Early skin-to-skin contact for mothers and their healthy newborn infants

Shifting the Paradigm for Establishing and Maintaining Milk Production in the Setting of Mother/Infant Separation

Establishing lactation when mother and infant are separated, such as when the neonate is admitted to the neonatal intensive care unit (NICU), is challenging. The most common clinical advice is to express milk eight or more times per day, every 3 hours, around the clock. Sometimes, the first time that parents hear this is after the birth of their baby. This can be overwhelming and sometimes unachievable. A five-step paradigm shift is proposed that refocuses lactation care on providing evidence-based assistance and ongoing clinical education, and assessment beginning prenatally and extending past maternal discharge, to improve outcomes through curated support. Simple guidelines can begin with expressing milk at least five times a day by Day 5 of life (5 × 5), and expressing milk at least once between 0100 and 0500 (overnight pumping). With these measures, neonatal care in the NICU setting can provide personalized and achievable guidance on pumping schedules.

Prophylactic dextrose gel use in newborns at risk for hypoglycemia

OBJECTIVE

To assess the impact of prophylactic dextrose gel on short-term outcomes in infants at risk for hypoglycemia.

METHODS

Retrospective, single-center, observational study of neonates at risk for hypoglycemia -infants of diabetic mothers, large and small for gestational age infants, born between January 2015 and May 2023. Infants were categorized into two groups for analysis. 1. Pre- dextrose gel (01/2015 to 04/2018, n = 788) and 2. Dextrose gel (01/2019 to 05/2023, n = 1495). Infant demographic data and outcome variables were compared between the two groups.

RESULTS

2283 infants were eligible. Prophylactic dextrose gel use was associated with decreased admission rates to NICU secondary to hypoglycemia (2.7% vs. 6.5%), reduced incidence of hypoglycemia (32% vs. 43.3%), and higher exclusive breastmilk use at discharge (47% vs. 37.3%).

CONCLUSION

The use of prophylactic dextrose gel in certain high-risk newborns was associated with improved patient outcomes.

Determining Consensus Alignment and Barriers of Neonatal Thermal Management in Nepal Using a Modified Delphi Process

Objective. Neonatal hypothermia is a worldwide health burden with an incidence ranging from 32% to 85% in hospitals and 11% to 92% in homebirths. It is prevalent in Nepal and associated with increased morbidity and mortality. The study objective was to identify key practice standards of newborn thermal management in Nepal. Methods. Our subjects included 6 lead newborn physicians from major birthing centers in Kathmandu. A modified Delphi process was used to identify the top 5 key practice standards for newborn thermoregulation in the hospital, health post, and home, compiled from 14 World Health Organization recommended practices. Results. There was consensus in all ranked practices except using radiant heat sources in the hospital and performing Kangaroo Mother Care in the homebirths. Comments conveyed that interventions during the immediate delivery phase were most impactful and feasible. Conclusion. Nepali physicians prioritized thermoregulatory practices during the immediate resuscitation period over the post-resuscitation period.

Cesarean birth is associated with lower motor and language development scores during early childhood: a longitudinal analysis of two cohorts

With global C-section rates rising, understanding potential consequences is imperative. Previous studies suggested links between birth mode and psychological outcomes. This study evaluates the association of birth mode and neurodevelopment in young children across two prospective cohorts, using repeated psychometric assessments. Data from the ELEMENT (Early Life Exposures in Mexico to Environmental Toxicants) and PROGRESS (Programming Research in Obesity, Growth, and Environment and Social Stress) cohorts, comprising 7158 and 2202 observations of 1402 children aged 2 to 36 months, and 726 children aged 5 to 27 months, respectively, were analyzed. Exclusion criteria for the cohorts were maternal diseases such as preeclampsia, renal or heart disease, gestational diabetes, and epilepsy. Neurodevelopment was gauged via Bayley's Scales of Infant Development: 2nd edition for ELEMENT and 3rd edition for PROGRESS. Mixed-effects models longitudinally estimated associations between birth mode and neurodevelopment scores, adjusting for cofounders. In ELEMENT, psychomotor development composite scores were significantly affected by birth mode from ages 2 to 8 months; the largest estimate within this range was at 2 months (β =-1.93; 95% CI: [-3.64, -0.22], reference: vaginal delivery). For PROGRESS, a negative association was found with motor development composite scores over all the studied age range (β=-1.91; 95% CI: [-3.01, -0.81]). The association was stronger between ages 6 to 18 months, with the strongest estimate at 11 months (β=-2.58; 95% CI: [-4.37, -0.74]). A negative impact of C-section on language scores in girls was estimated for the PROGRESS cohort (β=-1.92; 95% CI: [-3.57, -0.27]), most marked in ages 22 to 25 months (largest β at 24.5 months=-3.04; 95% CI: [-5.79, -0.30]). Children born by C-section showed lower motor and language development scores during specific age windows in the first three years of life. Further research is necessary to understand the complexities and implications of these findings.

Initiated Breastfeeding and Physiological Patterns in Newborn Infants When Reunited With Mother After Separation Due to Elective Cesarean Birth

BACKGROUND

The purpose of this study was to compare the effects of two caregiving models on full-term healthy infants' wakefulness, rooting and sucking reflexes, initiation of breastfeeding, and physiological parameters when reunited with their mothers after a mother-infant separation of 130 min after elective cesarean birth.

METHODS

Ninety-five mother-infant pairs participated in a randomized controlled trial, in which full-term healthy infants were allocated to be either dressed in their mothers' arms (n = 56) or skin-to-skin with their mother (n = 39) when reunited with the mother within 130 min after cesarean birth. Data were collected by the Neonatal Behavioral Assessment Scale (NBAS) to assess the infants' wakefulness and prebreastfeeding behaviors. Physiological parameters were assessed at 15 min intervals, from 130 to 205 min after birth. Time to first breastfeed was measured in minutes from the reunion with the mother.

RESULTS

The primary finding was that physiologic parameters did not differ but time for initiation of breastfeeding after the reunion with the mother was significantly faster in the skin-to-skin group compared to the infants in the mothers' arms group (p = 0.005). Over the full study period, a more relaxed state and drowsy were found in the skin-to-skin group compared to the infants in the mothers' arms group.

CONCLUSION

Healthy full-term infants born by elective cesarean, who were cared for by their mothers when reunited within 130 min of separation and cared for by their fathers during the mother-infant separation, initiated breastfeeding successfully and showed stable physiological patterns.

Prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania: evidence from a national survey

BACKGROUND

Timely initiation of breastfeeding is crucial for positive health outcomes for babies and mothers. Understanding the factors influencing timely initiation of breastfeeding is vital for reducing child morbidities and mortalities in Mauritania. This study, therefore, assessed the prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania, providing significant insights for improving maternal and child health in the country.

METHODS

We performed a secondary analysis of the 2019-2021 Mauritania Demographic and Health Survey data. A weighted sample of 4,114 mother-child pairs was included in the study. We used percentage to present the prevalence of early initiation of breastfeeding. A four-modelled multilevel binary logistic regression was used to examine the factors associated with early initiation of breastfeeding. The regression results were presented using adjusted odds ratio (aOR) with their respective 95% confidence interval (CI). Stata software version 17.0 was used to perform all the analyses.

RESULTS

The prevalence of early initiation of breastfeeding was 57.3% (95% CI 54.5, 60.00). Birth order was associated with early initiation of breastfeeding with the highest odds among those in the fourth birth order (aOR 1.61; 95% CI 1.08, 2.39). Mothers who practiced skin-to-skin contact were more likely to initiate breastfeeding early than those who did not (aOR 1.46; 95% CI 1.14, 1.87). There were regional disparities in the early initiation of breastfeeding. The odds of timely initiation of breastfeeding was lower among women who were delivered by caesarean section (aOR 0.22; 95%CI 0.14, 0.36), those who were working (aOR 0.57; 95% CI 0.45, 0.73), those who had four or more antenatal care visits (aOR 0.67; 95%CI 0.47, 0.94)], and those in the richest wealth quintile (aOR 0.61; 95% CI 0.38, 0.98) compared to those who had normal delivery, those who were not working, those who had zero antenatal care visits, and those in the poorest wealth quintile households, respectively.

CONCLUSION

Our study found a relatively low prevalence of early initiation of breastfeeding among women in Mauritania. Factor such as birth order, region of residence, mother and newborn skin-to-skin contact after birth, antenatal care visits, caesarean delivery, employment status, and wealth index were associated with early initiation of breastfeeding. Improving optimal breastfeeding practices, such as early initiation of breastfeeding in Mauritania, should be given adequate attention. There is a need for interventions such as baby-friendly facilities, providing an enabling environment for mothers to breastfeed their newborns early. Addressing regional health access disparities is important to improve early initiation of breastfeeding and other maternal, newborn, and child health interventions.

