www.who.int/topics/millennium_development_goals/en/
www.coinn2013.com55
FP08: Does Imparting New Knowledge Improve Neonatal Care In The Developing
World? If Not, Why Not? Reflections On Working In A Rural Hospital In Uganda
Crathern, Liz1; Evans, D2
freelance international healthcare consultancy, freelance consultancy, Leeds, United Kingdom;
2
Yorkshire neonatal network UK, United Kingdom
1
Introduction: For some years, we have worked with Nyakabale hospital, Rukungiri, Uganda and the school of nursing to help
improve care delivery of neonates within the maternity unit, culminating in the provision of a designated neonatal nursery
that provides basic care to neonates who are born early or require additional nursing / medical support. This paper presents
a reflection on this working relationship and the challenges inherent in such a task with reference to working in a different
culture, millennium development goals and relevant research that informed our decisions.
Background: Seven years ago, at Nyakabale hospital, neonates who were too ill or preterm to be nursed next to their
mothers were left in a room , unmonitored, no bigger than a cupboard, in a primitive incubator heated by light bulbs and
cared for by pupil nurses. Mortality was very high and infants were dying due to poor resuscitation skills at birth, hypothermia,
inadequate nutrition and a lack of staff training in neonatal care.
Content - issues explored: Working in a micro culture that was male dominated and hierarchical. Getting the medical and
nursing team on board with new ideas. Introducing new ways of teaching and learning. What we achieved. What we did not
achieve and why. What we struggled to achieve and how we managed to succeed - learning from our mistakes. Sustainability
training longer term - a serious issue Our legacy?
Summary: It is hoped our very honest reflection will help others, who want to work more globally, learn from our
achievements but also from our mistakes. As neonatal nurses we have a global responsibility to share new knowledge and
skills with developing countries in a way that is challenging but also congruent and sensitive to cultural norms.
FP09: Reasons Why The WHO/UNICEF 10 Steps To Successful Breastfeeding require
Modification For Application In Neonatal Wards
Nyqvist, KH1; Ezeonodo, A2; Haiek, LN3; Hannula, L4; Hansen, MN5; Kylberg, E6; Frandsen, AL7; Maastrup, Ragnhild8; Haggkvist, A-P5
Department of Women’s and Children’s Health, Uppsala University, Sweden; 2Helsinki University Children’s Hospital, Finland;
3
Direction Générale de la Santé Publique, Ministère de la Santé/Services Sociaux,Quebec, Canada; 4Faculty of Health Care
and Nursing, Helsniki Metropolia University of Applied Sciences, Finland; 5Norwegian Resource Centre for Breastfeeding, Oslo
University Hospital, Norway; 6School of Life Sciences, University of Skövde, Sweden; 7Neonatal Intensive Care Unit, Holbaek
Hospital, Denmark; 8Neonatalklinikken, Rigshospitalet Copenhagen, Denmark
1
Background: In response to the World Health Organization/United Nations Children’s Fund ‘Baby Friendly Hospital Initiative:
Revised, Updated and Expanded for Integrated Care’ (2009), the expert group prepared an expanded version of the 10 Steps
to Successful Breastfeeding for Neonatal Wards. The documents will be available in 2014.
Reasons for modification of the BFHI program: Infants requiring neonatal care and their mothers have different needs
compared with healthy term infants-mothers, and require a modified lactation/breastfeeding policy. In a Baby-Friendly
neonatal ward the clinical staff receive education and training in the specific knowledge and skills required for lactation/
breastfeeding counselling in neonatal care. Pregnant women at risk for delivery of a preterm/sick infant receive individualized
information about the specific benefits of breastfeeding for their infants, and about management of lactation and
breastfeeding in their situation.
56
Parents’ application of continuous or intermittent and prolonged skin-to-skin contact with their infants (Kangaroo Mother Care)
is facilitated without unjustified delays and restrictions. The mothers are shown how to initiate and maintain lactation using
breastmilk expression by hand or pump, and to initiate breastfeeding with infant stability as the only criterion. Staff members
offer mothers breastfeeding observation and hands-off support during the infants’ whole hospital stay. The infants are not given
any other nutrition than breast milk unless medically indicated. Efforts are made to enable mothers/infants to remain together 24
hours/day. A semi-demand breastfeeding strategy is used during the transition to full breast/oral feeding. Alternatives to bottle
feeding are used at least until breastfeeding is established; pacifiers/nipple shields may be used for justifiable reasons. Parents
are well prepared for discharge and ensured access to breastfeeding support after hospital discharge.
According to 3 Guiding Principles, the staff have a focus on the individual mother’s situation, and that families are ensured a
family-centered care and environment, and continuity of care.
FP10: Global Health Issues: Neonatal Nurse Education In Developing Countries
Mannering, Karien1; Beecroft, G2
1
Neonatal Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand; 2Neonatal Intensive Care Unit, Christchurch
Hospital, New Zealand
Background: The New Zealand Neonatal College Aotearoa (NNCA) is actively contributing to the United Nations Milleneum
Development Goal (MDG) number 4; to reduce Infant Mortality. In developing countries the three major causes of death in the
first month of life are; Preterm Birth, Birth Asphyxia and Severe Infection. A key issue in many developing countries is the lack
of specific neonatal nursing education and skills.
New Zealand has strategic relationships with Samoa, a developing Pacific Island nation. NNCA in association with the
Regional Pacific Development Unit, Counties Manukau District Health Board are currently supporting the pilot project for the
Provision of Neonatal Education in Samoa. The focus of this presentation is on the outcome and evaluation of this Neonatal
Education programme.
Method: Site and assessment visit in 2010 at the Neonatal Unit, Tupua Tamasese Meaole Hospital, Apia, Samoa. The
P.O.I.N.T.S of Care Neonatal Nurse Education Pilot programme implementation in February and August 2012, with imminent
evaluation in April 2013. The P.O.I.N.T.S of Care Neonatal Nursing Education programme is aimed at providing nurses with
the knowledge and skills around the six core aspects of neonatal care; Pain management, Oxygen management, Infection
management, Nutritional management, Temperature management, and Supportive Care. A major component of the
programme is the ‘train the trainer’ concept. This method is to provide transferable skills to designated Samoan Neonatal
nurses for ongoing sustainability and development of the Neonatal Nursing workforce in Samoa.
Result: The template for the provision of Neonatal Nurse Education in the Pacific. This outcome completes the quality
partnership loop between NNCA and the Regional Pacific Development Unit resources. The potential development of this
project has worldwide significant implications for Neonatal Nurses. The challenge is to grasp the opportunity to lead delivery
of Neonatal nurse education in developing countries to reduce infant mortality.
www.coinn2013.com57
FP11: Traditional Practices of Newborn Care in a Nepalese Village
Nepali, Shobha
Sydney Childrens Hospital Network, Westmead Campus, Westmead, Australia
Background: According to the Nepal Demographic and Health Survey 2011 the neonatal mortality rate is 33 per 1000 live
births. Unlike in previous surveys neonatal tetanus did not appear to be the leading cause of high neonatal mortality. However,
the 2011 annual report published by the Department of Health Services reports that in Nepal, 72 per cent of births still take
place at home. Although education and media have changed the behaviour of youths these days, the majority of people still
practice traditional birth rituals, some of which might contribute to the high neonatal mortality rate. This paper provides an
overview of traditional newborn care practices in a Nepalese village.
Method: This paper is based on the presenter’s cultural learning through her upbringing in the village. So, this is the result of
day-to-day observations carried out informally over time and comparison made between old traditions, recent practices and
the scientific evidence.
Results: Sunlight, rain and fire are considered nature’s gifts. Therefore, people in this village have their own rules for life
and traditions for newborn care. Firewood is the main source of energy, light and warmth in this village. Breastfeeding
the newborn baby is taken-for-granted and lactating neighbors are sought in the first place if mother is sick or unable to
breastfeed. Exposing the baby in sunlight is everyday practice. The baby is massaged vigorously with heated mustard oil.
Mother-baby co-sleeping is common. The practices of delivery in byres, cutting umbilical cords with the sickle and dressing
the cord stump with cow dung no longer exist. While some of the practices are harmful, others are harmless and/or beneficial
for neonate’s health and well-being.
Conclusion: Although many traditional rituals are still practised in this village, people have changed their attitudes and
behaviours dramatically over the years.
58
FP12: Stillbirths in Northern Ireland: what lessons can be learnt?
Spence, Dale1; Hunter, A2; Gardosi, J3
1
School of Nursing & Midwifery, Queen’s University Belfast, Belfast, United Kingdom; 2Fetal Medicine, Belfast Health & Social Care
Trust, United Kingdom; 3Perinatal Institute, Warwick University, United Kingdom
Background: Fetal growth restriction (FGR) is a leading cause of stillbirth. In many cases antenatal detection/management of
FGR could prevent stillbirth. The ReCoDe pathological classification system has shown that the actual percentage of stillbirths
due to FGR is greater than reported by the CMACE system.
Aim: Determine the rate of stillbirth in Northern Ireland (NI) due to FGR comparing CMACE and ReCoDe classifications.
Methods: NIMACH (NI) granted access to their stillbirth register January2008-December2011. Anonymous, data relating
to mother/baby were elicited (complete data 403 stillbirths). Details were categorised according to CMACE and ReCoDe
classifications. FGR (birthweight below the tenth customised centile), adjusted for maternal height/weight/ethnic group/parity,
with 2 days deducted from gestational age at delivery, representing the average delay between fetal death and delivery.
CMACE
ReCoDe
n
%
n
%
Congenital anomaly
62
15.4
62
15.4
Fetal growth restriction
25
6.2
144
35.7
Placenta and cord
118
29.3
63
15.6
Maternal conditions
40
9.9
22
5.5
Infection
34
8.4
26
6.5
Intrapartum
2
0.5
1
0.2
Miscellaneous
19
4.7
15
3.7
Unclassified / unexplained
103
25.6
70
17.4
Total
403
100.0
403
100.0
Results: Table shows main categories of stillbirths, according to CMACE and ReCoDe. A total of 25.6% and 17.4% cases,
respectively, remained unclassified. The main reason for fewer number according to ReCoDe was a higher rate of stillbirths
identified as FGR, representing the single largest category of stillbirths: 35.7%. Conversely, more cases according to CMACE
had placenta/cord conditions.
Conclusions: Use of maternal characteristics and customised fetal growth charts gives more accurate rate of stillbirth caused
by FGR. It is essential that the most accurate method of coding for stillbirth is used throughout the UK. These results highlight
the need for maternity services to develop better strategies to detect FGR in pregnancy and help reduce a preventable cause
of stillbirth.
www.coinn2013.com59
HEALTH & DEVELOPMENTAL OUTCOMES
FP13: The Survival Of The Neonate After Maternal Death, Time Series From 2006 To
2010, Florianopolis, Santa Catarina, Brazil
Souza, Maria de Lourdes1; Del Castanhel, Marcia Sueli2; Martins, Haimee E.Lentz3; Brüggemann,
Odaléa Maria4; Radünz, Vera5; Oliveira, Maria Emilia de6
1
Institute REPENSUL, Federal University of Santa Catarina, Florianópolis, Brazil; 2Coordinator of Child Health, Municipal Health
Secretariat of Florianópolis, Brazil; 3Course of Nursing and Nutrition, Federal University of Tocantins (UFT), Brazil; 4Department
of Nursing, Federal University of Santa Catarina (UFSC), Brazil; 5Nursing, Federal University of Santa Catarina, Brazil; 6Nursing,
Federal University of Santa Catarina (UFSC), Brazil
Introduction: The survival of the neonate may be compromised when maternal death occurs. Objective: To analyze the
survival of neonates born alive upon the occurrence of maternal death.
Method: Case study with historical series from 2006 to 2010, with monitoring of maternal deaths to live births of neonates
whose mothers were residents of the state capital Florianopolis, Santa Catarina, southern Brazil.
Results: Ten neonates surviving maternal death were identified. Nine of them were included in this study, and one excluded for
late maternal death due to non-obstetric. The mean birth weight was 2,647 grams including three babies weighing less than
2,500 grams. The average Apgar score for the first minute was 7, increasing in the fifth minute to 8. As for gestational age, five
were preterm, three were term, and one post term. The main causes of maternal deaths were associated with hypertensive
disease in pregnancy and infection. It is expected that the first social contact established by the neonate be with the mother, but
this was prevented by the maternal death. The nursing care was essential to provide the care and comfort measures necessary
to the neonate during the stay in the hospital neonatal unit. It was also important for guiding and following up with the family to
take on the role of providing security and protection to the child.
Conclusion: The nursing care, the support of the family and the vitality of the newborns studied were favorable, considering
that they were all alive until the fifth year of life, despite the events that triggered the maternal death have contributed to
premature birth.
60
FP14: Unexpected Birth Outcomes: The Pregnancy That Follows
O’Leary, Joann
Center for Early Education and Development, University of Minnesota, Minneapolis, MN, USA
Background: When families experience an unexpected outcome such as preterm birth, the loss of a baby in a multifetal
pregnancy, or an infant loss, parent’s view of pregnancy is greatly altered. This presentation describes changed parenting
behaviors that surface during the pregnancy that follows and raising children in families who have experienced a previous
unexpected outcome. Information includes the altered tasks of pregnancy for both mothers and fathers, sibling issues alive at
the time of loss, children born after and surviving siblings from a multi-fetal pregnancy. A prenatal relationship focused model
of attachment intervention will be described to support parenting of preterm babies and the continued bond of a deceased
baby to help parents attach to the baby that follows.
Method:
Data from the author’s three descriptive phenomenological studies:
1. Separate interviews of mothers and fathers in the pregnancy following loss
2. Parents raising children after a loss
3. Adults who were the child born after loss
Results: Findings in the pregnancy study address how ones view of parenting changes after an unexpected outcome in
the childbearing years. Both mothers and fathers spoke to increased fear and anxiety, fearing to attach because of another
preterm birth or loss and fathers feeling isolated while holding back emotions to protect the mother.
Findings in the study raising children after loss address intentional parenting while working to not be over protective.
Adult children born after a loss address themes of being invisible in their family or treasured, a theme not found with the
parents raising children who had intervention during their pregnancy. A surprising result was finding common themes in both
the young children and adult subsequent children of feeling a connection with their deceased sibling, sensitivity to others and
a comfort level, not fear, around death and grief in others.
FP15: An endeavour to reduce neonatal morbidity and mortality in Botswana
Rakata-Sejeso, Ruth Maitshoko1; Maree, Carin2
1
Midwifery, Institute of Health Sciences, Gaborone, Botswana; 2Nursing, University of Pretoria, Republic of South Africa
The education of nurses influences their clinical decision making and rendering of care. This is also the case in Botswana
regarding neonatal care.
The neonatal morbidity and mortality in Botswana is identified as a significant problem, which might be addressed by
implementation of neonatal training of staff. Instead of reinventing the wheel, the purpose of this study was therefore to
evaluate existing neonatal care programmes for suitability to implement evidence-based practice in the neonatal units of the
two referral hospitals in Botswana.
An integrative review was done as suggested by Whittemore and Knafl (2005). Thirteen neonatal training programmes were
reviewed for suitability to address the needs for neonatal care in Botswana’s referral hospitals.
The programmes had moderate to high levels of evidence-based practice, were scientifically based and respectively included
aspects that could significantly benefit Botswana, but there was not a particular programme that could be utilized as it was.
www.coinn2013.com61
It is recommended that Botswana should develop and implement their own neonatal training programme to address their
unique needs while adopting the valuable aspects from existing programmes that could be of relevance. A neonatal training
programme based on the particular needs of the country might be an efficient way to improve clinical decision making,
skills and quality of neonatal care rendered, which in turn is expected to reduce neonatal morbidity and mortality, as part of
reaching the millennium development goal: 4 in Botswana.
FP16: Neonatal pain causes alteration in long-term developmental outcomes:a systematic review
Ward-Smith, SJ
Child Health, Birmingham City University, United Kingdom
Background: There is now big questions that need to be asked about how certain areas of newborn care is evolving. One
of these questions is about the continued poor management of neonatal pain and the long-term consequences of this. This
systematic review was written to amass evidence to support the theory that poorly managed pain can cause detrimental
long-term developmental outcomes to the individual.
Methods: The search resourced 756 papers of which 46 were used for abstract appraisal. 32 papers were then chosen for
full study review. Studies that were selected all had partifipants who had expereinced pain and stress within the neonatal
period, regardless of their gestational age. All the studies were quantitative and there were a small number that had animal
based data. The age of the individual at the time of the study was varaible and the places where data was obtained depended
upon the age of the participants.
Results: 10 studies were finally selected. The main themes that emerged from these had a physiological background and
detailed that pain and stress experienced in the neonatal period caused alterations to the central nervous system affecting
normal development. The long-term effects of this causes chronic pain syndromes, depression and other mental health
conditions as the individual matures; causing developmental outcomes to be altered in some individuals with chronic
conditions that can be life restricting.
Conclusion: Pain and stress experienced during the neonatal period causes alterations in the cns, which increases the
risk of abnormal physical and psychological responses, regardless of the individual gestation. This can cause long-term
developmental outcomes to be altered in some individuals and cause chronic conditions that can be life restricting. Past
populations must continue to be followed up enabling the evidence to protect sick newborn of the future.
62
FP17: M-CHAT And Follow-up Interview Screening And ADOS Diagnosis Of Autism
In VPT Children Attending A Developmental Follow-up Program
Pritchard, Margo1; de Dassel, T2; Bogossian, F3; Scott, J3; Crothers, C4; Cartwright, D2; Johnston, L5;
Russo, S6; Beller, E7; Hovey, D4; Paynter, J8
1
Womens Newborn Services, Royal Brisbane Women’s Hospital, UQCCR, Brisbane, Australia; 2Womens Newborn Services,
Royal Brisbane Women’s Hospital, Australia; 3The University of Queensland, Australia; 4Womens Newborn Services, Royal
Brisbane Women’s Hospital, UQCCR, Australia; 5Queens University, Ireland; 6Better Life Psychology, Australia; 7Bond University,
Australia; 8AEIOU Foundation, Australia
Background/Aims: Very preterm children (VPT-born < 29 weeks gestation) are at high risk for neurodevelopmental
problems. We examined the utility and associated correlates of the Modified Checklist of Autism in Toddlers (M-CHAT) and
Follow-up Interview (FI) and, the prevalence of autism spectrum disorder (ASD), including autistic disorder, in a hospital based
VPT cohort.
Method: Cross-sectional cohort of infants returning for their 2 and 4-year corrected age for prematurity infant follow-up
neurodevelopmental assessment. Following completion of the M-CHAT-FI screening tool, blinded diagnostic assessments for
developmental status were conducted. Diagnostic assessment for autism was conducted on M-CHAT-FI positive infants using
the Autism Diagnostic Observation Schedule (ADOS).
Results: Complete data were available on 169/192 (88%) (2-years, 81/87 and 4-years, 88/105) children. Thirteen percent
(22/169) of children screened positive on the M-CHAT-FI. Multivariate analysis showed that social emotional delay (OR 26
95%CI 8.8, 80; p=<0.001) was independently associated with M-CHAT-FI positive results even after adjusting for profound
developmental disability, psychosocial risk, child gender and ADOS positive results (OR 19 95%CI 8.0, 60; p=<0.001). The
prevalence for autistic disorder using ADOS was 1.8% (3/169) and nil for ASD. The M-CHAT-FI false positive infants showed a
possible sub-threshold communication dysfunction profile on ADOS testing. Mothers stated they found the M-CHAT-FI useful
in articulating their infants’ behaviour.
Conclusion: This is the first study using the M-CHAT-FI within the context of developmental follow-up, which successfully
identified autism and a sub-clinical communicative phenotype suitable for early intervention. The findings document the rate
of ASD in VPT early infancy that is lower than previous reports, but higher than the general paediatric prevalence.
www.coinn2013.com63
FP18: Impact of neonatal intensive care admission on Late Preterm Infants: health
outcomes and family functioning at 3 years of age
McGowan, Jennifer1; Alderdice, F A2; Doran, J2; Holmes, V A2; Jenkins, J G3; Craig, S4; Johnston, L2
1
School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom; 2School of Nursing and Midwifery,
Queen’s University Belfast, United Kingdom; 3School of Medicine, Dentistry and Biomedical Sciences, Queen’s University
Belfast, United Kingdom; 4NICORE Project, Royal Maternity Hospital, Belfast, United Kingdom
Background: Late preterm infants (LPIs), born at 34+0 to 36+6 weeks gestation account for up to 75% of all preterm
births, constitute a significant proportion of all neonatal admissions and are increasingly regarded as being at risk of adverse
developmental outcomes compared to term born children. This study sought to assess the impact of neonatal intensive care
(NIC) on health outcomes of LPIs and family functioning at three years of age.
Method: This cohort study recruited 225 children born late preterm, between 1 January 2006 and 31 December 2006 in
Northern Ireland. A study group of children born late preterm and admitted for any episode of intensive or high dependency
care (British Association of Perinatal Medicine, 2001) (n=103) were compared with a control group of children born late
preterm who did not require NIC or who required Special Care only for less than or equal to three days (n=122). Health
outcomes were measured using the Health Status Questionnaire and family functioning using the PEDSQL: Impact on Family
Module.
Results: LPIs who received NIC were more often 34 weeks gestation (40.8%), with lower birthweight (<=2500g) (58.3%)
and poorer Apgar scores (<= 7 at 5 mins) (13.8%) compared to the control group (14.8%, 38.6%, and 2.7% respectively,
p<0.01). LPIs admitted to NIC were more often born by Caesarean section (70% vs. 33%, p<0.001) and were more likely to
have had resuscitation at birth (46% vs. 16%, p<0.001). Children born late preterm who received NIC revealed similar health
outcomes at three years to those born late preterm who did not require neonatal intensive care; despite this however, more
parents of LPIs who required IC at birth reported visiting their GP during their child’s third year of life. Differences in family
functioning were also observed with significantly lower levels of social and physical functioning; increased difficulties with
communication and increased levels of worry reported among mothers of LPIs who required IC at birth.
Conclusion: Whilst LPIs were observed to have similar health outcomes at three years of age, there was an observed
increase in GP usage among those infants who required neonatal IC. In addition, parents of these children reported some
difficulties with family functioning.
64
NEONATAL RETRIEVAL & TRANSPORT STABILISATION
FP19: Aeromedical Neonatal Nursing: Long distance repatriation of an extremely
preterm infant
Moran, Lisa1; Brown, G1; MacFarlane, L1; Emery, F1; Bennett, C2
Neonatal Unit, Oxford University Hospitals NHS Trust, United Kingdom; 2Neonatal Medical Director, AirMedical Ltd, Oxford,
United Kingdom
1
Background: A specialist international neonatal ‘fixed wing’ air ambulance service was established in Oxford, UK in 2011,
has to date undertaken 50 perinatal transfers comprising over 40,000 patient air-miles. The service was approached to assist
in the decision making and execution of a safe aeromedical repatriation of an extremely premature baby born in Denver
Colorado USA to London UK. Aeromedical neonatal nursing expertise was key to the successful planning of the mission and
delivery of high quality care during this long distance transfer.
Methods: Meticulous attention to detail was invaluable in the success of the project. Close collaboration and organisational
planning with all facets of the aeromedical service including neonatologists, pilots, ground operations team and engineers,
identified logistical challenges and potential solutions. Proposed flight plans were carefully reviewed to assess the impact
on clinical care and risk of team fatigue. Procurement of additional equipment and requirements for training were organised,
including simulated rehearsal of potential clinical emergencies. Bespoke checklists were devised, team roles allocated and
a strategy for conjoint multi-professional nursing and medical handovers developed. Contingency for emergency diversion in
flight included mapping of all NICU facilities en-route. Close collaboration with the assistance company, treating team, parents
and the receiving institution were implemented throughout the planning phase.
Results: A team comprising two senior neonatal nurses and a neonatologist working in close collaboration with the flight
crew and ground support teams, conducted a successful four day mission involving the 5,000 mile repatriation of a 1.2kg
neonate supported on high flow therapy. They recorded a photographic dairy and ensured communication with the family at
every step of the journey.
Summary: Success of this complex and challenging long distance transfer was dependent on meticulous pre-flight planning by
the aeromedical neonatal nursing team working in close collaboration with all multi-professional components of the service.
www.coinn2013.com65
FP20: Neonatal Nurse’s Perceptions And Experiences Of Neonatal Transport Services
Kelly, A
Department of Paediatrics and Newborn Medicine, Coombe Women & Infant’s University Hospital., Ireland
Neonatal transport occurs everyday throughout the world, both ground and air, acute and reverse transfers. The aims and
objectives of this study was to gain a valuable insight into the views of neonatal intensive care nurses presently working
on, or eligible to work on, the National Neonatal Transport Programme. An extensive literature review informed the research
question that lent itself to a quantitative descriptive survey design, using a questionnaire. The study was conducted in three
neonatal units from which the National Neonatal Programme operates. Following validation of the questionnaire, pilot study
and ethical approval, the questionnaires were distributed to ninety-nine neonatal nurses, working in the hospitals recruiting
to the National Neonatal Transport Programme. The participant’s perceptions and experiences of neonatal transport services
were assessed using a 15 - item section questionnaire rating their perceptions and experiences on a five point likert scale.
In addition two open-ended questions allowed participants to provide additional information on incentives and potential
disincentives to working on critical care transport. The response rate was 80.1 percent. The main findings of the study
revealed, the feelings of immense responsibility and accountability these nurses perceive or experience, when assisting
neonatal transport, and they have a strong desire for continued training and education to support them. Transporting an infant
from one neonatal intensive care unit to another is a critical situation; it requires expert nursing care, collaboration, and the
capability of quick decision-making. The supervision of patients during transport is a fast expanding area in healthcare and
the nurses assisting with neonatal transport both locally or nationally should be professionally recognized and supported.
FP21: Successful Back Transfers in Victoria Australia are they a Myth?
Presbury, FE1; Dawson, JA2; Kamlin, COF3; Smith, R4; Stewart, M4; Piriatinski, J5
Paediatric Infant Perinatal Retrieval Service (PIPER), Royal Children’s Hospital, Australia; 2Research, Royal Womens Hospital
Victoria, Australia; 3Neonatalogy, Royal Womens Hospital Victoria, Australia; 4Paediatric Infant Perinatal Retrieval Service
(PIPER), Royal Childrens Hospital, Australia; 5Information Technology, Royal Childrens Hospital, Australia
1
Background: Stable premature and term babies are often transferred from Neonatal Intensive Care Units (NICU’s) to hospitals
closer to their family home. Staff from Special Care Nurseries (SCN’s) in Victoria have raised concerns that some babies maynot
be ready for these transfers, as they have observed these babies experiencing deterioration in their clinical condition. The aim of
this survey was to describe factors contributing to clinical deterioration in the first 18-30 hours after the back transfer.
Method: Prospective convenience sample of babies transferred by road or air during 2010 were included. Collection of
demographic and clinical data on each baby prior to and during transfer. A survey completed by SCN staff was used to obtain
clinical data about the babies first 18-30 hours after admission to SCN.
Results: 600 babies were transferred during the study period. Babies not included in the study; the survey data was not
completed within the 18-30 hour of admission and 4 babies were discharged from the SCN before the 18-30 hours of
admission. A total of 396 babies were studied (mean (SD) gestation at back transfer 35(4) weeks and Medium weight
2382(846) grams. 23% (93) of babies were described as having a deterioration in their clinical condition, with 0.5% (3) babies
transferred and readmitted to a NICU, 8.5% (32) commenced oxygen, 19% (76) experienced feeding intolerance, 7.3% (27)
experienced apnoea and bradycardia. This current data represents all return audits.
Conclusion: Back transfers are well tolerated by the majority of babies, only a small proportion of babies deterioration in the
first 18-30 hours following transfer. Further analysis of the data will determine if mode, length of transport, post natal age,
gestation and weight at time of back transfer influence cardio-respiratory stability after transfer to SCN’s.
66
FP22: An Innovative Lactation Support Intervention For Mothers Of Premature
Infants - A Pilot Study
Héon, Marjolaine1; Goulet, Céline2
1
Faculté des sciences infirmières, Université de Montréal, Montreal, Canada; 2Faculté des sciences infirmières, Université de
Montréal, Canada
Background: Compared to mothers who give birth at term, mothers of premature infants are three times more likely to
present with an insufficient breast milk production. It is therefore crucial to support mothers of premature infants in the
establishment and maintenance of an adequate breast milk production.
A pilot randomized clinical trial (RCT) was undertaken to assess the acceptability and feasibility of an innovative lactation
support intervention in mothers of premature infants and estimate its effects on breast milk production outcomes. It was
hypothesized that mothers of premature infants receiving the innovative intervention would express their breast milk
significantly longer and more frequently and would produce a greater breast milk volume with a higher lipid concentration
compared to mothers of premature infants receiving usual care.
Methods: Forty mothers of premature infants born at <30 weeks of gestation were randomly assigned to the lactation
support intervention (experimental group) or usual care (control group). The lactation support intervention was delivered
by a certified lactation consultant nurse over a six-week period and had three components: an education session on the
establishment and maintenance of an adequate milk production, a telephone follow-up, and a telephone help line. In both
groups, mothers kept a logbook of their breast milk expression sessions (frequency, duration, and milk volume). Three breast
milk samples were collected and were analyzed for their lipid concentration.
Results: Both the intervention and study procedures were acceptable to mothers of premature infants and feasible. With the
exception of breast milk lipid concentration, results are oriented in the same direction as the research hypothesis.
Conclusion: A pragmatic full-scale RCT should be conducted to evaluate the effects of the lactation support intervention on
breast milk production outcomes in mothers of premature infants. The results of this pilot study are promising and underscore
the importance of supporting mothers of premature infants in their breastfeeding journey. .
FP23: An Evaluation of Cheshire and Merseyside Neonatal Network Transport
Service Transfer Activity to Paediatric Services
Jackson, Carol
Cheshire and Merseyside Neonatal Network Transport Service, Liverpool Women’s Hospital, Liverpool, United Kingdom
Objectives: to evaluate Cheshire and Merseyside Neonatal Network Transport Service referral and transfer activity to
paediatric services for specialist investigations and ongoing care.
Design: a retrospective review of neonatal transfers arranged and completed over a 12 month period (1st April 2012 to
31st March 2013). Data Source: Cheshire and Merseyside Neonatal Network Perinatal Cot Bureau Data. Main outcome
measures: frequency of neonatal transfers and reason for transfer to access paediatric services. Comparison of transfers
being undertaken during the week versus transfers being undertaken at the weekend and out of hours. Transport personnel
undertaking transfers.
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Results: during the period under review out of a total of 809 transfers 304 (38%) transfers were undertaken in order to
access paediatric services for specialist investigation, treatment and ongoing care. A total of 260 transfers were conducted
within hours and 44 out of hours. Transfers were undertaken to all paediatric wards and departments. Transfer referral
requests were classified as emergency 133 (44%); urgent 121 (40%); non-urgent 49 (16%). 279 transfers were undertaken
to Alder Hey Children’s Hospital. 110 transfers were doctor-led, 58 were ANNP-led and 111 were nurse-led. Further analysis
showed that there were 25 transfers undertaken which were direct referrals from Alder Hey Children’s Hospital to the transfer
service following day case investigation/surgery to NICU’s within C&MNN. Of the 25 day case transfers undertaken from Alder
Hey Hospital post investigation/surgery, 10 were doctor-led, 2 ANNP-led and 13 were nurse-led. When assessing reasons for
transfers, the majority were surgical (150 - 54%), 65 (23%) were for clinic/scan, 44 (16%) were cardiac, and 20 (7%) were
medical.
Conclusions: analysis of the data presented in this paper has highlighted that significant numbers of infants are transferred
by CMNNTS to access paediatric services for specialist services and ongoing care within the Cheshire and Merseyside
Neonatal Network.
FP24: Implementing Inter Facility, Ambulance KMC. Changing Attitudes, Saving
Lives in South Africa
Booysen, V E
Maternal, Neonatal and Child Health Unit Dept Of Health, Free State Province, South Africa, South Africa
Background: The transport of a neonate is always a very stressful situation because of a Neonates Physiological Instability.
The mode of transport by ambulance has always been in a Transport Incubator. Despite being in a pre warmed transport
incubator....neonates often complicate on route, and especially HYPOTHERMIA is life threatening for a neonate
Method: The Saving Babies Report and NaPeMMCo Triennial Reports recommend and insist that the Bogota Declaration of
1989 be adopted. “Kangaroo Mother Care is a Basic Right of the newborn, and should be an integral part of the management
of low birth weight and full term newborns, in all settings and at all levels of care, in all Countries.”
KMC has been widely accepted and adopted IN HOSPITAL Institutions... but very little has been researched or documented on
implementing KMC during a Neonatal Transfer by Ambulance
Results: The Free State Province has adopted Inter facility KMC AS THE PREFERRED MODE OF TRANSPORT FOR ALL
NEONATES. By road, helicopter and fixed wing airplane. A SUMMARIZED PRESENTATION on Staff experiences of “before
KMC...AND after KMC” with be shared with the delegates. Personal experiences, mother’s stories and vital signs of the
Neonate during transport and at the referral hospital.
Conclusions: KMC not only humanizes neonatology, it makes better use of the human resources available, even in an
Ambulance. Resulting in less stressed staff, mothers, and babies, thus improving Neonatal Outcomes, not only on route, but
increases the long term outcome for the Neonate.
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APN & WORKPLACE MANAGEMENT
FP25: Competency Development In Neonatal Care In South Africa
Scheepers, Mariana1; Maree, Carin2
1
Nursing, University of Johannesburg, Auckland Park, South Africa; 2Nursing, University of Pretoria, South Africa
Background: The neonatal period, which is the first four weeks of life, holds the highest risk of death compared to any
other period in the human lifespan. Due to this high risk period, there is an expectation for competent care which is directly
influenced by the required competencies from the healthcare workers responsible for the care.
In South Africa neonatal care is provided by various categories of nurses. Acquisition of competency in neonatal care is
essential to address the high neonatal mortality rate in South Africa. However, currently there is no framework for professional
development in neonatal practice that clarify what competencies can be associated with being a novice, advanced beginner,
proficient, competent or expert of each category of nurse regarding neonatal care.
Research methods: Improving neonatal practice by developing a competency framework for professional development of
different categories of nurses in neonatal practice can help facilitate the development of high quality nurses practicing with the
right skills and competencies in the health care facilities in South Africa.
The research is conducted in three phases utilising the principles of consensus research. In this study a sequential exploratory
mixed methods design is used to address the issue of professional development and competency of different categories of nurses
in neonatal practice. The research question is being answered by participants researching consensus on their understanding of
competency by constructing relationships between information and facts as well as their existing knowledge and experience.
Results: To date preliminary results of competency workshops would appear to indicate that there are essential competencies
that are central to the practice of nursing neonates unique to the South African context. The competency framework will
contribute to the global practice and understanding of neonatal competencies by providing a Southern African perspective.
FP26: A NICU-based Nursing Research Fellowship Program For Staff Nurses:
Empowered Nurses Lead To Better Patient Outcomes
Rodriguez, Nancy
Pediatrics, NorthShore University HealthSystem, Evanston, USA
Purpose: to describe the development, implementation and outcomes of a NICU-based Nursing Research Fellowship
Program (NRFP).
Background: NICU nurses are the “eyes and ears at the bedside” and often have the best ideas for neonatal clinical research.
However, they are often intimidated by research because they lack training and experience, and face many barriers including;
lack of time, busy patient assignments, inadequate resources, unavailability of research experts, lack of mentorship, and
limited knowledge and experience in research-proposal development.
