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Alemdar DK, İnal S, Bulut M. Clinical validation of the infant-driven feeding scales© in Turkey. J Pediatr Nurs 2022; 67:148-154. [PMID: 36122545 DOI: 10.1016/j.pedn.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/20/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Supporting the development of feeding skills among preterm infants is an important component of neonatal care. The selection of appropriate and supportive feeding interventions begins with a comprehensive assessment of the infant's skills. PURPOSE This study aimed to adapt the Infant-Driven Feeding Scales© (IDFS) to the Turkish language. METHODS This was a methodological, observational, single-center cross-sectional study. The study included 80 infants born at a gestational age ≥ 32 weeks, consecutively admitted to a tertiary Neonatal Intensive Care Unit (NICU). Research data were collected using a premature infant descriptive information form (IDIF), IDFS, and LATCH Score for Breastfeeding Assessment. For the Turkish validity-reliability of the IDF, the translate-back translate method was used with the content validity index (CVI) assessed. RESULTS The scale had CVI values between 0.90 and 1.00 with a mean CVI = 0.96. For measures 1 and 2, there were significant positive and high-level correlations between IFDS-R and IFDS-Q correlation values (r = 0.553-0.958; p = 0.001) and significant negative, low-level correlations between IFDS-R and IFDS-Q with the LATCH scale (r = 0.439-0.532; p = 0.001). According to inter-observer compatibility analyses, the kappa value was 0.94-1.00 for the first measure and 0.96-1.00 for the second measure (p = 0.001). There were negative significant correlations between IDFS-R points with gestational age and postmenstrual age (PMA) (p = 0.001), and gestational age and PMA were explanatory factors for 13.8% of IDFS-R points (F = 7.30, p = 0.001). CONCLUSIONS The IDFS is recommended for use as a valid and reliable tool to ease the safe and successful development of oral feeding skills in preterm infants and to plan evidence-based interventions. IMPLICATIONS FOR PRACTICE The IDFS appears to be a beneficial measurement device for use in assessing the state of readiness of preterm infants for oral feeding and for early determination of risks that may occur due to delayed feeding independence of infants.
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Affiliation(s)
- Dilek Küçük Alemdar
- Associate Professor, Ordu University Faculty of Health Sciences, Department of Pediatric Nursing, Ordu, Turkey.
| | - Sevil İnal
- Professor, İstanbul-Cerrah Paşa University Faculty of Health Sciences, Department of Midwifery, İstanbul, Turkey
| | - Muhammet Bulut
- MD, Associate Professor, Giresun University Faculty of Medicine, Department of Pediatrics, Giresun, Turkey
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Sarici SU, Ozcan M, Akpinar M, Altun D, Yasartekin Y, Koklu E, Serdar MA, Sarici D. Transcutaneous Bilirubin Levels and Risk of Significant Hyperbilirubinemia in Early-Term and Term Newborns. J Obstet Gynecol Neonatal Nurs 2021; 50:307-315. [PMID: 33684342 DOI: 10.1016/j.jogn.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment. DESIGN A prospective, controlled cohort analysis. SETTING A tertiary level mother-child birth and health care center. PARTICIPANTS Four hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period. METHODS A total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups. RESULTS All six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23-2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group. CONCLUSIONS Early-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.
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du Plessis-Faurie AS, Poggenpoel M, Myburgh CPH, Jacobs WO. Towards community-based nursing: Mothers' experiences caring for their preterm infants in an informal settlement, Gauteng. Health SA 2021; 25:1437. [PMID: 33391826 PMCID: PMC7756596 DOI: 10.4102/hsag.v25i0.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Pregnant women who experience preterm labour rush to public hospitals closest to the informal settlement in which they reside. Preterm infants are discharged when they reach a certain weight. Mothers take their preterm infants to their homes inside the informal settlements. Yet, preterm infants have special needs and require specific management. Research confirmed that nurses working in community clinics near informal settlements are unaware of the challenges faced by such mothers. Community nurses are at the heart of nursing, they work closest to the community and have a distinct opportunity to provide contextual, community-based care and support to these mothers, to promote good health and prevent diseases. Aim This article aims to enhance community nurses’ insight about the mothers’ experiences in caring for their preterm infants post-hospitalisation. Setting The study was conducted in an informal settlement in Midvaal, Gauteng. Methods A qualitative, exploratory, descriptive and contextual research design was used. In-depth, phenomenological interviews were conducted with 10 purposefully sampled mothers to explore their experiences in caring for their preterm infants in an informal settlement. Data were analysed using Giorgi’s coding method. Ethical approval was received from the University of Johannesburg. Measures were applied to ensure trustworthiness. Results Three themes emerged: mothers experienced intrapersonal responses, interpersonal responses and numerous physical challenges in taking care of their preterm infants. Conclusion Study findings revealed that mothers experienced several responses in caring for their preterm infants. Sharing their experiences can enhance community clinic nurses’ insight to provide contextual health education.
