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Neonatal Nurse Practitioner Posters: Class of 2021 20th NNP class with record 25 graduates
Exclusive Human Milk Diet to Improve Health
Outcomes for Very Low Birth Weight Infants
Kathryn M. Corcoran, BS, RN
Background or Significance Discussion
Methods
● Despite the available evidence, a strong policy recommendation does not
● The exclusive human milk diet for very low birth weight ● A literature search was performed using PubMed and Cochrane Library
currently exist to support the EHMD in VLBW infants
infants standardizes the exclusive use of breast milk databases
and human based milk fortifier ● Key words: exclusive human milk diet, human derived milk fortifier,
● Proponents of this diet report positive trends in major neonatal ICU, NICU ● In order to support a strong policy recommendation:
outcomes for VLBW infants ● Literature search yielded 32 publications ○ More research with high quality evidence is needed
● Major barrier to practice: lack of a strong policy ● Final selection criteria: high quality evidence, published within last 5 ○ More research that is specific to this diet is needed
recommendation years, and relevant to PICOT question ○ More current research is needed
● 6 publications were selected for final appraisal
● Potential areas of focus for future research should focus on outcome data
in units with a protocol for the EHMD
PICOT Question Implications for Practice
● In the Neonatal ICU, how does an exclusive human milk ● Evidence does exist to support the exclusive use of human milk products
.
diet affect the major health outcomes for very low birth in VLBW infants:
weight infants? ○ There is a reduction in incidence of negative outcomes associated with
the exclusive use of human milk (sepsis, necrotizing enterocolitis,
● Major health outcomes: feeding intolerance, and IVH)
○ Necrotizing enterocolitis ○ Bovine derived fortifier can be harmful and can increase time to full
feeds and time on TPN
○ Feeding intolerance
○ Exclusive use of human milk for enteral nutrition is associated with a
○ Sepsis reduction in total hospital costs and time to discharge
○ IVH Findings
○ Time on parenteral nutrition ● EHMD is associated with reduced incidence of:
○ Time to discharge ○ Necrotizing enterocolitis
○ Feeding intolerance
○ Total cost of hospital stay
○ Late onset sepsis
○ IVH
● Reduction in total cost of hospital stay:
○ Immediate cost savings of $16,309 per infant
○ Potential total cost savings of $117,239 per infant
● Reduction in time to discharge when human derived milk fortifier is used: Selected References
○ Average LOS: 74 days vs 86 days in control group Ananthan, A., Balasubramanian, H., Rao, S., & Patole, S. (2020). Human Milk-Derived
Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and
● Dose dependent harm associated with the use of bovine derived milk Meta-Analysis. Advances in Nutrition (Bethesda, Md.), 11(5), 1325–1333. https://doi-org.proxy.lib.ohio-
state.edu/10.1093/advances/nmaa039
fortifiers (standard HMF) Assad, M., Elliott, M. J., & Abraham, J. H. (2016). Decreased cost and improved feeding
○ Increase in days on TPN tolerance in VLBW infants fed an exclusive human milk diet. Journal of perinatology :official journal of
the California Perinatal Association, 36(3), 216–220.https://doi.org/10.1038/jp.2015.168
○ Increase in time to full feeds Hampson, G., Roberts, S.L.E., Lucas, A. (2019). An economic analysis of human milk
supplementation for very low birth weight babies in the USA. BMC Pediatr, 337(19).
https://doi.org/10.1186/s12887-019-1691-4
Racial Disparities in the NICU
Effects on Preterm Birth and Infant Mortality
Caitlin Craft, BS, RN-NIC
e(s), credentials
Purpose WHY? Closing the Gap
Is it strictly due to race?
Do black infants born to mothers of • Structural racism These various risk factors that • Define and acknowledge racism
higher socioeconomic risk have • Race concordance adversely affect black women interact • Recognize personal biases
higher rates of preterm birth and with each other and significantly • Communication training
infant mortality when compared to Individual Risk Environmental • Obstacle identification
contribute to the racial disparities we
infants of other races/ethnicities? Factors Risk Factors • Establish trust
see in the NICU.
Age, genetics, Microenvironmental • Active follow-up
income/employment, vs. • Public health programs (ex:
education Macroenvironmental Celebrate One)
Background and • Increasing accessibility
Significance • Medicaid coverage
Findings Individual stressors Environmental
Increased
What prevalence and severity
are racial disparities in of
stressors Implications for Practice
Microenvironmental Factors Single status
diseases
healthcare?
Behavioral factors (elements of choice) Intimate partner Violent crime
Poorer health outcomes • Accept that there is a problem
violence Air pollution
Greater struggle accessing healthcare • Utilize parents that represent
q Smoking Less education Lead exposure
services minority groups on unit
q Vitamin D deficiency Lack of social support Phthlates
committees to spread awareness
q Iron deficiency and anemia Stress
• Set clear expectations for behaviors
ü Safe sleep practices • Recognize your own privilege and
How do we see this in the NICU?
ü Maternal education approach each patient as you would
• Adverse outcomes
ü Marital status PRETERM BIRTH want yourself cared for
§ Preterm birth
ü Income/hospital payment source INFANT MORTALITY • Identify financial, social, and religious
§ Infant mortality
§ Perinatal death obstacles to provide culturally
§ ELBW competent care
Macroenvironmental Factors Community or structural • Ask questions
§ SGA
Social and physical exposures stressors
The United States ranks last among
ü Neighborhoods Poverty/Low-income
developed nations for infant mortality.
ü Exposures Racism/Discrimination
• Black infants: 3x higher risk
ü Social environments Unsafe neighborhoods
ü Access Food insecurity
Black women are at higher risk for
ü Stress Lack of access (education,
preterm birth
healthcare)
• Black preterm infants are at
elevated risk for perinatal death by
References
• Burris, H. H., Lorch, S. A., Kirpalani, H., Pursley, D. M., Elovitz, M. A., & Clougherty, J. E. (2019). Racial disparities in preterm birth
in USA: a biosensor of physical and social environmental exposures. Archives of disease in childhood, 104(10), 931–935.
https://doi.org/10.1136/archdischild-2018-316486
~50% • El-Sayed, A.M., Finkton, D.W., Paczkowski, M., Keyes, K.M., Galea, S. (2015). Socioeconomic position, health behaviors, and
racial disparities in cause-specific infant mortality in Michigan, USA. Preventative Medicine, 76, 8-13.
https://doi.org/10.1016/j.ypmed.2015.03.021
(More available upon request)
Neonatal Herpes Simplex Virus
Early Detection and Treatment
Sara Ellis, BSN, RNC-NIC
Background and Significance Findings Discussion
“nearly 80% of women who transmitted • Focused, selective screening based With focused, selective screening, 60%
HSV to their infants have no known on maternal, paternal and labor and of pregnancies would warrant testing,
history, previous or at the time of delivery factors is the most cost and 84% of cases would be identified.
delivery, of genital HSV lesions” effective with highest yield. (Mark, 2006, p. 410)
(James, 2015, p. 393)
• Age, Fever, premature rupture of
membranes (PROM) To improve patient outcomes:
҉ HSV is a difficult diagnosis • Testing with viral culture and PCR • Early identification of cases
• Transmission risk to infant is assay of surface, blood and CSF is • Recognition of clinical symptoms
multifactorial. the most thorough and accurate. • Thorough and accurate testing
• Symptoms may be mild, late or • Immediate initiation of treatment
absent. • Testing limitations
• Testing methods are not consistently o PCR not available in all settings.
available everywhere. Implications for Practice
o Accuracy depends on specimen
• High mortality and morbidity rate.
