How Neonatal Nurses Are Improving Infant Survival Rates


The neonatal mortality rate decreases with help of neonatal nurses

Premature babies are surviving to live long, healthy lives, thanks to innovative care from neonatal nurses and technology improvements

By Debra Wood, RN, contributor

“In NICU nursing, we have constantly evolved in a direction that integrates specialties and practices,” said Joe Marana, MEd, MSN, RNC-NIC, PHN, nurse manager of the neonatal intensive care unit (NICU) at Mercy Medical Center in Baltimore. 

“The edge of viability is now 22 to 23 weeks [of gestation],” added Gail Bagwell, DNP, APRN, CNS, president of the National Association of Neonatal Nurses (NANN) and a clinical nurse specialist at Nationwide Children's Hospital in Columbus, Ohio. “They can [after NICU care] go home and have normal lives with mom and dad.”

NANN reports about 40,000 low-birth-weight infants are born in the United States each year. Survival rates are 10 times better now than 15 years ago, NANN states.  

“The use of technology in this population has changed so drastically in my career,” said Lori Williams, DNP, RN, RNC-NIC, CCRN, NNP-BC, clinical nurse specialist at the American Family Children’s Hospital at the University of Wisconsin Hospitals and Clinics, Madison and Pediatric Perspectives section editor for AACN Advanced Critical Care.

Early efforts to improve neonatal mortality rates

Much has changed since the first “premature unit” opened in Chicago nearly a century ago. The first “intensive care” unit for preterm infants opened at Yale-New Haven Hospital in Connecticut. Back in those days, adult ventilators were used on the infants. 

Neonatal nurses now know better ways to ventilate some preterm babies exist, such a nasal continuous positive airway pressure.

“It’s less invasive,” said Bagwell, explaining that these small babies’ lungs are undeveloped and the ventilator pushing air in and out of the lungs can damage the tissues. 

Why have neonatal mortality rates decreased?

Neonatal mortality rates have improved due to technological improvements and a greater understanding of successful interventions. 

“Neonatologists and all related disciplines taking care of our population are constantly researching, learning and evolving practice,” Marana said. 

Several factors are associated with improved outcomes, Marana explained.

  • Less is more in many cases.
  • “We are extremely attentive to how necessary any of our interventions are, especially invasive interventions,” Marana reported. “We discontinue invasive lines as soon as we can.” 

  • Listening to babies is critical.
  • “We have evolved our ability to observe and measure infants’ cues and prompts,” Marana said. “A good example is our Infant Drive Feeding process,” which takes into account the individual baby and “incorporates standard cues to assess an infant’s readiness to feed, their quality of feeding and track their reasons for stopping.” 

    The Neonatal Abstinence Syndrome scoring tool has allowed NICU teams to decease days the infant stays on medications. Nurses also intentionally implement nonpharmacological techniques, Marana said. This has led to decreased lengths of stay. 

  • Love is medicine.
  • “We have found ways to quantify components of care in a meaningful way and integrate them with any other clinical interventions,” Marana explained. 

    That includes promoting skin-to-skin care, encouraging parents to hold their infant and perform some care, and involve parents in decisions, feedings and routines.  

Neonatal nurses also now realize that breastmilk is important and leads to better outcomes. Nurses or lactation consultants teach the mother how to pump her milk, if the baby cannot feed at the breast. That human milk can then be fed to the infant through a tube. 

“We highly encourage them to breastfeed,” Bagwell said. 

Scientific advances have contributed to improved outcomes. That includes the discovery of artificial surfactant therapy, which became common in the 1990s, to prevent respiratory distress syndrome; near-infrared spectroscopy to indicate tissue oxygenation levels; and extracorporeal membrane oxygenation.

“I worked with nurses in the early 1980s who did not have things we take for granted today, like peripheral IV catheters, umbilical catheters and ventilators,” Williams said. “I vividly recall the first patient I took care of who received a study dose of surfactant as part of the initial clinical trial.”

How you can be part of improving neonatal survival rates

Nurses may practice in a NICU as a new graduate or after working in another setting. Typically, they receive a lengthy orientation with a preceptor and didactic learning.  

Hospitals seeking NICU travel nurses usually want nurses with experience and require basic life support and pediatric advanced life support credentials. Some employers want the nurse to hold certification, which demonstrates a level of expertise in caring for critically ill newborns. 

Nurses and the entire neonatal team continuously work to improve the outcomes for critically ill newborns and bring down the neonatal mortality rate. They experience the rewards of starting these babies off with the best care possible.

If you are an experienced NICU nurse, has dozens of neonatal travel nurse jobs across the U.S. that can advance your career. APPLY TODAY to take the next step.


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