Report from Council of International Neonatal Nurses (COINN) 2019, attended by Dr Yvonne Freer, Clinical Reader in Neonatology - part funding provided by SSCB.
The 10th COINN meeting was held in Auckland, the "City of Sails" New Zealand. This beautiful city, built on a narrow isthmus of land, is known for its stunning waterfront and multi-cultural population.
The conference venue was located at the SkyCity Auckland Convention Centre in the heart of the city’s central business district. For over three-and-a-half-days, we experienced a wonderful event of networking with colleagues from around the world and listening and learning from exciting and thought provoking presentations – the theme of the event was Enriched Family – Enhanced Care.
As there were so many wonderful presentations, I will focus on just a few for this report.
Enriched Family – Enhanced Care (Whannau/Ko e Fakakoloa’o e Famili, share the care) was opened in both English and Maori by a Welcome (Pōwhiri) ceremony that included story-telling, singing, dancing and the famous Haka.
We were challenged on what it is to be ‘community’ and what if anything was our role in. Carol Kenner and Kerri Nuku then went on to talk about neonatal nursing in the global context and our contribution in caring for baby, whānau and wider community.
Carol outlined the purpose of COINN since its incorporation in 2005 – it now represents neonatal nurses in over 60 countries, and is affiliated to 14 national neonatal nursing organisation including the Scottish Neonatal Nurses Group. As an organisation she championed the view that ‘one can make a difference’ but ‘two can change the world’ through teaming. With this in mind COINN now works in partnership with Save the Children, WHO, USAID, ICM, ICN, IPA, Project Hope and Partners in Health.
Dr Heidelise Als presented both at the beginning and the end of the conference on her work on protecting the fetal/newborn brain. She compared the in-utero environment and expectations of the fetus with the sights, sounds and activities of the NICU. Her Synactive model of development was explained as were approaches to care, using NIDCAP, by staff and parents as collaborators to improve the situation for the baby. NIDCAP as an approach to care delivery was advocated because although many units provided developmentally appropriate/supportive care, the challenge was to “to achieve consistent, nursery- wide care implementation supportive of infant, family and staff development and the environment”. She believed the structure and implementation of NIDCAP met this challenge and offered strategies for transformation change to achieve unit buy in to the theory and practice.
A wonderful presentation was given by Dr Nikki Turner, an expert advisor to WHO. She explained that although there has been substantial innovation in vaccine development over the last 15 years, and significant increase in vaccine exposure, there remains a number of challenges to meeting vaccine targets. These include: demographic shifts, fragile states, conflict and migration, climate change, urbanization, antimicrobial resistance, outbreaks, epidemics, pandemics and inequities in wealth, health and security. She alluded to the rising phenomena of vaccine hesitancy but was more optimistic about its effect than what is currently portrayed in the press and social media. She concluded by showing us how technology is changing the vaccine landscape especially for low resource populations.
Professor Dieter Wolke spoke eloquently on adult outcomes following extreme preterm birth. He focused on the Bavarian longitudinal study (birth cohort of 1985-86) and the EPIcure study (birth cohort 1995). Essentially, extreme preterm infant survival has increased but their quality of life has changed very little. As children and adults they perform poorly in all aspects of cognition and have multiple rather than cognitive deficits; there is little change though in deficits between childhood and adulthood. He showed MRI images of structural and network alterations due to neonatal complications which are associated with adult IQ. Although anxiety and attention disorders are more prevalent in those individuals who were very preterm there is little evidence for depressive disorders. As children and adults, individuals are more often socially withdrawn, have poorer social relationships with peers and are less likely to partner, they are more likely to be bullied and they report poorer quality of life related to economic and social functioning. However he was optimistic that many of these factors are modifiable by optimal parenting and peer relationships and better social integration and development.
Rachael Callander received a standing ovation for her reflections, as a mother of a baby admitted to a NICU, on the language used by health professionals describing her baby, baby’s condition and likely outcome. The most memorable line was not to use ‘language of subtraction’ when describing someone; a ‘condition’ isn’t life limiting, after all, life itself is limiting. She spoke about her daughter Evie with joy and humour as well as the very confusing and dark moments of grief and loss in knowing that her life would be short. You can read her story on www.rachelcallander.co
Raylene Philips gave 2 presentations on the neuroscience of nurturing. First she spoke on maximising skin to skin and how to implement unrestricted contact time between parent and baby as this is the “developmentally expected environment for all mammals and is especially important for supporting physiological stability and optimal neurodevelopment in preterm infants”. Then there was a session on what her unit has termed the 7 Core Measures of Neuroprotective Family Centered Developmental Care. Key take home messages are that neuro-protective care usually begins with a few motivated caregivers and promotion of optimal care comes about through role modelling, mentoring and collaboration.
There was a panel discussion on ‘What is best for baby and What is optimal growth for babies born premature’. The 4 speakers (a neonatologist, a dietician, a mother and nurse) each presented different perspective to understanding what is meant by nutrition and growth but together gave a good overview of the challenges in knowing what to measure, how to measure it and then in defining optimal growth.
The concurrent sessions offered am eclectic mix of presentations themed under Baby, Family, NICU, Community and Global.
There were a number of presentations about clinical practice - I was particularly interested in respiratory and feeding outcomes as they are QI initiatives I have been involved with. Whilst interesting to hear what is happening in other areas of the world, I didn’t come away thinking I would change my practice.
I was keen to hear about nurse education, how it is delivered in different healthcare settings and what effect an informed nursing workforce has on patient outcomes. I was particularly impressed by a presentation on ‘Effects of nursing care on cerebral oxygenation’; this team of researchers showed of routine nursing practices may reduce cerebral oxygenation as measured by NIRS. The log term effect of this is unknown.
Ruth Davidge spoke passionately about developing and implementing governance standards to improve the provision of care in Kwa-Zulu, Natal SA; progress has been slow as staff were sceptical and resistant to measure and change but positive outcomes are now being seen in the quality of their care. Karen Walker talked about COINN and their work in Rwanda; a subsequent presentation by Andre Ndayambaje described how significant improvements to patient outcomes e.g. hypoglycaemia, hypothermia, sepsis, have been achieved through an education programme for nurses and midwives in district hospitals in Rwanda – truly inspiring work.
A poster that caught my eye said “ If you think you are too small to make a difference, try sleeping with a mosquito” (An African Proverb).
Conference evening dinners are always a joy as delegates share more than professional interests. This was no exception as the Great Gatsby got underway.
No conference would be possible without the support of sponsors; this conference brought together over 30 companies and organisations to inform, exhibit and demonstrate to delegates their latest products.