RADIATION DOSES OF X-RAYS IN PREMATURE INFANTS FOUND TO BE LOW
Donadieu J, Zeghnoun A, Roudier C, Maccia C, Pirard P, Andre C, Adamsbaum C, Kalifa G, Legmann P, Jarreau PH. Cumulative effective doses delivered by radiographs to preterm infants in a neonatal intensive care unit. Pediatrics. 2006;117(3):882-888.
Premature infants receive many radiographs during their hospitalizations. However, the frequency and intensity of the x-rays have not been quantified through research. This retrospective chart review study looked at the type and total radiation levels received by premature infants to see what levels were actually absorbed by the infants.
This study was carried out in one level III neonatal intensive care unit in Paris, France. The charts of 450 premature infants born less than 34 weeks gestation between January 2002 and June 2003 were reviewed. All of the infants' x-rays were in the charts and were also reviewed. Data regarding the gestational age, birthweight, infection, persistent ductus arteriosus, respiratory illness, and gastrointestinal illness during the hospitalizations in the neonatal intensive care unit were gathered from the charts. The history of mechanical ventilation and central venous catheter use was also collected. X-rays taken of the infants were also reviewed and were classified according to the organs that were in the radiographic field. The overall dose of radiation was determined by a software program that compared the standard levels of radiation per x-ray to the areas of the body that were seen in the x-ray.
The results showed that the average number of x-rays that each infant received was 10.6 over an average hospitalization of 16 days. Almost half (46.4%) of the total x-rays were of the chest and abdomen in one picture, with most of these in the smallest of the infants. The researchers acknowledged that the smaller and younger the infants, the more likely that they needed more x-rays and that more organs would be in the field; however, these data were significant when this was controlled for statistically. It was interesting to note that the higher levels of radiation were seen in infants who experienced feeding intolerance or necrotizing enterocolitis. Infants with respiratory disorders had a lower cumulative dose of radiation from the x-rays.
Overall, the total doses of radiation were moderate and were not of a concern to the researchers, supporting the proposition that the number of x-rays that premature infants receive are not of a deleterious nature to the well-being of the infants. However, the researchers recommended that x-rays be taken only when absolutely necessary and that shielding be used to reduce the exposure of radiation to organs in the premature infant that are not the subject of the x-ray.
'PARENTAL ROLE CONFLICT' NURSING DIAGNOSIS VALIDATED FOR NEONATAL INTENSIVE CARE UNIT USE
Carmona EV, Lopes MHBM. Content validation of parental role conflict in the neonatal intensive care unit. International Journal of Nursing Terminologies and Classifications. 2006;17(1):3-9.
Nursing diagnoses are used in all areas of nursing and in all types of units. The nursing diagnoses used in child health should also apply to neonatal nursing care. This study sought to validate the use of the nursing diagnosis of "parental role conflict" in a neonatal intensive care setting.
Researchers in Brazil used the Fehring Diagnostic Content Validation Model to provide a framework to a survey of nurses who worked in neonatal intensive care units. These nurses (N = 59) were asked to review 19 operational definitions regarding parental role conflict that had been gleaned from the literature. The definitions were weighted on a Likert scale, from being absolutely noncharacteristic to very characteristic (scale of 1-5). The scores were then tallied. Characteristics that garnered an average of 0.80 or higher were considered to be major, whereas those that had an average from 0.50 to 0.80 were considered to be minor.
The data showed that 4 of the operational definitions were considered to be major. These were related to having the mother expressing concerns about being inadequate to give the child care during the hospitalization (0.92) or at home (0.88), concerns about the parental role (0.88), and concerns about family health (0.87). The rest were considered to be minor characteristics, which ranged from 0.52 to 0.77.
The researchers did acknowledge that translation from English to Portuguese might have influenced some results and that more research is needed. However, it is extremely important to see that the use of the NANDA diagnosis of parental role conflict was pertinent to the neonatal intensive care unit setting and that nurses who care for infants in those settings need to consider the concerns that the mothers (and fathers) have regarding their parenting role.