Conference Schedule: Friday, October 13
7:45 am - 8:45 am
Roundtable Breakfast Forum on Health Policy and Advocacy (HPAR) CE: 1
The Health Policy and Advocacy Committee (HPAC) extends an invitation to all conference attendees to expand their knowledge, skills, and influence beyond the NICU and into the public policy arena. Join the HPAC co-chairs for a forum discussion to learn more about the hot topics in legislative policy and strategies for advocating for our patients, their families, and our profession.
1. Identify strategies for engaging in advocacy at the legislative level.
2. Identify two current hot topics related to neonatal nursing.
Roundtable Breakfast Forum New NNP (NNPR) CE: 1
Network with other neonatal nurse practitioners (NNPs) and discuss issues and concerns that you face in your clinical practice.
1. Examine competency statements as they apply to the clinical practice and professional role development of the new NNP.
2. Define a role for the mentor and discuss examples of mentoring opportunities between new and experienced NNPs that would help the new NNP experience a sense of integration and continuing development.
3. Discuss the challenges and opportunities of transitioning to the advanced practice role.
Special Interest Groups Networking Breakfast SIG CE: 1
NANN's Special Interest Groups (SIGs) gather to network and discuss problems in their area of interest and offer solutions as a group.
1. Describe priority issues for your area of interest.
2. Discuss possible creative solutions to these problems.
Special Interest Groups include:
Advanced Practice SIG (S01)
Research SIG (S05)
Eduation SIG (S02)
Staff Nurse SIG (S06)
Management SIG (S03)
Surgical Neonate SIG (S07)
NNP Faculty SIG (S04)
Discharge Transitioning SIG (S08)
9:00 am - 10:00 am
Head Over Heels - 10 Toes are Great, But the Examination of the Neonatal Head can be Instrumental to Physical Assessment (401) CE: 1
Roxanne Stahl, APRN MS NNP
Clinicians perform a thorough physical examination of infants shortly after birth to look at physical characteristics which determine overall health. Many problems can be identified, corrected and prevent further disability. Clusters of abnormal findings may indicate syndromes. This lecture will provide opportunities to apply anatomy/pathophysiology of the neonatal Head, Ears, Eyes & Throat (HEENT) system(s) related to Case Studies and several real life clinical problems in the Nursery/NICU. Clinicians will be able to move through a clinical neonatal problem, delve into its corresponding anatomy, pathology and physiology and arrive at a diagnosis. Medications will be discussed as we move through the case study.
1. Explore dysmorphology and pathophysiology related to the head, ear, eyes, nose, and throat (HEENT) in the neonate.
2. List malformations of the ears that can be seen at birth and recognize their associatedgenetic syndromes.
3. Discuss nasolacrimal duct obstruction and apply pathophysiology to clinical presentation in the newborn period.
4. Apply pathophysiology of cleft lip and palate to challenges of ventilation and feedings in the newborn.
Rationing and Caregiving Decision-Making -- How Do They Affect Neonatal Outcomes? (403) CE: 1
Jacqueline McGrath, FAAN PhD RN FNAP
Co-Author: Haifa Abou Samra, PhD RNC
For optimal care of premature and sick infants, a highly skilled nursing team is required. Evidence exists that nursing interventions in neonatal intensive care unit (NICU) are highly rationed because of limited nursing resources, staffing constraints and non-supportive work environments. How nurses prioritize nursing interventions is an important phenomenon that needs to be considered when examining nursing workloads and neonatal outcomes. Understanding how and what affects nursing decision-making in NICU has the potental to decrease adverse patient outcomes such as increased morbidity, mortality, and cost. In previous studies, increased nosocomial infections, intercranial hemorrhage and mortality have all been associated with poorer staffing levels. Interestingly in the NICU, interventions that are more often rationed include discharge planning (family readiness), and infant comfort care such as pain management and developmentally supportive interventions. These activities can be of lesser priority to a bedside nurses and yet, have implications for poorer long term outcomes such as increased health care utilization after discharge, increased parental anxiety with poorer coping, and poorer developmental and cognitive outcomes later in life. Supporting staff nurses to have the resources they need to prioritize care can also be important to nurse sense of accomplishment and overall long-term retention; ensuring a highly skilled nursing team is available to best support this vulnerable population. This presentation will provide a definition for rationing of care in the NICU. Research findings about how nurses prioritize caregiving interventions will also be presented. In conclusion, recommendations are provided to better support nurses in prioritizing their care.
1. Define caregiving decision-making and rationing of care in the neonatal intensive care.
2. Describe the research findings that provide the evidence for how rationing of care occurs and affects outcomes.
3. Apply the research findings and choose nursing activities that will provide ways to prioritize care to prevent rationing of essential nursing interventions.