Does an early hands-on breastfeeding intervention by midwives affect nipple pain incidence? An observational pilot study

AIM

To describe the timing and characteristics of midwives' hands-on interruptions of newborns' behavior while in skin-to-skin contact during the first hour after birth and to elucidate the relationship between these hands-on interruptions and the incidence of nipple pain during the first 4 days postpartum.

METHODS

An observational pilot study was conducted at a Baby-Friendly® hospital in Japan from 2016 to 2018. Iterative analysis of video recordings from a larger study of the behavior of newborns while skin-to-skin with their mothers in the first hour after birth found 16 full-term newborns who were born vaginally and that met the inclusion criteria of a midwife's hands-on intervention (HOI) interrupting the infant's progress toward breast self-attachment. The timing of the HOI and the stage of the newborn's progress through Widström's 9 Stages was noted by two research assistants who had been blinded to the medical records. The degree of nipple pain after breastfeeding was self-evaluated by mothers each day during their hospitalization. All data were statistically analyzed.

RESULTS

Interrupting the infant's progressive behaviors in the first hour after birth by midwives' hands-on "help" to breastfeed,  may increase nipple pain during the 4 days after birth. One hundred percent of the mothers reported nipple pain in the postpartum with the highest pain reports occurring on day 4.

CONCLUSION

Interrupting skin-to-skin contact with HOI does not decrease the incidence of nipple pain during the first days postpartum. HOI for newborn infants was not shown to support breastfeeding in the early postnatal period.

Early parental vocal contact in neonatal units: rationale and clinical guidelines for implementation

This paper aims to present clear and evidence-based proposals for the integration of Early Parental Vocal Contact into the clinical practices of neonatal units. In the first part, we present a comprehensive rationale exploring the ontogenesis of voice perception in both term and preterm newborns that establishes a foundational understanding. This knowledge serves as a crucial starting point for developing evidence-based auditory and multisensory interventions aimed at fostering the developmental trajectory of preterm infants. Drawing insights from neuroscience and brain development, our proposals underscore the significance of tailoring auditory environments within neonatal settings. Special attention is given to the unique needs of preterm infants, factoring in their gestational age and maturation levels. In the second part clinical guidelines for implementation are provided and healthcare professionals are supported to assist parents in modulating their vocal interactions, aligning them with the infant's responses. Furthermore, we provide practical suggestions for engaging in discussions with parents about the content, duration, and frequency of vocal interventions. Finally, we delve into the potential roles of caregivers, parents, and health professionals within this enriched parental vocal interactional environment. Our perspective is firmly grounded in an infant and family-centered developmental care philosophy, aiming to enhance the overall well-being and the neurodevelopment of preterm infants in neonatal units.

A Staff Educational Intervention to Increase the Time of Skin-to-Skin Care in a Swedish NICU: A Quality Improvement Project

BACKGROUND

Skin-to-skin contact (SSC) is crucial in neonatal intensive care unit (NICU) care; yet, challenges exist in its implementation. This study addresses a knowledge gap by examining the most effective ways to introduce SSC in the NICU, emphasizing the need to seamlessly integrate this practice for optimal infant and parent care. One way, among many, to implement SSC is to increase staff's knowledge and awareness about SSC.

OBJECTIVE

To describe the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life.

METHODS

A pre- and postinterventional study design was used to determine the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life.

RESULTS

The prevalence of infants receiving SSC during their first 24 hours of life, the number of SSC sessions per day, and the duration of each SSC session increased after the intervention, and these effects persisted over 2 years.

IMPLICATIONS FOR PRACTICE

Our study highlights the impact of staff education and reflective discussions on SSC in the NICU. Integrating these with practical training, parental education, and NICU environment modifications is pivotal for enhancing and sustaining optimal SSC practices, benefiting both infants and parents.

Longer skin-to-skin contact after birth enhances breastfeeding quality and duration: A cohort study

AIM

Skin-to-skin contact (SSC) immediately after birth may improve breastfeeding outcomes. This study explored the effect of the duration of SSC in the delivery room on breastfeeding quality and duration.

METHODS

In this prospective observational cohort study, mother-infant pairs practising SSC were categorised into two groups based on SSC duration (≤45 or >45 min). Outcomes included breastfeeding quality in the delivery room and at 24 h of age assessed by the Infant-Breastfeeding Assessment Tool (IBFAT) score, and long-term breastfeeding duration up to 6 months while accounting for potential confounding variables.

RESULTS

The study included 72 mother-infant pairs. SSC for more than 45 min was significantly correlated with longer immediate breastfeeding (65 vs. 19 min, p < 0.001) and higher breastfeeding quality scores immediately after birth (IBFAT score of 10 vs. 7, p < 0.001). Regarding the long-term effect, infants in the extended SSC group were breastfed longer (5.2 vs. 3.7 months, p = 0.005) and had exclusive breastfeeding (4.7 vs. 2.7 months, p > 0.001). No significant confounding variables were identified.

CONCLUSION

Extended SSC (>45 min) correlated with prolonged, higher-quality breastfeeding after birth and longer successful breastfeeding.

Olfactory stimulation for promoting development and preventing morbidity in preterm infants

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of olfactory stimulation with different odorants in the NICU for promoting development and preventing morbidity in preterm infants.

Having Enough Milk to Sustain a Lactation Journey: A Call to Action

The rates of human milk feeding are suboptimal worldwide. Recommendations for healthy, term mother-infant dyads include early breastfeeding initiation, frequent skin-to-skin contact, and frequent breastfeeding. The normal physiology of lactation can be affected by prenatal factors such as diabetes, obesity, and excessive gestational weight gain. Furthermore, birth-related factors such as early-term gestation, stressful labor, unscheduled cesarean birth, and postpartum hemorrhage can additionally disrupt recommended practices such as early initiation of breastfeeding and skin-to-skin contact. Given that the first 2 to 3 days postpartum are critical to achieving timely secretory activation and establishing an adequate volume of milk, a proactive approach to care can include building awareness of risk factors and development of protocols for the effective early initiation of lactation.

Multicomponent perinatal breastfeeding support in women with BMI >25: The Latch On multi-centre randomised trial

OBJECTIVE

To investigate the effectiveness of a multicomponent breastfeeding support intervention on breastfeeding prevalence at 3 months among women with a body mass index (BMI) >25 kg/m2.

DESIGN

Multicentre multicomponent randomised controlled trial.

SETTING

Four maternity centres in Ireland.

POPULATION

A total of 225 primiparous women and their nominated support partners. Participants were aged 18 years and over, with BMI ≥25 kg/m2, carrying a singleton pregnancy and without contraindication for breastfeeding.

METHODS

The intervention included an antenatal group breastfeeding education session for participants and their support partners, followed by a planned postnatal breastfeeding assessment and telephone support for up to 6 weeks by a lactation consultant.

MAIN OUTCOME MEASURES

Any breastfeeding at 3 months postpartum.

RESULTS

Any breastfeeding prevalence was 68.7% (n = 68) in the intervention group and 62.1% (n = 59) in the control group at 3 months postpartum (odds ratio 1.33, 95% confidence interval 0.72-2.46, p = 0.36). Any and exclusive breastfeeding rates did not significantly differ at any other time point. More women in the control group accessed support from private lactation consultants (intervention 23.5% [n = 12], control 45.3% [n = 24], p = 0.02).

CONCLUSIONS

The control group had higher than expected breastfeeding rates, and the study found no evidence of effect on the primary outcome. Providing comprehensive education and support for women intending to breastfeed remains of paramount importance.

Effects of automatic heel lancet on invasiveness in neonates: A systematic review and meta-analysis

AIM

We conducted a meta-analysis comparing the invasiveness of automatic lancet devices, which can collect adequate amount of blood at shallow puncture depths, with conventional manual lance devices (lancet or needle) to statistically identify less invasive instruments for neonatal heel lance.

METHODS

We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Ichushi databases for studies comparing the invasiveness between automatic lancet and manual lancet or needle in term and preterm neonates in neonatal intensive care unit.

RESULTS

This review included 9 out of 449 searched articles, with 673 neonates. Automatic lancet had significantly lower pain scores (standardised mean difference: -2.0, 95% confidence interval: -3.3 to -0.7), heart rate (mean difference: -8.0, 95% confidence interval: -13.8 to -2.1), cry duration (mean difference: -21.5, 95% confidence interval: -32.5 to -10.4), number of punctures (mean difference: -0.6, 95% confidence interval: -1.1 to -0.2), and duration of procedures (mean difference: -37.7, 95% confidence interval: -75.2 to -0.2) than manual lancet or needle. Furthermore, peripheral oxygen saturation was significantly higher in automatic lancet than in manual lancet or needle (mean difference: 4.5, 95% confidence interval: 0.5-8.5).