Methods collection and handling prior to lab
**Have a HIGH suspicion and LOW
arrival.
҉ If lesions go untreated, there is a 75% threshold
Search of Cochrane and PubMed yielded o Viral cultures take time to grow.
chance of progression to disseminated o High number of false positives in
63 articles with the search terms: Further studies should explore:
disease. moms and false negatives when
• HSV • Prevention of transmission
• Neonate tested early.
҉ Even with treatment, in cases of • Screening for asymptomatic shedding
• Testing and Treatment o Cost of testing is high compared
disseminated disease there is a 54% at time of delivery
to number of cases prevented.
mortality rate. • New/Combination antiviral therapies
Limited by dates 2015-2020. • Risk factors that should prompt
Factors influencing transmission from evaluation
Narrowed to 12 articles for relevance. Mom to Baby: • Guideline for physicians for testing
Purpose • Bedside nucleic acid detection kit for
Type of maternal infection real-time detection of HSV at time of
• Determine how we can identify delivery
infants at risk earlier so treatment Maternal antibody status
can be initiated faster and outcomes
Duration of ROM Selected References
can be improved. James, S.H., Kimberlin, D.W. (2015). Neonatal herpes simplex
virus infection. Infectious Disease Clinics of North America, 29,
391-400. http://dx.doi.org/10.1016/j.idc.2015.05.001
• Is there prenatal testing that includes HSV to Integrity of mucocutaneous
identify positive mothers so that infants may barriers Mark, K.E., Kim, H.N., Wald, A., Gardella, C., Reed, S.D. (2006).
be watched more closely? Targeted prenatal herpes simplex virus testing: can we identify
women at risk of transmission to the neonate. American Journal of
Obstetrics and Gynecology, 194, 408-414.
• What is the best way to test infants for HSV so Mode of delivery http://dx.doi.org/10.1016/j.ajog.2005.08.018
they may be identified and treated early?
More references available upon request
The Use of Near-Infrared Spectroscopy (NIRS)
for the Detection of Necrotizing Enterocolitis
(NEC) in Neonates
Lacey Fleek, RN
Background Search Methods Findings Discussion
•NIRS was Developed in the 1970’s. Search for the literature Research found that it should be paired • NIRS is continuous and non-invasive.
•Early NIRS devices used two was conducted using: with another device (Doppler ultrasound
wavelengths, limiting the use of their • PubMed (US) of superior mesenteric artery (SMA), • The sensors are not shown to cause
measurement. The addition of more • Cochrane Library US, cerebral NIRS) skin breakdown.
wavelengths has improved accuracy. • CINAHL
•NIRS and Ultrasound: • Sensor placement and monitoring can
•There is a lack of tools and tests to Key Words: Neonate, • US was used to identify peristaltic be affected by bladder distention or
reliably diagnose NEC in its early stages Infant, NICU, NIRS, NEC, activity. urinary catheterization.
and predict its progression to becoming a Splanchnic, Intestinal, • NIRS identified infants in the
complicated disease. Devices, Detection, Progression, “normal/hyperactive” group had higher • Variables that can affect oxygenation
•NEC is a leading cause of morbidity in Prevention means than the “no/low” peristalsis and affect the sensor: metabolic
neonates. group. activity, fever/hypothermia, perfusion
What is NIRS? status, blood pressure, hemoglobin
•Cerebral: hypoxic-ischemic level, anemia.
encephalopathy, oxygenation trends, •A continuous and non-invasive monitoring •Cerebral and Splanchnic NIRS: • Resulting in minimal evidence.
trends with a patent ductus arteriosus, technique used to assess regional oxygen • Can differentiate if an infant diagnosed
perioperative status, transition after birth, supply and demand. with NEC would progress to a Recommendations and
respiratory distress syndrome, complicated disease.
hypotension, Apnea/ bradycardic/
•Monitors proximal and deep tissues
• It was not beneficial in determining if
Implications for Practice
•Predominately measures venous blood.
desaturation events and intraventricular NEC would develop.
hemorrhage • Additional research is needed for:
•Renal: Identify acute kidney injuries Difference between NIRS and • Larger sample sizes
•Splanchnic: Perfusion trends, observing Pulse Oximetry •NIRS and Doppler SMA: • Determine accuracy of devices
feeding styles, and to assess the • Increased Doppler SMA vascular used
toleration of the initiation of feeds. resistance was higher in infants who • Cost effectiveness
• Pulse oximetry does not subtract out
•Identify the need for red blood cell developed NEC. • Time frame that monitoring is
non-pulsatile flow.
transfusion or the response to a • It only reflects the oxygen supply to initiated.
transfusion. the tissues.
•Regional tissue oxygenation saturation: • It needs used for long durations, not
• ≤ 56% were at 11x increased risk of short intervals.(>24 hours)
Aim developing NEC.
• Lower saturations with higher FTOE Selected References
The vascular perfusion of the splanchnic was associated with complicated NEC,
organs puts them at a high risk for Martini, S., & Corvaglia, L. (2018).
perforation or death. Splanchnic NIRS monitoring in neonatal
ischemic injuries. The aim was to
• Complications were seen with infants care: rationale, current applications and
investigate if NIRS could be used to help
with persistently low saturations, future perspectives. Journal of perinatology:
detect infants at high risk for developing followed by periods of very high official journal of the California Perinatal
NEC with continuous splanchnic saturations. Association, 38(5), 431–443.
monitoring. https://doi.org/10.1038/s41372-018-0075-1
Prophylactic Early Use of Low Dose Hydrocortisone
in Extremely Preterm Infants to Increase Rate of
Survival Without Bronchopulmonary Dysplasia
Kaylyn Hamilton BSN, RNC-NIC, C-ELBW
Background Methods Findings Implications for Practice
The rate of bronchopulmonary dysplasia A comprehensive search of the literature Low dose hydrocortisone initiated within the Early low dose hydrocortisone should be
(BPD) is most significant in the extremely was conducted. Including PubMed, first 24 hours of life in extremely preterm considered in extremely preterm infants
preterm population due to disruption of lung Cochrane Database, Google Scholar, and infants (less than 28 weeks) showed an ( > 28 weeks gestation) to increase the
development with preterm birth. With new Scopus. increased rate of survival without BPD. rate of survival without BPD.
technologies improving survival rates of
younger gestation infants, there is a higher Search terms included Premature, Neonate, Additionally, there was no evidence of Careful consideration should be taken with
rate of survival but with severe morbidities Hydrocortisone, and BPD. moderate to severe neurologic outcomes or concurrent indomethacin use due to
such as BPD. white or gray matter injury noted on MRI at a potential for intestinal perforation.