Description of Program: We developed a NICU-based-NRFP to encourage nurses to identify their own clinically-relevant
problem and to fully support them in conducting their own clinical trial. The nurse-research fellows identified problems of
major importance to neonatal nurses and physicians, and learned how data that is critically needed to guide clinical practice
can be obtained through systematic, rigorous scientific inquiry. During this presentation, we will describe how we developed
the program, sought funding, and established critical resources to make it successful. We will discuss strategies to overcome
common barriers to staff-nurse-led research and will teach bedside nurses how to conduct a clinically-relevant research
project; potentially making a positive impact on patient care and health outcomes.
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Future Directions: As NICU nurses, we must be cognizant of the fact that many of our clinical problems are not yet fully
investigated. Establishing a NICU-based-NRFP has the potential to generate significant new knowledge that can rapidly
expand our knowledge base in an efficient and systematic manner, leading to creative, innovative solutions to common NICU
clinical problems. This project serves as a model for nursing managers, educators and advanced practitioners, so they may
empower NICU nurses to contribute, through research, to the profession’s knowledge base and make a positive impact on
patient care and health outcomes. This increases nurse autonomy and job satisfaction and has the potential to positively
impact recruitment/retention efforts.
FP27: Profiling Neonatal Nurses’ Practice: Influences and Outcomes
Spence, K1; Laing, S1; Neonatal CNC Network, NSW2
Grace Centre for Newborn Care, The Sydney Children’s Hospitals Network (Westmead), Australia;
2
NSW Health, Australia
1
Background: Neonatal nursing is practiced in a variety of contexts. Recruitment and retention into the speciality has been a
challenge across Australia. We sought to gain an insight into the role of a neonatal nurse and their views on their practice. The
aim was a profile that could inform management, the profession and educationalists.
Method: A prospective multicentre study was undertaken across the NICUs and NETS in the state of NSW. A 2 phase study
consisted of focus groups, knowledge test and the development and distribution of a questionnaire. Data were analysed using
parametric and non-parametric techniques, with alpha levels adjusted as required. Comparisons between groups were based
on qualifications, experience, position, and hospital of employment.
Results: 375 nurses (63%) responded from NICUs & NETS. 27 focus groups provided the content for the questionnaire. There
was consensus among nurses with no significant group differences. There was a significant correlation between perceived
relevant outcomes of neonatal nurses’ practice (developmental and family centred care) and their contribution to short-term
outcomes, family involvement (r=.224, p=.003, rho=.215, p=.004) and their influence on infant development (r=.115,
p=.040, rho=.185, p=.014). However only 52% could identify an outcome they felt they contributed to. The majority of nurses
agreed that good multidisciplinary teamwork (98%), a positive workplace culture (97%), consistent care (94%), and applying
developmental care principles (92%) were changes could improve patient outcomes. ‘Workplace issues’ was most frequently
seen as both a change to improve outcomes’ (31%) and ‘a barrier preventing change’ (66%).
Conclusions: This study provides insight into neonatal nursing practice across one state in Australia, in particular what
nurses see as the focus and outcomes of their care. This information will be provided to workplace managers and curriculum
developers for neonatal nurses.
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FP28: The Value Of Bedside Learning Tools To Aid Clinical Decision Making In
Neonatal Nursing Care: Exploring The Needs Of Neonatal Nurses
Petty, Julia
Early Years, City University, Stotfold, United Kingdom
Background: The neonatal nurse performs a range of essential tasks and engages in key decision-making in the bedside
care of the neonate requiring them to learn a wide repertoire of knowledge (1). Literature within healthcare on how best to
support bedside learning suggests that resources should be designed and tailored to discipline-specific learning needs (2-5).
Work within the field of neonatal education specifically is limited.
Aims: The current study aims to * Ascertain the usage of two existing neonatal learning tools, one a bedside learning tool, the
other an online resource. * Evaluate the value of these tools in view of optimizing their use in the enhancement of knowledge
for practice. * Explore what junior neonatal nurses need at the patient bedside to inform their everyday clinical practice and
decision making in the care of neonate and family
Methods: An evaluation survey was distributed to 100 neonatal nurses exploring their use of said learning tools, asking them
to grade their value and prioritise clinical based learning needs. Data collection is in progress. On completion, descriptive
analysis of Likert scale responses will be presented and qualitative analysis of open responses. Usage of the online tool will
be analysed by ‘Google Analytics’.
Results: Preliminary results show that novice neonatal nurses regard the availability of a neonatal specific bedside tool within
the clinical area to be of great value to their learning and practice. They identify specific gaps in the provision of such tools
and key learning needs are identified as necessary to guide and assist bedside care. Full analysis will be complete by July
2013 and these issues will be discussed further.
Implications: The identified gaps in provision of bedside tools and the perceived benefit of those currently used will inform
the further development of user-friendly resources designed to facilitate bedside learning.
FP29: Transformational Leadership In The Neonatal Intensive Care Unit:
Implementing Change To Support Best Practice
Casey, Angela1; Spence, K2
1
Grace Centre For Newborn Care, Sydney Children’s Hospital Network - Westmead, Westmead, Australia; 2Grace Centre for
Newborn Care, Sydney Children’s Hospital Network - Westmead, Australia
Background: Effective clinical leadership is essential for nurses working in a Neonatal Unit. We are currently in a phase of rebuilding the workforce and a large volume of recruitment has created challenges in orientation and transitioning new recruits.
A team nursing model was used for several years to enable learners to work with an experienced nurse. It is imperative that
there is a creative transformational leadership model to manage relationships, various skill sets of nurses and increased
patient acuity.
Method: A new position was trialled over a 3 month period which consisted of a “Leader” (clinical support co-ordinator).
The transformational leader position was influenced by Kouzes & Posner (2002). They explored 5 practices of leadership;
Model the way, Inspire a shared vision, Challenge the process, Enable others to act and Encourage the heart. A program was
developed that explored these leadership strategies. A survey was constructed for staff at the completion of the trial.
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Results: The role was implemented in 2013 and to date 5 clinical leaders have been identified. 15 new recruits commenced working
a mix of 8 and 12 hour shifts. The occupancy in the high dependency unit was 80% for 12 cots. Informal and formal feedback
focused on leadership practices and development of the role to reflect transformational behaviours. Comments provided were “the
role has allowed professional growth and has improved my critical thinking skills”, “the role has a created a safety net and supported
my transition into the unit”, and “the role has created continuity of care and co-ordination of the babies”.
Conclusion: Transformational leadership plays an important supporting role in the professional development of new staff
to the NICU. The trial was a positive strategy to increase staffing within a framework that allowed motivated nurses to be
empowered to develop their own leadership qualities towards career progression.
FP30: Getting to a Better Place: Ethics Based Conflict Resolution in the Neonatal
Intensive Care Unit (NICU)
Cadogan, Julie1; Anderson, M,1; Jurchak, M.2
Neonatal Intensive Care Unit, Brigham and Women’s Hospital, USA; 2Ethics Service, Brigham and Women’s Hospital, USA
1
Background: NICU’s are known to be intense, stressful and complex work environments. The 2010 Employee Opinion Survey
at our hospital identified significant concerns regarding how conflict is managed and resolved in the discipline of nursing.
We required action to address lack of civility and ineffective communication. This poster describes the work of developing a
nursing-based intervention to effectively impact workplace conflict through enhanced communication skills.
Methods: A conflict communication committee consisting of nursing staff, nursing leadership, a nurse ethicist, and a hospital
chaplain used the guiding principle of “getting to a better place,” and the Code of Ethics for Nurses to inform our work.
We surveyed NICU nursing staff and found they lacked the tools to address conflict constructively, and addressed this with
workshops on conflict and communication skill building. Additional key features of our work included:
(1) Maintaining open membership to the committee for NICU nursing staff,
(2) Developing guiding principles (e.g. “What you permit you promote”, and “Be where your feet are”) to which we agreed to
hold ourselves accountable,
(3) Nurse ethicist facilitated discussions to de-brief communication breakdowns and generate new patterns of communication and
(4) extensive review of professional and pop culture literature.
Results: We report quantitative and qualitative outcome measures of impact, including elevated repeat employee opinion
survey scores, and how enhanced nurse communication skills have impacted the care environment. Additionally, we describe
efforts for sustainability, including the implementation of safety rounds, and the development of a NICU based interdisciplinary
communication group. Our next steps include participation in a hospital wide nursing based peer to peer feedback pilot
program to continue our work with promoting optimal nursing collaboration.
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FEEDING & GIT ISSUES
FP31: What Do We Know About The Care And Placement Of Feeding Tubes In Very
Low Birth Weight Infants?
Wallace, Tamara
HP, Vanderbilt, Franklin, USA
Background: Tube feeding is one of the most frequently performed procedures in the NICU. It is a procedure for which there
is limited empiric evidence to guide practice in newborns. The safety and success of this nursing procedure has the ability to
affect nutrition, growth and long term outcomes for our vulnerable patients. In the United States, no national standard of care
exists. While some countries have established guidelines, no international standard of care exists.
Review of the literature: How should we measure for tube placement? What is the most accurate method? How should we
verify placement? What should these tubes be made of? How often should tubes be replaced? Should tubes be place orally or
nasally? Should tubes remain in place or should they be intermittently placed for feedings? What are the known complications
of tube placement and feeding? Does nursing care of these tubes and feedings affect the incidence of complications such as
aspiration and necrotizing enterocolitis?
Discussion: This presentation uses literature and protocols from around the world to discuss current trends in practice,
reviews the published evidence available to guide practice, re-enforces nursing’s role in outcomes and makes suggestions for
further nursing research.
FP32: Clinical Indicators Of Oral Feeding Performance In Premature Infants With
Bronchopulmonary Dysplasia
Wang, YW1; Chang, YJ2
Institute of Allied Health Science, National Cheng Kung University, Taiwan; 2Department of Nursing, National Cheng Kung
University, Taiwan
1
Background: Premature infants with bronchopulmonary dysplasia (BPD) have difficulty to regulate cardiorespiratory function
and suck-swallow-breathe coordination during oral feeding because of their immature neurological systems and impaired
lung function. In order to identify clinical indicators for assessing BPD premature infants’ oral feeding performance, the
study aimed to explore the relationships among premature infants’ oral feeding indicators, cardiorespiratory adjustment, and
feeding performance during feeding.
Methods: In this descriptive correlational study, indicators of oral feeding, cardiorespiratory adjustment, and feeding
performance before, during, and after feeding were collected at one meal in the first week of bottle feeding. Forty-five
premature infants of gestational age less than or equal to 32 weeks diagnosed with BPD recognized for starting oral feeding.
Infants with systemic infection, grade III or IV intraventricular hemorrhage, other neurological diseases, known abnormalities,
and cyanotic congenital heart disease were excluded. Indicators were included maturation, cardiorespiratory conditions,
and heart rate variability. Severity of BPD was measured with duration of endotracheal intubation and pulmonary score (the
fraction of inspired oxygen FiO2 * support + medications). Feeding performance included consumed (percent consumed over
total feeding) and efficiency (volume consumed over total feeding time) during feeding was measured.
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Results: Multiple regression analysis showed that the predictors of the percentage of overall intake were pulmonary score
and high-frequency heart rate variability during feeding divided by baseline which accounted for 42% of the variance. The
strongest predictor of feeding efficiency is postmenstrual age which accounted for 22% of the variance.
Conclusions: Feeding performance of BPD premature infants could be predicted by pulmonary score, heart rate variability,
and infants’ postmenstrual age. Before feeding BPD premature infants, health professionals should assess their maturation
and severity of BPD to estimate their feeding performance in the first week of bottle feeding.
FP33: Staff’s Sensitivity And Focus Of Care -- Influence On Feeding In NICUs In
Sweden And England
Flacking, Renée1; Dykes, Fiona2
School of Health and Social Studies, Dalarna University, Falun, Sweden; 2School of Health, University of Central Lancashire,
United Kingdom
1
Background: Neonatal care with regard to feeding tends to be focused on the infants’ intake of breast milk due to the
beneficial nutritional and immunological properties and cognitive outcomes. However, the relational aspects of feeding are
often underrated or disregarded during the transition from tube feeding to breastfeeding/bottlefeeding. Some research has
focussed on the question of how to optimise the transitional process in terms of milk intake and initiation of breastfeeding
but very few studies have been undertaken to explore the process from the perspective of mother-infant relationship. The
aim of this study was, in part, to explore the ways staff interacted with parents and babies and the influence on feeding and
relationality in mothers of preterm infants in Neonatal Intensive Care Units (NICUs) in Sweden and England.
Methods: An ethnographic approach was utilised in two NICUs in Sweden and two comparable units in England, UK. Over
an eleven month period, a total of 52 mothers, 19 fathers and 102 staff were observed and interviewed. A grounded theory
approach was utilised to analyze data.
Results: Preliminary findings showed that the professional discourse strongly influenced the quality of the mother-infant
relationship and feeding practicies. A core category of ‘supporting relational feeding’ was identified, which comprised 1) staffs’
sensitivity to the process from tube-feeding to breastfeeding/bottle feeding and 2) a sensitivity to and an acknowledgement of the
mother-infant relationship. Three types of sensitivity to the process and the method of feeding were identified; being negotiable,
flexible or indifferent. Furthermore, two types of focus of care were identified: a ‘dyadic care’ in which the developing mother
-infant relationship were supported or a ‘monadic care’, which had a sole focus on the infant.
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FP34: Comparative Study Of Orogastric Versus Nasogastric Tube Feeding In VLBW
Neonates : An Open Labelled Randomised Controlled Trial
Singh, Harmesh
Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India
Background: Neonates are obligate nasal breathers. Feeding tube placed via nasal route can cause partial nasal obstruction,
increased airway resistance and hence increased work of breathing. This may involve increased energy expenditure and
hence affect the growth. On the other hand orally placed enteral tubes are frequently malpositioned and repetitive movements
may result in vagal stimulation causing apnea and bradycardia. Current practice with regard to route used for placement
of enteral feeding tubes varies among various neonatal units. The present study was carried out to compare the orogastric
versus nasogastric tube feeding in VLBW neonates.
Methods: Study design: A teaching hospital based prospective opened labeled randomized controlled trial
Subjects: Seventy four (74) haemodynamically stable VLBW neonates Methods : After obtaining the consent from the parents
the babies were randomized to orogastric and nasogastric feeding groups. Feeding tube was inserted as per standard
guidelines. The feed was started as per the protocol of the unit. The weight gain and adverse events were recorded the
statistical analysis was done using Stata 11.
Results: The median gestational age [OG: median (IQR) 32(30-33) weeks and NG: median (IQR) 32(28-33) weeks]. The birth
weight was also comparable among the two groups [OG: mean± SD 1231±178 gm and NG: mean ±SD 1176±219 gm). In
total 91 % of neonates in OG and 97 % in NG group were successfully discharged. The weight gain in the two groups was
comparable(p value 0.42). Other outcomes including time to regain birth weight (11.5 days versus 14.1 days p value 0.12) ,
need for tube reinsertion OG versus NG (4±2.7 versus 3.0 ± 2.3 p value 0.20 ) and episodes of apnea (0.13 versus 0.45) were
also comparable among two groups.
Conclusion: There is no significant difference in oral and nasal feeding tube groups in terms of weight gain and adverse events.
FP35: Factors Associated With Exclusive Breastfeeding Of Preterm Infants
Maastrup, Ragnhild1; Hansen, BM2; Kronborg, H3; Bojesen, SN2; Hallum, K4; Frandsen, A5; Kyhnaeb, A6; Svarer, I7; Hallstrom, I8
Knowledge Centre for Breastfeeding Infants with Special Needs, Copenhagen University Hospital Rigshospitalet, Denmark;
2
Department of Neonatology, Copenhagen University Hospital Herlev, Denmark; 34School of Public Health, Department of
Nursing Science, University of Aarhus, Denmark; 4Department of Neonatology, Viborg Hospital, Denmark; 5Department of
Neonatology, Holbaek Hospital, Denmark; 6Department of Neonatology, Copenhagen University Hospital Hvidovre, Denmark;
7
Department of Neonatology, Odense University Hospital, Denmark; 8Department of Health Sciences, Faculty of Medicine, Lund
University, Sweden
1
Background and Aim: Mothers of preterm infants needs support and guidance to establish breastfeeding, but evidence
concerning the best ways to guide the mothers is not clear. The aim was to investigate which factors in infants, mothers, and
clinical procedures (commonly used to facilitate breastfeeding) had effect on breastfeeding in preterm infants at discharge
from neonatal unit.
Method: An observational prospective study of a national cohort based on questionnaires including 1220 mothers and their
1487 preterm infants with gestational age 24 - 36 weeks. Clinical procedures for facilitating breastfeeding were adjusted for
maternal and infant factors in a multiple logistic regression analysis.
Results: At discharge 68 % of the preterm infants were exclusively breastfed (at and from the breast) and 17 % partially.
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The analysis showed that extremely and very preterm infants, multiple births, and boys had higher odds for not being
exclusively breastfed at discharge (OR (95% CI) 2,8 (1,3 - 6,1), 1,7 (1,1 - 2,7), 2,1 (1,5 - 3,0), and 1,7 (1,3 - 2,3) respectively).
Further more infants to mothers who had not breastfed previous infants or smoked had higher odds for not being exclusively
breastfed at discharge (OR 6 (2,2 - 16), and 2,3 (1,4 - 3,7) respectively).
Breastfeeding practices associated with significantly higher OR of not being exclusively breastfed at discharge were use of
nipple shield OR (95% CI) 2,3 (1,7 - 3,2), and delayed initiation of breast milk expression, which showed a dose response
effect, the later the higher OR, with initiation later than 48 hours post partum showing a significant higher odds for not
being exclusively breastfed at discharge (OR 4,9 (1,9 - 12)). Test-weighing the infant at most breastfeedings was associated
with lower OR 0,6 (0,4 - 0,8). In this study initiation or duration of skin-to-skin contact were not associated with exclusive
breastfeeding at discharge, nor the mothers’ educational level.
Conclusion: This national survey showed that both factors in infants, mothers and clinical procedures were associated with
exclusive breastfeeding at discharge for preterm infants.
FP36: A Longitudinal Evaluation Of Kangaroo Care For Preterm Infants In Thailand
Mannix, Trudi1; Eskirinimit, Thidarat2; Mayner, Lidia3
School of Nursing and Midwifery, Flinders University, Adelaide, Australia; 2School of Nursing, Walailak University, Thailand;
3
School of Nursing and Midwifery, Flinders University, Australia
1
Background: The percentage of premature births is increasing globally, and in particular in Thailand where the percentage
of preterm births increased from 5.1% in 1998 to 12% in 2012. It is well documented that separating mothers from their
infants following birth can lead to an increased risk of child abuse and neglect. In Thailand preterm infants are at greater risk
of abandonment, abuse and neglect related partially to the practice of separating mothers and their preterm infants in the early
stages after birth. Kangaroo care involves skin to skin contact between mothers and babies. This is the first study to examine the
longitudinal effects of Kangaroo Care (KC) for preterm infants over a period of 6 months on bonding between mother and infant.
Method: Thirty six mothers and their preterm infants participated in the study. Participants were randomly allocated to either
a KC group or a non-intervention group. Mothers completed four questionnaires; two described their socio-demographic
situation and that of their preterm infants, and two assessed bonding between mothers and their preterm infants using
previously validated tools (the MIBQ and BOCL). Mothers were visited in their homes at 4, 12 and 24 weeks post-birth in order
to be observed, and to complete the questionnaires assessing bonding.
Results: There was a statistically significant difference in bonding scores from Day 1 to week 24 between the two groups. Using
comparative analysis, mean scores in both the MIBQ and BOCL were significantly higher in the mothers in the KC group compared
to those in the non-intervention group. Results from this study support Klaus and Kennel’s bonding theory and demonstrate that
Kangaroo Care does improve infant-mother interaction, and has a positive effect on bonding between mothers and their preterm
infants over a sustained period. This is an important finding which supports the introduction of Kangaroo Care into maternity hospitals
in Thailand as a public health initiative to reduce levels of neglect and abandonment amongst preterm infants.
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CLINICAL ISSUES: ACUTE
FP37: Ten Years Of TOBY - A Cooling Journey
Strohm, B
National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, United Kingdom
Background: Therapeutic hypothermia for neonatal encephalopathy was only available as a clinical trial intervention 10 years ago.
Three major trials, including the TOBY Study, showed it to be a safe and beneficial treatment; it is now recommended by NICE
in the UK.
I have worked on the TOBY Trial, the UK TOBY Cooling Register, the TOBY Children follow-up Study and the TOBY Xenon Trial,
witnessing how a change in practice has been implemented.
Objective: To describe the TOBY journey through to the development of the UK TOBY Cooling Register and beyond and to
consider this journey alongside my own personal and professional development.
Methods: As one TOBY project led to another my own expertise broadened, not only around hypothermia but in the many and
varied aspects of clinical trial management; I learned much from my trials unit colleagues.
When TOBY trial recruitment ended, cooling was offered as an innovative treatment pending the publication of evidence from
trial results, including 18 month follow-up findings. We established the UK TOBY Cooling Register to monitor the growing use
of cooling and provide guidance to clinicians.
Trusts and Networks developed strategies to offer this service in their areas. Transports for cooling treatment increased and
clinical guidance was developed for the use of passive cooling.
Now cooling is the standard treatment arm in trials of neuroprotectants and adjunct therapies are the intervention. Additional
neuroprotective treatments such as inhaled xenon are being researched to accompany and complement cooling for NE.
The TOBY Group will soon be reporting on the school-age outcomes of its participants, providing new longer-term outcome
information.
Conclusion: Cooling is now an established neuroprotective treatment. Neonatal trial co-ordination is a satisfying career option
that utilises clinical experience but offers neonatal nurses a different role and an environment rich in shared knowledge and
discovery.
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FP38: Hypothermia And Neonatal Mortality
Prullage, GS; Yerger, J
Neonatal Intensive Care, Kibogora Hospital, Rwanda
Background: In 2012 UNICEF quoted the neonatal mortality rate for Rwanda as 21.1/ 1000. Although hypothermia is
not listed as a major cause of neonatal death by the UNICEF or the WHO (World Health Organization), it has addressed
hypothermia as a significant problem since 1996. Our clinical observations suggested that consistent early vital signs, such as
taking the temperature, can help identify neonates in trouble and policies and protocols can be developed for this problem.
Methods: We did a 10 month retrospective study of the inborn and transferred neonates to the Neonatal Unit at Kibogora
Hospital, a rural hospital in Southwestern Rwanda. We assessed the temperature of the baby at the time of arrival to Kibogora.
Results: A total of 275 neonates were admitted to Kibogora Hospital for assessment and evaluation. The WHO identifies
normal temperature at 36.5-37.5, potential cold stress at 36 to 36.4, moderate hypothermia at 32 to 35.9 and severe
hypothermia at less than 32. The results showed: 9% hyperthermia (>37.5), 32% normal thermic, 40% potential cold stress,
11% moderate hypothermic , 0.4% severe hypothermic, and unknown at 8%. Of the 275 neonates 12 died. Of those neonates
17% were normothermic, 42% potential for cold stress, 33% moderately hypothermic and 8% were severely hypothermic.
Conclusion: There is a significant problem with hypothermia affecting the neonate admitted to the NICU. Our study revealed
that infants at imminent risk for death showed more hypothermia, sometimes severe. We instituted measures such as direct
admission to the NICU, protocols for the delivery room evaluation and a policy for transferring the infant in Kangaroo care. The
effectiveness of these measures in reducing hypothermia and mortality are being monitored now in a prospective fashion.
FP39: Concordance of temperature measurements in the preterm and term neonate
using three thermometers®
Smith, Jacqueline
Neonatal, Queensland Health, Townsville, Australia
Background: Measuring temperature is an essential part of nursing care. It has been widely accepted as an indication of
a patients clinical conditions Once of the precepts of neonatal care, especially of preterm infants, is the practice of minimal
handling to reduce stress. The necessity for regular observations such as temperature measurement does however require
prolonged handling and disturbance.
Objective: The purpose of this study was to investigate agreement between the BD digital thermometer, Genius 2 tympanic
thermometer and the SureTemp®Plus 692 thermometer.
Method: A comparative design was used to evaluate the level of agreement between each thermometer in infants from 24
weeks gestation to post term.
Results: A total of 238 infants were enrolled in the study. In general the BD digital and SureTemp®Plus 692 measurements
were in closer agreement than the BD digital and the Genius 2™ tympanic thermometer1.
1. Smith, J., Usher, K., Alcock, G, Buettner, P. (2013). Concordance of temperature measurements in the preterm and term
neonate using three thermometers. Journal of Neonatal Nursing, In press, corrected proof.
78
FP40: Establishment of inter-observer reliability using the Finnegan neonatal
abstinence scoring tool
D’Apolito, K
Nursing, Vanderbilt University School of Nursing, USA
There is a great deal of subjectivity when assessing neonates for signs of drug withdrawal. This program trains healthcare
professionals to assess neonates for signs of withdrawal with accuracy using the Finnegan scoring tool in the clinical area.
The method is an inter-observer reliability program that includes a manual, demonstration exam, two infants being assessed
for signs of drug withdrawal and a review of the exams pointing out the signs present. The demonstration DVD and exam
reviews are narrated. Participants watch the exam, score the infant using the scoring tool and watch the exam review. Then
participants check their inter-observer reliability using a percent agreement chart. To be reliable in using the tool participants
must obtain 90% agreement or greater.
The results of using this program in the clinical area has demonstrated a 90-100% inter-observer reliability when using the
Finnegan scoring tool to assess neonates for signs of withdrawal.
The incorporation of this tool into practice will allow healthcare professionals to become more proficient in assessing neonatal
abstinence ( drug withdrawal) and neonates will receive the appropriate treatment to control signs of neonatal abstinence.
www.coinn2013.com79
PALLIATIVE CARE & BEREAVEMENT
FP41: Neonates And Infants With Neurodevelopmental Delay And End Of Life Care
Needs -- What Care Do We Provide At Home For These Children In Ireland?
Naughton, Margaret1; Reilly, Ann1; Nicholl, Honor2
1
The Jack and Jill Foundation, Ireland; 2School of Nursing and Midwifery, Trinity College Dublin, Ireland
Background: Nationally and internationally palliative care for neonates and infants is an underdeveloped specialism.
Numerous innovations are being implemented in Ireland for these children and their families including the provision of home
care and out of home respite services. However little is known about the actual care that is required and the multifaceted
roles of nurses who deliver care to neonates and infants who need end of life care at home.
Method: Based on the experiences of the nurses from the Jack and Jill Foundation** [and an analysis of organisational
statistics,] a review of the infants who have died in the past three years will be reported. The roles of nurses in the provision
of home care services at end of life for the child and their family, as well as the post bereavement services families received
will be examined. Using case studies as examples factors that are essential to the delivery of a rapidly responsive and flexible
discharge service for very ill infants into the community services will be examined. The roles of the children’s nurse, and
others in the multiprofessional team involved in facilitating end of life home care for these children, will be discussed. No
ethical approval is required to use this data and parental consent is given.
Results: Over the past three years 253 neonates and infants under 1 have been referred to this service from social workers,
nurse specialists and by self referral from the family. 21 children died in the first month of life and their diagnoses included
rare syndromes and genetic disorders. 17 of the children died at home and 3 in hospital.
Conclusion: There are many challenges is caring for neonates and infants who require rapid discharge home for palliative
and end of life care. Given the specific issues identified when caring for these children the importance of a rapidly responsive
community service will be explored, and the role of the nurse in the provision of care to the child and family will be examined.
**This Charity is the only voluntary organisation in Ireland that provides home specialist nursing care for children under the
age of four who have life limiting severe neurodevelopmental problems and non-oncology palliative care conditions. This
includes end of life care for infants with very rare and complex disorders that may be undiagnosed antenatally.
FP42: Turkish Neonatology Nurses’ Problems and Quality of Life
Altay, Naime1; Kilicarslan-Toruner, Ebru2; Zýraman, Selma3; Ateþ, Berrin4
Nursing Department, Gazi University Health Sciences Faculty, Besevler, Ankara, Turkey; 2Gazi University Health Sciences
Faculty, Nursing Department, Ankara, Turkey; 3Turgut Ozal University Hospital,, Turgut Ozal University Ankara,, Turkey;
4
Ministry of Health, Zekai Tahir Burak Women’s Health Education and Res, Turkey
1
Introduction: Working at night with a shift system can disturb quality of life due to chronic fatigue, sleepiness and somatic
symptoms.
Aim: Determine the working conditions and problems of the nurses working in the neonatal intensive care unit (NICU) and
the effect on their quality of life. Method: Nurses who were a member of the Neonatology Nursing Association of Turkey were
included in the study. Questionnaire forms were sent by e-mail to the 380 nurses. The study sample consisted of 119 nurses
who replied. Data were collected with the descriptive data form and SF-36 quality of life scale. The lowest and highest scores
are 0-100 respectively for each eight subgroup. A high score defines a more favorable health state. The data was evaluated
by frequency, percentage, Spearman’s test.
80
Results: 45.4% of the nurses were in the 26-30 years. Mean duration of work in the NICU was 4.5±3.5 years. Nurses mostly
worked day and night shifts (47.9%), the mean duration of work was 14.1±3.2 hours per shift. A nurse cared for 5.5±4.2
neonates on average. 6.7% of the nurses were pleased with the working environment. Common causes of dissatisfaction
were low wages, the large number of neonates cared for and the excessive working hours. The SF-36 subgroups, the
physical function score was high (60.4±28.9) while the scores of the other subgroups were under 50 points. Lower scores
were role-physical(25.430.7), pain(29.718.2), role-emotional(29.7 ±36.3). No relationship was found between nurses’
sociodemographic features and working conditions, and the scores of SF-36 subgroups.
Conclusion: The nurses’ quality of life scores were low in general. The majority of nurses were not satisfied with their
working conditions.
Keywords: neonatal intensive care, nurse, quality of life.
FP43: Are NICU nurses apprehensive when providing care for dying infants
Parker, Gary1; McEver, Michele2; Fanning, Linda2; Higgs, Tracy2
1
Research, Sisiters of Mercy Health Care, Oklahoma City, USA; 2NICU, Sisiters of Mercy Health Care, USA
Background: One does not often think of end-of - life nursing duties being performed in the Neonatal Intensive Care Unit
(NICU). However, nurses are now being called to interact with these dying infants and their families. These nurses must be
able to provide not only medical care, but psychological, social and spiritual care for both patient and family.
Purpose: The purpose of this study was to determine whether nurses working in the NICU experience apprehension while
caring for the palliative care infant and the infant’s family.
Method: NICU nurses from Missouri and Oklahoma received The Professional End-of-Life Care Attitude Scale (PEAS). This
scale allows the researcher to identify the level of apprehension nurses may experience (real or perceived) while providing
end of life care for patients and their families. Also, the data from the PEAS will allow us to explore attitudes by professional
degree, gender and years of experience.
Results: The sample consisted of 118 NICU nurses, 3 of whom were male, and 112 being female (3 persons failed to provide
information about gender); 36% were RNs, 17% were ADs, and 42% were BSNs. The reminder (2.5%) had either a MS or a
MSN. On average, they had 11.77 years of experience (SD = 10.36). Understandably, years of experience and PEAS scores
were negatively related (r = -.231, p < 02), indicating that nurses with more years of professional experienced to be less
disturbed about working with terminally ill patients and their families.
On average, PEAS scores indicated that the sample was at best, moderately concerned about interacting/communicating with
patients and families regarding matters of death and dying.
Conclusion: It appears that this sample of NICU nurses are reasonably comfortable regarding their interactions with dying
patients and their families, and that those with more professional experience were even more at ease in this respect. Given
the emotionally difficult task of caring for dying children, this data speaks to the resilience and compassion demonstrated by
this sample of NICU nurses in caring for infants with terminal prognoses.
www.coinn2013.com81
FP44: Rites Of Passage -- The Unexpected Transition From Pregnancy To Palliative Care
Price, Jayne1; Prior, L2; Jordan, J3
1
School of Nursing and Midwifery, Queens University Belfast, Belfast, United Kingdom; 2School of Sociology, Social Policy and
Social Work, Queens University Belfast, United Kingdom; 3None, United Kingdom
Background/Aim: In keeping with Van Gennep’s transition typology, pregnancy has been described as a rite of passage.
Pregnancy transition is usually a joyous life event. However, increased numbers of babies are being born and living with life
limited conditions. Many will die in the first year of life, necessitating a palliative approach from birth, through death and into
bereavement. The PATCH study used interpretive qualitative methodology to examine bereaved parents’ experiences of caring
for their life limited infant/child/young person.
Methods: In-depth interviews gained insights into bereaved parents experiences (n=25). The focus here is a sub group of
11 parents who told stories of the birth of a baby diagnosed as life limited. Data analysis involved sequential thematic and
narrative approaches.
Results: Parent accounts accorded with Van Gennep’s typology in that from confirmation of pregnancy they began a
transition, one in which they moved towards parenthood. This transition involved stages of preliminal, liminal (betwixt and
between) through to what parents expected would be reintegration into society as a parent of a healthy baby. However, the
birth of a baby with a life limited condition meant that there was no exit from the liminal state. Instead parents entered into a
new cycle of liminality, where reincorporation into society was in that of bereaved parent.
Conclusions: Van Gennep’s work served as a useful conceptual framework for understanding parents’ journey through
pregnancy, birth and subsequent death of their infant. In the analytically defined period ‘Holding it all together’ parents dealt
with emotional and practical chaos, feelings of isolation, marginalization and other worldliness. Insensitive /inconsistent
communication from professionals, movement from the Neonatal Unit and fighting for community services appeared to
heighten the chaos experienced. This paper highlights how professional support and services can help parents through the
often protracted, always painful loss of their child.
82
QUALITY
FP45: International collaboration for the translation of evidence into practice
Foster, Jann1; Kassab, Manal2; Spence, Kaye3; Khriesat, Wadah4
1
School of Nursing & Midwifery Family & Community Health Research Group, University of Western Sydney, Penrith NSW,
Australia; 2Faculty of Nursing, Jordan University of Science and Technology, Jordan; 3School of Nursing & Midwifery/Queens
University Belfast, The Sydney Children’s Hospitals Network-Westmead, Australia; 4Faculty of Medicine, Jordan University of
Science and Technology, Jordan
Background: This innovative collaborative project between Australia and Jordan will provide a leadership role in promoting
the translation of best evidence into clinicians’ everyday practice in Jordan. Jordan is increasingly contributing to the body of
research and the translation of evidence is seen to be the next step in Jordan’s ongoing development. This project will help
ongoing links and collaborations between Australian and Arab Universities and academics, the Jordanian Ministry of Health,
professional groups, health care institutions and health professionals.
Aims: The STEP (Strategies for the Translation of Evidence into Practice) project aims to close the evidence practice gap for
the management of newborn pain in neonatal intensive care units, special care nurseries and post natal wards throughout
Jordan through the provision of support, resources and collaboration. The objective of this project is strongly aligned to the
objectives for Australian-Arab Relations in that we are promoting productive partnerships between Australia and the Arab
World.
Method: Based on the successful PEGS project in Australia, a baseline survey of existing practice related to infant pain and
its management will be undertaken. The survey will be repeated after 12 months (at the completion of the project) allowing
the project collaborators to quantify the project’s success. Our aim is to increase the management of newborn pain over 30%
from the baseline survey. Yearly surveys for a further 2 years will continue to be undertaken to monitor ongoing increases in
the provision of pain management.
Discussion: The pain service currently being developed through a pain clinic in Northern Jordan will start the project. The aim
of the pain clinic is to promote, and use evidence based practice in the management of pain for adults, children and infants.
