P29
ADMISSION TEMPERATURES OF PRETERM INFANTS <1000G; CAN WE IMPROVE?
Meyer MP
Middlemore Hospital, Auckland, New Zealand
Email: mmeyer@middlemore.co.nz
Temperature on admission to the neonatal unit affects outcome; a temperature recording
below 35.5C has been associated with increased mortality. The problem is by no means
uncommon. Data from ANZNN for 1999-2000 confirmed a median admission temperature
of 35.7C (interquartile range 35.0C-36.3 ) for inborn infants <1000g.
Aims: We reviewed admission temperatures in <1000g infants and investigated the
effects of a change in delivery room management which included use of a plastic body
wrap to reduce heat loss.
Methods: Infants <1000g admitted to the neonatal unit at Middlemore Hospital between
1996 and 2002 were studied. Statistical relationships between outcome and admission
temperature were investigated. During the first period (June 1996-June 2001), thermal
management in the delivery room was carried out according to the Neonatal
Resuscitation Program of the American Academy of Pediatrics and American Heart
Association. The protocol included drying, use of warmed towels and overhead radiant
warmers followed by transfer to the neonatal unit in a transport incubator. The first
recorded temperature on admission to the neonatal unit was noted in 83/85 infants in this
group. During the second period (from October 2001 to present), changes were made in
that infants were not dried but wrapped with a thin sheet of plastic from the neck down
and then transported (19/21 of the <1000g infants born in this period were treated in this
way). Admission temperatures were compared for the 2 periods.
Results: Using logistic regression, admission temperature below 35C was significantly
associated with birth weight, use of antenatal steroids and delivery mode (ie caesarean
section or vaginal delivery) but not with Apgar score or the need for intubation and
resuscitation. Adverse outcome (defined as any of the following: death, chronic lung
disease, necrotising enterocolitis, severe intraventricular haemorrhage or retinopathy
requiring treatment) was more frequent if the admission temperature was below 35C.
(Relative risk 2.9; 95% CI 1.4-5.9).
Median admission temperatures were 35.5 C in the 83 infants using the standard
protocol and 36.7C in the 19 treated using the plastic wrap (p=0.002; Mann Whitney U).
Conclusions: Low temperatures are common in <1000g infants admitted to the nursery.
Our data demonstrated an increased risk of adverse outcome for temperatures below
35C. Use of a plastic wrap appeared to be an effective way of increasing admission
temperature.
P30
COMPLIANCE WITH A RISK FACTOR BASED GBS PROPHYLAXIS PROGRAM
Kneebone K, McIlwaine K, Barkehall-Thomas A, and Wallace EM.
Centre for Women’s Health Research, Dept. of Obstetrics & Gynaecology, Monash
University and Maternal-Fetal Medicine Unit, Monash Medical Centre, 246 Clayton Road,
Clayton, VIC 3168
Background and Aims: Early onset GBS disease (EOGBSD) of the newborn is an
important cause of serious neonatal morbidity and mortality. It is widely accepted that “at
risk” mother-infant pairs should receive intrapartum antibiotic prophylaxis which is known
to significantly reduce the risk of EOGBSD. Identifying the “at risk” mother-infant pairs has
been either bacteriological screening or risk factor based screening. Recently, it has been
suggested that compliance with risk factor based screening is less than with
bacteriological screening, thereby impairing the utility of the former. In this study we have
assessed compliance in our institution which has used a risk factor approach for many
years.
Materials and Methods: For the 6 month period August 2001 – January 2002 inclusive,
mother-infant pairs with three key risk factors for EOGBSD (intrapartum pyrexia >38˚C,
prolonged rupture of membranes >18 hours, preterm delivery <37 weeks) were identified
from a computerised birthing outcome system. The maternal case records of these were
retrieved and hand searched for: evidence of appropriate intrapartum antibiotic
administration, duration of labour,
Results: There were 297 women identified for the study period. Of these 40% were
preterm, 29% had prolonged ruptured membranes, 8% had an intrapartum pyrexia and
23% had more than one risk factor. Overall, 75% of the women with risk factors received
any antibiotic in labour with 59% overall receiving appropriate GBS prophylaxis (78% of
those women receiving any antibiotic). Of the remaining women who received any
antibiotic, 63% received an atypical antibiotic regimen and 37% received inadequate
therapy. Of the women who received no antibiotics, 60% were preterm, 28% had
prolonged ruptured membranes and 12% had an intrapartum pyrexia. Expressed as a
percentage of women with a given risk factor, 38% of women in preterm labour, 24% of
women with prolonged ruptured membranes and 38% of women with intrapartum pyrexia
did not receive antibiotics in labour.