10:00 am - 11:00 am
Break in Exhibit Hall
11:00 am - 12:00 pm
General Session II: Telling Stories in the Dark: The Healing Forces of Attention, Instinct and Love (GSII) CE: 1
Kelley French is the author, with her husband, of the critically acclaimed neonatal memoir Juniper: The Girl Who Was Born too Soon. The book tells the story of her daughter, born barely viable at 23 weeks gestation. French will takes us through the journey of two parents and their daughter Juniper's fight for her life in the NICU. Learn how these inspirational parents marvel at the science that conceived and sustained their daughter along with NICU staff, who simply paid attention as human beings, made the difference.
1. Identify two ways in which staff can contribute to infant-parent bonding in the NICU.
2. Describe the emotional and psychological challenges experienced by one couple during their extended NICU journey.
12:00 pm - 2:00 pm
Light Lunch in Exhibit Hall
Interprofessional Education Sessions CE: 2
2:00 pm - 4:00 pm
Feeding (701A- 701D) CE: 2
Complex Neonatal Feeding and Swallowing Issues: Looking Through the Lens of a Feeding Specialist (701A) CE: 0.5
Kelly Andrasik, MOT OTR/L
Co-Author: Allison D. Freccero, OTR/L SWC
Oral feeding is one of the most complex and important first tasks of a newborn's life. In the critical environment of a neonatal intensive care unit, the baby's medical complexity, developmental status, and overall fragility can make oral feeding difficult, at best, or unsafe, at worst. Infant driven feeding protocols have gained support and popularity in research, as they have been shown to decrease length of hospital stay and dramatically improve progress with oral feedings, however when the baby is not progressing as expected or safety concerns arise, what should we do?This presentation will cover more complicated and involved oral feeding issues with neonates, from the perspective of highly trained feeding and swallowing specialists. Overt and subtle signs of safety impairments will be covered, as well as strategies to improve the safety of oral feedings, such as specialized bottles/nipples and the appropriate use of thickening agents. A section of the presentation will cover instrumental evaluations of swallowing, including videofluoroscopic swallow studies (VFSS) and fiberoptic endoscopic evaluations of swallowing (FEES). Case studies and videos of VFSS/FEES will be utilized to optimize learning.
1. Discuss at least three subtle signs, which could indicate underlying dysphagia in the neonate.
2. Describe three immediate adaptations to oral feeding, to be applied at the bedside, to improve the safety of oral feeding for the neonate.
3. Identify two safe, potential thickening agents for neonates to improve swallowing safety.
4. List two primary differences between a videofluoroscopic swallow studies and fiberoptic endoscopic evaluations of swallowing.
Providing Infant-Guided, Co-Regulated Feeding Starts with Assessment of Feeding Skills (701B) CE: 0.5
Suzanne Thoyre, PhD RN
Co-Authors: Catherine S. Shaker, MS CCC-SLP BCS-S; Britt F. Pados, PhD NNP-BC RN
This session will focus on assessment of feeding skills. Background and Importance of the Topic: Feeding skills of premature and hospitalized ill infants are in an emergent phase of development while they receive neonatal care. Selecting interventions that are targeted to the individual infant begins with accurate assessment of their feeding skills. Thorough assessment also pinpoints behaviors and feeding patterns that indicate challenge and identifies adaptations made to maintain stability within the context of these challenges. It is therefore critical that we understand the meaning of the challenges expressed and the adaptations that are adopted, and accurately link these to the skills we observe. What Will be Covered: The audience will be guided to profile infants' feeding skills, including their ability to engage in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. The Early Feeding Skills checklist will be introduced as a means to organize feeding assessment and guide the selection of interventions to effectively co-regulate. Each skill area is evaluated as not yet organized, emerging, or consistently demonstrated; challenges and adaptations within each area are scored for frequency. Videotaped feedings with enhanced audio will be used to increase skill of the audience in assessment of feeding. Future Directions: Placing infants' feeding challenges and adaptations within the context of their skills, and within the environment we create (e.g., how we position, type of nipple selected, provision of pacing, resting, or swaddling), is the way we develop an infant-guided, co-regulated feeding practice.
1. Identify key components of an infant-guided, co-regulated feeding approach.
2. Evaluate the critical role of assessment in provided individualized feeding care.
3. Identify infant behaviors indicative of challenge, adaptation, and skill development in the following areas: ability to engage in feeding, organize oral-motors functioning, coordinate swallowing with breathing, and maintain physiologic stability.