A total of 11 resources were identified in the 2 year follow up as compared to those
Previous studies regarding prevention of literature and included: infants who did not receive hydrocortisone
BPD included the use of Dexamethasone. It therapy.
is well documented that this treatment was Textbook: 2 A decreased need for PDA ligation was
directly linked with adverse neurologic noted.
outcomes. Randomized Control Trial: 3
It was observed that infants receiving
Secondary Analysis of RCT: 2 prophylactic low dose hydrocortisone
experienced less time on mechanical
Position Statement: 1 ventilation, CPAP, or supplemental FiO2.
Systematic Review and Meta-Analysis: 2 An increased incidence of late onset sepsis
was noted in those infants receiving
Cohort Study: 1 hydrocortisone therapy.
Additionally, infants treated concurrently with
1 indomethacin had an increased risk for
2 intestinal perforation.
2 Low dose hydrocortisone therapy initiated at
>7 days of life was not shown to have any References
benefit and was of minimal consequence.
1 3
Baud, O., Maury, L., Lebail, F., Ramful, D.,
Purpose Discussion El Moussawi, F., Nicaise, C., ... Alberti, C.
2 (2016, April 30). Effect of early low-dose
Due to the small number of trials hydrocortisone on survival without
The purpose of this project is to determine Textbook bronchopulmonary dysplasia in extremely
if the early use of prophylactic low dose available it would be advised that further
Randomized Control Trials preterm infants (PREMILOC): a double-
hydrocortisone in extremely preterm infants research be conducted to continue to
Secondary Analysis of RCT blind, placebo-controlled, multicenter,
improved survival rates without BPD or replicate these findings as well as randomized trial. Lancet, 387, 1827-1836.
moderate to severe neurologic outcomes. Position Statement monitor long term outcomes in a larger doi:10.1016/ S0140-6736(16)00202-6
Systematic Review and Meta- Analysis sample size.
Cohort Study Additional resources available upon request
T-Piece Resuscitator Use in the
Delivery Room
Katelyn Huffman, BSN, RN
Significance Purpose Findings Discussion
• 10% of neonates require assistance • We know during resuscitation that • The results have shown the TPR has • The T-piece resuscitator is the gold
to transition to extrauterine life. over distention/ too high of become the gold standard in standard for neonatal resuscitation
• The most important part of pressures given to the lungs can neonatal resuscitation with with noteworthy outcomes such as
neonatal resuscitation is effective cause barotrauma, which can lead favorable outcomes. decreased intubation rates, more
ventilation. to chronic lung disease. resuscitation with room air,
• For some infants, this is continuous • The favorable outcomes include: decreased morbidity rates for
positive airway pressure (CPAP) or • It is our duty to use the most ü Decreased intubation rates :15% premature infants, however the T-
positive pressure ventilation (PPV) precise equipment in order to versus 34% Piece Resuscitator is not universally
• We are resuscitating younger and provide accurate pressures to the ü Less time given PPV: 30 seconds available due to increased cost of
younger infants with under- lungs. versus 60 seconds equipment, compared to other
developed lungs. ü The TPR provides PIPs that are resuscitation modalities.
• There are three main pieces of • This paper examines the different closest to the target PIP, with
equipment to give CPAP/PPV in the modalities used during least variation • This project revealed that T-piece
delivery room: Self-inflating bag, resuscitation in the delivery room, ü Decreased morbidities in resuscitator is associated with
Flow inflating bag, and the T-Piece and which device provides the best preterm infants from 47% to decreased intubation rates, less
Resuscitator (TPR). outcomes for the neonate. 35% time of positive pressure
• The TPR Delivers more accurate ü 5 min APGARs were higher with ventilation, more consistent target
• When infants require CPAP or PPV the TPR pressures, decreased morbidities in
and consistent Peak-Inspiratory
resuscitation in the delivery room, ü Better oxygen saturations preterm infants, higher 5 min
Pressure during resuscitation.
what is the best mode of delivery ü Less days requiring mechanical APGARS, which are all desirable
when comparing outcomes? ventilator support outcomes.
ü Decreased length of hospital stay
Methods
References
• Cochrane Library, CINAHL and
Pubmed data bases were searched, Implications for Practice Dang, S., Kanukula, R., Likhar, N., Vsn, M., & Dang, A.
(2015). Comparison of t-piece resuscitator with other
flow – inflating bags for providing positive pressure
8 articles were chosen regarding ventilation during neonatal resuscitation: A systematic
neonatal resuscitation and different • Every Delivery Room should be review. Value in Health, 18(7).
modalities of equipment used for equipped with a T-piece resuscitator. doi:10.1016/j.jval.2015.09.618
Thakur, A., Saluja, S., Modi, M., Kler, N., Garg, P., Soni, A., .
ventilating in the delivery room. . . Chetri, S. (2015). T-piece or self inflating bag for
Articles were published from 2015- • The T-piece resuscitator is the positive pressure ventilation during delivery room
resuscitation: An RCT. Resuscitation, 90, 21-24.
2020. recommended mode of ventilation doi:10.1016/j.resuscitation.2015.01.021
for neonatal resuscitation. Ng, K. F., Choo, P., Paramasivam, U., & Soelar, S. A. (2015).
Reduction of intubation rate during newborn
resuscitation after transition from self-inflating bag to T-
piece resuscitator. The Medical journal of Malaysia, 70(4),
228–231.