CONCLUSION

Automatic heel lancet devices were less invasive than manual heel lance devices (lancet or needle).

New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care

Background

In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days.

New perspectives

The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC.

Actionable recommendations

This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units.

Discussion

The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.

Antenatal and neonatal exposure to SARS-CoV-2 and children's development: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review of the impact of antenatal and neonatal exposure to SARS-CoV-2 on developmental outcomes in preterm and term-born infants.

METHODS

We searched Embase, Emcare, MEDLINE, PsycINFO, Web of Science and grey literature on May 27, 2022 and updated on May 8, 2023. Studies defining exposure with a positive SARS-CoV-2 protein or genetic material, used a contemporaneous non-exposed cohort, and reported developmental outcomes up to 2 years of age were included.

RESULTS

Four out of 828 screened studies were included. Meta-analysis included 815 infants screened for developmental delay (n = 306 exposed; n = 509 non-exposed) between 3- and 11-months of age. Among term-born infants, we did not find an increased risk of delay in communication (odd's ratio: 0.73 (95% CI: 0.24-2.24)), gross motor (1.50 (0.62, 3.62)), fine motor (2.90 (0.58, 14.43)), problem-solving (1.19 (0.54, 2.66)) or personal-social development (1.93 (0.78, 4.75)) in exposed infants. The number of preterm-born infants in the exposed (n = 37) and comparison cohorts (n = 41) were too few to report meaningful comparisons.

CONCLUSION

Evidence regarding the potential impact of antenatal or neonatal exposure to SARS-CoV-2 infection on developmental outcomes in early infancy is limited and inconsistent. Larger cohorts with outcomes beyond the first year of life are needed.

IMPACT

The current evidence examining associations between SARS-CoV-2 exposure during the neonatal period and developmental outcomes in infancy is limited by there being few studies with extremely small sample sizes. Based on sparse data there was no consistent association between antenatal or neonatal exposure to SARS-CoV-2 infection and an adverse impact on developmental outcomes below 12 months of age for babies born preterm or at term. This study highlights that larger cohorts with outcomes assessed beyond the first year are needed to determine the potential longer-term impact of SARS-CoV-2 infection exposure on child development.

Incidence and risk factors of neonatal hypothermia: A systematic review and meta-analysis

AIM

Hypothermia poses a threat to the health and lives of newborns. Therefore, it is essential to identify the factors that influence neonatal hypothermia and provide targeted intervention suggestions for clinical practice to reduce its occurrence.

METHODS

We conducted a literature search to identify factors influencing neonatal hypothermia and performed a meta-analysis to determine the prevalence of neonatal hypothermia and its associated factors. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of cohort and case-control studies, while the Agency for Healthcare Research and Quality (AHRQ) was used to evaluate the quality of cross-sectional studies.

RESULTS

Eighteen studies involving 44 532 newborns from 13 countries were included. The incidence of neonatal hypothermia was 52.5% (95% CI: 0.37, 0.68). Factors such as no skin-to-skin contact, prematurity, low birth weight, delayed breastfeeding, asphyxiation and resuscitation after birth, low APGAR score, not wearing a cap, and caesarean section were found to affect neonatal hypothermia.

CONCLUSION

Multiple factors influence neonatal hypothermia, and clinicians can utilise these factors to develop targeted intervention measures to prevent and reduce the incidence of neonatal hypothermia.

Implementation of shared decision-making about rooming-in: A before and after an audit of breastfeeding in Taiwan

BACKGROUND

The 24-h rooming-in policy is crucial to the Baby-Friendly Hospital Initiative (BFHI) for promoting breastfeeding. However, this policy may restrict maternal autonomy. In 2018, to integrate women's preferences into care decisions, Taiwan's Baby-Friendly certification included prenatal shared decision-making (SDM) for rooming-in. Prior to 2018, maternal knowledge, considerations, and intentions regarding rooming-in and the impact of prenatal SDM were unknown.

METHODS

A retrospective electronic medical record cohort study was conducted in southern Taiwan. Data on healthy postpartum women eligible for rooming-in and breastfeeding for the years 2017 and 2019, reflecting the periods before and after prenatal SDM was introduced, were gathered. Maternal and newborn characteristics, maternal knowledge, considerations, and prenatal intentions for postpartum rooming-in and breastfeeding during hospitalization were collected. Additionally, data on actual postpartum rooming-in practices during hospitalization and exclusive breastfeeding (EBF) practices from birth to hospital discharge, to 1 month, and to 2 months postpartum were collected. Descriptive and non-parametric statistics were applied to analyze the data.

RESULTS

A total of 621 women in 2017 and 311 women in 2019 were included. After prenatal SDM was introduced, the rooming-in rate during hospitalization fell from 42.2% in 2017 to 25.6% in 2019 (p < 0.001), and the EBF rate declined from 45.9% to 35.7% (p = 0.01). Additionally, the 1-month postpartum EBF rate decreased from 46.4% in 2017 (n = 571) to 44.3% in 2019 (n = 264), and the 2-month postpartum EBF rate dropped from 45.5% in 2017 (n = 591) to 40.2% (n = 308). According to the 2019 Patient Decision Aids responses (n = 236), women demonstrated limited understanding of rooming-in, with only 40.7% expressing an intention toward 24-h rooming-in. Women of older maternal age (p < 0.001), with a graduate degree (p = 0.02), full-time employment (p = 0.04), and concerns about rest disruption (p < 0.001), were more likely to prefer non-24-h rooming-in.

CONCLUSIONS

Initiatives must promote prenatal SDM to enable healthcare providers to address misconceptions and tailor education, thereby increasing women's intention toward 24-h rooming-in and EBF. Future research should explore women's experiences and unmet needs at BFHI facilities to inform the construction of a baby- and mother-friendly environment.

Roles and challenges encountered by midwives in the management of postpartum haemorrhage following normal vaginal delivery: A scoping review

AIMS

To establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery.

DESIGN

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) recommendations.

METHODS

We considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non-English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations.

RESULTS

We included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high-risk factors, managing labour and implementing skin-to-skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.

A perspective-based analysis of attachment from prenatal period to second year postnatal life

Attachment is one of the foundational themes in the history of the psychological development of human beings. For this reason, we assume that it must be approached by taking into account multiple scientific perspectives. The present review aims at analyzing the state of the art regarding the genetic, neurobiological and cognitive mechanisms underlying the development of attachment bonding, considering the child as the frame of reference. We hypothesize that attachment may be present in prototypical forms even in the prenatal period, thus our analysis has a temporal origin in the intrauterine period preceding birth. The intrauterine period is assumed to be a period of maximum sensitivity to stimuli and in particular to those coming from a potential primary caregiver: the biological mother. We conclude with a reframing of the state of the art and propose that future research work would benefit from a superordinate model of attachment, capable of containing and regulating all its components and variables.

Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study

INTRODUCTION

Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal.

METHODS

An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups.

RESULTS

In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room.

CONCLUSION

Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

Barriers and facilitators in implementing early essential newborn care of well-born babies in low- and middle-income countries: A mixed-method systematic review

BACKGROUND

Evidences have demonstrated the effectiveness of early essential newborn care. However, the implementation of early essential newborn care is suboptimal. The aim is to identify and synthesise the barriers and facilitators impacting the implementation of early essential newborn care in low- and middle-income countries.

DATA SOURCES

PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, CNKI, Wan Fang Data, SinoMed and Google Scholar.

METHODS

Two authors independently screened, performed quality assessment using the Mixed Methods Appraisal Tool and extracted data. This review includes papers that reported the barriers and facilitators of implementing early essential newborn care in low- and middle-income countries from the view of healthcare providers. Barriers and facilitators were coded according to the consolidated framework for implementation research in a deductive way and then been inducted into five common themes. This review followed synthesis without meta-analysis reporting guideline.

RESULTS

A total of 28 studies were included. Five inductive common themes influencing implementing early essential newborn care in low- and middle-income countries were system-level healthcare factors, healthcare providers' knowledge and beliefs, the requirements of mothers or families, adapting to routine practice and the working climate of organisation.

CONCLUSION

The factors were from system level, facility level and individual level and were inducted into five themes. Based on this review, decision-makers could tailor implementing strategies to narrow the gap between the evidence and implementation.

RELEVANCE TO CLINICAL PRACTICE

The study offers guidance for health professionals to identify barriers and facilitators in implementing early essential newborn care and make tailored strategies when implementing early essential newborn care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contributions.