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Affiliation(s)
- Alida S du Plessis-Faurie
- Department of Nursing Sciences, Faculty of Health, University of Johannesburg, Johannesburg, South Africa
| | - Marie Poggenpoel
- Department of Nursing Sciences, Faculty of Health, University of Johannesburg, Johannesburg, South Africa
| | - Chris P H Myburgh
- Department of Nursing Sciences, Faculty of Health, University of Johannesburg, Johannesburg, South Africa
| | - Wanda O Jacobs
- Department of Nursing Sciences, Faculty of Health, University of Johannesburg, Johannesburg, South Africa
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Bulut O, Buyukkayhan D. Early term delivery is associated with increased neonatal respiratory morbidity. Pediatr Int 2021; 63:60-64. [PMID: 32786118 DOI: 10.1111/ped.14437] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The recent increase in early term birth rates represents a growing challenge to public health given the association between early term birth and neonatal morbidities. We compared the risk of respiratory morbidity between early term and full-term infants. METHODS This retrospective cohort population study included infants born at 37-41 weeks' gestation in a single tertiary care university hospital between 2014 and 2016. Newborns were categorized as early term (37-38 weeks) and full term (39-41 weeks). The primary outcome was respiratory morbidity. RESULTS Of the 4,894 babies born at 37-41 weeks gestational age, 31% (n = 1,521) were early term births. The rate of cesarean deliveries, which were often elective, was higher for early term than for full-term newborns (P = 0.001). Compared with full-term newborns, early term newborns, had significantly higher risks of respiratory morbidity (13.2 % vs 6.3 %; odds ratio [OR], 2.28, P = 0.001), respiratory distress syndrome (0.5 % vs 0 %, P = 0.001), transient tachypnea of the newborn (11.2 % vs 4.6 %; OR, 2.72, P = 0.001), continuous positive airway pressure use (9.7 % vs 3.7 %; OR, 2.82, P = 0.001), and ventilation support (1.4% vs 0.4%; OR, 4.11, P = 0.001). CONCLUSIONS The elevated frequency of respiratory morbidity in early term infants emphasizes the importance of early term birth interventions. More than half of the early term births were elective cesarean sections; interventions should therefore focus on reducing elective cesarean procedures at the time of first birth.
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Affiliation(s)
- Ozgul Bulut
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Derya Buyukkayhan
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
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Yu M, Park CG. Factors associated with patient safety in neonatal intensive care units: A multicenter study using ordinal logistic regression. Jpn J Nurs Sci 2020; 18:e12374. [PMID: 32893444 DOI: 10.1111/jjns.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
AIM This study aimed to identify nurses' staffing levels, neonatal infection experience, infection control knowledge, and infection control performance, as well as levels of patient safety, and to verify the factors influencing patient safety related to infection control in multi-centered neonatal intensive care units (NICUs). METHODS A self-administered questionnaire was completed by 251 NICU nurses working in seven hospitals throughout South Korea. The data were collected in February 2019 and analyzed using generalized ordinal logistic regression. RESULTS The distribution of patient safety was as follows: level 1 (very poor) 0%, level 2 (poor) 6.8%, level 3 (fair) 29.7%, level 4 (good) 35.0%, level 5 (very good) 21.5%, and level 6 (excellent) 7.2%. The factors influencing patient safety differed across the different levels of patient safety. Comparing patient safety level 2 with the other levels (3, 4, 5, 6), the nurse staffing level (b = 1.12) was a significant influencing factor. Comparing patient safety levels 2, 3, 4 and 5 with level 6, the influencing factors were neonatal infection experience (b = -1.18) and infection control performance (b = 5.77). CONCLUSION The nurse staffing level was a factor when patient safety levels were low, and nurses' neonatal infection experience and infection control performance were factors when patient safety levels were high. Institutional policy efforts are required to identify patient safety levels in NICUs to develop comprehensive strategies to ensure appropriate nurse staffing and enhance neonatal infection control performance to prevent infections.
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Affiliation(s)
- Mi Yu
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Chang Gi Park
- Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
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刘 明, 戴 霄, 花 静. [Neurobehavioral development of 25 254 children with different gestational ages at birth in three cities of China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:931-935. [PMID: 32933621 PMCID: PMC7499444 DOI: 10.7499/j.issn.1008-8830.2003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the effect of gestational age at birth on the neurobehavioral development of preschool children. METHODS A total of 25 254 preschool children from Ma'anshan of Anhui Province, Taizhou of Zhejiang Province, and Yangzhou of Jiangsu Province were enrolled. The preschool children were divided into three groups based on their gestational ages at birth: preterm group (2 760 cases; 28-36+6 weeks), early term group (6 005 cases; 37-38+6 weeks), and full term group (16 489 cases; ≥39 weeks). The Ages and Stages Questionnaires-Third Edition (ASQ-3) was employed to evaluate the children's neurobehavioral development. RESULTS The preterm group had significantly lower scores of the five domains of ASQ-3, communication, gross motor, fine motor, problem solving, and personal-social, than the full term group (P<0.05), and significantly lower scores of communication, gross motor, fine motor, and problem solving than the early term group (P<0.05). There were no significant differences in the scores of the five domains of ASQ-3 between the early term and full term groups (P>0.05). The multiple linear regression analysis indicated a significant positive correlation between gestational age and the five domains of ASQ-3 after adjustment for confounding factors including sex, age, body mass index, and parental education level (P<0.01). CONCLUSIONS Children born preterm have poorer neurobehavioral development than those born full term and early term, whereas children born full term and early term have similar neurobehavioral development. Gestational age at birth is an independent influencing factor for neurobehavioral development in preschool children.
