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Vizzari G, Morniroli D, Consales A, Capelli V, Crippa BL, Colombo L, Sorrentino G, Bezze E, Sannino P, Soldi VA, Plevani L, Mosca F, Giannì ML. Knowledge and attitude of health staff towards breastfeeding in NICU setting: are we there yet? An Italian survey. Eur J Pediatr 2020; 179:1751-1759. [PMID: 32424743 DOI: 10.1007/s00431-020-03678-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
The benefits of human milk in preterm infants, a population at high risk for developing adverse outcomes for which breast milk is a protective factor, are widely acknowledged. However, preterms' admission in a neonatal intensive care unit (NICU) and newborn's clinical conditions have been described as significant barriers, leading to lower rates of breastfeeding initiation and duration. Healthcare workers play a crucial role in encouraging breastfeeding. We conducted a cross-sectional survey among nurses working in six Italian NICUs, exploring their knowledge and attitude towards breastfeeding. Although the majority of nurses had a specific breastfeeding education, our results show still some variations among answers regarding aspects of breastfeeding support in this setting. Specifically, family-centered care, transition feeding to the breast, and skin-to-skin practice, despite being extensively addressed by the Neo Baby-Friendly Hospital Initiative, are the items that highlighted a range of answers that could result in conflicting information to mothers.Conclusion: By underlining the gaps of knowledge and attitude towards breastfeeding of nurses working in NICUs, this study provides an insight into what needs to be improved, with the aim of promoting higher rates of breastfeeding in the preterm population. What is Known: • Breastfeeding is particularly challenging in the preterm population, despite its universally recognized health benefits. • Improving healthcare professionals' knowledge and attitude towards breastfeeding has been shown to be crucial for promoting breastfeeding in NICUs. What is New: • Our results provide useful insight into nurses' knowledge and attitude towards breastfeeding in NICU settings. • By acknowledging strengths and weaknesses highlighted by this study, tailored strategies could be developed to improve health staff breastfeeding education and support to parents in NICU settings.
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Affiliation(s)
- Giulia Vizzari
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy
| | - Daniela Morniroli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy.
| | - Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy.,NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Valentina Capelli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Beatrice Letizia Crippa
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Lorenzo Colombo
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Gabriele Sorrentino
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Elena Bezze
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Patrizio Sannino
- Direzione Professioni Sanitarie, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Valeria Andrea Soldi
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Laura Plevani
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy.,NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy.,NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
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Neonatal nursing in the COVID-19 pandemic: can we improve the future? JOURNAL OF NEONATAL NURSING : JNN 2020; 26:247-251. [PMID: 32837225 PMCID: PMC7351431 DOI: 10.1016/j.jnn.2020.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 12/23/2022]
Abstract
The current 2019 coronavirus disease (COVID-19) is the world's largest and most pervasive public health emergency in more than one hundred years. Although neonatal units have not been at the epicentre of the current health crisis, they have also been forced to adopt contingency plans with the aim of protecting hospitalised neonates, their families, and professionals. Neonatal units have been forced to alter the neonatal care framework based on promoting neurodevelopment and family-centred care. The peak of the pandemic is falling in most countries, but COVID-19 infection is not eradicated and there is uncertainty about new outbreaks. It is time to reflect about better strategies to preserve the rights and excellence of care for newborns and their families. This column will highlight the changes that have occurred in neonatal units, and their impact on neonatal care and families. It is a time for critical reflection on nursing practice.
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Darcy Mahoney A, White RD, Velasquez A, Barrett TS, Clark RH, Ahmad KA. Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. J Perinatol 2020; 40:36-46. [PMID: 32859963 PMCID: PMC7453850 DOI: 10.1038/s41372-020-0753-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine the relationship between the emergence of COVID-19 and neonatal intensive care unit (NICU) family presence as well as how NICU design affects these changes. STUDY DESIGN A cross-sectional survey from April 21 to 30, 2020. We queried sites regarding NICU demographics, NICU restrictions on parental presence, and changes in ancillary staff availability. RESULTS Globally, 277 facilities responded to the survey. NICU policies preserving 24/7 parental presence decreased (83-53%, p < 0.001) and of preserving full parental participation in rounds fell (71-32%, p < 0.001). Single-family room design NICUs best preserved 24/7 parental presence after the emergence of COVID-19 (single-family room 65%, hybrid-design 57%, open bay design 45%, p = 0.018). In all, 120 (43%) NICUs reported reductions in therapy services, lactation medicine, and/or social work support. CONCLUSIONS Hospital restrictions have significantly limited parental presence for NICU admitted infants, although single-family room design may attenuate this effect.
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Affiliation(s)
- Ashley Darcy Mahoney
- George Washington University, Washington, DC, USA
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
- Baptist Children's Hospital, Miami, FL, USA
| | | | - Annalyn Velasquez
- George Washington University, Washington, DC, USA
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | | | - Reese H Clark
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | - Kaashif A Ahmad
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL, USA.
- Baylor College of Medicine, San Antonio, TX, USA.
- Pediatrix Medical Group of San Antonio, San Antonio, TX, USA.
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Weber A, Elder M, Voos KC, Lambert JW, Kaplan HC, Jackson YC. Clinician Opinions and Approaches to Manage Risk Related to Safe Sleep During Skin-to-Skin Care. J Obstet Gynecol Neonatal Nurs 2020; 49:464-474. [PMID: 32726581 PMCID: PMC7492480 DOI: 10.1016/j.jogn.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To understand the opinions of clinicians about the risks, benefits, barriers, and facilitators to the practice of parent sleep during skin-to-skin care in hospital settings. DESIGN Cross-sectional survey. SETTING Online survey. PARTICIPANTS Clinicians who self-identified as infant care providers, that is, neonatal clinicians (N = 158). METHODS We sent an online survey invitation to neonatal clinicians through neonatal websites, conferences, and social media sites in the United States and used snowball recruitment. We used a risk management framework to analyze qualitative data. We used descriptive statistics and the chi-square and Fisher's exact tests to determine if opinions differed based on clinician and organizational characteristics. RESULTS Respondents' support of parent sleep during skin-to-skin care (yes/no) did not differ on the basis of whether the clinician had taken a formal course on skin-to-skin care, facilitated skin-to-skin care more than 100 times, or frequently promoted skin-to-skin care in current practice. Respondents who supported parent sleep (n = 93, 59% of respondents) reported greater implementation of risk control strategies than nonsupporters (n = 53 [57%] vs. n = 3 [5%]; p < .001), such as frequent monitoring of vital signs (n = 33 [35%] vs. n = 2 [3%]; p < .001), use of devices to support skin-to-skin care (n = 49 [53%] vs. n = 19 [29%]; p = .003), and proper positioning (n = 20 [22%] vs. n = 0 [0%]; p < .001). Nonsupporters more frequently reported that parent sleep during skin-to-skin care violates safe sleep recommendations, is habit forming for home, poses a fall risk, and jeopardizes the infant's airway. CONCLUSION Most respondents supported parent sleep during skin-to-skin care, but concerns regarding safety for the infant remained a barrier. The use of a risk management framework may help facilitate a systematic approach to improve the implementation of safe skin-to-skin practices.
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Skin-to-Skin Care Is a Safe and Effective Comfort Measure for Infants Before and After Neonatal Cardiac Surgery. Pediatr Crit Care Med 2020; 21:e834-e841. [PMID: 32740179 PMCID: PMC8865053 DOI: 10.1097/pcc.0000000000002493] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery. DESIGN A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2). SETTING Cardiac ICU and step-down unit in a large metropolitan freestanding children's hospital. SUBJECTS Convenience sample of 30 infants admitted preoperatively for critical congenital heart disease. INTERVENTIONS Eligible infants were placed into skin-to-skin care for 1 hour with their biological mothers once each at T1 and T2. MEASUREMENTS AND MAIN RESULTS Measurements of stress (salivary cortisol), pain and behavior state (COMFORT scale), and physiologic stability (vital signs) were assessed immediately before skin-to-skin care, 30 minutes into skin-to-skin care, and 30 minutes after skin-to-skin care ended.At both T1 and T2, infant pain scores were significantly decreased (p < 0.0001) and infants moved into a calmer behavior state (p < 0.0001) during skin-to-skin care as compared to baseline. At T1, infants also had significantly reduced heart rate (p = 0.002) and respiratory rate (p < 0.0001) and increased systolic blood pressure (p = 0.033) during skin-to-skin care. At both T1 and T2, infant cortisol remained stable and unchanged from pre-skin-to-skin care to during skin-to-skin care (p = 0.096 and p = 0.356, respectively), and significantly increased from during skin-to-skin care to post-skin-to-skin care (p = 0.001 and p = 0.023, respectively). Exploratory analysis revealed differences in cortisol reactivity for infants with higher baseline cortisol (> 0.3 μg/dL) versus lower (≤ 0.3 μg/dL) prior to skin-to-skin care. Infants with higher baseline cortisol at T2 experienced significantly reduced cortisol during skin-to-skin care (p = 0.025). No significant differences in demographics or baseline variables were found between infants in either group. CONCLUSIONS Skin-to-skin care is a low-cost, low-risk intervention that promotes comfort and supports physiologic stability in infants before and after neonatal cardiac surgery.
