Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis

Background Increasing numbers of neonates are undergoing painful procedures in low-income and middle-income countries, with adequate analgesia seldom used. In collaboration with a multi-disciplinary team in Kenya, we aimed to establish the first evidence-based guidelines for the management of routine procedure-related neonatal pain that consider low-resource hospital settings.

METHODS

We did a systematic review by searching MEDLINE, Embase, CINAHL, and CENTRAL databases for studies published from Jan 1, 1953, to March 31, 2019. We included data from randomised controlled trials using heart rate, oxygen saturation (SpO2), premature infant pain profile (PIPP) score, neonatal infant pain scale (NIPS) score, neonatal facial coding system score, and douleur aiguë du nouveau-né scale score as pain outcome measures. We excluded studies in which neonates were undergoing circumcision or were intubated, studies from which data were unextractable, or when pain was scored by non-trained individuals. We did a narrative synthesis of all studies, and meta-analysis when data were available from multiple studies comparing the same analgesics and controls and using the same outcome measures. 17 Kenyan health-care professionals formed our clinical guideline development panel, and we used the Grading of Recommendations, Assessment, Development and Evaluation framework and the panel's knowledge of the local health-care context to guide the guideline development process. This study is registered with PROSPERO, CRD42019126620.

FINDINGS

Of 2782 studies assessed for eligibility, data from 149 (5%) were analysed, with 80 (3%) of these further contributing to our meta-analysis. We found a high level of certainty for the superiority of breastfeeding over placebo or no intervention (standardised mean differences [SMDs] were -1·40 [95% CI -1·96 to -0·84] in PIPP score and -2·20 [-2·91 to -1·48] in NIPS score), and the superiority of oral sugar solutions over placebo or no intervention (SMDs were -0·38 [-0·61 to -0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2). We found a moderate level of certainty for the superiority for expressed breastmilk over placebo or no intervention (SMDs were -0·46 [95% CI -0·87 to -0·05] in heart rate and 0·48 [0·20 to 0·75] in SpO2). Therefore, the panel recommended that breastfeeding should be given as first-line analgesic treatment, initiated at least 2 min pre-procedure. Given contextual factors, for neonates who are unable to breastfeed, 1-2 mL of expressed breastmilk should be given as first-line analgesic, or 1-2 mL of oral sugar (≥10% concentration) as second-line analgesic. The panel also recommended parental presence during procedures with adjunctive provision of skin-to-skin care, or non-nutritive sucking when possible.

INTERPRETATION

We have generated Kenya's first neonatal analgesic guidelines for routine procedures, which have been adopted by the Kenyan Ministry of Health, and have shown a framework for clinical guideline development that is applicable to other low-income and middle-income health-care settings.

FUNDING

Wellcome Trust Research Programme, and the Africa-Oxford Initiative.

[Bad sleeping habits in infants: Risk factor for sudden infant death syndrome. Pilot study]

INTRODUCTION

The American Academy of Pediatrics recommends, through the implementation of the "Back to Sleep (BTS)" campaign, the supine sleeping position for infant sleeping since it prevents to prevent Sudden Infant Death Syndrome (SIDS).

OBJECTIVE

To describe the sleeping position of a group of infants and the risk factors associated with sudden infant death syndrome (SIDS).

SUBJECTS AND METHOD

Prospective pilot study, including infants < 45 days of life in well-child care visits at a medical center.

EXCLUSION CRITERIA

Preterm-born infant (gestational age < 37 weeks) and/or comorbidities (pulmonary, metabolic, cardiologic). A brief parental questionnaire was conducted regarding general demographic data and sleep habits. The questioner was based on the BISQ - Spanish version, due to the lack of validated instruments for infants < 3-month-old.

RESULTS

We included a sample of 100 infants between 16.78 ± 12.88 days old (57% girls). Mothers were the main information source (84%). 79% of the infants slept in supine position, 19% slept on their sides, and 2% in prone position. Regarding the place where the infants slept, 66% did in their crib in the parents' room and 31% slept in parents' bed. 74% of infants fell asleep while being fed. 28% of infants were exposed to passive smoking at home. 91% of parents were informed about safe sleep positions, reporting that pediatricians were the main source of information (54%). Conclu sion: We found a high percentage of infants < 45 days of life who slept in an unsafe position, and frequently co-sleep with their parents. Thus, it is important to implement local SIDS prevention campaigns to reinforce safe infant sleep.

