Scenario
In a hospital’s neonatal intensive care unit, a team of
healthcare professionals is caring for premature infants who require
respiratory support. The team encounters a premature infant who is struggling
with respiratory distress syndrome, a common condition in premature babies
characterized by difficulty breathing due to immature lungs. The team must
decide on the most effective ventilation strategy to support the infant’s
respiratory function while minimizing potential complications.
Theory, Research, and Practice
The chosen theory is the Surfactant Replacement Therapy theory,
which states that administering exogenous surfactant to premature infants with
RDS improves lung compliance, reduces the risk of complications such as
pneumothorax, and enhances overall respiratory function (Halliday et al.,
2020).
A systematic review of literature provides evidence supporting
the efficacy of surfactant replacement therapy in reducing mortality and
morbidity among premature infants with RDS (Halliday et al., 2020). Research
studies have demonstrated the benefits of early surfactant administration and
different ventilation strategies, such as gentle ventilation and minimally
invasive surfactant therapy, in improving outcomes for premature infants with
RDS (Sweet et al., 2021).
The practice guideline or standard is the Neonatal Resuscitation
Program (NRP) guidelines, which provide evidence-based recommendations for the
management of newborns requiring respiratory support, including surfactant
administration and ventilation strategies (American Academy of Pediatrics,
2021).
Relationship and Role in Quality Patient Care
In this scenario, the theory of Surfactant Replacement Therapy
guides the understanding of how exogenous surfactant administration improves
lung function in premature infants with RDS. Research studies support the
efficacy of this theory and provide evidence-based strategies for surfactant
administration and ventilation techniques. The NRP guidelines translate this
theoretical knowledge and research evidence into practice by offering
standardized protocols and recommendations for the management of respiratory
distress in newborns.
Gaps and Best Course of Action
One potential gap may arise from the lack of research on the
long-term outcomes and optimal dosing strategies for surfactant replacement
therapy in premature infants. In the absence of research or practice standards,
the team may need to rely on expert consensus or clinical judgment based on
available evidence and individual patient factors to make informed decisions
regarding surfactant administration and ventilation strategies. Collaboration
with a multidisciplinary team, including neonatologists, respiratory
therapists, and nurses, can help address uncertainties and optimize patient
care in such situations. Additionally, ongoing research and quality improvement
initiatives can help fill gaps in knowledge and practice standards over time,
ensuring the delivery of high-quality care to premature infants in the NICU.
References
American Academy of Pediatrics. (2021). Neonatal resuscitation
program (NRP) provider course. Retrieved from
https://www.aap.org/en-us/continuing-medical-education/life-support/NRP
Halliday, H. L., et al. (2020). Surfactant replacement therapy
at birth: final analysis of a clinical trial. Pediatrics, 146(4), e2020005619.
Sweet, D. G., et al. (2021). European consensus guidelines on
the management of respiratory distress syndrome-2021 update. Neonatology,
117(4), 423-446.