How the collaboration came about and the methods used to identify and refine the project is the focus of the presentation.
www.coinn2013.com83
FP46: Analysis Of Unexpected Events In Presumed Well-appearing Neonates After The
Implementation Of A Newborn Rapid Response System - A 4 Year Experience
Patnode, Rita1; Griswold, K2; Johnson, L3; Pantano, C4; Rothschild, J5; Insoft, R3
Newborn Nursing, Brigham and Women’s Hospital, USA; 2Center For Clinical Excellence, Brigham and Women’s Hospital, USA;
3
Newborn Medicine, Brigham and Women’s Hospital, USA; 4Newborn Respiratory Therapy, Brigham and Women’s Hospital,
USA; 5Partners eCare, Partners Healthcare, Brigham and Women’s Hospital, USA
1
Background: Mandatory safety goals outlined the need to respond to unexpected events of non-ICU inpatients. There are
scant data on the impact a newborn rapid response system (RRS) has on unexpected events in well-appearing late preterm
(LPT, 35-36.6), early term (ET, 37-38.6), term (39-40.6), or post-term (PT 41+) neonates.
Objective: To analyze unexpected events after the implementation of a RRS in an urban perinatal center with 8,500
deliveries/year.
Design/Methods: We established a RRS team consisting of a NICU nurse, physician, and NICU respiratory therapist with
well-defined early warning criteria (EWC). RRS calls arise from Labor & Delivery (L&D) and Well Baby Nursery (WBN). A RRS
committee reviews events, missed calls and resulting NICU admissions.
Results: Over the last 4 years, unexpected event rates were 68.6, 65.6, 36.3 and 23.0 per 1,000 newborns in LPT, ET, term
and PT, respectively. NICU admits resulted from 21.5% of calls. Relative risk of unexpected events in the LPT, ET and PT
compared to term were 1.9, 1.8, and 0.6, respectively. Based on our initial review of the RRS data we implemented a practice
change where all 35-35.6 week neonates were admitted to the NICU for 18-24 hrs of observation. This practice change led to
a dramatic decrease in the unexpected events from 114.8 to 21.4/1000.
Newborn RRS events: EWC utilization by category*
*Multiple EWC may be used as a trigger for a RRS
Respiratory
83.3%
Neurologic
3.2%
Cardiovascular
2.3%
Other
11.3%
Staff concern only
5.2%
Parental concern only
1.3%
Conclusions: New data shows escalation of unexpected events and increased admission rates to 94.3/1000 for 36-36.6
week neonates. Further analysis of these data is needed to determine future clinical practice changes. Ongoing studies will
determine if the RRS reduces morbidities and cost. Our experience with this safety initiative may benefit other centers in
implementing similar programs.
84
FP47: Decreasing multiple neonatal peripheral IV sticks
Schwoebel, Ann1; Jones, Annette2; Deeley, Annemarie2; Yocum, Jennifer2; Stango, Claire2; Wade, Kelly2; Power, Pamela2
Pennsylvania Hospital, Philadelphia PA, USA; 2Pennsylvania Hospital, USA
1
Background: Infants were experiencing multiple peripheral IV attempts during their stay in the intensive care nursery (ICN).
The range was from 1 to over 10 sticks for PIV placement. This caused a delay in the administration of the first dose of IV
antibiotic, contributing to a delay in parent visitation and/or transfer back to the mother’s room, and added pain/discomfort as
well as parental distress. In addition, while the central line blood stream infection (CLBSI) numbers were steadily improving for
2012, there was a concerning increase in the last quarter of 2012 in peripheral IV blood stream infections (PIVBSI).
Objective: To reduce the number of peripheral IV sticks for infants experiencing 4 or more attempts by 30 percent, within 3
months of implementing an action plan.
Design/Methods: A Performance Improvement in Action (PIIA) process was utilized to assist in improving the process. A
“fishbone” chart was developed looking at the most likely contributing factors. Three main factors were identified: supplies,
number of staff involved in the procedure, clinical variability/infant perfusion. A questionnaire was generated seeking additional
input. A process map was created from observations of “expert” IV clinicians versus clinicians. Countermeasures were
implemented: 2 person procedure, utilize expert clinician for insertion, notify physician after 3 attempts and evaluate a IV start kit
Results: There was a 40 percent decrease in the number of neonates experiencing 4 or more insertions attempts during the
initial PIV placement. The average number of PIV attempts went from 2.4 to 1.9.
Conclusions: The utilization of a standard process for the insertion of a PIV in the ICN yielded to a decrease in the number of
attempts. Data collection is ongoing to see if this standardized process will lead to a decrease in PIVBSI, faster back transfers
and faster administration of the first antibiotic.
www.coinn2013.com85
FP48: Development of the Neonatal Navigator Phone App as a supportive tool for
parents on their unexpected journey through the neonatal unit
Judy, HItchcock1; Hammond, BE2
1
NICU,, Wellington Hospital, Capital Coast District Health, Wellington, New Zealand; 2Neonatal/Paediatric Unit, Whanganui
Hospital Whanganui District Health Board, New Zealand
This poster/presentation follows the development of the Neonatal Navigator App (application) for parents, families and friends
to use for support when their baby is unexpectedly admitted to the neonatal unit; an environment where changing staff and
changing circumstances are constantly occurring. Having a reliable and constant point of reference in the form of an an app,
will be an asset in supporting parents during this vulnerable time.
The framework for the application is two-fold:
Firstly, it provides familiar, tried and true generic information that historically has been delivered by outdated posters,
pamphlets and brochures. The current generation of parents seek information on line via their smart phones. This app can be
accessed by parents, families and friends in any country, who suddenly find themselves on an unexpected journey through
the neonatal unit.
Secondly, the trend for using smart phones during visiting time is widespread, with parents engaged in social networking and
internet access whilst sitting by the cot. The app provides a tool to capture and journal baby’s progress in the neonatal unit, it is
not only the support that parents have to keep in touch with friends and family but also has potential to improve parental neonatal
experience by encouraging them to journal their baby’s progress; thereby increasing bonding and attachment as a result.
It is expected to be available as a web based application with the potential to upload it to an I-phone/pad or android phone/tablet.
It is envisaged that the information will be available in Maori, thereby recognising the Treaty of Waitangi and the principles of
partnership, protection and equality, with the potential to access other translations for our multi-cultural society.
Aligning with the NZ Neonatal Trust is being explored at time of submission.
86
INFECTION & PAIN
FP49: The Use Of Own Mother’s Colostrum As A Potential Immune Therapy For
Extremely Premature Infants: State Of The Science
Rodriguez, Nancy
Background/Significance: Own mother’s colostrum contains immunologically-derived factors that protect the recipient infant
against infection and have trophic, healing, and maturational effects on the intestinal mucosa. Colostrum produced by mothers of
extremely low birth weight (ELBW: BW<1000g) infants contains the highest concentrations of these protective factors, compared
to colostrum expressed at a later gestation, which suggests an important biological function. As such, own mother’s colostrum is
potentially an “immune therapy” or “medication” for the ELBW infant in the first days of life when the infant is the sickest, exposed
to numerous invasive procedures, and at highest risk for infection. Unfortunately, clinical instability precludes enteral feedings for
ELBW infants during this period. The inability to provide OMC in the first days of life is a critical barrier to optimizing care for these
infants, because OMC is often delayed for 5-15 days and this lack of enteral feeds leads to intestinal atrophy that increases the risk
for feeding intolerance, infection and necrotizing enterocolitis. Alternative methods for administering own mother’s colostrum as a
potential immune therapy during this critical period must be explored. Oropharyngeal administration is a feasible option.
Purpose for session: During this presentation, we will discuss the use of own mother’s colostrum as a potential “immune
therapy” to improve health outcomes for ELBW infants. The potential mechanisms of action will be discussed. Compelling
evidence from animal and human studies to support “oropharyngeal administration of colostrum” will be presented. Results from
research studies investigating the feasibility, safety and efficacy of oropharyngeal colostrum, and “mouth care” or “oral care” with
own mother’s colostrum will be presented as well. Future directions for multidisciplinary research will also be discussed.
FP50: National clinical guideline on Pain Assesment in Denmark - COMFORTneo
Haslund, Helle
Nursing Research, NICU, Aalborg University Hospital, Denmark
Background: Specific demands regarding pain management in Denmark require that Pain assessment must be conducted
using evidence based standards. Until spring 2012 we did not have this in Denmark. A National Special Interest Group in
Neonatal Nursing thus has developed a national clinical guideline on pain assessment for neonatal infants.
Methods: This work has been carried out in collaboration with the national Clearing House for clinical guidelines to ensure
methodological quality, and that recommendations reflect best evidence. A literature review was carried out and the validation
of six pain score instruments was assessed. Clinical utility was also considered, as many NICUs in Denmark are inexperienced
in pain assessment using a specific tool.
Results: A national guideline on pain assessment for neonates recommending the use of COMFORTneo or alternatively PIIP is
now approved for use in Denmark. The pain assessment tool is now being implemented nationally, supported by certification
of nurses, being trained to obtain satisfactory cappa-scores.
Conclusion: The work with conducting a national guideline is very demanding and academic research skills are needed. Even
though it is time-consuming it is essential to have evidence based standards in order to deliver nurse care of high standard.
The National Special Interest Group in Neonatal Nursing has arranged more national conferences for neonatal nurses about
pain assessment, as well as training in and implementation of the pain assessment tool in daily clinical work. It is important
that the clinical guideline is followed by an implementation strategy that ensures training, teaching as well as discussion and
mutual inspiration across the country.
www.coinn2013.com87
FP51: Impact Of Kangaroo Mother Care On Deleterious Consequences Of Pain Due
To Venipuncture In Neonates
Singh, Harmesh1; SONI, RK2
1
Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, India; 2Community Medicine, Dayanand Medical
College and Hospital, India
Background: Prevention of pain in the neonates is important not only ethically but also because of its deleterious
consequences on vital parameters and oxygen saturation. However, despite increased awareness of the importance of pain
prevention, neonates continue to be exposed to numerous painful procedures during the routine daily care. The impact of
kangaroo mother care on deleterious consequences of pain due to venipucture on vital parameters and oxygen saturation was
studied in 99 neonates.
Methods: Design & setting: Randomized Prospective Teaching Hospital Based study
Participants: Ninety nine neonates undergoing venipuncture Procedures: The mothers of the babies admitted in the neonatal unit
were explained about the nature and purpose of the study and a verbal consent was taken. The babies were randomized in to
KMC group and conventional (control) group. The venipuncture was performed as per standard protocol. In KMC group mother’s
face was separated by a sheet.
Measures: The vital parameters including Heart rate and respiratory rate and oxygen saturation (pulse oximetary) were noted
before, during and after the procedure until they settled down. NIPS score was also noted during and after the procedure. The
data obtained was analyzed by using SPSS 11.5.
Results: There were 30 babies in the KMC group and 69 in the control group. The mean birth weight and gestational age
was 1.33 +0.23 kg and 29.77 + 2.52 weeks in KMC group as compared to 1.91 + 0.80 kg and 33.80 + 4.45 weeks in
control group respectively. There was no difference in the mean baseline HR and oxygen saturation between the two groups.
There was a statistically significant difference in the HR (p=0.001) and oxygen saturation (p=0.013) during procedure up to
1 minute between the two groups. After 5 minutes the difference of HR (p=0.155) and oxygen saturation (p=0.992) became
nonsignificant. The NIPS score was statisticantly high (p=0.000) in control group (4.19 + 0.91) as compared to KMC group
(3.03 + 1.24) during procedure. The vital parameters in respect to KMC and control group were also analysed at baseline,
during and after the procedure.
Conclusions: The NIPS score was significantly lower in the KMC group. HR & Oxygen saturation changes were affected
significantly more in the control group.
88
FP52: Nursing contributions in a multi-institutional and multidisciplinary
collaborative reduces CLABSI rates
Moran, Susan L1; Chuo, John2; Brozanski, Beverly3; Grover, Theresa4; Piazza, Anthony5; Morelli, Lorna6; Pallotto, Eugenia7;
Smith, Joan8
1
CHND/Collaborative Initiatives for Quality Improve, Erie, USA; 2Children’s Hospital of Philadelphia, USA; 3University of
Pittsburgh School of Medicine, USA; 4Children’s Hospital Colorado, USA; 5Emory University, USA; 6Children’s Hospital
Association, USA; 7Children’s Mercy Hospitals & Clinics, USA; 8St. Louis Children’s Hospital, USA
Background: The Children’s Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement (CHNC-CIQI) was
designed to provide structure in support of multi-center quality improvement (QI) projects. The first project was aimed to
reduce central line associated blood stream infections (CLABSI) among participating hospitals by 15% in 14 months.
Methods: The multidisciplinary multi-center cooperative developed a web-based format to support a data repository and
identify best practice through evidence-based practice, expert opinion, and benchmarking surveys. Nursing contributions
through an “all teach, all learn” philosophy was most evident during monthly meeting team presentations and 30-minute
huddles attendance in which innovative ideas for data collection, process implementation and compliance to clinical practice
recommendations were emphasized. Success was measured by the percent of centers reporting CLABSIs, Institute for
Healthcare Improvement (IHI) self and faculty scoring, and staff compliance for scrub-the-hub, sterile versus clean tubing
change, line removal, and limiting line access.
Results: 17/24 (71%) of the CHNC centers participated and > 85% consistently collected data. 42% of the team
presentations were delivered by nurses and 58% of the 30-minute huddle participants were nurses. Collaborative efforts
showed a 23% reduction in CLABSI rates and sterile tubing change as having the greatest impact toward improvement
(reducing CLABSI by 0.82/1000 line days). 12/17 (71%) centers achieved compliance of >90%, while 16/17 (94%) attained
compliance of >75%. 6/17 (35%) centers achieved faculty assessment scores of > 4 (significant improvement), and 3 centers
achieved 4.5 (sustainable improvement).
Implications: Nursing participation is essential for successful QI projects. Multi-center collaboratives are an efficient means
to transfer knowledge, spotlight individual skills, and stimulate creativity to better ensure successful change. Future efforts to
identify specific nursing influences within the quality improvement health care team should be quantified.
www.coinn2013.com89
FP53: Reduced nosocomial bloodstream infection rate among very low birth
weight infants by sequential hand hygiene promotion: a ten-year experience
Helder, Onno1; Brug, J2; Goudoever van, JB3; Looman, CWN4; Reiss, IKM5; Kornelisse, RF5
1
Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands; 2VU mc, Netherlands; 3VU mc and AMC Emma Children’s
Hospital, Netherlands; 4Erasmus MC, Netherlands; 5Erasmus MC-Sophia Children’s Hospital, Netherlands
Background: Appropriate hand hygiene among healthcare workers is the most important infection prevention measure,
however compliance is generally low. The aim of the study was to determine the long-term effect of sequential hand
hygiene-promoting interventions on nosocomial bloodstream infection (BSI) rate and change in distribution of the most
frequent causative pathogens over a decade.
Methods: Observational study with an interrupted time series analysis conducted in a 27-bed neonatal intensive care unit.
Patients: Very low birth weight (VLBW) infants (< 1500 grams) admitted for more than 72 hours.
Interventions: Hand hygiene education program followed by a combination of gain-framed screen saver messages
concerning hand hygiene and an infection prevention week.
Results: Incidence of nosocomial BSIs; number of nosocomial BSIs per 1000 patient days; and inventory of causative pathogens
for BSIs. 1964 VLBW infants admitted from January 1st 2002 to December 31st 2011 were studied. The proportion of infants with
one or more BSI decreased from 47.6% to 21.2% (p<0.01); the number of BSIs per 1000 patient days from 16.8 to 8.9 (p<0.01).
At baseline, without interventions, number of nosocomial BSI per 1000 patient days significantly increased by +0.74 per quartile
(95% CI +0.27, +1.22). The level of instant change after the first intervention was -4.5 (95% CI -9.84, +0.85), followed by a
significantly declined BSI trend change of -1.27 per quartile (95% CI -2.04, -0.49). The next interventions were followed by a
direct drop in BSIs of -2.1 (95% CI -7.01, +2.88) and next a neutral trend change of +0.54 (95% CI -0.17, +1.24) BSIs per 1000
patient days. The predominant causative pathogens were coagulase-negative staphylococci (67%) and S. aureus (14%). Their
contributions relative to the other pathogens decreased significantly over time.
Conclusions: Sequential hand hygiene promotion seems to contribute to maintenance a low nosocomial BSIs rate.
90
FP54: Enhanced bacterial enrichment in the diagnostics of blood cultures taken
from neonatal patients®®
Pesola, J1; Sankilampi, U1; Heitto, A2; Hilden, M1; Laitiomäki, E3; Myöhänen, P3; Pesola, I4; Kokki, H5; Riikonen, P1; Paakkanen,
H6; Hakalehto, E7
1
Department of Paediatrics and Adolescents, Kuopio University Hospital, Finland; 2Finnoflag Oy, Finland; 3School of Medicine,
University of Eastern Finland, Finland; 4Clinic of Oral and Maxillofacial Diseases, Kuopio University Hospital, Finland;
5
Anaesthesia and Operative Services, Kuopio University Hospital, Finland; 6Environics Oy, Finland; 7Institute of Biomedicine,
University of Eastern Finland, Finland
Background: Sepsis is a major cause for morbidity and mortality in the neonatal intensive care units. Accurate and timely
diagnosis is essential for appropriate treatment of the patients. Blood culture is the golden standard in the diagnostics of
the neonatal septichaemia, but the bacterial agents are detected only in about 7 - 10% of all septic cases. Especially low
concentrations of the contaminants as well as their poor cultivability cause problems in rapid verification of the agents.
Aims of the study: In the on-going study PMEU Scentrion® (Finnoflag Oy, Kuopio and Siilinjarvi, Finland) is compared to
the standard enrichment protocol in the analysis of blood cultures. The goal is to evaluate the potential benefits of the PMEU
method in order to enhance the analysis of blood culture samples.
Methods: Blood culture samples are taken from peripheral arteries or veins at the time of the sepsis diagnosis at the
Neonatal Intensive Care Unit of Kuopio University Hospital, Kuopio, Finland.
The blood culture samples are incubated both by the BacT/ALERT® blood culture method (bioMerieux, France; standard
protocol) and by the PMEU Scentrion® (study protocol). When any bacterial growth is suspected, gram-staining, plate culture,
identification and antibiotic susceptibility testing of the strains are performed for all samples.
Analysis of the blood culture results: The blood culture results are compared and analysed for the identification of different
isolated microbial strains and colony counts, and for the detection time. Preliminary results between standard and study
methods are fairly similar complementing each other. The detection of obligate and facultative anaerobes could be enforced
by the PMEU system.
Conclusions: The efficiency and accuracy of the blood culture diagnostics in infants with suspected sepsis should be
enhanced. The PMEU approach presented here is applicable both in laboratories and bed-side, giving a real-time alarm on
detection of bacterial growth.
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CLINICAL ISSUES: LATE PRETERM INFANTS AND
NEWBORN HEALTH
FP55: A systematic review of recent research in late preterm infants
Bozzette, Maryann
College of Nursing, Seattle University, Seattle, USA
Background: The late preterm birth rate (infants born between 34 1/7 and 36 6/7 weeks gestation) has increased by 20%
in the last 20 years. This group now comprises approximately 70% of all premature births. Outcomes indicate that many
previously unanticipated problems are occurring in late preterm infants.
Method: A systematic review of health and developmental outcomes was conducted to determine the most current research
results for late preterm birth. The search included studies from 2008 to 2012. Utilizing the PRISM method, the search was
narrowed to 14 studies that met the review criteria.
Results: These studies report that late preterm infants are at higher risk for hypoglycemia, cold stress, poor breastfeeding and
kernicterus. Late preterm birth results in high rates of re-hospitalization, increased health care costs and early developmental
delays. Late preterm birth resutls in increased morbidity and mortality when compared to infants born at term age.
FP56: Factors influencing neonatal care admission of Late Preterm Infants born at
34-36 weeks gestation in Northern Ireland
McGowan, Jennifer1; Alderdice, F A2; Holmes, V A2; Johnston, L2
School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom; 2School of Nursing and Midwifery,
Queen’s University Belfast, United Kingdom
1
Background: Adverse neonatal outcomes have long been associated with preterm birth. Numerous large-scale studies
have considered broad ranging neonatal morbidities and mortality among very preterm infants. To date, however, research
describing the neonatal outcomes of Late Preterm Infants (LPIs) has been limited.
Methods: All late preterm infants (LPIs), born between 34 weeks + 0 days and 36 weeks + 6 days gestation, who required
neonatal care in Northern Ireland, between 1st January and 31st December, 2006 were included in the study (n=497).
Comparison of two groups was undertaken based on the level of care LPIs received (IC: Intensive Care (including Intensive
Care or High Dependency), BAPM, 2001) or SCO: Special Care Only). Four key areas of interest were considered in each
analysis: maternal characteristics, perinatal risk factors, infant characteristics and neonatal outcomes using data from the
Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) database.
Results: Of 497 LPIs admitted to a neonatal unit in Northern Ireland during 2006, 57.5% received at least one episode of IC.
Maternal sociodemographic characteristics did not differ between infants admitted for IC compared with those who required
SCO, while maternal health-related risk factors were greater among infants who required IC. Delivery by Caesarean section
and requiring resuscitation at birth were significant predictors for admission for Intensive Care (p<0.001). Neonatal outcomes
including: respiratory support, respiratory illness (including TTN and RDS), congenital malformations, and sepsis were all
higher in the IC group and significantly more LPIs admitted for IC had a length of stay >10 days compared to those receiving
Special Care Only.
Conclusion: The main findings from this study revealed increased maternal health-related risk factors, increased delivery by
Caesarean section and subsequently, increased adverse neonatal outcomes among those infants who required Intensive Care
(IC), compared to infants who received Special Care Only (SCO).
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FP57: Implications of Maternal Obesity-Associated Inflammation for Newborn and
Infant Health
Records, Kathie1; Hindoyan, N2; Ealy, RB3; Hobel, C4; Jackman, S5
1
College of Nursing & Health Innovation, Arizona State University, Phoenix, USA; 2Cedars-Sinai Medical Center, USA; 3College of
Nursing, University of Missouri - St. Louis, USA; 4The David Geffen School of Medicine at UCLA, Cedars Sinai Medical Center,
USA; 5Cedars Sinai Medical Center, USA
Background: Overweight and obesity before and during pregnancy contributes to lifelong alterations in health outcomes for
mothers and their offspring. Overweight and obesity are associated with chronic inflammation that, during pregnancy, can
interfere with critically important immune mechanisms that support fetal growth and development. Recent evidence suggests
that the intestinal microbiota contributes to inflammation and can further compromise immune functioning. The purpose
of this presentation is to review the latest evidence of the metabolic and immune changes associated with obesity during
pregnancy and the implications for fetal/newborn health.
Methods: A search of CINAHL, PubMed, and Web of Science was conducted for latest research evidence (2005-2013) using
the keywords of overweight, obesity, pregnancy, immune, and newborn. Exclusion criteria included studies focusing primarily
on maternal outcomes.
Results: Evidence suggests a critical role of Vitamin D in the etiology of obesity. The increased risk of preterm delivery and
cesarean sections in obese/overweight women, contributes to alterations in the newborn’s gut microbiota and subsequent
increased risk for childhood obesity. Evidence also suggests that deficiencies in Zinc and Fish Oil contribute to disease risk.
Risk extends beyond the development of obesity among offspring to alterations in infant behavior and cognitive development.
Neonatal nurses can help communicate to parents the importance of micronutrient intake and breastfeeding to optimize gut
metabolism in their children.
FP58: The coping styles of parents following the down-transfer of their infants
from tertiary NICUs to community SCNs in Victoria, Australia
Ramudu, L1; McDonald, S2; Thomas, S3
Nursing Education, The Northern Hospital, Victoria, Werribee, Victoria, Australia; 2Faculty of Health Sciences, La Trobe
University/Mercy Hospital for Women, Australia; 3Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia
1
Background: The down-transfer of infants from NICUs to SCNs is recognised as a source of stress for parents that affects
their coping abilities. Literature related to this topic is limited and whilst there is acknowledgement that support for parents is
essential, literature is scant on how parents actually cope.
Aim: The aim of this research is to identify the coping styles that parents employ following their infants’ down-transfer. The
final results of this research is being presented.
Method: A descriptive quantitative method using 2 validated tools, the Transfer Quality Scale (TQS) (Slattery et al, 1998) and
the Brief COPE (Carver, 1997) was administered to 80 parents at 3 SCNs. The tools were administered after 48 hours and
within 1 week of transfer simultaneously.
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Results: The overall quality of the down-transfer experiences of parents was positive. However, parents exhibited some stress
with no significant differences observed between mothers and fathers. Fathers and mothers differed significantly (p < 0.01)
in the use of 6 of the 14 coping styles. These were Using Emotional Support, Using Instrumental Support, Substance Use,
Behavioral Disengagement and Self-Blame. Venting was significant at p < 0.05. The stress variable in the TQS was correlated
with items in the Brief COPE. Fathers elicited a medium, positive correlation between stress and three items in the Brief
COPE. These were Active Coping r = 0.42, p < 0.05), Planning (r = 0.38, p < 0.05) and Religion (r = 0.38, p < 0.05). Mothers
exhibited a medium negative correlation between stress and Behavioral Disengagement (r = -0.30, p < 0.05). Parents
collectively displayed a small, positive correlation between stress and the coping style Venting (r =0.22, p <0.05).
Conclusion: The final results from this research informs all health professionals engaged in neonatal care of the importance
of being attuned to parents’ stress and coping styles, before and after the down-transfer of their infants.
FP59: A Correlational Analysis Of A National Survey Of Neonatal Peripherally
Inserted Central Catheter (PICC) Practices: Demographics And Training
Sharpe, EL
Pediatrix Medical Group, USA
Background: There are variations in radiographic monitoring practices for peripherally inserted central catheters (PICCs)
in neonates. The purpose of this study was to determine whether demographics and formal training were associated with
specific radiographic monitoring practices.
Methods: Study design was correlational secondary analysis performed on an original national database of neonatal PICC
practices, produced through a national survey completed in 2010. The sample consisted of 187 respondents, representing
25% of the 747 level III neonatal intensive care units in the United States (per the American Academy of Pediatrics directory)
at the time. A correlational factorial design was used to conduct associations exploring these research questions: What are
the relationships between: region, size of NICU, academic affiliation and training, and the variables of interest relevant to
radiographic monitoring of PICCs: routine surveillance, reconfirmation after repositioning of the catheter and consistent patient
positioning protocols? Institutional review board approval was obtained. Statistical significance was set at p < 0.05.
Results: The hypotheses were that there would be more routine surveillance and consistent positioning protocols in larger
NICUs with academic affiliation and formal training in PICC insertion and care, and that geography would have no relationship
to practice. The findings demonstrated that specialized formal training in PICC insertion and care and annual retraining
were associated with consistent patient positioning for catheter tip location monitoring. There were regional associations
between frequency of routine monitoring and use of the lateral radiographs. No significant practice correlations were found
between size of unit and academic affiliation. Study limitations include the original sample size (N = 187), and the veracity
of the respondents. Nursing is an integral partner in complications prevention and detection. The goal for future practice is
development of protocols for consistent radiographic surveillance. The results reflect the importance of formal training in
supporting best practices.
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FP60: Term Neonates with Bilious Vomiting - Should they be considered as Time
Critical Transfers to the Surgical Centre?
Bermundo, Benito1; Mohinuddin, S2; Ratnavel, N3; Sakhuja, P4; Fleming, P5; Sinha, A6
London Neonatal Transfer Services, United Kingdom; 2Barts Health NHS Trust, United Kingdom; 3London Neonatal Transfer Services,
Barts Health NHS Trust, United Kingdom; 4Division of Neonatology, The hospital for Sick Kids, Canada; 5Division of Neonatology,
Homerton University NHS Hospital, United Kingdom; 6Division of Neonatology, Barts Health NHS Trust, United Kingdom
1
Bilious vomiting in neonate could be a presenting sign of intestinal obstruction with consequences of gut compromise and
long term sequelae. As it is difficult to identify the baby with an underlying surgical problem,neonates who present with this
clinical sign are often referred and transferred to surgical centres. The burden and outcomes of this cohort of infants on
neonatal services are not described in the literature.
Aims: To evaluate the outcomes of neonates with bilious vomiting transferred by a regional neonatal transfer service and to
assess the need for a time critical response.
Methods: A retrospective review of neonatal transfers by the London Neonatal Transfer Service with bilious vomiting referred
at <7 days of age from January,2007 to December,2010 was undertaken. Transfer documentation and follow-up data was
collected.
Results: During the three year period, 203 neonates with bilious vomiting were transferred. 165 records were analyzed.38
records were excluded due to missing outcome data. The median gestation was 39.5 weeks and median birth weight 3.2
Kg. A male preponderance with a ratio of 1.4 to 1 was seen. Median age at referral was 36 hours (range 2.3 -- 166 hours).
Median age at referral was 36 hours (range 2.3 -- 166 hours). Median response time (time interval between time of referral
and transfer team arriving to the baby) was 80 minutes (IQR 55 -- 170 minutes). Median stabilisation times were 46 minutes
(IQR 40 -- 60 minutes). 54 (33%) infants had surgery. A further 17 had hirschprungs (conservatively managed), making a total
of 71 (43%) of babies with a surgical condition.
Diagnosis
Number (Percentage) n= 165
Intestinal Atresias
21 (13)
Malrotation/ Volvulus/ Bands
18 (11)
Surgically operated Hirschprungs disease
6 (4)
Necrotising enterocolitis
3 (2)
Gut Perforation (spontaneous)
2 (1)
Meconium Ileus
2 (1)
Ano-rectal malformations
2 (1)
Toatal Operated
54 (33)
Hirschprungs disease (Conservatively Managed)
17 (10)
Total Neonates with surgical diagnoses
71 (43)
Conclusion: We have demonstrated that 43% of neonates with bilious vomiting transferred have surgical conditions. These
transfers should be regarded as time critical and be taken into consideration in service and resource planning.
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EDUCATION
FP61: Development And Design Of An E Learning Portal To Assess And Address
Neonatal Clinicians’ Breastfeeding Knowledge And Practice
Higman, W1; Wallace, LM1; Law, S2; Blake, K3; Baum, A4
1
Applied Research Centre Health and Lifestyle Interventions, Coventry University, United Kingdom; 2Faculty of Health and Life Sciences,
Coventry University, United Kingdom; 3Neonatal Unit, UHCW NHS Trust, United Kingdom; 4Best Beginnings Charity, United Kingdom
Background: The evidence that breast milk feeding reduces mortality and short and long-term morbidity among premature
and small babies is well established but breastfeeding rates in neonatal units in the UK remain low.
Aim: This study designed and evaluated breastfeeding e-learning for clinicians.
Method: The Neonatal Unit Clinical Assessment Tool (NUCAT) was developed to evaluate the Small Wonders Change
Programme, by the charity Best Beginnings and Coventry University. It is an on-line objective knowledge test with ratings
of confidence and knowledge in physiology of lactation, benefits of breastfeeding, breastfeeding, breast milk expression,
kangaroo care and positive touch. In study 1, 51 medical and nursing clinicians at the Coventry Neonatal Intensive Care Unit
(NICU) completed NUCAT. In study 2, 10 clinicians, who had completed NUCAT, participated in semi-structured interviews to
explore factors that both support and inhibit breastfeeding. Study 3 comprised a workshop with key members of neonatal
staff (n=9). We are currently undertaking a pilot study with 10-15 clinicians to assess the efficacy of the first training module
(Physiology of lactation and breast milk expression).
Results: NUCAT results show staff have greater knowledge of positive touch and kangaroo care, with lower scores on breast
milk expression and breastfeeding practices. They were less knowledgeable about the physiology of breastfeeding and
benefits of breastfeeding. Interviews and the workshop highlighted the need for education in hand and pump expression.
The results informed the development of an e learning portal that addressed the key areas of knowledge deficit identified
(a one hour e learning module and individual supervised practice assessment). Early results of the pilot study of the training
effectiveness (Knowledge and confidence scores by T test, interview data by thematic analysis) will be available in April 2013.
Implications: On-line assessment and training, combined with supervised practice, provide a potentially effective training method.
FP62: PEDALO Project: The Development And Testing Of An E-learning Platform To
Promote Critical Thinking And Clinical Reasoning Skills In Neonatal Intensive
Nadine, Griffiths1; Spence, K2; Casey, A3; Jones, C3; Carmo Browning, K4; Janus, R5
1
Grace Centre for Newborn Care, The Sydney Children’s Hospital Network (Westmead), Westmead, Australia; 2Grace Centre for
Newborn Care, Sydney Children’s Hospital Network, Australia; 3Grace Centre for Newborn Care, The Sydney Children’s Hospital
Network (Westmead), Australia; 4Grace Centre for Newborn Care, Sydney Children’s Hospital Network (Westmead), Australia;
5
eLearning Consultant, The Sydney Children’s Hospital Network (Westmead), Australia
Background: Critical thinking and clinical reasoning are essential skills in the tool kit of the neonatal intensive care nurse.
Globally the NICU, as with other critical care settings is faced with an increasingly inexperienced nursing workforce. Clinical
settings are responding by implementing education programs to meet local needs however a gap exists between working in
a clinical setting and understanding the nuances of a speciality population. NICU’s require nurses who can interpret, anticipate
and respond to neonates as they transition through acute and chronic illnesses. Whilst education programs support the
development of foundational knowledge the development of critical thinking and clinical reasoning skills can take longer to
acquire. A challenge exists in the clinical setting to foster the development of these skills in a timely manner.
96
Method: A self-directed educational program was developed to assist in the acquisition of the critical thinking and reasoning
skills in nurses with 1-3 years’ experience in the NICU. A ‘choose your own adventure methodology’ in the form of the clinical
vignette’s was used as the framework for the program. Five vignettes exploring common clinical conditions were developed
using the programs’ eLearning platform. Reference information was provided including the potential clinical ramifications
of incorrect decisions. The program was tested with a group of experienced NICU nurses for content validity prior to its
implementation in the clinical setting.
Results: The participant’s confidence in managing the clinical scenario was explored pre and post the completion of the
scenario through a specific confidence tool. A follow up questionnaire was forwarded to staff that had completed the program
to gauge how they applied the concepts from the program in the clinical setting. The program was utilised by 10 staff in the
tertiary NICU setting.
Conclusion: This innovative program has the potential for wide application of clinical vignettes in multiple settings. After
further development we aim to roll out the program to special care nurseries in both district and rural settings.
FP63: An innovative approach to training neonatal nurses at the University of Cape
Town, South Africa
Barlow, Hilary; Coetzee, M; Davis, C; Hendry, I
Child Nurse Practice Development Initiative, University of Cape Town, South Africa
Background: The Child Nurse Practice Development Initiative is a nurse-led initiative based in the Department of Paediatrics
and Child Health at the University of Cape Town. Cognisant of the rising infant mortality rate on the continent, the Initiative
offers a Postgraduate Diploma in Critical Care Neonate Nursing to registered nurses from South Africa and various African
countries. The students’ varied range of experience and education requires the use of innovative teaching strategies to assist
students to develop the critical and analytical thinking needed to provide specific and specialised care to this vulnerable
patient population, especially within their under resourced practice settings.
Methods: Teaching approaches include student-led clinical case presentations, journal clubs, interactive classroom lectures
by specialists and clinical accompaniment. Students’ learning is assessed in diverse ways. A family study raises awareness
of the long term implications of the infants’ condition on the family and community after discharge. A structured portfolio of
evidence is collected which includes clinical work, ethics, advocacy and analytical thinking about their own clinical setting,
among other aspects of health care. They also gain skills in planning nursing care according to an innovative method, clinical
presentation, assessment and creating a poster.
