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CORRESPONDENCE
Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 218

Practice parameters in infant care in cardiovascular nursing


Department of CTVS, CN Centre, AIIMS, New Delhi, India

Date of Web Publication30-Sep-2015

Correspondence Address:
Dr. P Ramesh Menon
Department of CTVS, CN Centre, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-5414.166334

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How to cite this article:
Menon P R. Practice parameters in infant care in cardiovascular nursing. J Pract Cardiovasc Sci 2015;1:218

How to cite this URL:
Menon P R. Practice parameters in infant care in cardiovascular nursing. J Pract Cardiovasc Sci [serial online] 2015 [cited 2020 Apr 4];1:218. Available from: http://www.j-pcs.org/text.asp?2015/1/2/218/166334

Dear Editor,

I am writing this letter to bring to attention some of the practice parameters that highlight pediatric sensitization of nursing care for babies with congenital heart diseases. With technological advancement and basic pediatric training, babies are screened for anomalies (including congenital heart diseases) either in-utero or soon after delivery. In many high-volume centers, babies reach the cardiologist/cardiac surgeon even before they have tasted colostrum. The preoperative and the postoperative care are dependent to a large extent on the nursing expertise in infant and pediatric care.

Children are not small adults – In Intensive Care Units with no age separation, nursing staff are posted and rotated on each shift, to specific beds and not specific patients. This often leads to miniaturization (in size) of all sorts of care (bed, pillow, support, utensil, napkin, etc.) as a corollary of care.

Personnel hygiene and barrier nursing – Unlike adults, babies are far more immunocompromised with their normal microbial flora not yet fully developed. Too much of accessories in the form of cotton wraps/towel wraps/sterile drapes and then positioning of babies with sternum open and the “spaghetti syndrome” are a common sight in infants who have undergone a cardiopulmonary bypass (CPB) for their repair. This creates a favorable environment for bacteria (especially gut associated Enterobacteriacea) to multiply in enclosed, wet, and warm surfaces.

Infection control and antibiotic – In the absence of a specific and sensitive marker for infection, most of the infants are on high-end antibiotics. The systemic inflammatory response syndrome (SIRS) of babies after CPB precludes usage of inflammatory markers for monitoring infection as an etiology of fever. This generates dual responses: Prolonged use of high-end antibiotics and environmental sampling for surveillance purposes, both of which are cost-ineffective.

Infant feeding practices – As highlighted, many a times, babies are operated without even having tasted colostrum. Even for previous breast fed babies undergoing cardiac surgical repair, the inflammatory storm induced by the bypass and/or repair means that effectively the baby is not going to be fed for the next 24 h at least. The occurrence of postoperative chylothorax in these babies meant that use of simyl medium chain triglycerides fatty acids was far more common than the use of expressed breast milk (EBM), irrespective of the availability or need for the latter. The regimented feeding timetable truncated to restrict total daily fluid intake also meant that the babies were getting a fixed amount of milk feed every 2 h without any diurnal variation or escalation. The breast milk of mothers of such babies would soon dry up and babies would then be fed top milk. All such factors and more were acting in concert to create a situation of selective colonization of infant gut flora by hospital-based drug resistant microorganisms which would become the signature microbiota for the particular babies undergoing such an experience. Counseling of mothers and facilitation for EBM storage and utilization with avoidance of mixed feeding, with on-demand feeding as a norm, after the 1st week of surgery, has improved the situation.

I am writing this letter with an eye to impress upon the nursing administration cadre, who have facilitated my efforts whole heartedly, to continue with the good work and initiative that they have undertaken.




 

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