|
|
|
Welcome to another edition of NANN E-News. This month, we've included an update about vitamin D deficiency from Brenda Waber, a dietitian in the NICU at Children's Hospital of Philadelphia.
NANN E-News is for you, so we welcome your suggestions! Do you have professional news you would like to share in our Member News section? If you have received an honor or award or contributed to a publication, let us know! E-mail your item (75 words or fewer) to cszmurlo@connect2amc.com.
Don't forget to forward this newsletter to a friend or colleague. Thank you for being a member of the only nonprofit association exclusively for neonatal nurses!
|
| Vitamin D: Redefining Deficiency |
|
Brenda Waber, RD CSP CNSD LDN
Recently you have been hearing about vitamin D on talk shows, in the news, and, I hope, on NICU rounds. In 2008 the American Academy of Pediatrics issued new recommendations on vitamin D intake. These new guidelines have significantly changed the standard of care for neonatal vitamin supplementation. Vitamin D is not just for breastfed infants anymore. Formula-fed infants consuming less than 1 liter per day also need supplementation.
Vitamin D deficiency is common in the general population in part because of the widespread use of sunscreen, but NICU infants are at particularly high risk for three reasons: they are often growing rapidly, they are frequently receiving steroids or antiseizure medications, and malabsorption in neonates is common.
This fat-soluble vitamin and prohormone has multiple functions. It facilitates bone/calcium and phosphorus metabolism:
- Aids in maintaining calcium and phosphorus serum levels (Neonatal vitamin D deficiency may cause hypocalcemic seizures. Ionized calcium levels are needed to assess serum calcium, especially with low serum albumin intestinal absorption of calcium.)
- Maintains parathyroid hormone (PTH) levels (an increase in vitamin D deficiency leads to phosphorus losses)
- Prevents growth-plate disturbances (osteopenia, fractures, rickets)
- May affect alkaline phosphatase level (an increase is not always correlated with vitamin D deficiency; it may be related to liver dysfunction).
Adequate vitamin D levels also bring nonskeletal benefits:
- Increased muscle strength (deficiency leads to weakness)
- Increased immune function (deficiency leads to increased infection rates)
- Improved activity of neurotransmitters in the brain (deficiency leads to depression)
- Improved prostate, colon, and breast health (deficiency leads to increased cancer rates).
Vitamin D is involved in more than 200 genes that control apoptosis, cellular differentiation, and angiogenesis. In addition, a deficiency in vitamin D has possible links to Type I diabetes, arthritis, and autoimmune diseases.
Normal vitamin D status can be determined only by checking serum levels of 25-OH vitamin D (not 1-25 vitamin D, which is often normal even in cases of vitamin D deficiency).
Suggested Reference Levels (Holick, 2007; Misra et al., 2008)
Deficiency: <20 ng/ml (50 nmol/L)
Insufficiency: 21-29 ng/ml (52-72 nmol/L)
Sufficiency: 30-80 ng/ml (75-200 nmol/L)
Excess: >100 ng/ml (250 nmol/L)
Intoxication: >150 ng/ml (375 nmol/L)
Your unit's vitamin supplementation protocol may need to be updated to reflect the current recommendations.
Suggested Guidelines
All infants in NICU: When infants reach 100 ml/kg of enteral feeding, vitamin D supplements should be started at 400 international units (IU)/day.
Preterm infants, infants on steroids or anticonvulsants, and dark-skinned infants: Consider supplementation of vitamin D at 800 IU/day.
Monitoring vitamin D 25(OH) levels are the best way to track vitamin D status.
Deficiency: <20 ng/ml (50 nmol/L)
Insufficiency: 21-29 ng/ml (52-72 nmol/L)
Sufficiency: 30-80 ng/ml (75-200 nmol/L)
Excess: >100 ng/ml (250 nmol/L)
Intoxication: >150 ng/ml (375 nmol/L)
When treating vitamin D insufficiency or deficiency, supplement phosphorus as needed to maintain serum levels at 5.5-7.5 mg/dl.
For infants ages 0-12 months, the dose is 800-1,000 units/day. An endocrine consult should be obtained for doses exceeding this range.
Give vitamin D3 in conjunction with calcium until PTH and vitamin D levels normalize.
Monitor vitamin D 25(OH) levels; when normal, resume giving 400 units/day.
List available liquid supplements at your institution. Cholecaliferol (D3) is the preferred supplement. It is now available in a very-low-volume, well-tolerated liquid form from www.carlsonlabs.com. Baby D drops: one drop = 400 units.
References
Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.
