Neonatology 2

A.Y. 2020/2021
Overall hours
M-PSI/01 MED/38 MED/45
Learning objectives
- Being able to soothe suffering situations, including pain, with nursing interventions in order to improve the quality of life;
- Acquire the knowledge of the main pathologies of the critically ill newborn and their therapeutic approach;
- Acquire the knowledge related to the main monitoring systems of vital parameters and diagnostic findings in the newborn in critical conditions;
- Acquire the basic knowledge that guarantees safe neonatal transport;
- Acquire the knowledge and methods to manage nursing care (from data collection to the evaluation of evidence-based actions and the result) to the newborn with family involvement, which presents with biophysiological, pathophysiological, psychological and socio-cultural symptoms and signs related to critical states of the newborn (term newborn and preterm with/without pathology);
- Know and apply tools for assessing the clinical conditions of the newborn (eg pain, respiratory distress);
- Acquire the skills to establish an effective and adequate communication with family members;
- Acquire the knowledge for the delivery and application of therapeutic educational tools, thus developing appropriate parenting skills;
- Acquire the knowledge to ethically face deontological issues related to neonatal death and to support parents during this delicate phase.
Expected learning outcomes
Knowledge and understanding:
- psycho-social and humanistic sciences for the understanding of normal and pathological relational dynamics, defense or adaptive reactions of the newborn and the family in situations of mental and social distress and physical suffering;
- ethical, legal issues for the understanding of the organizational complexity of the Health Care System, relevance and usefulness of acting in compliance with regulations and procedures, as well as respect for values and ethical dilemmas arising in daily practice; they are also aimed at promoting an understanding of professional autonomy, integration areas and interdependence with other healthcare providers.

Ability to apply knowledge and understanding:
- plan the delivery of nursing care in collaboration with the family and the interdisciplinary care group;
- evaluate the progress of care in collaboration with the interdisciplinary group, guaranteeing continuity of care;
- be responsible for providing and evaluating pediatric nursing care in accordance with professional quality standards and considering legal indications and ethical responsibilities such as newborns' rights.

Knowledge and understanding:
- general and clinical nursing issues for the understanding of pediatric nursing's fields of intervention, clinical method leading to effective clinical approach intervention techniques and evidence supporting the decision making and the delivery of the pediatric nursing care;

Ability to apply knowledge and understanding:
- integrate the knowledge and skills stemming from the nursing discipline, from biomedical, psychological, socio-cultural and humanistic features to recognize the care needs of the newborn and the family and provide appropriate, effective and evidence-based pediatric nursing care;
- apply the nursing care on the basis of the reference disciplinary theoretical models to assess and diagnose health status and care needs in their physical, psychological and socio-cultural dimensions, plan goals, implement and evaluate the care provided and outcomes achieved;
- conduct a complete and systematic evaluation of data relating to the care needs of the newborn to facilitate growth, development and adaptation in health promotion, maintenance and recovery;
- analyze and accurately interpret the data collected through clinical reasoning;
- interpret and apply the results of research to nursing practice and link research paths to the theoretical development of the nursing discipline;
- provide nursing care in different care settings, both in- and out- of-hospital settings.
Course syllabus and organization

Single session

Prerequisites for admission
In order to ensure a balanced career progression consistent with professional training, to obtain enrollment in the second year the student must have passed at least three exams related to the teaching courses, of which:
- Human anatomy and physiology
- Fundamentals of maternal and child care
To obtain enrollment in the third year, the student must have passed at least eight exams, of which, in addition to the exams necessary to obtain enrollment in the second year:
- Pharmacology and Anesthesiology
- Pediatric Sciences II
- Neonatology I
Passing the annual internship exam is a necessary and mandatory condition for enrollment the following year
Assessment methods and Criteria
Written and oral exam
The written exam consists of a test with different types of questions: true-false, completion, correspondence, multiple choice with one or two correct answers, with open questions. The exam is considered passed if all the modules are sufficient. Examination time is 60 minutes
In the oral test the main criteria to be considered in the assessment of the response are the clarity of the exposition, the completeness and correctness of the contents, the ability to link the knowledge
General and subspecialty paediatrics
Course syllabus
Physiopathology of respiratory failure in the preterm infant
Respiratory distress syndrome (with focus in invasive and non-invasive ventilatory support)
Exogenous surfactant treatment in the preterm infant
Complications of respiratory distress syndrome: air leaks syndromes
Bronchopulmonary dysplasia: physiopathology, prevention and treatment
Monitoring systems in the preterm infant with ventilatory support
Cardiovascular problems:
Congenital heart disease
Hemodynamic problems of the premature (PDA, hypotension, hypertension)
Malformative syndromes:
Complex malformative syndromes: how to get diagnosed and what the practical consequences are for the patient and the family
Genetic tests: from karyotype to molecular techniques
Medical complications transversal to malformative syndromes (pediatrics of disability)
Medical complications and syndrome specific emergencies
Hemostasis of the newborn
Metabolic urgencies
Ethics in neonatal intensive care: - general framework
The infectious pathology
Follow-up of the preterm born

