Objective: This study describes the incidence, correlates and subsequent morbidities of hyperglycemia, a highly prevalent condition in extremely low birth weight (ELBW) infants.Study design: A retrospective chart review of 169 infants with birth weight (BW)<1000 g was conducted. Hyperglycemia was defined as plasma glucose level X150 mg/dl during the first 2 weeks of life. Data were analyzed by logistic regression, multivariate analysis and Fisher exact test.Results: Overall, 88% of the study sample developed hyperglycemia in the first 2 weeks of life. Both gestational age (GA) (odds ratio (OR) 0.11, 95% confidence interval (CI) ¼ 0.01-0.89) and chorioamnionitis (OR 0.10, 95% CI ¼ 0.01-0.64) were inversely associated with hyperglycemia, whereas BW, sepsis and postnatal steroid exposure were not. After adjusting for GA, BW and postnatal steroids, hyperglycemia was associated with a statistically significant increase in retinopathy of prematurity (ROP) (OR 4.6, 95% CI 1.12-18.9). No association was found with bronchopulmonary dysplasia, intraventricular hemorrhage, death or prolonged hospital stay. Conclusion:Lower GA was identified as the main factor associated with hyperglycemia in ELBW infants during the first 2 weeks of life. Hyperglycemia was associated with an increased incidence of ROP; further studies need to determine if this association is causal.

ObjectiveTo determine the prevalence of work-related psychological distress in staff working in UK paediatric intensive care units (PICU).DesignOnline (Qualtrics) staff questionnaire, conducted April to May 2018.SettingStaff working in 29 PICUs and 10 PICU transport services were invited to participate.Participants1656 staff completed the survey: 1194 nurses, 270 physicians and 192 others. 234 (14%) respondents were male. Median age was 35 (IQR 28–44).Main outcome measuresThe Moral Distress Scale-Revised (MDS-R) was used to look at moral distress, the abbreviated Maslach Burnout Inventory to examine the depersonalisation and emotional exhaustion domains of burnout, and the Trauma Screening Questionnaire (TSQ) to assess risk of post-traumatic stress disorder (PTSD).Results435/1194 (36%) nurses, 48/270 (18%) physicians and 19/192 (10%) other staff scored above the study threshold for moral distress (≥90 on MDS-R) (χ2 test, p<0.00001). 594/1194 (50%) nurses, 99/270 (37%) physicians and 86/192 (45%) other staff had high burnout scores (χ2 test, p=0.0004). 366/1194 (31%) nurses, 42/270 (16%) physicians and 21/192 (11%) other staff scored at risk for PTSD (χ2 test, p<0.00001). Junior nurses were at highest risk of moral distress and PTSD, and junior doctors of burnout. Larger unit size was associated with higher MDS-R, burnout and TSQ scores.ConclusionsThese results suggest that UK PICU staff are experiencing work-related distress. Further studies are needed to understand causation and to develop strategies for prevention and treatment.

Aims and objectivesTo explore what wellbeing means to medical and nursing staff working in a large paediatric intensive care (PIC).DesignExploratory qualitative design using an appreciative inquiry framework.SettingPIC unit; primary, secondary and tertiary.Participants46 nurses and doctors working on PIC.InterventionsA set of images were used together with open-ended questions to prompt staff to discuss what wellbeing means to them. Interviews were audiorecorded and transcribed. Data were analysed thematically.ResultsImages depicting nature, children and groups of adults were selected most. Meanings of wellbeing for PIC staff can be understood through three themes: (1) Being nurtured and supported at work, (2) Importance of nature and (3) Social support independent of work. The first theme considered the importance of being listened to at work as well as staff highlighting the value of being in control at work. Within the second theme, being active in nature and outdoors as well as the importance of being in the present moment was illustrated. Within the final theme, staff expressed the value of having support independent of work and highlighted the importance of spending time with family.ConclusionsThis study provides a unique insight into how individuals working in PIC experience wellbeing and what wellbeing means to them. Understanding how healthcare professionals in PIC settings experience wellbeing and what wellbeing means to them will enable researchers to develop interventions designed to enhance staff wellbeing based on lived experience.

Objective: Staff in pediatric and neonatal intensive care units (PICU and NICU) experience high rates of burnout due to the highly stressful environment. There is growing literature describing stress and burnout, but to date, no review of the evidence specific to pediatric and neonatal intensive care. For the development of interventions to reduce and prevent burnout, there needs to be a better understanding of this evidence. Little is known about coping strategies employed by critical care staff; it is important to collate and critique this literature to inform interventions. The objective of this systematic review was to examine burnout occurrence and coping strategies among staff working in PICU and NICU. Methods: A systematic search of Web of Science (WoS), Scopus, Medline, AMED, PsycINFO, CINAHL, Nice Evidence, and EMBASE was conducted following PRISMA guidelines. Results: Studies measuring burnout and/or coping in PICU and NICU were included in the review. Twenty-two studies met the inclusion criteria, the majority of which used a quantitative cross-sectional design. Of the included studies, 14 measured burnout, and 17 measured coping. Conclusion: Staff working in pediatric and neonatal intensive care settings experience high rates of burnout. While staff may have the ability to use coping strategies, often time and lack of awareness mean they don't. Psychologically informed interventions are required to prevent burnout and to provide staff with the tools and resources to develop healthy coping strategies in order to boost their well-being. Those interventions must then be formally evaluated to determine their impact on staff psychological outcomes.

ObjectivesEvidence shows paediatric critical care (PCC) nurses display high rates of burnout, moral distress, symptoms associated with post‐traumatic stress disorder (PTSD) and poor well‐being. The COVID‐19 pandemic magnified these pressures producing extremely challenging working conditions. The objective was to understand PCC nurses' lived experience of working during COVID‐19 to determine the impact it had on their well‐being.DesignA qualitative design was used with individual, semi‐structured online interviews analysed using thematic analysis.ResultsTen nurses from six PCC units in England participated. Five themes were generated: (i) Challenges of working in Personal Protective Equipment (PPE), (ii) Adapting to redeployment to adult intensive care, (iii) Changes to staff working relationships, (iv) Being unable to attain work‐life balance and (v) Unprocessed traumatic experiences of working in COVID‐19. It was clear COVID‐19 presented novel challenges to PCC nurses' well‐being. With those came enforced changes in practice; some were temporary, for example use of PPE and redeployment, but others provided insight into the prerequisites for good staff well‐being, for example strong professional relationships, work–life balance and managing one's psychological health.ConclusionsFindings show authentic connections between peers, verbal and non‐verbal communication and a sense of belonging were crucial to nurses' well‐being. A dent in PCC nurses' perceived competence significantly affected their well‐being. Finally, staff need a psychologically safe space to process distress and trauma experienced during COVID‐19. Future research needs to test evidence‐based, theoretically‐informed well‐being interventions to improve and maintain PCC nurses' well‐being.