Leave and employment in families of preterm low birthweight infants

OBJECTIVE

To determine how employment, income and out-of-pocket expenses changed in 224 families of low birthweight infants during the first 6 months after the infant was discharged home.

DESIGN

Prospective, descriptive. POPULATION, SAMPLE, SETTING, YEARS: Families of preterm, low birthweight infants. A convenience sample of families of 224 preterm (< 37 weeks gestation) low birthweight (< 2500 grams) infants was obtained from one hospital in the Northeastern U.S.A. Mothers were interviewed over the telephone at each of the data points. Years of data collections were 1990-1994.

METHODS

Mothers kept logs of expenses and were interviewed about changes in employment and income at infant discharge from the hospital and 1, 3, and 6 months later.

FINDINGS

All but two of the employed mothers had to leave employment early because of pregnancy complications. After delivery, fewer mothers returned to work or returned later and worked less than mothers in national studies. Families spent 2% to 4% of their income in non-reimbursed out-of-pocket expenses; transportation was a major expense.

CONCLUSIONS

Having a low birthweight infant results in unexpected changes in employment and in increased and unexpected out-of-pocket expenses.

CLINICAL IMPLICATIONS

Study findings support the need for longer leave for mothers who have small infants.

The correlation of sucking behaviors and Bayley Scales of Infant Development at six months of age in VLBW infants

The purpose of this study was to identify early predictors of developmental outcomes in infants of very low birth weight (< or = 1,500 g). The sample consisted of 19 infants with a mean birth weight of 1,238 g and a mean gestational age at birth of 29.1 weeks. The instruments used were the Kron Nutritive Sucking Apparatus, the Neonatal Morbidity Scale, and the Bayley Scales of Infant Development (BSID). Mean pressure generated by each suck and the length of sucking bursts were positively correlated (p < .05) with the Psychomotor Scale of the BSID. As a predictor of developmental outcomes at 6 months of age, nutritive sucking demonstrated a 78% specificity and an 80% sensitivity, as compared with neonatal morbidity, 58% and 69%, respectively. In a small sample of relatively healthy preterm infants, their ability to suck helped identify those with questionable early development.

Stress, immune function, and relationship to pregnancy outcome

Pregnancy and the postpartal period are a time of immunosuppression. The normal immunosuppression that occurs during the puerperium may be aggravated by stress. Normal mechanisms of immunosuppression are discussed, and the research related to stress and childbearing is examined in this article.

Family response to the low birth weight infant

Families of VLBW and LBW preterm infants are usually happy to have a new baby in the family, although they are anxious, depressed, and concerned about their infant's future health and well-being. During the first year of the infant's life, families of LBW and VLBW infants face many new challenges. They have infants with unique health-care needs who are often temperamentally difficult and who benefit enormously from excellent parenting. Preterm LBW and VLBW infants are often born to families who are poor and to mothers who are young. Families of VLBW and LBW preterm infants experience decreased employment possibilities at a time when they also have increased expenses. Families of LBW and VLBW preterm infants undergo a vulnerable period during which they may benefit greatly from receiving care from nurses who understand their needs.

Patterns of postpartum health in mothers of low birth weight infants

Our purpose in conducting this prospective, descriptive study was to examine patterns of maternal health in women who delivered a low birth weight (LBW; < or = 2,500 g) infant until 6 months past the mothers' estimated date of confinement (EDC). Sixty-eight mothers of LBW infants were interviewed at nine data collection points: delivery, original EDC, infant discharge, and every month thereafter for 6 months. Health was assessed using the Health Perceptions Questionnaire and a structured interview (the Health Interview Schedule). Maternal acute care visits occurred throughout the study, with at least 71% of the mothers reporting one acute care visit. Sixty-four percent of the mothers reported having to change their activities because of ill health between the time their infant went home and the 6-month data point. At the 6-month data point, 19% of the mothers still rated their health as fair to very poor. An ongoing assessment of maternal health is important in mothers of LBW infants so that their health can be optimized.