Outcomes: Programme evaluation and interviews 6-18 months after graduation have yielded valuable feedback. Students
appreciate the interactive and participative style of learning. While some find portfolio development time consuming, they
acknowledge significant learning benefits. Graduates report that learning is consolidated once they return to their clinical
settings. They experience increasing confidence and ability and describe that as their approach to their work changes, they
deliver an improved quality of care with better outcomes for sick neonates.
This presentation will clarify the reasons for the development of this training programme, it will explain the approaches of
teaching and learning and will discuss the assessment methods used.
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FP64: Application of wholebrain learning in neonatal nursing education
Maree, Carin
Department of Nursing Science, University of Pretoria, Pretoria, South Africa
Wholebrain or holistic learning became important in education, with the focus on the learners’ preferential learning styles. The
facilitation of wholebrain learning was identified as a valuable tool in neonatal nursing education to optimise learning in adult
learners from different backgrounds and with different learning styles.
The concept of wholebrain learning is based on the premis that thinking and therefore learning and behaviour of human
beings are strongly influenced by dominance of one or more of the four quadrants of the brain. The left cerebral quadrant
is associated with analysing, theorising, logical processing and quantifying. The functions associated with the right cerebral
quadrant are exploring, discovering, conceptualising and synthesising. The left limbic system is especially responsible for
organising, sequencing and practicing, while the right limbic system caters for sharing, internalising, moving, feeling and
involving. All four quadrants are used on a daily basis for living, but most people has one (some cases more than one)
quadrant that is dominant. The dominant quadrant(s) impact on thinking, doing and learning. The use of all four quadrants is
associated with balance in daily living, but also in neonatal nursing practice.
The purpose of this presentation is to illustrate the application of the principles of wholebrain learning in a postbasic neonatal
nursing programme at the University of Pretoria, and the students’ experiences thereof.
FP65: Creating A Core Syllabus For Clinical Competency: Standardising The
Education Of UK Specialised Neonatal Nurses
Turrill, Sue
Healthcare, Univeristy of Leeds, Leeds, United Kingdom
Aim: This paper examines the influences surrounding education provision for specialised neonatal nurses in the UK and
presents a standardised clinical competency framework in response.
Background: Within the last 5 years national drivers for improvements to quality neonatal care provision have defined links to
the numbers and ratios of specialised neonatal nurses in practice. Historical changes to professional nursing governance have
led to diversity of supporting formal education, making achievement of a standard level of clinical competence for this part of the
nursing workforce difficult. Current funding for education and training emphasises a move from central to local responsibility.
Recognising and understanding these influences led to proposals for a standardised approach to formal education.
Process: Evaluating the key influences on education provision rationalised the development and publication of a criteria
based framework to be utilised by both education and service providers. A UK wide neonatal professional consensus group
identified the vital elements to be measurable clinical competency (in terms of unique knowledge and skills), transferable
evidence of achievement, and principles supporting the quality of education.
Key issues: Access to specialised education relies on the availability of programmes of study and clear funding strategies.
It is not yet clear how this will be achieved in this field. With increasing emphasis on quality in care provision, Unit, Trust
and Network level service providers in the UK have responsibility to demonstrate methods to measure practice. With no
professional monitoring of education and training at specialised level, a clear framework can provide a tool to standardise
content, commission education and audit clinical competency for this element of the workforce.
Conclusion: Defining a common core syllabus of knowledge and skills acquisition ensures partnerships between healthcare
and education providers are successful in achieving standard specialised education for neonatal nurses.
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FEEDING & RESEARCH
FP66: Service Evaluation Of Nursing Practice On The Use Of NNS During Tube
Feeding Premature Infants In The NICU; An Observational Study
Donghong, Langley1; Chadborn, Neil2; Cooper, Joanne3; Dorling, Jon4
1
Neonatal Intensive Care Unit/School of Nursing, University of Nottingham, United Kingdom; 2Institute of Mental Health,
University of Nottingham, United Kingdom; 3Nursing and Midwifery Research, Nottingham University Hospitals NHS Trust,
United Kingdom; 4Neonatal Intensive Care Unit, Nottingham University Hospitals NHS Trust, United Kingdom
Background: Premature infants require tube feeding prior to full independent breast or bottle feeding. Research trials and
Cochrane systematic reviews suggest that the use of NNS (non-nutritive sucking) during tube feeding has positive outcomes
such as shorter hospital stay and quicker transition from tube to oral feeding. Previous studies focused on the effect of NNS
on the premature infants but not on how nurses utilise this simple intervention at feeding time when infants ‘parents are not
present. There is a need to explore this area of practice in order to benefit this vulnerable group.
Aims and objectives: to ascertain whether nurses apply NNS during tube feeding practice according to guidelines and
research evidence; to raise the awareness and promote best practice.
Methods: Direct clinical observation on nursing staff from band 3-6 (n=20) for a total of 19.5 hours by an experienced
neonatal nurse. Each nursing staff was observed once during a single tube feeding of a premature infant. DHL, as a
participant observer made field notes during or after each observation. Data of 20 observations were transcribed and then
organised using codes which then further developed into categories and themes.
Results: While a range of good practice was identified such as the utilisation of containment holding, supportive positioning (20/20)
and engagement with the infants at time of the feeding. NNS was infrequently used in association with tube feeding (7/20).
Conclusion: Poor utilisation of NNS was seen amongst generally good feeding practices. This finding may be due to a range of
factors; the most likely being the current knowledge of staff regarding NNS and tube feeding/breastfeeding. There may also be issues
on the perception of NNS. These findings merit further exploration to see if the benefits of NNS can be achieved more widely.
FP67: State Of The Science: Immune Protection Against Infection With Human Milk
Feedings For Premature Infants
Rodriguez, Nancy
Background/Significance: Mother’s milk feedings have been consistently linked to enhanced short term and long term
health outcomes for very low birth weight (VLBW; BW <1500 g), premature infants including enhanced feeding tolerance,
protection against nosocomial infection and necrotizing enterocolitis, and enhanced visual acuity and neurodevelopmental
outcomes. The milk expressed by women who deliver prematurely is even more protective against serious and costly
prematurity-associated morbidities. Many nurses are unaware of this reciprocal relationship between the concentration of
immunoprotective agents in mother’s milk, and the postnatal physiologic delays of the VLBW infant. Mother’s milk essentially
takes over the role of the placenta in providing critical immune factors (anti-microbial, anti-inflammatory, immunomodulatory
agents) polyunsaturated fatty acids for brain and retinal development, antioxidants and growth factors to the immunodeficient premature infant.
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Purpose for session: The purpose of this presentation is to teach NICU nurses about the fascinating immunology of breast
milk, with a focus on recent research pertaining to protection against nosocomial infection and NEC. Nurses will be taught
how to apply this scientific information clinically and share it with other healthcare professionals. They will also be taught how
to share this “evidence” with mothers at the bedside, in simple terminology, so that mothers can make an informed decision
about feeding preference for their baby.
FP68: Acceptability And Feasibility Issues Of Clinical Trials In A Context Of
Premature Birth
Héon, Marjolaine1; Aita, Marilyn2; Goulet, Céline3
1
Faculté des sciences infirmières, Université de Montréal, Montreal, Canada; 2Faculté des sciences infirmières, Université de
Montréal, Canada; 3Faculté des sciences infirmières, Université des Montréal, Canada
Purpose: Neonatal clinical trials are crucial for knowledge development and advancement of the clinical practice. However,
recruiting and retaining premature infants represents a challenge for researchers, as substantial acceptability and feasibility
issues may arise. In a context of neonatal research, acceptability refers to the willingness of parents to enrol their premature
infants in a clinical trial and complete research procedures, whereas feasibility may be defined as whether the research
protocol can be implemented as formerly planned. The purpose of this communication is to present the main acceptability and
feasibility issues that may be encountered when conducting clinical trials among this vulnerable population how to address
them in order to optimize the recruitment and retention of premature infants.
Methods: Acceptability and feasibility issues of conducting clinical trials among premature infants and strategies to optimize
their recruitment and retention were identified through a review of the scientific literature as well as authors’ experiences with
the implementation of neonatal clinical trials.
Results: Acceptability issues may be related to parental (values, beliefs, preferences) and research-related (recruitment
process, randomization, research procedures, benefits and risks of the clinical trial, burden of participants) factors. Feasibility
issues related to recruitment and retention of premature infants might result from restrictive selection criteria, suboptimal
recruitment process, and lost to follow-up. Methodological strategies and pragmatic approaches can be implemented to
facilitate the recruitment and enhance the retention of premature infants in clinical trials.
Conclusion: Premature infants represent a vulnerable population who is highly solicited to participate in clinical trials. As
their participation in clinical trials are crucial and valuable, different strategies should be used to address acceptability and
feasibility issues and thus enhance their recruitment and retention.
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RESPIRATORY & PATIENT DECISION MAKING
FP69: Trends in the prevalence and risk of multiple births with congenital anomaly:
a registry based study in 14 European countries 1984-2007
Boyle, Breidge1; McConkey, R2; Garne, E3; Loane, M1; Addor, MC4; Bakker, MK5; Boyd, PA6; Gatt, M7; Greenlees, R1; Haeusler,
M8; Klungsøyr, K9; Latos-Bielenska, A10; Lelong, N11; McDonnell, R12; Métneki, J13; Mullaney, C14; Nelen, V15; O’Mahony, M16;
Pierini, A17; Rankin, J18; Rissmann, A19; Tucker, D20; Wellesley, D21; Dolk, H1
1
Centre for Maternal Fetal and Infant Research University of Ulster, United Kingdom; 2Centre for Intellectual and Developmental
Disabilities, University of Ulster, United Kingdom; 3Hospital Lillebaelt, Kolding, Denmark; 4Division of Medical Genetics,
Lausanne, Switzerland; 5University of Groningen, The Netherlands; 6National Perinatal Epidemiology Unit, University of Oxford,
United Kingdom; 7Department of Health Information and Research, Guardamangia, Malta; 8Medical University of Graz, Austria;
9
Medical Birth Registry of Norway, Bergen, Norway; 10Polish Registry of Congenital Malformations, Poznan, Poland; 11INSERM,
UMRS953, Hospital St. Vincent de Paul, F-75014 Paris, France; 12Health Service Executive, Dublin, Ireland; 13National Centre
for Healthcare Audit and Inspection, Budapest, Hungary; 14Health Service Executive, Kilkenny, Ireland; 15Provinciaal Insituut
voor Hygiene, Antwerp, Belgium; 16Health Service Executive, Cork, Ireland; 17CNR Institute of Clinical Physiology, Pisa, Italy;
18
Institute of Health & Society, Newcastle University, United Kingdom; 19Malformation Monitoring Centre Saxony-Anhalt,
Medical Faculty Otto-von-Guericke University, Magdeburg, Germany; 20Public Health Wales, United Kingdom; 21Faculty of
Medicine, University of Southampton and Wessex Clinical Genetics Service, Southampton, United Kingdom
Objective: To assess the public health consequences of the rise in multiple births with respect to congenital anomalies
Design: Descriptive epidemiologic analysis of data from population-based congenital anomaly registries.
Setting: 14 European countries.
Population: 5.4 million births 1984-2007;of which 3% were multiple births.
Methods: Cases of congenital anomaly included livebirths, fetal deaths from 20 weeks gestation, and terminations of
pregnancy for fetal anomaly (TOPFA).
Main Outcome Measures: Prevalence rates per 10,000 births and relative risk of congenital anomaly in multiple versus
singleton births (1984-2007 Proportion of pairs where both co-twins were cases.
Statistical Analysis: Poisson and logistic regression.
Results: Prevalence of congenital anomalies from multiple births increased from 5.9 (1984-87) to 10.7 per 10,000 births
(2004-07). Relative risk of non-chromosomal anomaly in multiple births was 1.35 (95%CI 1.31-1.39), increasing over time,
and of chromosomal anomalies was 0.72 (95%CI 0.65-0.80), decreasing over time. In 11.4% of affected twin pairs both
babies had congenital anomalies (2000-2007
Conclusions: The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has
implications for pre and postnatal service provision. The contribution of assisted reproductive technologies to the increase
in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk
counselling.
www.coinn2013.com101
FP70: Non-invasive ventilation strategies in the extremely low birth weight infant.
Richards, Robyn
NICU, Liverpool Hospital, Liverpool, Australia
Background: Despite advances in technology, chronic lung disease remains a significant cause of morbidity and in some
cases mortality. The reported incidence of chronic lung disease, defined as a need for oxygen at 36weeks postmenstrual
age, is about 30% for babies with a birth weight of less than 1000grams. Despite the increasing use of antenatal steroids,
surfactant administration and improving ventilation strategies this incidence has not decreased. An increasing number of
studies support the use of non-invasive ventilation (NIV) to avoid using mechanical ventilation in the extremely low birth
weight infant (ELBW), with the aim of reducing the incidence of chronic lung disease.
Method: Management of the ELBW baby requires astute nursing and medical observation and care. Attention to detail
including prompt administration of surfactant, haemodynamic and thermal stability, fluid and electrolyte management,
prevention of sepsis, expert skin care, early institution of exclusive breast milk feeding and support for the family is of
paramount importance for preventing morbidity and mortality.
Results: Based on the Columbia Presbyterian method, Hudson prong CPAP was instituted in Liverpool Hospital NICU in 2000,
and has become the standard of respiratory care. This case review will follow the story of baby V, born at 28weeks gestation,
weighing 398grams and managed with CPAP at delivery, Intubation Surfactant Extubation (INSURE) and a variety of ventilation
strategies to minimise the severity of chronic lung disease. The literature demonstrates successful use of NIV strategies
increases with increasing expertise of the clinicians. Ongoing expert assessment of the neonate will determine the most
appropriate ventilation strategy required. The variety of NIV strategies used during baby V’s admission will be presented.
FP71: Parent involvement in the research process: lip service or meaningful
engagement? Shared reflections of the experiences from one research project
Crathern, Liz1; Jacobs, B2
1
School of Nursing and Midwifery, University of Sheffield, LEEDS, United Kingdom; 2parent representative, research advisory
panel, United Kingdom
Introduction: Research into the experiences of first time fathers of preterm infants was undertaken in one neonatal unit in
England. As part of the research process, guided by the researcher’s belief that parents should be integrated more meaningfully
into the research process, a father representative was invited to become an active member of the research advisory group.
Background to the study: Why did we do it? In order to set the context of the discussion within the real world of research in a
neonatal environment , a very brief synopsis of the research aims, objectives, methodology, method and findings will be presented.
Government and NHS Policy drivers will be identified as underpinning rationale for meaningful engagement with service users.
Structure: How did we do it? The paper will discuss how the father’s role, as a member of the research advisory group,
evolved over the six year duration of the research process. It will also reflect on the benefits and challenges when engaging
more meaningfully in such a way.
Process: What did we learn for the process? Importantly, the paper will include personal reflection on the experiences of the process
and will be co- presented by both the researcher and father member of the research advisory group. Areas explored will include:
the research protocol -- the benefits of parent participation in the process; ethical responsibilities of the researcher towards the user
participant in sensitive research; engaging the parent user in the on-going analysis of transcripts and emergent thematic analysis.
Outcomes: Why is our experience relevant to neonatal practitioners? By presenting a reflective paper, that is nevertheless
underpinned by theoretical and policy guidance, it is hope that the discussion will stimulate novice and expert neonatal
researchers to consider new ways of engaging more meaningfully with families in the research process.
102
ABSTRACTS
POSTERS
Abstracts: Posters
CLINICAL ISSUES: ACUTE
P01: Nasal cannula flow rate, cannula size and generated airway pressure:
an in-vitro study
Schwoebel, Ann1; Abbasi, Soraya2
Pennsylvania Hospital, Philadelphia, PA, USA; 2Pennsylvania Hospital, USA
1
Background: CPAP nasal prongs must have a snug fit to provide sufficient airway pressure causing nasal skin and mucosal
injury. High flow nasal cannula (HFNC) does not require a close fit. Generated airway pressure is dependent the cannula flow
rate and the amount of flow escaping through the mouth.
Objective: To quantify the effect of HFNC flow rate on delivered airway pressure while varying the ratio of nasal prong (NP) to
nares diameter using a simulated airway and active lung model for both open and closed mouth conditions.
Design/Methods: Fisher&Paykel 3.0 and 3.7mm nasal cannula were tested in combination with 7 sizes of simulated nares
openings for 13 NC-to-nares ratios ranging from 0.43 to 1.06 (Figure). A Fisher&Paykel HFNC system with integrated pressure
limiting valve was set to flows of 1 to 6 L/m while measuring mean NP and airway pressures, and cannula and airway flows
during open and closed mouth conditions.
Results: Figure illustrates airway pressure vs HFNC flow, each line representing a different NC/nares ratio. Airway pressure
increased with both flow rate and NC/nares ratio. Partial nasal occlusion ( ratios >0.86) demonstrated a rapid increase in
pressure with increasing flow. Complete nasal occlusion (ratio > 1.0) developed the highest pressures. The simulated closed
mouth condition produced higher airway pressures than open month by a mean factor of 12±7SD over all NC/nares ratios
Conclusions: Safe and effective use of HFNC requires careful selection of an appropriately low nasal prong-to-nares ratio to
allow air leak around the cannula and through the mouth avoiding the risk over- pressurization and lung injury.
104
Abstracts: Posters
P02: Heat Loss Prevention In The Delivery Room And On Admission To The
Intensive Care Nursery
Schwoebel, Ann1; Jones, A2; Yocum, J3; Wade, K4; Mollen, T4
1
Nursing - Intensive Care Nursery, Pennsylvania Hospital, Philadelphia, USA; 2Nursing - Intensive Care Nursery, Pennsylvania
Hospital, USA; 3Performance Improvement, Pennsylvania Hospital, USA; 4Neonatology, Children’s Hospital of Philadelphia, USA
Background of Problem: According to data from the Vermont Oxford Network in 2011 and in the first part of 2012, 50 % of the
infants weighing 1500grams or less had temperatures that were below 36.40 C (97.60 F) axilliary on arrival to the intensive care unit.
Purpose of Practice Change: The purpose of this quality improvement project was to improve the admission temperature
of infants greater than or equal to 30 weeks gestation age as evidenced by a temperature between 36.40 C & 370 C axilliary
within 15 to 30 minutes of arrive to the unit.
Supporting Research Evidence: Hypothermia is a major cause of morbidity and mortality in infants through mechanism of
convection, evaporation, conduction, and radiation. Thermoregulation is considered a critical element in the “Golden Hour” of
neonatal stabilization. Thermoregulation is critical to survival and studies show that hypothermic infants are at increased risk
for significant morbidities, including respiratory distress, hypoglycemia, and severe IVH.
Practice Change Methods: A multidisciplinary team reviewed published, evidenced based interventions. A “Golden Hour”
bundle was developed that included a clearly established time line, uniform parameters, admission supplies available
pre-delivery, and strategies for thermoregulation. A check list with assigned roles was used to ensure completion of tasks.
Staff education via a skill fair was conducted and reminders placed on the units before implementation of the bundle in July
2012. An audit form was created that followed the timeline set forth in the bundle. The audit was filled out in real time and
later examined for areas of improvement.
Recommendations: Current review of the data suggests that the implementation of the bundle and audit tool positively
impacted the temperatures of the infants leaving the delivery room and on arrival to the intensive care nursery.
P03: Current Practices on methods of temperature taking and practices to prevent
hypothermia and heat loss in the preterm infant
Smith, Jacqueline
Neonatal, The Townsville Hospital, Queensland Health, Townsville, Australia
Background: Keeping preterm infants warm continues to be a challenge to health professionals. There have been many different
methods studied on keeping the preterm infant ware and prevention of heat loss; the most beneficial to date has been wrapping
or placing the infant in a plastic bag. There are also many different temperature taking devices and methods of taking an infants
temperature in the term and preterm infant. What are the most common methods and devices used in neonatal units?
Objective: To describe current practices in neonatal units (special care and neonatal intensive care) with respect to methods
and devices used when temperature taking and current practices used to prevent heat loss in the preterm infant.
Design: Quantitative design; email and posted survey to neonatal units in Europe, Australia and New Zealand.
Results: Results were analysed using SPSS version 19, using descriptive analysis. A total of n=226 emails were sent out to
clinical leaders and to each of the named linked person who would then distribute the survey via a link. Surveys were also
posted out (n=97) (with return pre paid envelope) to all units in Australia and New Zealand. Emails had a response rate of
25.6% (n=58), 3% (n=7) opted out, 1.7% (n=4) were not received. A total of 25% (n=48) replies from the email survey were
from Europe, 14.3% (n=1) from Southern Ireland and 29% (n=9) from Australia and New Zealand. Interestingly the postal
survey had a higher response rate, a total of 61.8% (n=60) replied.
Abstracts: Posters
P04: The application of a plastic wrap to improve NICU admission temperatures in
infants born less than 30 weeks gestation: A randomised controlled trial
Smith, Jacqueline
Neonatal, Queensland Health, Townsville, Australia
Background: Heat loss is greatest in the first few minutes of life; therefore maintenance of normal body temperature is one
of the key challenges a newborn particularly a preterm infant, faces after birth. Evidence suggests that the application of a
plastic wrap or bag soon after birth will help minimise heat loss in the preterm infant.
Objective: The purpose of this study was to investigate if the application of the plastic wrap (NeoWrap) soon after birth to all
infants less than 30 weeks gestation prior to admission to the neonatal intensive care unit, improved admission temperatures
when compared to the standard model of care.
Design: Blinded randomised controlled trial, stratified by gestation. Control and intervention group had their first temperature
within the first few minutes of birth, on admission to NICU and then every 30 minutes until two hours of age.
Results: Data was analysed using SPSS version 19. Overall 269 infants were eligible for inclusion into the study. A total of
103 infants were enrolled, 95 were randomised with n=44 in the intervention group and n=51 in the control group, a total
of n=3 were excluded from the final analysis. The data showed a difference in NICU admission temperatures between the
intervention and control group (p=0.004). Limitations were also observed during this study.
1 Smith, J., Usher, K., Alcock, G., Buetner, P. (2013). The application of a plastic wrap to improve admission temperatures in
infants less than 30 weeks gestation: A randomised controlled trial. 32(4), In press, corrected proof.
P05: Comprehensive Care For The Infant Experiencing Narcotic
Abstinence Syndrome
Herzog Taft, Barbera
Neonatal Intensive Care Unit, Rogue Regional Medical Center, Medford, USA
In-utero narcotic exposure is placing a significant burden on nurseries and neonatal intensive care units across the United
States. Not only are the number of infants exposed to illegal narcotics rising, but over the past few years a great deal of
the attention is being directed at the population of infants exposed to prescription narcotics. To successfully manage the
narcotic exposed infants, a comprehensive approach must be in place. Utilizing a multidisciplinary team of physicians, nurses,
developmental and feeding specialists, as well as social workers, to care for and navigate through the hospitalization, is key.
Documents and tools tailored for each member of the team, including the parents, optimizes the care and outcome of the
infant. A detailed narcotic abstinence syndrome (NAS) algorithm outlining the medical management, along with standardized
physician orders using a medication formulary (NeoFax) ensures a consistent approach. The nursing staff utilizes their own
set of documents to assess and manage the baby while partnering with the parents in the infant’s care. The parents receive
written information, but more importantly, in our single-patient room environment, they are able to provide care around the
clock while the nursing staff observe, support, and assist them. If parents are taking their baby home on narcotic treatment,
they will receive additional training in how to assess the baby and dispense the medication at home. The complex social
situations that frequently accompany the babies experiencing NAS provides a significant challenge for our social worker and
our community’s resources. Partnering with our community programs has proven essential to improve the infant’s long term
outcome. The comprehensive team approach using specific documents to guide the care of the infant and parents ensures
consistent and optimal management. Examples of each of these tools will be presented and discussed.
106
Abstracts: Posters
P06: Effect of quality improvement for reducing incidence of severe retinopathy
of prematurity (ROP)
Goonthon, S; Tongsawang, N; Joeichum, S
Pediatric Nursing, Faculty of Medicine Ramathibodi Hospital Mahidol U, Thailand
Background: ROP is a serious problem that can lead to blindness or poor vision in preterm infants. This condition can be
partly prevented by improving nursing care, e.g. updating guidelines in oxygen supplementation and monitoring.
Aim: To determine the outcome of quality improvement on the incidence of ROP stage > 3 in preterm infants admitted in the
NICU, Ramathibodi Hospital, Bangkok, Thailand.
Methods: A retrospective analytical study was performed by medical chart review in infants with birth weight < 1000 g
(extremely low birth weight infant, ELBW) comparing between the 2 periods, before (January 1st 2006-December 31st
2008; the first epoch) and after (January 1st 2010 -- 31st December 2012; the second epoch) updating guidelines of
oxygen supplementation and monitoring. The guidelines improvements involved policy for oxygen monitoring, target oxygen
saturation, timing of ophthalmologic examination, and equipment alarm setting. Primary outcome was the incidence of ROP
stage > 3 or blindness.
Results: There were 50 and 70 ELBW infants in the 1st and 2nd epoch, respectively. The overall incidence of ROP stage >3was
24% in the 1st epoch and 20% in the 2nd epoch, with a relative risk reduction of 17%. . There was a trend in reducing incidence
of ROP stage > 3 per year during the 2nd epoch (22.7% to 17.3%), while the incidence was increasing in the 1st epoch (22.1%
to 26.7%).There were 3 infants had blindness in the first epoch, but no infants developed blindness in the 2nd epoch.
Conclusion: We found that, in our unit, the incidence of severe ROP stage >3 can be reduced by quality improvement process
involving an updating nursing guidelines of oxygen supplementation and monitoring.
P07: Development of an algorithm for management of delayed meconium passage
in extremely low birth weight infants
Patricia, Gil Castro1; Loren, MC2; Prat, J3; Rio, R2
1
Neonatal department, Hospital sant Joan de Déu, Vilafranca de Penedes, Spain; 2Neonatal department, Hospital sant Joan de
Déu, Spain; 3Pediatric Surgeon, Hospital sant Joan de Déu, Spain
Background: Management of delayed meconium evacuation (DME) in very low birth weight infants (VLBWI) is currently not
standardized. The aim of this study was to establish an evidence base protocol for this condition´s management.
Methods: This study was conducted in the framework of a quality improvement program in our unit. A multidisciplinary group
was formed. First a PICO question was elaborated. Interventions to evaluate were administration of enemas, alternatives to
this and position during all the procedures. The population was VLBWI with DME. Then, data concerning DME management
were recorded from the medical and nursing records of the last 10 VLBWI admitted to our Unit. In parallel with data collection,
a bibliographic search in international databases was performed including The Cochrane Library ®, Pubmed® and Cinahl®.
Spanish nursing databases as Cuiden®, and Enfispo® were also included.
Abstracts: Posters
Results: The review of our own data showed a wide variety of care for VLBWI with DME. Enemas with normal saline were
frequently administered after 48 hours of meconium passage absence. Gastrografin® was also used in VLBW infants.
Information about position during enema or speed of administration could not be obtained from medical or nursing records.
Based on the literature findings and our own data, an algorithm of DME management for VLBWI was proposed. Glycerine
suppositories were now included as the first management option in symptomatic patients. Precise instructions of enema
composition and administration were provided with the algorithm for cases when enema was still considered to be needed.
The final algorithm was consensuated with neonatologists and pediatric surgeons of our unit.
Conclusions: The evidence based multidisciplinary approach has helped us to unify management of DME in VLBWI in our
unit. We think this kind of approach will help us to improve the quality of care delivered to these infants.
P08: An audit of Sucrose use, pre and post implementation of Sucrose Guidelines
in a Neonatal Unit
Nurse, Sharon1; Cruise, S2
1
Nursing & Widwifery, Queen’s University, Belfast, United Kingdom; 2Queens University, Belfast, United Kingdom
Background: There is considerable evidence to substantiate the use of Sucrose to reduce pain in premature babies having
minor painful procedures. A Sucrose Clinical Practice Guideline (CPG) was developed 3 years ago in one neonatal unit (NNU) in
Northern Ireland. No evidence was available in relation to prescribing and administration practices.
Aim: The aim of the project was to determine prescribing and administration practices pre- and post-implementation of a
revised Sucrose clinical practice guideline using an established chart audit process.
Intervention: An updated version of the guidelines was agreed, as well as measures to educate staff and parents about
sucrose. A planned audit of nursing documentation was to be undertaken prior to implementation and at 3, 6 and 12 months
following CPG implementation.
Results: More than 80% of babies audited had at least one procedure carried out in the previous 24 hours of their care.
Venepuncture, heel stab, orogastric feeding tube insertion and tape removal were the most frequently performed procedures.
At 3 months post-implementation 36.8% of babies received Sucrose for minor painful procedures, at 6months 25% of babies
received Sucrose and at 12 months only 10% were given Sucrose in association with a minor painful procedure. One possible
explanation for the decline in Sucrose use might be that nurses administered it but did not record this in the notes. Another
theory might be the perception by nurses that if the baby was already receiving analgesia for other purposes that Sucrose
was unnecessary and therefore not prescribed.
Conclusion: There is a need for continuing education of staff in the use and documentation of Sucrose for babies during
minor painful procedures to ensure the sustained implementation of an evidence-based approach to procedural pain
management in the NNU.
108
Abstracts: Posters
P09: Parent Feedback From A Neonatal Nurse Delivered Infant Basic Resuscitation
Service
Barbara, Hills1; McDermott, Z2; Clifton, L2; Scott, M2; Eccleston, K2; Ellis, S2
Neonatal Unit, University Hospital Coventry and Warwickshire, Coventry, United Kingdom; 2Neonatal Unit, University Hospital
Coventry and Warwickshire, United Kingdom
1
Introduction: It is recommended that parents of high risk infants be equipped with the skills to perform basic life support
which has been shown to improve outcome of their infant. The policy at UHCW was to offer training to parents of infants
considered to be ‘high risk’ delivered by a doctor on discharge. A nurse led session was developed, open to all, on a monthly
basis and delivered as part of the parent craft programme. One to one sessions are offered prior to discharge, if parents are
unable to attend monthly sessions.
Methods: NLS trained neonatal nurses supervised by Neonatal consultant developed a session lasting 30 minutes in which
the skills of basic life support, choking and cot death prevention were covered with the aid of DVD, demonstration and
parental participation using manikins. All parents were asked to complete a questionnaire and score session components out
of 10. All parents are provided with a leaflet, summarising the session and a copy of the DVD to take home and watch at their
own leisure.
Results: Between September 2011 and March 2013 fourteen group sessions have been delivered. 146 parents (87 mothers and
52 fathers) 2 grandmothers and a sister from 86 families attended. 35 parents (24%) had received some formal resuscitation
training in the past. Parent’s objectives were to gain confidence (57%) and to gain skills in resuscitation (40%). All four session
components scored highly: DVD mean 9(mode 10), demonstration 9.4(10), practical 9.4(10) and handout 9.8(10).
Discussion: Nurse delivered infant basic resuscitation training is well received by parents with all four components scoring
highly. We intend to recruit and train more nurses, to be involved in teaching the sessions and our aim is to deliver this
programme on a weekly basis. We would like to look at further feedback from these families to evaluate how many used
these skills since discharge.
Abstracts: Posters
RETRIEVAL & TRANSPORT STABILISATION, APN &
WORKPLACE MANAGEMENT
P10: The transfer of infants from tertiary NICUs to community SCNs: the
perceptions and opinions of health professionals on parents’ transfer experiences
Ramudu, L1; McDonald, S2; Thomas, S3
1
Nursing Education, The Northern Hospital, Victoria, Australia; 2Faculty of Health Sciences, La Trobe University/Mercy Hospital
for Women, Australia; 3Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia
Background: The transfer of infants from NICUs to SCNs is often a difficult period for parents. This has been captured in
the literature over a number of decades with common themes such as parent stress, poor communication, differences in
practices, recurrence of medical problems and altered parental roles (Slattery et al, 1998; Rowe & Jones, 2008).
Aim: The aim of this study was to explore the views of health professionals (HPs) at the NICUs and SCNs, and to gain an
insight into their perspectives of parents’ experiences.
Method: A descriptive exploratory qualitative method was utilised in this study. An Interview Schedule was used to elicit the
opinions of HPs through focus groups. The common themes were analysed and categorised using directed content analysis.
Results: 80 HPs participated in the study. Additional themes to that of the literature review were staff-parent relationships
and the nature of the clinical environment. These were recoded to four main themes in this study: Causes of Transfer
Stress, Setting the Scene for Transfer, Relationships, and Organisational Context and Dynamics. Whilst the period after the
transfer was a positive experience for parents in this study, it was dependent on the quality of the pre-transfer and transition
preparation at both sites. NICU HPs’ practices that influenced parents’ acceptance to the transfer were also dependent on
the positive communication of information and a show of support for the SCNs. This was hindered if HPs were unaware of
the environment they were preparing parents for, or if HPs at both sites were not attuned to parents’ maladaptive coping
responses. The promotion and transfer of seamless continuity of care and reaffirming trust in a new group of health
professionals was viewed as valuable and contributed to parents’ acceptance of their infants’ transfer.
Conclusion: The results can be applied to support ongoing transfer practices at all NICU and SCN sites.
110
Abstracts: Posters
P11: Subgaleal Haemorrhage in newborns: the challenges faced by medical
retrieval teams
Roxburgh, J
Nursing, Newborn & paediatric Emergency Transport Service, Australia
Although rare, medical retrieval teams from the Newborn and paediatric Emergency Transport Service (NETS), NSW have
been required to manage newborns with Subgaleal haemorrhage at referring hospitals and then provied transfer to a tertiary
surgical unit for definitive care. The limitations of the retrieval environment and the rare nature of these cases impose
complexities for retrieval teams in both providing care in the referring centre and in retrieval.
A review of NETS case records from the past 10 years showed that NETS are called to attend 1-4 infants per annum with
Subgaleal haemorrhage. On reviewing all cases involving NETS teams, a number of challenges experienced by teams in
managing these infants were revealed. The literature also highlights the potential adverse events that can be associated with
this potentially fatal complication of birth.
Limitations and challenges for retrieval teams are mainly associated with delays, inexperienced staff and the lack of
appropriate blood products. From a retrieval perspective, these cases have demonstrated that there are additional resources
that need to be considered to provide optimal care for newborns with subgaleal haemorrhage who are delivered in and
require retrieval from non- tertiary centres.
P12: From Vision to Practice: Using Telehealth as a catalyst for strengthening the
Neonatal Care Network in Manitoba
Narvey, Michael1; Ramesar, D2; Muller, N3; Seshia, M2; Merrill, L4; Nyhof, G3
Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; 2Child Health, University of Manitoba, Canada;
3
MBTelehealth, University of Manitoba, Canada; 4Women’s Health, University of Manitoba, Canada
1
Background: The jointly MBTelehealth -- Health Sciences Centre NICU project was developed to meet Manitoba Health’s Maternal
and Child Health Task Force objectives for using telehealth to improve neonatal care. In our Province, practitioners are geographically
distanced and have varied experience and skill. The prospect of averting unnecessary neonatal transports through strengthened
relationships and 24/7 accessibility to NICU teams was the driving force to better support our rural and northern families. Communication
had almost exclusively been via telephone and therefore relationship building had to be a key to the project’s success. For this reason
services were launched in conjunction with the delivery of the Acute Care of at-Risk Newborns (ACoRN) course in each participating
facility. The project’s telehealth enhancements enabled an array of services including urgent transport decision consultation, discharge
planning, family tele-visitations as well as staff participation in guideline development and educational rounds.