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Affiliation(s)
- 明霞 刘
- />同济大学附属第一妇婴保健院妇幼保健部, 上海 201204Department of Maternal and Child Health Care, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
| | - 霄天 戴
- />同济大学附属第一妇婴保健院妇幼保健部, 上海 201204Department of Maternal and Child Health Care, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
| | - 静 花
- />同济大学附属第一妇婴保健院妇幼保健部, 上海 201204Department of Maternal and Child Health Care, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China
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Coggins S, Harris MC, Grundmeier R, Kalb E, Nawab U, Srinivasan L. Performance of Pediatric Systemic Inflammatory Response Syndrome and Organ Dysfunction Criteria in Late-Onset Sepsis in a Quaternary Neonatal Intensive Care Unit: A Case-Control Study. J Pediatr 2020; 219:133-139.e1. [PMID: 32037153 DOI: 10.1016/j.jpeds.2019.12.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/03/2019] [Accepted: 12/30/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate accuracy of systemic inflammatory response syndrome (SIRS) criteria in identifying culture-proven late-onset neonatal sepsis and to assess prevalence of organ dysfunction and its relationship with SIRS criteria. STUDY DESIGN This was a retrospective case-control study of patients in the Children's Hospital of Philadelphia level IV neonatal intensive care unit undergoing sepsis evaluations (concurrent blood culture and antibiotics). During calendar years 2016-2017, 77 case and 77 control sepsis evaluations were identified. Cases included infants who had sepsis evaluations with positive blood cultures and antibiotic duration ≥7 days. Controls were matched by gestational and postmenstrual age, and had sepsis evaluations with negative blood cultures and antibiotic duration ≤48 hours. SIRS criteria were determined at time of sepsis evaluation, and organ dysfunction evaluated in the 72 hours following sepsis evaluation. Statistical analysis included descriptive statistics, Mann-Whitney tests, and χ2 (Fisher exact) tests. RESULTS At time of sepsis evaluation, 42% of cases and 26% of controls met SIRS criteria. Among infants of ≤37 weeks postmenstrual age, SIRS criteria were met in only 17% of sepsis evaluations (4 of 23 in both cases and controls). Test characteristics for SIRS at diagnosis of culture-proven sepsis included sensitivity 42% and specificity 74%. Cases had higher rates of new organ dysfunction within 72 hours (40% vs 21%); however, 58% of cases developing organ dysfunction did not meet SIRS criteria at time of sepsis evaluation. Of 6 deaths (all cases with organ dysfunction), 2 did not meet SIRS criteria at sepsis evaluation. CONCLUSIONS SIRS criteria did not accurately identify culture-proven late-onset sepsis, with poorest accuracy in preterm infants. SIRS criteria did not predict later organ dysfunction or mortality.