C. SP, Joshi D, Baral SC. Essential newborn care practices in health facilities of Nepal: Evidence from Nepal Health Facility Survey 2015 and 2021

Availability of newborn care practices in health facilities (HFs) plays an important role in improving the survival and well-being of newborns. In this paper, we aimed to assess practice of carrying out different newborn care practices among HFs between 2015 and 2021, and associated factors in Nepal. We analyzed data of 621 and 786 HFs offering delivery and newborn care services from Nepal Health Facility Surveys 2015 and 2021, respectively. We summarized categorical variables with a weighted percent and 95% confidence interval (CI). We estimated weighted unadjusted absolute difference in percentage of different newborn care practices between 2015 and 2021, and its 95% CI using binomial regression model. We applied univariable and multivariable logistic regression analysis to determine the factors associated with the availability of all seven newborn care practices. The percentage of HFs carrying out all seven newborn care practices was 50.5% (95% CI: 44.6, 56.3) in 2015 and 83.7% (95% CI: 79.8, 87.0) in 2021 with an overall difference of 33.3 percent points (95% CI: 26.4, 40.1). The proportion of HFs reporting all seven newborn care practices increased significantly between 2015 and 2021 in each all three ecological regions and in provinces except Madhesh and Gandaki. In 2021, private hospitals had lower odds of carrying out all seven newborn care practices compared to federal/provincial hospitals (AOR = 0.26, 95% CI: 0.11, 0.63). Similarly, in 2021, the odds of HFs carrying out all seven newborn care practices was 2.87 (95% CI: 1.06, 8.31) times higher in Sudurpashchim compared to Koshi province. In 2021, HFs carrying out seven newborn care practices did not differ significantly based on ecological belts, quality assurance activities, external supervision, delivery service-related training, and frequency of HF meetings. In conclusion, there has been significant improvement in proportion of facilities carrying out seven essential newborn care practices between 2015 and 2021. Type of facility and provinces were associated with the HFs carrying out seven newborn care practices in Nepal.

Effect of epidural dexmedetomidine in single-dose combined with ropivacaine for cesarean section

BACKGROUND

Dexmedetomidine has arousal sedation and analgesic effects. We hypothesize that epidural dexmedetomidine in single-dose combined with ropivacaine improves the experience of parturient undergoing cesarean section under epidural anesthesia. This study is to investigate the effect of 0.5 µg/kg epidural dexmedetomidine combined with epidural anesthesia (EA) in parturients undergoing cesarean section.

METHODS

A total of 92 parturients were randomly divided into Group R (receiveing epidural ropivacaine alone) Group RD (receiveing epidural ropivacaine with 0.5 µg/kg dexmedetomidine). The primary outcome and second outcome will be intraoperative NRS pain scores and Ramsay Sedation Scale.

RESULTS

All 92 parturients were included in the analysis. The NRS were significantly lower in Group RD compared to Group R at all observation timepoint (P > 0.05). Higher Ramsay Sedation Scale was found in Group RD compared to Group R (P < 0.001). No parturient has experienced sedation score of 4 and above. No significant difference regarding the incidence of hypotension, bradycardia and nausea or vomiting, Apgar scores and the overall satisfaction with anesthesia was found between Group R and Group RD (P > 0.05).

CONCLUSION

Epidural dexmedetomidine of 0.5 µg/kg added slightly extra analgesic effect to ropivacaine in EA for cesarean section. The sedation of 0.5 µg/kg epidural dexmedetomidine did not cause mother-baby bonding deficit. Satisfaction with anesthesia wasn't significantly improved by epidural dexmedetomidine of 0.5 µg/kg. No additional side effect allows larger dose of epidural dexmedetomidine attempt.

TRIAL REGISTRATION

This study was registered at www.chictr.org.cn (ChiCTR2000038853).

Variation in Breastfeeding Initiation and Duration by Mode of Childbirth: A Prospective, Population-Based Study

Introduction: Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. Methods: We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Results: Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Conclusions: Through application of rigorous methods, this study provides compelling evidence that breastfeeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.

The impact of daily affective touch on cortisol levels in institutionalized & fostered children

Institutionalized children are often deprived of affective touch. Such tactile deprivation often leads to constant stress, as measured by the levels of salivary cortisol. We report here the impact of an affective touch program, optimized to activate a specific population of unmyelinated mechanosensitive nerves in the skin called c-tactile afferents (CT) on stress resistance. Two populations of children (age 4-10) were recruited: (i) a cohort living in an orphanage and (ii) a fostered cohort. Both groups received the affective touch program daily for 10-15 min for 5-6 weeks. A cohort of age-matched children living in a family environment acted as a control group and did not receive any instructions for tactile stimulation. Salivary cortisol was collected at the beginning (T1) and at the end (T2) of the study in all three groups. For institutionalized and fostered children there was a significant improvement in the level of cortisol (p < 0.0001) between T1 and T2, which is manifested in the balancing cortisol levels: a decrease where it was elevated and an increase, where the critically low level testified to the distress of the child. Balancing cortisol levels is a process of recovery to normal values, which indicates the restoration of neurohumoral mechanisms of stress regulation. The effect of balancing cortisol levels was more pronounced in the group of fostered children compared to the group of orphanage children (p = 0.0326). The children in the control group had no significant differences.

Effect of Lactation Management Model on Breastfeeding Process After Cesarean: A Prospective Randomized Controlled Study

It is important to implement supportive programs to ensure mothers breast feed for the desired period, and infants are fed by only mother's milk. In the research, it was aimed at evaluating the effects of lactation management model on mothers' breastfeeding process following a caesarean section. Women who gave birth by planned cesarean delivery were divided into two groups, randomized control and experimental. Data collection was performed during gestation, first day after postpartum, pre-discharge, on the 9th day in a face to face interview, and in the form of monthly phone interviews up to 6 months. While the experimental group exercised the lactation management model, the control group received routine lactation practices in clinic. In the scores of Breastfeeding Charting System and Documentation Tool, a significant difference was found between the groups (p<0.001). 87.9% of the experimental group and 48.5% of the control group were determined to apply successful breast-feeding techniques. In addition, it was found that all of the experimental group breast fed 1 month longer than the control group, and for the first month, 90.9% of the experimental group and 78.8% of the control group breast fed with mother's milk only and a higher breastfeeding. Among in the experimental group, it was found that breastfeeding self-efficacy was higher, and breastfeeding techniques were accurate and successful and breastfeeding only and continuity rates were higher while breastfeeding related breast problems developed less frequently. Clinical Trials.gov Protocol Registration Number: NCT04593719.

Neonatal hypoglycemia and neurodevelopmental outcomes: Yesterday, today, tomorrow

Neonatal hypoglycemia is a major source of concern for pediatricians since it has commonly been related to poor neurodevelopmental outcomes. Diagnosis is challenging, considering the different operational thresholds provided by each guideline. Screening of infants at risk plays a crucial role, considering that most hypoglycemic infants show no clinical signs. New opportunities for prevention and treatment are provided by the use of oral dextrose gel. Continuous glucose monitoring systems could be a feasible tool in the next future. Furthermore, there is still limited evidence to underpin the current clinical practice of administering, in case of hypoglycemia, an intravenous "mini-bolus" of 10% dextrose before starting a continuous dextrose infusion. This brief review provides an overview of the latest advances in this field and neurodevelopmental outcomes according to different approaches.   Conclusion: To adequately define if a more permissive approach is risk-free for neurodevelopmental outcomes, more research on continuous glucose monitoring and long-term follow-up is still needed. What is Known: • Neonatal hypoglycemia (NH) is a well-known cause of brain injury that could be prevented to avoid neurodevelopmental impairment. • Diagnosis is challenging, considering the different suggested operational thresholds for NH (<36, <40, <45, <47 or <50 mg/dl). What is New: • A 36 mg/dl threshold seems to be not associated with a worse psychomotor development at 18 months of life when compared to the "traditional" threshold (47 mg/dl). • Further studies on long-term neurodevelopmental outcomes are required before suggesting a more permissive management of NH.

Parents' Perception and Use of Skin-to-Skin Care in Jeddah, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Skin-to-skin care (SSC) between newborns and their parents provides many positive outcomes for both newborns and their parents. However, there is a lack of research assessing the perception of parents, especially fathers, of SSC in Saudi Arabia.

PURPOSE

The aim of the study is to assess parents' perception of SSC in Saudi Arabia.