Misra, M., Pacaud, D., Petryk, A., Collett-Solberg, P. F., Kappy, M., & Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. (2008). Vitamin D deficiency in children and its management: Review of current knowledge and recommendations. Pediatrics, 122(2), 398-417.
Brenda Waber is a dietitian in the NICU at Children's Hospital of Philadelphia, Philadelphia, PA.
|
| Update from NANN's June Board Meeting |
 Lori Armstrong, MSN RN, NANN President
The NANN Board of Directors meets regularly to discuss finances, publications, organizational liaisons, the annual conference, and other projects and issues of strategic importance for the association. Staff members record the proceedings and make sure that the directions of the board are carried out.
The most recent board meeting took place June 25 via conference call. The board discussed details concerning the 2009 and 2010 conferences, including plans for an exciting 25th anniversary celebration in Austin in September. NANNP Council Chair Robin Bissinger discussed NANNP projects and initiatives currently under way. Sherri Brown, BSN RN, was approved as a liaison to the Council of International Neonatal Nurses (COINN) and the Global Network for Perinatal and Reproductive Health. The NANN board is happy to announce approval of the nomination of Charles (Chuck) Rait, MSEd BSN RN PNC, for the Lifetime Achievement Award, and Robin Bissinger, PhD APRN NNP-BC, for the Distinguished Service Award. The status of NANN publications was also reviewed. NANN is pleased to announce that several new publications will be released at the 2009 annual meeting or soon afterward, so look for updates on these publications in NANN E-News, and on the Web site in the near future!
Stay tuned for additional board meeting updates in future issues of NANN E-News. And, as always, please direct any questions to me at President@nann.org.
|
|
Ask the Professor© Webcasts
|
Necrotizing Enterocolitis (available only through July 24)
"Necrotizing Enterocolitis," the third in the Ask the Professor series, is presented by Leslie Parker, MSN RN RNC.The presentation will focus on innovative preventive interventions for necrotizing enterocolitis, including probiotics, arginine, erythropoietin, growth factors, breast milk, and oral immunoglobulin preparations. Information on mechanism of action as well as potential risks and benefits will be presented, along with research-based material related to potential effectiveness of the treatments. Access the Webcast on the NANN Web site.
Creating a Healthy Work Environment
"Getting Behaviors Under Control: A Unit-Based Code of Conduct," scheduled from July 25 through August 24, 2009, has been canceled. NANN will strive to make this session available to you at another time.
Palliative Care
"Palliative Care in the NICU: What Do We Do When We Have Met the Limits of Technology?" presented by David Munson, MD, will be offered in the near future. NICU staff members are faced with significant mortality and morbidity in their patients. Learning how to provide compassionate care of the infant and family in these situations is just as important as learning how to master aggressive interventions. This in-depth symposium will explore how to discuss death, burdens of care, quality of life, and goals of care effectively and compassionately and will consider how to support a family through difficult choices in a way that facilitates healthy grieving. The session will also address procedures for the withdrawal of technology (including ventilator support), giving attention to medications and nonpharmacologic techniques that minimize suffering in an infant who is dying.
About the Series
Keep your skills sharp and learn new ones! Each 1-hour Webcast will include a comprehensive presentation, answers to commonly asked questions, and immediate access to your continuing nursing education (CNE) certificate. Go to www.nann.org for more information!
The Ask the Professor Webcasts are supported through an educational grant from Abbott Nutrition, a division of Abbott Laboratories, Inc.
Not sure what a Webcast is? It's a media file distributed over the Internet using streaming media technology. The Ask the Professor Webcasts are recorded PowerPoint presentations (slides) that use both audio and video and are available on demand. Please contact NANN Member Services at 800/451-3795 if you have any questions.
|
| Recent Nursing Program Accreditations |
At its April 2009 meeting, the board of commissioners of the Commission on Collegiate Nursing Education (CCNE) made decisions granting, continuing, or denying accreditation of U.S. baccalaureate and graduate nursing programs. Recognized by the U.S. Secretary of Education as an autonomous accrediting agency, CCNE serves the public interest by assessing and identifying programs that engage in effective educational practices. As a voluntary, self-regulatory process, CCNE accreditation supports and encourages continuing self-assessment by nursing education programs and the continuing growth and improvement of
collegiate professional education.
Click here for a summary of the agency's recent accreditation decisions. CCNE identifies the status of its affiliated programs on its Web site and also publishes information about accredited programs in its Directory of Accredited Baccalaureate and Graduate Degree Programs in Nursing.
For more information about CCNE, contact Libby Cooperman, executive administrative assistant, at lcooperm@aacn.nche.edu or by calling 202/887-6791, ext. 256.
|
| Member News |
Left to right: Amy Paradis, Marcella Macartney, and Kathi Salley-Randall. Photo taken by Cathy Ann Taylor.
