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Eto E, Maeda T, Kobayashi O, Ihara K. Intrauterine twin environment and genetic factors subliminally affecting general movements in preterm infants. Brain Dev 2024; 46:255-261. [PMID: 38705801 DOI: 10.1016/j.braindev.2024.05.002] [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: 01/11/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Understanding background factors is beneficial for interpreting general movements (GMs). This study examines the factors involved in preterm-writhing GMs by comparing twins and singletons. METHOD The subjects were 107 infants cared for at Oita University. The cohort consisted of very-low-birth-weight infants, including twins with a birth weight < 2000 g. The median gestational age (GA) was 29 weeks 1 day. The subjects consisted of 75 singletons, 32 twins (16 pairs), 20 monochorionic twins (M-twins), and 12 dichorionic twins (D-twins). GMs were scored according to the GMs optimality score (GMOS) and integrated into 6 items: the quality, neck-trunk and space, amplitude-speed, rotation, onset-offset and cramped, and tremulous score at 32-34 weeks, 35-36 weeks, and 37-42 weeks' GA. A hierarchical cluster analysis was performed using integrated GMOS, and the characteristics of clusters were examined according to clinical backgrounds. RESULTS Three clusters were identified. Cluster 1 was characterized by good-quality GMs, cluster 2 by a poor repertoire but optimal space and rotatory components, and cluster 3 by overall poor-quality GMs, respectively. The mean GMOSs were 36.6, 31.8 and 24.3 in clusters 1, 2, and 3, respectively. There were no marked differences in proportions within clusters with respect to sex and twins. Small-for-gestational age (SGA) was significantly more frequent in cluster 3 at 32-34 weeks' GA than in other clusters. Perinatal brain injury had a significantly lower proportion in cluster 1 and a higher proportion in cluster 3 at 35-36 weeks' GA and 37-42 weeks' GA. M-twin pairs tended to belong to the same clusters at 35-36 weeks' GA. CONCLUSION Preterm writhing GMs are associated with SGA and perinatal brain injury. Cluster matching in M-twins suggests that certain genetic factors may substantially influence GMs.
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Affiliation(s)
- Eriko Eto
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Tomoki Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan.
| | - Osamu Kobayashi
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
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Olgun AB, Yüksel D, Yardımcı F. The Effect of a Light-Dark Cycle on Premature Infants in the Neonatal Intensive Care Unit: A Randomized Controlled Study. J Pediatr Nurs 2024; 77:e343-e349. [PMID: 38724313 DOI: 10.1016/j.pedn.2024.04.050] [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: 03/12/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE To investigate potential differences in discharge time, feeding methods and amounts, daily weight gain, vital signs, pain, and comfort levels among preterm infants born at 28-32 weeks' gestation who were hospitalized in the neonatal intensive care unit during long-term follow-up while implementing a light-dark cycle. DESIGN AND METHODS This is a randomized controlled study conducted with the support of a day-night cycle in premature infants born at 28-32 weeks' gestation and admitted to the neonatal intensive care unit of a teaching and research hospital affiliated with the Ministry of Health. The study compared the follow-up results from hospitalization to discharge over a period of 8 weeks. RESULTS 50% of premature infants admitted to the unit are multiple pregnancies. There was no significant difference in discharge weight, comfort level, pain level, vital signs of the infants included in the study (p > 0.05). The optimal development of infant feeding patterns was examinedand it was observed that the study group had significantly improved before the control group in terms of the time to switch to full enteral feeding and oral feeding (p < 0,05). The daily weight gain of the babies was examined, it was seen that the weight gain was higher in the study group compared to the control group (p < 0,05). The mean duration of hospitalization was compared, it was seen that the babies in the study group were discharged significantly earlier (p < 0,05). CONCLUSION The study compared the long-term outcomes of premature babies hospitalized in neonatal intensive care and babies exposed to a light-dark cycle and regularly monitored in standard care. The results showed that the babies in the study group had higher daily weight gain and were discharged earlier than the control group. There were also no statistically significant differences in comfort and pain scores, vital signs or oxygen saturation between the study and control groups. PRACTICE IMPLICATIONS A light-dark cycle was found to be a feasible and promising intervention for infants at 28-32 weeks' gestation. It was a nurse-led management of care that could be integrated into the usual care of 28-32-week-old babies in neonatal units.
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Affiliation(s)
- Ayşe Betül Olgun
- Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Didem Yüksel
- Assistant Professor, Atılım University Faculty of Health, Department of Nursing, Child Health and Diseases Nursing, Ankara, Turkey.
| | - Figen Yardımcı
- Associate Professor, Ege University, Faculty of Nursing, Department of Child Health and Diseases Nursing, Izmir, Turkey.
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Franco F, Chifa M, Politimou N. Home Musical Activities Boost Premature Infants' Language Development. CHILDREN (BASEL, SWITZERLAND) 2024; 11:542. [PMID: 38790537 PMCID: PMC11120229 DOI: 10.3390/children11050542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 05/26/2024]
Abstract
Infants born prematurely are considered at risk for language development delay and impairments. Using online parental reports, the present study investigated the influence of early musical experience in the home environment (Music@Home Infant Questionnaire) on language development (MacArthur-Bates Communicative Development Inventory) while controlling for general enrichment at home (Stim-Q Cognitive Home Environment Questionnaire) and perinatal post-traumatic stress disorder (Perinatal PTSD Questionnaire). Caregivers of 117 infants between 8 and 18 months of age (corrected age) without reported developmental difficulties completed an online survey. Results revealed that the musical home environment significantly predicted outcomes in reported infants' receptive vocabulary and gestural communication, independently from infants' corrected age and general enrichment of home activities. These findings constitute the first evidence that an enriched musical experience can enhance the development of early communication skills in a population at risk for language delays, namely infants born prematurely, opening the path for future intervention research in home and/or early childcare settings. Given that the majority of participants in this study were highly educated and from socioeconomically stable backgrounds, considerations regarding the generalizability of these results are discussed.