METHODS

This cross-sectional study used an online survey. Data were collected from a convenience sample of 140 parents of hospitalized neonates between January and June 2023. Data were collected from one private hospital (Dr. Soliman Fakeeh Hospital) and one public hospital (King Abdulla Medical Complex) in Jeddah, Saudi Arabia. The parents' perceptions of SSC were assessed using the Parents' Perceptions of SSC tool. An independent t-test was used to compare mothers and fathers in their perceptions of SSC.

RESULTS

One hundred and forty parents completed the online survey (70 females and 70 males). The majority of the parents did not use SSC with their babies (n=102, 73%), did not read or hear about the use and benefits of skin-to-skin care (n=100, 71%), and did not receive information or training on SSC from healthcare professionals (n=112, 80%). Mothers' perception of SSC was significantly higher than that of fathers (p ≤ 0.05).

CONCLUSION

Fathers' perception of SSC was lower than that of mothers. Awareness and training programs are needed to inform parents, especially fathers, regarding SSC and its benefits in Saudi Arabia.

The concept analysis of parent-infant bonding during pregnancy and infancy: a systematic review and meta-synthesis

INTRODUCTION

Despite the emerging body of literature on mother-to-infant bonding and the associated variables, there are various definitions of bonding construct. Also, there is a lack of a comprehensive conceptual framework of antecedents and consequences of bonding that would guide empirical work.

OBJECTIVE

Aim of the study was to provide a systematic review and synthesis of concept analysis studies on maternal-foetal, mother-infant, or father-infant bonding.

METHOD

A systematic search was performed in PubMed, EBSCOHost (including PsycINFO), ProQuest, and CINAHL. In addition, a hand search was conducted. Papers were eligible for inclusion if they conducted concept analyses on mother or father to foetus/infant bonding. A qualitative meta-synthesis was applied to synthesise the findings.

RESULTS

Eight papers on concept analyses were eligible for inclusion. In meta-synthesis, six aspects of parent-to-(unborn) child bonding emerged, including direction, domain, process, timing, endurance, and parental gender. Defining attributes are (i) a close relationship, (ii) filled with positive parental affection, (iii) manifested during pregnancy as monitoring foetal development and behaviour and after childbirth in proximity and interaction. Antecedents, affecting factors, and consequences of the parent-child bonding have been summarised.

CONCLUSION

Parent-infant bonding refers to an emotional, behavioural, cognitive, and neurobiological tie of the parent to the (unborn) child, as a process from intention to have a child throughout infancy. This is a parental-driven process which can continue to evolve throughout child's and parent's life, characterised as enduring, committed, and engaged. Based on meta-synthesis, a conceptual structure of parent-infant bonding has been provided, which needs further empirical testing.

Skin-to-Skin Contact and Breastfeeding After Planned Cesarean Birth Before and During the COVID-19 Pandemic

Background: Benefits of early skin-to-skin contact (SSC) between mother and newborn are widely documented, including improved breastfeeding outcomes. While promoting immediate SSC is standard practice for vaginal birth, it happens less often after cesarean birth. It is not known how changes in hospital practices and staffing shortages during the COVID-19 pandemic have influenced the practice of SSC in the operating room (OR). This study aims to identify the relationship between SSC after cesarean birth and breastfeeding and compare SSC before and during the COVID-19 pandemic at a single institution. Materials and Methods: This was a retrospective cohort study of 244 subjects who had scheduled cesarean births during 2019 and 2020. The primary outcome was newborn feeding at hospital discharge. Secondary outcomes were time to initiate breastfeeding, newborn feeding at 4-8-weeks postpartum, and location of SSC initiation in 2019 versus 2020. Results: SSC within 3 days of birth was significantly associated with feeding type on discharge and/or 4-8 weeks postpartum. More subjects intending to exclusively breastfeed met this intention at discharge with SSC in the OR. Newborns who had SSC in the OR had significantly earlier initiation of breastfeeding. There was an increase in SSC in the OR between 2019 (27%) and 2020 (39%). Conclusion: SSC in the OR was associated with improved short-term breastfeeding outcomes in our study. If immediate SSC is not possible, SSC within 3 days of birth may have breastfeeding benefits. The increase in SSC in the OR during the COVID-19 pandemic indicates that SSC practices can be implemented, despite challenging circumstances.

Spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia: A spatial and multilevel mixed-effect analysis

BACKGROUND

Skin-to-skin contact care practice is placing a naked baby on the mother's chest with no cloth separating them, in a prone position covered by a cloth or blanket. It improves the survival of newborns by preventing hypothermia, improving breastfeeding, and strengthening mother-to-child bonding. Nevertheless, it remains under-practiced in many resource-constrained settings. Therefore, the main objective of this study is to explore the spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia.

METHOD

The study was done using the 2016 Ethiopian Demographic and Health Survey data. A weighted sample of 10417 mothers who gave live birth before the five-year survey was extracted for the analysis. Arc GIS version 10.3 and SaTscan version 10.0.2 were used for the spatial analysis. A multilevel mixed logistic regression model was fitted to identify factors associated with skin-to-skin contact care practices of mothers and newborns. Finally, a statistically significant association was declared at a P-value of < 0.05.

RESULT

In this study, skin-to-skin contact care practice of mothers and newborns was non-random across Ethiopia with Moran's I: 0.48, p < 0.001. The most likely significant primary and secondary clusters were found in Addis Ababa (RR = 2.39, LLR = 116.80, p <0.001) and Dire Dewa and Harari (RR = 2.02, LLR = 110.45, p <0.001), respectively. In this study, place of delivery (AOR = 12.29, 95%CI:10.41, 14.54), rich wealth index (AOR = 1.29, 95% CI: 1.05,1.59), medium wealth index (AOR = 1.38, 95% CI:1.17, 1.68), having 1-3 antenatal care visits(AOR = 1.86,95% CI: 1.56, 2.29), having ≥4 antenatal care visits (AOR = 1.93,95% CI: 1.56, 2.39), initiating breastfeeding within the first hour (AOR = 1.75,95% CI:1.49,2.05) and media exposure (AOR = 1.20,95%CI 1.02,1.41) were factors associated with skin to skin contact care practice of mothers and newborns.

CONCLUSION

This study concludes that the Skin-to-skin contact care practices of mother and newborn is not random in Ethiopia. Therefore, the implementation of essential newborn care packages should be regularly monitored and evaluated, particularly in the cold spot areas of skin-to-skin contact care practices. Besides, media advertising regarding the importance of Skin-to-skin contact care practices for mothers and newborns should be scaled up to increase the practices.

Quality improvement in the golden hour for premature infants: a scoping review

BACKGROUND AND OBJECTIVE

Evidence-based research has shown that golden hour quality improvement (QI) measures can improve the quality of care and reduce serious complications of premature infants. Herein, we sought to review golden hour QI studies to evaluate the impact on the outcome of preterm infants.

METHODS

A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and SinoMed databases from inception to April 03, 2023. Only studies describing QI interventions in the golden hour of preterm infants were included. Outcomes were summarized and qualitative synthesis was performed.

RESULTS

Ten studies were eligible for inclusion. All studies were from single centers, of which nine were conducted in the USA and one in Israel. Seven were pre-post comparative studies and three were observational studies. Most included studies were of medium quality (80%). The most common primary outcome was admission temperatures and glucose. Five studies (n = 2308) reported improvements in the admission temperature and three studies (n = 2052) reported improvements in hypoglycemia after QI. Four studies (n = 907) showed that the incidence of bronchopulmonary dysplasia (BPD) was lower in preterm infants after QI: 106/408 (26.0%) vs. 122/424(29.5%) [OR = 0.68, 95% CI 0.48-0.97, p = 0.04].

CONCLUSIONS

Our study showed that the golden hour QI bundle can improve the short-term and long-term outcomes for extremely preterm infants. There was considerable heterogeneity and deficiencies in the included studies, and the variation in impact on outcomes suggests the need to use standardized and validated measures. Future studies are needed to develop locally appropriate, high-quality, and replicable QI projects.

An Evidence-Based Practice Project to Provide Standardized Education on Skin-to-Skin Contact and Neonatal Hypoglycemia

OBJECTIVE

To develop and examine the implications of formalized education with staff and familial caregivers on skin-to-skin in relation to neonatal hypoglycemia, including the impact on NICU admission rate, exclusive breastfeeding, and glucose gel administration.

DESIGN

Evidence-based practice (EBP) project with a comparison of data pre-/postintervention.

SETTING/LOCAL PROBLEM

Implemented at a large health system in the mid-Atlantic, including four hospitals with postpartum care units. The EBP implementation site had approximately 19,400 births in 2021.

PARTICIPANTS

Participants included 320 postpartum nurses in addition to the familial neonatal caregivers these nurses provided care for.

