Neonatology 1

A.Y. 2021/2022
Overall hours
MED/20 MED/34 MED/38 MED/45
Learning objectives
-To acquire the knowledge related to the mechanisms that regulate adaptation to extrauterine life;
- To acquire knowledge on the main functional characteristics of the healthy and sick newborn;
- To acquire knowledge on the main neonatal diseases and their therapeutic approach;
- To develop knowledge related to maternal breastfeeding for women and children, in the short and long term;
- Training in the protection, promotion and support of breastfeeding during healthcare (practical management and breastfeeding counseling);
- To know the main neonatal surgical diseases and their therapeutic approach;
- To acquire an adequate knowledge of the main rehabilitative interventions related to the most frequent developmental age disabilities;
- Activate and support the residual abilities during the developmental stage to promote adaptation to the disease-related limitations and to the modification of lifestyles;
- To 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);
- To know and apply tools for assessing the clinical conditions of the newborn (eg pain, respiratory distress);
- To develop manual skills to train students in the therapeutic and diagnostic procedures, according to planned interventions and actions based on standards and scientific evidence (Professional Laboratory 2);
- To apply data collection methods for the identification of nursing care needs related to acute and chronic illnesses of medical or surgical relevance of the preterm infant and to plan nursing care. Records will be based on the theoretical reference model, evaluation of actions and expected results (Professional Laboratory 2).
Expected learning outcomes
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;
- To 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;
- To 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;
- To analyze and accurately interpret the data collected through clinical reasoning;
- provide nursing care in different care settings, both in- and out- of-hospital settings
Course syllabus and organization

Single session

More specific information on the delivery modes of training activities for academic year 2021/22 will be provided over the coming months, based on the evolution of the public health situation.
Prerequisites for admission
To obtain enrollment in the second year, the student must have passed at least three exams related to teaching courses, of which: - Human anatomy and physiology, Fundamentals of maternal and child care. Passing the annual internship exam is a necessary and mandatory condition to obtain registration for the following year
Assessment methods and Criteria
Written and oral exam
The written exam which consists of a test with different types of questions: true-false, completion, correspondence, multiple choice with one or two correct answers, is considered passed if all the modules are sufficient, performance time 90 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.
The lessons will be delivered through microsoft Teams platform and the exams will be held orally on the moodle or microsoft teams platform
Paediatric surgery
Course syllabus
· Oesophageal Atresia
· Duodenal and small bowel atresia
· Anorectal Malformations: classification and management
· Surgical aspects of necrotising Enterocolitis ( NEC )
· Idiopatic small bowel perforation in newborns
· Anterior abdominal defects: classification and surgical management
· Prenatal and neoanatal management of sacrococcigeal teratoma.
· Hypertrofic Pyloric Stenosis
· Congenital Lung Malformations: classification and management.
· Undescended testis and torsion of the gonade.
· Midgut volvolus