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Rose SJ, LeBel TP. Confined to Obscurity: Health Challenges of Pregnant Women in Jail. HEALTH & SOCIAL WORK 2020; 45:177-185. [PMID: 32746452 DOI: 10.1093/hsw/hlaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/16/2019] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
Research about pregnant women in jail is scant. This exploratory study begins to fill this gap by examining the demographics; background characteristics; and self-reported physical health, mental health, and substance use challenges reported by 27 pregnant women incarcerated in a large midwestern county jail. It further reports on the prenatal care before and during their incarceration, plans of these pregnant women for delivery of their child, caring for their infant after their release from jail, and their expectations of paternal or family support post-release. Among the sample, 66.7 percent reported a physical health care problem, 48.2 percent had received mental health treatment, and 18.5 percent had substance use treatment in the previous year, but only 51.9 percent had seen a health care professional before their incarceration. All women expected the father of their child to provide financial support, but only 76.9 percent expected the father to be involved with the child. The authors also discuss implications of the findings for jail health care services and reintegration policy and practice for pregnant women.
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Affiliation(s)
- Susan J Rose
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee
| | - Thomas P LeBel
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee
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Comparative Evaluation of Parental Stress Experiences Up to 2 to 3 Years After Preterm and Term Birth. Adv Neonatal Care 2020; 20:301-313. [PMID: 32108660 PMCID: PMC7379044 DOI: 10.1097/anc.0000000000000714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Parenting stress after preterm birth (PTB) has negative long-term effects on parenting. Research about parental experiences after PTB and on parenting stress in early childhood has focused on mothers.
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Andrews KG, Martin MW, Shenberger E, Pereira S, Fink G, McConnell M. Financial Support to Medicaid-Eligible Mothers Increases Caregiving for Preterm Infants. Matern Child Health J 2020; 24:587-600. [DOI: 10.1007/s10995-020-02905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Walsh RS, Payne A, Cossler NJ, Thompson CL, Bhola M. Safety of immediate skin-to-skin contact after vaginal birth in vigorous late preterm neonates - A pilot study. J Neonatal Perinatal Med 2020; 14:95-100. [PMID: 32083594 DOI: 10.3233/npm-190311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To evaluate the safety of immediate skin-to-skin contact (SSC) in vigorous late preterm neonates, where observation under radiant warmer is standard of care, in a prospective, randomized, controlled, and equivalence pilot study. METHODS Singletons born vaginally at 35-36 6/7 weeks gestation were randomized to initiate immediate SSC or standard of care with continuous pulse oximeter monitoring for the first hour of life. RESULTS Forty-seven dyads were randomized to SSC (n = 21) or radiant warmer (n = 26). Vitals were recorded at designated time intervals to assess tolerance of postnatal transitioning. We found no significant difference in the number of SSC interruptions, pulse oximeter readings, initial glucose level, and rates of hypoglycemia, hypothermia, or NICU admission between the two groups. CONCLUSIONS Vigorous late preterm neonates transitioned to immediate SSC without additional risks compared to control counterparts. Large, multicenter, and randomized-control studies need to be conducted to establish standardized guidelines for this practice.
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Affiliation(s)
- R S Walsh
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - A Payne
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - N J Cossler
- University Hospitals MacDonald Women's Hospital, Cleveland, OH, USA
| | - C L Thompson
- Case Western Reserve University, Cleveland, OH, USA
| | - M Bhola
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
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The Beneficence of Cuddle Therapy in Hyperekplexia: A Case Report. Adv Neonatal Care 2020; 20:33-37. [PMID: 31567315 DOI: 10.1097/anc.0000000000000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Benevolent injustice occurs when well-intentioned treatment efforts produce an outcome that limits the potential of a patient. The unintended harm can result in significant moral distress for the family and the healthcare team. CLINICAL FINDINGS We discussed an ethical dilemma regarding a neonate who had suspected seizure and hypoxic-ischemic encephalopathy after home birth delivery. The healthcare team experienced moral distress about the mother's desire to not use anti-seizure medications and instead trial other interventions such as cuddling. Subsequently, clinical analysis ruled out a seizure disorder. Genetic studies on this neonate confirmed hereditary hyperekplexia, which presented as exaggerated Moro reflex and apnea that mimicked seizure. INTERVENTION We discussed how applying any one of the 4 basic ethical principles of autonomy, beneficence, nonmaleficence, or justice could counteract benevolent injustice and moral distress. OUTCOMES Discussions with the patient's mother and nurse allowed the team to overcome their reluctance to try the mother's treatment recommendations. This resulted in adopting the seemingly counterintuitive intervention of cuddling that turned out to be effective for this neonate with hereditary hyperekplexia. PRACTICE RECOMMENDATIONS The moral distress associated with benevolent injustice should be identified early to minimize long-term consequences to the patient, family, and healthcare team. Healthcare teams should learn to apply ethical principles when discussing patient care concerns in an unbiased manner. Guided ethical discussions allow us to be more efficient in providing family-centered care that aligns with the patient's best interest.
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Desorcy-Scherer K, Bendixen MM, Parker LA. Determinants of the Very Low-Birth-Weight Infant's Intestinal Microbiome: A Systematic Review. J Perinat Neonatal Nurs 2020; 34:257-275. [PMID: 32697547 PMCID: PMC7464589 DOI: 10.1097/jpn.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The intestinal microbiome is the genetic material from microorganisms residing in the intestinal tract. Very low-birth-weight infants (VLBW; birth weight ≤1500 g) are a physiologically compromised population undergoing a unique period of initial intestinal microbiome establishment. Evidence supports a connection between the intestinal microbiome and gastrointestinal illness that disproportionately affects VLBW infants. Necrotizing enterocolitis, an inflammatory and often necrotic condition of the intestine, and late-onset sepsis, a bloodstream infection occurring after 3 days of life, are thought to be associated with delayed or abnormal intestinal microbiome development. Here, we review the determinants, or factors, that influence the VLBW infant's intestinal microbiome and discuss clinical implications. PubMed, Web of Science, EMBASE, and CINAHL were systematically searched for publications addressing factors with the potential to affect the intestinal microbiome of VLBW infants. Results indicate that infant's age and weight, mode of delivery, antibiotic exposure, medication use, feeding regime, environment, and perinatal-/infant-associated factors may be important determinants of the microbiome in this vulnerable population. Clinicians have opportunities to support positive development of the VLBW infant's intestinal microbiome through antibiotic stewardship, support of human milk feeding, and hygienic care practices.
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Kangaroo Mother Care in Hospitalized Low Birth-Weight Infants on Respiratory Support: A Feasibility and Safety Study. Adv Neonatal Care 2019; 19:E21-E25. [PMID: 31567182 DOI: 10.1097/anc.0000000000000666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low birth-weight (LBW) infants on respiratory support are often deprived of kangaroo mother care (KMC) due to fear of instability. Data on safety of KMC in these infants are lacking. PRIMARY OBJECTIVE To determine the feasibility of KMC in LBW infants on continuous positive airway pressure or synchronized intermittent mandatory ventilation. SECONDARY OBJECTIVES To compare vital signs (heart rate [HR], respiration, temperature, and SpO2) and ventilatory parameters (FIO2, peak inspiratory pressure [PIP], and positive end-expiratory pressure [PEEP]) before, during, and after KMC, and assess the mother's perception of the KMC intervention. METHODS LBW infants stable on respiratory support were given KMC for 1 hour. Vital signs and ventilator parameters were recorded before, every 15 minutes during and after KMC. Feasibility was defined as continuation of KMC for 1 hour without interruption, with stable vital signs (HR > 100/min, SpO2 > 90%, and temperature 36.5°C-37.5°C) and ventilator parameters (no change in PIP, PEEP, or increase in FIO2 not more than 0.1) without tube dislodgement. RESULTS Twenty LBW infants with a mean birth weight of 1390 ± 484 g were included. All infants completed 1-hour duration of KMC without interruption. No significant changes in temperature, respiratory rates, or saturations were noted. The HR and FIO2 were marginally higher during KMC than before or after (HR before 147.3 ± 11.5, during 150.8 ± 11, and after 147.3 ± 11.1, P = .04; FIO2 before 30.6 ± 8.1, during 31.8 ± 8.1, and after 30.7 ± 8.0, P = .034). No accidental extubation or dislodgement of lines occurred. Most mothers were happy. IMPLICATIONS FOR PRACTICE The vital signs were stable during KMC. KMC is feasible in infants receiving respiratory support. IMPLICATIONS FOR RESEARCH Effectiveness of early initiation and prolonged duration of KMC.