Conclusions: Our clinical audit suggests that compliance with risk factor based GBS
prophylaxis is only modest (59%) in our institution, although 75% of at risk women receive
at least some antibiotics in labour. These data are similar to those reported elsewhere
and significantly poorer that previously reported compliance rates with bacteriological
screening programs. No particular risk factor was associated with better compliance than
others. Our audit would support recent international recommendations to resume
bacteriological screening for maternal GBS carriage.
P31
WHAT IS BEST PRACTICE IN THE NURSING MANAGEMENT OF NAPPY RASH?
Urquhart CC
Department of Neonatology, The Townsville Hospital, Queensland, Australia.
Aim: To identify the recommended management of non-fungal, non-bacterial nappy rash
and practice accordingly.
Methods: A problem of inconsistency in the treatment of nappy rash in the Neonatal Unit
was identified. In an effort to ensure that all staff are consistent in their management, and
following recommendations from evidence-based literature, we propose to introduce
uniform management. We then propose to assess that method of management in six
months time.
In the past, many and varied forms of treatment have been used for non-fungal, nonbacterial nappy rash. Some of these forms of management introduce added risks or
adverse effects, or even worsen the existing condition. What, then, is best practice in the
nursing management of nappy rash?
Results: According to the 21 articles reviewed there are several common
recommendations for both the prevention and treatment of nappy rash.

18 of the 21 articles recommend exposure to air, leaving the nappy off for extended
periods throughout the day. This is to reduce exposure to irritants and allow genitalia
and buttocks to “air” and dry.

15 articles recommend washing the baby’s bottom each nappy change, and 13 of
those 15 articles recommend that this be done with warm water only.

14 articles recommend the application of a barrier cream, 9 recommended the use of
a product containing Zinc Oxide.

9 articles discussed complications and/or medical intervention; more particularly,
some discussed infection with Candida Albicans. Overall, the common
recommendations were to seek medical opinion when:
-Condition no better (or worse) after 2 days of treatment.
-There is evidence of oral thrush
-The rash is scaly, yellowing or found in other than the nappy area.
-If blistering occurs.
-If the penis is red, swollen or has a discharge.
-If there is a fever.
-If the rash extends.
Recommendations:

That a policy be written according to the common recommendations in the literature
reviewed.

That the Neonatal Unit follow the written policy for the “Management of Nappy Rash”
and exclude all other “remedies”.

That the policy and outcomes be reviewed over a 6 month period.
Conclusions:
 The new policy for “Nursing Management Of Nappy Rash’ is now in practice.
 Staff are being inserviced to encourage uniformity of practice.
 Review of the policy is planned for April 2003.
P32
WORKLOAD PART 1: METHODS OF MEASURING WORKLOAD IN THE NICU:
WHICH METHOD BEST REFLECTS PRACTICE?
Spence K, Jayasuria N, Duncan G, Elliott J, King J, Tarnow-Mordi W, McCloskey J, Kite F
The Children’s Hospital at Westmead1 and The Westmead Hospital2, Sydney, NSW
Aim: Recent studies suggest that nursing workload is related to infant outcome. The aim
of our study was to identify a suitable method of measuring nursing workload and patient
needs of varying case mix in the NICU at a Children’s Hospital and a Perinatal Centre.
Method: A 5 month prospective study was undertaken in two NICUs. Bedside nurses
scored their patient’s dependency each shift using two tools. One was a UK based
prototype that estimated nursing hours required for 4 categories of dependency (Northern
Neonatal Network NNN-DT) and the other was a factorial type that estimated nursing
hours required for 7 components of care scored into 5 dependency levels (Patient
Dependency Tool PDS). Bedside nurses also scored their subjectivity perceived level of
intensity of care required by their patients using the PAONCIL tool, and how busy their
day had been using a five-point Likert scale. Daily bed occupancy, number of ventilated
patients and nurses’ experience in their current employment were also recorded.