High-risk obstetric nursing role: perinatal nurse practitioner

This article chronicles the development of the perinatal nurse practitioner (PNNP) role in providing care to high-risk obstetric patients in ambulatory and inpatient settings. Factors in the health care delivery system as well as the philosophic basis of the role are discussed. This role was modeled after neonatal nurse practitioners. Curriculum examples and role competencies are identified. Four programs are currently in existence with several more in the planning stages

Perinatal nurse practitioners and health care reform

Health care delivery for pregnant women at high risk is changing in response to the nation's need to contain costs and improve care. Perinatal nurse practitioners can provide specialized care to women at high risk in a wide variety of settings. They provide quality, cost-effective care and can improve access to prenatal care for families at risk for untoward pregnancy outcomes.

The perinatal evaluation center: a nurse practitioner service delivery model

Efforts to reduce overall health care costs, improve efficiency and enhance patient and provider satisfaction have stimulated the design and evaluation of new models of practice. The Perinatal Evaluation Center, a nurse practitioner-staffed service providing triage and evaluation for obstetrical patients, was developed to address the competing demands of health care redesign. The service has yielded improved outcomes in measures of efficiency and satisfaction.

A sociodemographic comparison of families of very low-birthweight infants: 1982-1991

Social and demographic characteristics were investigated in families who had very low birthweight infants between 1982 and 1984 (historical cohort). Since those data were collected, the number of women using drugs during pregnancy has increased significantly. Therefore, between 1989 and 1991 (current cohort) we continued to document sociodemographic characteristics of families of very low-birthweight infants (144 mothers, 156 infants). Data were collected from review of hospital charts and outpatient health records, and monthly interviews. The two cohorts were similar demographically. Changes in family composition occurred more frequently in the current cohort. There was a startling increase in illicit drug use between the two groups of women 3% in the historic cohort and 20% in the current cohort. In the historical cohort all infants went home to their mothers; however, in the current cohort 7.8% of infants were placed with other family caretakers. Infant health outcomes for the first six months after hospital discharge were similar in both groups. From 1982 to 1991 the increases in substance abuse, nonmaternal caretakers, family moves, and changes in family composition have implications for health care providers involved in infant follow-up care.

Research utilization: an overview

Nursing practice needs to be research based, not only to provide the best possible care to patients but also to ensure that nursing as a profession continues to grow. Criteria to help nurses determine how and when to implement research-based practice changes are presented. Forces that facilitate research utilization are discussed, as are barriers to research utilization. Areas of research that are ready to be implemented in women's health, obstetric, and neonatal nursing are presented.

The association between CNS direct care time and total time and very low birth weight infant outcomes

This study examined the association between the amount of direct care time and total time (direct and administrative) spent by CNSs with families of 39 very low birth weight infants (< or = 1500 grams) and infant outcomes (rehospitalizations and acute care visits). Documentation of the CNSs' time spent with infants and families was recorded during infant hospitalization and for 18 months after infant discharge. The number of infant rehospitalizations and acute care visits was recorded from hospital and physician records. The mean total time the CNS spent per infant for the 18-month period was 27.3 hours. After discharge, there were significant relationships between the amount of CNS direct care time and the number of acute care visits (r = 0.45, p < 0.01) and infant rehospitalizations (r = 0.51, p < 0.01). Although the study findings did not demonstrate improved infant outcomes associated with the amount of time the CNS spent with this high risk population, they document the amount of CNS time spent in intervention and follow-up of these infants. This study provides data for costing home visiting by the CNS in this patient population.

Health policy dilemmas related to high technology infertility services

As cost containment in health care becomes an important concern, the costs and benefits of specific health care services will be more closely examined. The costs and benefits of one type of health care, high technology infertility services, are explored in this paper. These services may be particularly susceptible to cost containment since they are costly, raise ethical issues, and because they currently are provided to healthy individuals not experiencing life-threatening illness who can afford them.