Parents' informational needs at the birth of a baby with a surgically correctable anomaly

Parents of Children Diagnosed with Congenital Anomalies or Cerebral Palsy: Identifying Needs in Interaction with Healthcare Services

The changes deriving from the birth of a child with a congenital anomaly (CA) or cerebral palsy (CP) imply, in many cases, an increased interaction with health services. A cross-sectional descriptive study was conducted with a convenience sample of parents of children diagnosed with four groups of CA (severe heart anomalies, spina bifida, orofacial clefts, and Down syndrome) and/or CP. A semistructured online questionnaire to be answered by parents was sent by web link to focal points of five parent associations and professional institutions. Data were analyzed through thematic content analysis (open-ended questions) and descriptive analysis (closed-ended questions). The results indicate consistency of responses of parents of children diagnosed with different conditions, namely with respect to the perception of health services and professionals. Closed and open-ended responses indicated three main topics in the interaction between health services and parenthood: information, coordinated and integrated responses, and support. The less positive outcomes suggest unmet information needs, while positive aspects include confidence in the care provided and the "training" received from health professionals.

Family risk communication preferences in pediatric surgery: A scoping review

BACKGROUND

Effective patient-surgeon communication is vital in pediatric surgical practice. However, family (including child) preferences for the format and content of risk communication information are largely unknown. In order to optimize the shared-decision making process, this scoping review explored the family-preferred methods for risk communication in pediatric surgery.

METHODS

A search was conducted in 7 databases from inception until June 2020 to identify family risk communication preferences in pediatric surgical patients, with language restricted to English and French. Two independent reviewers completed the screening in Rayyan software following PRISMA protocol. Included publications were reviewed for data extraction, analyzed, and assessed for risk of bias using standardized instruments.

RESULTS

A total of 6370 publications were retrieved, out of which 70 were included. Studies were predominantly from ENT (30.0%), general surgery (15.7%), and urology (11.4%). Family-preferred risk communication methods were classified as visual, verbal, technology-based, written, decision aids or other. Technological (32.4%) and written tools (29.7%) were most commonly chosen by families as their preferred risk communication methods. Written tools were frequently used in general surgery and urology, while technology-based tools were widely used in ENT. Most studies were cross-sectional and had a significant risk of bias.

CONCLUSION

Eliciting families' preferences for risk communication methods is critical for the implementation of shared decision-making. Different risk communication media appear to be preferred within specific surgical domains. To further improve shared-decision making in pediatric surgery, the development and usage of robust, validated risk communication tools are necessary.

LEVEL OF EVIDENCE

Level IV (Scoping Review).

Information needs of parents of children with congenital anomalies across Europe: a EUROlinkCAT survey

BACKGROUND

Parents of children who have a congenital anomaly can experience significant worry about their child's health. Access to clear, helpful, and trustworthy information can provide a valuable source of support. In this study the aim was to explore the information needs of parents/carers of children with congenital anomalies across Europe.

METHOD

A cross-sectional online survey was developed in nine languages to measure parents' information needs, including: (1) the 'helpfulness'/'trustworthiness' of information received from eight relevant sources, and (2) overall satisfaction with information received. Parents/carers of children (0-10 years) with cleft lip, spina bifida, congenital heart defect [CHD] requiring surgery, and/or Down syndrome were recruited online via relevant organisations in 10 European countries from March-July 2021. Quantitative analyses using multivariable logistic regressions were performed.

RESULTS

One thousand seventy parents/carers of children with a cleft lip (n = 247), spina bifida (n = 118), CHD (n = 366), Down syndrome (n = 281), and Down syndrome with CHD (n = 58) were recruited in Poland (n = 476), the UK (n = 120), Germany (n = 97), the Netherlands/Belgium (n = 74), Croatia (n = 68), Italy (n = 59), other European countries (n = 92), and not specified/non-European countries (n = 84). Most participants were mothers (92%) and aged 31-40 years (71%). Participants were most likely to rate support groups (63%), patient organisations (60%), specialist doctors/nurses (58%), and social media (57%) as 'very helpful' information sources. 'Very trustworthy' ratings remained high for specialist doctors/nurses (61%), however, they declined for support groups (47%), patient organisations (48%), and social media (35%). Germany had the highest proportion of participants who were 'very satisfied' (44%, 95% CI = 34%-54%) with information, whereas this percentage was lowest in Croatia (11%, 95% CI = 3%-19%) and Poland (15%, 95% CI = 11%-18%). Parents of children with Down syndrome had significantly lower satisfaction ratings than parents of children with CHD; 13% (95% CI = 8%-18%) reported being 'very satisfied' compared to 28% (95% CI = 23%-33%) in the CHD group.