Results: Three perspective of measuring nursing workload are reported for the NICUs in
two hospitals. Over the 5 month period there were 255 patients and 2483 patient days at
the Children’s Hospital and 149 patients and 698 patient days at the Perinatal Unit.
Unit perspective
Patient perspective
Nurse perspective
Measure per day
Bed occupancy
Ventilator beds
Average no. nurses
Average experience of nurse
No of nurses during study
No of shifts per nurse (median)
NNN-DT (nursing hours required)
PDS (nursing hours required)
PAONCIL (average intensity)
Busy (mode)
Children’s Hospital
83% (42-110)
24% (0-56)
23
2.56 yrs – 7.55 yrs
186
2 (IQR=33)
7.98 (SD 3.66)
14.19 (SD 6.55)
0.21 (SD 1.00)
3 (spread 1-5)
Perinatal Unit
74% (36-100)
42% (21-80)
22
3 yrs – 10.3 yrs
98
27.5 (IQR = 55.5)
9.32 (SD 3.61)
15.16 (SD 5.58)
0 (SD 1.00)
3 (spread 1-5)
Conclusion: The finding that the NNT-DT tool estimated only about half the hours of
nursing care were required compared with the PDS tool is consistent with actual
differences in recommended practice between the UK and Australia. In the UK
professional bodies recommend a ratio of two ventilated infants per nurse, but in Australia
one ventilated infant per nurse is recommended. Measuring workload from the nurses
perspective may be advantageous if this can capture otherwise hidden aspects of care
that alter perceived intensity. The use of bed occupancy and nursing staff numbers alone
does not reflect the different case mix and staff experience in workload measurements.
The finding that many relief nurses worked so few shifts in one unit is of concern. The
validity and reliability of these tools now needs to be tested by relating variations in
dependency and intensity of care with outcome.
P33
WORKLOAD PART 2: IS SEVERITY OF ILLNESS ASSOCIATED WITH NURSING
WORKLOAD IN THE NICU?
Spence K, Tarnow-Mordi W, Jayasuria N, Duncan G, Baird J, Halliday R, Peat J, Kite F,
King J, Elliott J, McClosky J, Richardson D
The Children’s Hospital at Westmead and The Westmead Hospital, Sydney, NSW
Background: Serial SNAP (Score for Neonatal Acute Physiology) scores have been
used to quantify cumulative severity of illness and as a measure of outcome for infants in
the NICU. We hypothesised that they may be a useful measure of nursing workload when
trying to match the demands of the sick infant with nursing resources.
Aim: To determine if serial SNAP scores are associated with nursing workload in the
NICU of both a Children’s Hospital and a Perinatal Centre.
Method: Serial SNAP scores were obtained either through daily computerised or manual
collection every 3rd day for all infants in the two NICUs for a five-month period from
September 2001- January 2002. These scores were correlated with workload using two
different patient dependency tools, the UK based NNN-DT (Northern Neonatal Network
Tool) and the Australian PDS (Patient Dependency Tool), both scored by the bedside
nurse at the end of each shift.
Results:
SNAP (average daily score)
SNAP / NNN-DT
(Pearson’scorrelation)
SNAP / PDS
(Pearson’s correlation)
Children’s Hospital
3.99 (1-7.35)
0.616 (R2 = 0.38)
Perinatal Unit
5.43 (SD 5.2)
0.089 (R2 = 0.00)
0.616 (R2 = 0.38)
0.286 (R2 = 0.008)
In one hospital there was moderate relationship between daily serial SNAP scores and
NNN-DT average daily nursing hours (R2=0.38) and between daily serial SNAP scores
and PDS average daily nursing hours (R2=0.38). However there was poor or no
relationship between the SNAP and the average daily nursing hours with either tool in the
Perinatal Unit.
Conclusion: With both nursing dependency tools in the Children’s Hospital, 38% of the
variability in nursing hours required for each patient can be explained by the patient’s
physiological instability. The remaining variability may be due to the patient’s behavioural
and support needs, such as feeding or wound and stoma care, which are not captured in
serial SNAP scores. The findings were not consistent between the two NICUs. Daily
SNAP scores might have been necessary to capture cumulative severity accurately in the
Perinatal Unit.