Sounds in the NICU: An Evidenced-
Based Approach to Noise Management
John Idzakovich, BA, RN
Background Picot Question Evidence: Positive Auditory Implications for Practice
• Many infants spend weeks to months Among infants in the NICU how do Experiences • Education and “gentle reminders” to
in the Neonatal Intensive Care Unit music therapy and the use of parental Maternal Voice staff and parents/family members
(NICU). Some units have moved to voices as compared to noxious auditory • Increased autonomic and about maintaining the recommended
strictly private rooms and others still stimuli affect physiological and physiological stability of the infant’s noise levels
have the traditional open-bay style. behavioral developmental outcomes in heart rate • Examine the unit and evaluate
ICUs in general have many monitors infants during a NICU admission? • Infants gained more weight as proper placement of monitors/alarms
and equipment, new admissions, compared to the control group. and other equipment
code situations, and many other • Increased feeding rates, number of • Utilize private rooms whenever
Methods feedings per day, volume intake
noises. NICUs are unique in that the possible
Using the keywords “NICU”, “noise”, • Decreased length of stay
patients are undergoing formative • No negative effects were noted of • Incorporate parents, especially
“maternal voice”, “music”, “neonate”,
developmental changes during their using maternal voice as a therapy in mothers, as much as possible during
“development”, “developmental”,
stay infant care care times
“outcomes”, and “behavior”
Music Therapy • Utilize pre-recorded maternal voices
• Noxious auditory stimuli: staff • Decreased heart rate and increased to play during care times when the
• PubMed yielded 20 articles
conversations, monitors alarming, oxygen saturation parents are not able to be at the
• CINAHL yielded 11 articles
ventilators, phones, other infants • Reduction in pain signs and scores bedside
• Cochrane Library yielded 10 articles
crying, etc. • Significant reduction in resting energy
• All articles were from the past 5 years
• Positive auditory experiences: expenditure References
music therapy and live or recorded • A deeper sleep state was noted Casavant, S.G., Bernier, K., Andrews, S., &
parent voices talking or singing to Bourgoin, A. (2017). Noise in the neonatal
the infants Recommendations intensive care unit: What does the
evidence tell us? Advances in Neonatal
• Continue research into this topic to
Significance Care, 17(4), 265-273. Doi:
get more data supporting the use of 10.1097/ANC.0000000000000402
• Noise levels have been estimated to the interventions Foroushani, S.M., Herman, C.A., Wiseman,
be as high as 120 decibels on a • Research the effects of paternal C.A., Anthony, C.M., Drury, S.S., &
regular basis in some NICUs. voices on infants in the NICU Howell, M.P. (2020). Evaluating
• The American Academy of • Study ambient level sounds with the physiologic outcomes of music
Pediatrics (AAP) recommends added music therapy levels interventions in the neonatal intensive
sound levels in the NICU be less
Evidence: Noxious Auditory care unit: A systematic review. Journal of
• Research gender differences with
than 45 decibels. Stimuli musical interventions Perinatology.
• Premature infants are still • Tachycardia, tachypnea, and hypoxia • Evaluate different types of music and Https://doi.org/10.1038/s41372-020-0756-
are all short-term effects of excessive 4
developing while in the NICU and the benefits of each to determine
noise in the NICU which causes Martin, R. J., Fanaroff, A.A. & Walsh, M.
they need special developmental which is most beneficial for infants (2020). Neonatal-Perinatal Medicine:
care strategies to enhance their stress to the infants. • Research live music vs. recorded Diseases of the Fetus and Infant. (11th
well-being and health outcomes. • An increased oxygen demand leads music, especially if provided by ed., Vol 2). Philadelphia, PA: Elsevier
to a decreased number of calories trained music therapists Saunders.
available for growth and
development. (More references available upon request)
Therapeutic Hypothermia in the Preterm Infant
with Hypoxic-Ischemia Encephalopathy
Amy Jackson BSN, RNC-NIC
Significance Findings Discussion
Hypoxic-Ischemic Encephalopathy
Challenge of properly diagnosing TH is more challenging in the
Hypoxic Ischemic Encephalopathy premature infant compared to the
Therapeutic hypothermia (TH) and constantly defining the HIE in
newborn. There are poor
implemented in the term newborn has
shown clinical improvement in O 2
the preterm infant outcomes in preterm asphyxiated
infants as well as un-asphyxiated
randomized trial data.
A shortage of A shortage of blood Resulting in brain In clinical trials mortality and preterm infants who are cold.
oxygen in the blood flow to the brain damage
morbidity of the premature infants
The idea of applying this treatment remained high despite undergoing
to the premature infant for improved therapeutic hypothermia. Implications for Practice
clinical outcomes is being explored.
Data is lacking in long-term
Methods Due to inadequate data, a concern
Is there enough evidence-based outcomes of the surviving premature
for safety and the high mortality rate,
research to implement a change in infants.
therapeutic hypothermia should not
clinical practice and treat preterm A search of therapeutic be utilized in the infant less than 35
babies less then 35 weeks gestation hypothermia, preterm infant, and Safety remains a concern for the weeks outside of the clinical trial
with TH? hypoxic-ischemia encephalopathy premature infant due to the side- setting. Currently there are still trials
was performed which revealed 13 effects of therapeutic hypothermia: underway and until data proves
results with 5 being relevant and Coagulopathy otherwise therapeutic hypothermia in
included for this projects purpose. surfactant production the preterm infant should not be
hyperglycemia implemented.
Purpose
Increased incidence of intracranial
hemorrhage, nosocomial infection, References
In preterm infants less then 35 and impaired oxygenation were
weeks with hypoxic-ischemic Therapeutic Hypothermia Process present in clinical trial findings.
Herrera, T. I., Edwards, L., Malcolm, W. F., Smith, P. B.,
Fisher, K. A., Pizoli, C., . . . Bidegain, M. (2018).
encephalopathy (HIE) how does Outcomes of preterm infants treated with hypothermia
therapeutic hypothermia compare to for hypoxic-ischemic encephalopathy. Early Human
infants greater than 35 weeks treated Development, 125, 1-7.
with therapeutic hypothermia in terms doi:10.1016/j.earlhumdev.2018.08.003
Rao, R., Trivedi, S., Vesoulis, Z., Liao, S. M., Smyser, C. D.,
of improving survival and A newborn's The newborn’s & Mathur, A. M. (2017). Safety and Short-Term
Cells can recover,
neuroprotection? body body
Decreased body
preventing the Outcomes of Therapeutic Hypothermia in Preterm
temperature is temperature
temperature is spread and
lowered to 33.5 lowered for 72 slows the body’s Neonates 34-35 Weeks Gestational Age with Hypoxic-
severity of brain
degrees Celsius metabolic rate Ischemic Encephalopathy. The Journal of Pediatrics,
hours damage
183, 37-42. doi:10.1016/j.jpeds.2016.11.019
(Full reference list available)
Hyperglycemia in the
Extremely Premature Infant
Beth James, BSN, RN, RNC-NIC
Background and Significance Methods Research Studies Discussion
• Sustained hyperglycemia, defined as • Databases: PubMed, CINAHL, • Minimal studies have been done to • There is currently a large variation in
a glucose level greater than 180 Cochrane Library compare and contrast the two main current clinical practice.
mg/dL., may have significant treatment options.