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Safety and feasibility of skin-to-skin care for surgical infants: A quality improvement project. J Pediatr Surg 2019; 54:2428-2434. [PMID: 30879741 DOI: 10.1016/j.jpedsurg.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Skin-to-skin care (SSC) for infants improves physiologic stability, pain perception, brain development, parental bonding, and overall survival. Using quality improvement (QI) methodology, this project aimed to increase SSC for surgical infants in the neonatal intensive care unit (NICU). METHODS A multidisciplinary working group composed of key NICU stakeholders instituted a needs assessment querying perceptions and concerns about SSC. Based on survey results, multiple system level interventions were implemented. Data for surgical infants receiving SSC during hospitalization were tracked over time using the electronic health record. RESULTS Overall, 315 infants requiring a surgical consult were admitted to the NICU in the first 12 months of the project. After six months, SSC rates in this group increased from 51% to 60.5% (p < 0.01) and were sustained for 12 months. After one year, nursing staff reporting that they were somewhat to very comfortable providing SSC for surgical infants increased from 44% to 75% (p = 0.001) and the percent of nurses providing SSC for a surgical infant increased from 12% to 37% (p = 0.001). Inadvertent extubation did not significantly increase after implementation of the QI project. CONCLUSIONS Using QI methodology and multidisciplinary engagement, SSC was integrated safely into the routine care of surgical infants in the NICU. LEVEL OF EVIDENCE Level V.
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What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief. Adv Neonatal Care 2019; 19:383-393. [PMID: 30893096 DOI: 10.1097/anc.0000000000000602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Benefits of exclusive human milk diets for preterm and low birth-weight infants are well established. Despite known benefits, supporting mothers in the provision of mother's own milk for high-risk infants is challenging. Lactation support in the neonatal intensive care unit (NICU) is highly variable. Lactations consultants (LCs) are often shared between postpartum units and the NICU, potentially increasing LC workload with less time spent with high-risk mothers. Furthermore, less than half of NICUs in the United States staff an international board-certified lactation consultant. Limited understanding exists regarding impacts of NICU-specific lactation support on breastfeeding outcomes. PURPOSE The purpose of this evidence-based practice brief is to synthesize the literature on the impact of NICU-specific lactation support, LCs who work exclusively in the NICU, and provide guidance about how NICU staffing with LCs solely focused on supporting mothers of high-risk infants impacts breastfeeding outcomes for low birth-weight infants. SEARCH STRATEGY CINAHL PLUS, PubMed, Cochrane Library, and OVID databases were searched using key words and restricted to English language. FINDINGS During hospitalization, NICUs staffed with dedicated board-certified LCs have increased potential to yield improved breastfeeding rates through hospital discharge, increased proportion of infants who receive mother's own milk, and increased duration of breastfeeding or human milk expression through hospital discharge. IMPLICATIONS FOR PRACTICE Human milk nutrition is related to improved outcomes for high-risk infants. Neonatal intensive care unit-specific lactation support can potentially optimize maternal breastfeeding practices and improve outcomes for high-risk infants. IMPLICATIONS FOR RESEARCH There is a need for further studies pertaining to NICU-specific lactation consultants and influences on breastfeeding outcomes.
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Ryan M, Lacaze-Masmonteil T, Mohammad K. Neuroprotection from acute brain injury in preterm infants. Paediatr Child Health 2019; 24:276-290. [PMID: 31239818 PMCID: PMC6587421 DOI: 10.1093/pch/pxz056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Infants born at ≤32+6 weeks gestation are at higher risk for intracranial ischemic and hemorrhagic injuries, which often occur in the first 72 hours postbirth. Antenatal strategies to reduce the incidence of acute brain injuries include administering maternal corticosteroids and prompt antibiotic treatment for chorioamnionitis. Perinatal strategies include delivery within a tertiary centre, delayed cord clamping, and preventing hypothermia. Postnatal strategies include empiric treatment with antibiotics when chorioamnionitis is suspected, the cautious use of inotropes, the avoidance of blood PCO2 fluctuation, and neutral head positioning. Clinicians should be aware of the policies and procedures that, especially when combined, can provide neuroprotection for preterm infants.
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Affiliation(s)
- Michelle Ryan
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | | | - Khorshid Mohammad
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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Ryan M, Lacaze-Masmonteil T, Mohammad K. La neuroprotection contre les lésions cérébrales aiguës chez les nouveau-nés prématurés. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michelle Ryan
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | | | - Khorshid Mohammad
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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Scime NV, Gavarkovs AG, Chaput KH. The effect of skin-to-skin care on postpartum depression among mothers of preterm or low birthweight infants: A systematic review and meta-analysis. J Affect Disord 2019; 253:376-384. [PMID: 31078838 DOI: 10.1016/j.jad.2019.04.101] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mothers of preterm or low birthweight (LBW) infants are at two to three times greater risk of postpartum depression (PPD) than mothers of healthy infants, which may be partially due to mother-infant separation during hospitalization. Skin-to-skin care could protect against PPD among these vulnerable mothers. We examined the effect of skin-to-skin care on PPD among mothers of preterm or LBW infants through a systematic review and meta-analysis. METHODS We searched six peer-reviewed databases for prospective studies of skin-to-skin interventions that took place in neonatal intensive care units (NICUs), used a validated PPD tool, and were published in English between 1979 and 2017. Data were standardized and pooled using Hedges method in a quality-weighted meta-analysis. RESULTS Eight studies detailing seven interventions met inclusion criteria. Intervention characteristics varied with duration ranging from one week to over two months, skin-to-skin sessions ranging from 15 min to 1 h, and frequency ranging from thrice daily to thrice weekly. Five PPD tools were used predominantly as continuous measures. Meta-analysis demonstrated that skin-to-skin interventions were associated with a 1.04% reduction in standardized depression scores versus standard care (p < 0.001), though high heterogeneity was evident (I2 = 82.4%, p < 0.001). LIMITATIONS Studies differed markedly with respect to design and intervention features, and were methodologically limited by using continuous depressive scores (not dichotomous PPD diagnoses) as the outcome. CONCLUSIONS Skin-to-skin care has a small protective effect on maternal depressive scores, however the clinical relevance of this finding is arguably minimal. Additional well-designed studies are warranted to conclusively assess the effects of skin-to-skin on PPD.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.
| | - Adam G Gavarkovs
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Katie H Chaput
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada; Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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van Manen MA. Towards the Womb of Neonatal Intensive Care. THE JOURNAL OF MEDICAL HUMANITIES 2019; 40:225-237. [PMID: 29130125 DOI: 10.1007/s10912-017-9494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Within the mother's womb, life finds its first stirrings. The womb shelters the fetus, the growing child within. We recognize the existential traces of a wombed existence when a newborn calms in response to being held; when a newborn stills in response to his or her mother's heartbeat; and, when a newborn startles in the presence of bright light. Yet, how does experiential human life begin within another human being? What are the conditions and paths of becoming for the fetus within the womb? And for the child born early, what "womb" welcomes the premature child in neonatal intensive care?
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Affiliation(s)
- Michael A van Manen
- John Dossetor Health Ethics Centre, University of Alberta, 5-16 University Terrace, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.
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Strzelewicz AR, Ordoñes Sanchez E, Rondón-Ortiz AN, Raneri A, Famularo ST, Bangasser DA, Kentner AC. Access to a high resource environment protects against accelerated maturation following early life stress: A translational animal model of high, medium and low security settings. Horm Behav 2019; 111:46-59. [PMID: 30708031 PMCID: PMC6527488 DOI: 10.1016/j.yhbeh.2019.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/18/2018] [Accepted: 01/10/2019] [Indexed: 12/21/2022]
Abstract
Early life exposure to a low security setting, characterized by a scarcity of resources and limited food access, increases the risk for psychiatric illness and metabolic dysfunction. We utilized a translational rat model to mimic a low security environment and determined how this manipulation affected offspring behavior, metabolism, and puberty. Because food insecurity in humans is associated with reduced access to healthy food options the "low security" rat manipulation combined a Western diet with exposure to a limited bedding and nesting manipulation (WD-LB). In this setting, dams were provided with limited nesting materials during the pups' early life (P2-P10). This manipulation was contrasted with standard rodent caging (SD) and environmental enrichment (EE), to model "medium security" and "high security" environments, respectively. To determine if transitioning from a low to high security environment improved outcomes, some juvenile WD-LB offspring were exposed to EE. Maternal care was impacted by these environments such that EE dams engaged in high quality care when on the nest, but spent less time on the nest than SD dams. Although WD-LB dams excessively chased their tails, they were very attentive to their pups, perhaps to compensate for limited resources. Offspring exposed to WD-LB only displayed subtle changes in behavior. However, WD-LB exposure resulted in significant metabolic dysfunction characterized by increased body weight, precocious puberty and alterations in the hypothalamic kisspeptin system. These negative effects of WD-LB on puberty and weight regulation were mitigated by EE exposure. Collectively, these studies suggest that both compensatory maternal care and juvenile enrichment can reduce the impact of a low security environment. Moreover, they highlight how utilizing diverse models of resource (in)stability can reveal mechanisms that confer vulnerability and resilience to early life stress.