P34
EVALUATION OF THE AVL OMNI BLOOD GAS ANALYZER AGAINST LABORATORY
METHODS IN THE MEASUREMENT OF HAEMOBLOBIN AND HAEMATOCRIT
Feng YS, Yu VYH
Newborn Services, Monash Medical Centre, 246 Clayton Road, Victoria 3168, Australia
E-mail: susanysf@yahoo.com
Iatrogenic blood loss is a major cause for anaemia and blood transfusion requirements in
neonates requiring intensive care. The capability of the AVL-OMNI blood gas analyzer
(OMNI) for estimating blood gases, haemaglobin (Hb) and haematocrit (Hct) on the one
blood sample using the same volume of blood as for estimating blood gas alone, may
lead to a reduction in iatrogenic blood loss by obviating the need for additional laboratory
analysis.
Aims:
1.
To evaluate the accuracy of OMNI against standard laboratory techniques in
estimating Hb and Hct levels in neonates.
2.
To examine if the results are affected by the collecting methods.
Methods: 252 samples for blood gas analyses were collected from neonatal intensive
care unit (NICU) admissions, Monash Medical Centre, between January and November,
2002. Each sample was analysed with OMNI (0.25 ml) and by the laboratory (0.25 ml) for
Hb and Hct. Samples were divided into subgroups according to collection methods of
arterial (ART, n=100), venous (VEN, n=49) and capillary (CAP, n=103). Results were
collected prospectively and the Pearson product-moment correlation coefficients (r)
calculated using SPSS v10.0 for the entire group and for each subgroup.
Results: Correlation analyses of Hb and Hct from OMNI against laboratory results
showed r values of 0.956 (p<0.01) and 0.904 (p<0.01) respectively. There were no
significant differences in the r values between the subsets for Hb (ART v VEN v CAP,
0.972 v 0.977 v 0.919) and Hct (0.913 v 0.926 v 0.881).
Conclusions: The AVI-OMNI blood gas analyzer correlates well with laboratory
techniques in measuring Hb and Hct levels in neonates. These results are not affected by
collecting methods. Concurrent measurements of blood gases, Hb and Hct with the AVLOMNI could reduce the need for laboratory requests for Hb and Hct, and therefore reduce
iatrogenic blood loss in the NICU.
Fig. 1. Linear relationship of OMNI and laboratory Hb
measurements
Fig. 2. Linear relationship of OMNI and laboratory Hct
measurements
25
0.7
0.6
20
15
OMNI Hct
OMNI Hb g/dl
0.5
10
0.4
0.3
0.2
5
0.1
0
0
0
5
10
Lab Hb g/dl
15
20
25
0
0.1
0.2
0.3
0.4
Lab Hct
0.5
0.6
0.7
P35
AN AUDIT ON RED BLOOD CELL TRANSFUSION PRACTICE IN VERY LOW BIRTH
WEIGHT INFANTS
Feng YS, Yu VYH
Newborn Services,,Monash Medical Centre, 246 Clayton Road, Victoria 3168, Australia
E-mail: susanysf@yahoo.com
Red blood cell (RBC) transfusions are common in infants born 1500 grams (VLBW), but
their potential benefit must be balanced against the exposure risk to infective agents and
multiple donors.
Aims: Review RBC transfusion practice in VLBW infants who were also 32 weeks
gestation over a 11-month period to (1) identify factors associated with RBC transfusion
and (2) adherence to local guidelines.
Methods: Data including gestational age (GA), birth weight (BW), type of respiratory
support required, oxygen requirement, haemoglobin (Hb) and haematocrit (Hct) at birth
and at time of transfusion, and the indications for RBC transfusion were collected
prospectively over a period of 11 months. Infants of similar GA and BW not transfused
over the study period acted as control. Student t-test and Mann-Whitney rank sum test
(Sigmastat) were used for parametric and non-parametric analyses.