The Emergence of the Complexity of Coordinating Sucking And Breathing during Preterm Infant Feeding (701C) CE: 0.5
Suzanne Thoyre, PhD RN
Co-Author: Jinhee Park, PhD RN
Optimal feeding occurs when a regular, rhythmic relation exists between sucking, swallowing, and breathing. This is managed through coordination of co-dependent systems that are responding to dynamically changing internal and external constraints. Understanding coordination complexity within and across feedings may identify modifiable constraints that offer potential for intervention. Purpose:. Identify change in the complexity of suck/breathe coordination within and across feedings for very preterm infants as their skill advances. Explore physiologic and contextual factors associated with loss of gain in complexity. Methods: Thirty-two very preterm infants were studied when infants were taking approximately half of their feedings orally and when they were fully oral feeding. Feedings were videotaped while heart rate, oxygenation, respiration, and sucking were continuously sampled. Sucking bursts were categorized by degree of integration of breathing. Infant and maternal behaviors were continuously coded. Infant maturity, feeding experience, and health factors were identified through medical record review. Results: Three dominant suck/breathe coordination patterns were identified: (1) no or rare breaths, (2) attempted breaths, (3) integrated. Over time, infants increased the integration of breaths within the sucking burst. The most complex pattern was most evident early in the feeding at both time points. Factors contributing to more complex coordination: co-regulated feeding approach, infant engagement, and higher oxygenation. Implications for Practice and Research: The complexity of coordination is a marker of feeding skill. Focusing future research on shifts in coordination patterns that occur within feedings has potential for contributing to the advancement of feeding care.
1. Identify variation in breathing patterns that occur during sucking as preterm infants transition from garage to oral feeding.
2. Examine suck, swallow, breathe coordination patterns during feeding.
Evidenced Based Practice: Supporting Successful Feeding Outcomes in the NICU (701D) CE: 0.5
Kristy Fuller, OTR/L
Description of Presentation: Achieving and sustaining full oral feedings is challenging for many infants in the NICU and often difficulties persist beyond the NICU stay. This presentation utilizes the four standards of developmental care as a framework for discussing barriers to feeding progress and strategies for implementing supportive feeding practices. Adopting supportive pre-feeding readiness practices from birth and progressing feedings utilizing established feeding readiness guidelines provides the infant with safe, pleasurable and successful feeding interactions. Videos examples will be utilized in modeling a teaching approach that can be used with families to effectively read and respond to their baby's cues during feedings. Barriers to feeding progress and interventions to support long-term success will be discussed and demonstrated. The ultimate goal is to teach consistent practices that prevent long-term feeding problems and promote timely discharge from the NICU. It is critical to implement a solid foundation that supports successful feeding skills beyond the NICU stay.
1. Communicate supportive pre-feeding and feeding readiness strategies that provide a foundation for optimal oral feeding performance for all babies in the NICU.
2. Identify barriers to feeding progress and interventions to promote long-term success.
3. Identify strategies for teaching families to identify and respond to infant cues during feedings
Zika Virus: Update on a New Teratogen (702) CE: 2
Augustina Delaney, PhD
In 2016, the Centers for Disease Control and Prevention (CDC) joined the global health community to rapidly address the many emerging public health needs on the front lines against Zika. To respond effectively, new public health surveillance and infection control tools were developed that will reduce the effect of Zika virus infection on children and families and will provide a foundation for continued efforts to fight the disease. This presentation will provide an overview of the current knowledge of Zika virus and pregnant women, the clinical presentation and management of Zika virus infection, the updated CDC guidance on Zika, and the public health surveillance systems are in place for Zika within the United States.
1. Provide an overview of the current knowledge of Zika virus and pregnant women.
2. Describe the clinical presentation and management of Zika virus infection.
3. Identify the key facets of CDC guidance on Zika and pregnancy planning/contraception.
4. Identify the public health surveillance systems in place for Zika within the US.
5. Describe how clinicians can contribute to the registries and surveillance.
Pain in the Neonate (703) CE: 2
Session details coming soon.
4:00 pm - 4:15 pm
4:15 pm - 5:15 pm
No Escaping the ESKAPEs (501) CE: 1
Amy Koehn, NNP-BC PHD
According to the CDC, each year approximately two million individuals in the US acquire serious bacterial infections which now have resistance to at least one antibiotic originally used to treat it. Worldwide, infectious disease accounts for 33% of all deaths and 58% of deaths in children under the age of 5 years. The ESKAPE pathogens nterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae) have gained notoriety as the collection of organisms which present the greatest danger to vulnerable patients. This danger stems from science's inability to treat or, in some instances, even to contain these pathogens. Resistant organisms identified in NICUs include vancomycin-resistant enterococci, vancomycin-intermediate and vancomycin-resistant S. aureus (VISA and VRSA, respectively), and Carbapenem-resistant Enterobacteriaceae (CRE). Traditional responses would call for introduction of new antimicrobial therapies. However, pharmaceutical companies have slowed or abandoned the development of new antimicrobials. In the absence of effective antimicrobial therapies, efforts to manage these microbes are appearing on two fronts: one addresses the use of new technologies such as structurally nanoengineered antimicrobial peptide polymers (SNAPPs), and the second targets practices aimed at minimizing the opportunities for microbes to develop resistance by using the principles of antimicrobial stewardship programs (ASPs). In 2015 the American Academy of Pediatrics reaffimed their support of ASPs as a means of optimizing clinical outcomes. Neonatal nurse practitioners are ideally positioned to guide clinical practice in the doctrines of ASPs in order to lower the risk of antimicrobial resistance development.