• Search Terms: hyperglycemia, • An insulin infusion promotes growth and
consequences in the extremely
extremely premature infant, • Retrospective database study to neurodevelopment benefits but presents a
premature infant.
hyperglycemia treatment determine the association between large risk for hypoglycemia.
hyperglycemia, insulin therapy, and
• Immediate consequences include: • Searches limited to the last 5 years severe ROP • Lowering the glucose infusion rate is often
• Increased risk of death • Hyperglycemia alone was not preferred by clinicians, since it is
• Intraventricular hemorrhage (IVH) Findings associated with severe ROP considered the “safer” option.
• Sepsis • Possible trend between the use of
• Necrotizing enterocolitis (NEC) insulin and severe ROP Implications for Practice
• Two main treatment options to treat
• Retinopathy of prematurity (ROP) hyperglycemia in the extremely
• Longer length of hospitalization • Prospective collected data from the • A large randomized controlled trial is
premature infant:
Extremely Preterm Infants in Sweden needed comparing the outcomes of these
Study (EXPRESS) to determine the interventions to determine the optimal
• Long-term complications include: 1. Lower the glucose infusion rate
prevalence of hyperglycemia and the treatment.
• Alterations in growth • Benefits
associations between nutritional
• Alterations in neurodevelopment • Less likely to result in
intakes, hyperglycemia, insulin Selected References
• Alterations in metabolic health hypoglycemia
treatment, and mortality
• Risks
• Insulin treatment associated with
• Inadequate caloric intake • Lee, J., Hornik, C., Testoni, D., Laughon,
Purpose lower mortality
M., Cotten, C., Maldonado, R., . . . Smith, P.
2. Administration of an insulin (2015). Insulin, hyperglycemia, and severe
• To compare the two main treatment infusion retinopathy of prematurity in extremely low-
modalities for hyperglycemia, the use • Benefits
of an insulin drip versus lowering the birth-weight infants. American Journal of
• Improved growth and
glucose infusion rate. Perinatology,33(04), 393-400.
development
• Risks doi:10.1055/s-0035-1565999
• Should an insulin infusion be the first • Hypoglycemia
line of treatment in the extremely • Zamir, I., Tornevi, A., Abrahamsson, T.,
premature infant to minimize short- Ahlsson, F., Engström, E., Hallberg, B., . . .
and long-term consequences Domellöf, M. (2018). Hyperglycemia in
associated with hyperglycemia? extremely preterm infants—insulin
treatment, mortality and nutrient
intakes. The Journal of Pediatrics, 200.
doi:10.1016/j.jpeds.2018.03.049Resuscitation on the
Cusp of Viability
Allison Jerome, BS, RN
Significance Purpose Findings Discussion
• Infants are being resuscitated at • How does a standardized approach One study by Backes et al. (2019) • Babies, in fact, are surviving after being
earlier and earlier gestational ages. to resuscitating 22-23 week infants compared two hospitals’ approaches to 22 born at 22 weeks.
• It is not uncommon to have infants compared to a non-standardized week infants. • Studies differ in their survival and morbidity
being resuscitated at 22-23 weeks. approach affect morbidity and • UUCH in Sweden utilizes a results for infants born at 22 weeks due to
• This is a huge ethical dilemma; mortality? proactive/comprehensive approach the relatively small population at this
should infants be resuscitated at • NCH in Columbus utilizes a selective gestation and the ethical considerations
such a premature gestational age? approach. when doing studies on infants.
• Powell et al. (2012) claims that • This study suggests a • Maternal history and hospital of delivery
resuscitating these infants directly
Methods comprehensive/proactive approach is make a huge difference.
contradicts the ethical principles of more successful.
autonomy, beneficence, • An online search of EBSCO Implications for Practice
nonmaleficence, and justice. Discovery via The Ohio State Mehler et al. (2016) looked at 22-23 week
• Generally, it is recommended to just University Health Sciences Library infants born in Germany. • The benefits of a standardized approach to
provide comfort care for infants born was conducted. • There was a specific protocol used if extremely premature infants found by
at 22-23 weeks (Guillén et al., 2015). • The following search terms were families and providers agreed upon Nankervis et al. (2009) are applicable to 22
• In 2009, Nankervis et al. found that utilized: “cusp of viability”, “22 week resuscitation. week infants.
“adopting a unified guideline driven resuscitation”, “extremely preterm”. • Proactive care was offered to 62% of • The information available can help provide
approach to the infant born atVentilation Strategies in the Neonate:
Pressure Limited vs Volume Controlled
Molly Johnson, BSN, RN, RNC-NIC, C-ELBW
Background Search Strategy Findings Discussion
Despite best efforts to utilize non- A search of the Cochrane Library, CINAHL, Infants ventilated with VTV strategies had: The benefits of VTV over traditional PLV
invasive respiratory support, PubMed, and Google Scholar was completed. modes have been well documented in the
approximately 95% of ELBW infants will Keywords of “neonatal ventilation strategies”, past decade. Lack of suitable equipment
require mechanical ventilation (MV) “volutrauma”, “BPD”, and “volume-targeted and knowledge regarding its use have
during their NICU admission. Although ventilation” were used. The search was limited Reduction in been identified as perceived barriers to the
to articles published between 2010-2020. use of VTV.
life-sustaining, overdistension outcome of death
(volutrauma) associated with MV has
been implicated in the development of
or BPD
Systematic Review: Implications for Practice
Bronchopulmonary Dysplasia (BPD).
Volume-targeted versus pressure-
Technological advances now allow Development of formal ventilation
providers to target a set tidal volume limited ventilation in neonates
protocols, increased education and training
instead of pressure-limited ventilation
(PLV) modalities that set a fixed Ø 20 randomized controlled trials Less regarding VTV is needed to increase its
use and improve neonatal outcomes.
inspiratory pressure. Volume-targeted Ø 1,065 neonates hypo/hypercarbia
ventilation (VTV) provides a more stable Ø Outcomes evaluated: rates of death or
tidal volume with the goal of reducing BPD, air leak, head ultrasound findings and
lung injury and increased stability of neurodevelopment.
pCO2 levels.