On June 24, 2009, Amy Paradis, of Modesto, CA, and Kathi Salley-Randall, of Moreno Valley, CA, scaled northern California's 14,162-foot Mt. Shasta with the Breast Cancer Fund's Climb Against the Odds expedition of breast cancer survivors and others affected by the disease. Paradis and Salley-Randall underwent 6 months of rigorous physical and mental preparation for the climb. Both climbed to honor the many women in their lives diagnosed with breast cancer and to support the Breast Cancer Fund's work to eliminate the environmental causes of the disease. This year's Climb Against the Odds raised more than $450,000 for the Breast Cancer Fund.
Illustrations by Anne Brenner, of Antioch, IL, appear in the recently published book The Journey Home, a funny and touching story by Bucky Hempen. Hempen, the father of preemie twins and NICU graduates, hopes that the book will provide support for other parents of preemies. The book is available at www.booklocker.com.
|
| Celebrate and Honor NANN's Founders |
|
 Join us at the opening plenary session of NANN's 25th annual educational conference, Thursday, September 24, where we will honor our founders and NANN's 25 years of service to the neonatal nursing profession! Twenty-five years ago, NANN's six founders--Linda Bellig, Patricia Johnson, Tracy Karp, Donna Lee Loper, Linda McCollum, and Charles Rait--established and incorporated NANN to address on a national level the educational and practice needs of the evolving specialty of neonatal nursing. Celebrate with the founders of NANN at the plenary session and later at the 25th anniversary celebration!
NANN's basic mission remains the same but has expanded today to include giving neonatal nurses a voice in shaping the specialty through excellence in practice, education, research, and professional development. Both an advocate and a leading change agent, NANN equips neonatal nurses to optimize care for neonates and their families. It is the only professional nonprofit organization founded exclusively for neonatal nurses and is home to those who are interested in a professional model of practice at any stage of their career.
Plan now to join us in Austin!
25TH ANNUAL EDUCATIONAL CONFERENCE
The Neonatal Community: Creating the Silver Lining
September 23-26, 2009
Austin Hilton and Austin Convention Center
Austin, Texas
NANN thanks these companies for their generous support of the annual conference: Gold Level--Abbott Nutrition, Discovery Laboratories, Lundbeck Inc., Mead Johnson Nutritionals, Pediatrix Medical Group, Procter and Gamble; Silver--GE, March of Dimes, Medela; Bronze--Advance Newsmagazines, Draeger Medical.
|
| Greening the Annual Conference |
|
NANN is committed to minimizing the impact of the annual conference on the environment.
- The session handouts and abstracts will be available for downloading to paid registrants from August 24 to October 23 in PDF format at www.nann.org. To access these, you will need to use the same ID and password that you use for your Members Only log-in on the NANN Web site. If you have any problems logging in, please call NANN Member Services at 800/451-3795.
- In the interests of environmental responsibility, printed handouts and CDs will not be provided (except for preconference sessions), but handouts can be reproduced at the business center for a fee.
- New this year: Evaluation forms and continuing education certificates will be accessible online. A form for recording evaluation notes during the conference will be provided in the program guide.
- Exhibitors are being encouraged to bring to the event only what they need, to reuse materials and packing, and to recycle or take away what they don't hand out.
- NANN will be working with vendors to use the convention center's recycling program to recycle corrugated cardboard and other nonfood waste produced during the conference.
- NANN used recycled paper for the conference brochure.
In 2008 and 2009, a number of NANN meetings staff implemented green inititatives, working with the facility and event production partners to support environmentally friendly solutions wherever possible.
The Austin Convention Center has instituted these practices:
- Green Seal Certified chemicals are used for 95% of all cleaning.
- Its integrated pest management program uses 100% organic materials.
- Equipment purchases are compliant with Leadership in Energy and Environmental Design (LEED)--Existing Buildings indoor environmental quality standards.
- It currently recycles paper, cardboard, metal, batteries, light bulbs and ballasts, plastic, toner, and glass and uses recycled crushed 6th St. glass in all ash trays.
- It employs a LEED-accredited professional, a certified energy manager, and a master electrician.
|
|
Silent Auction to Benefit March of Dimes
|
|
The Silent Auction will take place in the exhibit hall at the NANN Annual Educational Conference, September 23-26, 2009, in Austin, TX. We ask you, as a friend of the March of Dimes, to help raise money for research and programs that bring comfort and care to babies born premature or sick. The following items are examples of appropriate entries for the silent auction: gift baskets, autographed sports memorabilia, funding for a travel grant to the NANN meeting, housewares, garden accessories, gift certificates for national chain restaurants or stores, and medical equipment.
