Background Hypothermia is a problem for very premature infants after birth and leads to increased morbidity and mortality. Previously we found very premature infants exhibit abnormal thermal patterns, keeping foot temperatures warmer than abdominal temperatures for their first 12 hours of life. Purpose We explored the utility of infrared thermography as a non-invasive method for measuring body temperature in premature infants in an attempt to regionally examine differential temperatures. Results Our use of infrared imaging to measure abdominal and foot temperature for extremely premature infants in heated, humid incubators was successful and in close agreement using Bland and Altman technique with temperatures measured by skin thermistors. Conclusions Our study methods demonstrated that it was feasible to capture full body temperatures of extremely premature infants while they were resting in a heated, humid incubator using a Flir SC640 infrared camera. This technology offers researchers and clinicians a method to examine acute changes in perfusion differentials in premature infants which may lead to morbidity.
This review underscores the need for further research into current warming and humidification techniques for invasive and noninvasive neonatal ventilation. A focus on human studies and the impact of aberrant levels on infant body temperature are needed. Future research may provide management options for achieving and maintaining target temperature/humidity parameters, thus preventing the aberrant levels associated with BPD.
Background: Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants. Purpose: To evaluate the effectiveness of a Golden Hour protocol for infants born at less than 32 weeks' gestation on improving the admission process in a military care facility. Specific aims focused on temperature, time to initiation of intravenous (IV) fluids, time to administration of antibiotics, and time to close of the incubator top. Methods: A pre-/postdesign was used to compare outcomes from preimplementation to postimplementation. Predata were collected using electronic health record chart review and postdata were collected from the Neonatal Intensive Care Unit admission worksheet. Results: Although we did not find statistical significance, we found that more infants had a temperature greater than 36.5°C within 1 hour of birth and decrease in time to initiation of IV fluids and antibiotics from preimplementation to postimplementation, which is clinically significant. Time to close of the incubator top remained greater than 1 hour. Implications for Practice: Implementation of a Golden Hour protocol provides a guide to caring for preterm infants during the first hour of life to improve patient outcomes. Involvement of key stakeholders and staff education are key to successful implementation. Implications for Research: Researchers should examine long-term outcomes related to implementation of a Golden Hour protocol in future studies. Future quality improvement projects should include the effectiveness of similar protocols and address possible barriers.
Future research should focus on establishing normal blood pressure ranges and safe pain management during the "golden hour" and beyond. Future quality improvement should focus on improving subsequent temperature and blood glucose levels after admission umbilical artery and venous catheter placement.
Background Hypothermia is related to increased morbidity and mortality in very preterm infants; continuous temperature monitoring is necessary. Thermoregulation is limited in preterm infants. Objectives The purpose of the research was to assess describe negative temperature differential (NTD) and assess the associations of NTD with infant demographic characteristics, medical history, and clinical events. Methods An exploratory, case study design was used. Abdominal and foot temperature was measured every minute over the first two weeks of life in 22 preterm infants < 29 weeks GA. Results All infants experienced NTD. Daily NTD in all infants across all study days ranged from 0–70.7%; 2-week mean NTD over all infants ranged from 7.3–38.5%. Four infants treated for late onset of infection had a higher NTD than 18 infants without infection (M = 27.8%, SD = 9.52 vs. M = 16.4%, SD = 5.34, p < .05). Although not statistically significant, higher mean percent of NTD were noted in infants having early onset infection (24.1% vs. 16.4%), African-American race (20.0% vs. 15.3%) and/or being born to a mother who smoked during pregnancy (26.6% vs. 16.7%). Discussion A larger study is needed to examine associations between NTD and race, maternal smoking history, and infection. NTD might be used as a biomarker to guide acute clinical care and identify infants at risk for acute and chronic morbidity.
These findings demonstrate that perfusion is increased in the periphery in extremely premature infants when FT is increased. PI measures can be used as a trend for peripheral perfusion, and these values increase over the first 2 weeks of life in infants weighing more than 750 g.
The purpose of this study is to identify the most supportive and restrictive factors contributing to students’ ability to persist through nursing program course completion as perceived by 59 nontraditional students enrolled in a nursing associate degree program. The Student Perception Appraisal-Revised tool was used. Results include that encouragement by friends within school is the top supportive factor, while financial status was found to be the most restrictive factor. Students’ perceptions of why they are not successful in staying in school may help nurse educators to plan and implement changes for improvement based on changing student needs.
Background Alterations in cognitive/affective functioning are among the most challenging side effects experienced by 80% of patients with metastatic melanoma and metastatic renal cell carcinoma undergoing high-dose Interleukin-2 (IL-2) therapy. Objective The purpose of this literature review is to describe what is known about IL-2—induced cognitive/affective symptoms, their prevalence and level of severity, and synthesize findings to determine areas for future research to address symptom management challenges. This review describes the IL-2 patient experience, and the pathophysiology leading to these changes. Methods An online electronic search using PubMed was performed to identify relevant literature published between 1992 and 2015. Of the original 113 manuscripts, information was extracted from nine articles regarding cognitive symptoms, affective symptoms, sample size, research design, reliability and validity. Results Our review suggests that the trajectories, breadth and depth of cognitive/affective symptoms have yet to be described. Despite intervention studies designed to address the psychosocial complications of IL-2, an understanding of the level of altered cognitive/affective symptoms experienced by IL-2 patients remains unclear. Conclusion Our literature review reveals a lack of standardization when assessing, reporting and managing cognitive/affective symptoms. Patients/family members have reported cognitive/affective symptoms to be the most alarming and difficult symptoms, yet these symptoms are not adequately screened for and patients were not informed about potential changes. Implications for Practice Assessing patients for cognitive/affective alterations is important to reduce anxiety while improving outcomes. Education about the illness trajectory (what to expect during/after treatment) can help care partners/patients set realistic shared expectations, and increase coping.
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