Methods: A steering committee created an inclusive culture of leadership based on trust that generated a constant
momentum toward well understood and specific goals. Implementation of the project was individually tailored for each
participating facility, yet met timelines, budget and scope parameters.
Results: The project’s phase 1 was completed in spring 2012 with all of the technology in place. Use of telehealth has
increased over 12 fold when comparing 2011 to 2012. Since May of 2012, 5 air transports have been averted through the use
of this program. Outcomes presented will include telehealth utilization data as well as clinical care delivery impacts as noted
by rural staff and neonatal care providers involved for the first year following implementation.
Conclusion: Through a shared vision for excellence in the care of sick newborns in Manitoba, the neonatal network
stakeholders are developing a mutually meaningful relationship. Implications include the reduction of unnecessary transports
and an increase in confidence at rural and northern participating facilities in the care of sick newborns. Addition of new sites
and services in are anticipated in the next few years due to the success of this initiative.
Abstracts: Posters
P13: The Effectiveness Of E-learning In Enhancing Neonatal Resuscitation Skills,
Knowledge And Confidence Of Undergraduate Nursing Students
Elarousy, Wafaa1; Abdulshakoor, Ebtesam2; Bafail, Raniah2; Shebaili, Makiah2
1
Pediatric Nursing, College of Nursing, Jeddah, Saudi Arabia; 2Pediatric Nursing, College of Nursing-Jeddah, KSAU-HS, Saudi Arabia
Background: In recent decades, the use of information and communication technologies (ICT) for educational purposes
has increased, and the spread of network technologies has caused e-learning practices to evolve significantly. E-learning is
used increasingly in healthcare professionals’ education. In higher education, audio and video productions prove effective in
enhancing student-learning outcomes and increase student satisfaction. Evidence suggests that e-learning is more efficient
because learners gain knowledge, skills, and attitudes faster than through traditional methods.
Methods: The purpose of the study is to investigate the effectiveness of e-learning in enhancing neonatal resuscitation skills,
knowledge and confidence of undergraduate nursing students. Forty one undergraduate students who registered for Pediatric
course from College of Nursing -- Jeddah were recruited for the study. A single-blind Randomized Control Trial design was
used. Results: still on the process.
P14: Examination of the role of advanced practice registered nurses in the NICU in
the United States, a model for global role expansion
OConnor, Susan
Neonatal Intensive Care, Texas Children’s Hospital, Houston, Texas, USA
Background: Advance Practice Nurses (APNs) have been in use in the USA for over thirty years.
Methods: Literature review
Results: APNs have proven outcome data in the USA, but have much room for expansion in Europe and Australia
P15: Creating A Program Of Quality Improvement For A Group Of Advanced Practice
Nurses
Wallace, Tamara
HP, Vanderbilt, Franklin, USA
Background: Stakeholders in healthcare, institutions, and regulatory bodies are increasingly asking for proof of competency
and quality of care from all providers. Advanced Practice Nurses (APNs) are not immune from these forces. Traditionally, APN
outcomes have not been tracked outside of multidisciplinary outcomes.
Goals: Improve patient outcomes. Generate APN quality data that can be used to demonstrate the unique contributions of the
APN to the NICU and to patient outcomes. Generate productivity data to support the ongoing growth of APN programs.
Program: This poster will examine how to create a culture of quality in a group of APNs and will suggest strategies to select
quality metrics that demonstrate the unique care provided by APNs. This poster will highlight one method for performing data
collection, that is simple, quick and can become a part of daily routine.
Conclusion: A program of continuous quality improvement has the potential to allow us to articulate what parts of outcome
are unique to the APN role and how APNs improve outcomes. In the future, this information can be used to create benchmarks
for the performance of APNs.
112
Abstracts: Posters
P16: Ethnography of Nursing Workplace Relations in an Australian NICU: A Review
Spence, K1; Nepali, Shobha2; Rudge, T3; West, S3
1
Sydney Childrens Hospital Network, Westmead Campus, Australia; 2Sydney Nursing School, The University of Sydney,
Camperdown, Australia; 3Sydney Nursing School, The University of Sydney, Australia
Background: The nursing workplace relationships within a Neonatal Intensive Care Unit (NICU) involve interactions and social
relationships formed among nurses, doctors, allied health professionals and support staff involved in providing health care
to neonates and their families. Today in an Australian NICU the staffs bring to their workplace a variety of life experiences,
nationalities, backgrounds and cultures as well as their professional training/education. This paper is based on the review of
literature that discusses an overview of what is already known about the nursing workplace relationships and specifically (i)
the cultural practices embedded in NICU; (ii) nurses’ experience of everyday work in the NICU, (iii) what social interactions
take place within the unit and (iv) how workplace relationships are constructed.
Findings of Literature Review: An extensive literature review of research about nurses’ relations at work has revealed very
little about actual ward culture in general and NICUs specifically or the everyday work experiences of nurses and the day-today realities of how nurses act and interact in providing care and how they relate to nursing colleagues and other members of
the health care team. The review found little use of forms of cultural analysis as are possible with an ethnographic approach.
Thus, these findings of the literature review inform the need for an ethnographic study that enables in-depth and rich
examination of these issues in the context of NICU of an Australian hospital.
Methodology: Ethnography is a method used to best explore the workplace relationships of neonatal nurses as this approach
enables an examination of how people view situations they face and how they regard one another. Due to its free nature and
wide applicability, ethnography has been utilized in many diciplines including nursing.
Implication: Ultimately, this study will contribute to strategies for nurturing positive workplace relationships in NICU.
P17: Exploring The Power Of Neonatal Specific Education: The Impact On Practice,
And The Nurses’ Attitudes Toward Professional Relationship
Konishi, Miki1; Yoshioka, T2; Kusuda, S3; Okubo, Y2; Suganuma, T2
1
Department of Medical Education, Tokyo Womenfs Medical University, Tochigi, Japan; 2Department of Medical Education,
Tokyo Womenfs Medical University, Japan; 3Department of Neonatal Medicine, Maternal & Perinatal Center, Tokyo Womenfs
Medical University, Japan
Background: Japanese NICUs do not generally offer neonatal nursing orientation, relying mostly on the self-learning and
on-the-job training. Invasive procedures such as blood sampling or starting intravenous lines are rarely part of the scope of
nursing practice. The main role focuses on the non-invasive routine task such as, bathing, feeding, administering medication,
and recording vital signs. Author attempted to study the potential impact of the educational offerings including the invasive
procedural skill lab.
Method: A 5-day education program provided over a 3 months period for experienced neonatal nurses was developed
and 16 nurses completed the study program. Data were collected using questionnaires on four occasions: the first day,
the final day, and 3 and 6 months after the program. Nurses were asked which invasive procedures are within their role.
The Jefferson Scale of Attitudes toward Physician--Nurse Collaboration and Nakayama job satisfaction scale were used.
Nakayama scale includes the four subscales: administration system, interpersonal relationships, professionalism, and nurses’
self-actualization. Eighteen months after the program, semi-structured interview was conducted individually with six nurses
and qualitative content analysis was performed.
Abstracts: Posters
Results: Two nurses began incorporating the learned procedural technique in the routine care. No significant differences were
noted in the total score on the Jefferson scale. Compared with the baseline, the scores on the interpersonal relationship on
the final day were significantly lower, and the nurses’ self-actualization scores at 6 months post program were significantly
higher. The interview results suggested that the nurses developed better understanding and communication with the
partnering neonatologists. They became more proficient at assessing and anticipating the needs of the patients and felt that
they worked more autonomously and independently. Other findings include dissatisfaction with the standard role, and a sense
of dissatisfaction in not being able to share this feeling with the nurse colleagues.
P18: Implementing An Educational Program To Improve Patient Outcomes By
Improving The Success Of PIV Insertion In A Large Multilevel NICU
O’Neill, Nancy
IWK Health Centre, Canada
Background: Previous to our quality improvement intervention, peripheral intravenous insertion was an expectation of all nurses
working in our 45 bed Level 3/2 neonatal intensive care unit. In order to improve the experience of the patient and to increase
successful placement of peripheral intravenous lines a change was made in the educational program for nurses working in
our unit. The educational program was associated with a change in practice whereby insertion of a peripheral intravenous was
restricted to nurses with training at the intensive level who had completed the peripheral intravenous insertion workshop.
Methods: Peripheral intravenous insertion as an expected skill was transferred from intermediate level nursing orientation to
intensive level orientation. An educational workshop was developed which includes lectures on infection risks, safety issues,
the pain experience and relief techniques, demonstration of the skill and practice sessions, mentoring and evaluation. The
workshop was made mandatory for all health professionals who wished to insert peripheral intravenous line’s in the neonatal
intensive care unit, even those already inserting peripheral intravenous line’s in the unit.
Results: All nurses practicing intensive level care in the neonatal intensive care regardless of experience level and all pediatric
residents took part in the workshop. Since implementation of the program, there has been a decrease in the number of attempts
for intravenous insertions and an increase in practices of infection control and pain relief for patients undergoing this procedure in
our unit. There has been a 50 percent decrease in the non central infection rate since the initiation of the educational initiative.
Conclusions: A standardized educational program given to nursing staff orientated to intensive level care increases
successful intravenous line placement and is associated with improved patient outcomes.
P19: Neonatal simulation study days facilitated by advanced neonatal nurse
practitioners
Quinn, Denise
Neonatal Unit, Southern Area Health and Social Care Trust, Portadown, United Kingdom
Background: Neonatal simulation is an important teaching aid in the neonatal workforce. Nursing and medical staff have
less exposure to emergency procedures rendering them less able to effectively manage neonatal emergencies. Participation
in simulation scenarios allows increased exposure to procedures and enables the development of competence of specific
techniques and clinical management with ultimate aims of improved patient outcomes, standardisation and control of training,
improvement of procedural competence and the provision of training in a safe environment.
114
Abstracts: Posters
Methods: A neonatal simulator was purchased by the neonatal unit, Craigavon Area Hospital, in April 2011and to date is the
only hospital in Northern Ireland to own a neonatal simulator. Since then a various number of approaches have been tried to
embrace simulation training. It was initially introduced on an adhoc basis, then semi planned simulation and its current, most
successful format is to have full day neonatal simulation study days.The day is run and managed by an advanced neonatal
nurse practitioner and facilitated by a neonatal consultant.
8 nurses and 2 doctors are booked onto each day.
A total of 4 scenarios are carried out in each study day. Each scenario is allocated 30 minutes with 45 minutes allocated
for debriefing following the scenario. The debriefing is as important if not more important than the actual simulation. This
allocation of time allows all members of the group to discuss the management of the scenario and provides an opportunity to
discuss optimal management of each emergency or procedure.
Results: Staff have been very receptive to these days with each session being booked up very quickly. Feedback has been
100% positive with staff feeling that participation in these days has contributed to their ability to effectively manage neonatal
emergencies and increased their competence in clinical procedures.
P20: Perceptions Of Doctors Working In Labour Wards Of The Use Of
Cardiotocography As An Intrapartum Monitoring Tool
James, Sindiwe
Nelson Mandela Metropolitan University, Nelson Mandela Bay, South Africa
Introduction and Background: Electronic foetal heart rate monitoring using a cardiotocograph (CTG) has been widely
studied and is a universally accepted form of foetal heart rate monitoring in high risk patients during labour.The use of CTG
monitoring during labour is essential in identifying foetal challenges which, if missed, could prove fatal or result in major
neonatal complications. Fetal complications have led to litigations involving claims of large amounts of money due to babies
either being born with brain injuries or dying.
Methods: This qualitative research study, using semi-structured interviews, was conducted to explore and describe the
perceptions of doctors working in labour wards and their use of CTG as an intrapartum monitoring tool. A further objective
of this study was to recommend activities for doctors and obstetrical health care managers in the Department of Health to
optimize the use of CTG as an intra-partum monitoring tool in labour ward units.
Twelve participants were individually interviewed using a digital recorder and field notes were captured. Data collection was
immediately followed by data analysis employing Tesch’s method of data analysis.
Results: Three main themes emerged from the data analysis and the independent coder assisted with finalising the results.
The main themes were: * Participants perceive the use of CTG as an important obstetrical tool for the purpose of diagnosis,
guidance and communication; * Participants perceive the use of CTG as having the potential to evoke emotions; * Participants
perceive the use of CTG as having an ethical implication. Guba’s model of trustworthiness guided the ethics of the study and
non-maleficence, beneficence, justice and autonomy were ensured. Recommendations were developed for clinical practice,
nursing education and research.
Key concepts: Perceptions, Cardiotocograph, Monitoring, Intrapartum, Obstetrician
Abstracts: Posters
P21: The essential role of the Neonatal Nurse Research Coordinator Need for position security
Lontis, Rosslyn1; Goodchild, L1; Collins, C T2; McPhee, A J1; Omari, T3; Haslam, R R1
1
Department of Neonatology, Women’s & Children’s Hospital, North Adelaide, Australia; 2Women’s and Children’s Health
Research Institute, Adelaide, Australia; 3Department of Gastroenterology, Women’s and Children’s Hospital, North Adelaide,
Australia
Background: Investigator led clinical research underpins high quality care yet research nurse positions are often
undervalued. With the volume and scope of neonatal research increasing the implications for management within a local
neonatal unit are increasingly complex and costly. We describe the research profile of a tertiary neonatal unit in 2 time
periods: 2000-2005 and 2006-2011.
Method: Records of research conducted between 2000 and 2011 in the neonatal unit of the Women’s and Children’s Hospital
were reviewed.
Results: 54 studies were conducted with 1442 infants enrolled in primary studies and 284 in follow-up studies. The average
(range) number of studies in any one year has increased from 10(7-17) in 2000-2005 to 15(13-18) in 2006-2011. Only
67% of the studies were funded. The overall participation rate of families in primary studies improved over time (72% vs.
76% for 2000-2005 vs. 2006-2011). 259(18%) infants were enrolled in 2 to 3 studies and 16(1%) in 4 to 6 studies. In 2003,
management of neurodevelopmental follow-up assessments for trials was added to the Coordinator’s role. This expanded the
workload with need to manage both in-hospital and follow-up trial assessments.
Conclusions: While the majority of families willingly participate in research and investigators continue to drive research
initiatives, up to one third of projects remain unfunded creating a financial burden on local units. Experienced research nurses,
with appropriate job security, are essential for the continuing high quality conduct of research in neonatal settings. Provision
for research nurse positions in tertiary unit operational budgets, needs to be supported.
116
Abstracts: Posters
GLOBAL HEALTH ISSUES AND HEALTH & DEVELOPMENTAL
OUTCOMES
P22: Obstacles in Providing Neonatal Care in Kurdistan, Iraq
Kareem, Atiya
Maternal & neonat Health Nursing, Sulimanie University/ School Of nursing, Sulimanie / Kurdistan, Iraq
Life has been disrupted for many years by war and strife for the Kurds of Northern Iraq. This decaying infrastructure within the
health sector has resulted in many problems, among them, care to women and newborns, especially newborns with health
problems. Infant & maternal mortality rates are throught to be higher than in surrounding countries, but the true statistics
are not are not known because birth and death registration is not mandatory. The neonatal mortality rate was recorded by
the Word bank as 20 of 1000 in 2012 for all those in Iraq. Their deliveries are managed by nurse midwives in a crowded
maternity ward with only 18 labor-delivery beds.
This article will focus on the obstacles to providing quality neonatal care and will address neonatal transport. The obstacles
with neonates can be summarized by issues within these 2 categories: infrastructure and training education.
P23: Retinopathy of prematurity in Northern Ireland: can we achieve 100%
screening coverage?
Fraser, L1; McCall, E1; Jenkins, JG1; McLoone, E2; McGinnity, G2; Datta, K2; Stevenson, M3; Craig, S4
1
NICORE, School of Nursing & Midwifery, Queen’s University Belfast, United Kingdom; 2Department of Ophthalmology, Royal
Victoria Hospital, United Kingdom; 3Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s
University Belfast, United Kingdom; 4Regional Neonatal Unit, Royal Maternity Hospital, United Kingdom
Background: In Northern Ireland (NI), Retinopathy of Prematurity (ROP) screening data collected on neonatal discharge by
the Neonatal Intensive Care Outcomes Research & Evaluation Group (NICORE) suggest that eligible infants are being missed.
This is concerning with respect to potential long-term consequences and the ability to meet the 2008 RCPCH/RCOphth
recommended standard of 100% ROP screening coverage.
Objectives: To ascertain whether NICORE ROP dataset is fit for purpose with regard to monitoring screening coverage and
ROP outcomes, and to make urgent recommendations for process improvement.
Methods: Retrospective audit using comparative analyses (Cohen’s Kappa test) and linkage of two routine ROP datasets
(NICORE and Ophthalmology).
Setting: NI neonatal units.
Patients: Infants <1501g birth weight or <32 weeks’ gestation born and admitted to neonatal care during a 12-month period.
Main outcome measurement: Percentage attainment of screening standard.
Results: Overall, 84.3% infants were screened. One third of 45 infants not screened were small for gestational age (SGA). Of 232
screened infants, 61 (26.3%) had ROP (any stage), 22 (9.5%) had greater than or equal to stage 3 ROP and 14 (6%) required laser
treatment. The Ophthalmology dataset reported more infants screened, tended towards more ROP present and higher stage ROP.
Conclusions: NI did not meet the recommended standard. Missed infants were bigger, more mature and one third was SGA. Current
ROP performance monitoring datasets are sub-optimal. ROP datasets need to include all ophthalmic screens even after discharge
from the neonatal unit to truly reflect ROP screening performance and outcomes if recommended targets are to be met.
Abstracts: Posters
P24: Evaluation of neonatal care in public and private hospitals considering the
objectives of the Stork Network (Rede Cegonha)
Tonete, Vera1; Carvalheira, APP2; Costa, CC2; Borgato, MH2; Malta, MB2; Parada, CMGL2
1
Nursing, Univ Estadual Paulista/Botucatu Medical School, Botucatu, Brazil; 2Nursing, Univ Estadual Paulista/Botucatu Medical
School, Brazil
Introduction: Brazil reached the target proposed by Millennium Development Goal 4 in 2010: the mortality rate was 15.6
out of every one thousand live births, and the target proposed for 2015 was 15.7 out of every one thousand live births. This
important advancement resulted primarily from reduction in postnatal deaths, although the neonatal mortality rate remained
high. In 2011, the public policy “Stork Network” (Rede Cegonha) was instituted so as to ensure qualified and humanized
health care to women and children in the puerperal pregnancy cycle, safe childbirth and children’s healthy development and
growth. Maternal and neonatal mortality rates are expected to be reduced.
Objective: To evaluate neonatal care in maternity hospitals in a medium-sized city in Sao Paulo state by comparing public and
private services.
Method: Cross-sectional study with the analysis of 1,343 births occurring from January to June 2012 in the city’s maternity
hospitals. Data were obtained from hospital charts, prenatal cards and interviews with puerperae. Analysis included
gestational age at the moment of delivery, the need for neonatal resuscitation in the delivery room and data related to
neonates’ care during hospitalization: blood collection for blood typing; gestational age estimated by physical examination;
use of an incubator whenever necessary and diet type at the moment of hospital discharge. The chi-square test was used for
data analysis, and p<0.05 was applied as a critical level, with a 95% confidence interval.
Results: In the public hospital, gestational age estimation by physical examination and incubator use in case of need were
more often used, and children were exclusively breastfed at the moment of hospital discharge.
Conclusions: Considering that the variables included in this study are consolidated as good practices in neonatal care, it was
observed that the situation in the public service was more favorable than that in the private institution.
P25: Kangaroo Mother Care (KMC) among High-Risk Infants: Nurses Knowledge,
Attitudes and Education
McGowan, Jennifer; Johnston, L; Browne, J
School of Nursing and Midwifery, Queen’s University Belfast, United Kingdom
Background: While KMC is widely accepted as a safe and beneficial intervention, its use within neonatal units, particularly
among high-risk, technology dependent throughout the world varies. Neonatal nurses play a central role in the promotion and
practice of KMC. To date however, there is very limited understanding relating to neonatal nurses knowledge, attitudes and
education related to KMC.
Method: This literature review which considered neonatal nurses knowledge, attitudes and education related to KMC,
involved an extensive search of all studies (RCTs, prospective and retrospective cohort studies and case control/case
series) from 1980-2012. It was conducted using major electronic databases and manual searching and key words included:
neonatal; Intensive Care; high-risk infants; nurses; Kangaroo Mother Care; skin-to-skin; knowledge; attitudes and education.
118
Abstracts: Posters
Results: This literature review revealed 6 studies relating specifically to neonatal nurses’ perceptions, attitudes and education
around KMC (2 reported nurses’ experiences of implementing KMC; 3 descriptive studies of nursing attitudes and knowledge;
1 RCT of an educational intervention of KMC). Overall, studies reported that KMC is viewed as a beneficial intervention,
yet uncertainty remains around the practical implementation of KMC. Environmental infrastructure and staffing were also
highlighted as potential barriers to KMC. The development of practical education interventions were called for to encourage
the philosophy of change and to promote KMC.
Conclusion: In response to this evidence base, there is a very real need to develop a theoretically grounded training tool designed
to educate healthcare staff in the neonatal unit about the benefits of KC, and how to encourage its use among parents.
P26: Smoking load of Brazilian pregnant women and weight at birth
Parada, Cristina1; Kataoka, MC2; Carvalheira, APP2; Carvalhaes, MABL2; Duarte, MTC2; Tonete, VLP2
Nursing, Univ Estadual Paulista/Botucatu Medical School, Botucatu, Brazil; 2Nursing, Univ Estadual Paulista/Botucatu Medical
School, Brazil
1
Background: smoking is considered to be a public health problem in Brazil due to its high prevalence and its relation to
numerous cases of death and diseases. When associated with the gestational period, the situation can be even more serious
as it may compromise not only maternal but also fetal health. A common result of this habit is the occurrence of low weight at
birth, which is an important risk factor to children’s health. This study aimed at evaluating the association between smoking
load during pregnancy and the conceptus’ weight at birth. Methods: cross-sectional, retrospective study conducted on 1,343
pregnant women whose deliveries occurred in the first semester of 2012 in a city in Sao Paulo state, Brazil. Data were
analyzed by the Epi Info 6.0 software, using the chi-square test and considering p< 0.05 as a critical value and a 95% CI.
Results: most of the pregnant smokers were young, poorly educated, unemployed, multiparous and lived with the child’s
father. Smoking prevalence was 13.2%; the smoking load ranged from 1 to 40 cigarettes a day. When the potential
confounding variables were controlled, an association between the number of smoked cigarettes and at-term neonates’
weight at birth was observed: from 6 cigarettes a day, weight decreased by 319.6 grams, and above 10, it decreased by
343.9 grams.
Conclusions: based on these results, it was concluded that the universal recommendation of smoking abstinence during
pregnancy is appropriate. However, it is noteworthy that, in face of the impossibility of abstinence as a way to reduce the damage
related to low weight at birth, pregnant women must be encouraged to reduce the number of cigarettes smoked daily.
Abstracts: Posters
P27: Does implementation of a Central Line Bundle reduce Central line associated
blood stream infection? -- A tertiary centre’s experience and outcome
Lindrea, KB
Newborn Care Centre, Royal Hospital for Women, Australia
Background: Central line associated blood-stream infection (CLABSI) is a preventable Hospital Acquired Infection (HAI).
Reducing CLABSI rates to zero is everyone’s goal and it is achievable with collaborative work, standardisation and consistency
with practice - all of which improves the quality of care to the neonates in the NICU. The Institute for Healthcare Improvement
(IHI) defined Bundles as a group of best practices which are evidence-based that individually improve care but when applied
together result in substantially greater improvement (http.//www.ihi.org./IHI/Topics/CriticalCare/IntensiveCare/Changes/
ImplementtheCetralLineBundle.htm The common thread with programs introduced in the UK & Canada is an attempt to
standardise the delivery of best practices so that they are carried out consistently among all clinicians.
Method: One of the many measures introduced to control infection in the Unit was the implementation of a multifaceted
proactive practice bundle to reduce CLABSI rate in the NICU in 2008. This included the implementation of principles in
standardising line insertion and care practices.
Result: The governance, collaboration and support of medical and nursing teams working together with the implementation of
the central line care bundle resulted in an impressive reduction of CLABS in the NICU with a downward trend of CLABSI.
Conclusion: Introducing the Central Line Insertion and Maintenance Bundle into a dynamic NICU in 2008 has its challenges
but is an achievable project to prevent CLABSI Having a rigorous training program with strict infection control practices and a
dedicated team for catheter insertion has proven effective in reducing CLABSI rates in the NICU
P28: “Halo” phenomenon (phenomenon “Stefanis”) in relation with antimicrobial
copper implementation
Efstathiou, Panos1; Anagnostakou, Marina2; Kouskouni, Evaggelia2; Petropoulou, Chrysa2; Karageorgou, Katerina1; Gogosis,
Kostantinos1; Manolidou, Zacharoula1; Papanikolou, Spiros1; Logothetis, Emmanuil2; Efstathiou, Labrini2; Agrafa, Ioanna1
1
National Health Operations Centre, Ministry of Health, Greece; 2Medical School of the University of Athens, Microbiology
laboratory of Aretaieio Hospital, Ministry of Health, Greece
Aim: The aim of this study was to evaluate the antimicrobial action of copper alloys in the form of a ‘circle’ (“halo” phenomenon),
resulting in a further reduction of microbial loads in non antimicrobial copper implemented multi-touch surfaces.
Method - Material: In a Neonatal Intensive Care Unit (NICU) with the capacity of 26 beds (boxes) of a pediatric hospital
implemented with antimicrobial copper Cu+ (Cu+63% Zn - 37% low lead) and certified for the antimicrobial activity of objects
and surfaces, samples and cultures were taken within 50cm distance from the Cu+ implemented objects and surfaces, in
order to measure the microbial flora. This process took place the period before, during and 2 months after Cu+ implementation.
Parameters such as Operational Protocols and staffing of the NICU during the research were not differentiated.
Results: The reduction of microbial load on multi-touch surfaces of Cu+ was recorded at 90%, and at a distance of 50 cm
from the Cu+ implemented objects or surfaces the reduction of microbial loads (cfu / ml) was recorded at a rate of 70-75% (N
= 36-P <0,05). Microbial strains found were: Klebsiellaspp., Staph. Epidermidis, Staph. Aureus, Sphingomonaspaucimobilis.
Conclusions: The recorded ‘radial action’ of the Cu+ alloys in a circular form ( “halo” phenomenon) provides further
confirmation of copper’s antimicrobial ability. The “halo” phenomenon enables Cu+ to reduce microbial flora and increase its
beneficial effects on health sector and sets the bases for further comparative research.
120
Abstracts: Posters
P29: The Role of Nursing in Implementing Helping Babies Breathe® in Countries
with Limited Resources: An Analysis of Critical Challenges
Barber, G1; Clarke, S2; Flanagan, V3
1
Perinatal Outreach Services, Cardinal Glennon Children’s Medical Center, USA; 2Continuing Education and Outreach,
Children’s Hospital Colorado, USA; 3Northern New England Perinatal QI Network, Children’s Hospital at Dartmouth, USA
Purpose: Evaluate the role of nurse trainers/learners in planning and implementation for various Helping Babies Breathe®
(HBB) trainings in India, Kenya, Rwanda and Sudan.
Background: Prevention and early treatment of perinatal asphyxia must be addressed to meet the United Nations Millennium
Development Goal 4 of decreased infant mortality by 2015. HBB is a global, evidenced-based, train the trainer curriculum for
newborn resuscitation in low resource settings focusing on the first minute after birth. Nurses and birth attendants are the primary
health care providers present during labor and delivery, yet often systematic training for newborn resuscitation is not available.
Methods: The authors were designated as experienced regional perinatal educators and participated in the inaugural June 2010
HBB Master Trainer Course with United States and international colleagues. Since that time they have participated in 25 HBB
trainings. Additionally, local nurses, physicians and birth attendants were identified and recruited from hospitals, community
health centers and villages to be trained as HBB master trainers/facilitators and/or learners, following the HBB training curriculum.
Results: Positive elements of the trainings included 1) interdisciplinary facilitators and learners, 2) importance of coordination
with other obstetrical and newborn programs, institutions and Ministries of Health, 3) the learner/facilitator dyad and scenario
practice and 4) commitment to translation of teaching materials. Challenges included 1) funding for training materials and
equipment, 2) transportation for rural birth attendants, 3) role clarity during newborn resuscitation and initial care, 4) difficulty
in tracking patient outcomes and 5) plans for sustainability.
Conclusions: Positive elements and continuing challenges were recognized before, during and after HBB training.
Collaboration and support by nurses, physicians, midwives, birth attendants, local mentors and MOH are making a difference.
Ongoing practice and follow-up is needed for skill retention and integration with other areas of maternal and newborn care.
Abstracts: Posters
FATHERS, PARENTING & DEVELOPMENTAL CARE,
PALLIATIVE CARE AND BEREAVEMENT
P30: A Parenting Intervention For Families With A Very Preterm Baby;
Prem Baby Triple P
Slaughter, V1; Pritchard, Margo2; Clditz, PB3; Boyd, R4; Gray, P5; O’Callaghan, M6; Sanders, M1; Whittingham, K7
1
School of Psychology, The University of Queensland, Australia; 2Womens Newborn Services,, Royal Brisbane Women’s
Hospital,The Uni of QLD, Brisbane, Australia; 3Centre for Clinical Research, The University of Queensland, Australia;
4
3Queensland Cerebral Palsy & Rehabilitation Research Centre, The University of Queensland, Australia; 5Mater Mothers’
Hospital, The University of Queensland,, Australia; 6School of Medicine, Mater Mothers’ Hospital., Australia; 7Queensland
Cerebal Palsy & Rehabilitation Research Centre, The University of Queensland, Australia
Background and aims: Very preterm birth is associated with a high prevalence of parental stress and relationship
breakdown and in the child, a range of motor, cognitive, behavioural and educational developmental disabilities. Postnatal
environmental factors are important in establishing and modifying these trajectories. Parenting is a pervasive and continuous
environmental influence. We sought to identify an effective and practical strategy to enhance the parenting skills of parents of
very preterm infants.
Methods: We conducted focus groups and surveyed parents of very preterm infants to assess needs (1). We sought a strategy
that would (i) maximise exposure to a parenting intervention whilst the preterm baby was still hospitalised and beyond into
the community, (ii) was readily implementable both within existing services and for families and (iii) was structured to allow
testing of efficacy.
Results: We developed a parenting intervention, Prem Baby Triple P, based on the principles underlying the Triple P parenting
program (2) which is widely implemented throughout Australia and in more than 20 countries.
Conclusions: Prem Baby Triple P is currently being evaluated in an Australian NHMRC funded randomised controlled trial
to involve 330 families to test efficacy in relation to the primary endpoints of child behavioural and emotional problems at 2
years age.
References: 1. Ferrari AJ et al. Prem baby Triple P. A new parenting intervention for parents of infants born very preterm.
Infant Behav Devel 2011;34:602-9 2. Sanders MR. Development, Evaluation, and Multinational Dissemination of the Triple
PPositive Parenting Program. Ann Rev Clin Psychol 2012;8:1-35
122
Abstracts: Posters
P31: Experiences Of Fathers Of Premature Infants And Their Feelings For Their Babies
Higai, Shigeka
School of Nursing, Gunma Prefectual College of Health Sciences, Gunma, Japan
Objectives: Few studies have attempted to determine the experiences and feelings of the fathers of premature infants in
Japan. Accordingly, the objectives of this study are to determine the experiences of fathers of premature infants and their
feelings for their babies, thereby supporting them.
Methods: Semi-structured interviews were conducted for qualitative and inductive analysis. The subjects were twelve fathers
whose premature babies were in stable condition and aged about 1 month.
Results: Fathers were pleased that their babies were born alive and simultaneously had “peace of mind from the birth of
[their] babies” because childbirth had reduced the physical burden on their wives. At the same time, information on the
development of their premature infants was lacking. Consequently, as it was unclear whether ongoing medical treatment and
weight loss would affect the future development of their babies, and the fathers had “vague anxieties about the development
of [their] babies.” The fathers felt joy and anxiety when they were visiting their babies at the hospital. During the “time as a
parent” that they spent with their babies at the hospital, if they could share with nurses the understanding of their babies’
motions and reactions, which changed from day to day, their affection for their babies increased. Moreover, they enjoyed
spending “time as a family” when staying with their wives during nursing, by appreciating them and talking with them about
their feelings for their babies.
Conclusion: It was suggested that nurses should provide support that recognizes a family as a system, allowing them to help
fathers understand their babies in a step by step manner, to facilitate making time as a family, and to encourage the family to
develop together.
P32: The Relationship between Maternal Mental Health and Quality of Preterm
Infant-Mother Interaction
Margo, Pritchard1; Delaney, M2; Kenardy, J3; Cartwright, D4; De Dassel, T4; Bogossian, F5; Newman, L6; Rose, M7
Womens Newborn Services, Royal Brisbane Women’s Hospital, UQCCR, Brisbane, Australia; 2School of Medicine,, University
of Queensland, Australia; 3School of Medicine, The University of Queensland, Australia; 4Womens Newborn Services, Royal
Brisbane Women’s Hospital, Australia; 5School of Nursing and Midwifery, The University of Queensland, Australia; 6Centre for
Developmental Psychiatry & Psychology, Monash University, Australia; 7Womens Newborn Services, Royal Brisbane Women’s
Hospital, UQCCR, Australia
1
Background: Mothers of preterm infants may experience higher than usual levels of stress, depression and Post-Traumatic
Stress Disorder (PTSD) in the first year, negatively impacting the mother-infant relationship.
Aim: This study explored the influence of Reflective Functioning capacity (RF, the ability to infer mental states in oneself
and others, and to understand and interpret behaviour based on these mental states), stress, depression and PTSD, on
mother-infant relationship quality, using the Still-Face Procedure (SFP, interactive social stressor task that assesses the
infant’s emotion regulation capacity in the context of maternal variations in responsiveness).
Methods: Home-visits at 6 months corrected age to assess maternal RF and infants’ SFP responses. Mothers completed
questionnaires (using Parenting Stress Index, Edinburgh Postnatal Depression Inventory and the Post-Traumatic Stress
Diagnostic Scale).
Abstracts: Posters
Results: Maternal RF is related to differences in levels of infant positive and negative affect in the SFP. Multiple regression
revealed that RF accounted for 31% of variance in negative affect scores, F(1, 19)=8.38, p=.009. If mothers had a higher
RF capacity, infant negative affect increased when the infant experienced the stressful situation, â = .55, p = .009. A
hierarchical multiple regression revealed that after controlling for RF, mothers with higher levels of stress (â = -.50, p = .017)
and depression (â = -.85, p = .004) were more likely to have infants who did not exhibit self-soothing behaviours during a
stressful situation.
Conclusion: These results indicate that poorer maternal RF and higher levels of maternal stress and depression are
associated with poorer infant coping mechanisms during a stressful situation, even as early as 6-months corrected age.
These subjects will be followed up to 2 years.
P33: Fathers’ Perceptions Of The Barriers And Facilitators To Their Involvement
With Their Newborn Hospitalized In The Neonatal Intensive Care Unit
Feeley, N1; Waitzer, E2; Sherrard, K3; Boisvert, L4; Zelkowitz, P5
1
McGill University School of Nursing, Canada; 2Jewish General Hospital, Canada; 3Neonatal Intensive Care Unit, Jewish General
Hospital, Canada; 4McGill University Health Centre, Canada; 5Psychiatry, Jewish General Hospital, Canada
Background: Fathers of NICU infants often feel that they have a limited role in infant care, and surveys suggest they are not
typically involved in caregiving. Paradoxically, qualitative studies find that fathers want to be involved, and lack of involvement
is stressful.