Results: Sixty seven VLBW infants were admitted to Newborn Services, Monash Medical
Centre, between January and November 2002. 38 infants received a total of 106 RBC
transfusions (Group A). 29 infants were not transfused (Group B, control). Group A was
more premature (median 27 weeks, 1st/3rd quartile 26/28 weeks) than group B (median 29
weeks, 1st/3rd quartile 29/31 weeks; p<0.001). BW in Group A was also lower (median
795 gm, 1st/3rd quartile 722/1093 gm vs. median 1232 gm, 1st/3rd quartile 1128/1415 gm;
p<0.001). Mean day 1 Hb and Hct in Group A were significantly lower (15.6 g/dl vs 17.2
g/dl; p=0.019 and 0.45 vs 0.49; p=0.034 respectively). Group A infants were more likely to
be on ventilatory support than controls (p<0.001). The mean age for RBC transfusion was
22.8 days with mean Hb and Hct of 10.3 g/dl and 0.3 respectively. Indications for RBC
transfusion were replacement of iatrogenic sampling loss (24%), suspected or fulminant
sepsis with respiratory deterioration including profound apneas and bradycardias or
increase in ventilation or oxygen requirement (26%), respiratory deterioration alone
(14%), sepsis alone (9%), and asymptomatic but fulfilling the Hb/Hct guideline for RBC
transfusion (26%). Five of the 29 control infants (17.2%) fulfilled the criteria for RBC
transfusion but were not transfused. No difference in short term morbidity was observed in
these infants.
Conclusion: The smallest, most premature, ventilator-dependent infants are at highest
risk of requiring RBC transfusion. No infant was transfused inappropriately against current
guidelines. This data could be used as baseline information to study the effects of a more
stringent approach to RBC transfusion.
P36
THE EFFECT OF A CHIN STRAP ON THE TRANSMISSION OF CPAP PRESSURE TO
THE PHARYNX IN PREMATURE NEWBORN INFANTS
Broadbent RS, LeRoy J, Baker JF
Section of Paediatrics, Department of Womens and Childrens Health, University of Otago,
Great King St, Dunedin, New Zealand
For nasal CPAP to be effective there must be transmission of the pressure from the nose
through to the larynx. Release of pressure from the pharynx and out through the mouth
will limit the effectiveness of CPAP. A pharyngeal pressure seal can perhaps be
optimised if the mouth is kept closed, and one way of achieving this is with a chin strap.
Aim: The aim was to measure the effect that a chin strap has on the transmission of
pressure from the nose through to the pharynx.
Method: Ten premature infants requiring CPAP but on minimal oxygen supplementation
were recruited after informed consent was obtained from their parents. An air filled
catheter size 8 French feeding catheter was introduced to the pharynx with the tip placed
just above the larynx and the other end attached to a pressure transducer. The CPAP
was supplied by an EME Flow Driver and the CPAP pressure measured through a
pressure transducer attached to the CPAP pressure line by a y arm. The flow rate of the
Flow Driver was adjusted prior to the commencement of the monitoring to deliver a CPAP
pressure of 5 cm H2O pressure and the flow rate was thereafter left unchanged. A
nonelastic chin strap was used and attached to the CPAP hat with elastoplast. Babies
were randomised to have the chin strap either first or second while being monitored for an
hour with the chin strap on and an hour with the chin strap off.
Results: The average pharyngeal pressure was higher (p < .05) with the chin strap on
(4.02 cm H2O) than with it off (2.52 cm H2O).
Pharyngeal pressure with chinstrap on and chinstrap off
6
Pharyngeal pressure (cmH20)
Chinstrap on
Chinstrap off
5
4
3
2
1
0
A
B
C
D
E
F
G
H
I
J
Babies
Conclusions: In premature infants a chin strap makes a significant difference to the
transmission of CPAP pressure to the pharynx and therefore to the lungs. Further
research is warranted to determine whether this leads to significantly improved clinical
outcomes.
P37
EQUIPMENT USED FOR NEONATAL RESUCITATION AT LEVEL 3 PERINATAL
CENTRES IN AUSTRALIA AND NEW ZEALAND
O’Donnell CPF, Davis PG, Morley CJ
Division of Neonatal Services, Royal Women’s Hospital, Melbourne, Australia.