1. Understand the mechanisms bacteria use to develop antimicrobial resistance.
2. Identify implication of the ESKAPE pathogens in disease management in the NICU.
3. Describe alternative therapies in development to combat the ESKAPE pathogens.
4. Acknowledge the NNP's role in antimicrobial stewardship.
Legalization of Marijuana: Unintended Consequences on our Most Vulnerable Patients (502) CE: 1
Carol Wallman, APRN DNP NNP-BC
Co-Author: Robyn Gustafson, MSN
Background: States with legalized marijuana have faced increased complexities in decision making regarding management of infants exposed to marijuana through pregnancy and breastfeeding. In Colorado one hospital's review of meconium and cord tissue toxicology data from 2008 to 2015 revealed an increased THC positivity rate from 0.009% to 2.2% of all births. This increased positivity rate correlated with the 2012 legalization of medicinal THC and 2014 legalization of recreational THC. Staff and family reported inconsistent messaging and practice management patterns among staff and providers in response to these patients. Purpose: A comprehensive literature search guided the development and implementation of best practice strategies to address the unintended consequences of increased use of THC during pregnancy and breastfeeding correlating with the legalization of THC.Method: A multidisciplinary team met, and identified the need for educational tools and consistent guidelines for THC use during pregnancy and breastfeeding in both the well newborn nursery and NICU. Results/Outcomes: Evidence based educational tools for families, and practice guidelines for providers regarding the risk related to the use of THC during pregnancy and breastfeeding were developed. Implications: Hospitals across the country are experiencing increased THC use from patients during pregnancy and while breastfeeding. This presentation will provide a review of current scientific evidence available to support the development of guidelines for consistent messaging and management of these newborns and their families during pregnancy and while breastfeeding.
1. Discuss the increased newborn exposures to THC correlated with its legalization.
2. Discuss three potential complications of newborn THC exposure through pregnancy and breastfeeding
3. Discuss evidence based education and management strategies for working with newborns exposed to THC through pregnancy and breastfeeding.
Advocacy Session: Advocacy through Social Media: The Double-Edged Sword (503) CE: 1
Cynthia Acree, APRN CNS DNP MEd NNP-BC
Co-Author: Stephanie M. Blake, DNP NNP-BC RN
Purpose: To educate engage members in the safe use of social media for patient/family advocacy. Social Media has become a prevalent way to communicate in society today. It has become the preferred tool of communication for millions of Americans and health care providers. Thus, the young staffers in the offices of lawmakers as well as lawmakers in their home districts and in Washington DC have opted to use social media to communicate with constituents. Neonatal nurses in all roles can learn to use social media to advocate for issues important to them and their patients. There are many unwritten rules that health care providers are unaware of and have suffered penalties because they should have known the ethically acceptable rules of social media. An historical overview of the advent and use of social media will be presented. An overview of how major nursing and health care organizations are using social media and how participants can benefit from involvement with these organizations. Participants will learn about the advantages and disadvantages of the most popular social media sites and how to set up and use these social media accounts. Participants will learn about the unwritten rules of social media, how it is viewed by one's employer and how to stay out of harm's way when using these sites for advocacy and communication. Future Directions: Increased member use of NANN's social media applications.
1. Discuss the ability to cut through barriers to directly advocate and communicate with lawmakers and the public through social media channels while complying with the unwritten rules involved for this type of communication.
2. Demonstrate how to sign up and use social media applications.
5:30 pm - 6:30 pm
Bonus General Session: Transforming Care for Extremely Premature Babies (GSLB) CE: 1
Marcus Davey, PhD
Since the 1950s, it has been realized that infants born extremely preterm (23-25 weeks) could benefit from an artificial womb to support organ development and avoid iatrogenic injury associated with invasive mechanical ventilation strategies. We have developed a system that incorporates a pumpless oxygenator circuit connected to the umbilical cord of fetal sheep immersed in amniotic fluid. With appropriate nutritional support, lambs on the system demonstrate normal growth and lung and brain maturation. Clinical translation of this ground-breaking technology will be presented.
7:00 pm - 9:00 pm