OBJECTIVE: to analyze the reliability of the items that compose the instrument for classifying newborns according to the degree of dependence on nursing care in a neonatal intensive care unit.
METHODS: methodological study that analyzed the agreement and reliability of the instrument in a neonatal intensive care unit. Six care nurses and a research nurse assessed 35 newborns and completed the instrument, which was made up of 15 areas of care. The weighted Kappa coefficient and the Intraclass Correlation Coefficient were used for analysis.
RESULTS: the areas of: weight (92%), oxygenation (93%) and catheter control (95%) had almost perfect agreement and the area of reaction to stimuli (50%) had poor agreement. The areas of elimination and vital signs showed low reliability, due to the low variability of responses. The Intraclass Correlation Coefficient was 0.94.
CONCLUSIONS: there are variations in the evaluations of some areas of care due to the imprecise description of items to which scores are assigned, however the instrument is reliable for categorizing the type of care (minimal, intermediate and intensive). Its use can contribute to measuring the quality and safety of newborn care.

BACKGROUND: The Qualineo Strategy is an effective measure for reducing neonatal mortality in regions with the highest death rates. In addition, it is a relevant Brazilian tool for strengthening teamwork and neonatal assistance. This study aims to analyze the predictors of neonatal death in the indicators of care provided by the Qualineo Strategy at a reference maternity hospital in Piauí, in the years 2021 to 2022.
METHODS: This is a retrospective study of 1856 newborn records. Pearson\'s chi-squared test was used to assess the association between the variables; a predictive regression model was used to identify the variables that predict neonatal mortality.
RESULTS: There was a significant association between all neonatal variables and the outcome of death (p < 0.05). The predictor variables for death in term newborns were the use of drugs by the mother and admission to the Neonatal Intensive Care Unit. For premature newborns, the predictor variables were, as follows: the use of cannula ventilation, an Apgar score in the 1st minute <7; and admission to the Neonatal Intensive Care Unit.
CONCLUSIONS: The results will make it possible to visualize better strategies for the reality analyzed and reinforce the importance of prenatal care.

BACKGROUND: Nursing shortages are an ongoing concern for neonatal units, with many struggling to meet recommended nurse to patient ratios. Workforce data underlines the high proportion of neonatal nurses nearing retirement and a reduced number of nurses joining the profession. In order to recommend strategies to increase recruitment and retention to neonatal nursing, we need to understand the current challenges nurses are facing within the profession. The aim of this study is to investigate current job satisfaction, burnout, and intent to stay in neonatal nursing in England and Wales.
METHODS: This study has two parts: (1) a systematic review exploring job satisfaction, burnout and intent to stay in neonatal nursing, and any previous interventions undertaken to enhance nurse retention, (2) an online survey of neonatal nurses in England and Wales exploring job satisfaction, burnout and intent to stay in neonatal nursing. We will measure job satisfaction using the McCloskey Mueller Satisfaction Scale (MMSS), burnout using the Copenhagen Burnout Inventory (CBI) and the Nurse Retention Index (NRI) will be used to measure intent to stay. All nurses working in neonatal units in England and Wales will be eligible to participate in the nursing survey.
CONCLUSIONS: Retention of neonatal nurses is a significant issue affecting neonatal units across England and Wales, which can impact the delivery of safe patient care. Exploring job satisfaction and intent to stay will enable the understanding of challenges being faced and how best to support neonatal nurses. Identifying localised initiatives for the geographical areas most at risk of nurses leaving would help to improve nurse retention.

BACKGROUND: Although routine nurse caregiving is vital for the overall health of preterm infants, variations in approaches may exert distinct effects on preterm infants\' stress responses and behavior state.
OBJECTIVE: The purpose of this systematic review was to examine routine nurse caregiving in the neonatal intensive care unit and its effect on stress responses and behavior state in preterm infants.
METHODS: A systematic search was conducted using PubMed, Embase, and CINAHL for studies published between 2013 and 2023.
METHODS: Included studies enrolled preterm infants born <37 weeks gestational age and investigated nurse caregiving practices and effects on stress responses and/or behavior state.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data about study design, methods, findings, and limitations were extracted and summarized. Included studies were evaluated for bias using the National Health, Lung, and Blood Institute quality assessment tools.
RESULTS: All 13 studies included in the review received a fair quality rating. Nurse caregiving activities, including suctioning, diaper changes, bathing, and weighing, were associated with increases in heart and respiratory rates, blood pressure, energy expenditure, and motor responses, lower oxygen saturations, and fewer sleep states.
CONCLUSIONS: Adapting nurse caregiving frequency and duration, aligning caregiving with infant state, and integrating developmental care strategies may reduce infant stress responses and support behavioral rest. Further research is needed to understand how caregiving activities affect stress responses and behavior state in preterm infants, aiding in identifying modifiable caregiving stressors to promote optimal development.

