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NICU design of tomorrow: Ways of implementing a NICU design for family-centred care using the example of Offenburg, Germany

2024-05-14

A guest article by Kathrin Litterst, paediatric intensive care nurse, Ortenau Klinikum Offenburg-Kehl © Kathrin Litterst   Idea In order to ensure the best possible care for preterm babies and newborns, an individual, development-promoting and family-orientated form of care, such as FINE and NIDCAP, is required. This also means that it must be possible for parents to be with their child all the time.  When the decision was made in 2017 to merge smaller clinics into a new, modern central clinic as part of the clinic structure reform in Offenburg, the interest of the neonatology staff was aroused and their hopes were high that special structural features with a forward-looking family-centred approach could be implemented.    © LUDES Architekten München / Ortenau Klinikum Offenburg   Implementation steps and their challenges  The initial design plans of the architect and specialist planner did not fulfill these expectations.  There was a constructive and intensive dialogue with architects, specialist planners, and people from the bedside staff, who were able to implement the structural requirements for zero separation in the plans in just 6 weeks without changing the floor plan.    Result: Implementation of “Zero Separation” from birth There is now sufficient space in the delivery rooms and in the Caesarean section operating room for initial care on the intact umbilical cord. There is also space for an adult bed for early bonding in the primary care room. A wall-to-wall solution means that the delivery rooms are right next to the neonatology department.  Couplet care units, based on examples from Sweden, are planned for the neonatology department. These are divided into a maternity room and a NICU room, which are connected by a large sliding door. This allows for privacy, if needed, and, on the other hand, the greatest possible closeness.   With a bed or comfortable armchair, parents are invited to do Kangaroo Mother Care (KMC) at their child’s bedside.   A cosy atmosphere is designed to promote the well-being of parents and encourage them to stay at their child’s bedside for longer.   In so-called family rooms, the medical equipment is located in the cupboard, following the example of the Children’s Hospital Dritter Orden Passau, Germany (see Lighthouse project NICU design: Children’s Hospital Dritter Orden). Here, parents have the opportunity to grow together as a family, experience their self-efficacy and live together with their child until they are discharged.  The cosy atmosphere with invisible medical monitoring reduces anxiety, provides security and trust, and makes it easier to go home.     all pictures © LUDES Architekten München / Ortenau Klinikum Offenburg   Recommendations  There should always be a planning phase 0 after a decision to build or remodel a NICU is made.  A project team should be set up that consists not only of managers, but also includes the expertise of employees from the bedside as well as parents/parents’ associations.  Visits to other clinics that have already implemented similar projects are helpful. The expertise of these departments represents a value that should not be underestimated for your own planning.  Even if not everything goes perfectly at first, you can achieve your goals with a lot of commitment and perseverance. 

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ESCNH information brochure is now available in Hungarian

2024-04-24

We are delighted to share that the information brochure about the European Standards of Care for Newborn Health (ESCNH) is now also available in Hungarian! Translating the brochure into Hungarian is an essential step in enhancing accessibility to the ESCNH for healthcare professionals, parents, and policymakers across Hungary, thereby facilitating progress in the implementation process. EFCNI would like to thank BT (British Telecommunication), for providing the Hungarian translation of the information brochure, and Professor Dr Ertl Tibor for his great expertise in proofreading the translation. A very special thanks goes to Lívia Nagy Bonnard, founding member of our partner parent organisation “Melletted a helyem – Egyesület a koraszülött ellátásért“ (in English: “Right(s) Beside You – Association for the care of preterm infants”), who has coordinated and supported the entire translation process. Lívia is not only an Ambassador of the ESCNH, actively supporting the implementation of the standards across Hungary and beyond, but also a member of the Parent, Patient, and Public Advisory Board of the ESCNH. The information brochure is currently available in English, Bulgarian, German, Greek, Hungarian, Portuguese, Romanian and Ukrainian. You can download these, and other materials, at: https://newborn-health-standards.org/downloads/ Download your copy in Hungarian! © EFCNI

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Same shot, same schedule: Vaccination equality for preterm and full-term infants

2024-04-25

Despite being widely recommended, immunisation of preterm infants is frequently delayed, exposing this vulnerable group to various preventable diseases. The review article “An update on vaccination in preterm infants” by Lillian de Santos Rodrigues Sadeck and Renato de Ávila Kfouri delves into recent research on vaccine safety, effectiveness, and immunogenicity in preterm infants, shining a light on the importance of timely vaccination.    Preterm infants more at risk for preventable illnesses Compared to full-term infants, preterm infants face increased susceptibility to morbidity and mortality caused by vaccine-preventable diseases. This heightened vulnerability is primarily linked to their underdeveloped immune system, which has not fully matured yet and is not fully functional. Additionally, the transfer of maternal antibodies through the placenta begins around the 17th to 18th week of gestation, gradually increasing and reaching peak levels with greater gestational age at birth. Consequently, antibody levels are lower in preterm infants, leaving them more vulnerable to infections.  Prolonged hospitalisation in the Neonatal Intensive Care Unit (NICU) poses additional risks. Infants are exposed to resistant pathogens and administered broad-spectrum antibiotics or steroids. Additionally, they often experience a lack of breastfeeding and disruption of protective barriers due to invasive medical procedures. Reasons for delayed vaccinations  Research indicates that preterm infants frequently encounter delays in their vaccination schedules, particularly those with lower gestational age and birth weight. These delays stem from concerns surrounding their vulnerability and the development of their immune system as well as apprehensions regarding vaccine safety. This highlights a gap in understanding vaccine safety and effectiveness among healthcare providers and parents, often driven by fear of adverse reactions. While preterm infants may exhibit higher rates of post-vaccination fever and cardiorespiratory events compared to full-term infants, these effects are typically temporary and mild, with no lasting clinical impact. Immunisation just as safe for preterm infants  Several studies have indicated that preterm infants generate an adequate immune response, according to their chronological age, as recommended, for instance by the German Standing Committee on Vaccination (“Ständige Impfkommission” in German, abbreviated as STIKO) and by the American Academy of Pediatrics Committee on Infectious Diseases. While their initial antibody responses may be lower than those of full-term infants, when vaccinated according to chronological age, most reach protective antibody concentrations. Provided they are clinically stable and there are no contraindications, preterm infants should receive vaccines according to the schedule recommended for full-term infants and based on their chronological age.  Given that preterm infants tolerate vaccination well and exhibit protective immune responses, studies have shown that preterm infants undergo unjustified delays in their vaccination schedule. To address this, several actions are necessary: evidence-based education for healthcare professionals,   widespread dissemination in lay-friendly formats for parents and caregivers,  improved access to immunisation, and  administration of vaccines prior to NICU discharge. Education initiatives should stress the importance of chronological age, alongside clinical conditions, in commencing the immunisation process.  Paper available at: https://pubmed.ncbi.nlm.nih.gov/36608935/   Full list of authors: Lilian dos Santos Rodrigues Sadeck, Renato de Ávila Kfouri.  DOI: 10.1016  Keywords: #PretermBirth #FollowUp #ESCNH #ResearchNews 

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