Effect of Fathers' Presence and Involvement in Newborn Care in the NICU on Mothers' Symptoms of Postpartum Depression

OBJECTIVE

To determine the prevalence of symptoms of postpartum depression (PPD) and examine how fathers' presence and involvement in the care of their newborns affect symptoms of PPD within the first 2 weeks after birth among mothers with newborns in the NICU.

DESIGN

Observational cohort study.

SETTING

Open-bay, 40-bed, tertiary level NICU in Eastern Canada.

PARTICIPANTS

Mothers (N = 105) of newborns who were anticipated to survive and required more than 5 days of hospitalization in the NICU.

METHODS

Participants completed the Postpartum Depression Screening Scale (PDSS) 14 days after they gave birth. They kept daily diaries to record the amount of time that fathers spent by the newborns' bedsides (i.e., presence) and actively caring for their newborns (i.e., involvement such as skin to skin). Participants completed daily diaries from the time of enrollment in the study until their newborns were discharged home. We analyzed the data using linear regression; score on the PDSS was the dependent variable, and fathers' presence and involvement were the independent variables. We adjusted for covariates.

RESULTS

The prevalence of positive screening for symptoms of major PPD was 24.1% (n = 20), and the prevalence of significant symptoms of PPD was 27.7% (n = 23). Participants reported that fathers were present in the NICU an average of 3.8 hours per day and were actively involved with their newborns 53% of the time. Fathers' involvement was significantly associated with lower scores on the PDSS (adjusted β = -3.85; 95% confidence interval [CI] [-6.10, -1.60]). A history of anxiety was significantly associated with greater scores on the PDSS (adjusted β = 12.06, 95% CI [2.07, 22.05]). Maternal age and income less than $50,000 CAD were marginally associated with greater scores on the PDSS (adjusted β = -0.86, 95% CI [-1.77, 0.05] and adjusted β = 10.69, 95% CI [-0.73, 22.11], respectively). The overall explained variance in the PDSS scores with the independent variables was R² = 0.35.

CONCLUSION

Fathers' involvement in the care of their newborns in the NICU was significantly associated with fewer symptoms of PPD among mothers. We recommend research with targeted interventions to promote fathers' involvement in the NICU to potentially mitigate the symptoms of PPD among mothers of newborns in the NICU.

Management of neonates born to mothers with thyroid dysfunction, and points for attention during pregnancy

Thyroid hormone (TH) is indispensable for normal embryonic and fetal development. Throughout gestation TH is provided by the mother via the placenta, later in pregnancy the fetal thyroid gland makes an increasing contribution. Maternal thyroid dysfunction, resulting in lower or higher than normal (maternal) TH levels and transfer to the embryo/fetus, can disturb normal early development. (Maternal) thyroid dysfunction is mostly caused by autoimmune hypo- or hyperthyroidism, i.e. Hashimoto and Graves disease. Autoimmune hyperthyroidism is caused by stimulating TSH receptor antibodies (TSHR Ab), patients with autoimmune hypothyroidism may have blocking TSHR Ab. Maternal TSHR Ab cross the placenta from mid gestation and may cause fetal and transient neonatal hyper- or hypothyroidism. Anti-thyroid drugs taken for autoimmune hyperthyroidism cross the placenta throughout gestation, and may cause fetal and transient neonatal hypothyroidism. This review focusses on the consequences of maternal hypo- and hyperthyroidism for fetus and neonate, and provides a practical approach to clinical management of neonates born to mothers with thyroid dysfunction.

Management of newborns exposed to mothers with confirmed or suspected COVID-19

There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are center-specific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother-newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.

Does entry to center-based childcare affect gut microbial colonization in young infants?