Please observe these rules as you select your items:
- The item must be able to be easily displayed on a table.
- Any gift basket with loose items or valuables must be wrapped in clear plastic wrapping. Please note: items will not be supervised at the silent auction site.
- All entries must be able to be boxed and shipped to the recipient's home.
- All entries must include a card with the name of the donating organization.
- Gift baskets, or any other wrapped items, should include a list of the contents.
Use your imagination to come up with a silent auction item that will invite everyone to place a bid. Items and gift baskets incorporating NANN's 25th anniversary are encouraged. For more information about the silent auction, please visit the meetings page at www.nann.org. NANN and the March of Dimes thank you for your support of premature babies.
|
|
 |
| This Newsletter Supported by |
|
|
 |
|
|
| High-Frequency Jet and Oscillatory Ventilation Guide Available in August! |
|
Hang it on the vent or keep it in your office! This 16-page desk reference, in a handy 9-by-6-inch format, suggests strategies to use when managing infants on either high-frequency jet ventilation (HFJV) or high-frequency oscillatory ventilation (HFOV). The tool will help you quickly manage the ventilator settings and offers a guide for both respiratory and blood-gas abnormalities. It provides guidelines for starting patients on high-frequency ventilation and weaning them off.
- The resource guide can be hung from your unit's ventilator using the O-ring.
- A smaller 5-by-3-inch card containing quick guides for using both jet and oscillatory ventilators fits conveniently into your pocket or badge holder.
- Abbreviations used in the desk reference and quick guides are defined in a comprehensive list.
- A bibliography provides a list of resources with further information.
- Both the pages and the cards are laminated and easily cleaned.
Whether you keep the desk reference in your office or place it on your unit's high-frequency ventilator as a resource for your entire multidisciplinary team, this handy guide, developed by the National Association of Neonatal Nurse Practitioners (NANNP), will help you adjust ventilator settings with confidence!
To order this product or to obtain more information, call NANN Member Services at 800/451-3795 or visit www.nann.org.
For their valuable contributions to this publication, NANN thanks authors Robin Bissinger, PhD APRN NNP-BC, Medical University of South Carolina, Charleston, SC, and Lee Shirland, MS APRN NNP-BC, Cape Fear Valley Health Care System, Fayetteville, NC, along with reviewers Mark C. Mammel, MD, Children's Hospitals and Clinics of Minnesota, St. Paul, MN, Joseph P. Mancinelli, RRT-NPS CPFT, Medical University of South Carolina, and Charles Reid, RCP RRT, Cape Fear Valley Health Care System.
|
|
NANN Election Results
|
|
Thank you to all members who voted in the NANN and NANNP annual elections. The results are in, and the newly elected officers are as follows:
NANN Directors-at-Large
Cheryl A. Carlson,
PhD APRN NNP
Regina Grazel,
MSN-BC RN APN-C
Moni K. Snell, MSN NNP
NANNP Council Members
District 3: Carol B. Jaeger,
MS RNC PNP CNNP
District 5: Ellen P. Tappero, DNP RN NNP-BC
District 6: Carol Greene,
MSN NNP-BC
District 7: Paula M. Timoney,
MN ARNP NNP-BC
Thanks also to all those who ran in the election. Your willingness to lend time and expertise to your association is truly valued. An additional thank-you is due to both the NANN and NANNP Nominating Committees, whose dedication has been apparent throughout the year.
Both NANN and NANNP have a great year ahead with many important initiatives on the agenda and an excellent team of leaders to guide the way.
|
| 2009 Award Winners |
NANN is proud to acknowledge the 2009 award winners for their dedication to neonatal nursing and for their extraordinary contributions to the field.
Robyn Main Excellence in Clinical Practice Award
Barbara J. Hering, MSN RNC-NIC CCN-S, is a staff nurse and perinatal outreach educator at Loyola Medical Center in Maywood, IL. Barbara is co-coordinator of the NICU Education Program, co-coordinator of the NICU Magnet committee, and, as a seasoned Level-III NICU nurse, the "go-to" person in her unit. The Robyn Main Award is supported by Draeger Medical.
Lifetime Achievement in Neonatal Nursing Award
In the early 1980s Charles Rait, MSEd BSN RN PNC, identified a group of nurses with the skills and interest to form an association exclusively for neonatal nurses and neonatal nurse practitioners. This vision led to the creation of the National Association of Neonatal Nurses (NANN) in 1984. Chuck's lifelong passion has been to strengthen and support the profession of neonatal nurses, and he served as NANN's first executive director. For these efforts he is being honored at NANN's 25th anniversary celebration in Austin.