CONCLUSIONS

Findings suggest that informal sources of information (e.g. support groups) are of value to parents, however, they are not deemed as trustworthy as specialist medical sources. Satisfaction ratings differed across countries and by anomaly, and were particularly low in Croatia and Poland, as well as for parents of children with Down syndrome, which warrants further investigation.

The effect of educational program on stress, anxiety and depression of the mothers of neonates having colostomy

OBJECTIVE

One of the problems that mothers of neonates having colostomy face is their disability in caring colostomy at home. This article is going to demonstrate the impact of educational program for these mothers on their sense of empowerment in caring their neonates.

METHODS

This clinical trial was performed in the Neonatal Intensive Care Units (NICUs) to evaluate the level of stress, anxiety and depression of mothers of neonates having colostomy before and after the educational program. In this program, 42 mothers were divided into two groups: experimental group (21 mothers who went under educational plan) and control group (21 mothers who only received the routine care). The levels of stress, anxiety and depression in all mothers were evaluated before and after the educational program with DASS 21 questionnaire.

RESULTS

The results showed that educational program in the NICU for experimental groups made them independent and also empowered to care better for their babies. In addition, their depression, anxiety and stress levels were decreased.

CONCLUSION

Since the educational program led to a decrease in the levels of stress, anxiety and depression in mothers, this program is recommended to mothers of neonates having colostomy.

A risk calculator predicting postoperative adverse events in neonates undergoing major abdominal or thoracic surgery

PURPOSE

This study sought to demonstrate the feasibility of a risk calculator for neonates undergoing major abdominal or thoracic surgery with good discriminative ability.

METHODS

The American College of Surgeons' National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-P) 2011-12 data were queried for neonates who underwent major abdominal or thoracic surgery. The outcome of interest was the occurrence of any adverse event, including mortality, within 30-days postoperatively. The preoperative clinical characteristics significantly associated with any adverse event were used to build a multivariate model. The model's discriminative ability was assessed with the area under the receiver operating characteristic curve (AUROC). The model was split-set validated with 2013 data.

RESULTS

A total of 2967 neonates undergoing major abdominal or thoracic surgery were identified. The overall rate of adverse events was 23.3%. Sixteen variables were found to be associated with adverse events. Four variables increased the odds of adverse events at least two-fold: dirty or infected wound class [odds ratio (OR)=2.1] dialysis (OR=3.8), hepatobiliary disease (OR=2.1), and inotropic agent use (OR=2.6). The AUROC=0.79 for development data and 0.77 on split-set validation.

CONCLUSION

Preoperatively estimating the probability of postoperative adverse events in neonates undergoing major abdominal or thoracic surgery with good discrimination is feasible.

Knowledge of birth defects among nursing mothers in a developing country

BACKGROUND

In the absence of established guidelines, where formal screening is unavailable for birth defects, a lot of responsibility is placed on parents in the recognition of these defects.

OBJECTIVES

The aim of the study was to determine the awareness of mothers about birth effects in a developing country and assess what they know about the prevention, detection and treatment of children with birth defects.

METHODS

This was a descriptive cross-sectional study of 714 mothers consecutively selected at two major hospitals in Nigeria between May and December, 2012. Data were collected with interviewer administered questionnaires. Descriptive and inferential statistics were performed using SPSS and statistical significance set at p <0.05.

RESULTS

The participants were aged 17 to 42 years. Only 183 (25.6%) were aware of birth defects. Factors associated with awareness of birth defects were older age, religious belief, better education, higher socioeconomic class, early age at booking and registering at a tertiary care facility. Education, socioeconomic class as well as month and location of booking were found to be independent predictors of awareness of birth defects.

CONCLUSION

Mothers in Ibadan, Nigeria, a country without a formal newborn screening programme, have a poor level of awareness about birth defects.

The effectiveness of a brief intervention for emotion-focused nurse-parent communication

OBJECTIVE

A child's hospitalization is stressful for both the children and their parents. Nurse-parent communication during stressful hospitalizations requires skilled nurse communicators. Brief methods of training emotion-focused communication for newly licensed nurses are needed, but as yet are rare. The purpose of this study was to evaluate the effectiveness of a validated brief communication training (Four Habits Model) session using simulation for newly licensed pediatric nurses.