BACKGROUND: Neonatal nurses should provide timely and high-quality palliative care whenever necessary. It\'s necessary to investigate the knowledge, attitude and behavior of palliative care among neonatal nurses, to provide references and evidences for clinical palliative care.
METHODS: Neonatal intensive care unit (NICU) nurses in a tertiary hospital of China were selected from December 1 to 16, 2022. The palliative care knowledge, attitude and behavior questionnaire was used to evaluate the current situation of palliative nursing knowledge, attitude and behavior of NICU nurses. Univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors.
RESULTS: 122 nurses were finally included. The average score of knowledge in neonatal nurses was 7.68 ± 2.93, the average score of attitude was 26.24 ± 7.11, the score of behavior was 40.55 ± 8.98, the average total score was 74.03 ± 10.17. Spearman correlation indicated that score of knowledge, attitude and behavior of palliative care in neonatal nurses were correlated with the age(r = 0.541), year of work experience(r = 0.622) and professional ranks and titles(r = 0.576) (all P < 0.05). Age (OR = 1.515, 95%CI: 1.204 ~ 1.796), year of work experience (OR = 2.488, 95%CI: 2.003 ~ 2.865) and professional ranks and titles (OR = 2.801, 95%CI: 2.434 ~ 3.155) were the influencing factors of score of knowledge, attitude and behavior of palliative care (all P < 0.05).
UNASSIGNED: NICU nurses have a positive attitude towards palliative care, but the practical behavior of palliative care is less and lack of relevant knowledge. Targeted training should be carried out combined with the current situation of knowledge, attitude and practice of NICU nurses to improve the palliative care ability and quality of NICU nurses.

UNASSIGNED: Nurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses\' perceptions of developmental care.
UNASSIGNED: To determine perceptions and attitudes towards developmental care in a specialty neonatal setting.
UNASSIGNED: Cross-sectional study.
UNASSIGNED: Two surgical neonatal intensive care units in Australia.
UNASSIGNED: Registered nurses permanently employed at the study sites between May 2021 to April 2022.
UNASSIGNED: A modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses\' perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)].
UNASSIGNED: Of 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3-8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1-6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1-6.2].
UNASSIGNED: The results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units\' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

UNASSIGNED: The main role of nurses is not only to inform about the disease and treatment of the patient but also to establish an effective therapeutic relationship to address concerns and provide empathy, comfort, and support. This issue is very prominent in neonatal intensive care units (NICUs) and doubles the importance of empathetic communication between nurses and parents and promoting empathy skills in nurses working in neonatal intensive care units.
UNASSIGNED: This study aimed to evaluate the effect of a support program on the empathy of neonatal intensive care nurses across the Iran.
UNASSIGNED: This study was conducted in 2021 as a semi-experimental intervention in a group of 166 nurses working in the neonatal department all over Iran who met the inclusion criteria. Jefferson\'s empathy questionnaire was completed electronically by the participants before and after the online education program start. Data were analyzed using SPSS software (V 24.0).
UNASSIGNED: The empathy score of nurses was 60.31 ± 5.76 before and 66.47 ±6.60 after the intervention. The empathy scores of nurses after the intervention increased statistically significantly.
UNASSIGNED: Nurses can communicate empathically with parents by training their verbal and nonverbal communication skills and gaining a common understanding of the feelings of parents of premature infants.

A newborn\'s admission to the Neonatal Intensive Care Unit (NICU) can be both stress inducing and frightening for a parent or caregiver. With nursing being a constant calming presence, a trusting bond between the parents and nurses often becomes the lifeline to survive the NICU journey. This bond impacts not only the baby and family, but also promotes the institution\'s reputation within the community. In today\'s climate of healthcare professional shortages, the power of the nurses\' connections to families cannot be overlooked. It is critical in all neonatal units, especially where parents are being approached to enroll their infant in clinical research.

UNASSIGNED: Clinical medical staff should be aware of and examine the correlation between breastfeeding and neonatal hospitalization. Additional attention should be paid to work dilemmas experienced by the nursing staff caring for newborns to avoid exposing newborns to hospitalization risk.
UNASSIGNED: The present study investigated the working dilemmas by neonatal nurses caring for breastfed newborns and risk of newborn hospitalization.
UNASSIGNED: This hospital-based study in Taiwan surveyed 84 neonatal nurses using a structured questionnaire entitled \"Working Dilemmas in Clinical Care for Breastfed Newborns.\"
UNASSIGNED: Collected data were analyzed statistically (descriptive analysis, chi-square test, and t test) using Statistical Package for the Social Sciences (SPSS) software. Neonatal intensive care unit (NICU) staff noted that breastfed newborns showed a high risk of hospitalization and nursery staff highlighted a lack of manpower and time. NICU staff experienced more working dilemmas (117.460±12.260) than nursery staff (87.410±15.820) when caring for breastfed newborns (t = 1.080, P < 0.001). NICU staff reported a higher risk of hospitalization in breastfed newborns and experienced more working dilemmas caring for these patients compared with nursery staff, who reported a lack of manpower and time.
UNASSIGNED: Our findings highlight the working dilemmas by neonatal nurses and can serve as a foundation for further critical studies.

Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.
A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.
Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.
A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.