EBP Project: Reducing IVH in NICU .

Posted: November 29th, 2022

EBP Project: Reducing IVH in NICU .

Please all sources need to be within the last 5 years and APA in 7th edition
I will attach paper requirements and systematic review source I had used for this project.

This was systematic review I would like you to include in the paper.
Romantsik, O., Calevo, M. G., & Bruschettini, M. (2017). Head midline position for preventing
the occurrence or extension of germinal matrix-intraventricular hemorrhage in preterm infants. Cochrane Database of Systematic Reviews, (7), 1–30. https://doi.org/10.1002/14651858.cd012362.pub2

EBP Project: Reducing IVH in NICU .

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Intraventricularhemorrhage (IVH) is among the key health issues affecting premature infants. According to Afsharkhas et al (2015), the prevalence of this condition among preterm infants is rising considerablyboth in the country and worldwide. The occurrence of IVH is attributed to adverse health complicationsamong this patient population (Christ et al., 2015). In some case, IVH results to death of the infant in the first few days of life. Death mainly occurs if neonatal nurses fail to implement some intervention measures in time. Consequently, some measures need to be adopted to curb the rising cases ofintraventricularhemorrhage (IVH) among premature infants. Notably, this issue can be addressed by answering the clinical question, “In premature infants born with low birth weight (P), does the practice of putting these patients in a midline head position (I) compared to side to side positioning (C) lower the cases of IVH (O) during the first three days of life (T) in the neonatal intensive care unit setting (S).”

Evidence

Research shows that placing extreme low birth weight premature infants in a midline head position a few days after birth lowers the possibility of IVH among these infants. According to Romantsik, Calevo, and Bruschettini(2017) placing an infant in midline lowers the severity of IVH and mortality associated with the condition.Lying an infant in midline head position enhances cerebral oxygenation and venous drainage of these infants.EBP Project: Reducing IVH in NICU .Thus, this condition is less likely to occur since it is triggered by a lack of adequate oxygen in the cerebral region of the infant. Therefore, many healthcare institutions have incorporated the use of midline head positioning in their infant care units. Additionally, a study conducted by De Bijl-Marcus et al (2017) indicates thatplacing premature infants in a midline head positionenhances cerebral oxygenation. The supply of adequate oxygen in the cerebral region lowers the possibility of IVH among this patient population. Furthermore, a study conducted by Kochan et al (2019), indicates the effectiveness of this intervention measure in preventing IVH among preterm infants. Kochan et al (2019) argue that putting a premature infant in head position enhances cerebrovascular hemodynamics. This practice, in turn, lowers the incidence of IVH among these patients.Finally, Carroll et al (2019), reveal the effectiveness of midline head position in preventing preterm infants from IVH. These researchers claim that pathogenesis of IVH is triggered by the irregular flow of blood in the head and the germinal matrix immaturity. Placing an infant in the midline head position within 72 hours after birth enhances this blood flow. Therefore, this practice minimizes the likelihood of IVH among these infants.

Appraisal of Evidence

Carroll et al. (2019) aimed to establish the effectiveness of placing an infant born between 23 and 28 weeks in midline head position in preventing intraventricular Hemorrhage (IVH). This study is associated with both strengths and weaknesses. On the strengths, the researchers utilized reliable evidence during the study. They analyzed data that was gathered by three and one level-IV and level III NICU respectively. Additionally, they utilized the Wilcoxon two-sample test and Pearson’s chi-square in group comparisons for both continuous and categorical variables. On the weaknesses, the researchers did not give adequate evidence regarding the ineffectiveness of midline head position in lowering the incidence of IVH among preterm infants.EBP Project: Reducing IVH in NICU .

Secondly, the aim of De Bijl-Marcuset al. (2017) was to evaluate the impact of tilting head position on the incidence of IVH among preterm infants. The major strength of this study is the critical analysis of data since only 5 studies were involved during the study. These 5 studies constituted a total of 120 preterm infants. However, the study is attributed to some weaknesses. First, the researchers only included original, published studies, thus resulting in a bias of the literature. Secondly, the lack of uniformity among various aspects of this study prevented the researchers from gathering data for meta-analysis. Also, selection bias resulted since the researchers selected data based on language.EBP Project: Reducing IVH in NICU .