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Affiliation(s)
- Arielle R Strzelewicz
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston,MA 02115, United States
| | | | - Alejandro N Rondón-Ortiz
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston,MA 02115, United States
| | - Anthony Raneri
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, United States
| | - Sydney T Famularo
- Department of Psychology, Temple University, Philadelphia, PA 19122, United States
| | - Debra A Bangasser
- Department of Psychology, Temple University, Philadelphia, PA 19122, United States
| | - Amanda C Kentner
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, United States.
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71
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Shattnawi KK, Al-Ali N. The Effect of Short Duration Skin to Skin Contact on Premature Infants' Physiological and Behavioral Outcomes: A Quasi-Experimental Study. J Pediatr Nurs 2019; 46:e24-e28. [PMID: 30782417 DOI: 10.1016/j.pedn.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed at assessing the effect of short duration Skin to skin contact (SSC) (5 days) on premature infants' short-term physiological and behavioral outcomes. DESIGN AND METHODS A quasi-experimental control group design was utilized. 89 stable premature infants were allocated to either an interventional or control group. RESULTS Results showed that in comparison to the control group, newborns in the SSC group demonstrated higher weight gain (g/day) from day 3-5 of practicing SSC (53.7 g Vs. 32.6 g; P < .05), experienced significantly fewer numbers of apneas (48% Vs. 33.3%; P = .001), and were less likely to use formula feeding (60% Vs. 90%) and more likely to use mixed feeding (formula and breastfeeding) at discharge (33.3% Vs. 10%). Significant differences were also found in the crying, and sleeping patterns of the infants; infants of mothers who practiced SSC were less likely to cry in a continuous pattern and more likely to experience good sleep than infants in the control group. CONCLUSIONS The study highlights the importance of the early and short duration of SSC for premature infants. PRACTICE IMPLICATIONS The initiation of SSC in the first few days of life may have a significant influence on the newborn's short-term outcomes.
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Affiliation(s)
| | - Nahla Al-Ali
- Jordan University of Science and Technology, Irbid, Jordan.
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72
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Makris NM, Vittner D, Samra HA, McGrath JM. The PREEMI as a measure of parent engagement in the NICU. Appl Nurs Res 2019; 47:24-28. [PMID: 31113541 DOI: 10.1016/j.apnr.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/30/2018] [Accepted: 03/24/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Nefeli M Makris
- Connecticut Children's Medical Center Hartford and Farmington, CT; University of Connecticut, School of Nursing, Storrs, CT.
| | - Dorothy Vittner
- University of Connecticut, School of Nursing, Storrs, CT; Division of Neonatology, Wake-Medical NIDCAP Training Center, Wake- Medical Hospital and Health System, Raleigh, NC
| | - Haifa A Samra
- University of South Dakota, School of Nursing, Sioux Falls, SD
| | - Jacqueline M McGrath
- University of Connecticut, School of Nursing, Storrs, CT; University of Texas Health Science Center San Antonio, School of Nursing, San Antonio, TX
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73
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Eliades C. Mitigating Infant Medical Trauma in the NICU: Skin-to-Skin Contact as a Trauma-Informed, Age-Appropriate Best Practice. Neonatal Netw 2019; 37:343-350. [PMID: 30567883 DOI: 10.1891/0730-0832.37.6.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant's traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant's traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes.
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74
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Hunter LML, Blake S, Simmons C, Thompson J, Derouin A. Implementing a Parent Education Program in the Special Care Nursery. J Pediatr Health Care 2019; 33:131-137. [PMID: 30146361 DOI: 10.1016/j.pedhc.2018.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Parents of preterm hospitalized infants, whose lengths of stay can range from a few days to several months, often experience emotional liability. Because the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) is a stressful and intimidating environment, prompt attention should be given to reducing parental stress and increasing parental confidence in preparation to care for their child post-discharge. METHODS A quality improvement pilot project was designed to evaluate the parent education and support program, titled HUG Your Baby, in a Level II SCN for its ability to decrease stress and increase confidence for postpartum mothers of preterm infants born at less than 35 weeks gestation during the infant's hospitalization. RESULTS The outcomes demonstrated a statistically significant decrease in maternal stress and a statistically significant increase in maternal confidence. DISCUSSION The HUG Your Baby program is an effective parent education and support program that would benefit NICU and SCN families.
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Affiliation(s)
- La Monica L Hunter
- La Monica L. Hunter, Certified Pediatric Nurse Practitioner, Duke Regional Hospital, Durham, NC.
| | - Stephanie Blake
- Stephanie Blake, Neonatal Nurse Practitioner-Board Certified, Duke University Medical Center, Durham, NC
| | - Catherine Simmons
- Catherine Simmons, Neonatal Nurse Practitioner-Board Certified, Duke University Medical Center, Durham, NC
| | - Julie Thompson
- Julie Thompson, Statistical Consulting Associate, Duke University, Durham, NC
| | - Anne Derouin
- Anne Derouin, Certified Pediatric Nurse Practitioner and Associate Professor, Duke University, Durham, NC
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75
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Pados BF. Physiology of Stress and Use of Skin-to-Skin Care as a Stress-Reducing Intervention in the NICU. Nurs Womens Health 2019; 23:59-70. [PMID: 30590016 DOI: 10.1016/j.nwh.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/18/2018] [Accepted: 11/01/2018] [Indexed: 06/09/2023]
Abstract
Advances in neonatal care have allowed for the increasing survival of critically ill infants. These infants experience significant stress related to painful procedures and physical separation from their parents. The purpose of this article is to describe the physiologic stress mechanisms that contribute to mortality and morbidity in infants in the NICU and the physiologic mechanisms by which skin-to-skin care (SSC) acts on the stress response system. Findings from current literature supporting the use of SSC and barriers and facilitators to implementation are reviewed. SSC is a safe and effective intervention to reduce stress for infants and their parents. Nurses play a key role in facilitating SSC to optimize outcomes of care in the NICU.
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76
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Jannes C, Miedaner F, Langhammer K, Enke C, Göpel W, Kribs A, Nitzsche A, Riedel R, Woopen C, Kuntz L, Roth B. Increased parental satisfaction by unrestricted visiting hours and developmentally supportive care in NICUs - results of a German multicenter study. J Matern Fetal Neonatal Med 2018; 33:1874-1880. [PMID: 32216530 DOI: 10.1080/14767058.2018.1532499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: This study aims to provide insights into the impact of organizational family-centered care characteristics at German neonatal intensive care units (NICUs) on the satisfaction of parents of very low birthweight (VLBW) infants.Materials and methods: Using multilevel modeling, this study analyzed whether organizational characteristics of NICUs fostering parent-infant interaction (by way of the existence of a recreation room, possibility of rooming in, existence of unrestricted visiting hours for parents, existence of parental classes, and the connection to parent associations as well as the existence of standards on developmentally supportive care) increase the satisfaction of parents after the infants' high-intensive care phase within the NICU.Results: Nine hundred and twenty-three VLBW infants from 66 NICUs in Germany born between May and October 2013 were enrolled in this multicenter study. We retrieved 1493 questionnaires completed by 1277 parents. The existence of unrestricted visiting hours (adjusted odds ratio (AOR): 1.967; 95% CI [1.118, 3.459]) and standardized procedures for developmentally supportive care (AOR: 1.775; 95% CI [1.166, 2.704]) were positively associated with parental satisfaction.Conclusions: Fostering the parent-infant interaction through the provision of developmentally supportive care and unrestricted visiting hours for parents whose infants are hospitalized within an NICU significantly contributes to the satisfaction of parents.