Retrospective Study: VTV vs PLV Decreased
severe HUS
Ø 100 premature infants (23-34 weeks) findings
Ø Compared ventilation strategies for
treatment of RDS
Ø Outcomes evaluated: mortality, BPD, blood
gas parameters, IVH, ROP
Reduced “Do the best you can until you know better. Then
Systematic Review & pneumothoraces when you know better, do better.” – Maya Angelou
Meta-Analysis: VTV is more
PICO Question References
suitable than PLV for the preterm Chen, L., & Chen, J. (2019). Volume-targeted versus pressure-limited ventilation for
infant preterm infants. Journal of the Chinese Medical Association, 82(10), 791-794.
doi:10.1097/jcma.0000000000000111
Do volume-targeted ventilation (VTV)
Klingenberg, C., Wheeler, K. I., McCallion, N., Morley, C. J., & Davis, P. G. (2017).
strategies as compared to pressure-
limited ventilator (PLV) modalities
Ø 18 randomized controlled trials Less days of Volume-targeted versus pressure-limited ventilation in neonates. Cochrane Database
of Systematic Reviews. doi:10.1002/14651858.cd003666.pub4
decrease the incidence of
Ø 954 infants ventilation Peng, W., Zhu, H., Shi, H., & Liu, E. (2013). Volume-targeted ventilation is more
suitable than pressure-limited ventilation for preterm infants: A systematic review and
Ø Outcomes evaluated: duration of meta-analysis. Archives of Disease in Childhood - Fetal and Neonatal Edition, 99(2).
Bronchopulmonary Dysplasia (BPD) in doi:10.1136/archdischild-2013-304613
mechanical ventilation, blood gas
mechanically ventilated neonates? (full reference list available upon request)
parameters, IVH, pneumothorax, PVL, BPDTraumatic Stress in Neonatal Nurses
and the Psychological Effects of the COVID-19
Pandemic
Ashlee Kelly, BA, RN, RNC-NIC
Significance Findings
Nurses are exposed to an array of •A multicenter retrospective study of
workplace stressors repeatedly NICU nurses found 46% had multiple
putting them at risk for symptoms of symptoms of post-traumatic stress
traumatic stress and re- disorder (PTSD) with high scores in
traumatization: depression.
• Patient deaths
• Previable resuscitation •A multicenter cross-sectional study
• Medical futility found that 40% of nurses working during
the pandemic meet criteria for clinical Discussion
Signs and symptoms of traumatic depression.
stress include
• The true prevalence of traumatic stress
• Depression •Single-center cross-sectional survey
in neonatal nurses is unknown.
• Anxiety found that 65% of those who utilized
Methods • Traumatic stress is highly associated
• Apathy hospital-based peer support services
with depression, anxiety, and nurses
reported positive experiences.
A search of the literature was conducted leaving the profession.
Healthcare workers are currently
utilizing PubMed, Cochrane Library, CINAHL. • Peer support is the preferred method of
working during a “pandemic within a •A single-center cross-sectional survey
pandemic.” found that program utilization was
support by medical personnel.
• Limited supplies Search words included: primarily by nurses and 71% of sessions
• Isolation •Moral distress were following patient deaths. Implications for Practice
• Fear •Burnout
•Neonatal nurse In response to the mental health crisis of • More research is needed in order to
Purpose or Aim •NICU the COVID-19 pandemic prioritize institutional changes that
•COVID-19 • Multicenter cross-sectional study address the healthcare systems and
The purpose of this presentation is to •Mental health utilized a digital learning package to interventions to prevent the experience
describe traumatic stress and ways promote mental health. Early reports of traumatic stress in nurses.
in which nurses experience it, how it Limited search toNeonatal Hypothermia Protocol on Transport:
Which Way is the Best Way?
Jessica Litscher, RN, BSN
credentials Discussion
Background and Significance Methods
If the best-case scenario of having
Hypoxic ischemic encephalopathy
Performed an expansive database access to all equipment, education and
(HIE) is the most common brain injury technology is not available to you,
search to expand on evidence based
in term infants. Therapeutic remember that the foremost important
best practice for what mode is most
hypothermia is only offered at high- effective in achieving hypothermia and factor is reliable core temperature
level regional NICUs, therefore Findings monitoring during transport. Total body
why it is not currently being utilized in
necessitating the need to transport cooling can be achieved passively but
some areas. Initial search produced 14 ● Newborns with encephalopathy cooled with must be monitored continuously to
sick infants to referral centers. Being results that were then refined by a servo-controlled device during transport prevent excess hypothermia.
within the target temperature range feasibility and efficacy of said cooling reached target temperature within 44
minutes on average compared to 63
Additionally, education of outlying
(33-34ºC) is considered methods resulting in 7 studies that were hospitals is imperative to achieve early
minutes when using passive cooling.
neuroprotective for HIE patients. deemed relevant to this topic. ● Servo-controlled cooling was found to be intervention with infants experiencing
more optimal at reaching target HIE.
Barriers to Cooling on Transport temperature range and decreasing
variability in core temperature. Implications for Practice
Distance ● Initiation of cooling before and during
○ Both to and from travel times Even if we do not have the best equipment,
transport resulted in hypothermia protocol
Equipment beginning 4.6 hours earlier than if initiated achieving our goal temperature is attainable.
○ Availability on arrival at the cooling center. Development and implementation of a
○ Cost ● Whether it is active or passive cooling, standardized transport cooling protocol can
when temperatures were not recorded it improve arrival temperatures. As technology
○ Weight resulted in infants arriving with a
■ Must withstand collision forces advances, so can our practices in cooling
temperature lower than 32C.
○ Type infants effectively. By prioritizing what is
● The use of rectal thermometers to monitor
■ Criticool wrap, Tecotherm Neo, core temperature needs further emphasis in most important when effectively initiating
Blanketrol infants receiving hypothermia. hypothermia protocol on transport, we can
Purpose and Aim ○ Power utilize whatever equipment is available to us
■ AC power with no battery backup and help lower the 10% disability-adjusted
This poster seeks to differentiate ○ Transport Mode life years that add to societal morbidity levels.
between the various modes of cooling ■ None certified for air transport References
available to the infant on transport ■ Could require dedicated Neonatal Hagan, J. (2020). Meta-analysis comparing temperature on arrival at the referral
transport vehicles hospital of newborns with hypoxic ischemic encephalopathy cooled with a
servo-controlled device versus no device during transport. Journal of
and determine which one provides Neonatal-Perinatal Medicine. doi:10.3233/NPM-200464
Skin vs Internal Monitoring Ibrani, D., & Molacavage, S. (2018). The Six-Hour Window: How the Community
most benefit to the infant. ○ Internal best for core monitoring Hospital Nursery Can Optimize Outcomes of the Infant with Suspected
Hypoxic-Ischemic Encephalopathy. Neonatal Network, 37(3), 155-163.
Additionally, which mode allows the ○ Rectal is preferred as no x ray
doi:10.1891/0730-0832.37.3.155
Kendall, G. S., Kapetanakis, A., Ratnavel, N., Azzopardi, D., & Robertson, N. J.
infant to arrive at the receiving needed (2010). Passive cooling for initiation of therapeutic hypothermia in neonatal
encephalopathy. Archives of Disease in Childhood - Fetal and Neonatal
hospital within the targeted Untrained physicians at birth hospital Edition, 95(6). doi:10.1136/adc.2010.187211
Sharma, A. (2015). Provision of Therapeutic Hypothermia in Neonatal Transport: A
○ Determining infants meeting criteria Longitudinal Study and Review of Literature. Cureus. doi:10.7759/cureus.270
hypothermia temperature range. Stafford, T. D., Hagan, J. L., Sitler, C. G., Fernandes, C. J., & Kaiser, J. R. (2017).