METHODS

Quantitative and qualitative methods provided data for this experimental study, using a group-by-trials repeated measures ANOVA design. The intervention group participated in a 1-h three-part education simulation session and the control group observed a 1-h video.

RESULTS

Compared with the controls, the intervention group improved significantly in four of five areas: preparation, communication skills, relationships, and confidence. Experience level had minimal effect. Over half of the nurses in the intervention group reported using one or more of the Four Habits in clinical practice.

CONCLUSIONS

The findings of this study suggest that a 1-h Four Habits communication-training program improves newly licensed nurses' self-perception of their preparation for emotion-focused conversations with parents.

PRACTICE IMPLICATIONS

The findings of this study suggest that the Four Habits Model can be useful in communication training with nurses.

Parenting an infant with a congenital anomaly: An exploratory study on patterns of adjustment from diagnosis to six months post birth

The present study examined psychological adjustment in parents of infants with congenital anomalies (CAs), focusing on the interval from the disclosure of the diagnosis to six months after the infant's birth and considering the effects of the parent's gender and the timing of diagnosis (pre- vs postnatal). Within-group diversity was also examined by identifying distinct patterns of individual adjustment over time. Parents of 43 infants (43 mothers and 36 fathers) with a pre- or postnatal diagnosis of a CA answered questionnaires assessing psychological distress and quality of life one month after the disclosure of the diagnosis and six months after the infant's birth. Results showed a significant reduction in psychological distress and a significant increase in physical quality of life over time, for both parents, regardless of the timing of diagnosis. In all, 57% of parents presented a pattern of recovery from diagnosis to six months post birth and 26.6% presented a pattern of resilience. However, 15.2% of parents showed chronic adjustment difficulties. Findings suggest that most parents tend to adjust to their infant's CA, although some experienced difficulties and should be targeted for specialised counselling. Both members of the couple should be acknowledged, as both experience similar patterns of adjustment.

Psychosocial burden and quality of life in parents of children with anorectal malformation

AIM

To assess the psychosocial burden and quality of life in parents of children with anorectal malformation.

SUBJECTS AND METHODS

This is a prospective study conducted in a tertiary care specialty hospital. Sample consisted of 50 parents (care givers), having children with anorectal malformation in the age group of 0-14 years. Data were collected through a semi structured interview with the care givers, using Zarit Burden Interview for assessing extent of burden and WHOQOL-BREF for assessing different aspects of quality of life.

STATISTICAL ANALYSIS USED

frequencies, percentages, mean and standard deviations were calculated for analyzing the data.

RESULTS

The study reveals greater psychosocial burden and poor quality of life, in terms of the psychological and environmental aspects as compared to the physical and social aspects, among the care givers.

CONCLUSIONS

The study found increased psychosocial burden and negative impact on the quality of life of parents, which varies with the stages of management and proper continuous counseling is recommended.

End-of-life decision before and after birth: changing ethical considerations

Despite the dramatic improvement in the outcome of somatically handicapped neonates, vexing ethical issues remain. In which fetuses would termination be indicated? In which neonates are the malformations so serious that surgery and intensive care should not be initiated (withholding or not starting treatment)? Conversely, in which neonates should the initiated treatment be stopped (withdrawal of treatment)? These questions pose huge medical, legal, ethical, moral, and financial problems for doctors, lawyers, ethicists, and families. Fetuses and neonates with congenital anomalies can be divided into 6 groups: 1, those who have the potential for total recovery; 2, those with anomalies that would allow for a nearly normal life; 3, those with malformations requiring permanent supervision and/or medical care; 4, those with somatic rest defect and subnormal mental development; 5, those with serious somatic and mental damage; and 6, those with anomalies that are incompatible with life. The decision making should be tailored to each of these groups. The pediatric surgeon, besides taking into consideration the quantity and quality of the rescued life, should lower the anxiety of the parents, should follow the morals of a civilized society, should act according to the law, and finally, should convince himself to be a solution to a problem and not to be a cause of any.

Minimally invasive neonatal surgery

Minimally invasive surgery is now an option to patients as light as 1.2 kg, extending the benefits of small incisions, faster recoveries, decreased pain, and more precise procedures in critically ill neonates. This article provides a review of the historical development of minimally invasive surgery and an overview of the equipment involved, identifies the roles of the neonatal and perioperative nurse, and briefly describes several minimally invasive surgery procedures currently performed in the neonatal population.