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Affiliation(s)
- Christiane Jannes
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Felix Miedaner
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Kristina Langhammer
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| | - Christian Enke
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Angela Kribs
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| | - Anika Nitzsche
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Rainer Riedel
- Institute for Medical Economics and Health Services Research, Rheinische Fachhochschule Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Bernhard Roth
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany.,Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
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Targeted sensory enrichment interventions protect against behavioral and neuroendocrine consequences of early life stress. Psychoneuroendocrinology 2018; 98:74-85. [PMID: 30121011 DOI: 10.1016/j.psyneuen.2018.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/20/2018] [Accepted: 07/29/2018] [Indexed: 12/16/2022]
Abstract
Both basic and clinical research support the use of tactile stimulation to rescue several neurobiobehavioral consequences that follow early life stress. Here, using a translational rodent model of the neonatal intensive care unit (NICU), we tested the individual prophylactic potential of a variety of sensory interventions including tactile (brushing pups with a paint brush to mimic maternal licking), auditory (a simulated lactating rat dam heart beat), and olfactory (a series of aroma therapy scents) stimulation. The NICU model was developed to mimic not only the reduced parental contact that sick infants receive (by isolating rat pups from their litters), but also the nosocomial infections and medical manipulations associated with this experience (by utilizing a dual lipopolysaccharide injection schedule). Each of the neurobiobehavioral consequences observed were dissociable between isolation and inflammation, or required a combined presentation ('two hits') of the neonatal stressors. Sprague-Dawley rats exposed to these early life stressors presented with sex-specific disruptions in both separation-induced ultrasonic vocalization (USV) distress calls (males & females) and juvenile social play USVs (males only). All three sensory enhancement interventions were associated with the rescue of potentiated distress calls while olfactory stimulation was protective of social vocalizations. Female rats exposed to early life stress experienced precocious puberty and shifts in the hypothalamic GnRh axis; sensory enrichment counter-acted the advanced pubertal onset. Animals that underwent the NICU protocol also displayed maturational acceleration in terms of the loss of the rooting reflex in addition to hyperalgesia, a reduced preference for a novel conspecific, blunted basal plasma corticosterone and reduced hippocampal glucocorticoid receptor expression. These alterations closely simulated the clinical effects of early life adversity in terms of disruptions in the hypothalamic pituitary "stress" axis, social communication and engagement, tactile system processing, and accelerated maturation. Moreover, sensory enrichment attenuated many of these behavioral and neurophysiological alterations, and even slowed maturation. Overall, this supports the translatability of our novel rodent model and its potential utility in understanding how brain maturation and quality of early life experiences may interact to shape the integrity of stress and sensory system development. Future work must determine the appropriate modalities and parameters (e.g. patterning, timing) for effective sensory enrichment interventions.
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78
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Li B, Yu FZ, Minich A, Hock A, Lee C, Pierro A. Neonatal intestinal injury induced by maternal separation: pathogenesis and pharmacological targets 1. Can J Physiol Pharmacol 2018; 97:193-196. [PMID: 30383976 DOI: 10.1139/cjpp-2018-0370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Maternal separation (MS) is a well-studied phenomenon thought to play a role in the pathogenesis of many diseases ranging from neuropsychiatric to early intestinal disorders such as necrotizing enterocolitis. The existing evidence suggests that MS initiates a variety of processes that in turn lead to early intestinal injury. Although there are many theories as to how MS alters normal physiological processes, the exact mechanism of action remains to be elucidated. This review aims to describe some of the pathological processes affecting the intestine that are caused by MS, including (i) brain-gut axis, (ii) intestinal epithelial barrier function, (iii) microbiome, (iv) oxidative stress and endoplasmic reticulum stress, and (v) gut inflammation.
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Affiliation(s)
- Bo Li
- a Division of General and Thoracic Surgery, Translation Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Fang Zhou Yu
- a Division of General and Thoracic Surgery, Translation Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.,b School of Medicine, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Adam Minich
- a Division of General and Thoracic Surgery, Translation Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Alison Hock
- a Division of General and Thoracic Surgery, Translation Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Carol Lee
- a Division of General and Thoracic Surgery, Translation Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Agostino Pierro
- a Division of General and Thoracic Surgery, Translation Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Casper C, Sarapuk I, Pavlyshyn H. Regular and prolonged skin-to-skin contact improves short-term outcomes for very preterm infants: A dose-dependent intervention. Arch Pediatr 2018; 25:469-475. [PMID: 30340943 DOI: 10.1016/j.arcped.2018.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/18/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Skin-to-skin contact (SSC) is a cornerstone of neurodevelopment and family-oriented care for preterm infants. The purpose of the present study was to investigate the effectiveness of skin-to-skin contact in preterm babies depending on regularity, duration, and the period of the first contact. MATERIALS AND METHODS This retrospective study involved 26 premature infants with gestational age 24/0-28/6 weeks who were treated in the neonatal intensive care unit and neonatal department. All infants had SSC with their parents. RESULTS According to the first SSC, newborns were divided into two groups: group 1 (SSC began in the 1st week of life) and group 2 (SSC began after the 1st week of life). Group A (SSC was performed regularly, i.e., everyday) and group B (SSC was irregular, i.r., once every 2 or 3 days) were based on the regularity of SSC. Depending on the duration of SSC, group І (SSC was more than 3h per day) and group II (SSC was less than 3h per day) were formed. Early SSC correlated with lower incidence of secondary infections (OR=6.75; 95% CI 1.06-42.84; P=0.051), bronchopulmonary dysplasia (OR=10.67; 95% CI 1.70-66.72; P<0.015), and cholestasis (P=0.022). Regular SSC correlated with lower incidence of secondary infections (OR=15.0; 95% CI 1.50-149.70; P=0.014). Duration of SSC was correlated with lower rates of secondary infections (OR=7.00; 95% CI 1.20-40.83; P=0.043) and better rates of breastfeeding (OR=7.00; 95% CI 1.20-40.83; P=0.043). CONCLUSION Early, regular, and prolonged SSC has a positive impact on premature infants' health. In particular, early SSC is associated with a reduced risk of BPD development, cholestasis, and nosocomial infection. Prolonged daily skin-to-skin contact is associated with a lower incidence of nosocomial infection and promotes breastfeeding.
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Affiliation(s)
- C Casper
- Université Toulouse III Paul-Sabatier, 330, avenue de Grande Bretagne, 31059 Toulouse cedex 9, France
| | - I Sarapuk
- I.Ya. Horbachevsky Ternopil State Medical University, 1, Maydan Voli, 46001 Ternopil, Ukraine.
| | - H Pavlyshyn
- I.Ya. Horbachevsky Ternopil State Medical University, 1, Maydan Voli, 46001 Ternopil, Ukraine
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Zhang Y, Deng Q, Zhu B, Li Q, Wang F, Wang H, Xu X, Johnston L. Neonatal intensive care nurses' knowledge and beliefs regarding kangaroo care in China: a national survey. BMJ Open 2018; 8:e021740. [PMID: 30166300 PMCID: PMC6119424 DOI: 10.1136/bmjopen-2018-021740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Kangaroo care (KC), a well-established parent-based intervention in neonatal intensive care units (NICUs), with documented benefits for infants and their parents. However, in China there remains a lack of knowledge and a reluctance to implement KC in hospitals. Therefore, our aim was to investigate the current knowledge, beliefs and practices regarding KC among NICU nurses in China using the 'Kangaroo Care Questionnaire'. METHODS A quantitative descriptive survey was designed. This questionnaire comprised 90 items classified according to four domains: knowledge, practice, barriers and perception. Data were analysed using SPSS V.20.0, and content analysis was used to summarise data derived from open-ended questions. RESULTS The survey involved 861 neonatal nurses from maternity and general hospitals across China (response rate=95.7%). The findings showed that 47.7% (n=411) of the nurses had participated in the implementation of KC. Neonatal nurses in the 'experienced in KC' group showed an overall better understanding of KC and its benefits with a higher 'correct response' rate than those in the 'not experienced in KC' group. In the 'experienced in KC' group, over 90% considered KC beneficial to the parent-baby relationship and attachment, and over 80% believed that KC positively affected outcomes of preterm infants. The 'not experienced in KC' group perceived more barriers to KC implementation than did the 'experienced in KC' group. CONCLUSION Although most nurses working in NICUs in China were aware of the benefits of KC, there remain substantial barriers to its routine use in practice. Education for both staff and parents is necessary, as is the provision of appropriate facilities and policies to support parents in providing this evidence-based intervention.
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Affiliation(s)
- Yao Zhang
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qingqi Deng
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
| | - Binghua Zhu
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Qiufang Li
- Neonatal Intensive Care Units, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Wang
- Nursing Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Wang
- Neonatal Intensive Care Units, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinfen Xu
- Nursing Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Haining Maternal and Child Health Hospital, Haining, China
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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81
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von Rahden O, Seidenberg J. Eltern frühgeborener Kinder. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-017-0282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Preterm birth interrupts the precise process of fetal maturation, forcing critical neurologic growth to continue within the Neonatal Intensive Care Unit (NICU). Concern for the impact of the NICU experience on the developing brain led to a unit-based Quality Improvement (QI) project to promote best outcomes for our graduates. The objective was to implement a standard of care for neonatal neuroprotection in a large urban tertiary center. A multidisciplinary committee researched and developed the Neonatal Neuroprotective Best Practice Guidelines to identify optimal interventions, as well as provide physiologic rationales to reinforce importance of these practices. An educational initiative accompanied release of this document to support consistency in clinical practice and to stress the critical role that every caregiver played in a child's outcome. As the Best Practice Guidelines encompassed virtually all aspects of caregiving in the NICU, it was impractical to measure the impact of such a broad range of interventions in a methodical manner. The full effect of these interventions will not likely be evident until NICU graduates have grown into childhood and adolescence. These constraints limited the scope of this QI project to the practicalities of identifying neuroprotective best practice and bringing it to the bedside. When combined with evidence-based medical and nursing care, neuroprotective care represents the best means of facilitating normal development and minimizing disability for our NICU graduates.