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Affiliation(s)
- Sarah Coggins
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mary Catherine Harris
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert Grundmeier
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth Kalb
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ursula Nawab
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lakshmi Srinivasan
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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Chen Y, Lehmann CU, Hatch LD, Schremp E, Malin BA, France DJ. Modeling Care Team Structures in the Neonatal Intensive Care Unit through Network Analysis of EHR Audit Logs. Methods Inf Med 2020; 58:109-123. [PMID: 32170716 DOI: 10.1055/s-0040-1702237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the neonatal intensive care unit (NICU), predefined acuity-based team care models are restricted to core roles and neglect interactions with providers outside of the team, such as interactions that transpire via electronic health record (EHR) systems. These unaccounted interactions may be related to the efficiency of resource allocation, information flow, communication, and thus impact patient outcomes. This study applied network analysis methods to EHR audit logs to model the interactions of providers beyond their core roles to better understand the interaction network patterns of acuity-based teams and relationships of the network structures with postsurgical length of stay (PSLOS). METHODS The study used the EHR log data of surgical neonates from a large academic medical center. The study included 104 surgical neonates, for whom 9,206 unique actions were performed by 457 providers in their EHRs. We applied network analysis methods to model EHR provider interaction networks of acuity-based teams in NICU postoperative care. We partitioned each EHR network into three subnetworks based on interaction types: (1) interactions between known core providers who were documented in scheduling records (core subnetwork); (2) interactions between core and noncore providers (extended subnetwork); and (3) interactions between noncore providers (extended subnetwork). For each core subnetwork, we assessed its capability to replicate predefined core-provider relations as documented in scheduling records. We further compared each EHR network, as well as its subnetworks, using standard network measures to determine its differences in network topologies. We conducted a case study to learn provider interaction networks taking care of 15 neonates who underwent gastrostomy tube placement surgery from EHR log data and measure the effectiveness of the interaction networks on PSLOS by the proportional-odds model. RESULTS The provider networks of four acuity-based teams (two high and two low acuity), along with their subnetworks, were discovered. We found that beyond capturing the predefined core-provider relations, EHR audit logs can also learn a large number of relations between core and noncore providers or among noncore providers. Providers in the core subnetwork exhibited a greater number of connections with each other than with providers in the extended subnetworks. Many more providers in the core subnetwork serve as a hub than those in the other types of subnetworks. We also found that high-acuity teams exhibited more complex network structures than low-acuity teams, with high-acuity team generating 6,416 interactions between 407 providers compared with 931 interactions between 124 providers, respectively. In addition, we discovered that high-acuity and low-acuity teams shared more than 33 and 25% of providers with each other, respectively, but exhibited different collaborative structures demonstrating that NICU providers shift across different acuity teams and exhibit different network characteristics. Results of case study show that providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those who treated higher PSLOS patients (p = 0.03). CONCLUSION Network analysis can be applied to EHR log data to model acuity-based NICU teams capturing interactions between providers within the predesigned core team as well as those outside of the core team. In the NICU, dissemination of information may be linked to reduced PSLOS. EHR log data provide an efficient, accessible, and research-friendly way to study provider interaction networks. Findings should guide improvements in the EHR system design to facilitate effective interactions between providers.
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Affiliation(s)
- You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Department of Electrical Engineering and Computer Science, School of Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - Christoph U Lehmann
- Departments of Pediatrics, Bioinformatics, and Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Leon D Hatch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Emma Schremp
- Department of Anesthesiology, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Department of Electrical Engineering and Computer Science, School of Engineering, Vanderbilt University, Nashville, Tennessee, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Daniel J France
- Department of Anesthesiology, Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Transitioning Into the Role of Mother Following the Birth of a Very Low-Birth-Weight Infant: A Grounded Theory Pilot Study. J Perinat Neonatal Nurs 2020; 34:125-133. [PMID: 32332442 DOI: 10.1097/jpn.0000000000000466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of "reconstructing normal" emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development, maternal caregiving and role-reclaiming strategies, and infant developmental milestones. Findings from this study suggest that women found the transition into motherhood following the birth of a VLBW infant as a multidimensional and dynamic process. Further research is warranted to confirm these results and to further explore mothering issues with VLBW infants.
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Impact of Gestational Age on Surgical Outcomes in Patients With Functionally Single Ventricle. Ann Thorac Surg 2019; 109:1260-1266. [PMID: 31580862 DOI: 10.1016/j.athoracsur.2019.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/26/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Younger gestational age (GA) is known to be associated with worse outcomes after congenital cardiac surgery. We sought to determine the impact of GA on surgical outcomes of single-ventricle palliation. METHODS Among the 284 patients with functionally single ventricle who were born between January 2005 and December 2014, 50 neonates were born prematurely (GA < 37 weeks) and 113 neonates in the early term period (37 weeks ≤ GA < 39 weeks). Initial palliation was required in 251 patients, whereas 33 patients received primary bidirectional cavopulmonary anastomosis (BCPA). RESULTS BCPA and the completion Fontan operation were performed in 200 and 169 patients, respectively. Overall survival at 5 years were 62.5% ± 2.9%. On Cox regression younger GA (hazard ratio, 1.14 per 1-week decrease; P = .007) was identified as a risk factor for increased interstage mortality (ISM) between initial palliation and BCPA. On subgroup analysis of the preterm or early-term patients with initial palliation (n = 145), younger postmenstrual age at initial palliation was associated with increased ISM before BCPA (hazard ratio, 1.18; P = .005). After BCPA, however, younger GA did not increase the risk of ISM between BCPA and the Fontan operation (P = .47). CONCLUSIONS Younger GA is a risk factor for ISM between initial palliation and BCPA. Deferral of initial palliation may be beneficial to decrease the risk of ISM in patients who were born at preterm or early term. Adverse effects of younger GA on survival disappeared once BCPA was performed.