Entry to center-based childcare (CC) at three months of life can be an important challenge for infants as it includes major stressors such as long maternal separations and frequently changing caregivers. Stress and the new environment may in turn alter the composition of the gut microbiota with possible implications for future health outcomes. As part of an ongoing longitudinal study, we investigated whether CC, as compared to being cared for by the parents at home, alters the composition of the gut microbiota, while accounting for known covariates of the infant gut microbiota. Stool samples of infants who entered CC (n = 49) and control infants (n = 49) were obtained before and four weeks after CC entrance. Using Redundancy analysis, Random Forests and Bayesian linear models we found that infant gut microbiota was not affected in a uniform way by entry to CC. In line with the literature, breastfeeding, birth mode, age, and the presence of siblings were shown to significantly impact the microbial composition.

Research Recommendations on the Effects of Postpartum Depression and Pain on Infant Care and Development

Postpartum depression is one of the most common complications of childbirth, and another is pain. A growing body of research shows that the severity and duration of postpartum pain can increase a woman's risk for postpartum depression. Postpartum depression and pain negatively affect maternal well-being, and postpartum depression has been associated with adverse outcomes in children. However, there is a dearth of information about the effects of postpartum depression and pain on infant care and development. The objectives of this commentary were to highlight the need to address this gap in the literature, offer a preliminary conceptual model to advance the field, and ignite new lines of inquiry to inform infant care and development.

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.

[Newborn care: International recommendations confronted with the social challenges surrounding birth]

INTRODUCTION

Driven by international programs specifically targeting neonatal survival, a set of recommended care practices is being promoted in West Africa. Using data from a multi-centered anthropological study, we enquire as to how local practices integrate the recommendations disseminated by these programs.

METHOD

The surveys were conducted in rural localities in five countries : Benin, Burkina Faso, Mali, Mauritania, and Togo. In every site, the investigations combined ethnography of newborn care and in-depth interviews in maternity homes and homes.

RESULTS

The care of newborns is based on a set of local social representations and logics, where medical recommendations are integrated heterogeneously. In maternity wards, health professionals face difficulties in implementing recommended practices, and make various conciliations when faced with local material and social constraints. In private homes, the "messages" promoting life-saving care for newborns punctuate conversations, but lead to various interpretations and variations in care.

DISCUSSION

The irregular integration of medical recommendations in neonatal care is analyzed around three areas: the divergence of intentions around the birth, the dissonances between the recommended care and the local conceptions of the newborn, the influence of intra-family power relations. Considering the complexity of the changes in neonatal care, we argue for the implementation of programs that respect local cultures, and for health professionals to skillfully accommodate conflicting constraints.

[Lay knowledge and newborn care in Benin - home-made remedies for umbilical cord care going against recommendations]

INTRODUCTION

Driven by international programs specifically targeting neonatal survival, a set of recommended care practices is being promoted in West Africa. Using data from a multi-centered anthropological study, we enquire as to how local practices integrate the recommendations disseminated by these programs.

METHOD

The surveys were conducted in rural localities in five countries: Benin, Burkina Faso, Mali, Mauritania, and Togo. In every site, the investigations combined ethnography of newborn care and in-depth interviews in maternity homes and homes.

RESULTS

The care of newborns is based on a set of local social representations and logics, where medical recommendations are integrated heterogeneously. In maternity wards, health professionals face difficulties in implementing recommended practices, and make various conciliations when faced with local material and social constraints. In private homes, the "messages" promoting life-saving care for newborns punctuate conversations, but lead to various interpretations and variations in care.

DISCUSSION

The irregular integration of medical recommendations in neonatal care is analyzed around three areas: the divergence of intentions around the birth, the dissonances between the recommended care and the local conceptions of the newborn, the influence of intra-family power relations. Considering the complexity of the changes in neonatal care, we argue for the implementation of programs that respect local cultures, and for health professionals to skillfully accommodate conflicting constraints.

[Using anthropology to improve newborn health care in Cameroon]

INTRODUCTION

Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research.

METHOD

Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care.

RESULTS

The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care.

CONCLUSION

The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.

[“Forgetting” the newborn: An anthropological analysis in Mauritania]

INTRODUCTION

In Mauritania, as in other West African countries, a series of actions has been taken to combat neonatal mortality. Considering the mixed success of these programs, we wondered how health workers are investing in neonatal care.

METHOD

An anthropological study was carried out in a locality in the Senegal River Valley. The surveys consisted of an ethnography of a health center, which resulted in detailed observations of care and interviews with health workers.