Background: While the evidence for the optimal equipment that should be used for
neonatal resuscitation is not abundant, an internationally agreed consensus statement
exists which outlines the preferred equipment to be used at resuscitation. Most
resuscitation devices available, while anecdotally effective, have not been formally
evaluated. Recent studies suggest that infants can be effectively resuscitated with O 2
concentrations of less than 100%.
Aims: To establish what equipment is used for neonatal resuscitation at level 3 perinatal
centres in Australia and New Zealand
Methods: A postal questionnaire was sent to a neonatologist at each of the 29 level 3
centres in Australia and New Zealand. Four of these centres do not have on-site
deliveries. The questionnaire detailed the type of equipment used at neonatal
resuscitations. If it was not returned, follow-up was conducted by e-mail and telephone.
Results:
Face masks: All units routinely use round silicone face masks. Anatomically shaped
masks are in use at three centres (10%), and then only occasionally in two of these.
Infant resuscitators: The Laerdal Infant Resuscitator (240mL) self-inflating bag is the
most commonly used device - used in 22/29 (76%) centres, used at >75% of
resuscitations in 17 (59%), used exclusively in 6 (21%).
Anaesthesia bags are used widely - used in 12 (41%), occasionally in 7 (24%) and
exclusively in 5 (17%).
The Neopuff device (Fisher & Paykel, NZ) is used widely - used in 14/29 (48%), at >75%
of resuscitations in 3/29 (10%) and exclusively in 1/29 (3%).
Endotracheal tubes: Straight endotracheal tubes are used exclusively in 23/29 (79%).
Shouldered (Coles) endotracheal tubes are used infrequently 3 of the 6 centres that use
them.
Oxygen blenders: While most centres provide varying oxygen concentrations for
resuscitation in the NICU setting, only 6/25 (24%) do so in the delivery room or operating
theatre.
Conclusions: The equipment used for resuscitation of the newborn varies. Round face
masks are used predominantly. The Laerdal Infant Resuscitator is the most widely used
device though it has been previously demonstrated to be of questionable efficacy.
Anaesthesia bags are widely used though concerns regarding their efficacy, particularly in
relatively inexperienced hands, have been expressed. Newer resuscitation devices are in
widespread use despite a lack of evidence for their efficacy. The majority of babies are
resuscitated using 100% O2 immediately at birth. Further research is necessary to assess
which devices are preferable for the resuscitation of the newborn.
P38
SALIVARY CORTISOL AS A CLINICAL MEASURE OF STRESS
Harrison D 2, Spence K 1, Gillies D 1, Johnston L 2, Nagy S 1
1. Department of Neonatology, The Children’s Hospital at Westmead, NSW 2145 and The
University of Western Sydney
2. Department of Neonatology, Royal Children’s Hospital & Murdoch Children’s Research
Institute, Melbourne, 3052
Aims: To determine if the collection of salivary cortisol samples is a useful clinical tool for
validating a pain assessment tool.
Methods: Design: A prospective correlational study undertaken in two neonatal intensive
care units within two specialist children’s hospitals in Australia. Data collection comprised
observations of infants for a 20-minute period, in which time observations of noise, light
and activity levels around the infant’s bedside, and the infant’s behavioural states were
documented. Other demographic data collected included details of previous surgery,
analgesic agents, and procedures occurring in the four hours prior to data collection.
Following the 20-minute observation period the data collectors recorded the infant’s pain
score using the Pain Assessment Tool (PAT). Saliva samples were then taken from the
infant using a three mL syringe attached to a shortened size 8 FG feeding tube. Saliva
was collected from the infant’s mouth, inside the cheek and under the tongue. Saliva
collected was immediately stored at 4O C. Samples that needed to be stored for longer
than one week before testing were stored at minus 20O C. The Salimetrics HS-Cortisol kit
was used to measure salivary cortisol (Salimetrics, LLC, PA, USA).