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Sharma D, Padmavathi IV, Tabatabaii SA, Farahbakhsh N. Late preterm: a new high risk group in neonatology. J Matern Fetal Neonatal Med 2019; 34:2717-2730. [PMID: 31575303 DOI: 10.1080/14767058.2019.1670796] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Late preterm infants are those infants born between 34 0/7 weeks through 36 6/7 week of gestation. These are physiologically less mature and have limited compensatory responses to the extrauterine environment compared with term infants. Despite their increased risk for morbidity and mortality, late preterm newborns are often cared in the well-baby nurseries of hospital after birth and are discharged from the hospital by 2-3 days of postnatal age. They are usually treated like developmentally mature term infants because many of them are of same birth weight and same size as term infants. There is a steady increase in the late preterm birth rate in last decade because of either maternal, fetal, or placental/uterine causes. There has been shift in the distribution of births from term and post-term toward earlier gestations. Although late preterm infants are the largest subgroup of preterm infants, there has been little research on this group until recently. This is mainly because of labeling them as "near-term". Such infants were being looked upon as "almost mature", and were thought as neonate requiring either no or minimal concern. In the obstetric and pediatric practice, late preterm infants are often considered functionally and developmentally mature and often managed by protocols developed for full-term infants. Thus, limited efforts are taken to prolong pregnancy in cases of preterm labor beyond 34 weeks, moreover after 34 weeks most centers do not administer antenatal prophylactic steroids. These practices are based on previous studies reporting neonatal mortality and morbidity in the late preterm period to be only slightly higher in comparison with term infants and whereas in the current scenario the difference is significant. Late preterm infants have 2-3-fold increased risk of morbidities such as hypothermia, hypoglycemia, delayed lung fluid clearance, respiratory distress, poor feeding, jaundice, sepsis, and readmission rates after initial hospital discharge. This leads to huge impact on the overall health care resources. In this review, we cover various aspects of these late preterm infants like etiology, immediate and long-term outcome.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Sciences, Jaipur, India
| | | | | | - Nazanin Farahbakhsh
- Department of Pulmonology, Pediatric Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gaynor JW, Parry S, Moldenhauer JS, Simmons RA, Rychik J, Ittenbach RF, Russell WW, Zullo E, Ward JL, Nicolson SC, Spray TL, Johnson MP. The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates. Eur J Cardiothorac Surg 2019; 54:348-353. [PMID: 29447332 DOI: 10.1093/ejcts/ezy015] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/04/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Pregnancies with congenital heart disease in the foetus have an increased prevalence of pre-eclampsia, small for gestational age and preterm birth, which are evidence of an impaired maternal-foetal environment (MFE). METHODS The impact of an impaired MFE, defined as pre-eclampsia, small for gestational age or preterm birth, on outcomes after cardiac surgery was evaluated in neonates (n = 135) enrolled in a study evaluating exposure to environmental toxicants and neuro-developmental outcomes. RESULTS The most common diagnoses were transposition of the great arteries (n = 47) and hypoplastic left heart syndrome (n = 43). Impaired MFE was present in 28 of 135 (21%) subjects, with small for gestational age present in 17 (61%) patients. The presence of an impaired MFE was similar for all diagnoses, except transposition of the great arteries (P < 0.006). Postoperative length of stay was shorter for subjects without an impaired MFE (14 vs 38 days, P < 0.001). Hospital mortality was not significantly different with or without impaired MFE (11.7% vs 2.8%, P = 0.104). However, for the entire cohort, survival at 36 months was greater for those without an impaired MFE (96% vs 68%, P = 0.001). For patients with hypoplastic left heart syndrome, survival was also greater for those without an impaired MFE (90% vs 43%, P = 0.007). CONCLUSIONS An impaired MFE is common in pregnancies in which the foetus has congenital heart disease. After cardiac surgery in neonates, the presence of an impaired MFE was associated with lower survival at 36 months of age for the entire cohort and for the subgroup with hypoplastic left heart syndrome.
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Affiliation(s)
- James William Gaynor
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel Parry
- Division of Maternal Fetal Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca A Simmons
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William W Russell
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Zullo
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John Laurenson Ward
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan C Nicolson
- Division of Pediatric Cardiac Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L Spray
- Division of Cardiac Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Johnson
- Center for Fetal Diagnosis and Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Settle M, Francis K. Does the Infant-Driven Feeding Method Positively Impact Preterm Infant Feeding Outcomes? Adv Neonatal Care 2019; 19:51-55. [PMID: 30672812 DOI: 10.1097/anc.0000000000000577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Achievement of independent oral feeding is a major determinant of discharge and contributes to long lengths of stay. Accumulating evidence suggests that there is great variation between and within newborn intensive care units in the initiation and advancement of oral feeding. The Infant-Driven Feeding (IDF) method is composed of 3 behavioral assessments including feeding readiness, quality of feeding, and caregiver support. Each assessment includes 5 categories and is intended as a method of communication among caregivers regarding the infant's readiness and progression toward independent oral feeding. PURPOSE To identify and summarize the available evidence on the use of the IDF method at initiation of oral feeds, time to independent oral feedings, and length of stay in the newborn intensive care unit or level II nursery for preterm infants. METHODS/SEARCH STRATEGY Four databases including CINAHL, Medline/PubMed, Ovid Nursing, and Embase were searched for "infant guided feedings," "infant driven feeding," "cue-based feeding," and "co regulated feeding." The full text of 32 articles was reviewed to identify experimental, quasiexperimental, or retrospective design to assess the evidence related to cue-based feeding. FINDINGS There were no randomized control, quasi-experimental, or retrospective studies utilizing the IDF method. There were 3 quality improvement projects utilizing the IDF method. The findings were conflicting: 1 project found the IDF method favorable in the achievement of full oral feedings, 2 projects found the IDF method favorable for reducing length of stay, and 1 project did not find differences in initiation, achievement of oral feedings, or length of stay. IMPLICATIONS FOR PRACTICE There is scant evidence limited to quality improvement projects to support the use of the IDF method. IMPLICATIONS FOR RESEARCH Research is needed to empirically validate the IDF method and to inform practice related to the initiation and advancement of oral feeding for preterm infants.
