Evidence-Based Practice Essay.

A health care facility has many departments to meet the varying health needs of the clients. The Neonatal Intensive Care Unit (NICU) is a part of maternity where babies are born with health critical health conditions. Low birth weight is a high-risk health situation that needs intensive medical attention. The babies transit from growth in the uterus and the outside world requires strong immunity. Neonates with low birth weight have compromised immunity that puts them at risk of infections and other complications. Preterm babies and those with low birth weight are nursed from NICU until they acquire the minimum weight required by age (Mank et al., 2016). The purpose of this essay is to establish clinical challenges encountered in the NICU. The Knowledge in the paper is essential for nurses to understand the effectiveness of skin-to-skin contact and conventional care for low birth weight neonates.Evidence-Based Practice Essay.

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Clinical Practice Problem- Hypothermia

Low birth weight and preterm babies have health risks related to their nutritional status. A neonate is said to have hypothermia when their temperature drops below 36.5 °C (97.7 °F). The human body losses heat to the environment through various methods including, conduction, convection, and evaporation. However, loss of heat in neonates varies depending on various factors, thus the risk of hyperthermia is determined by personal characteristics. Preterm and underweight neonates have a large surface area to volume ratio, poor muscle tone, and limited subcutaneous fats (Mank et al., 2016). Those characteristics make it easier for them to lose heat to the surrounding environment. Unfortunately, they have insufficient brown fat stores that are required to generate heat. Thus, preterm and low birth weight neonates are at higher risk of hypothermia than other babies.Evidence-Based Practice Essay.

PICO Question

Various medical interventions are applied in the NICU to correct hypothermia. The broad classification of the interventions used is heat loss barriers and external sources of heat. Heat loss barriers help the neonate preserve the little heat produced by the body examples of the same include, wraps, and head covering (Li et al., 2016). External sources of heat include skin-to-skin care, thermal mattress, and routine care. Both the interventions are applied to evidence based principle with effectiveness in previous applications. Whoever, a clinical question may arise on which intervention is better than the other. Thus the PICO question, in that case, would be; In low-birth-weight/pre-term neonates in health facilities (P), is skin to skin contact immediately after birth (I) more effective than conventional care (C) in preventing hypothermia (O)?Evidence-Based Practice Essay.

Article Selection

McCall, E. M., Alderdice, F., Halliday, H. L., Vohra, S., & Johnston, L. (2018). Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database of Systematic Reviews, (2).Evidence-Based Practice Essay.

Background of the Research

Keeping preterm babies warm is challenging and more so during resuscitation. According to the World Health Organization, a child is said to have hyperthermia when they have a skin temperature below 36 ᵒ C or core body temperature below 36.5 ᵒ C. Hypothermia remains a challenge across the globe and climates despite the resource status of the setting. According to the study, the prevalence rate of hypothermia is high among neonates with low birth weights (22.1% of 501 to 750 grams) and premature infants (26.2% at < 24 weeks’ gestation). During the first 12 hours of life, the human body does not carry out the hemostasis process of balance heat loss and heat gain with the response to changes in the surrounding environment.Evidence-Based Practice Essay. Therefore, thermal regulation in infants largely depends on protective measures against exposure to cold. Cold stress is essential in initiating breathing and protecting the asphyxiated brain (McCall et al., 2018). However, prolonged exposure to cold and more so to the preterm infants increases the risk of hypothermia. Poorly managed hypothermia causes complications like delayed readjustment from fetal to newborn circulation, necrotizing enterocolitis, acute renal failure, metabolic acidosis, coagulation defects, intraventricular hemorrhage, chronic lung disease, late-onset sepsis, hypoxia, and death. Therefore, nurses ensure hypothermia does not occur to neonates and correct it urgently when a diagnosis of the same is made.Evidence-Based Practice Essay.