Baby Friendly University
3 Manage of challenges which may arise at any time during breastfeeding
2.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.
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.
e. Support for mothers returning to work or inserting a child in daycare.
4 Facilitate and protect mother-child relationship
2. Be able to apply their knowledge of attachment theory to promote and encourage close and loving relationships between mothers and babies.
a. Strengthen mother's confidence in herself and in her ability to feed and care her baby.
b. Support mothers who formula feeding the baby in recognizing the baby's hunger signs
5 Spread culture of breastfeeding and proper nutrition for mother and child through effective communication.
Tutoring with IBCLC Consultants
1. Use of effective communication to iniziate mother-centred conversations with pregnant women and new mothers
c. Debrief of personal breastfeeding stories.
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
Chirurgia pediatrica - M. Lima, G. Ruggeri - Edises - 2015
Physical and rehabilitation medicine
Course syllabus
· Concepts and Meanings of Rehabilitation and Re-education.
· International Classification of Functioning - Children and Youth (ICF-CY): ICF and concepts of "body function and structure, activity and partecipation, environment".
· Early Intervention and Family Centered Care.
· Neurofunctional assessment (NFA) and musculoskeletal disorders in childhood.
· Observation tools in premature infants: spontaneous spontaneous motricity and General Movements (GMs); evoked motricity for prognosis and intervention.
· The premature baby: the main neurodevelopmental disorders during follow-up; major and minor impairments.
· Cerebral palsy: etiology and classification.
· The hypotonic newborn; overviews of muscle and neuromuscular diseases.
· Postural development and postural abnormalities of the child.
· Musculoskeletal system and main diseases in childhood: plagiocephaly, cyphosis, scoliosis, obstetric paralysis, congenital hip dysplasia.
Teaching methods
The course includes lectures and interactive activities
Teaching Resources
Schwarz Tiene Manuale di pediatria CEA
G.V. Zuccotti - Manuale di pediatria. La Pratica Clinica . Ed. Esculapio Medicina II ed. 2016
General and subspecialty paediatrics
Course syllabus
The newborn with respiratory pathology: Elements of the development of the respiratory system and adaptation to extrauterine life, Transient tachypnea of the newborn, Meconium aspiration syndrome, Pulmonary hypertension, Malformative pathology of the respiratory system
Gestational age assessment.
Neurological physical examination.
Neurological pathology of the term infant: hypoxic-ischemic encephalopathy
Neonatal seizures
Neurological pathology of the preterm born: intraventricular hemorrhage, white matter disease
Neonatal infections: risk factors, causative agents, symptoms, diagnosis and therapy
Vertical infections: Group B beta-hemolytic streptococcus
Vertical infections: TORCH group (Toxoplasmosis, Cytomegalovirus, Herpes Simplex virus, etc.)
Nosocomial infections: catheter-related infections
Nosocomial infections: epidemic events in Neonatal Intensive Care
Virus and breast milk
Acid-base balance. Hypoglycemia. Electrolyte disturbances.
The newborn with pathological jaundice
Late preterm newborn
Pain in the newborn
The biological specificity of breast milk
- Milk synthesis and types of milk (colostrum, transition milk, mature milk, first and second milk)
- Energy value, volume and growth of the baby in the first weeks of life
- Nutrients (fats, lactose, proteins, vitamins and micronutrients, minerals) of the milk of women who have given birth at term and preterm
- Immunological, anti-infectious factors and bioactive components (enzymes, hormones, growth factors, taurine)
- Which formula for children who cannot be breastfed
- How to prevent the risks of formula contamination
Sucking physiology
- Breastfeeding and the reflexes of the newborn
- Breastfeeding: the coordination between sucking, swallowing and breathing
- The relationship between milk flow and coordination between sucking, swallowing and breathing
- Frequency of meals
- The influence of anatomical and structural factors on sucking skills (ankyloglossia, micrognathy and mandibular hypoplasia, macroglossia, labiopalatoschisis, etc.)
- Differences between breastfeeding and bottle feeding
Impact of childbirth and labor practices on sucking the newborn
- Induction of labor and maturity of the newborn
- Drugs and their effect on sucking, swallowing and / or breathing
- Mechanical effects of birth procedures
- Maintain lactation in the event of a mother-infant separation
- Notes on the use of the mastosuctor (manual, electric)
- Role of the pediatric nurse in helping mothers and babies in breastfeeding
Breastfeeding in infants with minimal pathology or in the presence of maternal pathologies
- Delayed lactogenesis
- Jaundice
- Hypoglycemia
- Sinus rejection and attachment problems
- Gemini
- Breastfeeding and maternal drugs
- Maternal pathologies (diabetes, obesity, rheumatoid arthritis, hypertension, depression, etc.)
Teaching methods
the course includes lectures and interactive activities
Teaching Resources
Schwarz Tiene Manuale di pediatria CEA
Janet M. Rennie Robertson's Textbook of Neonatology 4ed. Elsevier Churchill Livingstone
G.V. Zuccotti - Manuale di pediatria. La Pratica Clinica . Ed. Esculapio Medicina II ed. 2016
Nursing sciences: general, clinical and paediatric
Course syllabus
Nursing need of nutrition and hydration
Nutritional problems of the preterm newborn and different types of feeding: parenteral nutrition, Minimal Enteral Feeding, Continuous Enteral Nutrition, Feeding for Gavage-breast-bottle feeding, Feeding through PEG
Promote breastfeeding in the preterm or pathological newborn
Feeding techniques of the preterm or pathological newborn (breast, syringe, small glass, baby bottle)
Know the qualitative and quantitative characteristics of gastric stagnation
Recognize, report and attend if there are signs of food intolerance
Assist the newborn with surgical pathology of the gastro-intestinal tract (esophageal atresia, nec, intestinal atresie) and restart of post-surgical nutrition
Educational interventions towards parents:
a) Teach parents to be able to recognize signs of hunger and signs of satiety
b) Teach parents the weight measurement - double weighing indications
c) Teach parents how to start stimulation of nutritional suction
d) Teach the mother the importance of Kangaroo mother care for breastfeeding purposes
Positioning techniques for the orogastric tube and nasogastric tube
Nursing need of Urinary and intestinal elimination
Know the characteristics of urine
Monitor diuresis: the weight of the diaper or urine collection through the bag
Know the characteristics of faeces
Detect signs and symptoms of pathology affecting the abdomen
Assist the newborn with surgical pathology of the gastro-intestinal tract (intestinal atresie, omphalocele wall defects and gastroschisis, intestinal obstruction, congenital malformations of the anus and rectum, NEC ...)
Technique for the application of the non-sterile urine bag for urine examination
Technique for the application of the sterile urine bag for urine culture
Preparation of the material and techniques for enteroclisma

Sleep - Rest Pattern
The importance of sleep in the preterm infant for the promotion of neurobehavioral development
The behavioral states
Guarantee the sleep-wake rhythms
Guarantee macro and micro environment care useful to promote sleep of the preterm infant
Educational interventions towards parents
Provide simple information to parents about the behavioral states of the preterm infant