○ Undetermined care guidelines Therapeutic Hypothermia During Neonatal Transport: Active Cooling Helps
Reach the Target. Therapeutic Hypothermia and Temperature Management,
7(2), 88-94. doi:10.1089/ther.2016.0022Association of Necrotizing Enterocolitis
with Blood Transfusions in the Neonate
Kaitlyn Lucas, RN, BSN
Purpose Findings Discussion
Current practice has shown that there • Three retrospective case studies, These studies suggest there is evidence
are no standard guidelines for changing along with one case- crossover study to support some benefit to holding feeds
enteral feeds associated with blood were found. Two other studies were for blood transfusions, but more research
transfusions which led to the PICOT not completed and did not have results is needed to standardize these
question: due to absence of NEC in their guidelines.
patients or the study had concerns of
Can neonates benefit from discontinuing bias and was not completed. There are many limitations to these
versus continuing feeds during and after studies:
blood transfusions to decrease NEC? • One study of 152 infants found that • Very little information on this topic
infants who received PRBC has been studied and the studies
transfusions were less likely to conducted have small sample
Background sizes.
develop NEC. A second showed no
significant decrease in 125 preterm • The last studies that support
Necrotizing enterocolitis (NEC) is one of holding feeds are from 2008-2009.
the most common neonatal morbidities infants.
• There are always ethical concerns
with an incidence of about nine percent with enrolling infants in research
and mortality rates of 20-30% in • Another study with 63 infants found no
studies.
extremely preterm infants (Bajaj et al., association with the development of
• These studies did not examine
2019). It is one of the most devasting NEC and feed fortification, feed
potential confounders that may
disease processes that occurs in the volume increase, or PRBC
skew results.
NICU and its pathophysiology is still not transfusions within 48 hours prior to
well understood. NEC onset.
Methods Implications for Practice
Transfusion-associated NEC (TANEC) • Three other studies that were
This was a qualitative secondary examined in a review article that found Research is limited on this topic and more
refers to NEC episodes that are related
a decrease in NEC when feeds were information is needed before guidelines
to the transfusion of packed red blood literature search completed by searching
held prior to blood transfusions. One can be recommended. This information is
cells, typically within 48 hours of a The Ohio State University Library’s
of these studies demonstrated a 5.3% promising that there could be benefit to
transfusion (Yeo et al., 2019). TANEC is Database system online. Search terms
to 1.3% decrease in NEC after withholding enteral feeds prior to blood
responsible for up to 20-35% of NEC such as “NEC”, “neonate” and “blood
implementing a new policy restricting transfusions to prevent NEC.
cases in the NICU, is most likely to transfusion” were used. Research
require surgical intervention and causes articles used are from the past five years. feeds for blood transfusions. Another
study had 39% of their infants develop References
higher mortality. Blood transfusions in Bajaj, M., Lulic-Botica, M., Hanson, A., & Natarajan, G. (2019).
our very low birth weight (VLBW) Research on this topic is very limited. NEC with blood transfusions when fed Feeding during transfusion and the risk of necrotizing enterocolitis in
preterm infants. Journal of Perinatology, 39(4), 540-546.
neonates are a common occurrence, There were six different studies and zero infants develop NEC when doi:10.1038/s41372-019-0328-7
making this a controversial topic in many evaluated for the effects of blood feeds were held for blood transfusions.
Yeo, K. T., Kong, J. Y., Sasi, A., Tan, K., Lai, N. M., & Schindler, T.
NICUs. transfusions in relation to NEC in the (2019). Stopping enteral feeds for prevention of transfusion-
associated necrotising enterocolitis in preterm infants. Cochrane
neonatal population and any Database of Systematic Reviews.
doi:10.1002/14651858.cd012888.pub2
recommendations they could provide.
Complete reference list available upon requestEvidence-Based Practice
Cycled Lighting in the NICU
Eliza McIntire BSN, RN
Introduction/Background Discussion References
Cycled lighting is greatly used and The evidence supports the clinical use of -Morag, I., & Olhsson, A. (2016). Cycled
supported by Occupational Therapists (OT) cycled lighting for age-appropriate infants light in the intensive care unit for preterm
who work with infants and children who within the NICU. and low birth weight infants. Cochrane
were previously hospitalized in a NICU Database of Systematic Reviews.
environment. Cycled lighting and its effects https://doi.org/10.1002/14651858.CD0069
on long term outcomes has been studied 82.pub4
widely in various NICUs throughout the Methods/Measurements
world. Various studies analyzed various -Vasquez-Ruiz, S., Maya-Barrios, J., Torres-
outcomes in a quantitative manner and the The studies analyzed for this presentation Narvaez, P., Vega-Martinez, B., Rojas-
incidence of each outcome as it relates to included one randomized control trial, one Granados, A., Escobar, C., & Angeles-
the use of cycled vs other types of lighting. randomized interventional study, and three Castellanos, M. (2014). A light/dark cycle in
systematic reviews. the NICU accelerates body weight gain and
shortens time to discharge in preterm
infants. Cochrane Database of
Systematic Reviews.
Results/Findings https://doi.org/10.1016/j.earlhumdev.201
4.04.015
The randomized control trial showed no
results either way. The systematic reviews - Zores-Koenig, C., Kuhn, P., Caeymaex, L.,
combined showed improved outcomes in
Implications for Practice
& Group of reflection and evaluation of the
the cycled lighting participants in the environment of newborns study group of
categories of total sleep time (TST), weight, • Room infants of similar gestational age
and fragility together, when possible the French neonatology society. (2020).
LOS, and mean days on the ventilator. Recommendations on neonatal light
Furthermore, these studies showed cycled • Begin CL at 32 weeks corrected
gestational age environment from the French Neonatal
lighting to be safe and beneficial, and Society. National Library of Medicine,
furthermore, led to recommendations of • Turn on the lights or open the blinds
to allow for artificial light at 8am 109(7), 1292–1301.
the use of natural light, a gradual increase https://doi.org/10.1111/apa.15173
to cycled lighting, gestational age • Turn off the lights and close the
requirements, and maximum light. The blinds to facilitate darkness at 8pm
randomized interventional study showed • Begin initiation of CL slowly, based
Aims/Purpose improved outcomes in the cycled lighting upon infant’s status and response
participants in the categories of weight, • If infants are sharing a room, use the
The purpose of analyzing these studies is to LOS, oxygen saturation, as well as daily gestational age of the younger/more
answer the following PICOT question: Does melatonin rhythm. fragile infant to determine CL for the
the use of cycled lighting for hospitalized shared space
infants in the NICU improve overall
neonatal outcomes?Web-based Cameras in the NICU
Ashley Meiter, BSN, RNC-NIC, C-ELBW
Background or Significance Methods Implications for Practice
• Web-based cameras are a technology • CINAHL was searched for articles using • Implement parent education to help
being utilized more and more in the the key words web-based cameras, NICU, alleviate stress caused by cameras.