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Fan WQ, Gan A, Crane O. Commencing Nutrient Supplements before Full Enteral Feed Volume Achievement Is Beneficial for Moderately Preterm to Late Preterm Low Birth Weight Babies: A Prospective, Observational Study. Nutrients 2018; 10:nu10101340. [PMID: 30241325 PMCID: PMC6213071 DOI: 10.3390/nu10101340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to observe after following a routine change in the feeding protocol whether the earlier introduction of nutrient supplements improved nutritional outcomes in moderately preterm to late preterm low birth weight (LBW) babies. In this prospective observational study, LBW babies between 31 and 39 weeks’ gestation admitted to a Special Care Nursery were assigned to two groups (F80, n = 45, F160, n = 42) upon commencing nutrient supplement at total fluid intake achievement of 80 or 160 mL/kg/day. Outcomes included weight, protein intake, biochemical markers, feeding intolerance, and length of stay (LOS). F80 nutrient supplements commenced before F160 (2.8 vs. 6.7 days, p < 0.0001) and lasted longer (15.2 vs. 12.2 days, p < 0.03). Weight gain velocity and LOS were similar. F80 mean protein intake during the first 10 days was higher (3.38 vs. 2.74 g/kg/day, p < 0.0001). There were fewer infants with protein intake <3 g/kg/day in the F80 group (8% vs. 65%, p < 0001). F80 babies regained birthweight almost two days earlier (7.5 vs. 9.4 days, p < 0.01). Weight gain Z-scores revealed an attenuation of the trend towards lower weight percentiles in the F80 group. Feeding intolerance was decreased for F80 (24.4% vs. 47.6%, p < 0.03). There were no adverse outcomes. Earlier nutrient supplementation for LBW babies lifts mean protein intake to above 3 g/kg/day and reduces both the duration of post-birth weight loss and incidence of feeding intolerance.
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Affiliation(s)
- Wei Qi Fan
- Department of Paediatrics, The Northern Hospital, 185 Cooper Street, Epping, VIC 3076, Australia.
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Grattan Street, Melbourne, VIC 3010, Australia.
| | - Amy Gan
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Grattan Street, Melbourne, VIC 3010, Australia.
| | - Olivia Crane
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Grattan Street, Melbourne, VIC 3010, Australia.
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15
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Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial. Trials 2017; 18:467. [PMID: 29017578 PMCID: PMC5634877 DOI: 10.1186/s13063-017-2181-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023] Open
Abstract
Background Every year, about 15 million of the world’s infants are born preterm (before 37 weeks gestation). In Alberta, the preterm birth rate was 8.7% in 2015, the second highest among Canadian provinces. Approximately 20% of preterm infants are born before 32 weeks gestation (early preterm), and require care in a Level III neonatal intensive care unit (NICU); 80% are born moderate (32 weeks and zero days [320/7] to 336/7 weeks) and late preterm (340/7 to 366/7 weeks), and require care in a Level II NICU. Preterm birth and experiences in the NICU disrupt early parent-infant relationships and induce parental psychosocial distress. Family Integrated Care (FICare) shows promise as a model of care in Level III NICUs. The purpose of this study is to evaluate length of stay, infant and maternal clinical outcomes, and costs following adaptation and implementation of FICare in Level II NICUs. Methods We will conduct a pragmatic, cluster randomized controlled trial (cRCT) in ten Alberta Level II NICUs allocated to one of two groups: FICare or standard care. The FICare Alberta model involves three theoretically-based, standardized components: information sharing, parenting education, and family support. Our sample size of 181 mother-infant dyads per group is based on the primary outcome of NICU length of stay, 80% participation, and 80% retention at follow-up. Secondary outcomes (e.g., infant clinical outcomes and maternal psychosocial distress) will be assessed shortly after admission to NICU, at discharge and 2 months corrected age. We will conduct economic analysis from two perspectives: the public healthcare payer and society. To understand the utility, acceptability, and impact of FICare, qualitative interviews will be conducted with a subset of mothers at the 2-month follow-up, and with hospital administrators and healthcare providers near the end of the study. Discussion Results of this pragmatic cRCT of FICare in Alberta Level II NICUs will inform policy decisions by providing evidence about the clinical effectiveness and costs of FICare. Trial registration ClinicalTrials.gov, ID: NCT02879799. Registered on 27 May 2016. Protocol version: 9 June 2016; version 2. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2181-3) contains supplementary material, which is available to authorized users.