Theme Area 4Facilitate and protect mother-child relationship
Develop an understanding of the importance of secure mother-infant attachment and the impact this has on their health and emotional wellbeing.
Oxytocin role in supporting healthy brain development as a function of love / friendship relationships.
Theme Area 5 Spread culture of breastfeeding and proper nutrition for mother and child through effective communication.
Use of effective communication to iniziate mother-centred conversations with pregnant women and new mothers
a. Effective communication skills; theory and practice.
d. Mother and family centred care.
e. Skills required to support families with different languages and cultures.
f. Skills required for providing telephone support.
Teaching methods
The course includes lectures
Teaching Resources
· Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European consensus guidelines on the management of respiratory distress syndrome-2016 Update. Neonatology. 2017;111(2):107-125.
· Committee on Fetus and Newborn; American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics 2014 Jan;133(1):171-4.
· Sardesai S, Biniwale M, Wertheimer F, Garingo A, Ramanathan R. Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future. Pediatr Res. 2017;81(1-2):240-248
· Richard A. Polin, Waldemar A. Carlo and Committee on Fetus and Newborn. Surfactant Replacement Therapy for Preterm and Term Neonates with Respiratory Distress. Pediatrics 2014;133;156.
· Cloherty and Stark's Manual of Neonatal Care, Lippincott, 2016
· Jobe AH. Surfactant function and metabolism. Boynton B.R. New therapies for neonatal respiratory failure. A physiological approach. Cambridge:Cambridge University Press;1994.16.
· Cotton RB. Pathophysiology of hyaline membrane disease. Polin R. Fetal and Neonatal Physiology-4th edition.Volume 1. Elsevier Saunders;2011.1026-34
· Hwang JS,Rehan VK. Recent advances in bronchopulmonary dysplasia: pathophysiology, prevention, and treatment. Lung 2018; 196:129-138
· Thekkeveedu RK, Guaman MC, Shivanna B. Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology .Respiratory Medicine 2017;132:170-177
· Holme N, Chetcuti P. The pathophysiology of respiratory distress syndrome in neonates. Pediatrics and Child Health 2012 ;12:507-512
· Iyengar A, Davis JM. Drug therapy for the prevention and treatment of bronchopulmonary dysplasia. Front Pharmacol. 2015 Feb 16; 6:12.
· Bertino E, Spada E, Occhi L, Coscia A, Giuliani F, Gagliardi L, Gilli G, Bona G, Fabris C, De Curtis M, Milani S.
· Neonatal anthropometric charts: the Italian neonatal study compared with other European studies. J Pediatr
· Gastroenterol Nutr. 2010;51:353-361.
· Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, Adler A, Vera Garcia C, Rohde S, Say L, Lawn JE. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379:2162-2172.
· Consiglio Superiore di Sanità Raccomandazioni per le cure perinatali nelle età gestazionali estremamente basse
· Sessione XLVI- Seduta del 4 marzo 2008
· ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the European
· Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50:85-91.
· ESPGHAN Committee on Nutrition, Aggett PJ, Agostoni C, Axelsson I, De Curtis M, Goulet O, Hernell O, et al Feeding preterm infants after hospital discharge: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2006;42:596-603.
· Mwaniki MK, Atieno M, Lawn JE, Newton CR Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet 2012;379:445-452.
· Orzalesi M, Cuttini M. Ethical issues in neonatal intensive care Ann Ist Super Sanità 201;47: 273-277.
· Raccomandazioni della Società di Neonatologia per la prevenzione delle malattie da virus respiratorio sinciziale. Aggiornamento 2004. Redatto dal Consiglio Direttivo Della Società di Neonatologia. Acta Neonatologica e Pediatrica. 2004; 18:19-29.
