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The postnatal period is crucial for infants in establishing a connection with and security in primary caregivers and can have enduring effects on attachment patterns. However, due to the need for symptom management, many infants diagnosed with neonatal abstinence syndrome (NAS) may be separated from primary caregivers and cared for in a neonatal intensive care unit (NICU) or special care nursery (SCN) soon after birth. Research has shown that substance-exposed infants are more likely to experience insecure attachment patterns with their primary caregivers and that mothers with a history of substance abuse are less sensitive to their infants' cues. Therefore, the aim of this research was to explore nurses' and midwives' experiences in promoting the attachment relationship for infants admitted to an NICU/SCN with NAS. A qualitative research design was used to gather data on the experiences of nine nurses/midwives from various NICU and SCN settings in Australia. Individual, semi-structured interviews were conducted, and transcribed interviews were coded using thematic analysis. While nurses/midwives valued the attachment relationship for infants with NAS, facilitation of the attachment relationship was mainly promoted when the mother was present. However, parents were often reported to be absent from the nursery. Difficulties in promoting an attachment relationship were also identified when an infant had child protection involvement. This research identifies areas in need of innovative change regarding the approach taken to promote the attachment relationship for infants with NAS when they are admitted to an NICU/SCN. [ABSTRACT FROM AUTHOR]

The global incidence of Neonatal Abstinence Syndrome (NAS) has increased significantly in the last decade. Symptoms of NAS manifest from the central and autonomic nervous systems as well as the gastrointestinal system and vary in severity and duration. The clinical management of infants experiencing NAS is dependent on symptoms and may include both pharmacological and non-pharmacological measures. In cases where symptoms are severe, infants may be admitted to special care nurseries or neonatal intensive care units. Existing research on nurses' involvement in caring for infants with NAS focuses on pharmacological and non-pharmacological interventions to treat physical symptoms associated with NAS. This research sought to add to the body of knowledge around NAS and conveys nurses' and midwives' experiences of delivering care for infants with NAS. Semi-structured interviews were held with nine nurses/midwives. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Five themes emerged from the data. These themes are: Complex care needs; Prioritising physiological care; Experiencing compassion fatigue; Lacking continuity of care; and Stigma. The findings demonstrated the complex nature of care provision for infants with NAS. Competing priorities and the stigmatising nature of NAS threaten optimal care being delivered to these vulnerable infants and their parents. [ABSTRACT FROM AUTHOR]

Background Psychotropic medication use occurs in 8% of pregnancies, with rates increasing, and often multiple medications prescribed. Aims This study aims to determine if the use of psychotropic medication, in a cohort of women with severe mental illness, increases rates of special care nursery admission and reports differences between antidepressant and antipsychotic medication use either alone or in combination. Methods A retrospective database analysis from a cohort with severe mental illness in pregnancy identified 268 pregnant women who were grouped according to medication type. Demographic, obstetric and neonatal variables were analysed using t-tests, χ2, analysis of variance and logistic regression analysis for special care nursery admission. Results The medication groups consisted of: women taking no psychotropic medications ( n = 67); those taking antipsychotics ( n = 87); those taking antidepressants ( n = 55); those taking and a combination of antidepressants/antipsychotics ( n = 59). Rates of special care nursery admission in women who took psychotropic medication (41.3%) were elevated compared to those who did not (26.9%) ( P = 0.035), and were significantly raised when compared to the general population ( P < 0.000). No significant difference occurred between the medication groups. A significant adjusted odds ratio of 2.79 (95% CI 1.286-6.049) was found for special care nursery and psychiatric admission during pregnancy but not for psychotropic medication. Conclusion Rates of special care nursery admission are elevated in neonates of women with severe mental illness taking psychotropic medication, but were not different for monotherapy or polytherapy when prescribing antidepressants or antipsychotic medication. Additional vulnerability occurs in the neonates of women with a mental illness and paediatric presence at delivery is recommended. [ABSTRACT FROM AUTHOR]

Objective To compare time to first dose of oral morphine used in the treatment of neonatal abstinence syndrome ( NAS) in a neonatal intensive care unit ( NICU) versus a special care nursery ( SCN) setting. Methods A retrospective chart review was completed of patient data from two community hospitals in a single health network. Infants born at either facility between January 2013 and August 2015 were eligible for inclusion in the study if treated for NAS with a course of oral morphine. The primary outcome was time from birth to first dose of oral morphine. Secondary outcomes included details about the morphine treatment course, length of stay, and complications from NAS. Results A total of 54 patients (19 NICU patients and 35 SCN patients) fulfilled inclusion criteria for the study. The primary outcome of median time from birth to first dose of oral morphine did not differ between the two groups (42.5 hrs [ NICU] vs 43 hrs [ SCN], p=0.53). No significant differences were found between the morphine regimens used in the two units. The median length of hospital stay (27 days [ NICU] vs 26 days [ SCN], p=0.66) and median length of NICU/ SCN stay (26 days [ NICU] vs 23 days [ SCN], p=0.75) were not statistically significantly different. Time between transfer to the NICU or SCN and administration of the first dose of oral morphine was significantly shorter in the SCN setting (28 hrs [ NICU] vs 4 hrs [ SCN], p=0.009). Conclusions This study found that infants treated for NAS had similar treatment in an NICU and an SCN. No difference was observed in time from birth to initiation of medication therapy. In addition, no differences were seen in all but one marker for quality of care including length of stay and cumulative morphine dose. Infants treated for NAS, whether in an NICU or SCN setting, can receive similar treatment and comparable outcomes. [ABSTRACT FROM AUTHOR]

Aim We aimed to determine, in full-term newborns born between 2000 and 2499 g, what proportion develop problems or the need for interventions that would likely require admission to a special care nursery ( SCN) (i.e. needed an intravenous line ( IV) or a nasogastric tube ( NGT). Methods A multicentre, retrospective audit of all babies born from 1 January to 30 June 2011 was used. Eligible babies were term, inborn at one of four centres in south-east Queensland, with a birthweight between 2000 and 2499 g. Results The cohort of 98 babies had a mean ( SD) birthweight of 2340 (122.3) g and a mean ( SD) gestational age of 38.3 (1.0) weeks. Forty-three had at least one low temperature, 55 had at least one low blood glucose, 35 had an NGT, 22 had an IV cannula. In the entire cohort, 48 babies (49%) required either an IV cannula or an NGT. Fifteen per cent had a second problem (either low blood glucose or low temperature) at a median (interquartile range) age of 11 (5.5-25.5) h: none required a second NGT or IV. The proportion of babies that required either an NGT or an IV was larger in the 2000-2199 g group ( P = 0.026). Conclusions About half of the babies born with a birthweight of 2000-2499 g will require some intervention that will require them to be admitted to a SCN. However, about half would be able to avoid an SCN admission if they are well and admitted to the post-natal ward. [ABSTRACT FROM AUTHOR]

A 45-day-old male neonate (born 25 weeks and 5 days) presented with an annular, erythematosquamous eruption covering the head, neck, trunk, upper limbs and thighs. The eruption most resembled tinea corporis, however unusual the setting. Routine fungal culture grew Microsporum canis. No contacts could be identified. No previous case of tinea corporis had been seen in this neonatal unit, and very few reports are in the literature, particularly regarding this zoophilic organism. Our patient cleared with topical miconazole 2% cream applied twice daily for 24 days. This case highlights the importance of considering dermatophyte infection even in neonatal intensive care. [ABSTRACT FROM AUTHOR]