Olmsted syndrome is a rare and complex skin disorder affecting 46 (published) infants as of 2012. The infants affected in this case were born premature at 28 weeks' gestation. Infants affected by this syndrome demonstrate numerous plaques on several specific areas of the skin. Common treatments include exfoliation in addition to psoriasis treatments. The extremely fragile nature of the premature infants' skin complicates treatment modalities. The progression of the infants' dermatologic findings and plaque formation is discussed in this case study. The primary diagnosis of Olmsted syndrome was made with the assistance of a multidisciplinary team to work through several differential diagnoses presenting with severe forms of palmoplantar keratoderma. The management of skin plaques in twin premature infants is presented in this case study. An evidence-based approach, utilizing the model of family-centered care, is presented with multidisciplinary involvement and an outline of the specific plan of care for the extensive skin care regimen used. An interdisciplinary skin care regimen was created to provide consistency in transition from hospital to home. Using a consistent approach, the plaques were able to be softened and many removed. Continual maintenance is required to manage continual buildup of skin plaques. Premature infants are at increased risk for infection due to the immaturity of their skin. The complexity of their skin complicates the ability to recognize and care for rare skin disorders. This case study illuminates the practicality of a consistent and evidence-based approach to a complex and rare skin disorder.

Advances in Neonatal Care: June 2021 - Volume 21 - Issue 3 - p E43 doi: 10.1097/ANC.0000000000000871

Reported benefits of virtual programs include user satisfaction and feasibility to train nurses to utilize pain scales. However, the effectiveness of the virtual neonatal pain management program on nurses' knowledge and scoring skill acquisition has not been examined. This study developed a comprehensive virtual program on neonatal pain management and examined its effectiveness on nurses' knowledge and skill acquisition of selected pain scales. Evidence-based content was designed as a virtual program and pre-and posttests to examine skill and knowledge acquisition were developed and validated. Analysis of covariance was used to assess the differences from pre- to posttest based on the intensity of participants' involvement while examining the overall effectiveness of the program. A total of 115 nurses representing 7 hospitals completed the virtual neonatal pain management program, and 52 nurses completed the posttest. The Student paired t test showed an increase in posttest scores from pretest scores among participants. Participants' final degrees and years of experience were not related to posttest scores. The analysis of covariance showed that the high study group had a significantly higher amount of change in total scores and pain measurement skill scores than the low study group on the posttest. The virtually delivered neonatal pain management program can be useful for nurses' attainment of knowledge and skills for managing neonatal pain, including an appropriate use of selected scoring tools. It is necessary to examine how organizational unit attendance rate for e-learning and posttest results are related to patient outcomes. https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=46.

Parent involvement in neonatal care is beneficial to families and infant outcomes. Few studies have explored parental experiences of neonatal therapy participation. This study had 2 purposes: (1) to explore parental attitudes and beliefs about participating in neonatal therapies and (2) to identify barriers and facilitators to parental involvement and suggest ways to optimize neonatal therapy services. The study design and data analysis were informed by constructivist grounded theory methods. Semistructured telephone interviews were conducted with 9 mothers of children who had received neonatal therapy. After an early period of fear and powerlessness, a transition point occurred where the survival of their infant became more certain and parents were able to consider the future. At this point, participation in therapies was perceived to be more relevant. Therapy participation was experienced as a means of regaining autonomy and control in a context of trauma, but parents encountered barriers related to accessing therapists and external demands on their time. Parental participation is best facilitated by frequent and flexible access to neonatal therapists and staffing levels should reflect this. On commencing therapy, parents should be given therapists' contact details to maximize opportunities for face-to-face encounters. Future research is needed to explore parental readiness to participate in therapies in the neonatal intensive care unit. Research exploring the impact of parental involvement in therapies over a longer time frame would be beneficial. Finally, there is a need to determine efficacy and effectiveness of parent-delivered neonatal therapies.

Traditional medication-based management of neonatal abstinence syndrome (NAS) results in long hospitalizations. Nonpharmacologic treatment and using the Eat, Sleep, Console (ESC) model of care have been shown to decrease lengths of stay (LOSs). To determine whether using the ESC model of care to treat infants with opioid withdrawal resulted in decreased LOSs and number of infants receiving morphine when compared with traditional medication management. Retrospective medical review for all patients admitted for NAS 12 months before and 12 months after implementing the ESC model of care. Data collected from electronic health records included demographic data, maternal history, infant LOS, infants receiving morphine, and birth weight/weight on day of life (DOL) 5. Univariate analysis was used to control for demographic data/risk factors. A 2-samples t test was used to compare average LOSs. Chi-square test was used to detect differences in the number of infants receiving morphine. Data were analyzed using SAS 9.4 software. LOS decreased from mean of 17.7 days to a mean of 5.9 days (P < .0001). The number of infants receiving morphine decreased from 20 (58.9%) to 1 (2.7%) (P < .0001). No statistically significant difference was noted in the percentage of weight loss on DOL 5. Data showed an increase in breastfeeding rates from 41.18% to 64.86% (P = .0456). The ESC model of care decreased infant LOS and the number of morphine doses administered for opioid withdrawal symptoms. Maternal breastfeeding rates increased. More research is needed to determine long-term neurodevelopmental outcomes of infants managed using ESC principles.

Advances in Neonatal Care: February 2021 - Volume 21 - Issue 1 - p E1 doi: 10.1097/ANC.0000000000000842

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied. To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift. Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models. NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001). Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress. Strategies are needed for reducing stress in NICU nurses who work night shift.

Advances in Neonatal Care: December 2020 - Volume 20 - Issue 6 - p E100-E101 doi: 10.1097/ANC.0000000000000813