· Ronconi A, Corchia C, Bellù R, Gagliardi L, Mosca F, Zanini R, Donati S. Esiti dei neonati di basso peso nelle Terapie Intensive Neonatali partecipanti all'Italian Neonatal Network nel 2008 Rapporti ISTISAN 11/44
Nursing sciences: general, clinical and paediatric
Course syllabus
Characteristics of newborn admitted in NICU
Reasons for NICU admission
Welcoming newborn admitted from DR (Delivery Room) or other Unit, other hospital or arriving from home
NICU bed equipment, monitoring and positioning newborn in incubator
Data collection
Newborn assessment
Acquire knowledge about respiratory activity of the newborn
Detect respiratory failure signs
Acquire knowledge about supporting respiratory activity
Nursing care of the newborn with respiratory disease requiring invasive or non-invasive ventilation (distress respiratory syndrome, air leak syndrome, meconium aspiration syndrome, congenital diaphragmatic hernia, bronchopulmonary dysplasia)
Nursing techniques
Vital signs monitoring
NCPAP equipment and management
Intubation procedure
Ventilator equipment and management
Inhaled nitric oxide therapy equipment and management
Surfactant administration
Chest tube positioning procedure
Tracheostomy management
Laryngeal mask management
Promote breastfeeding in newborn in NICU
Spread breastfeeding culture through effective communication
Detect urinary tract signs and symptoms
Nursing care of the newborn affected by renal failure
Monitoring fluid balances and electrolyte levels
Nursing care of the newborn affected by surgical gastrointestinal tract alteration, with special reference to after surgery nursing care
Nursing techniques
Dressing and management of peritoneal dialysis catheter
Paracentesis procedure
Theme Area 3 Manage of challenges which may arise at any time during breastfeeding
Be able to apply their knowledge of the physiology of lactation and infant feeding to support effective management of challenges which may arise at any time during breastfeeding.
a. Expression of breastmilk to include hand and pump expression technique.
b. How to feed the newborn when it is unable to breastfeed: benefits and risks .
c. Initiating and sustaining lactation when mother and baby are separated including sick and preterm infants or hypoglycaemia risk.
d. Supporting breastfeeding where there are maternal health issues (e.g. diabetes).
f. Situations when breastfeeding is not recommended.
Theme Area 5 Spread culture of breastfeeding and proper nutrition for mother and child through effective communication.
Use of effective communication to iniziate mother-centred conversations with pregnant women and new mothers
a. Effective communication skills; theory and practice.
d. Mother and family centred care.
e. Skills required to support families with different languages and cultures.
f. Skills required for providing telephone support.
Teaching methods
The course includes lectures and activities of an interactive and practical nature
Teaching Resources
Pediatria generale e specialistica P.Careddu Casa Editrice Ambrosiana
NURSING PRACTICE & SKILL Mechanical Ventilation in the Neonate: Monitoring Author Carita Caple, RN, BSN, MSHS Reviewers Eliza Schub, BSN, RN Cinahl Information Systems Glendale, California Nursing Practice Council Glendale Adventist Medical Center Glendale, California Editor Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems August 5, 2011
EVIDENCE-BASED GUIDELINE FOR SUCTIONING THE INTUBATED NEONATE AND INFANT Denice L. Gardner, neonatal nurse practitioner - board certified, master of science in nursing. Lee Shirland, neonatal nurse practitioner - board certified, master of science. Neonatal Network, vol. 28, No. 5, September/October 2008
Effect of nasal continuous positive air way pressure and cannula use in the neonatal intensive care unit setting. Jatana, Oplateck, Stein, Phillips, Kang. Arch Otolaryngol Head Neck Surg. 2010;136(3):287-291.