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16
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Mughal MK, Ginn CS, Magill-Evans J, Benzies KM. Parenting stress and development of late preterm infants at 4 months corrected age. Res Nurs Health 2017; 40:414-423. [DOI: 10.1002/nur.21809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Joyce Magill-Evans
- Department of Occupational Therapy; University of Alberta; Edmonton Alberta Canada
| | - Karen M. Benzies
- Faculty of Nursing, Department of Paediatrics; University of Calgary; Calgary Alberta Canada
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17
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Qiao NN, Gong MH, Jin ZA. [Concerns about neonates discharged against medical advice from the neonatal intensive care unit]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:254-258. [PMID: 28202129 PMCID: PMC7389475 DOI: 10.7499/j.issn.1008-8830.2017.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
Discharge against medical advice (DAMA) conflicts with the purpose of disease treatment in children. Some research has shown that there are high proportions of extremely preterm infants and infants with asphyxia or congenital malformation in neonates with DAMA. This suggests that the sustainable development of neonatology needs cooperation and co-development with obstetrics, neonatal surgery, and radiology to reduce the rate of DAMA. With reference to the current status of research in both China and other countries, this article reviews the causes for DAMA and the strategies for reducing the rate of DAMA, in order to provide a theoretical basis for effectively reducing the rate of DAMA from the neonatal intensive care unit, improving treatment outcomes of the neonates, and increasing hospitals' comprehensive benefits.
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Affiliation(s)
- Ning-Ning Qiao
- Department of Pediatrics, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, China.
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18
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Ballantyne M, Benzies KM, McDonald S, Magill-Evans J, Tough S. Risk of developmental delay: Comparison of late preterm and full term Canadian infants at age 12 months. Early Hum Dev 2016; 101:27-32. [PMID: 27405053 DOI: 10.1016/j.earlhumdev.2016.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 04/09/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late preterm (34(0/7) to 36(6/7)weeks gestation) infants may experience developmental delays greater than those found in term (≥ 37(0/7)weeks gestation) infants. AIM The aim of this study was to compare the risk of developmental delay between late preterm and full-term Canadian born infants at age 12months, and to determine infant and maternal factors associated with risk of delay. METHODS A descriptive comparative study was conducted from data available from the All Our Babies community-based, prospective, pregnancy cohort in Calgary, Alberta. Participants were a sample of mothers of 52 infants born late preterm and 156 randomly selected mothers of term infants, matched for infant sex; eligible infants were singleton births. Mothers completed a developmental screening tool, the Ages and Stages Questionnaire, version 3 (ASQ-3), when their infant was age 12months. Corrected age (CA) was used for preterm infants. RESULTS Both late preterm and term infants who required neonatal intensive care (NICU) were more likely to demonstrate risk of developmental delay. Compared to term infants, there was a trend for late preterm infants to be at risk of communication and gross motor delay at age 12months CA that was attenuated to the null when adjustments were made for NICU admission and other covariates. CONCLUSIONS Infants born between 34 and 41weeks who are admitted to NICU are at increased risk of developmental delay. Early identification of risk provides an opportunity for referral for developmental assessment and early intervention programming.
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Affiliation(s)
- Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, 2W305, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada.
| | - Karen M Benzies
- Faculty of Nursing, University of Calgary, PF2222, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada; Department of Paediatrics, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T2N 4N1, Canada.
| | - Sheila McDonald
- Alberta Health Services, Calgary Zone, 10301 Southport Lane, SW, Calgary, Alberta, T2W 1S7, Canada.
| | - Joyce Magill-Evans
- Department of Occupational Therapy, 8205 - 114 Street, University of Alberta, Edmonton, Alberta, T6G 2G4, Canada.
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T2N 4N1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T2N 4N1, Canada.