Purpose and methods: A qualitative descriptive study examined what fathers perceive to be barriers and facilitators to their
involvement. 18 fathers from two NICUs were interviewed and interviews content analyzed.
Results: Three categories of barriers/facilitators were identified: infant, interpersonal, and NICU environment factors. These
factors could be a barrier or facilitator depending on context.
Infant factors: Infant size and health status were barriers. Involvement was reinforced by positive feedback from the infant,
while negative feedback was a barrier.
Interpersonal factors: A range of interpersonal factors played a role including: positive feelings, beliefs concerning
fatherhood, family responsibilities, support and previous experiences. Positive feelings evoked when involved reinforced
and motivated further involvement. Fathers who believed that involvement affected child well-being engaged in activities
such as feeding and bathing. Fathers’ involvement could be adversely affected by conflicting demands. Paternity leave and
instrumental support contributed to greater involvement. Mothers affected involvement directly and indirectly.
NICU environment factors: Physical aspects of the NICU, as well as the social context shaped involvement. Observing other
parents with their infant, and an open visiting policy motivated involvement. Medical jargon and mixed messages from staff
about involvement created confusion. When nurses provided encouragement and coaching, involvement was fostered.
Implications: Nurses should explore the involvement that a father desires, as well as demands on their time, and determine
what might be done to promote involvement. Fathers should be assisted to maximize the time that they do have with the
infant. Nurses must provide consistent information about whether caregiving is advisable, and can explain/demonstrate how
fathers can provide care.
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Abstracts: Posters
P34: Implementing Family Integrated Care In A Neonatal Intensive Care Unit: The
Importance Of Providing Guided Parent Education To Facilitate Learning
Bracht, M1; Raiman, C2; O’Brien, K2
1
NICU, Mount Sinai Hospital, Canada; 2Paediatrics, Mount Sinai Hospital, Canada
Background: Today’s neonatal intensive care units (NICU) are highly technical places where infants are physically, emotionally
and psychologically separated from their parents. In Family Integrated Care, (FICare), mothers have the opportunity to be an
integral part of their infants’ care team. Parents’ learning is enhanced through small group education sessions to support this
change. FICare was piloted in a Canadian NICU, enrolling 42 mothers. The parent education was evaluated within the pilot and
has provided guidance for the parent education programme used in the Canadian cluster randomised controlled trial (RCT).
Method: Veteran parents’ feedback, a literature review and our experiences of developing and facilitating parent programmes
formed the basis of the parent education curriculum. A general lesson plan template was created and provided to staff (i.e.
nurses, neonatologist, multidisciplinary team) volunteering as educators, to create their teaching goals and curriculum.
The core program component was the daily interactive teaching allowing for individual education at the bedside. A weekly
education schedule was created depending on the parent learning needs, staff availability while ensuring that every family
received the core education programme.
Results: The pilot curriculum was modified in response to the staff and the pilot mothers’ evaluations. Their feedback also
guided how, when and where the curriculum would be best received. A binder incorporating all aspects of the education
programme was developed. Guidance on the use of the binder and on parent education was provided at a workshop prior
to initiating the RCT. As part of their implementation of the model of care the RCT intervention sites are obliged to provide a
parent education programme and to use the binder as their guide.
Conclusion: Successful translation of FICare requires a programme of parent education that is responsive to parent needs
and is modifiable across many different social contexts.
P35: Effects of cycled lighting versus near dark lighting on physiologic stability
and motor activity level of preterm infants
Lebel, Valérie1; Aita, M2; Johnston, C3
1
neonatology, Université de Montréal, St-Lazare, Canada; 2Université de Montréal, Canada; 3McGill University, Canada
Background: After birth, preterm infants evolve in the neonatal intensive care unit (NICU) characterized by a high and variable
lighting which differs significantly from the dimmed intra-uterine environment. Exposure to high or variable NICU lighting can
create physiological instability in preterm infants as well as increasing their motor activity level. An appropriate control of the
NICU lighting can prevent the adverse effects of exposing infants to inadequate levels of lighting. To date, it appears that two
methods of lighting control have been discussed and studied: near dark lighting and cycled lighting. At the same time, it is
acknowledged that there is ambiguity about the results of studies which have evaluated these two NICU lighting methods.
Therefore, the optimal NICU lighting remains unknown and further research is needed to identify the lighting mode witch
promote preterm infant’s adaptation to the NICU environment.
Objective:The objective of this research is to evaluate the effects of cycled lighting versus near dark lighting on the
physiological stability and motor activity level of preterm infants.
Abstracts: Posters
Methods: A randomized controlled trial (RCT) will allow the assessment of the preterm infants’ physiological stability and
motor activity level. Preterm infants born between 28 to 32 weeks of gestational age will be recruited from a level III NICU
university affiliated hospital. Each infant will be randomly allocated to one of the following groups for 24 hours: cycled
lighting or near dark lighting. Preterm infants’ physiological stability will be assessed with the score of Stability of the Cardio
Respiratory System in Premature Infants (Fischer, 1998), while the motor activity level will be evaluated by an accelerometer
(Actiwatch TM) which will be attached to the preterm infants’ ankles for the 24-hour period. The light intensity level will be
measured with a light meter to ensure that the lighting mode assigned is respected.
Results: Preliminary results to come.
Implications: Results generated by this research will guide clinical practice related to the lighting control of the neonatal
intensive care unit.
P36: Maternal representations of the care for low birth weight preterm babies:
collective subject discourse
Parada, Cristina1; Zani, AV2; Tonete, VLP2
1
Nursing, Universidade Estadual Paulista, Botucatu, Brazil; 2Nursing, Universidade Estadual Paulista, Brazil
Introduction: The process of caring for low birth weight preterm newborn babies has made great advances in the last
couple of years due to scientific and technological developments, which make possible the survival of hospitalized children in
neonatal intensive care units, promoting changes in the profile and a decrease in children’s death rate.
Objective: Detect maternal representations of the care for very low weight newborns in neonatal admission units of hospitals
from the interior of Paranï, Brazil.
Method: Qualitative study with 41 mothers interviewed between November 2011 and July 2012. For the analysis we adopted
the Social Representation referential, followed by the Collective Subjective Discourse method.
Results: Eight key ideas emerged: Fear of the unknown, separation from the child, Difficulty in accepting the separation,
Difficulty in talking about the baby, Concrete possibility of death, Impotence regarding the child’s hospitalization, Hope for a
miracle, Trust in the team and proximity with the newborn baby bring satisfaction to the mother.
Conclusion: The most important difficulties faced by mothers were: fear of the unknown, having to provide information on
which they had no control, concrete possibility of the child’s death and impotence regarding the experience. On the other
hand, faith in God, trust in the health team and proximity with the newborn are seen as facilitating aspects related to the
experience. The importance of the maternal role in the care for low weight preterm newborn in a neonatal admission unit
which is mentioned in the scientific literature was not made explicit clearly by the mothers who participated in this study,
revealing their lack of knowledge on this aspect. So it is important to emphasize the need for interventions specially directed
to mothers, to listen to them, support them and include them effectively in the process of caring for their children, being the
health professionals responsibility, specially nurses, to take into consideration that, in practice, an unidirectional care for
the preterm baby should not exist but, instead, a context of shared care between the team and the mother/relatives of the
preterm baby.
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Abstracts: Posters
P37: Developing An Advanced Neonatal Nurse Practitioner (ANNP) Programme That
Is Fit For Purpose: Mini Doctor, Maxi Nurse Or Something More Hybrid
Crathern, Liz1; Evans, D2; Cusack, J3; Thurlby, A4
1
School of Nursing and Midwifery, University of Sheffield, Leeds, United Kingdom; 2Yorkshire neonatal network, Yorkshire
neonatal network UK, United Kingdom; 3Neonatal consultant, Leicester NICU, United Kingdom; 4School of Nursing and
Midwifery, University of Sheffield, United Kingdom
Introduction: This paper discusses the multidisciplinary team journey experienced when developing an ANNP programme. It
refers to national drivers, and educational and collegiate processes critical to ensuring provision of a product that meets the
needs of service delivery and regional health education commissioning.
Background: The University of Sheffield has a long tradition of delivering neonatal education for nurses who require
qualification in speciality (QIS). It also provides an enhanced neonatal course to expand clinical skills and knowledge further
when caring for infants within a neonatal unit. Recently, a successful bid to develop an ANNP programme represents a
commitment to expanding neonatal education provision further at Sheffield. Importantly, it also meets regional commissioning
aims that are driven by the impact on working time directives for doctors hours and their training.
Educational processes - issues that will be explored: What prerequisites were identified to access an ANNP programme
and why? Preparing nurses to work across traditional boundaries - mini doctor versus maxi nurse or something more hybrid?
How do you ensure an educational programme that reflects an ANNP role? ANNP clinical skillsn- what is needed ? What did
we decide to use and why? How do you begin to prepare student ANNPs to become the next inspirational leaders in their
field? Post course support and yearly master classes -- rationale for this approach. Along the journey -- multidisciplinary
consensus and preparation for present and future service needs
Concluding summary: The aim of the process was to develop a programme that would provide a new set of knowledge for
neonatal nurses that reflects a new type of care and the skills set to work across traditional boundaries. It is hoped that this
very practical presentation will provide insight into the benefits and challenges of developing such a programme and generate
lively discussion and debate.
Abstracts: Posters
P38: The sleep of preterm newborns admitted to a neonatal unit*
Pinheiro, EM1; Modesto, IF2; Llaguno, NS2; Sato, MH3; Pedreira, MLG1; Hallinan, MP4; Avelar, AFM1
Department of Pediatric Nursing, Universidade Federal de São Paulo, Brazil; 2Universidade Federal de São Paulo, Brazil; 3Hospital São
Paulo, Brazil; 4Psychobiology Department, Universidade Federal de São Paulo, Brazil
1
Introduction: Knowing the characteristics of sleep of preterm newborns (PN) admitted to neonatal units in order to promote
interventions to prevent adverse effects is an essential element of nursing care.
Objective: To describe the sleep pattern of newborns admitted to neonatal intermediate care units.
Method: a descriptive study conducted at a Brazilian teaching hospital. Sample comprised five clinically stable infants
(gestational age (GA) > 31 weeks) placed in incubators and who were receiving or not caffeine orally. PN taking central
nervous system depressant drugs, corticosteroids and those whose mothers had used illegal drugs were excluded from the
study. We used the Alice 5 Polysomnography (Respironics ®) with continuous recording data for 24 hours.
Results: GA of preterm newborns ranged from 31 to 33 weeks and their mean weight was 1702. We analyzed 1440 minutes
of polysomnography, identifying a total average of PN sleep of 978 minutes, with a mean time of 32% of waking periods.
The identified average proportions of active, quiet and indeterminate sleep were 37.2%, 35.4% and 27.2%, respectively.
There were on average 358 episodes of central apnea -- 25.4 mixed and 37.6 obstructive. The mean O2 saturation during
wakefulness, active and quiet sleep was, respectively, 94.6%, 95.4% and 95%, with minimum saturation of 81.8%.
Conclusion: PNs remained a short period of time in active sleep during the period investigated. The pattern of active sleep
was proportionally a little longer than during quiet sleep. Among PNs, we identified greater variation in patterns of quiet and
active sleep compared to the indeterminate one.*This research was conducted with the financial support of the Fundacao de
Amparo a Pesquisa do Estado de Sao Paulo - FAPESP, Sao Paulo - SP (Brazil), number: 2012/50365-2.
P39: Enhancing Bereavement Care In A Dublin Maternity Service
Shine, Brid
Coombe Women & Infants University Hospital, Ireland
Perinatal death is the death of a baby from 24 weeks, weighing over 500gms. It includes stillbirth and neonatal death. The
overall perinatal mortality rate in Ireland in 2009 was 6.8 per 1000 live births. The literature now indicates that perinatal death
is a major bereavement, one that can trigger profound grief and sadness, with some parents at risk of a complicated grief.
Staff caring for bereaved families are also impacted by the loss, as they bear witness to one of life’s greatest paradoxes, death
at the time of birth.
The author completed a developmental change project as part of an MSc in Bereavement Studies. The overall aim was to
enhance an aspect of bereavement care within the maternity care organisation.
Working collaboratively with the multidisciplinary team the lack of written material as a reference guide for bereaved parents
was identified as a notable gap in service. Therefore the objective was to develop, produce and disseminate a booklet, entitled
“Information for parents following Bereavement” with individual objectives detailed in the project report. Contemporary grief
theory as well as an identifiable bereavement support framework underpinned the booklet detail. The national health strategy
places service users at the heart of health and social care delivery ,so bereaved parents were also involved in the process.
The author’s utilisation of the HSE Model of Change guided the process of this developmental change from “Conception
to birth”. A description of the change process also included Lewin’s force field analysis technique as the author details the
driving and resisting forces influencing change in this area of clinical practice.
128
Abstracts: Posters
The outcome of the project is the booklet was developed and printed and has been implemented within the organisation.
Formal evaluation is planned for later this year.
Though internationally there is a much needed strive now to reduce the incidence of perinatal death, there remains an
important role for advocacy groups to remind the policy makers of the human tragedy of perinatal death and the need for not
just adequate supports for bereaved parents but the best standards in bereavement care.
P40: Life narrative of Brazilian mother-women which child born with no current
curative possibility
Santos, Ines Maria Meneses1; Camargo, FCM2; Silva, LR3; Santos, RS4
1
Departamento de Enfermagem Materno-Infantil, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil;
2
Instituto Fernandes Figueira, Fundação Osvaldo Cruz, Brazil; 3Departamento de Enfermagem Materno-Infantil, Universidade
Federal do Estado do Rio de Janeiro, Brazil; 4Departamento de Enfermagem Materno-Infantil, Universidade do Estado do Rio
de Janeiro, Brazil
Background: The objectives of this research were 1) to discuss the needs of mother-women in performing the motherhood
of their children with no current curative possibility; 2) to discuss the nursing performance from the necessity of every
mother-woman with her child with no current curative possibilities. Method: Qualitative study.
Method: Narrative of Life conducted with 10 mother-women who gave birth to children with fetal anomalies, genetic
syndromes, neurological considered no current curative possibility. The production data was performed using an instrument
to record socioeconomic obstetric data, and an open interview with the following question: tell me about your life that has
relation with the experience of mothering your child (name of child). The analytical procedure was based on thematic analysis.
Approved by the Research Ethics Committees of the UNIRIO and IFF/FIOCRUZ, protocol 0059/2011
Results: the socioeconomic profile revealed that maternal age ranged from 21 to 41 years, the majority had completed high
school and their own income.
Discussion: narratives emerged from an analytical category: nursing activities on the needs of mother-women gestating /
giving birth / mothering / mourning a baby with no current curative possibilities, and 4 subcategories: 1) the discovery of fetal
malformation; 2) the (no) gestating / giving birth to a baby out of curative possibilities; 3) the (im)possibility of motherhood a
baby with no current curative possibility; 4) experience of mourning in the dying process.
Conclusion: pregnant women were exposed to violence institutional by being informed about the request and fetal pathology
of non-involvement with pregnancy. It is observed that the hard technology and soft-hard is being deprecated in relation to
soft technology.
Descriptors: women’s health, mother-child relations, maternal-child nursing, qualitative research.
Abstracts: Posters
QUALITY, INFECTION & PAIN AND EDUCATION
P41: Trauma Informed Age Appropriate Care - A New Paradigm For The Neonatal ICU
Coughlin, Mary
Caring Essentials Collaborative, Boston, USA
Neonatology and perinatology have made significant medical and technological advances over the past twenty years. The
limits of viability have been pushed to 23-24 weeks gestation. Global neonatal mortality has decreased by 28% since 1999. In
the US, survival rates of infants born at 25 weeks gestation are 72%. Despite these advances, many survivors face a lifetime
of disability, including learning disabilities, neurosensory problems, neurodevelopmental challenges, psycho-emotional,
behavioral and mental health concerns that extend across the lifespan. It is estimated that 50-70% of infants born preterm
develop behavior problems including internalizing and externalizing behaviors, symptoms of Attention Deficit/Hyperactivity
Disorder (ADHD), generalized anxiety disorders and other psychopathologic conditions. Informed with this data and applying
biological models with evidence based caring strategies, neonatal clinicians can transform the experience of care in the
NICU to favorably impact the psychological sequelae and quality of life for this vulnerable and highly susceptible patient
population. Trauma informed care is a framework for care that is grounded in the knowledge that trauma affects the victim
at a neurobiological level with potentially life altering consequences. Hospitalization in a neonatal ICU is a traumatic life event
that poses an additional risk due to the developmental nature of the trauma to the premature and critically ill infant. Events
that occur or do not occur during this critical period significantly influence the infant’s psychological and socio-emotional
developmental trajectory. First and foremost the NICU patient is a baby - requiring the same nurturance and social-emotional
experience as their healthy term counterpart. Providing age appropriate care (a Joint Commission requirement) within the
context of trauma informed care enables the neonatal clinician to meet the complex human needs of this special population.
The impact of trauma on neuroendocrine function, brain development and the associated sequelae is managed and mitigated
through the reliable provision of evidence based caring actions, attitudes and behaviors that convey competence, compassion,
communication , and consistency. In essence these attributes create a trusting milieu that is developmentally and age
appropriate for the infant.
P42: A Neonatal ICU And Their Unseen Environmental Enemies
Mensinger, Darlene1; Cook, J2; Johnson-Robbins, LA3; Yeich, DL4; Travelpiece, KA5
1
Department of Neonatology, Janet Weis Children’s Hospital @ Geisinger Medical, Danville, USA; 2Neonatology, Janet Wies
Children’s Hospital, Geisinger Medical, USA; 3Neonatology, Janet Weis Childrens Hosp., Geisinger Medical Cent, USA;
4
Neonatal ICU, Janet Wies Childrens H., Geisinger Medical Center, USA; 5Neonatal ICU, Janet Weis Childrens Hospt Geisinger
Medical Cent, USA
Background: Neonatal Infections in the Neonatal ICU cause significant morbidity and mortality. Identifying the source of these
infections and developing strategies for prevention will improve patient outcomes. Morbidity and mortality from nosocomial
infections is enormous. In the US more than 2,000,000 (infants and adults) occur each year, 50-60% by resistant organisms.
The population of Neonatal ICU infants is most susceptible to nosocomial infections. HAI (Hospital Acquired Infections) in the
Neonatal environment is a significant cause of illness and death.
Objective: The objective of this quality improvement initiative was to decrease the rate of nosocomial infections in our
Neonatal ICU, to improve patient’s outcomes and to decrease morbidity and mortality.
130
Abstracts: Posters
Method: Reducing the incidence of nosocomial infections requires a comprehensive approach. A systematic literature review
was conducted of current research and policies. The following areas were identified as potential sources of nosocomial
infections: central lines, peripheral lines, lab draws, catheter hubs, and health care provider hand hygiene. Standardized
processes, such as a central line bundle, decreasing central line days, aseptic line hanging procedure, catheter hub care,
clustering lab draws, and reminders to staff for hand hygiene were implemented. Education was disseminated and then each
process was introduced at different stages, to allow time for evaluation of each new process. Information was shared about
what worked and what did not work with creators and users.
Results: Infections rates showed a steady improvement trend. Monthly average rate for nosocomial infections was 4.5 per
month prior to the instituted changes. The monthly average of infections after the changes was 1.8 per month. Our goal is to
have zero infections per month.
Conclusion: Consistency of infection control practices in a Neonatal ICU decreased infection rates. Amalgamated infection
control interventions showed a steady decrease in the incidence of nosocomial infections, thus decreasing the incidence and
risk of severe morbidity and mortality of infants in the Neonatal ICU. Although there was an overall improvement there is more
work to be done.
P43: Determination of acute procedural pain responses in Extremely Low
Gestational Age (ELGA) infants over time: A case report
Stevens, B1; Dionne, K2; Yamada, J2; Gibbins, S3; Victor, JC4; Skitch, A2
Centre for Nursing and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Canada;
2
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Canada; 3Neonatology, The Hospital for
Sick Children, Canada; 4Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
1
Background: There is limited knowledge on ELGA infants’ responses to acute procedural pain and how these responses
change as the infant matures. The purpose of this case report was to examine physiological and behavioural indicators of
acute pain and how they changed over time.
Methods: 5 ELGA infants were observed for 3 consecutive weeks during a painful (e.g., heel lance) and non-painful (i.e.,
diaper change) procedure at a single Canadian NICU. Detailed data were collected during each observation including:(a)
physiologic (heart rate and oxygen saturation) and (b) behavioural (i) facial (brow bulge and eye squeeze) and (ii) body (finger
splay, fist and hand on face) action indicators. Data were coded second by second for approximately 10 minutes in 30 second
intervals during baseline, procedure and return to baseline phases of the procedure. A profile analysis was conducted.
Results: Five infants (1 male, 4 female) with gestational ages at birth ranging from 23 to 26 weeks were evaluated.
Differences in physiologic and behavioural indicators existed between painful versus diaper change procedures over time
(Time X Procedure interaction; F = 5.86, p <0.001). Changes over time were noted in individual indicators including Minimum
O2 saturation, brow bulge, eye squeeze, and fist forming (p<0.01). Greater responses in both physiologic and behavioural
indicators occurred during the diaper change procedure when infants were less mature; however, the differences during
the procedural phase of the procedures reversed as infants matured. No differences were noted during baseline or return to
baseline phases of the procedure over time.
Conclusion: Less mature infants reacted more to the diaper change than the painful event; however this profile or responses
reversed as they matured. Provision of pre-procedural pain-relieving strategies (e.g.,sucrose, physical interventions) may have
also influenced these findings. A larger sample size is required to further verify these results.
Abstracts: Posters
P44: Quality improvement initiative in reducing late onset sepsis
Murray, SD; Cairns, SA; Mayes, C; Craig, S
NNICU, RJMH, United Kingdom
Aim: The improvement aim was to reduce Central Line associated infection.
Setting: The clinical setting was a tertiary neonatal unit which cares for all sick babies including preterm, surgical, cardiac
and neurosurgical (VON level 3B).
Mechanisms: A multidisciplinary group was formed when it was identified that the Neonatal Unit had higher infection
rates compared to similar units within the Vermont Oxford Network. The group wanted to discover areas in practice which
contributed to high infection rates and therefore needed improvement. The group’s theory about why our changes would lead
to improvements was that after auditing current practices, implementing focussed education and training packages then
improvements would be made. Close monitoring of infections rates was undertaken.
Methods: Multiple interventions were undertaken over an 18 month period including;
• Staff hand hygiene training using ultraviolet light and random peer observation audits
• Training videos on Aseptic Non Touch Technique (ANTT) and Personal Protective Equipment were developed and used in
staff training and practices were audited.
• Training of parents and grandparents on hand hygiene and a slide-show illustrating the 7 step hand hygiene technique was
provided.
• Following a review of skin cleansing guidelines, the cleansing solution was changed.
• Feeding guidelines were revised, effectively reducing the time to full enteral feeds by 1-3 days, thereby facilitating the
removal of central lines earlier.
Results: The central line associated infection rate was reduced.
Discussion: After acknowledging that infection was a problem, we had to critically examine all areas of our practice,
improving on areas we felt we were lacking in but also provide positive reinforcement of good practices. A reduction in
infection rates is possible to achieve but difficult to consistently maintain. We need to ensure all staff remain motivated and
enthusiastic to ensure improvements continue.
P45: Closing the link between practice and theory
Goggin, Mary1; Podsiadly, E2
1
Neonatal Unit, St. George’s Healthcare NHS Trust, London, United Kingdom; 2Faculty of Health, Social Care and Education,
Kingston University, United Kingdom
Education and opportunities to develop skills and knowledge are essential to staff new to NICU.
Background: Currently, new staff are orientated with a programme that requires the acquisition and assessment of relevant
skills, but the programme is heavily weighted towards assessment of theoretical content. Many new staff members fail to
complete the assessment document despite the input.
Following a review of the current programme, consideration was given to a Work based Learning (WBL) model successfully employed
in PICU and Emergency care in conjunction with the parent university It was felt that such an approach would be advantageous for
NICU and would require the development of a new theoretical programme and a skills based competency document.
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Abstracts: Posters
Methods: Feasibility of the WBL programme was discussed by the Neonatal Senior Lecturer and Practice Educator. The result
was a rewriting of the programme by the practice educator to reflect the skills and knowledge required for delivery of care in
Special Care and respiratory support in High Dependency. Newly employed nurses register for the programme at the outset of
their four week supernumery period. It is envisaged that completion of the programme will take place within 6-8 months with
attend 3 to 4 study days. Upon successful completion of theory and practice the University will award the student 15 credits
at Level 5 or 6.
Results: Completion of the programme will become a pre-requisite for staff to be considered for further neonatal study.
Completion of the WBL module sets a tone or learning precedent of the NNU’s expectation of staff. It will also smooth the
transition for students undertaking neonatal modules that on completion will result in them becoming Qualified in Speciality.
This programme has the potential to be extended to Trusts within the authors Neonatal Network.
P46: Effect Of Reducing NICU Light And Noise During Kangaroo Mother Care on
Preterm Infants’ And Mothers’ Outcomes: A Pilot Study
Aita, M1; Stremler, R2; Feeley, N3; Barrington, K4; Nuyt, AM4
1
Université de Montréal, Canada; 2University of Toronto, Canada; 3McGill University, Canada;
4
CHU Sainte-Justine, Canada
Background: For the past 2 decades, Kangaroo Mother Care (KMC) has gained popularity in Neonatal Intensive Care Units
(NICUs). KMC, where preterm infants are in skin-to-skin contact with their mother, is an intervention aimed at improving
preterm infants’ growth and development and mothers’ well-being. As NICU light and noise have been reported as factors
influencing preterm infants’ and mothers’ outcomes during KMC, experiencing KMC in a dimmed and quiet environment could
therefore be beneficial for preterm infants’ as well as mothers’ outcomes.
Purpose: To evaluate the feasibility and acceptability of a developmental care intervention combining NICU light and noise
reduction with KMC, and estimate its effect on preterm infants’ physiological stability and sleep-wake states, as well as
mothers’ anxiety and salivary cortisol levels.
Methods: For the pilot study, 30 dyads of mothers and preterm infants born between 28 to 32 weeks of gestational age
will be recruited from a level III NICU university affiliated hospital. Each dyad will be randomly allocated to one of the
following groups: KMC combined with NICU light and noise reduction or KMC only. The KMC sessions will last one hour in
the morning for 3 consecutive days. The feasibility and acceptability of the intervention will be assessed by a logbook that
will be completed by a research assistant along with questionnaires which will also be completed by the research assistant,
mothers and neonatal nurses. Preterm infants’ physiological stability will be assessed using the score of Stability of the
CardioRespiratory System in Premature Infants (Fischer, 1998), while sleep-wake states will be evaluated through infants’
videotaping. Maternal anxiety will be assessed by the State-Trait Inventory Scale (Spielberger et al., 1970), and salivary
cortisol levels by saliva collection and analysis.
Results: To come.
Implications: The findings of this pilot study may support the planning of a full-scale randomized controlled trial (RCT).
Findings of this pilot study will also provide direction and incentive toward the implementation of protocols and guidelines
relating to KMC as well as to the control of NICU light and noise. Ultimately, the goal is to promote mothers well-being and
allow preterm to grow in a developmentally sounded environment supporting physiological systems and encouraging periods
of rest long enough to allow optimal growth and development.
Abstracts: Posters
P47: Educational Approaches To Inspire Neonatal Nurses -- But Is There An Impact
On Care Delivery?
Morris, Sara1; Cookson, JL2
1
School of Nursing & Midwifery, Keele University, Stoke-on-Trent, United Kingdom; 2Staffordshire, Shropshire & Black Country,
Newborn Network, United Kingdom
Background: Neonatal education at Keele University provides a professional journey from novice special care nurse to a
competent critical care practitioner. The modules are mapped against national competencies (RCN, 2011). After a content
analysis, it became apparent that the sessions were appropriate and contemporary which lead to an evaluation of our
educational approaches.
Methods: The educational imperative from the Education Outcomes Framework (2013) is to ensure that education is linked
to improvements in patient care. This develops Kirkpatrick’s (1994) seminal work on understanding educational impact in the
work place. By utilising active teaching approaches we anticipate that we are effectively bridging the theory practice gap.
Within the University we have devised a multi modal approach:
• Clinical scenarios to facilitate classroom discussion
• Medium fidelity simulation
• Newborn Life Support (RCUK)
• Skills training
• Application to practice workshops
• Simulation debrief -- critical analysis, feedback and feed forward
• Use of simulated patients to enhance communication around loss
Within clinical practice the Lecturer Practitioner probes and develops understanding working on a 1:1 with the students.
Results: Early anecdotal feedback suggests that the use of active learning strategies has ensured the students have engaged
with the programme. This has been demonstrated with a greater awareness of problem solving and feedback from mentors
supports this development.
The opportunity to undertake skills practice in a safe, simulated environment has increased confidence in the student group
(Kirkpatrick, 1994). The multi modal approach has enabled us as educators to make synergistic links with theory and practice.
Clinical reasoning and clear articulation of the evidence base supporting their decision making has been a tangible output of
this educational approach.
Department of Health (2013) The Education Outcomes Framework. London: DH Kirkpatrick DL (1994) Evaluating Training
Programs: the four levels. San Francisco: Berrett-Koehler Publishers
RCN (2011) Competence, education and careers in neonatal nursing. London: RCN
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Abstracts: Posters
P48: Development of the Neonatal Navigator Phone App as a supportive tool for
parents on their unexpected Journey through the Neonatal unit
Hitchcock, Judith1; Hammond, Barbara E2
1
NICU, Capital and Coast District Health Board, Wellington, New Zealand; 2Neonatal unit, Whanganui District Health Board, New Zealand
Background: This poster/presentation follows the development of the Neonatal Navigator App (application) for parents, families
and friends to use for support when their baby is unexpectedly admitted to the neonatal unit and suddenly everything is out of
their control, which is the hardest challenge facing parents and families. In an environment where changing staff and changing
circumstances are constant, having a constant point of reference would be an asset in supporting parents during this vulnerable time.
The framework for the application is two fold:
• F irstly, it provides familiar, tried and true generic information that historically has been delivered by pamphlets and
brochures; and can be accessed on the app by parents, families and friends anywhere, who suddenly find themselves
on an unexpected journey through the neonatal unit. It has to be said, referring to pamphlets is out dated for the current
generation of young parents. It is hoped to increase support and be an already familiar tool for providing ease of access to
information. It is expected to be available as a web based application with the potential to upload it to an I-phone/pad or
android phone/tablet
• Secondly, the trend for parent’s use of smart phones is widespread, using social networking and internet access whilst visiting
their baby. The app will be a tool to capture and journal baby’s progress in the neonatal unit, as It is not only the support
that parents have to keep in touch with friends and family but also has potential to improve parental neonatal experience by
encouraging them to journal their baby’s progress, it is expected that greater bonding and attachment will occur as a result.
P49: Neonatal Pain Causes Physiological Changes Affecting Long-Term Outcomes
Ward-Smith, SJ
Child Health, Birmingham City University, United Kingdom
Background: As the neonatal speciality progresses some areas are widely research but often poorly implemented. This can
be said of pain and its management. Long-term outcomes are widely unknown as the initial population base is only just
reaching adulthood.
Physiological Changes:The primitive brain structure goes through a series of flexures and foldings and as the cerebral
cortex develops fibres called commisures connect corresponding areas of the cerebral hemispheres with each other. These
encompass most of the brain mass. Most corticol neurones are in place by 20 -24 weeks gestation. Growth proceeds forming
convolutions called gyri and sulci. These cause a considerable increase in the surface area of the cerebral cortex, preventing
the need for excessive cranium size. This is more prominent in the last 3 months of pregnancy; being most rapid between
26-28 weeks gestation causing a change in the shape of the foetal head. Iatrogenic insults in the premature infant will cause
defects in this progression.
Behaviour effect in research: The natural response to pain is able to be demonstrated by how the cns works. The studies
were all able to demonstrate that an action causing pain induces a variety of changes in how the physiological system
performs. The presentations of any alterations were different according to the actual age of the individual at the time of the
study. The results of the studies of the older age groups appear to show that any alteration can happen soon after an insult
and is showing to be a permanent change.
Conclusion: Increasingly it is being recognised that the brain structure and function is different in groups that receive pain
during the neonatal period, when compared to their term peers at a comparable age.
Abstracts: Posters
P50: Determination Of Knowledge And Skill Levels Of Neonatal Nurses About
Peristomal Skin Care
Ilhan, T1; Kılıçarslan Törüner, E2
Neonatal Intensive Care Unit, Zekai Tahir Burak Hospital, Turkey; 2Nursing, Gazi University Health Sciences Faculty, Turkey
1
Introduction: The main objective of the management of stoma in neonates; is to develop high quality care and evidencebased nursing.The basic headings for the criterias required for this; are appropriate application of ostomy care and training of
health care professionals.
Method: This study had been conducted as descriptive to assess the knowledge and skills of nurses working in neonatal
intensive care unit of a hospital about peristomal skin care, between 2012-2013 in Ankara, Turkey. The data was collected by
three separate forms in order to evaluate the descriptive characteristics of nurses and neonates and the knowledge and skills
of nurses about stoma care. The forms, that were used in the research to determine nurses’ knowledge and skill levels, were
based on 9 experts’ opinion. Information form was filled by 120 nurses, skill form was filled by the researcher by observing 75
nurses who performes stoma care. Information form consisted of 14 questions with at least 0 and a maximum of 100 points.
Skill assessment form consisted of 26 steps. Evaluating for each step was carried out as “applied right”, “false/inaccurate
applied”, “not applied” or “N/A”.
Results: The majority of nurses were between 25-29 years (33.2%) and were women (94.2%). The mean score of knowledge
level of the nurses about the peristomal skin care was determined as 59.09±16.1 (min-max=12.7-91.4). In skill assessment,
the procedures which do not perform mostly were not to record the used pomad/barriers (n=65), and the name of nurse
(n=65), not to place gauze around the stoma after removing the bag (n=58), not to arrange the distance between the stoma
and the adapter as not exceed 1-2 mm (n=56). It has been determined that, incomplete applications mostly happened were
not to take curved tipped scissors (n=68) and measuring guide (n=62) during the preparation of the materials.
Conclusion: It has emerged that, there is a need for development of knowledge and skill levels of nurses in peristomal skin care.
Keywords: Neonatal, Stoma, Nurse, Peristomal care.
136
Abstracts: Posters
P51: Implementation of antimicrobial copper in Neonatal Intensive Care Unit (NICU)
Anagnostakou, Marina1; Efstathiou, Panos2; Kouskouni, Evaggelia1; Petropoulou, Chrysa1; Karageorgou, Katerina2;
Manolidou, Zacharoula2; Papanikolaou, Spiros2; Logothetis, Emmanuel1; Agrafa, Ioanna2
1
Medical School of the University of Athens, Microbiology laboratory of Aretaieio Hospital, Ministry of Health, Greece; 2National
Health Operations Centre, Ministry of Health, Greece
Aim: The aim of this study was to investigate the effectiveness of the application of antimicrobial copper alloys (Cu +) in a
Neonatal Intensive Care Unit (NICU) in relation to the reduction of microbial flora.
Materials & Methods: At a Level III Neonatal Intensive Care Unit of a pediatric hospital, with the capacity of twenty-six
(26) incubators, antimicrobial copper (Cu +) was implemented on touch surfaces and objects. The copper alloy contains Cu
63% - Zn 37% (Lead Low). Microbiological cultures were taken in three different time periods, before and after the application
of Cu+, using dry and wet method technique.
