Neonatal nursing

An infant placed in a neonatal intensive care unit

Neonatal nursing is the provision of nursing care for newborn infants up to 28 days after birth. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin".^[1] Neonatal nurses are a vital part of the neonatal care team.^[2]

Levels

There are four different levels of neonatal nursery where a neonatal nurse might work.^[3] The updated classification of neonatal levels by the American Academy of Pediatrics (AAP) includes a Level IV.

• Level I consists of caring for healthy newborns. Level I nurseries are now uncommon in the United States. Healthy babies typically share a room with their mother, and both patients are usually discharged from the hospital quickly.^[4]
• Level II provides intermediate or special care for premature or ill newborns. At this level, infants may need special therapy provided by nursing staff, or may simply need more time before being discharged.
• Level III, the Neonatal intensive-care unit (NICU), treats newborns who cannot be treated in the other levels and are in need of high technology to survive, such as breathing and feeding tubes. Nurses comprise over 90 percent of the NICU staff.^[2]
• Level IV includes all the skills of the level III but involves the extensive care the most critically and complex newborns. This facility will have 24 hour resident neonatologists and surgeons. They are involved with intricate surgical repairs like congenital cardiac issues and acquired malformations.^[5]

Changes in Neonatal Care

Neonatal Care became a specialty in the United States in 1960 and that is the same year that the first NICU was established in the United States. There have been some major changes in the Neonatal Care over the past 120 years. Some of these changes include the invention of the incubator, changes in respiratory care, and the development of surfactants.

The Incubator

• In 1880, Dr. Tarnier was convinced that the maintenance of internal temperature was key to the premature infant's survival. This led him to introduce the first human incubator. He saw an incubator in use for hatching chickens by a zookeeper, and asked the zoo keeper to design a similar incubator for premature infants.
• Dr. Delee expanded the use and function of the incubator by incorporating an oxygen chamber and an electric controlled thermostat which allowed the incubator to be transported in ambulances.

Respiratory Care

• The survival rate of neonates has greatly improved since the discovery of oxygen use in preterm infants.
• Oxygen administration began with a metal forked device in the nostrils, it is now administered through thin plastic tubes in the nostrils
• The first ventilation of an infant was in 1961 in a positive pressure situation, and mechanical ventilation was improved in 1971.
• CPAP masks were first used in 1973 as an alternate less invasive form of support.

Surfactants

• In 1980, the first study of the use of surfactants on infants took place in Japan.
• Surfactant therapy since has improved the infant morality rate by 50%.
• Surfactants combined with the least invasive respiratory therapy (bubble CPAP or nasal CPAP) has greatly improved the infant mortality rate in the US.

Qualifications and requirements

Healthcare institutions have varying entry-level requirements for neonatal nurses. Neonatal nurses are Registered Nurses (RNs), and therefore must have an Associate of Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) degree. Some countries or institutions may also require a midwifery qualification.^[6] Some institutions may accept newly graduated RNs who have passed the NCLEX exam; others may require additional experience working in adult-health or medical/surgical nursing.^[3]

Some countries offer postgraduate degrees in neonatal nursing, such as the Master of Science in Nursing (MSN) and various doctorates. A nurse practitioner may be required to hold a postgraduate degree.^[6] The National Association of Neonatal Nurses recommends two years' experience working in a NICU before taking graduate classes.^[3]

As with any registered nurse, local licensing or certifying bodies as well as employers may set requirements for continuing education.^[3]

There are no mandated requirements to becoming an RN in a NICU, although neonatal nurses must complete the Neonatal Resuscitation Program. Some units prefer new graduates who do not have experience in other units, so they may be trained in the specialty exclusively, while others prefer nurses with more experience.

Intensive care nurses receive intensive didactic and clinical orientation, in addition to their general nursing knowledge, to provide highly specialized care for critical patients. Their competencies include the administration of high-risk medications, management of high-acuity patients requiring ventilator support, surgical care, resuscitation, advanced interventions such as extracorporeal membrane oxygenation or hypothermia therapy for neonatal encephalopathy procedures, as well as chronic-care management or lower acuity cares associated with premature infants such as feeding intolerance, phototherapy, or administering antibiotics. NICU RNs undergo annual skills tests and are subject to additional training to maintain contemporary practice.

References

External links

• Association of Women's Health, Obstetric and Neonatal Nurses
• The Academy of Neonatal Nursing
• Pre Conception& Neonatal