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An Observational Cohort Study Examining the Effect of the Duration of Skin-to-Skin Contact on the Physiological Parameters of the Neonate in a Neonatal Intensive Special Care Unit. Adv Neonatal Care 2018; 18:208-214. [PMID: 29596071 DOI: 10.1097/anc.0000000000000485] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Focus on skin-to-skin contact (SSC) as a family-centered care intervention in Neonatal Intensive Special Care (NISC) Units continues to increase. Previously, SSC has been shown to improve neonatal physiological stability, support brain development, and promote bonding and attachment. Limited research exists investigating SSC duration and neonatal physiological responses. PURPOSE This study examined the relationship between SSC duration and the neonate's oxygen saturation, heart rate (HR), respiratory rate (RR), and temperature. METHOD An observational cohort study was conducted at The Royal Women's Hospital NISC Unit in Melbourne, Australia. For each neonate participant, 1 SSC with their parent was studied (parent convenience) and neonatal physiological parameters recorded, with a bivariate correlation used to explore the relationship between the duration of SSC and the percentage of time during SSC that the neonate's physiological variables remained within a target range. FINDINGS No correlation existed between the duration of SSC and the neonatal physiological variables of oxygen saturation, HR, RR, and temperature. However, neonatal oxygen requirement was more often reduced across the duration of SSC. IMPLICATIONS FOR PRACTICE AND FUTURE RESEARCH Due to previously documented benefits to neonates physiologically from SSC, and our supportive finding that SSC reduces neonatal oxygen requirement, we believe that this study adds to the evidence to support promotion of SSC in NISC Units. The duration of SSC does not appear to negatively impact the physiological effects to the neonate. Thus, SSC should be encouraged in all NISC Units to be conducted for the length of time the parent is able. This study should be repeated with a larger sample size.
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84
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Rao S, Thankachan P, Amrutur B, Washington M, Mony PK. Continuous, real-time monitoring of neonatal position and temperature during Kangaroo Mother Care using a wearable sensor: a techno-feasibility pilot study. Pilot Feasibility Stud 2018; 4:99. [PMID: 29796294 PMCID: PMC5961490 DOI: 10.1186/s40814-018-0293-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Remote biomonitoring of vital parameters in hospitals and homes has the potential to improve coverage and quality of maternal and neonatal health. Wearable sensors coupled with modern information and communication technology now offer an opportunity to monitor temperatures and kangaroo mother care (KMC) adherence in a continuous and real-time manner remotely for several days' duration in hospital and home settings. Using an innovative remote biomonitoring device to measure both temperature and baby position, we undertook a techno-feasibility study in preparation for a clinical trial. Methods We designed and developed a wearable sensor for tracking KMC adherence and neonatal temperature, using social innovation design principles. After screening mother-infant dyads using clinical and logistic eligibility criteria, we piloted this wearable sensor along with a gateway device and the commercial cellular network. The dyads were recruited during hospitalization and followed up in the hospital and home phases for several days. Simple descriptive statistical analysis was undertaken. Results Recruitment rate was 50% (6/12), and consenting rate was 83% (5/6) during a 2-month period. These five neonates contributed a total of 39 study days (15 hospital days and 24 home days). Their mean [± standard deviation (S.D.)] birth weight was 1490 (± 244) g.The mean (± S.D.) of the vital signs for the five babies was temperature [36.5 °C (± 0.3)], heart rate [146.5/min (± 14)], and oxygen saturation [94% (± 4)]. No severe or moderate side-effects were noted; one baby developed mild dermatitis under the device that was transient and self-limiting, yielding an incidence proportion of 20% and incidence rate of 2.6/100 person-days.None of the mothers reported any discomfort with the use of the device. Temperatures detected from 81 paired readings revealed that those from the wearable sensor were 0.2 °C lower than those detected by clinical thermometers [36.4 (± 0.7) vs 36.6 (± 0.3); < 0.001].There was also iterative feedback that was useful for hardware and software design specifications of the wearable sensor, the gateway device, and the analytics platform. Lastly, lessons were learnt with regard to the logistics of research team interactions with healthcare professionals and study participants during the hospitalization and post-discharge home phases of the study. Conclusions The pilot study has shown that it is feasible and acceptable to track KMC adherence as well as maternal and newborn temperatures in a potentially safe manner on a real-time mode for several days' duration during hospitalization and home phases. The pilot has also helped inform modifications in clinical monitoring, technological modifications, and logistics planning in preparation for the definitive clinical trial. Trial registration Clinical Trials Registry of India, CTRI/2017/09/009789.
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Affiliation(s)
- Suman Rao
- 1Department of Neonatology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, 560034 India
| | - Prashanth Thankachan
- 2Division of Epidemiology and Population Health, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, 560034 India
| | - Bharadwaj Amrutur
- 3Robert Bosch Center for Cyber Physical Systems, Indian Institute of Science, Bangalore, 560012 India.,4Department of Electrical Communication Engineering, Indian Institute of Science, Bangalore, 560012 India
| | - Maryann Washington
- 2Division of Epidemiology and Population Health, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, 560034 India
| | - Prem K Mony
- 2Division of Epidemiology and Population Health, St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, 560034 India
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Kenny KS. Mental Health Harm to Mothers When a Child Is Taken by Child Protective Services: Health Equity Considerations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:304-307. [PMID: 29258344 PMCID: PMC5912303 DOI: 10.1177/0706743717748885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kathleen S. Kenny
- Department of Maternal and Child Health, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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86
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Siegel JD, Guzman-Cottrill JA. Pediatric Healthcare Epidemiology. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152479 DOI: 10.1016/b978-0-323-40181-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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87
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Kudchadkar SR, Barnes S, Anton B, Gergen DJ, Punjabi NM. Non-pharmacological interventions for sleep promotion in hospitalized children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sapna R Kudchadkar
- Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children’s Center; Department of Anesthesiology and Critical Care Medicine; 1800 Orleans Street, Suite 6318B Baltimore MD USA 21287
| | - Sean Barnes
- Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children’s Center; Department of Anesthesiology and Critical Care Medicine; 1800 Orleans Street, Suite 6318B Baltimore MD USA 21287
| | - Blair Anton
- Johns Hopkins University School of Medicine; William H Welch Medical Library; 2024 E. Monument Street Baltimore MD USA 21287
| | - Daniel J Gergen
- Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children’s Center; Department of Anesthesiology and Critical Care Medicine; 1800 Orleans Street, Suite 6318B Baltimore MD USA 21287
| | - Naresh M Punjabi
- Johns Hopkins University School of Medicine; Department of Medicine; Division of Pulmonary and Critical Care Medicine 5501 Hopkins Bayview Circle, 4B-36 Baltimore MD USA 21224
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88
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Hall SL, Hynan MT, Phillips R, Lassen S, Craig JW, Goyer E, Hatfield RF, Cohen H. The neonatal intensive parenting unit: an introduction. J Perinatol 2017; 37:1259-1264. [PMID: 28796241 PMCID: PMC5718987 DOI: 10.1038/jp.2017.108] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/23/2017] [Accepted: 05/26/2017] [Indexed: 01/06/2023]
Abstract
This paper describes a paradigm shift occurring in neonatal intensive care. Care teams are moving from a focus limited to healing the baby's medical problems towards a focus that also requires effective partnerships with families. These partnerships encourage extensive participation of mothers and fathers in their baby's care and ongoing bi-directional communication with the care team. The term Newborn Intensive Parenting Unit (NIPU) was derived to capture this concept. One component of the NIPU is family-integrated care, where parents are intimately involved in a baby's care for as many hours a day as possible. We describe six areas of potentially better practices (PBPs) for the NIPU along with descriptions of NIPU physical characteristics, operations, and a relationship-based culture. Research indicates the PBPs should lead to improved outcomes for NIPU babies, better mental health outcomes for their parents, and enhanced well-being of staff.
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Affiliation(s)
- S L Hall
- St. John’s Regional Medical Center, Oxnard, CA, USA
| | - M T Hynan
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - R Phillips
- Division of Neonatology, Department of Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - S Lassen
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - J W Craig
- School of Occupational Therapy, Brenau University, Gainesville, GA, USA
| | - E Goyer
- Family Advocacy Network, National Perinatal Association, Austin, TX, USA
| | - R F Hatfield
- Newborn Intensive Care Unit, University of Utah Medical Center, Salt Lake City, UT, USA
| | - H Cohen
- Neonatal Intensive Care Unit, Salem Hospital, Salem, OR, USA
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89
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Rodriguez J, Jordan S, Mutic A, Thul T. The Neonatal Microbiome: Implications for Neonatal Intensive Care Unit Nurses. MCN Am J Matern Child Nurs 2017; 42:332-337. [PMID: 29049058 PMCID: PMC5679116 DOI: 10.1097/nmc.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nursing care of the neonate in the neonatal intensive care unit (NICU) is complex, due in large part to various physiological challenges. A newer and less well-known physiological consideration is the neonatal microbiome, the community of microorganisms, both helpful and harmful, that inhabit the human body. The neonatal microbiome is influenced by the maternal microbiome, mode of infant birth, and various aspects of NICU care such as feeding choice and use of antibiotics. The composition and diversity of the microbiome is thought to influence key health outcomes including development of necrotizing enterocolitis, late-onset sepsis, altered physical growth, and poor neurodevelopment. Nurses in the NICU play a key role in managing care that can positively influence the microbiome to promote more optimal health outcomes in this vulnerable population of newborns.