Neonatal Intensive Care Units (NICUs) and parental stress and anxiety • Provide parent’s schedule of infant's
for parents and families to be able to • 5 articles that were relevant, recent, and care times that the cameras will be
see their babies when they can’t be accurate were found in the search. routinely turned off.
present in the unit. • The research was more limited than • Educate parents on the need for rest
• They were made to help parents feel anticipated. and relaxation while at home.
close to their infants even when they • Educate parents that if there is truly
can’t be with them in person. Findings something wrong with their infant a
• The cameras are password protected so Negative evidence: provider would notify them.
the parents can decide who gets access Positive evidence: • Educate parents that it is okay to turn
to see their babies. • When parents saw their baby in times off the cameras while they aren’t
• The cameras are controlled by the • Research shows that web-based of pain, crying, or when in need of present in the unit.
nursing staff taking care of patients. cameras in the NICU decrease stress medical attention, they caused
• The introduction of web-based cameras and anxiety for parents. increased stress.
has had a huge impact on stress and • Parents report that being able to see • It is also stressful for the parents any
anxiety of parents, both positive and their infants when they are away from time the camera is turned off as they
negative. the bedside reduced their stress and aren’t sure if there is a problem or if it
anxiety. is just off for routine care.
Purpose or Aim • It was also reported that when the • The hypervigilance caused by the
parents saw that their infants were cameras leads to increased stress for
The purpose of this poster is to take a doing okay on the cameras it was the parents.
deeper dive into how these cameras truly calming for them. • Parents reported being unable to
impact stress and anxiety of parents. • Virtual visitation can have a positive relax and rest while at home due to
impact on the maternal infant bonding feeling like they could not stop References
process. watching their baby.
• The cameras led to an enhanced • Parents reported a feeling of Epstein, E. G., Arechiga, J., Dancy, M., Simon, J., Wilson, D., &
Alhusen, J. L. (2017). Integrative Review of Technology to
emotional well-being for most helplessness when viewing their Support Communication With Parents of Infants in the NICU.
parents. babies upset which led to increased Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3),
357-366.
• Parents were overall appreciative of anxiety.
Gibson, R., & Kilcullen, M. (2020). The Impact of Web-Cameras
the new technology.
Discussion on Parent-Infant Attachment in the Neonatal Intensive Care
Unit. Journal of Pediatric Nursing, 52, e77–e83.
Web-based cameras are still a positive tool Rhoads, S. J., Green, A., Mitchell, A., & Lynch, C. E. (2015).
Neuroprotective Core Measure 2: Partnering with Families –
in the NICU; we just need to find ways to Exploratory Study on Web-camera Viewing of Hospitalized
Infants and the Effect on Parental Stress, Anxiety, and
lessen the negative impacts. Bonding. Newborn & Infant Nursing Reviews, 15(3), 104–110.Intravitreal Anti-Vascular Endothelial Growth
Factor versus Laser Photocoagulation for
Treatment of Retinopathy of Prematurity
Haley Merrell, BSN, RN
Background and Significance Purpose Findings Discussion
• Retinopathy of Prematurity (ROP) is • The purpose of this project was to • Short-term efficacy and ocular safety • There is a growing number of
a disease that affects infants born analyze current evidence on the were found to be similar and effective evidence and increase in use of anti-
prematurely as vascularization of the advantages and disadvantages of among treatment groups for VEGF as treatment.
developing retina is incomplete. ROP treatment modalities. regression of ROP disease. • Current research is focused on
• Laser photocoagulation has long finding the best Anti-VEGF neonatal
• ROP remains a leading cause of • The purpose was to compare laser been the standard of treatment with a dosage and to evaluate long term
childhood blindness worldwide. photocoagulation versus intravitreal history of success. Ocular morbidities neuro developmental effects.
injection of anti-VEGF management remain a risk which include retinal
• 28,300-45,600 are diagnosed strategies and examine ocular scarring and loss of peripheral vision.
outcomes among the two groups. • Anti-VEGF injection is simple to
Implications for Practice and
annually with irreversible visual
impairment. administer, often doesn’t require Research
Search Strategy sedation, can be done at the bedside
• Risk factors for development of ROP and has fewer negative ocular • Based on findings and risk factors,
are inversely related to gestational structural outcomes. Although, use implications for research conclude
Databases: Cochrane Library, CINAHL, need for high quality RCT’s with
age with low birth weight and remains off-label with a lack of
PubMed longer follow up.
prematurity the highest. optimal dosage. There is concern for
systemic effects on other organs and • Consider the need of longer follow
Search terms: “ROP”, “Retinopathy of up versus fewer adverse ocular
• Due to the risk of lifelong visual need for longer follow up as complete
prematurity”, “laser photocoagulation”, outcomes with anti-VEGF
impairment, careful evaluation and vascularization delayed.
“laser”, “anti-VEGF”, “intravitreal”, • Important consideration for practice
timeliness of treatment is essential. • Consistency among Anti-VEGF use
“Avastin”, “Bevacizumab”, is balancing risks versus benefits.
for zone 1 and severe posterior
“Ranibizumab”, “prematurity” • Anti-VEGF may be an appropriate
disease, as laser more challenging.
• The Cochrane review from 2018 option for unstable patients.
• The search for evidence yielded
concluded low levels of evidence and
eighteen total articles. Five of these
cautioned routine use as there is not Selected Reference
articles deemed current and relevant
enough data.
for purpose of research project.
VanderVeen, D., Melia, M., Yang, M.
• Evidence found consisted of an Hutchinson, A., Wilson, L., & Lambert,
PICOT Question American Academy of Ophthalmology S. (2017). Anti-Vascular Endothelial
systematic review, a Cochrane Growth Factor Therapy for Primary
In preterm infants diagnosed with systematic review, a randomized Treatment of Type 1 Retinopathy of
Retinopathy of Prematurity requiring open-label trial, a retrospective case Prematurity: A Report by the American
treatment, how does the use of series, and a systematic review and Academy of Ophthalmology.
intravitreal Anti-VEGF versus laser meta-analysis. Ophthalmology.
photocoagulation affect ocular
outcomes? More references available upon requestYou can also read