RESULTS

Our observations reveal that in the crucial minutes and hours following a normal birth, the attention of caregivers tends to turn away from the newborn. Recommended care such as keeping warm, examining and monitoring the newborn is not provided, while early breast-feeding occurs in a fluctuating manner. The newborn is quickly handed over to the family. Newborn care is thus "forgotten", both in the sequence of actions around childbirth and in the collective distribution of professional responsibilities.

DISCUSSION

Newborn care at birth remains poorly medicalized. We analyze the least involvement of health workers with newborns in two aspects : the perception of the uncertainty of neonatal survival, and the predominance of local childbearing. We are making proposals to put the spotlight back on the newborn in order to promote a better quality of neonatal care.

[What sociotechnical arrangement is responsible for newborn deaths in West Africa?]

INTRODUCTION

In Sub-Saharan Africa, despite the establishment of many health care programs, neonatal mortality rates remain extremely high. From a medical point of view, the main causes are obstetric, along with diarrhea and pneumonia. Understanding how these risks and pathogenic situations are constructed cannot be achieved without observing, analyzing, and understanding the underlying gestures and meaning systems.

METHOD

Rather than describing obvious inequalities in the access to health care, our study aimed at questioning the different actors' operational capacities and at considering what is actually possible to improve in the most common healthcare situations. More specifically, how are births, neonatal care, and popular practices carried out in the first days of the lives of these newborns? In five countries of West Africa, a "multi-sited" anthropological study was carried out to observe the first weeks of newborns. This study not only allowed for the methodical identification of care interactions at and around childbirth in peripheral health care services, but also the popular practices related to the socialization of the child in family settings.

RESULTS

Our fieldwork investigations show that neonatal risk corresponds to the combination of several sets of behavior. In obstetric services, for reasons linked to the symbolic status of the child as much as to a certain idea of the obstetric profession, the newborn remains marginal in the preoccupations of the midwives. This results in many dysfunctions (not warming the child, leaving the child in a drafty area, not feeding the child…) which constitute discontinuous risk factors.In the village and in the family, the newborn is at the center of many social practices - baths, rituals, ingestions of various "protective" products, period of seclusion, baptism… - which not only aim at conferring an identity and including the infant in the social group, but also build a set of infectious risks.Finally, while health actions build a translation space, no preventive dialogue has been established by healthcare personnel to inform people about the risks associated with certain social practices.Overall, these longitudinal follow-ups of newborns, as well as precise observations and interviews conducted with the actors on their reasons for acting, have made it possible to analyze the attitudes, gestures and social behaviors that constitute the concrete causes of neonatal risk.

DISCUSSION

Describing the practices that newborns "benefit from" during their first days is essential to concretely identify and analyze the risks and reasons for high neonatal mortality. The empirical and documented approach of anthropology is essential to carry out these studies. But, more importantly, this qualitative approach must be implemented in vivo and in situ in the health services and during the training of health personnel to create a reflexivity of the caregivers and to initiate professional practices concerned with newborns. In the same way, our studies open the way for precise and documented dialogues with families which will enable the indispensable follow-up care for the newborns and ensure adapted preventive care and coherence in the care provided by the healthcare structures, the families, and the collectivities.

Pacifiers: A Cause for Confusion

Pacifier avoidance is recommended in the newborn nursery to optimize exclusive breast-feeding rates according to the Baby-Friendly Hospital Initiative. There are many reasons why parents may choose to provide a pacifier to their infant, particularly due to the association between pacifier use with sleep and risk reduction for sudden infant death syndrome. Early use of a pacifier does not likely cause direct harm to infants or lead to difficulty breast-feeding. Pediatricians should partner with families to share a clear message in support of establishing exclusive breast-feeding, ideally before introduction of a pacifier. [Pediatr Ann. 2020;49(5):e204-206.].

A multi-year analysis of kangaroo mother care outcomes in low birth weight babies at a Nyakahanga Hospital in rural Tanzania

BACKGROUND

Kangaroo Mother Care (KMC) requires few specialized resources, reduces mortality, and can be implemented in low resource environments. It is now recommended for implementation around the globe.

OBJECTIVES

This paper discusses KMC use with low birth weight newborns at a Tanzania hospital providing valuable outcomes assessment of KMC use in rural areas of sub-Saharan Africa.