Research Methodology

The study employed randomized or quasi‐randomized allocation to evaluate the effectiveness of identified interventions used to prevent hypothermia during the first hours of life. The inclusion criteria were preterm infants born before 36 weeks of gestation and those born with less than 2500grams who received interventions to prevent hypothermia within 10 minutes after birth in the delivery room (McCall et al., 2018). The study is a systematic review of other studies that employed randomized control trials and used Cochrane Neonatal methods during data collection and analysis. The study has no stated ethical consideration; however, it was submitted to the Cochrane library for review.Evidence-Based Practice Essay. The paper has a high-quality rating since it involves the analysis of other peer-reviewed articles. The result indicated that plastic wraps or bags have a higher heat preservation effect than routine care. In conclusion, plastic wraps are more effective than routine care in the prevention of hypothermia in premature and low-birth-weight neonates.Evidence-Based Practice Essay.

Article Two

Hypothermia in Neonates by Robert L. Stavis, PhD, MD

Last full review/revision Jul 2019| Content last modified Jul 2019

Background Information

According to The World Health Organization, a hypothermic state is when core temperature < 36.5° C (97.7° F).  Hypothermia increases the risk of morbidity and mortality in premature infants. Hypothermia could be caused by environmental factors or represent an illness like sepsis. Healthcare workers should maintain the recommended environmental temperature in the delivery room to prevent neonatal hypothermia.Evidence-Based Practice Essay. Hypothermia should be corrected immediately and an assessment is done to determine the possibility of an underlying condition (Robert, 2019). The article is based on expert opinion thus has unfiltered information. The paper has no rating since it was published for consumer education rather than scholars’ use. The author’s recommendation includes admission of hypothermic infants in the NICU, maintaining recommended temperatures with the delivery room, drying and swaddling babies immediately after birth, and neonates exposed to resuscitation should be placed under radiant warmer to prevent heat loss.Evidence-Based Practice Essay.

Involvement of Key Stakeholders

Key stakeholders in prevention and treatment include NICU nurses, midwives, and their assistants, mothers, and other healthcare workers working in the department. The core responsibilities include regulation on room temperature in the delivery room or operating room for mothers undergoing cesarean section (Caldas  et al., 2018). The other responsibility is effective communication from the midwife to the assistant to wipe the baby immediately and wrap them warmly before placing them in a resuscitaire. NICU nurses should ensure that babies are kept in warm incubators while still admitted to the unit. Mothers should learn to dress their babies warmly throughout and practicing kangaroo mother care. Evidence-Based Practice Essay.

Barriers in Implementing the Changes 

The main barrier in most health care settings that requires intensive care is staff shortages. The ratio of nurses to the patient in a department like the NICU where preterm and underweight neonates are admitted should be 1:1. That ratio allows optimum care to the infant where the nurse can observe even the slightest change in temperature or the general health status of the child (Caldas et al., 2016). However, there are many cases of shortages due to various factors including lack of qualified personnel and human resource department organization. Evidence-Based Practice Essay.The other barrier is the lack of proper equipment required to regulate room temperature or even warm the baby directly like the thermal mattresses. The other challenge is inadequate information on a measure to prevent and control hypothermia and more so among mothers to preterm and underweight babies. Poor coordination and communication among healthcare workers is also a challenge in meeting the recommendation of preventing hypothermia among the group at risk.Evidence-Based Practice Essay.

Strategies to Overcome the Barriers   

Strategies to overcome the barriers of prevention and control hypothermia should be a collective responsibility of all the stakeholders. Thus the goals of the same should include adequate education on the issues and more so the mothers since it might be something new to them. Knowing is one step towards implementing the same. Facilities should ensure that their nurses are trained to obtain the skills required in a NICU setting (Caldas et al., 2016). The hospital should also ensure the effective distribution of staff among all departments to reduce shortages and burnout among the healthcare workers in the labor-intensive units.Evidence-Based Practice Essay.

Collusion

Hypothermia is a health status when the individual has skin temperature below 36 ᵒ C or core temperature below 36.5ᵒ C. Preterm and low-birth-weight babies are at higher risk of developing hypothermia due to low energy production. Various measures are applied to prevent hypothermia which either reduces heat loss or provides warms to the neonate. Some methods more effective than others thus, they are highly recommended. However, there are barriers to the prevention and control of hypothermia. It is the responsibility of all the stakeholders to overcome the barriers to ensure neonates at risk do not suffer from the same.Evidence-Based Practice Essay.