As with any medical specialty, procedures for neonatal nurse practitioners (NNPs) evolve constantly. This ensures NNPs continue to provide the best care for neonates by leveraging new evidence-based practices as they emerge. While it’s still important to stay up-to-date with procedural updates in your NICU, here are a few recent procedural changes all NNPs should be aware of.
Newest Procedures for NNPs
1. Prevention & Management of Hyperbilirubinemia
In September 2022, the American Academy of Pediatrics updated their guidelines for managing neonatal hyperbilirubinemia. The 2004 guidelines were updated to recommend that all newborns be tested with a device to measure bilirubin levels, instead of relying on appearance alone. Since elevated bilirubin levels can have potentially severe consequences if left untreated (including permanent brain damage), this is an important update that could have life-altering outcomes for infants. Additionally, the guidelines were updated to slightly adjust recommendations for phototherapy, which could help to prevent interference with breastfeeding.
2. Prevention & Control of Central Line-associated Blood Stream Infections
In early 2022, the CDC released a 37-page document with updated recommendations for the prevention and control of infections in NICU patients. Specifically designed to address central line-associated blood stream infections (CLABSI), the evidence-based recommendations call for specific practices involving catheter use. To link evidence and recommendations, a GRADE approach was used to evaluate the strength of available evidence.
Specifically, the updated guidelines attempted to answer 14 questions, including:
- Does using non-sterile gloves after hand hygiene compared to hand hygiene alone help to prevent CLABSI?
- Does the use of one central line catheter type compared to another help to prevent CLABSI?
- Does the use of one insertion site compared to another help to prevent CLABSI?
Since guidelines are extensive and are being published in a segmental manner as sections are completed, NNPs should review the latest documents and check back with the CDC continuously.
3. Updates to Neonatal Resuscitation Program & Guidelines
Since its first release in 1987, the American Heart Association and American Academy of Pediatrics Neonatal Resuscitation Program® has been the standard on which clinicians have been trained to provide neonatal resuscitation. Although the basic approach, which emphasizes the importance of teamwork, preparation, and ventilation, has not changed, program was updated in 2020 and several practices were updated.
The 8th edition of the Textbook of Neonatal Resuscitation, published in 2021, featured these changes, which included updates to:
- Pre-birth questions
- Initial steps
- Use of electronic cardiac monitors
- Initial dose of epinephrine
- Flush volume after intravascular epinephrine
- Duration of resuscitation with absent heart rate
The new program also features new textbook components to enhance learning, new course delivery options, and multiple course levels to help NNPs prioritize the material that is most relevant to their role.
Staying up-to-date with clinical guidelines is an important part of any NNP’s career, but it’s also critical to ensure that you’ve found the right career fit for your needs and goals. If you’re an NNP exploring career opportunities, allow Ensearch to help. Contact us for a free career consultation today.
