Introduction The purpose of this article is to present the collective experiences of six federally-funded critical congenital heart disease (CCHD) newborn screening implementation projects to assist federal and state policy makers and public health to implement CCHD screening. Methods A qualitative assessment and summary from six demonstration project grantees and other state representatives involved in the implementation of CCHD screening programs are presented in the following areas: legislation, provider and family education, screening algorithms and interpretation, data collection and quality improvement, telemedicine, home and rural births, and neonatal intensive care unit populations. Results The most common challenges to implementation include: lack of uniform legislative and statutory mandates for screening programs, lack of funding/resources, difficulty in screening algorithm interpretation, limited availability of pediatric echocardiography, and integrating data collection and reporting with existing newborn screening systems. Identified solutions include: programs should consider integrating third party insurers and other partners early in the legislative/statutory process; development of visual tools and language modification to assist in the interpretation of algorithms, training programs for adult sonographers to perform neonatal echocardiography, building upon existing newborn screening systems, and using automated data transfer mechanisms. Discussion Continued and expanded surveillance, research, prevention and education efforts are needed to inform screening programs, with an aim to reduce morbidity, mortality and other adverse consequences for individuals and families affected by CCHD.
NICU nurses are in influential positions to educate parents and model SIDS risk-reduction strategies. This study supports other published research that points to inconsistencies in nursing practice regarding implementation of methods to reduce the risk of SIDS.
Objective:To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening.Study Design:Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants).Results:Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ⩾2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%).Conclusion:Given the majority of NICU infants were ⩾2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.
Background: Zika virus (ZIKV) is an emergent flavivirus, transmitted predominately by Aedes genus mosquitos that recently reached the Americas and was soon implicated in an increase in microcephaly and other serious birth defects. Purpose: This report provides updated information and recommendations on testing, screening, and care for pregnant women and infants affected by ZIKV. Methods: Current published recommendations from the Centers for Disease Control and Prevention, the World Health Organization, and the American Academy of Pediatrics were reviewed and included in this report. Results: Although largely a self-limiting disease usually without symptoms, pregnant women and their fetuses are at greatest risk. Maternal transmission of ZIKV to the fetus can lead to congenital Zika infection with potentially devastating sequelae to the infant. The available evidence suggests that infection during the first trimester of pregnancy, in which the fetus' central nervous system is being formed, is associated with higher risk of brain abnormalities and perinatal loss. Implications for Practice: Uncertainties remain about the course of the disease, and the full spectrum of effects of the virus on the developing infant is not yet understood. Infants with congenital Zika syndrome need coordinated follow-up and long-term specialty care, as well as support for the family. Implications for Research: There is no known cure for ZIKV infection and no vaccine is currently available. The full spectrum of developmental disabilities and other adverse early childhood outcomes associated with congenital ZIKV infection needs to be studied.
In How to Treat People: A Nurse's Notes, British author Molly Case presents an unusual, yet intriguing blend of textbook nursing fundamentals and historical snippets with her personal and professional experiences in conveying the art and science of nursing. The book is divided into sections according to the ABCDE (Airway Breathing Circulation Disability Exposure) systematic approach to assessment of patients that is commonly used in the United Kingdom. Within these sections, the author offers a fascinating amalgamation of anatomy, physiology, pathophysiology, history, linguistics, and mythology as they correspond to different illnesses, clinical conditions, and the associated nursing care procedures. She explains the etymology of various medical terms and the reasoning behind common medical and nursing procedures. Although packed full of information, the book flows in short, easy-to-read chapters within the sections.Though not designed as a classic textbook, it is rich with facts, trivia, and personal musings. In addition to clinical lessons, the reader is presented with the origins of medical terms and concepts from ancient peoples, and examples of how modern medical practice was influenced by historical events. The derivation of familiar names such as diabetes mellitus are explained from their Greek and Latin roots. Wound care techniques from ancient Egyptians and Greeks, cardiac and pulmonary physiology from Egyptian medical papyrus writings, the vital life force of the Mayan breath soul, the association of the heart with love by the Romans and other constructs provide contextual background to a particular disease or patient's infirmity. The inclusion of noteworthy influencing events from modern history, such as the discovery of sweat testing for cystic fibrosis as a result of observations during an extreme heatwave in New York in 1948, offers further interest and understanding of the ailment of focus.Within each ABCDE section, the author introduces patients, their stories, and the nursing care she provides and enhances these topics with assorted factoids and curiosities. Case shares her personal story of chronic illness and suffering as a child, firsthand experiences as a surgical patient, family medical emergencies and other influencing factors on her nursing career. Childhood memories and reflections from this young nurse's student training and professional practice are sprinkled in with the present. The style is effective in conveying voluminous bits of knowledge around a central theme, yet is sometimes choppy with such diverse material packed into each section. The language is beautifully expressive describing a laugh as "rainwater on tin, cold north-east rain trickling and tinkling down the copper wings of an angel" and oft times poetic when describing medical situations "his shoulders heaved, his breath was ragged and clipped short, a trapped wing flapping against a cage." The theme of the respective section is illuminated by the patients' experiences while the recounting of the author's own illness and...
The original version of this article listed one of the coauthor name as Kim Naarden Van Braun. It should be Kim Van Naarden Braun. This error is now corrected with this erratum.
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