The primary goal of Kochan et al. (2019) was to identify the effect of raising the midline head position of preterm infants in enhancing cardiopulmonary functioning and reducing the incidence of IVH. The major strength of this study was the utilized research design. The researchers randomized these infants to either flat or positions that were elevated to 30 degrees. They documented the cardiopulmonary functioning and the possibility of developing IVH while infants were lying in these positions. Another strength of this study is a clear conclusion that indicated. The authors concluded that placing extreme low birth weight premature infants in an elevated midline head position within 72 hours after birth was safe and minimizes the possibility of severe IVH, thus increasing the chances of survival.Nonetheless, this study had one weakness. It was not possible to establish whether an elevated midline head position could enhance the functioning of cardiopulmonary and lower chances of IVH among the study population by observing the study population for a short while.

Lastly, Romantsik et al. (2017) focused on establishing how head midline position among infants hinders the occurrence or severity of IVH in this patient population. The major strength of this study is utilizing reliable data from clinical trials databases and quasi‐randomized trials. Additionally, the researchers evaluated the eligibility of studies before including them in their work. Also, they utilized standard techniques of the Cochrane Neonatal Review Group in data collection and analysis. Consequently, the results of the study were accurate and valid. On the weaknesses, the inclusion criteria for this study was inaccurate. The researchers only utilized randomized clinical trial, which was carried out in one region, thus resulting in selection bias. Additionally, the included gestational age (≥ 28) was a bit ambiguous since it could be interpreted as 1 to 28 weeks. Also, the postnatal age of 48 hours and below was relatively short to get appropriate results.EBP Project: Reducing IVH in NICU .

Summary of Evidence

            The prevalence of intraventricularhemorrhage (IVH) is high among premature infants, especially those born between 23 and 28 weeks. This condition is associated with fluctuations in the flow of blood in the head regions of these infants. The blood flow can be improved by placing them in midline head position within 3 to 4 days after birth. Additionally, placing this patient population in the midline head position enhances cerebral oxygenation and venous drainage.Therefore, neonatal nurses place extreme low birth weight, premature infants, in a midline head position some days after birth to lower the incidence and severity of IVH.

Conclusion

Placing premature infants who were born with extremely low birth weight in a midline head position after birth has proved to lower the chances of IVH.This intervention has been effective since it improves cerebral oxygenation and venous drainage of these infants significantly. Additionally, placing premature infants in a midline head position enhances cerebral oxygenation. Adequate cerebral oxygenation, in turn, reduces the possibility of IVH among preterm infants. Furthermore, putting a premature infant in head position enhances cerebrovascular hemodynamics, thus lowering the incidence of IVH in these patients. Therefore, lying these infants in a midline head position a few days after their birth is an effective strategy of preventing IVH.

The purpose of this paper is to discuss the evidence that has been gathered to support the EBP project. The paper should include:
1. Introduction (without header) that includes the clinical question with a single intervention and single outcome (formulated using the guidelines in the first paper)My PICOT QUESTION is:The clinical question, therefore, In extreme low birth weight premature infants population (P), does the practice of putting extreme low birth weight premature infants in an midline head position (I) compared to side to side positioning (C) lower the incidence of periventricular-intraventricular hemorrhage (O) during the first three days of life (T) in the neonatal intensive care unit setting (S).EBP Project: Reducing IVH in NICU .

2. Evidence to support the intervention (and its effect on the outcome of interest).
o Three types of sources of evidence (minimum of four total sources within the last five years and one must be a systematic review)
 If there is an Evidence-based Clinical Practice Guideline (EbCPG) that supports the proposed intervention, it must be included.
Systematic review (REQUIRED) – Every paper must include a systematic review that supports the intervention. I used:
Romantsik, O., Calevo, M. G., & Bruschettini, M. (2017). Head midline position for preventing the occurrence or extension of germinal matrix-intraventricular hemorrhage in preterm infants. Cochrane Database of Systematic Reviews, (7), 1–30. https://doi.org/10.1002/14651858.cd012362.pub2
 Individual original research studies that support intervention:
1. Recent original research study/studies on the intervention (REQUIRED) – Serves to provide most current research evidence for practice.
2. Landmark studies – Often the first study that reported the relationship between the intervention and its effect on the outcome.