Results: One hundred and forty four infants were enrolled into the study. The mean age
on day of study was 20 days ±25 (SD) and the mean gestational age was 36 weeks ± 4
(SD) weeks. Forty-eight infants (33%) were ventilated and 84 (58%) had undergone
surgery. Sufficient salivary cortisol samples were only able to be collected for 50 infants
(35%). The mean salivary cortisol level was 0.92 ± 0.86 (SD) g/dL. There was a low
correlation between salivary cortisol levels and PAT scores (r = -0.186). There was also
low correlation between salivary cortisol levels and number of procedures within the
previous four hours (r =- 0.16), and levels of noise (r = 0.05), light (r= 0.06), and activity (r
= 0.11). In addition, there was low correlation between salivary cortisol and time since
most recent surgery (r = 0.27), and administration of intravenous opiods (r = -0.14). Mean
cortisol levels were significantly higher, at 1.16 g/dL (SEM=0.19) in those infants who
had been fed within the previous hour compared to 0.59 g/dL (SEM=0.09) for infants not
fed within the previous hour. This difference was significant P= 0.019 (equal variances
assumed).
Conclusion: Salivary cortisol was unable to be utilised in this validation study of the PAT
due to likely milk contamination of the samples that were collected and due to difficulties
in collecting adequate volumes of saliva for assay from the majority of infants. If further
studies of salivary cortisol are to be undertaken, the method of collection needs to be
substantially revised.
P39
MEETING THE ‘REAL’ EDUCATIONAL AND SUPPORT NEEDS OF THE NEONATAL
NURSING TEAM…RECREATING THE EDUCATION TEAM
Kain VJ, Little SAF
Neonatal Intensive Care Unit (NICU) and Special Care Nursery (SCN).
Mercy Hospital for Women, East Melbourne, Victoria, 3002.
Email: vkain@mercy.com.au, slittle@mercy.com.au
Aims: Surveys of our nursing staff highlighted that ongoing education and professional
development were pivotal issues when addressing retention and recruitment of nursing
staff in our Nurseries. We strongly believe that our nursing team are the consumers of
education, therefore we need to ensure that we were able to ascertain their real
educational and support needs. A situational analysis of our former education structure
highlighted a number of inadequacies and so the nursing management and education
teams combined in order to better address retention of our nursing population and
ongoing recruitment to ensure our future. A proposal was created to redevelop a new
style of Education Team for our Nurseries
Method: It was clearly evident that there was a need for more clinical support for both
the increasing numbers of learners in the area and the established staff in terms of
professional development and clinical support. This lead to the development of the
unique role of Clinical Support Nurse (CSN). The CSN’s would be responsible for the
provision of clinical teaching and support at the bedside. We also required additional
Nurse Educator (NE) hours to coordinate and facilitate program and course development,
as well as address the team’s professional development needs. The establishment of the
CSN and additional NE roles comprised the new Education Team. The methodology was
to create the new roles with basic position descriptions (PD). Once the appointments had
been made, the incumbents then worked toward the development of more robust PD’s
with clearly defined Key Performance Indicators. To do this the new education team
surveyed the neonatal nursing staff to ensure that they participated in the design of the
new education team.
Results: Six months after implementing the new Education Team, the NICU and SCN
have found that we are better able to address the needs of our learners and established
staff. We are experiencing an increasing number of applicants who claim to be attracted
to our nurseries because of our reputation of commitment to providing exemplary
orientation programs and individualised and flexible supernumerary time with CSN
support. Our established staff experience increased support in their roles as Preceptors
and clinicians. The development of two NE roles with portfolios in Professional
Development and Courses, and Program Coordination ensure that the ongoing needs of
all staff are continually met. The establishment of a Professional Development Manager
at an organisational level provides ongoing support and leadership to the NE’s within the
Nursery setting.
Conclusions: By conferring with our nursing staff, and with management support, we
have increased our education personnel from 1.4 EFT to 3.5 EFT. This commitment to
education has clearly begun to address both the recruitment of nursing staff to our
Nurseries and the equally pertinent issue of nursing retention within the area. We believe
that the recreation of the Education Team and our investment in education has yielded
many rewards.
P40
THE ‘ZERO LIFT’ NEONATAL RETRIEVAL SYSTEM
Grant-Thomson JC, Douglas, AK, Hilton, J
University of Southern Queensland, Toowoomba, Queensland, Australia.