Distinguished Service Award
Robin Bissinger, PhD APRN NNP-BC, director of graduate education, associate professor, and NNP program director at the Medical University of South Carolina, has served NANN over the years in many capacities, including as NANN president and as chair of the NANNP Council. In 2007, Robin was instrumental in founding the National Association of Neonatal Nurse Practitioners (NANNP), which is dedicated to the support, education, and advancement of the neonatal nurse practitioner.
Research Abstract Award
Coauthors Joseph A. Carcillo, MD, and Richard A. Orr, MD, received this award for their paper presentation "Shock Index (HR/SPB) Is Related to Outcome in Neonates Requiring Transport."
Leadership Award
Mary Ellen Honeyfield, MS RNC NNP, was one of the first neonatal nurse practitioners in the United States. She was instrumental in establishing the first neonatal nurse practitioner program in Denver, CO, through the Children's Hospital in collaboration with the University of Colorado. Mary Ellen is now an NNP at HCA Presbyterian/St. Luke's Medical Center in Denver. In addition, her business, NNP Services of Colorado, consults with other hospitals and employs and mentors NNPs in several states.
Chapter of the Year Award
The Southeastern Michigan Association of Neonatal Nurses, which celebrated its 17th anniversary in 2008, has consistently maintained a high degree of enthusiasm and quality programs over the years. In 2008 the chapter met and exceeded its high standard, as demonstrated by its many accomplishments and its strong member participation.
Individual Chapter Projects
Chapter Communications: Central California Association of Neonatal Nurses
Community Service: Delaware Valley Association of Neonatal Nurses
Educational Offerings: Delaware Valley Association of Neonatal Nurses
Fundraising Efforts: Delaware Valley Association of Neonatal Nurses
Membership Recruitment and Retention: Delaware Valley Association of Neonatal Nurses
|
| Call for Abstracts for the 2010 Conference and Research Summit |
See the NANN Web site home page under What's New for links to the submission guidelines.
|
| Discounted CE for NANN Members |
NANN members receive a 30% discount on Advances in Neonatal Care continuing education courses taken on the NursingCenter Web site. Log in to the NANN Members Only site to get the coupon.
|
|
Navigator: Mentoring Resources Helps Improve Retention Rates in NICUs
|
Twenty percent of first-year nurses quit! With a critical shortfall of nurses predicted in the next decade, nursing leaders are searching for approaches that will help retain the novice nurse.
NANN's Navigator: Mentoring Resources is designed to provide formal support for novice nurses for 6 months beyond the orientation period. The Navigator Mentor Program has resulted in improved retention rates within the NICU and has helped build a more cohesive work environment. Organizations with formal mentoring programs realized higher retention rates for novice nurses and higher job satisfaction compared with those that did not have mentoring programs.
This program takes orientation a step beyond development of the novice nurse's technical and critical-thinking skills, addressing the need for interpersonal skill development. The Navigator program pairs new nurses with mentors who have been in the unit for 18-24 months. These mentors are seasoned in the ways of the unit but still remember what it was like to be a new hire.
To order this product or to receive more information, call NANN Member Services at 800/451-3795 or visit www.nann.org.
|
| Are You Involved in Advocacy? |
Consider joining NANN's Advocacy e-mail discussion group.
If you have been involved in nursing or patient-related health policy or advocacy activities at any level (local, state, or federal), we'd love to hear about it! Please send a brief summary of your activity to NANNadvocacy@nann.org.
|
| New Discussion Area on NANN's Facebook Page! |
|
Visit NANN on Facebook to connect with your colleagues in the brand-new discussion area, where you can discuss topics concerning neonatal nursing and NANN events and initiatives! Click the "Discussions" tab at the top of the NANN page, and start topics and conversations of your choice.
|
|
Faces of Neonatal Nursing Photo Contest
|
|
Submissions Due August 3
Neonatal nursing has many faces: the faces of dedicated nursing professionals in the NICU, in transport, in home care, in academic settings, within local communities, on Capitol Hill; the faces of neonates from days to years old, growing and prospering; the faces of mothers, fathers, grandparents, and siblings. Celebrate neonatal nursing by participating in NANN's Faces of Neonatal Nursing photo contest. Submission of photos incorporating NANN's 25th anniversary is encouraged. Photo submissions and narratives will be displayed at the NANN Annual Educational Conference in September, where attendees will determine the winning photo via ballot vote. The submitter of the winning entry will receive a complimentary registration to NANN's 2010 annual conference, and the photo will be considered for use on the cover of an issue of Advances in Neonatal Care.
|
|