Results: In the above NICU, the reduction of microbial flora after the implementation of the antimicrobial copper (Cu +) on the
selected surfaces and objects was statistically significant (n = 15, p <0,05) and was recorded at 90%. The pathogens isolated
at high rates (CFU / ml) prior to copper implementation were as follows: Klebsiella spp., Staph. Epidermidis, Staph. Aureus,
Enterococcus spp.
Conclusions: This study highlights the positive impact of antimicrobial copper (Cu +) and demonstrates that copper
implemented surfaces and objects are effective in neutralizing bacteria, which are responsible for Health Care Acquired
Infections in the nosocomial environment (HCAIs). The innovative implementation of antimicrobial copper in the NICU and the
significant reduction of microbial flora heralds the reduction of antimicrobial drugs use, and a possible reduction of hospital
acquired infections and hospitalization time.
P52: Financial Benefits after the implementation of antimicrobial copper in
Intensive Care Units (ICUs)
Efstathiou, Panos1; Kouskouni, Evaggelia2; Papanikolaou, Spiros1; Karageorgou, Katerina1; Manolidou, Zacharoula1;
Gogosis, Konstandinos3; Logothetis, Emmanuil4; Efstathiou, Lambrini4; Karyoti, Vassiliki1
1
National Health Operations Centre, Ministry of Health, Greece; 2AIM: Aim of this study was to evaluate the reduction on
Intensive Care Unit (ICU) microbial flora after the antimicrobial coppe, Ministry of Health, Greece; 3National Health Operations
Centre, Ministry of Heal, Greece; 4Medical School of the University of Athens, Microbiology laboratory of Aretaieio Hospital,
Ministry of Health, Greece
Aim: Aim of this study was to evaluate the reduction on Intensive Care Unit (ICU) microbial flora after the antimicrobial copper
alloy (Cu+) implementation as well as the effect on financial - epidemiological operation parameters.
Methods: Medical, epidemiological and financial data into two time periods, before and after the implementation of copper
(Cu 63% - Zn 37%, Low Lead) were recorded and analyzed in a General ICU. The evaluated parameters were: the importance
of patients’ admission (Acute Physiology and Chronic Health Evaluation - APACHE II and Simplified Acute Physiology Score SAPS), microbial flora’s record in the ICU before and after the implementation of Cu+ as well as the impact on epidemiological
and ICU’s operation financial parameters.
Abstracts: Posters
Results: During December 2010 and March 2011 and respectively during December 2011 and March 2012 comparative
results showed statistically significant reduction on the microbial flora (CFU / ml) by 95% and the use of antimicrobial
medicine (per day per patient) by 30% (p = 0,014 ) as well as patients hospitalization time and cost.
Conclusions: The innovative implementation of antimicrobial copper in ICUs contributed to their microbial flora significant
reduction and antimicrobial drugs use reduction with the apparent positive effect (decrease) in both patients hospitalization
time and cost. Under the present circumstances of economic crisis, survey results are of highest importance and value.
P53: Impaired Lung Function and Health Status in Adult Survivors of
Bronchopulmonary Dysplasia
Gough, A1; Linden, M2; Spence, D2; Patterson, CC3; Halliday, HL4; McGarvey, L5
1
Institute of Child Care Research, Queen’s University, Belfast, United Kingdom; 2School of Nursing and Midwifery, Queen’s
University, Belfast, United Kingdom; 3Centre for Public Health, Queen’s University, Belfast, United Kingdom; 4Regional Neonatal
Unit, Royal Maternity Hospital, Belfast Health and Social Care Trust, United Kingdom; 5Centre for Infection and Immunity,
Queen’s University, Belfast, United Kingdom
Background: More infants with bronchopulmonary dysplasia (BPD) now survive to adulthood but little is known regarding
persisting respiratory impairment. We report respiratory symptoms, lung function and health-related quality of life (HRQoL) in
adult BPD survivors compared with preterm (non-BPD) and full term (FT) controls.
Method: Respiratory symptoms (European Community Respiratory Health Survey) and HRQoL [EuroQol 5D (EQ-5D)] were
measured in 72 adult BPD survivors [mean(SD) study age 24.1(4.0)y; mean(SD) gestational age (GA)=27.1(2.1)wk; mean(SD)
birth weight (BW)=955(256)g] cared for in the Regional Neonatal Intensive Care Unit, Belfast (between 1978 and 1993) were
compared with 57 non-BPD controls [mean(SD) study age 25.3(4.0)y; mean(SD) GA 31.0(2.5)wk; mean(SD) BW 1238(222)g]
and 78 FT controls [mean(SD) study age 25.7(3.8)y; mean(SD) GA=39.7(1.4)wk; mean(SD) BW=3514(456)g] cared for at the
same hospital. Spirometry was performed on 56 BPD, 40 non-BPD and 55 FT participants.
Results: BPD subjects were twice as likely to report wheeze and three times more likely to use asthma medication than
controls. BPD adults had significantly lower FEV1 and FEF25-75 than both the preterm non-BPD and FT controls (all p<0.01).
Mean EQ-5D was 6 points lower in BPD adults compared to FT controls (p < 0.05).
Conclusions: BPD survivors have significant respiratory and quality of life impairment persisting into adulthood.
138
Abstracts: Posters
FEEDING & GIT ISSUES
P54: The Role Of Complementary Applications In The Treatment Of Infantile Colic
cke, Sibel; Sarican, ES; E.Genc, R
Midwifery, Ege University, Turkey
Background: Complementary methods in order to reduce the pain of colic is becomingincreasingly popular. The aim of this
review is; to examine the location of Complementary applications in the treatment of infantile colicin accordance of scientific
studies carried out.
Methods: This research is a descriptive retrospective study of literature and on 01/03/2013-01/04/2013 all the articles
in PubMed been published in the last decade were scanned. In the literature review, infantile colic and complementary
applications keywords have been searched.
Findings: Number of the articles that were identified with keywords seen as nineteen. Six of the full-text articles were
evaluated for the purpose of study. As a result, in the descriptive study of Smitherman and his colleagues, the women use
of folk medicine is common to eliminating colic, also, education level and the status of folk medicine use wasn’t associated
with each other. In Bland and colleagues study, mothers mostly use oral drug application, for the rest they give wather for
treatment of colic. In Ludlowand his colleagues study, China anise plant is used for eliminate of infantile colic, but the usage
is documented to cause neurological and gastrointestinal toxicity. In Hudley and colleagues study, 16% of babies with colic
used activated dimeticone, 13% grape wather. In another study of Landgren and colleagues, published in 2010, been shown
that minimal acupunture reduce the duration and severity of cry in colicky babies. In the case-control study of Landgren
and colleagues, published in 2011, to evaluate the effect of minimal acupuncture on nutrition and defecation, there was no
significant difference on time and frequency of feeding and frequency of defecation.
Results: According the studies benefited from complementary medicine practices to eliminate infantile colic, applications is
listed onto be effective in eliminating Colic whether or not the effect of some of the applications are discussed.
Key Words: Complementary application, Infantile, Infantile colic
P55: IBCLC Counselling - Does It Help Mothers’ Experienced Breastfeeding
Problems In A NICU?
Bojesen, Susanne Norby
Neonatal care unit E110N, Herlev Hospital, Herlev, Denmark
Background and Aim: It is already known that the advantages of breast milk and breastfeeding are numerous and
that admission to a neonatal unit present obstacle to successful breastfeeding. The problems often have some extent of
complexity and can be related to many factors: the infant, the mother, their interaction etc. For that reason breastfeeding is
a challenging procedure for all actors: the premature or sick new-born infant, the mother and the health care team. The aim
of this project is to investigate if private counselling on the mothers’ request, performed by an International Board Certified
Lactation Consultant (IBCLC), can prevent the continuation of the experienced breastfeeding problems.
Methods: Performance of counselling on maternel request, in a private setting, by an IBCLC from the staff, followed by the
mothers’ evaluation (questionnaire)
Result and conclusion: Not yet available (on-going project)
Abstracts: Posters
P56: The Effectiveness Of Proactive Telephone Support Provided To Breastfeeding
Mothers Of Preterm Infants Study Protocol For A Randomized Controlled Trial
Ericson, Jenny1; Flacking, R2; Eriksson, M3; Hoddinott, P4; Hagberg, L5; Hellström Westas, L6
Department of Women’s and Children’s Health, Uppsala University, Center for Clinical Resarch Dalarna, Sweden; 2School
of Health and Social Studies, Dalarna University, Falun, Sweden; 3Centre for Health Care Sciences, Örebro University
Hospital, Örebro, Sweden, Sweden; 4Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling,
Stirling, Scotland, United Kingdom; 5Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden, Sweden;
6
Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden, Sweden
1
Background: Mothers of preterm infants (< 37 gestational weeks) have shorter breastfeeding duration than mothers of term
infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to
the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to
promote mothers’ sense of trust in their own capacity and thereby facilitate breastfeeding.
Methods: A multicentre randomized controlled trial (RCT) has been designed to evaluate the effectiveness and costeffectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants.
Participating mothers will be randomized to either an intervention group (i.e person-centred proactive and reactive telephone
support) or a control group (i.e. only reactive telephone support). In the proactive support, mothers will be called daily, for up
to 14 days after hospital discharge, by a NICU based support team. In the reactive support, mothers are offered to call the
support team up to day 14 after hospital discharge. Recruitment will be performed continuously until 1116 mothers (I: 558 C:
558) have been included.
Primary outcome: proportion of women who are exclusively breastfeeding at 8 weeks after discharge from the NICU.
Secondary outcomes: breastfeeding (exclusive, partial, none and method of feeding), mothers’ satisfaction with
breastfeeding, attachment, stress and quality of life in mothers/partners at 8 weeks after hospital discharge and at 6 months
postnatal age. A qualitative evaluation of experiences of receiving/providing the intervention will be undertaken with mothers
and staff respectively. With a health economic evaluation, the cost-effectiveness of the intervention will be assessed.
Results: The study commenced in March 2013 and will continue for about 18 months and hence no findings are available.
Conclusion: This abstract presents the rationale and study design for a RCT designed to improve breastfeeding duration,
exclusivity and infant-parent experiences.
P57: Acceptability, Feasibility, And Estimated Effects Of Breast Milk Expression At
The Preterm Infant’s Bedside
Héon, Marjolaine1; Flacking, Renée2; Bell, Linda3
Faculté des sciences infirmières, Université de Montréal, Canada; 2School of Health and Social Studies, Dalarna University,
Sweden; 3Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Canada
1
Background: Mothers who give birth prematurely struggle to achieve a sufficient milk production. Milk expression at
the preterm infant’s bedside is a recommended intervention in the scientific literature to enhance milk production. It is
hypothesized that it maximizes mother-infant contacts and thus stimulates the release of oxytocin, a hormone associated with
milk production and maternal attachment. However, to date, there is no research-based evidence supporting this intervention.
The primary aim of this pilot randomized controlled trial (RCT) is to assess the acceptability and feasibility of milk expression
at the preterm infant’s bedside and estimate its effects on milk volume, early mother-infant relationship, and salivary oxytocin
levels in mothers of preterm infants.
140
Abstracts: Posters
Research hypothesis: Mothers expressing milk at their preterm infants’ bedside will present a significantly enhanced milk
volume, mother-infant relationship, and salivary oxytocin levels over a 3-week period than mothers expressing milk in a
separate room, according to usual care.
As the neonatal intensive care unit (NICU) environment and separation of the mother-infant dyad can be stressful for mothers,
and that stress can negatively influence milk production and mother-infant relationship, the secondary aim of this study is to
compare mothers’ physiological stress levels via salivary cortisol levels.
Methods: Forty mothers of preterm infants born at <30 weeks of gestation and admitted to a NICU of a university health centre
will be recruited and randomly assigned either to the control or experimental group. Mothers in the control group will express
their milk in a separate room according to usual practice, while mothers in the experimental group will be encouraged to express
milk at their preterm infant’s bedside over a three-week period. Folding screens will be provided in order to secure mothers’
comfort and intimacy during milk expression at bedside. In both groups, mothers will keep a logbook of their milk expressions.
Early mother-infant relationship will be assessed through the Baby and You questionnaire (Furman & O’Riordan, 2006) at 3
weeks’ postnatal and 40 weeks’ postmenstrual ages. Saliva samples will be collected at days 1, 7, 14, and 21 of the study, and
will be analyzed via enzyme immunoassay for oxytocin levels and and radioimmunoassay for cortisol levels.
Results: To come.
P58: Preterm newborn sleep patterns before and after feeding and during nap time*
Pinheiro, EM1; Araujo, FM2; Sato, MH3; Avelar, AFM1; Pedreira, MLG1; Hallinan, MP4
1
Department of Pediatric Nursing, Universidade Federal de São Paulo, Brazil; 2FAPESP, Brazil; 3Hospital São Paulo, Brazil;
4
Psicobiology, Universidade Federal de São Paulo, Brazil
Introduction: promoting the sleep of preterm newborns (PN) admitted to neonatal units must be a constant focus of care.
Objective: to compare the sleep patterns of preterm newborns admitted to a Neonatal Intermediate Care Unit before and after
feeding and during nap periods.
Methods: a descriptive study conducted at a Brazilian teaching hospital. Sample comprised five clinically stable newborns
(gestational age (GA) > 31 weeks) placed in incubators and who were receiving or not caffeine orally. Preterm newborns
taking central nervous system depressant drugs, corticosteroids, analgesic drugs, opiates and sedatives and those whose
mothers had used illegal drugs were excluded from the study. We used the Alice 5 Polysomnography (Respironics ®) with
continuous recording data for 24 hours. We analyzed the sleep patterns of newborns 15 minutes before and after feeding and
60 minutes daily in the nap periods, totaling eight daily administrations of four periods of feeding and nap, amounting to 480
minutes of sleep pattern analysis. For statistical analysis, we used the Chi-square test (p <= 0.05).
Results: of the total sample, 60% of newborns were males and were using caffeine whereas 40% were females and did
not use this drug. GA ranged from 31 to 33 weeks. During nap time, quiet sleep predominated (80.4%), followed by active
(17.5%) and undetermined (2.1%). During feeding periods, the predominant pattern was active sleep (70.8%), followed by
quiet sleep (15.8%) and indeterminate sleep (13.4%). There was a significant difference between sleep patterns identified
during feeding and nap periods (p = 0.001). Adjusted residual analysis showed a significant association between feeding
periods and the presence of active sleep (res = 5.6); during nap time, quiet sleep (res = 3.6) predominated. Conclusion:
PN had longer active sleep periods before and after feeding than during nap time. *This research was conducted with the
financial support of the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP, Sao Paulo - SP (Brazil) number:
2012/50365-2.
Abstracts: Posters
P59: The Impossibility of Breastfeeding for Brazilian HIV-Seropositive Women
Santos, Ines Maria Meneses1; Silva, LL2; Nazareth, IV2
2
Departamento de Enfermagem Materno-Infantil, Universidade Federal do Estado do Rio de Janeiro, Brazil
1
Background: This research had 3 objectives:
1) to describe the expectations of seropositive for HIV pregnant women with the recommendation not to breastfeed the child
that will be born;
2) analyze the experience of rooming-seropositive woman in front of the impossibility to breastfeed her newborn son;
3) analyze the behavior of about breastfeeding puerperal woman seropositive for HIV after hospital discharge.
Method: Longitudinal descriptive qualitative study. It was conducted with 16 HIV-seropositive women in pregnancypuerperium cicle followed in university hospital in Rio de Janeiro, Brazil, in the period 10.10.2011 to 08.20.2012. For the
production of the data produced an instrument featuring women by social clinical obstetric history and an interview guide
developed in 3 distinct stages of pregnancy and puerperium. The analytical procedure was based on thematic analysis,
respecting the individuality and uniqueness of each witness. Approved by the Research Ethics Committee, unqualified, under
protocol 06/2011.
Results: Maternal age ranged from 17 to 37 years. Regarding marital status, 8 women were single, 6 married and 2 widows.
2 had incomplete primary education, 2 finished elementary school, 6 high school and 6 incomplete secondary education. It
was found that 11 women were secundiparous 3 multigestas and only 2 were primiparous; 5 of them had already suffered
abortion.
Discussion: narratives emerged from 2 analytical categories:
1) feelings of women seropositive for HIV opposite the impossibility of breastfeeding;
2) professional assistance to HIV seropositive woman and her newborn.
Conclusion: the breakthrough for HIV seropositivity in women is a reality to be faced by society, even in our everyday
assistance in finding possibilities for care that values human relationships, respect for individuals and the socio-cultural
issues for a care congruent and mutual.
Descriptors: women’s health, breastfeeding, HIV Seropositivity.
142
Abstracts: Posters
P60: Life Narratives of Brazilian Women who Breastfed Adoptive Children
Santos, Ines Maria Meneses1; Lage, SR2; Nazareth, IIV2
1
2
Departamento de Enfermagem Materno-Infantil, Universidade Federal do Estado do Rio de Janeiro, Brazil
Background: The objective of this research was to analyze the experience of breastfeeding by women with adopted son.
Method: we used a qualitative approach, method of life narrative, conducted with 3 women who experienced breastfeeding of
foster children in the city of Rio de Janeiro, Brazil. The production data was performed using an instrument to record data on
socioeconomic, child’s age at the time of adoption and current professional help, duration of breastfeeding and on medications,
and an open question with the following question: talk about your life that is related to their experience of breastfeeding (name of
the adopted child). The analytical procedure was based on thematic analysis, respecting the individuality and uniqueness of each
witness. Approved by the UNIRIO Research Ethics Committee, unqualified, under protocol 56228.
Results: it was found that maternal age was between 41 and 57 years, the child age at the time of adoption diversified from
14 hours to four days. The duration of breastfeeding of children ranged from 04 months to 01 years and 11 months.
Discussion: narratives emerged from the 2 analytical categories: 1) the paths of adoption; 2) experience of the breastfeeding
process adopted son.
Conclusion: Significant clarifications are possible adoptive mothers the possibility of breastfeeding, leaving healthcare
professionals, especially nurses, encourage this practice as a way to strengthen the mother-child bond.
Descriptors: Maternal-child nursing; breast feeding; adoption.
P61: Early vs late initiation of breast milk expression on lactation success and
infant nutritional outcomes among mothers of very low birth weight infants
Parker, Leslie1; Krueger, Charlene2; Sullivan, Sandra3; Mueller, Montina4
1
Nursing, University of Florida, Gainesville, Florida, USA; 2Nursing, University of Florida, USA; 3Pediatrics, University of Florida,
USA; 4Medical University of South Carolina, USA
Background: Breast milk is associated with health benefits in very low birth weight (VLBW) infants. A low milk supply
and delayed lactogenesis stage II (LGS2) limits delivery of breast milk to VLBW infants. Mothers of VLBW infants are often
encouraged to begin milk expression prior to 6 hours following delivery. However, it is not known whether milk expression
prior to 6 hours following delivery increases milk volume or decreases time to lactogenesis stage II.
Objective: The purpose of this prospective observational study was to evaluate the effect of initiation of milk expression <
6 hours following delivery compared to > 6 hours in mothers of VLBW infants on the onset of LGS2, milk volume, length of
lactation and neonatal nutritional outcomes.
Methods: Group I (n=20) consisted of mothers who initiated milk expression < 6 hours following delivery and Group II (n=20)
consisted of mothers who initiated milk expression > after 6 hours following delivery. Measurement of milk volumes were obtained
on Days 1-7, 21 and 42. Timing of LGS2, length of lactation and infant nutritional outcomes were measured. Mean milk volume was
compared using Wilcoxin rank sum. Timing of LGS2, length of lactation and infant nutritional outcomes were compared using t-tests.
Results: Group I produced more milk during the first 7 days and this was statistically significant on Day 6 and 7 and at 3 and
6 weeks. Total milk volume of mothers in Group I during the first week was nearly twice that of Group II and was marginally
significant (p = .056). Women in Group I lactated for a longer period of time.
Conclusions: These findings suggest initiation of milk expression prior to 6 hour may increase milk volume in mothers of VLBW infants.
SPONSORSHIP
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ALPHABETICAL LIST OF SPONSORS AND EXHIBITORS
Organisation
AbbVie Inc.
AbbVie UK
22
Aerogen Ltd
17
Armstrong Medical 5
Atom Medical
Bank Partners
26
25a
Canadian Association of Neonatal Nurses (CAINN)
20
Carefusion 13
COINN 18
Cow and Gate
Draeger Medical UK Limited
23
10
EFCNI European Foundation for the
Care of Newborn Infants
19
Elsevier
n/a
ESPNIC 1
Fisher & Paykel Kanmed (central Medical)
7
Medela 9
NPEU
21
Saving New Born Lives
Sterifeed Visit Belfast
Vygon 24
11
Neotech Products 146
Stand Number
Satellite Symposia – Friday 6 September,
07:30 – 08:15
16
2
27
8
Directory of Exhibitors and Sponsors
AbbVie Inc.
Armstrong Medical
Stand 22
Stand 5
AbbVie
1 North Waukegan Road
North Chicago,
IL 60064-6075, USA
www.abbvie.com
Armstrong Medical
Wattstown Business Park,
Newbridge Road, Coleraine
BT52 1BS, Northern Ireland
www.armstrongmedical.net
AbbVie
Paediatrics
Abbott House
Vanwall Business Park
Maidenhead SL6 4XE
Phone: 01628 774994
www.abbvie.co.uk
AbbVie is a global, research-based biopharmaceutical company
formed in 2013 following separation from Abbott. With its
125-year history, the company’s mission is to use its expertise,
dedicated people and unique approach to innovation to develop
and market advanced therapies that address some of the
world’s most complex and serious diseases. In 2013, AbbVie
employs approximately 21,000 people worldwide and markets
medicines in more than 170 countries.
Aerogen Ltd
Stand 17
Galway Business Park,
Dangan,
10 Galway Ireland,
Galway
www.aerogen.com
Aerogen is a specialty medical device and drug delivery
company specialising in the design, manufacture,
marketing of nebulization systems, aimed at the critical
care respiratory market. Aerogen’s patented aerosol
technology is an integral part of its drug delivery systems.
Founded in Galway in 1997, Aerogen has grown to become
the global leader in acute care aerosol drug delivery
equipment and today its Aeroneb products play a critical
role in treating patients on life-support ventilation, as well
as home care offerings in over 50 counties worldwide.
Aerogen is dynamic and evolving company, focusing on
innovative products that create new market opportunities.
It is this innovative approach that has seen Aerogen
register over 40 international patents and continually
develop new products, leading the way in the aerosolized
drug delivery market.
Armstrong Medical is a UK manufacturer of high quality
innovative products for use in anaesthesia and critical care.
Armstrong Medical was established in 1984 to manufacture and
sell respiratory disposable products for critical care applications.
We supply products to over 52 countries worldwide
from our 90,000 square foot office, warehouse and
manufacturing facility in Northern Ireland.
AquaVENT NEO heated breathing circuits for neonates
will be the key product range being showcased at the 8th
International Neonatal Nursing Conference.
AquaVENT® NEO heated breathing circuits combine
technological advances in thermal conductivity and
breathing circuit construction to deliver optimal and
controlled humidification.
Atom Medical Corporation
Stand 26
Street: 3-18-15 Hongo,
Bunkyo-ku,
Tokyo 113-0033
Japan
www.atomed.co.jp
Ever since the foundation of the company (1938),
ATOM MEDICAL CORPORATION has been watching and
supporting the birth of obstetrics and gynecology and in
medical care for neonatal and premature babies.
ATOM MEDICAL CORPORATION is one of the world’s
leading manufacturers of medical equipments. We offer
high-quality products, distribution, services and dedicated
solutions for obstetric and gynecological field, for neonatal
and infant care, for infusion therapies, for respiratory care,
for nursing wards and disposable medical products.
An active and strong sales network is made up to over 65
distributors who market, sell and service ATOM brand perinatal
products to hospitals and clinicians in over 90 countries.
“To save a tiny baby’s life”
is the everlasting objective of ATOM MEDICAL CORPORATION
Bank Partners
CareFusion
Stand 25a
Stand 13
Bank Partners
Olivia Hughes
Email: [email protected]
Phone: +442079593550 option 2
www.bankpartners.co.uk
CareFusion
The Crescent, Jays Close, Basingstoke
RG22 4BS United Kingdom
Phone: +44 (0)800 917 8776
Phone: +44 (0)1256 330860
www.carefusion.co.uk
Bank Partners is the UK’s leading independent provider
of bank management services to the NHS. We have been
working with University College London Hospitals (UCLH)
for over 5 years and are recruiting Neo-Natal Nurses to
work for this prestigious trust. The Neonatal Intensive Care
Unit at UCLH is situated in the heart of London. The Unit
works very closely with Great Ormond Street Hospital.
At UCLH we care for 22 intensive care babies. We also
have a transitional care unit, enabling babies who require
special/extended care to stay with their mothers. For more
information come and visit us on stand 25a.
CANN - Canadian Association
of Neonatal Nurses
Stand 20
Canadian Association of
Neonatal Nurses
32 Colonnade Road, Unit 100
Ottawa, Ontario, Canada
K2E 7J6
www.neonatalcann.ca
The Canadian Association of Neonatal Nurses/Association
canadienne des infirmières et infirmiers en néonatologie
[CANN/ACIIN] is a not-for-profit organization that
represents nurses from across Canada who specialize in
the care of newborn infants and their families. CANN/ACIIN
is a national voice committed to health and wellness of
neonatal nurses, newborns and their families.
CANN/ACIIN promotes both the art and science of neonatal
nursing and provides opportunities for neonatal nurses to
network and share knowledge, experiences and innovations
that influence provincial, federal and international
healthcare, decision making and policy development.
We value: Knowledge, Professional Practice and Ethics.
148
At CareFusion, we are united in our vision to improve the safety
and lower the cost of healthcare for generations to come. Our
14,000 worldwide employees are passionate about healthcare
and helping those that deliver it - from the hospital pharmacy to
the nursing floor, the operating room to the patient bedside.
Our infusion technologies combine the leading IV
medication safety systems and clinically differentiated
IV sets and accessories. We offer the industry’s most
comprehensive portfolio of infusion products, helping
you address two of the most significant issues affecting
you and your patients today—medication errors and
healthcare-associated infections (HAIs).
COINN – Council of International
Neonatal Nurses, Inc.
Stand 18
Council of International
Neonatal Nurses (COINN)
‘Unifying Neontal Nurses Globally’
94 Lyall Terrace
Boston MA 02132
Phone: 1.405.684.1476
www.coinnurses.org
The Council of International Neonatal Nurses (COINN)
is an international collaboration of National Neonatal
Nursing Associations and individuals who represent nurses
who specialise in the care of newborn infants and their
families or have a special interest in this area of nursing.
As recognized global leaders in neonatal nursing care we
are committed to fostering excellence in neonatal nursing
in both high and low resource countries, promoting the
development of neonatal nursing as a recognized global
specialty, high standards of neonatal care, enhancing
quality of care, decreasing health disparities, and
improving healthcare outcomes. To become a member or
get your association involved visit www.coinnurses.org.
Cow and Gate
Stand 23
EFCNI - European Foundation
for the Care of Newborn Infants
Cow & Gate
Newmarket Avenue
White Horse Business Park
Trowbridge
Wiltshire
BA14 0XQ
Phone: 01225 768381
www.in-practice.co.uk
Stand 19
Cow & Gate is dedicated to providing tailored nutrition
to support the growth and development of babies. Its
specialist range of preterm milks is the only range to
contain our unique blend of prebiotic oligosaccharides,
and also includes a breastmilk fortifier supplement. Cow
& Gate can be contacted via the website www.in-practice.
co.uk or via our dedicated HCP Careline 0800 977 5656.
The European Foundation for the Care of Newborn Infants
(EFCNI) is the first pan-European organisation and network
to represent the interests of newborn and preterm infants
and their families. It gathers together parents, medical
professionals and scientists from different disciplines
with the common goal of improving long-term health
of newborn and preterm children by ensuring the best
possible prevention, treatment, care and support.
Dräger
Stand 10
Draeger Medical UK Limited
The Willows
Mark Road
Hemel Hempstead
Hertfordshire
HP2 7BW
United Kingdom
Phone: 0044 (0) 1442 213542
Fax: 0044 (0) 1442 240327
www.draeger.com
Founded in Lübeck in 1889, Dräger is an international
leader in the fields of medical and safety technology. Our
long-term success is based on four central strengths:
close collaboration with our customers, the expertise of our
employees, continuous innovation and outstanding quality.
“Technology for Life” is our guiding principle and our
mission. Wherever they are deployed – Dräger products
protect, support and save lives.
The medical division’s product range covers anaesthesia
workstations, ventilators, warming therapy devices,
jaundice management, patient monitoring & IT, wall &
ceiling supply units and surgical lights.
European Foundation
for the Care of Newborn Infants
Hofmannstraße 7A
D-81379 Munich, Germany
Phone: +49 (0)89 / 89083260
www.efcni.org
european foundation for
the care of newborn infants
The European Society of Paediatric
Neonatal Intensive Care - ESPNIC
Stand 1
ESPNIC Administrative Office
c/o Kenes Associations Worldwide
1-3 Rue de Chantepoulet
P.O. Box 1726
1211 Geneva 1
Switzerland
Phone: +41 22 906 9178
www.espnic-online.org
ESPNIC is a non-for-profit organisation , comprised of
Nurses, Doctors and Allied Healthcare professionals
committed to share knowledge , improve the quality of
paediatric and neonatal intensive care and devoted to
highly promoting multidisciplinary collaboration amongst
all professionals involved in the field giving them a voice
within the European and international context.
In this endeavor, ESPNIC thrives to promote and advance
the art and science of paediatric and neonatal intensive
care through various activities including annual congresses,
training programmes and network opportunities with the
leading experts in the fields of PICU & NICU.
Fisher & Paykel
Healthcare
Medela
Stand 7
Medela AG
Lättichstrasse 4b, 6430 Baar
Switzerland
www.medela.com
Fisher & Paykel Healthcare Limited,
16 Cordwallis Park, Clivemont Road
Maidenhead, Berks SL6 7BU, UK
Phone: +44 1628 626136
www.fphcare.co.uk
Fisher & Paykel Healthcare aims to provide caregivers
with humidified respiratory care solutions for the Infants
journey from hospital to home.
Each step is focused on protecting compromised airways,
fostering developmental care and optimizing infant
outcomes. From the first breath, the Infant Respiratory
Care Continuum facilitates transition from immature lung
function to respiratory independence.
The latest addition is Optiflow Junior, Optimal Humidity and
a comfortable nasal interface gives this revolutionary system
a flow range and accuracy level not previously possible, to
provide a bridge between CPAP and low flow therapy, uniquely
displacing these by providing simply better oxygen therapy.
Kanmed
Stand 24
Kanmed AB
Gardsfogdevagen 18B
SE-168 66 Bromma
Sweden
www.kanmed.se
Kanmed is a Swedish company specializing in Medical
Patient Warming Products.
The Kanmed BabyWarmer is based on a very soft designed
Water Mattress that is 37 °C warm. The Mattress warms
newborn or premature babies weighing from as little as
1000 gram. It works well with Kangaroo Mother Care. The
optimal warming ensures growth rates that are equal to or
better than that of the best incubators.
Stand 11
The Medela family company, headquartered in the Canton
of Zug, Switzerland, was founded by Olle Larsson in 1961.
Medela Breastfeeding Group passionately transforms
research findings into the most advanced breastpumping
technology. For more than 50 years, Medela has helped
to enhance babies’ health through the life-giving
benefits of breastmilk and supports mothers during their
breastfeeding experience – making it as safe and easy
as possible. The company serves customers through a
worldwide network of 16 subsidiaries in Europe, North
America and Asia, and distributes its products through
independent partners in more than 90 countries.
Neotech Products
Stand 9
Neotech Products
27822 Fremont Ct
Valencia, CA 91355 USA
Phone: 661-775-7466
www.neotechproducts.com
Neotech Products has been Making a Difference for babies
and clinicians worldwide for over 25 years. We specialize
in unique, simple skin friendly products for neonates
and pediatric patients in the NICU and PICU, and now,
home care. Some of our most popular products are the
NeoShades for Phototherapy, NeoBar ET Tube stabilizer,
Little Sucker suction aspirator, and the Neotech RAM
Cannula. Our products are invented by nurses, physicians,
and respiratory specialists. All of our products are Made in
the U.S.A. We look forward to Making a Difference in your
hospital!
Advantages
• The baby feels like being on its mother’s skin which
makes it relax, sleep and develop well.
• R
educes the need of incubators and the time spent in
incubators
• Very safe and simple to use
• L ow investment, long lifetime
• M
ore than 10 000 units in use worldwide
150
NPEU
Sterifeed
Stand 21
Stand 2
National Perinatal Epidemiology
Unit (NPEU)
University of Oxford
Old Road Campus, Oxford OX3 7LF
United Kingdom
www.npeu.ox.ac.uk
Sterifeed
Post Cross Business Park
Kentisbeare
Cullompton, EX15 2BB
United Kingdom
www.sterifeed.com
Established at the University of Oxford in 1978, the mission
of the NPEU is:
With 200 Pasteuriser installations in over 30 countries
Sterifeed is at the forefront of technological advances in
the safe treatment of Donor Mothers’ Milk and Special
Feeds. Alongside the pasteuriser range we are now able
to offer the new concept of Breastmilk analysis equipment
to allow Neonatal Clinicians more accuracy when fortifying
mothers’ milk. The consumables provided by Sterifeed are
relied on worldwide by Neonatal, Paediatric and Milk Bank
staff to provide a high quality and safe product for mothers
and babies to use.
‘to produce methodological rigorous research evidence
to improve the care provided to women and their families
during pregnancy, childbirth, the newborn period and
early childhood as well as promoting the effective use of
resources by perinatal health services.’
We involve women, patients, families, and voluntary
and user organisations to ensure our research answers
questions which are important to health services.
The Department of Health Policy Research Programme
(PRP) provides funding for a broad Programme of Work.
We also receive grants from a range of other funding
bodies for specific projects, such as clinical trials or
observational studies.
Saving new Borns Lives
Stand 16
Save the Children
2000 L St NW, Suite 500
Washington DC, 20036
www.savethechildren.org.uk
Save the Children is the leading independent
organization for children in need, with programs in 120
countries, including the United States. We aim to inspire
breakthroughs in the way the world treats children,
and to achieve immediate and lasting change in their
lives by improving their health, education and economic
opportunities. In times of acute crisis, we mobilize rapid
assistance to help children recover from the effects of war,
conflict and natural disasters.
Visit Belfast
Stand 27
Belfast Welcome Centre
47 Donegal Place
Belfast
BT1 5AD
www.visit-belfast.com
Belfast has a unique history and heritage as well as a
world famous welcome. Whether you’re just here for the
conference or plan to stay a little longer, a trip to Belfast
promises memories to last a life time… Belfast may be
small, but it’s certainly big on personality! Visit Belfast
offers advice and insider tips on all the best things to
see and do while you’re in the city, so tap in to our Travel
Advisors knowledge on the Visit Belfast stand or at the
Belfast Welcome Centre on Donegall Place.
Vygon
Stand 8
Vygon
5 Rue Adeline
95440 Ecouen
FRANCE
www.vygon.com
Vygon is a world leader in the creation of high technology
single-use medical devices, distributed throughout the
world by our dedicated network of 25 subsidiaries and 90
integrated distribution partners.
We are committed to providing health-care professionals
with the best possible solutions to treat and care for your
patients in the safest way possible with cost effective and
innovative medical devices designed specifically for your
needs.