Aims: Traditionally Neonatal Retrieval Systems vary to such an extent that they are not
compatible with one another and they are physically large, heavy and difficult to
manoeuvre. The aim of this work was to design and develop a light-weight Neonatal
Retrieval System which could be loaded and unloaded with ‘zero lifting’ effort on the part
of the operator. In addition, the system is to be transported by road and air in all States of
Australia.
Methods: Accomplishment of such a task required the co-operation and assistance of
Neonatologists, Nursing personnel, Paramedics, Ambulance and Emergency personnel
throughout Australia.
Objective information derived from these personnel through
surveys and meetings, facilitated the development of a generic specification which,
through an iterative process, resulted in a prototype Neonatal Retrieval System being
constructed. Several of these systems were then trialled in the clinical environment
including hospitals, road ambulances, helicopters and the Royal Flying Doctor Service.
Results:
Each prototype Neonatal Retrieval System comprised a very light weight
heated capsule interfaced to an equipment sled containing monitoring and resuscitation
equipment, perfusion pumps and electric suction together with oxygen and power
management systems. The whole ensemble weighing only 85kg was supported by a
variable height electrically powered undercarriage. Prototype Neonatal Retrieval Systems
were installed at various times in The Royal Women’s and The Mater Hospitals in
Brisbane and The Townsville Hospital. Trials were effected in Queensland Ambulance
Service road ambulances, The Queensland Emergency Services helicopter and with the
Royal Flying Doctor Service B200 and C90 fixed wing aircraft. During these trials, over
120 retrievals were conducted in a nine months period. All retrievals were documented
and analysed post event which assisted with fine tuning the system.
Conclusions: The project has achieved its aims as this Neonatal Retrieval System has
no boundaries and for the first time in Australia retrievals between States with no
equipment incompatibility problems are a reality. The unique ‘zero lift’ powered
undercarriage has revolutionised the loading and unloading process thus minimising the
risk of back injuries identified as a major problem with most existing systems.
P41
WEANING INFANTS FROM INCUBATORS TO COTS – WHAT IS A REASONABLE
WEIGHT TO AIM FOR?
West CR1, Harris G2, Weston PJ2
1
Newborn Services, National Women’s Hospital, Claude Rd, Auckland, New Zealand
2
Neonatal Intensive Care Unit, Waikato Hospital, Pembroke St, Hamilton, New Zealand
Background: Thermoregulation is important in premature infants as exposure to cold
environments and subsequently lowered body temperatures are closely correlated with
reduced survival. There is some research to indicate that infants can be transferred to
cots at weights of approximately 1500g. In our NICU it has been protocol to leave infants
in their incubators until they reach a minimum weight of 1800g.
Aim: To determine the safety of early transfer of infants from incubators to cots.
Methods: We established a protocol to reduce the weight of transfer in a step-wise
fashion aiming at decreasing the weight needed for transfer from our current 1800g down
to 1500g in stable, self-ventilating infants. Infant weight gains for 5 – 8 days before and
after transfer were analysed. Temperatures outside the acceptable range (36.7 – 37.1 oC)
for the 48 hours after transfer into the cot were analysed.
Results: We report here our experience for infants removed from their cots at 1800g (15
infants), 1700g (16 infants) and 1600g (6 infants at the time of abstract submission). One
infant, transferred at 1707g failed to maintain their temperature and were returned to their
incubator. Four days later at a weight of 1849g they made a successful transition to a cot.
All other consented infants eligible for the research protocol were successful in their
transition from incubator to cot.
The main results are shown in the table below.
Weight
fort
transfe
r
Median
gestatio
n
(weeks)
1800g
30
(N
=
15)
1700g
28
(N
=
16)
1600g
32
(N = 6)
Median
birthwei
ght
(grams)
Median
wt
at
transfer
(grams)
Median wt
increase
before
transfer
(g/kg/d)
17.6
Median
wt
increase
after
transfer
(g/kg/d)
16.9
Median
no
of
low
temp
after
transfer
0
Median
no
of
high
temp
after
transfer
3
1140
1820
1027
1712
17.4
17.1
0
2
1330
1636
20.2
19.6
0
3
Conclusion: Results indicate that moving stable, self-ventilating infants into cots may be
achieved for most infants at a weight of 1700g. Preliminary results are promising for the
same to be said for infants transferred at 1600g.