METHODS

The research used retrospective records (136 Low Birth Weight (LBW) and 33 Very Low Birth Weight (VLBW) neonates) supplemented by observations. Data included weights (longitudinal), survival period, and cause of death if it occurred. This hospital's KMC use and study data began when the mother-baby dyad was referred, usually birth day.

RESULTS

This KMC group demonstrated 70% survival, but 77% of deaths occur within 24 hours. After the first 24 hours, KMC survival rate was 92%. Even VLBW neonates (<1000 g) had 37.5% survival among the KMC program. Prematurity and respiratory distress caused nearly half of the deaths, but hypothermia (19% of deaths) and infection were factors also.

CONCLUSION

Our study indicates the value of KMC in rural low resource environments. Results are comparable to KMC programs in urban areas where newborns begin KMC after stabilization and better than outcomes reported for comparable populations not practicing KMC in rural sub-Saharan Africa.

The Barriers to Neonatal Hepatitis B Vaccination in Israel: A Prospective Study

BACKGROUND

Opposition to neonatal Hepatitis B vaccination is a growing trend in Israel.

OBJECTIVES

To assess the sociodemographic factors and attitudes associated with non-vaccination of term singleton newborns.

METHODS

This prospective, pair-matched, controlled trial was conducted in a tertiary university-affiliated hospital. Data on maternal sociodemographic parameters, delivery, and infant care practices were gathered. Knowledge and references of Hepatitis B virus (HBV) vaccination, vaccination schedule, and health government policies were assessed. A follow-up telephone survey was completed at the age of 7 weeks postpartum regarding vaccine catch-up rate.

RESULTS

Mothers in the study group were mostly Jewish white middle class married multiparous women with some higher education. Hepatitis B serology was not tested in most. Higher rates of rooming-in and exclusive breastfeeding were observed. Knowledge about HBV was stated, multiple sources of information were significantly associated with newborn non-vaccination. Many objected to the timing of the vaccine and its necessity. Multiple medical encounters are viewed as missed opportunities.

CONCLUSIONS

Multiple sources of vaccine information are associated with non-vaccination. Medical encounters prior and post-delivery should be used for vaccination education and may improve vaccination coverage.

The Care of the Infant Being Placed for Adoption

Adoption in the United States is a way for families to grow, and pediatricians will invariably take care of infants being placed for adoption. Reasons why an infant will be adopted are highly variable, as are the types of relationships that birth parents have with their infants. Care of the infant being placed for adoption in the nursery involves close attention to detail to ensure appropriate continuity of care and information as the infant transitions into their eventual medical home. Adoptive parents often seek additional information from their child's health care providers, and pediatricians should be equipped to provide guidance both prior to and after the adoption process. Office-based pediatricians should support adoptive parents with a longitudinal approach informed by best practices and principles of well-child care. [Pediatr Ann. 2020;49(2):e61-e63.].

Umbilical cord separation time, predictors and healing complications in newborns with dry care

Objective

The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old.

Design

A quantitative longitudinal observational analytical study by stratified random sample was adopted.

Setting

Public health system hospitals in southern Spain and at newborns’ homes.

Participants

Between April 2016 and December 2017, the study included 106 neonates born after 35–42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy.

Methods

The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller.

Results

The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16–7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R² = 0.439 F: 15.361, p <0.01).

Conclusion

The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.

[The plurality of men and women’s involvement in newborn health care in rural Mali]

OBJECTIVE

This ethnographic work seeks to understand the construction of gender and generational social relationships around the health of the newborn in both the care setting and in the family setting.

METHOD

An immersion of several weeks made it possible to collect data on the most common perceptions and practices that shape the daily lives of the various actors involved in the health of the newborn. The data was collected using participant observation, semi-structured interviews. Much additional data was collected through informal interviews.

RESULTS

In health institutions, people who play the role of caregiver are usually women. They come most often from the husband's family and are engaged in a role that can be assimilated to "care". In most cases, the involvement of husbands concerns the transport of the woman to the health center, the transport of food, the administrative procedures, the payment of prescriptions. In a family environment, caring for the newborn also follows sexual logic as well as generational logic that shows a better integration of biomedicine guidelines by young women. However, the data from the survey showed that men's involvement and women's involvement can not be defined according to a dual separation between masculine and feminine roles because social relations are constructed according to many other variables.