SKILL Competency checklist Mechanical Ventilation in the Neonate: Monitoring Author Carita Caple, RN, BSN, MSHS Editor Diane Pravikoff, RN, PhD, FAAN Cinahl Information Systems August 5, 2011
A nurse's Guide to Common Mechanical Ventilation Techniques and Modes Used in Infants- Nursing Implications Timothy M. Snow, Rn,NNP Debra H. Brandon Rn Phd CCNS Advances in Neonatal Care vol7 No 1 pp 8-21 2007)
Procedure infermieristiche in pediatria, Badon P Zampieron A edizione CEA pag.412-414 2010
Puntura arteriosa Paola Di Giulio Tratto da NURSINGFAD IPASVI MI-LO-MB "Quesiti clinico-assistenziali" Evidence based nursing N.3/2012 IJN
Procedura aziendale Fondazione IRCCS Ca' Granda - Terapia Intensiva Neonatale TRATTAMENTO DELL'INSUFFICIENZA RESPIRATORIA DEL NEONATO Redazione : Mosca Fabio Colnaghi Mariarosa
Tracheostomy in Infants: Parent Education for Home Care Rachel A. Joseph, MA, MSN, CCRN N E O N ATAL NETWORK VO L . 3 0 , N O . 4 , J U LY / AU G U S T 2 0 1 1
Come si gestisce la tracheostomia nel bambino Analisi critica della gestione della tracheostomia nel bambino realizzata in "Rianimazione Pediatrica" in base alle evidenze scientifiche Autori Rapacchiani Patrizia ,,
Effect of silicon gel sheeting in nasal injury associated with nasal CPAP in preterm infants. Gunlemez, Isken, Gokalp, Turker. Indian pediatr. 2010;47(3): 265-7
Incidence and risk factors of pressure ulcers in seven neonatal intensive care units in Japan: a multisite prospective color study. Fujii, Sugama, Okuwa, Sanada. Int Wound J 2010; Vol7, N°5: 323-328.
Prevention of nasal injury secondary to nasal continuous positive airway pressure in ELBW. Quires, Hyndman. Rete neonatale 2009, 28(1):13.27
Nasal Continuous Positive Airway Pressure (CPAP) for the Respiratory Care of the Newborn Infant. Robert M DiBlasi RRT-NPS. RESPIRATORY CARE.- SEPTEMBER 2009 VOL 54 NO 9
General psychology
Course syllabus
- Knowledge of methods and modalities of communication with family members in relation to the patient / user and the health care team
- Knowing of one's own behavior and that of the persons / family members involved in the disease and the type of relationship that follows
- Death and dying: to know the meaning of the "emotional burden" by the operators derived from the management of the relational dynamics between the operators themselves, caregivers and users
- Awareness of the degree of knowledge and experience in critical situations concerning the accompaniment to death, sudden death and palliative care
- Promoting the level of self-efficacy perceived by the operator through the development of concrete strategies for controlling events and stress-relief dynamics related to death
- Strengthen resilience skills considered protective against emotional exhaustion
- Genesis of conflicts over suffering
- Empathic listening: communicate effectively the discomfort, feelings and emotions that are a constant component of daily working life in care and assistance.
Teaching methods
The course includes lectures and interactive activities
Teaching Resources
G. Morasso: Cancro: curare i bisogni del malato. Il pensiero scientifico
M. Luise von Franz: La morte e i sogni. Bollati Boringhieri
F. Toscani: Il malato terminale. Il Saggiatore
E.Kubler- Ross: La morte e il morire. Cittadella edizioni
G.C. Zapparoli, E. Adler Segre: Vivere e morire. Feltrinelli 1997
N. Elias: La solitudine del morente. Il mulino 1983
S. Natoli:L'esperienza del dolore. Feltrinelli 1986
General and subspecialty paediatrics
MED/38 - PAEDIATRICS - University credits: 2
Lessons: 30 hours
Professor: Mosca Fabio
General psychology
M-PSI/01 - GENERAL PSYCHOLOGY - University credits: 1
Lessons: 15 hours
Nursing sciences: general, clinical and paediatric
MED/45 - NURSING - University credits: 2
Lessons: 30 hours