INTERVENTION/MEASUREMENT

All team members were provided with online education via the HealthStream learning platform, a microlearning introduction video, weekly huddle messages, and unit-specific champions who shared a champion information sheet that included information such as the hypoglycemia protocol, how to perform safe skin-to-skin care, and how to effectively administer glucose gel. Familial caregiver education included a handout given upon admission with an explanation from the postpartum nurse if the neonate met the criteria for the hospital system's neonatal hypoglycemia protocol.

RESULTS

We observed a 4% system-wide increase in exclusive breastfeeding rates, a decrease in NICU admissions by 17.3% at 1-month postimplementation at the smallest hospital site (Hospital A), and a 12.3% reduction in NICU admission rates at the largest hospital site (Hospital B). Two hospitals reported a decrease in the need for glucose gel administration to neonates after the educational intervention.

CONCLUSION

This nurse-led project detailed the process of a system-wide EBP project to implement consistent and standardized education regarding neonatal protocols. Although the benefits of skin-to-skin contact are widely known, this project demonstrated that focused, targeted education on skin-to-skin protocols for neonates at risk for neonatal hypoglycemia may be effective at improving outcomes.

Neonatal mortality and video assessment of resuscitation in four district hospitals in Pemba, Tanzania

BACKGROUND

We aimed to assess risk factors for neonatal mortality, quality of neonatal resuscitation (NR) on videos and identify potential areas for improvement.

METHODS

This prospective cohort study included women in childbirth and their newborns at four district hospitals in Pemba, Tanzania. Videos were analysed for quality-of-care. Questionnaires on quality-of-care indicators were answered by health workers (HW) and women. Risk factors for neonatal mortality were analysed in a binomial logistic regression model.

RESULTS

1440 newborns were enrolled. 34 newborns died within the neonatal period (23.6 per 1000 live births). Ninety neonatal resuscitations were performed, 20 cases on video. Positive pressure ventilation (PPV) was inadequate in 15 cases (75%). Half (10/20) did not have PPV initiated within the first minute, and in one case (5.0%), no PPV was performed. PPV was not sustained in 16/20 (80%) newborns. Of the 20 videos analysed, death occurred in 10 newborns: 8 after resuscitation attempts and two within the first 24 h. Most of HW 49/56 (87.5%) had received training in NR.

CONCLUSIONS

Video analysis of NR revealed significant deviations from guidelines despite 87.5% of HW being trained in NR. Videos provided direct evidence of gaps in the quality of care and areas for future education, particularly effective PPV.

IMPACT

Neonatal mortality in Pemba is 23.6 per 1000 livebirths, with more than 90% occurring in the first 24 h of life. Video assessment of neonatal resuscitation revealed deviations from guidelines and can add to understanding challenges and aid intervention design. The present study using video assessment of neonatal resuscitation is the first one performed at secondary-level hospitals where many of the world's births are conducted. Almost 90% of the health workers had received training in neonatal resuscitation, and the paper can aid intervention design by understanding the actual challenges in neonatal resuscitation.

An in-depth analysis of the polyvagal theory in light of current findings in neuroscience and clinical research

The polyvagal theory has led to the understanding of the functions of the autonomic nervous system in biological development in humans, since the vagal system, a key structure within the polyvagal theory, plays a significant role in addressing challenges of the mother-child dyad. This article aims to summarize the neurobiological aspects of the polyvagal theory, highlighting some of its strengths and limitations through the lens of new evidence emerging in several research fields-including comparative anatomy, embryology, epigenetics, psychology, and neuroscience-in the 25 years since the theory's inception. Rereading and incorporating the polyvagal idea in light of modern scientific findings helps to interpret the role of the vagus nerve through the temporal dimension (beginning with intrauterine life) and spatial dimension (due to the numerous connections of the vagus with various structures and systems) in the achievement and maintenance of biopsychosocial well-being, from the uterus to adulthood.

90 versus 60 min of early skin-to-skin contact on exclusive breastfeeding rate in healthy infants' ≥35 weeks: A randomised controlled trial

AIM

To compare the effect of 90 versus 60 min of early skin-to-skin contact (SSC) among vaginally born healthy infants ≥35 weeks of gestation on their exclusive breastfeeding rates and breastfeeding behaviour.

METHODS

This parallel-group, open-label, randomised controlled trial enrolled healthy term and late preterm infants born vaginally. Infants in the intervention group received early SSC for 90 min compared to 60 min in the control group. The primary outcome was the proportion of infants on exclusive breastfeeding at 60 ± 12 h.

RESULTS

One hundred ninety-eight mother-infant dyads were randomised (99 in each group). The infants in the 90-min SSC group were more likely to be exclusively breastfed at 60 ± 12 h as compared to the 60-min SSC group (RR, 95% CI-1.44, [1.15-1.79], p < 0.01). The modified infant breastfeeding assessment tool score at 60 ± 12 h was significantly higher in the 90-min SSC group (median [IQR]-9, [8, 10] versus 8 [7, 10], p = 0.03]. The proportion of infants on exclusive breastfeeding at 6, 10, and 14 weeks of age was also significantly higher in the 90-min SSC group (RR, 95% CI-1.39 [1.11-1.74], 1.36 [1.08-1.07], and 1.38 [1.08-1.75], respectively).

CONCLUSION

Increasing the duration of early SSC showed a dose-response benefit on exclusive breastfeeding rates and breastfeeding behaviour.

TRIAL REGISTRATION

CTRI/2018/09/015632, registered on 06/09/2018.

Skin-to-Skin Care and Spontaneous Touch by Fathers in Full-Term Infants: A Systematic Review

A series of studies have shown that mothers' early tactile behaviors have positive effects, both on full-term and preterm infants, and on mothers alike. Regarding fathers, research has focused mostly on paternal skin-to-skin care with preterm infants and has overlooked the tactile behavior effects with full-term newborns on infants' outcomes and on fathers themselves. The current systematic review considered the evidence regarding paternal tactile behaviors with full-term infants, including skin-to-skin care (SSC) and spontaneous touch (ST), during parent-infant interactions, and differentiated biophysiological, behavioral and psychological variables both in fathers and in infants. We also compared fathers' and mothers' tactile behaviors for potential differences. The few available studies suggest that paternal touch-SSC and ST-can have positive effects on fathers and infants alike. They also show that, despite some intrinsic differences, paternal touch is as pleasant as maternal touch. However, given the paucity of studies on the topic, we discuss why this field of research should be further explored.

Daily skin-to-skin contact alters microbiota development in healthy full-term infants

The gut microbiota is vital for human body development and function. Its development in early life is influenced by various environmental factors. In this randomized controlled trial, the gut microbiota was obtained as a secondary outcome measure in a study on the effects of one hour of daily skin-to-skin contact (SSC) for five weeks in healthy full-term infants. Specifically, we studied the effects on alpha/beta diversity, volatility, microbiota maturation, and bacterial and gut-brain-axis-related functional abundances in microbiota assessed thrice in the first year. Pregnant Dutch women (n = 116) were randomly assigned to the SSC or care-as-usual groups. The SSC group participants engaged in one hour of daily SSC from birth to five weeks of age. Stool samples were collected at two, five, and 52 weeks and the V4 region was sequenced. We observed significant differences in the microbiota composition, bacterial abundances, and predicted functional pathways between the groups. The SSC group exhibited lower microbiota volatility during early infancy. Microbiota maturation was slower in the SSC group during the first year and our results suggested that breastfeeding duration may have partially mediated this relation. Our findings provide evidence that postpartum SSC may influence microbiota development. Replication is necessary to validate and generalize these results. Future studies should include direct stress measurements and extend microbiota sampling beyond the first year to investigate stress as a mechanism and research SSC's impact on long-term microbiota maturation trajectories.

Neonatal outcomes of maternal prenatal coronavirus infection

The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

Social predictors of breastfeeding and the impact of interventions on breastfeeding of preterm infants: A longitudinal study

INTRODUCTION

The multifaceted benefits of breastfeeding for mothers and infants include enhanced neurodevelopment and immune function in preterm infants. However, more research is needed to understand the unique factors affecting breastfeeding practices in preterm infants. This study aimed to identify key social predictors of breastfeeding in preterm infants and assess the effectiveness of specific interventions on their feeding practices during the first six months postpartum.

METHODS

A prospective, monocentric, longitudinal study involving a cohort of 201 preterm infants was executed at the Neonatology Department, Ceske Budejovice Hospital, Czech Republic, from January 2020 to January 2023. The STROBE guidelines were used.