Activity - Exercise Pattern
postural attitude of the preterm
Postural care: correct positioning, preventing the onset of decubitus and plagiocephaly
The aids for the correct positioning of the newborn and encourage its containment (nest, wrapping, pillow from prone)
Stabilization of the newborn: holding through the hands and body of the caregiver
Newborn mobilization experiences: handling

Role - Relationship Pattern
The importance of the mother-child relationship
Promote early contact of parents with their child
The synactive theory (Als)
The Kangaroo mother care

Coping - Stress Tolerance Pattern
Be able to observe the signs of stress and stabilization of the newborn

Intestinal ostomy management

Cognitive - Perceptual Pattern
Signs of pain in the newborn
Apply non-pharmacological techniques for pain prevention and control
Apply the main neonatal related pain score
Teaching methods
frontal presentations and activities of an exercise and interactive nature
Teaching Resources
Chirurgia pediatrica - M. Lima, G. Ruggeri - Edises - 2015
Lab 2
Course syllabus
Activity - Exercise Pattern
General principles for hygiene of the preterm infant
Educational interventions towards parents:
a) Teach parents to change diapers on the changing table and in the incubator
b) Teach parents the immersion bath
Nursing techniques for immersion baths, in incubators and sponging
Know how to clean the incubator and daily linen change
Know and understand the respiratory activity in the preterm infant
Detect signs of respiratory failure
Maintenance of airway patency and assessment of the quality and quantity of secretions
Nursing assistance to the newborn in the main respiratory diseases that don't require invasive ventilatory assistance (mild respiratory failure, transient tachypnea of the newborn, preterm apnea, meconium inhalation in the vigorous newborn)
Know the postures that facilitate breathing
Detect and interpret respiratory rate and arterial oxygen saturation
Oxygen therapy
Know the main devices for oxygen therapy: nose-cannulas, vapotherm, free-flow O2, incubator O2
Know the thermoregulation of the preterm infant
Ensure a microclimate to keep normal temperature of the newborn
Know the characteristics of incubators
Maintain an adequate body temperature in neonatal island, during transport from the delivery room and during other transports
Maintain adequate body temperature during different nursing care
Identify hypothermia and hyperthermia
Know and interpret heart rate in preterm
Detect and interpret changes in heart rate and skin color
Detect and interpret arterial pressure
Monitoring of the hydro-electrolyte balance
Methods for detecting heart rate, respiratory rate, blood pressure, body temperature, SatO2
· Heart rate monitoring, respiratory rate, blood pressure, body temperature, SatO2
· Know the normal range of heart rate, respiratory rate, blood pressure, body temperature, SatO2
· Know the alarm limits to be set on the monitors
· Nursing techniques in case of hypo / hyperthermia of the newborn

Nutritional - Metabolic Pattern
Evaluate the skin (Detect redness, erythema or pustules)
Risk assessment of injury
Educational interventions towards parents:
a) Teach parents to observe the skin of the newborn
Detect skin lesions (pressure injuries, diaper rash, chemical and physical lesions, tear injuries) and strategies to prevent them

Health Perception - Health Management Pattern
Care of the micro and macro environment
Prevent and control noise and the correct use of light sources
Ensure maintenance of the incubator and its cleaning and disinfection
Prevent and control hospital infections
Assist the newborn with neonatal infection
Preparation of the newborn and assistance during the execution of the lumbar puncture

Vascular accesses
Difference between the various types of PICCs
Positioning of a peripheral intravenous access (CVP)
Positioning of a PICC
Management of CVP and PICC
Execution of venous blood sampling and blood culture
Teaching methods
Frontal presentations and activities of an exercise and interactive nature. Demonstration lessons in the department (in group)
Teaching Resources
Il modello delle prestazioni infermieristiche di M. Cantarelli-Masson
Manuale di nursing pediatrico- Badon ed. CEA
Procedure infermieristiche in pediatria. Badon, Zampieron
Atlas of Procedures in neonatology. Mhairi G. MacDonald
Metodologia infermieristica applicata di S. Ortelli-Masson
Infermieristica clinica materno-infantile di Gialli, Miragoli, Rocchi, Stefanel - Hoepli
Developmental care of newborn e infants a guide for health professionals - C. Kenner, J.Mcgrath N.a.n.n. Mosby
Principi di neonatologia Puericultura e Pediatria neonatale Maglietta V, Vecchi CEA 2001
Percorsi assistenziali neonatologici. Romagnoli C
Bibliografia specifica per allattamento
General and subspecialty paediatrics
MED/38 - PAEDIATRICS - University credits: 3
Lessons: 45 hours
Lab 2
MED/45 - NURSING - University credits: 1
Lessons: 15 hours
Nursing sciences: general, clinical and paediatric
MED/45 - NURSING - University credits: 2
Lessons: 30 hours
Professor: Magnani Silvia
Paediatric surgery
MED/20 - PAEDIATRIC SURGERY - University credits: 1
Lessons: 15 hours
Professor: Leva Ernesto
Physical and rehabilitation medicine
Lessons: 15 hours
Professor: Picciolini Odoardo