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Affiliation(s)
- Jeannie Rodriguez
- Jeannie Rodriguez is an Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. She can be reached via e-mail at Sheila Jordan is a Pre-Doctoral Fellow, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Abby Mutic is a Certified Nurse Midwife, Doctoral Candidate, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Taylor Thul is a Doctoral Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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90
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Jones H, Santamaria N. Physiological benefits to parents from undertaking skin-to-skin contact with their neonate, in a neonatal intensive special care unit. Scand J Caring Sci 2017; 32:1012-1017. [PMID: 29131378 DOI: 10.1111/scs.12543] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/18/2017] [Indexed: 11/28/2022]
Abstract
There has been increased focus on the use of family-centred care interventions, such as skin-to-skin contact (SSC) in Neonatal Intensive Special Care (NISC) Units over the past two decades. SSC between a parent and their neonate has previously shown to promote positive mental and emotional health in parents and assist in bonding and attachment between parent and neonate. The purpose of this study was to investigate the effect that SSC between parent and their neonate has on the parent's heart rate (HR) and blood pressure (BP). There has been a lack of prior research investigating the physiological responses from SSC on parents, hence the need to conduct this study. The study was conducted as an observational cohort study at The Royal Women's Hospital NISC Unit in Melbourne, Australia. One SSC between parent and neonate was recorded, and three repeated measures analysis of variance (anova) were conducted to investigate the relationship between SSC and the parent's HR, systolic BP and diastolic BP. The study found statistically significant differences between the parent's initial HR and BP, to measurements taken during the SSC (p < 0.05). This may suggest that parents' find SSC with their neonate to be a stress-reducing intervention, whilst they are in a NISC Unit. This may in turn promote associated benefits, such as a decrease in parental depression and anxiety, whilst they are in the NISC Unit, physical health benefits, as well as increased feelings of bonding between parent and their neonate. Based on the findings, it is suggested that SSC should be promoted in NISC Units as a family-centred care intervention that lowers parent's HR and BP and may provide associated health benefits.
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Affiliation(s)
- Hannah Jones
- University of Melbourne, Melbourne, Vic., Australia.,Newborn Intensive Care, The Royal Women's Hospital, Parkville, Vic., Australia
| | - Nick Santamaria
- Nursing Research, Translational Research, University of Melbourne, Melbourne, Vic, Australia
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91
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Barbeau DY, Weiss MD. Sleep Disturbances in Newborns. CHILDREN (BASEL, SWITZERLAND) 2017; 4:E90. [PMID: 29053622 PMCID: PMC5664020 DOI: 10.3390/children4100090] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this review is to serve as an introduction to understanding sleep in the fetus, the preterm neonate and the term neonate. Sleep appears to have numerous important roles, particularly in the consolidation of new information. The sleep cycle changes over time, neonates spend the most time in active sleep and have a progressive shortening of active sleep and lengthening of quiet sleep. Additionally, the sleep cycle is disrupted by many things including disease state and environment, and the amplitude integrated EEG can be a useful tool in evaluating sleep, and sleep disturbances, in neonates. Finally, there are protective factors for infant sleep that are still being studied.
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Affiliation(s)
| | - Michael D Weiss
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA.
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92
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Dereymaeker A, Pillay K, Vervisch J, De Vos M, Van Huffel S, Jansen K, Naulaers G. Review of sleep-EEG in preterm and term neonates. Early Hum Dev 2017; 113:87-103. [PMID: 28711233 PMCID: PMC6342258 DOI: 10.1016/j.earlhumdev.2017.07.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neonatal sleep is a crucial state that involves endogenous driven brain activity, important for neuronal survival and guidance of brain networks. Sequential EEG-sleep analysis in preterm infants provides insights into functional brain integrity and can document deviations of the biologically pre-programmed process of sleep ontogenesis during the neonatal period. Visual assessment of neonatal sleep-EEG, with integration of both cerebral and non-cerebral measures to better define neonatal state, is still considered the gold standard. Electrographic patterns evolve over time and are gradually time locked with behavioural characteristics which allow classification of quiet sleep and active sleep periods during the last 10weeks of gestation. Near term age, the neonate expresses a short ultradian sleep cycle, with two distinct active and quiet sleep, as well as brief periods of transitional or indeterminate sleep. Qualitative assessment of neonatal sleep is however challenged by biological and environmental variables that influence the expression of EEG-sleep patterns and sleep organization. Developing normative EEG-sleep data with the aid of automated analytic methods, can further improve our understanding of extra-uterine brain development and state organization under stressful or pathological conditions. Based on those developmental biomarkers of normal and abnormal brain function, research can be conducted to support and optimise sleep in the NICU, with the ultimate goal to improve therapeutic interventions and neurodevelopmental outcome.
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Affiliation(s)
- Anneleen Dereymaeker
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Kirubin Pillay
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom..
| | - Jan Vervisch
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Maarten De Vos
- Institute of Biomedical Engineering (IBME), Department of Engineering Science, University of Oxford, Oxford, United Kingdom..
| | - Sabine Van Huffel
- KU Leuven (University of Leuven), Department of Electrical Engineering-ESAT, Division Stadius, Leuven, Belgium; Imec, Leuven, Belgium.
| | - Katrien Jansen
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium; Department of Development and Regeneration, University Hospitals Leuven, Child Neurology, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Gunnar Naulaers
- Department of Development and Regeneration, University Hospitals Leuven, Neonatal Intensive Care Unit, KU Leuven (University of Leuven), Leuven, Belgium.
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93
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Caravale B, Sette S, Cannoni E, Marano A, Riolo E, Devescovi A, De Curtis M, Bruni O. Sleep Characteristics and Temperament in Preterm Children at Two Years of Age. J Clin Sleep Med 2017; 13:1081-1088. [PMID: 28760193 DOI: 10.5664/jcsm.6728] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/06/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to compare 2-year-old children born preterm with children born full term regarding: (1) sleep characteristics, (2) temperament, and (3) relations between sleep pattern and habits and temperament. METHODS The study included 51 preterm children with normal cognitive, language, and motor development (mean = 20.94 months, standard deviation [SD] = 4.08) and 57 full-term children (mean = 21.19, SD = 4.32). To assess sleep-related difficulties and habits and child temperament, mothers completed the following questionnaires: the (1) Sleep Disturbance Scale for Children-adapted (SDSC); (2) Brief Infant Sleep Questionnaire (BISQ); and (3) Italian Temperament Questionnaires-version 12-36 months (QUIT). RESULTS Preterm children needed less support to fall asleep and fell asleep more often alone in their own bed compared to those born at full term; however, preterm children showed more frequent sleep difficulties, such as restlessness and breathing problems during the night. In addition, preterm children had lower scores in the temperamental dimension of attention and higher scores in negative emotionality than full-term children. Finally, sleep problems were correlated with higher motor activity, lower social orientation and attention, and increased negative emotionality; a shorter nocturnal sleep duration was related to higher motor activity and lower inhibition to novelty whereas an earlier rise time was associated with lower attention and social orientation. CONCLUSIONS Preterm children showed sleep pattern problems and disturbance, predominance of attention problems, and negative emotionality related to sleep disruption.
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Affiliation(s)
- Barbara Caravale
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefania Sette
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Eleonora Cannoni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Assunta Marano
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Erika Riolo
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonella Devescovi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Mario De Curtis
- Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
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94
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Skin-to-Skin Contact in Cesarean Birth and Duration of Breastfeeding: A Cohort Study. ScientificWorldJournal 2017; 2017:1940756. [PMID: 29082306 PMCID: PMC5610826 DOI: 10.1155/2017/1940756] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/17/2017] [Accepted: 07/31/2017] [Indexed: 11/22/2022] Open
Abstract
Early skin-to-skin contact (SSC) after birth is a physiological practice that is internationally recommended and has well-documented importance for the baby and for the mother. This study aims to examine SSC with a cohort of mothers or fathers in the operating room after a Cesarean section (C-section) and its relationship with duration of breastfeeding. From January 1, 2012, to December 31, 2012, at the Castelli Hospital in Verbania, Italy, a Baby Friendly designated hospital, 252 consecutive women who had a C-section were enrolled in the study and followed for 6 months. The sample was later divided into three groups depending on the real outcomes in the operating room: SSC with the mother (57.5%), SSC with the father (17.5%), and no SSC (25%). Our study showed a statistical association between skin-to-skin contact with the mother and the exclusive breastfeeding rates on discharge. This effect is maintained and statistically significant at three and six months, as compared to the groups that had paternal SSC or no SSC. After a C-section, skin-to-skin contact with the mother can be an important practice for support, promotion, and duration of breastfeeding.