RESULTS

The study results elucidated a transition from breastfeeding to bottle feeding and formula within the infants' first six months. Notable social predictors of breastfeeding encompassed factors such as the number of children in the household, the mother's marital status, and the nature of housing. Certain interventions, including immediate skin-to-skin contact between mother and child, and initiation of nutritive feeding within the first half-hour post-birth, significantly influenced the probability of breastfeeding.

CONCLUSIONS

The data underscored that social predictors and nursing interventions substantially shape the breastfeeding practices of preterm infants during the first six months postpartum. Inequities in health outcomes among premature infants can be effectively curbed through comprehensive care models that account for socioeconomic factors influencing breastfeeding.

Oral dextrose gel to prevent hypoglycaemia in at-risk neonates

BACKGROUND

Neonatal hypoglycaemia is a common condition that can be associated with brain injury. Current practice usually includes early identification of at-risk infants (e.g. infants of diabetic mothers; preterm, small- or large-for-gestational-age infants), and prophylactic measures are advised. However, these measures often involve use of formula milk or admission to the neonatal unit. Dextrose gel is non-invasive, inexpensive and effective for treatment of neonatal hypoglycaemia. Prophylactic dextrose gel can reduce the incidence of neonatal hypoglycaemia, thus potentially reducing separation of mother and baby and supporting breastfeeding, as well as preventing brain injury. This is an update of a previous Cochrane Review published in 2021.

OBJECTIVES

To assess the effectiveness and safety of oral dextrose gel in preventing hypoglycaemia before first hospital discharge and reducing long-term neurodevelopmental impairment in newborn infants at risk of hypoglycaemia.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and Epistemonikos in April 2023. We also searched clinical trials databases and the reference lists of retrieved articles.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs comparing oral dextrose gel versus placebo, no intervention, or other therapies for the prevention of neonatal hypoglycaemia. We included newborn infants at risk of hypoglycaemia, including infants of mothers with diabetes (all types), high or low birthweight, and born preterm (< 37 weeks), age from birth to 24 hours, who had not yet been diagnosed with hypoglycaemia.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias. We contacted investigators to obtain additional information. We used fixed-effect meta-analyses. We used the GRADE approach to assess the certainty of evidence.

MAIN RESULTS

We included two studies conducted in high-income countries comparing oral dextrose gel versus placebo in 2548 infants at risk of neonatal hypoglycaemia. Both of these studies were included in the previous version of this review, but new follow-up data were available for both. We judged these two studies to be at low risk of bias in 13/14 domains, and that the evidence for most outcomes was of moderate certainty. Meta-analysis of the two studies showed that oral dextrose gel reduces the risk of hypoglycaemia (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95; risk difference (RD) -0.06, 95% CI -0.10 to -0.02; 2548 infants; high-certainty evidence). Evidence from two studies showed that there may be little to no difference in the risk of major neurological disability at two years of age after oral dextrose gel (RR 1.00, 95% CI 0.59 to 1.68; 1554 children; low-certainty evidence). Meta-analysis of the two studies showed that oral dextrose gel probably reduces the risk of receipt of treatment for hypoglycaemia during initial hospital stay (RR 0.89, 95% CI 0.79 to 1.00; 2548 infants; moderate-certainty evidence) but probably makes little or no difference to the risk of receipt of intravenous treatment for hypoglycaemia (RR 1.01, 0.68 to 1.49; 2548 infants; moderate-certainty evidence). Oral dextrose gel may have little or no effect on the risk of separation from the mother for treatment of hypoglycaemia (RR 1.12, 95% CI 0.81 to 1.55; two studies, 2548 infants; low-certainty evidence). There is probably little or no difference in the risk of adverse effects in infants who receive oral dextrose gel compared to placebo gel (RR 1.22, 95% CI 0.64 to 2.33; two studies, 2510 infants; moderate-certainty evidence), but there are no studies comparing oral dextrose with other comparators such as no intervention or other therapies. No data were available on exclusive breastfeeding after discharge.

AUTHORS' CONCLUSIONS

Prophylactic oral dextrose gel reduces the risk of neonatal hypoglycaemia in at-risk infants and probably reduces the risk of treatment for hypoglycaemia without adverse effects. It may make little to no difference to the risk of major neurological disability at two years, but the confidence intervals include the possibility of substantial benefit or harm. Evidence at six to seven years is limited to a single small study. In view of its limited short-term benefits, prophylactic oral dextrose gel should not be incorporated into routine practice until additional information is available about the balance of risks and harms for later neurological disability. Additional large follow-up studies at two years of age or older are required. Future research should also be undertaken in other high-income countries, low- and middle-income countries, preterm infants, using other dextrose gel preparations, and using comparators other than placebo gel. There are three studies awaiting classification and one ongoing study which may alter the conclusions of the review when published.

Factors associated with high exclusive breastfeeding rates among preterm infants under 34 weeks of gestation in Da Nang, Vietnam: A retrospective cohort study

Background

Preterm infants have higher mortality than full-term infants. While breastfeeding dramatically reduces preterm death, it is limited by biological and practice barriers, particularly for babies born before 34 weeks gestational age. Da Nang Hospital for Women and Children developed a quality improvement approach to improve breastfeeding of preterm infants by strengthening feeding support, non-separation, and kangaroo mother care (KMC).

Methods

To determine breastfeeding outcomes following discharge and explore factors associated with improved feeding, mothers of infants under 34 weeks gestational age born October 2021 to March 2022 and discharged alive were interviewed at six months and their medical records were reviewed.

Results

Out of 104 preterm infants included, all were exclusively breastfed at discharge and one month, 86.5% at three months, and 63.5% at six months; 47.1% received immediate skin-to-skin contact, 31.7% immediate and continuous KMC, and the remaining 68.3% continuous KMC beginning at a median of three days. Exclusive breastfeeding at six months was associated with the mother antenatally seeking breastfeeding information (odds ratio (OR) = 14.5; 95% confidence interval (CI) = 1.2-173.6), avoiding bottle-feeding at home (OR = 7.7; 95% CI = 1.7-33.7) and reduced with each day delay between birth and full breastfeeding (OR = 0.8; 95% CI = 0.6-0.9).

Conclusions

Hospital environments that limit mother-baby separations and feeding delays, including rooming-in of mothers and infants, KMC, and breastfeeding support from birth, enabled 100% of preterm infants born before 34 weeks gestational age to breastfeed exclusively with continued rates higher than previously reported. Addressing antenatal and post-natal factors limiting practice can further improve longer-term breastfeeding outcomes. The approach can be adapted to achieve high exclusive breastfeeding rates, regardless of gestational age.

Skin-to-skin contact and early initiation of breast feeding in Bangladesh: a cross-sectional study using MICS6, Bangladesh (2019) data

BACKGROUND

To curb neonatal deaths, practices such as skin-to-skin contact (SSC) and early initiation of breast feeding (EIBF) can play an important role. Despite being effective, globally only 48% of newborns receive EIBF, and SSC is practised at varying prevalence (1%-74%) among low-income and middle-income countries.

OBJECTIVES

The objective of the current study was to estimate the level of SSC and EIBF practice in Bangladesh and examine factors associated with SSC and EIBF.

METHODS

The cross-sectional study used data from the Multiple Indicator Cluster Survey, Bangladesh (2019). Women of reproductive age with live birth during the last 2 years were included in the analysis (n=8854). A p<0.05 as considered statistically significant (significance level of α=0.05).

RESULTS

The prevalence of SSC and EIBF was 16.4% and 70.4%, respectively. Higher secondary or more level of education (AOR 1.43; 95% CI 1. 07 to 1.90; p=0.016), skilled birth attendant's (SBA) assistance at birth (AOR 2.04, 95% CI 1.60 to 2.61; p<0.001) and receiving antenatal care (AOR 1.40; 95% CI 1.15 to 1.70; p<0.001) had higher odds of practising SSC. Having institutional delivery (AOR 0.35; 95% CI 0.28 to 0.43; p<0.001) and belonging to the richest category (AOR 0.78; 95% CI 0.65 to 0.94; p=0.008) had lower odds of practising EIBF. SSC and EIBF did not have a statistically significant association in the study.

CONCLUSION

The prevalence of SSC in Bangladesh is quite low. However, EIBF prevalence can be considered as 'good'. Targeted interventions such as antenatal care, and assistance by SBA during birth can help in promoting SSC. To promote EIBF practice, interventions should focus on institutes providing delivery support and the richer strata of the society.