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19
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Giannì ML, Roggero P, Piemontese P, Liotto N, Orsi A, Amato O, Taroni F, Morlacchi L, Consonni D, Mosca F. Is nutritional support needed in late preterm infants? BMC Pediatr 2015; 15:194. [PMID: 26597280 PMCID: PMC4657334 DOI: 10.1186/s12887-015-0511-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Late preterm birth accounts for 70 % of all preterm births. While the impact of feeding problems in very preterm infants has been widely investigated, data on late preterm infants’ feeding issues are scarce. The aim of the present study was to investigate the need of nutritional support during hospital stay in a cohort of late preterm infants and to identify the factors that most contribute to its occurrence. Methods We analyzed the medical records of late preterm infants, born 2011–2013, admitted to a single institution. Neonatal data, the need for nutritional support, defined as the need for parenteral nutrition or intravenous fluids or tube feeding, and the feeding status at discharge were retrieved. The occurrence of respiratory distress syndrome, congenital malformations/chromosomal diseases, cardiac diseases, sepsis, hypoglycemia, poor feeding and the need for surgical intervention were also collected. Results A total of 1768 late preterm infants were included. Among the 592 infants requiring a nutritional support, 228 developed a respiratory distress syndrome, two developed a sepsis, one presented with a cardiac disease, 24 underwent a surgical intervention, eight had a chromosomal disease/congenital malformation, 80 had hypoglycemia. In addition, 100 infants required nutritional support due to poor feeding and 149 were born small for gestational age. Birth weight ≤2000 g (adjusted OR = 12.2, 95 % CI 7.5-19.9, p < 0.0001), gestational age of 34 weeks (adjusted OR = 4.08, 95 % CI 2.8-5.9, p < 0.0001), being small for gestational age (adjusted OR = 2.17, 95 % CI 2.8-5.9, p=0.001), having a respiratory distress syndrome (adjusted OR = 79.6, 95 % CI 47.2-134.3, p < 0.0001) and the need of surgical intervention (adjusted OR = 49.4, 95 % CI 13.9-174.5, p < 0.0001) were associated with a higher risk of need of nutritional support during hospital stay. Conclusions Late preterm infants are at relatively high risk of requiring nutritional support during hospital stay, especially if they have a birth weight ≤2000 g, a gestational age of 34 weeks, are born small for gestational age, develop a respiratory distress syndrome and require a surgical intervention. The present findings add to the knowledge of late preterm infants’ feeding issues and may contribute to tailoring nutritional approaches for these infants.
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Affiliation(s)
- Maria Lorella Giannì
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Paola Roggero
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Pasqua Piemontese
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Nadia Liotto
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Anna Orsi
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Orsola Amato
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Francesca Taroni
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Laura Morlacchi
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
| | - Dario Consonni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Epidemiology Unit, Via San Barnaba 8, 20122, Milan, Italy.
| | - Fabio Mosca
- Department of Clinical Science and Community Health, Neonatal Intensive Care Unit, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via Commenda 12, 20122, Milano, Italy.
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Torday JS. Homeostasis as the Mechanism of Evolution. BIOLOGY 2015; 4:573-90. [PMID: 26389962 PMCID: PMC4588151 DOI: 10.3390/biology4030573] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/11/2015] [Accepted: 09/08/2015] [Indexed: 12/17/2022]
Abstract
Homeostasis is conventionally thought of merely as a synchronic (same time) servo-mechanism that maintains the status quo for organismal physiology. However, when seen from the perspective of developmental physiology, homeostasis is a robust, dynamic, intergenerational, diachronic (across-time) mechanism for the maintenance, perpetuation and modification of physiologic structure and function. The integral relationships generated by cell-cell signaling for the mechanisms of embryogenesis, physiology and repair provide the needed insight to the scale-free universality of the homeostatic principle, offering a novel opportunity for a Systems approach to Biology. Starting with the inception of life itself, with the advent of reproduction during meiosis and mitosis, moving forward both ontogenetically and phylogenetically through the evolutionary steps involved in adaptation to an ever-changing environment, Biology and Evolution Theory need no longer default to teleology.
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Affiliation(s)
- John S Torday
- Harbor-UCLA Medical Center, 1224 W. Carson Street, Torrance, CA 90502, USA.
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21
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[Recommendations for the perinatal management and follow up of late preterm newborns]. An Pediatr (Barc) 2014; 81:327.e1-7. [PMID: 25106929 DOI: 10.1016/j.anpedi.2014.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/18/2014] [Accepted: 06/05/2014] [Indexed: 11/20/2022] Open
Abstract
Prematurity is the main reason for neonatal morbidity and mortality, and has become one of the greatest problems in public health, especially in developed countries. Prematurity rate has increased during the last 2 decades. This increase may be attributed to late preterm babies, that is, those with a gestational age between 34(+0) and 36(+6) weeks. Perinatal morbidities, as well as long term complications, are more frequent in this population than in term babies. The incidence is more similar to the one observed in earlier premature babies. The SEN34-36 group of the Spanish Society of Neonatology suggests these recommendations for the management of late preterm babies. Strategies are offered not only for the early detection of possible complications, but also for the correction of these morbidities, and from the point of view of a family and development centered care. Follow up is strongly recommended due to the high rate of late morbidities.
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Olcese J, Beesley S. Clinical significance of melatonin receptors in the human myometrium. Fertil Steril 2014; 102:329-35. [DOI: 10.1016/j.fertnstert.2014.06.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/03/2014] [Accepted: 06/13/2014] [Indexed: 01/05/2023]
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