Neonatal and Pediatric Medicine
Open Access

Infant newborn; Paediatrics; Neonatal nurses; Empowerment; Nursing

Introduction

Protecting human health is a goal for all healthcare practitioners, and high-risk infants especially require greater care than other populations. This group is broadly defined as including: the preterm infant; the infant with special healthcare needs or dependence on technology; the infant at risk because of family issues; and the infant with anticipated early death.[1-3] The proportion of preterm infants who also have a low birth weight, defined as less than 2.5 kg, has increased steadily over time, rising from 3.3% in 1997 to 4.7% in 2007 and reaching 6.2% in 2018, with concomitant increases in high-risk infants those categorized as in need of the neonatal intensive care unit (NICU) in South Korea (hereafter Korea). Immediately after birth, high-risk infants are admitted to the NICU, where they spend at least 24 h in the care of NICU staff, who play a critical role in their survival and eventual thriving. NICU nurses provide various treatments and nursing care to newborns, including oxygen therapy, mechanical ventilation, and maintenance of vital signs, nutritional supplementation, and infection prevention [4]. Notably, after birth, most newborns in the NICU experience various respiratory issues while transitioning to voluntary breathing, which may lead to emergency situations. In these situations, emergency nursing care from experienced nurses is also vital [5]. Moreover, NICU nurses also facilitate the interaction between the newborns and their parents and help the parents to learn their new parental roles. Clearly, NICU nurses face the burden of achieving expertise in a range of complicated tasks spanning several domains in order to respond to the rapidly changing health conditions of newborns, and they are required to have excellent clinical decisionmaking skills to provide timely, accurate nursing care depending on the new-born’s conditions. Clinical decision-making skills in NICU nurses are one of those nursing competencies that increase the quality of nursing and exert a positive influence on the treatment outcome in newborns.

The problem of premature and congenitally ill infants is not a new one. As early as the 17th and 18th centuries, there were scholarly papers published that attempted to share knowledge of interventions. It was not until 1922, however, that hospitals started grouping the newborn infants into one area, now called the neonatal intensive care unit (NICU). [6-8] Disorders of fluid and electrolyte imbalance are amongst the most common disorders encountered in unwell neonates (both term and preterm). The fluid and electrolyte requirements of the neonate are unique due to fluids shifts within the first few days and weeks of life. At birth, there is an excess of extracellular fluid which decreases over the first few days after birth; extracellular fluid and insensible water losses increase as weight and gestational age decrease. Therefore, appropriate management of fluid and electrolytes must take into consideration the birth weight, gestational age and corrected age. In addition, consideration needs to be given to the un well term or preterm neonate as the disease pathophysiology may significantly influence fluid and electrolyte requirements [9].

Before the industrial revolution, premature and ill infants were born and cared for at home and either lived or died without medical intervention. In the mid-nineteenth century, the infant incubator was first developed, based on the incubators used for chicken eggs. Dr. Stephane Tarnier is generally considered to be the father of the incubator (or isolette as it is now known), having developed it to attempt to keep premature infants in a Paris maternity ward warm. Other methods had been used before, but this was the first closed model; in addition, he helped convince other physicians that the treatment helped premature infants. France became a forerunner in assisting premature infants, in part due to its concerns about a falling birth rate.

After Tarnier retired, Dr. Pierre Budin followed in his footsteps, noting the limitations of infants in incubators and the importance of breastmilk and the mother’s attachment to the child. Budin is known as the father of modern perinatology, and his seminal work The Nursling (Le Nourisson in French) became the first major publication to deal with the care of the neonate.

Using Technology

By the 1970s, NICUs were an established part of hospitals in the developed world. In Britain, some early units ran community programmes, sending experienced nurses to help care for premature babies at home. But increasingly technological monitoring and therapy meant special care for babies became hospital-based. By the 1980s, over 90% of births took place in hospital. The emergency dash from home to the NICU with baby in a transport incubator had become a thing of the past, though transport incubators were still needed. Specialist equipment and expertise were not available at every hospital, and strong arguments were made for large, centralised NICUs. On the downside was the long travelling time for frail babies and for parents. A 1979 study showed that 20% of babies in NICUs for up to a week were never visited by either parent. Centralised or not, by the 1980s few questioned the role of NICUs in saving babies. Around 80% of babies born weighing less than 1.5 kg now survived, compared to around 40% in the 1960s. From 1982, paediatricians in Britain could train and qualify in the sub-specialty of neonatal medicine.

Use of Neonatal Nursing

The neonatal nurse practitioner provides specialized care for newborns with a wide range of acuity (level of illness) and conditions from prematurity, infections, genetic conditions, heart disease, surgical diagnoses, respiratory problems, and other disorders. NNPs primarily work in the hospital setting in well-baby nurseries, special care nurseries, neonatal intensive care units and the delivery room. Neonatal nurse practitioners can also work in office settings or private practices. Their specialized training allows them to provide individualized care to infants from the moment of delivery and from well babies to critically ill newborns. NNPs typically work in collaboration with Neonatologists and/or Pediatricians but (in most states) are licensed, independent providers who can diagnose and treat patients. NNPs have prescriptive authority and can prescribe medications as needed for the neonatal population (in most states). [10] Hours for neonatal nurse practitioners can vary a great deal. They typically work 40-hour weeks but might have to pick up overtime depending on the status of the patients and if there is another nurse to take over. The shifts can be five eight-hour shifts a week, four ten-hour shifts, or 3 twelve-hour shifts. Neonatal nurse practitioners can also have the possibility of working holidays.

The Care of Newborn

1. Handling a newborn, including supporting the baby’s neck

2. Bathing

3. Dressing

4. Swaddling

5. Soothing

6. Feeding and burping

7. Cleaning the umbilical cord

8. Using a bulb syringe to clear the baby’s nasal passages

9. Taking a newborn’s temperature

10. Immunization

11. Change the baby’s diaper on time to prevent diaper rash

Conclusion

The present study used the Delphi method to develop a NICU nursing standard guideline for the Korean context and to confirm aspects of practice and professional skills that should be emphasized in clinical education for nursing students. This study is significant in that it developed a NICU nursing standard guideline upon consideration of the Korean clinical environment through clinical observation and literature review. Moreover, the proposed standard guideline can also be used as basic data when developing clinical guidelines for nurses in practice. Future studies should select specific domains and skills from the NICU nursing standard guideline that are expected to be demonstrated in practice by clinical experts, developing educational standard guidelines and materials based on these target areas.

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