Breast feeding practices after normal vaginal and caesarean delivery in Gujarat, India

Breast feeding is the mainspring of child survival, nutrition, development and maternal health. Early initiation of breastfeeding is an extremely important factor associated with the maintenance of long-term breastfeeding practice. Breastfeeding practices can be influenced by a variety of variables such as parity, mode of delivery; body mass index (BMI), breast or nipple abnormalities and behavioural factors are equally as important. The present study was conducted to analyze Breast Feeding Practices after Normal Delivery and Caesarean Delivery at a Tertiary Care Hospital. This cross sectional study was conducted at tertiary care hospital, by Convenient non-random sampling method, which included two groups; Group A: 100 mothers who delivered vaginally Group B: 100 mothers who gave birth through caesarean section (n=100 each). Participants were asked to complete standardized questionnaire consists of information on socio demographic and breast feeding practice. All anthropometric measurements were taken. A semi-structured questionnaire was used to collect data on maternal socio demographic characteristics, breastfeeding knowledge, practices along with source of information regarding breastfeeding and maternal experience. The study results shows that initiation of breastfeeding is most common in normal vaginal delivery (70%) among total 100 subjects of vaginal delivery category and also common in subjects with planned C-section (49%) of 100 subject"s caesarean delivery category. Association between the modes of delivery and initiation of breastfeeding within an hour was statistically significant (p<0.01). The present study indicates that C-sections are linked to higher breastfeeding challenges, greater resource usage, and shorter nursing duration.

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

BACKGROUND

Skin-to-skin contact between mother and infant after birth is recommended to promote breastfeeding and maternal-infant bonding. However, its impact on the incidence of neonatal hypoglycaemia is unknown. We conducted a systematic review and meta-analysis to assess this.

METHODS

Published randomised control trials (RCTs), quasi-RCTs, non-randomised studies of interventions, cohort, or case-control studies with an intervention of skin-to-skin care compared to other treatment were included without language or date restrictions. The primary outcome was neonatal hypoglycaemia (study-defined). We searched 4 databases and 4 trial registries from inception to May 12th, 2023. Quality of studies was assessed using Cochrane Risk of Bias 1 or Effective Public Health Practice Project Quality Assessment tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results were synthesised using RevMan 5.4.1 or STATA and analysed using random-effects meta-analyses where possible, otherwise with direction of findings tables. This review was registered prospectively on PROSPERO (CRD42022328322).

RESULTS

This review included 84,900 participants in 108 studies, comprising 65 RCTs, 16 quasi-RCTs, seven non-randomised studies of intervention, eight prospective cohort studies, nine retrospective cohort studies and three case-control studies. Evidence suggests skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycaemia (7 RCTs/quasi-RCTs, 922 infants, RR 0.29 (0.13, 0.66), p < 0.0001, I2 = 47%). Skin-to-skin contact may reduce the incidence of admission to special care or neonatal intensive care nurseries for hypoglycaemia (1 observational study, 816 infants, OR 0.50 (0.25-1.00), p = 0.050), but the evidence is very uncertain. Skin-to-skin contact may reduce duration of initial hospital stay after birth (31 RCTs, 3437 infants, MD -2.37 (-3.66, -1.08) days, p = 0.0003, I2 = 90%, p for Egger's test = 0.02), and increase exclusive breastmilk feeding from birth to discharge (1 observational study, 1250 infants, RR 4.30 (3.19, 5.81), p < 0.0001), but the evidence is very uncertain.

CONCLUSION

Skin-to-skin contact may lead to a large reduction in the incidence of neonatal hypoglycaemia. This, along with other established benefits, supports the practice of skin-to-skin contact for all infants and especially those at risk of hypoglycaemia.

Investigating short-stay admission to a neonatal intensive care unit as a risk factor for reduced breast feeding at discharge in infants ≥36 weeks' gestation: a retrospective cohort study

OBJECTIVE

This study aims to determine the effect of infant-mother separation following a short-stay (≤72 hours) admission to a Level 5 neonatal unit versus no admission on infant-feeding outcomes at hospital discharge.

DESIGN

Retrospective cohort study.

SETTING

An Australian Level 5 neonatal unit within a tertiary referral hospital.

PARTICIPANTS

Mothers and their infants born between 1 January 2018 and 31 December 2020 had a short-stay admission to the neonatal unit or no admission. All participants met admission criteria to the postnatal ward and were discharged home at ≤72 hours (n=12 540). Postnatal ward admission criteria included ≥36 weeks' gestation and birth weight ≥2.2 kg.

MAIN OUTCOME MEASURES

Infant feeding at discharge from hospital. Multivariate logistic regression analysis was conducted, adjusting for confounders associated with known breastfeeding issues. These included age, ethnicity, parity, obesity, socioeconomic score, hypertensive disorders of pregnancy, diabetes, infant gestation and birthweight centile, caesarean section birth, postpartum haemorrhage and skin-to-skin contact.

RESULTS

Of the 12 540 live births meeting inclusion criteria, 1000 (8%) infants were admitted to the neonatal unit. The primary reasons for admission were suspicion of sepsis (24%), maternal diabetes (19%) and jaundice (16%). We found a reduction in full breast feeding at hospital discharge in cases of a short admission to the neonatal unit compared with no admission (aOR 0.40; 95% CI 0.34 to 0.47; p<0.001). We identified that women of different ethnicities had differing levels of risk for formula supplementation at hospital discharge. The ethnic grouping least likely to be fully breast feeding at discharge was Southeast Asian women (aOR 0.47; 95% CI 0.39 to 0.57; p<0.001).

CONCLUSIONS

Identifying mother-infant dyads at risk of non-exclusive breast feeding at hospital discharge will help target resources for practice improvement.

Race and Intention to Breastfeed are the Strongest Predictors of Exclusive Breastfeeding: a Retrospective Study

INTRODUCTION

Racial disparities exist in maternal and neonatal care including breastfeeding (BF). The purpose of this study is to assess factors associated with BF success by race with a specific focus on pre-birth BF plan and time duration from birth until initiation of skin-to-skin contact and from birth to the first feed or breastfeed.

METHODS

A database query of our electronic medical records was performed for all patients who had a vaginal delivery that met our study criteria. Demographic information, pre-delivery feeding plan (exclusive BF, exclusive formula, or mixed), time to first feed and first breastfeed, and time to skin-to-skin were compared among different postpartum feeding practices (exclusive BF, exclusive formula, mixed), and compared across race/ethnic groups using ANOVA, Chi-square, and Fisher's exact statistical tests as appropriate. Logistic regression was used to investigate the independent effect of each variable on exclusive BF.

RESULTS

The study analyzed 12,578 deliveries. There was a significant difference in intended feeding plans among the different racial groups. Approximately 61% of Black patients intended to exclusively BF as compared to 79% of the other groups. Overall, 3994 (32%) patients breastfed exclusively, 872 (7%) exclusively used formula, and 7712 (61%) used a mix of breast and formula. White patients were most likely to exclusively BF (35%) and Black patients were least likely (21%), p < 0.001. Our model found that self-identified race and pre-delivery feeding plan were the strongest predictors of exclusive BF.

CONCLUSIONS

The main findings of this study are that self-identified race and intention to BF are the strongest predictors of exclusive BF. Black patients intend to BF at a significantly lower rate than other racial groups, for reasons not determined by this study, and this affects feeding practice. Our findings are notable because prehospital intention to BF can be modified by outreach, education, and changes to in-hospital practices.

Perceived stress of mothers and fathers on two NICUs before and during the SARS-CoV-2 pandemic

Parents of very low birth weight (VLBW) infants in a neonatal intensive care unit experienced additional stress during the SARS-CoV-2 pandemic due to the related restrictions in hospital visiting policies. Our study aimed to compare parents' burdens before and during the pandemic. This survey included 121 parents of 76 VLBW infants in two European Level IV perinatal centers before and during the pandemic. We performed standardized parent questionnaires with mothers and fathers separately to evaluate their emotional stress and well-being. The pandemic worsened the emotional well-being of parents of VLBW infants, particularly of mothers. During the pandemic, mothers reported significantly higher state anxiety levels (48.9 vs. 42.9, p = 0.026) and hampered bonding with the child (6.3 vs. 5.2, 0 = 0.003) than before. In addition, mothers felt more personally restricted than fathers (6.1 vs. 5.2, p = 0.003). Fathers experienced lower levels of stress than mothers; they were equally burdened before and during the pandemic. Restrictions in visiting policies for families of VLBW infants during the SARS-CoV-2 pandemic have a significant negative impact on parental stress and should therefore be applied cautiously.

Nutritional Considerations for the First Year of Life

Feeding during the first year of life is a dynamic process with unique questions, concerns, and milestones emerging at every step. This article will review a small selection of specific questions and concerns related to feeding in the first 12 months of infancy. The aim of this article is to inform and support pediatric providers and parents during this crucial developmental period. [Pediatr Ann. 2023;52(9):e316-e321.].