3. Appraisal of Evidence – Each source of evidence should be summarized and critiqued (identification of strengths and weaknesses) using the criteria from Brown (2014). See example in the assignment folder.EBP Project: Reducing IVH in NICU .
Example of Summary of an Appraisal
See Appendix G – Appraisal Quantitative Study in Brown (2018) Here is how I would summarize the appraisal in Appendix G:
Evangelista et al. (2008) aimed to identify the prevalence of fatigue as well as predictors of fatigue in patients with heart failure. Weaknesses of the study included: convenience sampling, inadequate description of recruitment process, and inclusion of only English-speaking participants. Strengths of the study were, use of measurement tools with established validity and reliability, design appropriate to answer research question, and report published in a peer reviewed journal. The findings of the study were statistically significant and clinically significant, holding promise in improving clinical outcomes for people with heart failure.EBP Project: Reducing IVH in NICU .
4. Summary of Evidence
5. Conclusion of the paper
Needs all 5 components numbered 1-5 in the headers for each section except the introduction.

RUBRIC:
See the Student Resources folder for the Title page Template and for the Frequent Comments I make on student papers regarding APA.
Rubric
PAPER 2
PAPER 2
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeINTRODUCTORY PARAGRAPH INCLUDES:
1. brief background for problem in practice including the initiating trigger, 2. clinical question in narrative form, description of the relationship between proposed intervention on outcome of interest. 15.0 to >8.0 pts
Excellent
All required elements addressed and introduces the issues to be addressed in the paper. 8.0 to >0.0 pts
Missing Content
Only one component addressed or incomplete introduction to the paper. 0.0 pts
No Marks
15.0 pts
This criterion is linked to a Learning OutcomeEVIDENCE:
1. Present the evidence identified to support the intervention on the outcome of interest, 2. Appraisal of each source in narrative form, (a) Summarize strengths and weaknesses, (b) use criteria identified in the Brown textbook; 3. Sources (minimum of four) should be included, (a)Evidence-Based Clinical Guideline – required, if one exists, (b) systematic review(s)- required, (c) Individual (original) studies, 1. Recent original research study/studies – required, 2. Landmark study – recommended. 50.0 to >40.0 pts
Excellent
All elements required included and addressed completely. 40.0 to >30.0 pts
Accomplished
Included all elements however missing or inconclusive information relative to with in the section. 30.0 to >7.0 pts
Developing
Missing two of the main elements and/or incomplete reporting of elements. 7.0 to >0.0 pts
Begining
Two or more of the elements missing and/or incomplete. Difficult to follow the logic of information presented. 0.0 pts
No Marks
50.0 pts
This criterion is linked to a Learning OutcomeSUMMARY of EVIDENCE:
Paragraph summarizing the body of evidence. 10.0 to >0.0 pts
Points 0.0 pts
No Marks
10.0 pts
This criterion is linked to a Learning OutcomeCONCLUSION:
Summarize the paper and provide concluding remarks. 10.0 to >0.0 pts
Points 0.0 pts
No Marks
10.0 pts
This criterion is linked to a Learning OutcomeSTYLE/FORMAT:
(Note: This section is not a percentage of the paper that has the correct format. Points are deducted for each error. Number of points deducted will increase for errors repeated from previous papers.) 1. Writing is clear, well organized, and professional in tone (avoid personal pronouns, colloquialisms, and contractions). 2. Paper is free of errors. 3. Level 1 headings used (use bolded section headings from this rubric). 4. Correct title page template is used. 5. APA format is used throughout the paper. 6. Sources are cited and referenced appropriately using APA format. 7. No more than 5-pages excluding title page and reference list. Pages in excess of five will not be included in the grading. 8. Include your last name in the file name or less additional 5-points after grading. 15.0 to >14.0 pts
Excellent
Free of Errors 14.0 to >0.0 pts
Developing 0.0 pts
No Marks
Greater than 15 errors in the paper relative to the criteria required.
15.0 pts
This criterion is linked to a Learning OutcomeO_5367_03
03. Synthesize the literature to answer the clinical question. 100.0 pts
Exceeds Expectations 80.0 pts
=>80 Meets Expectations 70.0 pts
=< 70 Does Not Meet Expectations
100.0 pts
Total Points: 100.0

EBP Project: Reducing IVH in NICU .