Vygon offers an extensive range of products for
neonatology and paediatrics:
• E nteral nutrition
• Vascular access devices for short, mid and long term
• I.V. accessories
• Invasive and non-invasive ventilation
For more information about our recent innovations,
visit our website www.vygon.com.
152
Delegate List
TITLE
FIRST NAME
FAMILY NAME
ORGANISATION/HOSPITAL
COUNTRY
MISS
EBTESAM
ABDULSHAKOOR
KING ABDULAZIZ MEDICAL CITY
SAUDI ARABIA
MRS
ADEOLA
ADE-EKISOLA
CEDARS-SINAI MEDICAL CENTER
USA
DR
MARILYN
AITA
UNIVERSITÉ DE MONTRÉAL
CANADA
PROF
FIONA
ALDERDICE
QUEENS UNIVERSITY BELFAST
UNITED KINGDOM
MRS
NAIME
ALTAY
GAZI UNIVERSITY HEALT SCIENCES FACULTY
TURKEY
MS
LESLIE
ALTIMIER
PHILIP’S HEALTHCARE
USA
MRS
BASMA
ALYAZEEDI
SULTAN QABOOS UNIVERSITY
OMAN
MRS
HETTE
ANDERSEN
NICU RIGSHOSPITALET
DENMARK
MS
MARY ANDERSON
BRIGHAM AND WOMEN’S HOSPITAL
USA
MRS
EVA
ANTHON
NICU HILLEROD
DENMARK
MS
GRAINNE
ARMSTRONG
SAMSO
SAUDI ARABIA
MISS
FRANCES
ARMSTRONG
BELFAST HEALTH AND SOCIAL CARE TRUST
UNITED KINGDOM
MRS
ROSALIND
ASTLES
LEICESTER ROYAL INFIRMARY
UNITED KINGDOM
MS
KUMARI
ATTANYOKE
WOMEN’S HOSPITAL
AUSTRALIA
MS
DEBBIE AYLWARD
CMNRP
CANADA
MS
LYNN
AYLWARD
SHANDS HOSPITAL AT THE UNIVERSITY OF FLORIDA
USA
MRS
HELEN
AYO-AJAYI
BUCKS NEW UNIVERSITY
UNITED KINGDOM
MR
GLENN BARBER
ST LOUIS UNIVERSITY
USA
MRS
ANILA ALI
BARDAI
THE AGA KHAN UNIVERSITY HOSPITAL
PAKISTAN
MS
HILARY
BARLOW
UNIVERSITY OF CAPE TOWN
SOUTH AFRICA
MS
KELLY
BARRON
JANEWAY CHILD HEALTH CENTER
CANADA
MISS
ALISON
BARTLETT
UHD
UNITED KINGDOM
MISS
CORALIE
BATCHELOR
SYDNEY ADVENTIST HOSPITAL
AUSTRALIA
DR
JESSE
BENDER
WOMEN & INFANTS HOSPITAL
USA
MISS
DEE
BERESFORD
NEONATAL NURSES ASSOCIATION
UNITED KINGDOM
MR
BENITO
BERMUNDO
LONDON NEONATAL TRANSFER SERVICE
UNITED KINGDOM
MRS
JUDY
BERRY
ROYAL DARWIN HOSPITAL
AUSTRALIA
MS
DONNA
BERRY
CATAWBA VALLEY MEDICAL CENTER
USA
MS
LYNDA BIEDENBENDER
CHILDREN’S HOSPITAL OF THE KINGS DAUGHTERS
USA
MS
RHODA
BILLONES
COOMBE WOMEN & INFANTS UNIVERSITY HOSPITAL
IRELAND
MRS
MELINDA
BISSETT
CHILDREN’S HOSPITAL OF THE KINGS DAUGHTERS
USA
MISS
TANIS
BLACKLEY
ROYAL ALEXANDRA HOSPITAL CANADA
MRS
JILL
BLYTH
ROYAL INFIRMARY OF EDINBURGH
UNITED KINGDOM
DR
MARY BETH
BODIN
UAB SCHOOL OF NURSING
USA
MS
SUSANNE NORBY
BOJESEN
HERLEV HOSPITAL
DENMARK
MRS
CLARE
BOYCE
SOURTHERN AREA HEALTH AND SOCIAL CARE TRUST
UNITED KINGDOM
MRS
PAMELA
BOYD
ROYAL GWENT HOSPITAL UNITED KINGDOM
MS
GERALDINE
BOYLAN
PAEDIATRICS & CHILD HEALTH, UNIVERSITY COLLEGE CORK
IRELAND
MRS
CAROL
BOYLE
PETER LOUGHEED CENTRE / ALBERTA HEALTH SERVICES
CANADA
MS
BREIDGE
BOYLE
THE INSTITUTE OF NURSING AND HEALTH RESEARCH
UNITED KINGDOM
DR
MARYANN
BOZZETTE
UNIVERSITY OF MISSOURI-ST. LOUIS
USA
MRS
MARIANNE
BRACHT
MOUNT SINAI HOSPITAL
CANADA
MS
MARY-GRACE
BRESLIN
ROYAL JUBILEE MATERNITY HOSPITAL
UNITED KINGDOM
MRS
ANN
BROGAN
ROYAL MATERNITY HOSPITAL
UNITED KINGDOM
MISS
GEMMA
BROWN
JOHN RADCLIFFE
UNITED KINGDOM
Delegate List
TITLE
FIRST NAME
FAMILY NAME
COUNTRY
MRS
KATHRYN
BRYMER
UNITED KINGDOM
MRS
CLAIRE
BUCANELLI
GEISINGER MEDICAL CENTER
USA
MISS
JULIE
CADOGAN
USA
MRS
SANDRA
CAIRNS
UNITED KINGDOM
MRS
MARIAN CAMPBELL
UHD
UNITED KINGDOM
DR
MARSHA
CAMPBELL-YEO DALHOUSIE UNIVERSITY
CANADA
MS
BARBARA
CAPEWELL
SUNSHINE HOSPITAL, MELBOURNE, AUSTRALIA
AUSTRALIA
MRS
NICOLA
CARVILLE
UNITED KINGDOM
MRS
ANGELA
CASEY
SYDNEY CHILDREN’S HOSPITAL NETWORK
AUSTRALIA
MISS
SIEW
CHANG
THE WOMENS
AUSTRALIA
MRS
NATHALIE
CHARLIER
MUMC MAASTRICHT NETHERLANDS
NETHERLANDS
MISS
YU-NU CHEN
QUEEN’S UNIVERSITY BELFAST
UNITED KINGDOM
MS
RHODA
CHIFISI
COLLEGE OF MEDICINE
MALAWI
MS
ANN-MARIE
CLARK
ROYAL HOSPITAL FOR WOMEN
AUSTRALIA
MISS
JUDITH
CLARK
ROYAL NORTH SHORE HOSPITAL
AUSTRALIA
PROF
MIKE
CLARKE
UNITED KINGDOM
MRS
JULIE
CLEARY
UNITED KINGDOM
MRS
PATRICIA
CLIFFORD
CHILDREN’S HOSPITAL OF PHILADELPHIA
USA
MRS
ANNE
COCKBURN
UNITED KINGDOM
MR
MARTIN
COLTON
INFANT UNITED KINGDOM
MS
HAZEL
COOKE
THE ROTUNDA HOSPITAL
IRELAND
MRS
JOANNE
COOKSON
UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE
UNITED KINGDOM
MR
DECLAN
COOPER
RIYAL HOSPITAL FOR WOMEN-RANDWICK
AUSTRALIA
MRS
JEANNE
CORR
UNITED KINGDOM
MRS
PATRICIA
COUCHMAN
UNITED KINGDOM
MRS
HEATHER
COUGHLIN
ROYAL JUBILEE MATERNITY
UNITED KINGDOM
MS
MARY
COUGHLIN
CARING ESSENTIALS COLLABORATIVE, LLC
USA
DR
STANLEY
CRAIG
UNITED KINGDOM
DR
LIZ
CRATHERN
UNIVERSITY OF SHEFFIELD UNITED KINGDOM
MISS
MARY
DALY
AUSTRALIA
MR
COLM
DARBY
UNITED KINGDOM
MISS
RUTH
DAVIDGE
KWAZULU-NATAL DEPT. OF HEALTH
REPUBLIC OF SOUTH AFRICA
MS
LEANN
DAVIES
UCLH
UNITED KINGDOM
MISS
SARAH
DAVIES
ELSEVIER LTD
UNITED KINGDOM
DR
JENNIFER A
DAWSON
THE ROYAL WOMEN’S HOSPITAL
AUSTRALIA
MISS
KAITIE
DE BRUYN
ROYAL ALEXANDRA HOSPITAL
CANADA
MS
CATHY
DENNIS
SHOALHAVEN DISTRICT MEMORIAL HOSPITAL
AUSTRALIA
MRS
INGER
DOEJ
NICU ODENSE
DENMARK
MRS
COLLETTE
DONNELLY
RBHSC
UNITED KINGDOM
MS
CATHERINE
DRISCOLL
DARTMOUTH-HITCHCOCK MEDICAL CENTER
USA
MRS
WAKAKO
EKLUND
NORTHEASTERN UNIVERSITY
USA
DR
WAFAA
ELAROUSY
KING SAUD BIN ABDULAZIZ UNIVERSITY FOR HEALTH SCIENCE
SAUDI ARABIA
MSJENNIFER
ELLIOTT
SCHN
AUSTRALIA
MISS
JENNY
ERICSON
FALU HOSPITAL
SWEDEN
DR
MATS
ERIKSSON
ÖREBRO UNIVERSITY HOSPITAL
SWEDEN
154
Delegate List
TITLE
FIRST NAME
FAMILY NAME
COUNTRY
MRS
ELENA
ETON
HUTT VALLEY DISTRICT HEALTH BOARD
NEW ZEALAND
MRS
DENISE
EVANS
BRADFORD ROYAL INFIRMARY
UNITED KINGDOM
MSPATTY
EVERITT
RHW
AUSTRALIA
MISS
FAHEY
PLENTY VALLEY COMMUNITY HEALTH
AUSTRALIA
JOHANNA
MS
PHILOMENA
FARRELL
BELFAST TRUST
UNITED KINGDOM
DR
NANCY
FEELEY
MCGILL UNIVERSITY
CANADA
MRS
SHARON FERGUSON
UHD
UNITED KINGDOM
MRS
VANDA FERREIRA
MATERNIDADE ALFREDO DA COSTA PORTUGAL
MRS
MARTINA
FITZSIMONS
UNITED KINGDOM
DR
RENÉE
FLACKING
DALARNA UNIVERSITY
SWEDEN
DR
JANN
FOSTER
UNIVERSITY OF WESTERN SYDNEY
AUSTRALIA
MS
MARIE
FRANCIS
ROYAL WOMENS HOSPITAL, MELBOURNE, AUSTRALIA
AUSTRALIA
MRS
LYNN
FRANCIS
UHD
UNITED KINGDOM
DR
LINDSAY
FRASER
ULSTER HOSPITAL
UNITED KINGDOM
MS
ODILE
NETHERLANDS
FRAUENFELDER
SOPHIA’S CHILDRENS HOSPITAL
MSYASMIN
FREEMAN
WESTMEAD
AUSTRALIA
DR
FREER
UNITED KINGDOM
YVONNE
MR
ERIC FROST
CHILDREN’S MEMORIAL HERMANN HOSPITAL
USA
MS
MARY PATRICIA
GAFFNEY
WOMEN’S & CHILDRENS’ HOSPITAL
AUSTRALIA
MRS
KATERINA
GALLAGHER
UNITED KINGDOM
MISS
DIANA
GAŠIĆ
PEDIATRIC KLINIC
SLOVENIA
DR
RABIA
GENÇ
EGE UNIVERSITY
TURKEY
MRS
JOSEPHINE
GIBSON
CONNECCT
UNITED KINGDOM
MRS
PATRICIA
GIL CASTRO
HOSPITAL SANT JOAN DE DEU
SPAIN
MRS
CLARE
GILG
STAFFORD HOSPITAL
UNITED KINGDOM
MRS
AMANDA
GODDARD
UNITED KINGDOM
DR
MARY
GOGGIN
ST. GEORGE’S HOSPITAL
UNITED KINGDOM
MISS
SOMYING
GOONTHON
FACULTY OF MEDICINE RAMATHIBODI HOSPITAL
THAILAND
DR
AISLING
GOUGH
UNITED KINGDOM
MS
NETSAYI
GOWERO
COLLEGE OF MEDICINE
MALAWI
MS
SHIRLEY
GREATOREX
CENTRAL GIPPSLAND HEALTH SERVICE
AUSTRALIA
MS
NADINE
GRIFFITHS
SYDNEY CHILDREN’S HOSPITAL NETWORK (WESTMEAD)
AUSTRALIA
MRS
KAREN GRISWOLD
USA
MS
SARAH
GULU
MALAWI GENERAL HOSPITAL
MALAWI
MRS
SIOBHAN
HACKETT
OUR LADY OF LOURDES HOSPITAL
IRELAND
PROF
HENRY L
HALLIDAY
UNITED KINGDOM
PROF
INGER
HALLSTRÖM
DEPT OF HEALTH SCIENCES MEDICAL FACULTY, LUND UNIVERSITY
SWEDEN
MS
SALLY
HAMILTON
ROYAL JUBILEE MATERNITY SERVICE
UNITED KINGDOM
MS
INGRID
HANKES DRIELSMA
VUMC
NETHERLANDS
MRS
SARA
HARRIS
CUHFT
UNITED KINGDOM
DR
DENISE
HARRISON
CHILDREN’S HOSPITAL OF EASTERN ONTARIO (CHEO),
CHEO RI AND UNIVERSITY OF OTTAWA
CANADA
MRS
ROYAL DEVON AND EXETER
UNITED KINGDOM
SADIE
HARRISON
MRS
KERRY
HART
ALBERTA CHILDREN’S HOSPITAL-ALBERTA HEALTH SERVICES
CANADA
DR
MERRYL
HARVEY
BIRMINGHAM CITY UNIVERSITY
UNITED KINGDOM
Delegate List
TITLE
FIRST NAME
FAMILY NAME
COUNTRY
MRS
HELLE
HASLUND
NICU AALBORG
DENMARK
DR
KERSTIN
HEDBERG NYQVIST
UPPSALA UNIVERSITY
SWEDEN
DR
ONNO
HELDER
ERASMUS MC
NETHERLANDS
MS
PAM
HENDERSON
TOOWOOMBA HOSPITAL
AUSTRALIA
MS
CARMEN
HENRICKSON
STROGER HOSPITAL AT COOK COUNTY
USA
DR
MARJOLAINE
HÉON
UNIVERSITÉ DE MONTRÉAL
CANADA
MS
BARBERA
HERZOG TAFT
ROGUE REGIONAL MEDICAL CENTER
USA
MRS
BERNADETTE
HEVRIN
UNITED KINGDOM
MISS
SHIGEKA
HIGAI
GUNMA PREFECTUAL COLLEGE OF HEALTH SCIENCES
JAPAN
MS
APRIL
HIGHAM
KING FAISAL SPECIALIST HOSPITAL
SAUDI ARABIA
MRS
WENDY
HIGMAN
COVENTRY UNIVERSITY
UNITED KINGDOM
MS
BELINDA
HILL
THE CHILDREN’S HOSPITAL
AUSTRALIA
MRS
BARBARA
HILLS
UHCW NHS TRUST
UNITED KINGDOM
MS
JUDY
HITCHCOCK
WELLINGTON
NEW ZEALAND
DR
MARTINA
HOGAN
CRAIGAVON AREA HOSPITAL
UNITED KINGDOM
MRS
CATHERINE HOLDER
CALDERDALE AND HUDDERSFIELD NHS TRUST
UNITED KINGDOM
MRS
SAMANTHA
HOLLYWOOD
CONNECCT
UNITED KINGDOM
MRS
LEIGH
HOPE
ABBVIE
UNITED KINGDOM
MRS
RITA
HOUGHTON
MATER MOTHERS HOSPITAL
AUSTRALIA
MRS
DONNA
HOVEY
ROYAL BRISBANE & WOMEN’S HOSPITAL
AUSTRALIA
MS
MARIE
HUBBARD
UNITED KINGDOM
DR
KEVIN
HUGILL
UNIVERSITY OF CENTRAL LANCASHIRE
UNITED KINGDOM
MRS
HELEN
HUNT
LOGAN HOSPITAL/ QUEENSLAND HEALTH
AUSTRALIA
MS
ELIZABETH
HUSSEY
ETSU PHYSICIANS
USA
MISS
SIBEL
ICKE
EGE UNIVERSITY
TURKEY
MRS
CAROL
JACKSON
CHESHIRE AND MERSEYSIDE NEONATAL
NETWORK TRANSPORT SERVICE
UNITED KINGDOM
DR
NELSON MANDELA METROPOLITAN UNIVERSITY
SOUTH AFRICA
SINDIWE
JAMES
MRSDIANA
JOHANSSON
WCH
AUSTRALIA
MISS
JOHNSTON
UHD
UNITED KINGDOM
GAIL
DR
EDUARDO
JORDAN
CP LOMAS
ARGENTINA
MS
MARY
JOSEPH
IRELAND
DR
MARTHA
JURCHAK
BRIGHMAN AND WOMEN’S HOSPITAL
USA
MRS
JINSUN
KANG
KYUNG HEE UNIVERSITY AT GANGDONG
KOREA, REPUBLIC OF
MS
ANN
KELLY
IRELAND
MRS
KAREN
KENNALLY
WOMEN & INFANTS HOSPITAL OF RHODE ISLAND
USA
MISS
SUSAN
KENNEDY
SAUDI ARAMCO
SAUDI ARABIA
DR
CAROLE
KENNER
NORTHEASTERN UNIVERSITY SCHOOL OF NURSING
USA
MRS
MARGARET KERR
NHS DUMFRIES AND GALLOWAY CMW DGRI
SCOTLAND
MRS
EBRU
KILICARSLAN TORUNER
GAZI UNIVERSITY HEALTH SCIENCES FACULTY
TURKEY
MISS
DENISE
KINROSS
JOHN HUNTER CHILDREN’S HOSPITAL
AUSTRALIA
MISS
NADINE
KIRK
UHD
UNITED KINGDOM
MRS
BUMJA
KO
KONKUK UNIVERSTY MEDICAL CENTER IN SOUTH KOREA
KOREA, REPUBLIC OF
MRS
JACQUIE
KOBERSTEIN
ROTORUA HOSPITAL
NEW ZEALAND
MS
MIKI
KONISHI
SOPHIA UNIVERSITY
JAPAN
156
Delegate List
TITLE
FIRST NAME
FAMILY NAME
COUNTRY
MRS
LYNETTE
KUHNERT
ROYAL BRISBANE & WOMEN’S HOSPITAL
AUSTRALIA
MRS
ANU
KURIAN
UNITED KINGDOM
MR
SEAN
LALLY
ABBVIE LIMITED
IRELAND
MR
PHILIPPE
LAMER
MCGILL UNIVERSITY HEALTH CENTER
CANADA
MRS
GLENDA
LANE
HUTT VALLEY DISTRICT HEALTH BOARD
NEW ZEALAND
MRS
DONGHONG
LANGLEY
NEONATAL INTENSIVE CARE UNIT/SCHOOL OF NURSING
UNITED KINGDOM
MISS
VICTORIA
LARRAD RAHKONEN
UNIVERSITY COLLEGE OF LONDON HOSPITALS
NHS FOUNDATION TRUST
UNITED KINGDOM
MR
CONNECCT
UNITED KINGDOM
PATRICK
LAWLOR
MRS
VALÉRIE
LEBEL
SAINTE-JUSTINE’S HOSPITAL
CANADA
DR
SHOO
LEE
MOUNT SINAI HOSPITAL
CANADA
DR
LISA
LEONARD
INFANT JOURNAL
UNITED KINGDOM
MRS
ANN
LESLIE
HEALTHCARE TECHNOLOGIES.
SOUTH AFRICA
MS
KWEE BEE
LINDREA
AUSTRALIA
MS
LISA
LOCZY
UNIVERSITY OF CALGARY
CANADA
MS
ROSSLYN
LONTIS
WOMEN’S & CHILDREN’S HOSPITAL
AUSTRALIA
MS
CAROLINE
LOUGHLIN
COOMBE WOMAN’S AND INFANTS UNIVERSITY HOSPITAL
IRELAND
MRS
GRACE
LUKE
SOUTH EASTERN TRUST
UNITED KINGDOM
MRS
RAGNHILD
MAASTRUP
NICU RIGSHOSPITALET
DENMARK
MS
LORRAINE MACDONALD
MCMASTER CHILDREN’S HOSPITAL
CANADA
MRS
ROSA
MACHADO
HOSPITAL DE LEIRIA PORTUGAL
MS
MARY
MACKENZIE
WCH ADELAIDE
AUSTRALIA
MRS
SILKE MADER
EFCNI
GERMANY
MS
AGNES
MADIMBO
COLLEGE OF MEDICINE
MALAWI
MRS
MARIE
MAGUIRE
MANNING RIVER RURRAL HOSPITAL
AUSTRALIA
MRS
TAINA
MALM
UNIVERSITY HOSPITAL OF TAMPERE
FINLAND
MS
KARIEN
MANNERING
AUCKLAND CITY HOSPITAL
NEW ZEALAND
DR
TRUDI
MANNIX
FLINDERS UNIVERSITY
AUSTRALIA
MISS
ZACHAROULA
MANOLIDOU
MINISTRY OF HEALTH
GREECE
DR
CARIN
MAREE
UNIVERSITY OF PRETORIA
SOUTH AFRICA
MS
ANNIE
MARSHALL
DUNEDIN HOSPITAL
NEW ZEALAND
MS
GERARDINE
MC CARTHY
PACKARD HOSPITAL AT STANFORD
USA
MS
EMMA
MCCALL
UNITED KINGDOM
MRS
CLAIR
MCCARTHY
AUSTRALIA
MRS
JOANNE
MCCAUGHEY
UNITED KINGDOM
MRS
ANGELA
MCCOY
UHD
UNITED KINGDOM
MS
CHRISTINE
MCDERMOTT
THE ROTUNDA HOSPITAL
IRELAND
MRS
PATRICIA
MCDERMOTT
CONNECCT
UNITED KINGDOM
MRS
ZARA
MCDERMOTT
UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE
UNITED KINGDOM
DR
JENNY
MCGOWAN
UNITED KINGDOM
MISS
CAROLINE
MCGREGOR
ROYAL JUBILEE MATERNITY SERVICE
UNITED KINGDOM
MRS
ANGELA
MCINTEE
DUNEDIN PUBLIC HOSPITAL
NEW ZEALAND
MS
ANN
MCINTYRE
COOMBE WOMAN’S AND INFANTS UNIVERSITY HOSPITAL
IRELAND
MRS
LESLEY-ANN
MCLAUGHLIN
UNITED KINGDOM
MRS
JANE
MCLEAN
UNITED KINGDOM
Delegate List
TITLE
FIRST NAME
FAMILY NAME
COUNTRY
MR
ROBIN
MCMAHON
ROYAL WOLVERHAMPTON HOSPITALS
UNITED KINGDOM
MRS
HEATHER
MCMASTER
UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE
UNITED KINGDOM
DR
BERNADETTE MAZUREK
MELNYK
THE OHIO STATE UNIVERSITY COLLEGE OF NURSING
USA
PROF
INES MARIA
MENESES DOS SANTOS
UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO
BRAZIL
MRS
DARLENE
MENSINGER
GEISINGER MEDICAL CENTER
USA
MISS
JOANNA
MICHALOWSKI
AUSTRALIA
MRS
MURIEL
MILLAR
UNITED KINGDOM
DR
DAVID
MILLAR
UNITED KINGDOM
MISS
STEFANIA
MINGOZZI
NORTHAMPTON GENERAL HOSPITAL
UNITED KINGDOM
MRS
LYNDA
MOLLOY
CHILDREN’S HOSPITAL OF THE KING’S DAUGHTERS
USA
MISS
JENNIFER
MOORE
THE CANBERRA HOSPITAL. ACT
AUSTRALIA
MS
RUTH
MOORE
UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE NHS TRUST
UNITED KINGDOM
MISS
LISA
MORAN
JOHN RADCLIFFE HOSPITAL
UNITED KINGDOM
DR
SUSAN L
MORAN
CHILDREN’S HOSPITAL COLORADO
USA
MS
SARA
MORRIS
KEELE UNIVERSITY
UNITED KINGDOM
MS
MARY
MURRAY
LETTERKENNY GENERAL HOSPITAL
IRELAND
MISS
SHARON
MURRAY
UNITED KINGDOM
DR
MICHAEL
NARVEY
UNIVERSITY OF MANITOBA
CANADA
MS
MARGARET
NAUGHTON
JACK AND JILL FOUNDATION
IRELAND
MISS
GRACE
NEIL
UNITED KINGDOM
MS
SOOI (PHYLLIS)
NEOH
RNSH
AUSTRALIA
MRS
SHOBHA
NEPALI
SYDNEY CHILDRENS HOSPITAL NETWORK, WESTMEAD CAMPUS
AUSTRALIA
DR
KAREN
NEW
THE UNIVERSITY OF QUEENSLAND
AUSTRALIA
MISS
EIJA
NIEMINEN
UNIVERSITY HOSPITAL OF TAMPERE
FINLAND
MRS
SHARON
NURSE
UNITED KINGDOM
MISS
REGINA
OBENG
KOMFO ANOKYE TEACHING HOSPITAL
GHANA
MS
DEIRDRE
O’CONNELL
MIDWESTERN REGIONAL HOSPITAL
IRELAND
MRS
SUSAN
OCONNOR
TEXAS CHILDRENS HOSPITAL
USA
MRS
DEBBIE
O’DONOGHUE
CANTERBURY DISTRICT HEALTH BOARD
NEW ZEALAND
MRS
MAUREEN
O’DOWD
UNITED KINGDOM
MS
PAT
O’FLAHERTY
CHAMPLAIN MATERNAL NEWBORN REGIONAL PROGRAM
CANADA
MS
PATRICIA
O’HARA
IRELAND
PROF
JOANN O’LEARY
UNIVERSITY OF MINNESOTA
USA
MISS
CAMILA
OLIVEIRA DE ATHAYDE
UNIVERSITY OF GLASGOW
UNITED KINGDOM
MS
DEBBIE
OLSEN
LOGAN HOSPITAL
AUSTRALIA
MS
NANCY
O’NEILL
IWK HEALTH CENTRE
CANADA
MR
TADHG
O’RIORDAN
ABBVIE LIMITED
IRELAND
MS
ANNE O’SULLIVAN
IRELAND
MISS
WENDY
OWEN
UNITED KINGDOM
DR
CRISTINA
PARADA
BOTUCATU MEDICAL SCHOOL
BRAZIL
DR
GARY
PARKER
SISTERS OF MERCY
USA
DR
LESLIE PARKER
UNIVERSITY OF FLORIDA
USA
MRS
ANN
PARRY
LIVERPOOL WOMEN’S NHS FOUNDATION TRUST
UNITED KINGDOM
MS
RITA
PATNODE
USA
MISS
KAREN
PEARSE
RBWH, QLD AUSTRALIA
AUSTRALIA
158
Delegate List
TITLE
FIRST NAME
FAMILY NAME
COUNTRY
MR
JOUNI
PESOLA
KUOPIO UNIVERSITY HOSPITAL, DEPARTMENT OF PEDIATRICS
FINLAND
MRS
JULIA
PETTY
UNIVERSITY OF HERTFORDSHIRE
UNITED KINGDOM
MRS
SANDRA PHOENIX
CONNECCT
UNITED KINGDOM
MISS
LORRAINE
PICHE
ABBVIE CORPORATION
CANADA
MSLORRAINE
PICHÉ
ABBVIE
CANADA
MRS
PILLAY
WESTMEAD HOSPITAL
AUSTRALIA
NEELA
DR
ELIANA
PINHEIRO
UNIVERSIDADE FEDERAL DE SAO PAULO
BRAZIL
MRS
ELISABETH
PODSIADLY
KINGSTON UNIVERSITY AND ST. GEORGE’S, UNIVERSITY OF LONDON
UNITED KINGDOM
MISS
SWEET HAR
POH
THE WOMENS HOSPITAL
AUSTRALIA
MS
TINA
POLLARD
NEONATAL NURSES ASSOCIATION
UNITED KINGDOM
MR
NEIL
POWER
ABBVIE LIMITED
IRELAND
MRS
PRATIBHABEN
PRATIBHABEN PATEL
ROYAL HOSPITAL FOR WOMEN SYDNEY
AUSTRALIA
MISS
FAY
PRESBURY
ROYAL CHILDREN’S HOSPITAL
AUSTRALIA
MRS
KAREN
PRICE
WESTMEAD SYDNEY
AUSTRALIA
DR
JAYNE
PRICE
UNITED KINGDOM
DR
MARGO ANNE
PRITCHARD
ROYAL BRISBANE WOMEN’S HOSPITAL, UNIVERSITY OF
QUEENSLAND CENTRE FOR CLINICAL RESEARCH
AUSTRALIA
MRS
KIBOGORA HOSPITAL
USA
GERALYN SUE
PRULLAGE
MS
BLAITHIN
QUINLAN
NATIONAL MATERNITY HOSPITAL
IRELAND
MRS
DENISE
QUINN
UNITED KINGDOM
DR
PHIL
QUINN
CRAIGAVON AREA HOSPITAL
UNITED KINGDOM
MS
RUTH MAITSHOKO
RAKATA-SEJESO
INSTITUTE OF HEALTH SCIENCES
BOTSWANA
MR
DAVID
RAMESAR
HEALTH SCIENCES CENTRE
CANADA
DR
LOUISA
RAMUDU
THE NORTHERN HOSPITAL
AUSTRALIA
DR
KATHRYN RECORDS
UNIVERSITY OF MISSOURI-ST. LOUIS
USA
MRS
NOELENE
REES
CAIRNS BASE HOSPITAL
AUSTRALIA
MS
ANNE
REILLY
THE JACK AND JILL CHILDRENS FOUNDATION
IRELAND
MRS
ROBYN RICHARDS
LIVERPOOL AUSTRALIA
MRS
PATRICIA
RICHARDS-FLEMING
WOMENS + CHILDRENS HOSPITAL
AUSTRALIA
DR
NANCY RODRIGUEZ
NORTHSHORE UNIVERSITY HEALTHSYSTEM USA
MISS
EMMA
ROONEY
UNITED KINGDOM
MRS
ANNIE
ROSEN
ROYAL DEVON AND EXETER
UNITED KINGDOM
MS
JANE
ROXBURGH
SYDNEY CHILDREN’S HOSPITALS NETWORK
AUSTRALIA
MRS
CHRISTINE
SAMMY
MINISTRY OF MEDICAL SERVICES
KENYA
MRS
MARIANA
SCHEEPERS
UNIVERSITY OF JOHANNESBURG
SOUTH AFRICA
MR
STEFAN
SCHMID
MEDELA AG
SWITZERLAND
MS
ANN
SCHWOEBEL
PENNSYLVANIA HOSPITAL
USA
MS
NEROLI
SEBERRY
SYDNEY ADVENTIST HOSPITAL
AUSTRALIA
MS
CORALINN (COREY)
SEIDEL
FORSYTH MEDICAL CENTER
USA
MRS
JENNY
SEMCZUK
FLINDERS MEDICAL CENTRE
AUSTRALIA
MRS
PATRICIA
SHAW
UNITED KINGDOM
MRS
KATERINA
SHAW
UNITED KINGDOM
MRS
DIANNE
SHEA
THE MONCTON HOSPITAL HORIZON HEALTH NETWORK
CANADA
MS
MELISSA
SHERIDAN
ABBVIE LIMITED
IRELAND
MS
SIANG
SIM
ST GEORGE’S HEALTHCARE NHS TRUST
UNITED KINGDOM
Delegate List
TITLE
FIRST NAME
FAMILY NAME
COUNTRY
MISS
HELEN
SIMMONS
CRESSWELL MATERNITY WING
UNITED KINGDOM
DR
HARMESH
SINGH
DAYANAND MEDICAL COLLEGE AND HOSPITAL
INDIA
MRS
HELLE
SKOVGAARD
NICU SKEJBY
DENMARK
DR
JACQUELINE
SMITH THE TOWNSVILLE HOSPITAL
AUSTRALIA
MRS
MONI
SNELL
REGINA QU’APPELLE HEALTH REGINA
CANADA
MS
KIMBERLY
SOUDER
LONGMONT UNITED HOSPITAL
USA
DR
MARIA DE LOURDES
SOUZA
FEDERAL UNIVERSITY OF SANTA CATARINA
BRAZIL
PROF
KAYE
SPENCE
THE CHILDREN’S HOSPITAL AT WESTMEAD
AUSTRALIA
UNITED KINGDOM
DR
DALE
SPENCE
MRS
ANNA
SPICER
ARROWE PARK HOSPITAL - WIRRAL UNIVERSITY TEACHING HOSPITAL UNITED KINGDOM
MISS
VICKI
STEVENS
TOOWOOMBA HOSPITAL
AUSTRALIA
DR
BONNIE
STEVENS
HOSPITAL FOR SICK CHILDREN
CANADA
MRS
BRENDA
STROHM
UNIVERSITY OF OXFORD
UNITED KINGDOM
DR
DAVID G
SWEET
REGIONAL NEONATAL UNIT, ROYAL MATERNITY HOSPITAL
UNITED KINGDOM
MRS
INDIRADEVI
THANKAPPAN
UNITED KINGDOM
MR
KWAME
TOBIASI DOSSI
COLLEGE OF MEDICINE
MALAWI
DR
VERA
TONETE
BOTUCATU MEDICAL SCHOOL
BRAZIL
MS
SUE TURRILL
UNIVERSITY OF LEEDS UNITED KINGDOM
MS
MANPREET
UPPAL
PETER LOUGHEED CENTRE ALBERTA HEALTH SERVICES
CANADA
DR
AGNES
VAN DEN HOOGEN
WILHELMINA CHILDRENS HOSPITAL
NETHERLANDS
DR
MARCIA
USA
VAN RIPER
UNIVERSITY OF NORTH CAROLINA CHAPEL HILL
DRTAMARA
WALLACE
VANDERBILT
USA
MS
WANG
NATIONAL CHENG KUNG UNIVERSITY
TAIWAN
YU-WEN
MRS
SUSAN
WARD-SMITH
BIRMINGHAM CITY UNIVERSITY
UNITED KINGDOM
MRS
GILLIAN
WEIR
UNITED KINGDOM
MRS
KAREN
WEIR
UNITED KINGDOM
MS
BARBARA
WHELAN
UNIVERSITY COLLEGE HOSPITAL
IRELAND
DR
JOKE
WIELENGA
EMMA CHILDRENS HOSPITAL /ACADEMICAL MEDICAL CENTER
NETHERLANDS
MS
JANE
WITHERS
AUSTRALIA
MRS
CECILE
WOLFS
AZM MAASTRICHT
NETHERLANDS
MS
EDNA
WOOLHEAD
ROTUNDA HOSPITAL
IRELAND
MISS
CAITLYN
ZAPF
ROYAL ALEXANDRA HOSPITAL
CANADA
MS
BONNIE
ZAWISLAK
MCMASTER CHILDREN’S HOSPITAL
CANADA
MS
SELMA
ZIRAMAN
OZEL TURGUT OZAL HOSPITAL
TURKEY
160
Notes
Notes
162
Notes
Notes
164
Notes
Notes
166
Notes
Notes
168

Program - Unifying Neonatal Nurses Globally

Transcription

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