CONCLUSION

The health of the newborn is at the center of several normative registers that try to influence it in their own way. This necessarily plural reality often escapes public health programs.

Providing Expressed Breast Milk to Preterm Neonates Admitted in an Extramural Neonatal Intensive Care Unit: Where do we stand?

Provision of expressed breast milk (EBM) to premature neonates poses a great challenge in extramural Neonatal Intensive Care Units (NICUs). We conducted a questionnaire-based survey to identify the various challenges faced by the parents to provide EBM to their hospitalized premature infant. 40 preterm neonates (<34 wk gestation and <1500 g weight) planned to be started on EBM were included in the study. The median (range) duration after which EBM was received in NICU after the time it was asked for was 34.5 (13 to 40) hours, and it was received in a clean, sterile and covered container in only 8 (20%) cases. There were multiple hurdles in ensuring early availability of EBM in optimal condition. Sensitization and motivation of families regarding the importance of ensuring early administration of EBM to their prematurely delivered neonate may lead to substantial improvement in outcome of these neonates.

Common parenting misconceptions regarding infant care: setting the record straight for parents (and some pediatricians)

PURPOSE OF REVIEW

First-time parents often turn to friends and family for advice regarding feeding, sleeping, bathing, diapering and toilet training, and childhood illnesses. Unfortunately, parents may at times be given incorrect and potentially dangerous advice as several widely embraced parenting practices are no longer deemed appropriate. In addition, young children are cared for by family and friends - many of whom are older and may still subscribe to outdated parenting practices.Parents and grandparents are not the only ones who subscribe to child care myths and misconceptions. Pediatricians also believe in the effectiveness of some outdated child care practices. Although some of these parenting myths are relatively benign, others may indeed pose a significant health risk or safety hazard to a young child. The purpose of this article is to review 10 commonly held myths or misconceptions regarding infant care.

RECENT FINDINGS

In this review article, we not only highlight many of the studies that document which outdated health beliefs are still endorsed by parents and/or pediatricians, but also review the specific health risks associated with these parenting myths or misconceptions.

SUMMARY

It is important that pediatricians educate parents and other primary caregivers about the potential risks of following outdated parenting practices.

Transitioning from an ICU ventilator to a portable home ventilator

There is a variety of portable ventilators on the market, each with its' own features. A clinician needs to understand the unique characteristics of the ventilators available in his or her region, as well as the nuances of primary and secondary settings for these portable home ventilators in order to create a comfortable breath that allows for adequate gas exchange for the patient. Understanding the interplay of the portable home ventilator and the ventilator circuit is also a key component of transitioning a patient to a portable home ventilator. This review details characteristics of some of the more commonly used machines in the United States, as well as the settings to be considered in supporting a child with chronic respiratory failure outside of the hospital. As more patients are being discharged from the hospital with mechanical home ventilation, new ventilators are being developed that expand upon features of current machines.

Parents' Descriptions of Feeding Their Young Infants

OBJECTIVE

To explore parents' descriptions of and concerns about their infants' feeding in the first 6 months of life.

DESIGN

Descriptive study.

SETTING

Online survey.

PARTICIPANTS

We recruited 29 parents of infants younger than 7 months old from a variety of online local, regional, and international communities to complete a survey about their infants' feeding.

MEASUREMENTS

The survey included a combination of selection and open-text entry questions. Qualitative data from open-text questions were analyzed with directed content analysis to identify factors that influenced infant feeding. Two coders coded all data.

RESULTS

Concerns about feeding were common, and many parents made changes to facilitate feeding. Parents described characteristics of the infant (e.g., temperament), the task of feeding (e.g., milk flow), and factors external to the infant (e.g., breast anatomy) that affected feeding. Although some parents described feeling happy, calm, and bonded during feeding, others described feeling terrified, anxious, and worried. Health care providers played a significant role in helping parents navigate feeding, but they sometimes provided conflicting and even unsafe advice.

CONCLUSION

Understanding the experience of feeding from the parent perspective may help to identify targets for intervention to support parents and infants when feeding is difficult.