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95
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Maastrup R, Weis J, Engsig AB, Johannsen KL, Zoffmann V. ‘Now she has become my daughter’: parents’ early experiences of skin-to-skin contact with extremely preterm infants. Scand J Caring Sci 2017; 32:545-553. [DOI: 10.1111/scs.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Janne Weis
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Anne B. Engsig
- Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - Vibeke Zoffmann
- The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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96
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Thyagarajan B, Baral V, Gunda R, Hart D, Leppard L, Vollmer B. Parental perceptions of hypothermia treatment for neonatal hypoxic-ischaemic encephalopathy. J Matern Fetal Neonatal Med 2017. [PMID: 28637367 DOI: 10.1080/14767058.2017.1346074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Hypothermia Treatment (HT) is now the standard care for neonatal hypoxic-ischaemic encephalopathy (HIE). We conducted a survey to explore parental perceptions of HT as there is little information about this in the current literature. METHODS Postal questionnaire survey included families (n = 51) whose babies received HT at Princess Anne Hospital, Southampton, UK, with 23 questions covering communication, clinical management, follow-up, and care in general. Statistical analysis of descriptive and analytical tests were done using Minitab 16. RESULTS The response rate was 60.8%. All parents had concerns amongst which perceptions of pain and distress were described by 41%. Temporary concerns about bonding were common (83.8%), more so in babies transferred from other hospitals (p = .04). Only 61.3% felt they had a good understanding of HT. The need for improvements in the quality (71%) and frequency of communication (48.3%) were also highlighted. CONCLUSIONS Parents were worried about pain and distress, bonding and about outcomes after HT. Consistency in communication, regular updates, involvement of parents in decision making, strong support mechanisms and balanced discussions about long term outcomes at an early stage are of high importance to families whose babies undergo HT.
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Affiliation(s)
- Balamurugan Thyagarajan
- a Neonatal Unit, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Regional Neonatal Intensive Care Unit, St Michaels Hospital , Bristol , UK
| | - Vijay Baral
- a Neonatal Unit, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust , Southampton , UK.,c Department of Neonatal and Developmental Medicine , Singapore General Hospital , Singapore
| | - Ranjit Gunda
- a Neonatal Unit, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust , Southampton , UK.,d Neonatal Unit, Queen Alexandra Hospital , Portsmouth , England
| | - Denise Hart
- e Department of Paediatric Physiotherapy , Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Lisa Leppard
- a Neonatal Unit, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Brigitte Vollmer
- f Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton , Southampton , UK.,g Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust Southampton , Southampton , UK
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Roué JM, Kuhn P, Lopez Maestro M, Maastrup RA, Mitanchez D, Westrup B, Sizun J. Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2017; 102:F364-F368. [PMID: 28420745 DOI: 10.1136/archdischild-2016-312180] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 12/30/2022]
Abstract
Despite the recent improvements in perinatal medical care leading to an increase in survival rates, adverse neurodevelopmental outcomes occur more frequently in preterm and/or high-risk infants. Medical risk factors for neurodevelopmental delays like male gender or intrauterine growth restriction and family sociocultural characteristics have been identified. Significant data have provided evidence of the detrimental impact of overhelming environmental sensory inputs, such as pain and stress, on the developing human brain and strategies aimed at preventing this impact. These strategies, such as free parental access or sleep protection, could be considered 'principles of care'. Implementation of these principles do not require additional research due to the body of evidence. We review the scientific evidence for these principles here.
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Affiliation(s)
| | - Pierre Kuhn
- Department of Neonatal Medicine, University Hospital of Strasbourg, Strasbourg, France
| | | | | | - Delphine Mitanchez
- Division of Neonatology, Department of Perinatology, Hopital Armand-Trousseau, Paris, France
| | - Björn Westrup
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jacques Sizun
- Department of Neonatal Medicine, CHRU de Brest, Brest, France
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98
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Effects of Skin-to-Skin Care on Late Preterm and Term Infants At-Risk for Neonatal Hypoglycemia. Pediatr Qual Saf 2017; 2:e030. [PMID: 30229167 PMCID: PMC6132485 DOI: 10.1097/pq9.0000000000000030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/08/2017] [Indexed: 01/01/2023] Open
Abstract
Objective The objective of this study was to evaluate the effects of prolonged skin-to-skin care (SSC) during blood glucose monitoring (12-24 hours) in late preterm and term infants at-risk for neonatal hypoglycemia (NH). Study design We conducted a retrospective pre- and postintervention study. We compared late preterm and term infants at-risk for NH born in a 1-year period before the SSC intervention, May 1, 2013, to April 30, 2014 (pre-SSC) to at-risk infants born in the year following the implementation of SSC intervention, May 1, 2014, to April 30, 2015 (post-SSC). Results The number of hypoglycemia admissions to neonatal intensive care unit among at-risk infants for NH decreased significantly from 8.1% pre-SSC period to 3.5% post-SSC period (P = 0.018). The number of infants receiving intravenous dextrose bolus in the newborn nursery also decreased significantly from 5.9% to 2.1% (P = 0.02). Number of infants discharged exclusively breastfeeding increased from 36.4% to 45.7%, although not statistically significant (P = 0.074). Conclusion This SSC intervention, as implemented in our hospital, was associated with a significant decrease in newborn hypoglycemia admissions to neonatal intensive care unit. The SSC intervention was safe and feasible with no adverse events.
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99
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Almutairi WM, Ludington-Hoe SM. Kangaroo Care Education Effects on Nurses' Knowledge and Skills Confidence. J Contin Educ Nurs 2017; 47:518-524. [PMID: 27783834 DOI: 10.3928/00220124-20161017-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/24/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Less than 20% of the 996 NICUs in the United States routinely practice kangaroo care, due in part to the inadequate knowledge and skills confidence of nurses. Continuing education improves knowledge and skills acquisition, but the effects of a kangaroo care certification course on nurses' knowledge and skills confidence are unknown. METHOD A pretest-posttest quasi-experiment was conducted. The Kangaroo Care Knowledge and Skills Confidence Tool was administered to 68 RNs at a 2.5-day course about kangaroo care evidence and skills. Measures of central tendency, dispersion, and paired t tests were conducted on 57 questionnaires. RESULTS The nurses' characteristics were varied. The mean posttest Knowledge score (M = 88.54, SD = 6.13) was significantly higher than the pretest score (M = 78.7, SD = 8.30), t [54] = -9.1, p = .000), as was the posttest Skills Confidence score (pretest M = 32.06, SD = 3.49; posttest M = 26.80, SD = 5.22), t [53] = -8.459, p = .000). CONCLUSION The nurses' knowledge and skills confidence of kangaroo care improved following continuing education, suggesting a need for continuing education in this area. J Contin Educ Nurs. 2016;47(11):518-524.
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100
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Grossman MR, Berkwitt AK, Osborn RR, Xu Y, Esserman DA, Shapiro ED, Bizzarro MJ. An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome. Pediatrics 2017; 139:e20163360. [PMID: 28562267 PMCID: PMC5470506 DOI: 10.1542/peds.2016-3360] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of neonatal abstinence syndrome (NAS), a constellation of neurologic, gastrointestinal, and musculoskeletal disturbances associated with opioid withdrawal, has increased dramatically and is associated with long hospital stays. At our institution, the average length of stay (ALOS) for infants exposed to methadone in utero was 22.4 days before the start of our project. We aimed to reduce ALOS for infants with NAS by 50%. METHODS In 2010, a multidisciplinary team began several plan-do-study-act cycles at Yale New Haven Children's Hospital. Key interventions included standardization of nonpharmacologic care coupled with an empowering message to parents, development of a novel approach to assessment, administration of morphine on an as-needed basis, and transfer of infants directly to the inpatient unit, bypassing the NICU. The outcome measures included ALOS, morphine use, and hospital costs using statistical process control charts. RESULTS There were 287 infants in our project, including 55 from the baseline period (January 2008 to February 2010) and 44 from the postimplementation period (May 2015 to June 2016). ALOS decreased from 22.4 to 5.9 days. Proportions of methadone-exposed infants treated with morphine decreased from 98% to 14%; costs decreased from $44 824 to $10 289. No infants were readmitted for treatment of NAS and no adverse events were reported. CONCLUSIONS Interventions focused on nonpharmacologic therapies and a simplified approach to assessment for infants exposed to methadone in utero led to both substantial and sustained decreases in ALOS, the proportion of infants treated with morphine, and hospital costs with no adverse events.
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Affiliation(s)
| | | | | | | | | | - Eugene D Shapiro
- Departments of Pediatrics
- Epidemiology, Yale University School of Medicine and School of Public Health, New Haven, Connecticut
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