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Affiliation(s)
- Fabia Franco
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK;
| | - Maria Chifa
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK;
| | - Nina Politimou
- Department of Psychology and Human Development, IOE Faculty of Education and Society, University College London, London WC1H 0AA, UK
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Tarrell A, Giles L, Smith B, Traube C, Watt K. Delirium in the NICU. J Perinatol 2024; 44:157-163. [PMID: 37684547 DOI: 10.1038/s41372-023-01767-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Abstract
Delirium in the NICU is an underrecognized phenomenon in infants who are often complex and critically ill. The current understanding of NICU delirium is developing and can be informed by adult and pediatric literature. The NICU population faces many potential risk factors for delirium, including young age, developmental delay, mechanical ventilation, severe illness, and surgery. There are no diagnostic tools specific to infants. The mainstay of delirium treatment is to treat the underlying cause, address modifiable risk factors, and supportive care. This review will summarize current knowledge and areas where more research is needed.
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Affiliation(s)
- Ariel Tarrell
- University of Utah School of Medicine, Department of Pediatrics, Division of Neonatology, Salt Lake City, UT, USA.
| | - Lisa Giles
- University of Utah School of Medicine, Department of Pediatrics, Division of Pediatric Behavioral Health and Psychiatry, Salt Lake City, UT, USA
| | - Brian Smith
- Duke University Medical Center, Division of Neonatology, Durham, NC, USA
| | - Chani Traube
- Weill Cornell Medical College, Division of Pediatric Critical Care Medicine, New York, NY, USA
| | - Kevin Watt
- University of Utah School of Medicine, Department of Pediatrics, Divisions of Pediatric Critical Care Medicine and Clinical Pharmacology, Salt Lake City, UT, USA
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Bembich S, Risso FM, Stan N, Lamba D, Banova C, Pagnini A, Bin M, Trappan A, Sanson G. Preterm Newborn Adaptive Responses to Daily Nursing during Neonatal Intensive Care Unit Stay, Associate with Neurodevelopment, 2 Years Later. Am J Perinatol 2023; 40:1454-1460. [PMID: 34544168 DOI: 10.1055/a-1649-2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate if adaptive responses of very preterm newborns to neonatal intensive care unit (NICU) daily nursing, specifically bathing and weighing procedures are associated with their neurodevelopment after 2 years. STUDY DESIGN Twenty-six very preterm newborns, with a gestational age <32 weeks, were enrolled. Infants' adaptive responses to daily nursing were evaluated, at 30 to 32 to 35 postmenstrual age (PMA) weeks by an observational sheet. Neurodevelopment was assessed at 24 months of corrected age by the Bayley Scales of Infant and Toddler Development, third edition. Autonomic, motor, and self-regulatory responses to NICU nursing were analyzed by Spearman's correlation coefficient and multivariate linear regression with Bayley's cognitive, language, and motor scales. RESULTS Significant (p < 0.05) positive correlations of self-regulatory and autonomic responses to nursing with all Bayley's scales were found at 30- and 32-week PMA. At 35-week PMA, only self-regulatory responses had significant positive correlations with all Bayley's scales. When adjusted for birth weight and sex, the significant associations were confirmed only at 30- and 32-week PMA. CONCLUSION Very preterm newborn adaptive responses to NICU daily nursing reveal to be positively related to forthcoming neurodevelopment 2 years later, as early as the 30-week PMA. Helping preterm babies to adapt to daily NICU nursing may promote their future neurobehavior. KEY POINTS · Preterm adaptation to nursing was studied.. · Adaptation positively relates to neurodevelopment.. · Such relation is detected since 30-week PMA..
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Affiliation(s)
- Stefano Bembich
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo," Trieste, Italy
| | - Francesco M Risso
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo," Trieste, Italy
| | - Nicoleta Stan
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Domitilla Lamba
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Carolina Banova
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo," Trieste, Italy
| | - Arianna Pagnini
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo," Trieste, Italy
| | - Maura Bin
- Division of Child Neuropsychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Antonella Trappan
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo," Trieste, Italy
| | - Gianfranco Sanson
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
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Çetin K, Ekici B. The Effect of Incubator Cover on Newborn Vital Signs: The Design of Repeated Measurements in Two Separate Groups with No Control Group. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1224. [PMID: 37508721 PMCID: PMC10378478 DOI: 10.3390/children10071224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
(1) Background: During their stays in neonatal intensive care units (NICU), newborns are exposed to many stimuli that disrupt their physiological indicators. The aim of this study was to investigate the impact of the light-dark cycle created with and without an incubator cover on the vital signs of term and preterm newborns. (2) Methods: A repeated measures design was used in the study utilizing two separate groups, without a control group. The study included 91 neonates hospitalized in a NICU (44 term and 47 preterm). With and without an incubator cover, the newborns' vital signs (heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and body temperature (BT)) were measured. Three separate measurements were taken. (3) Results: The mean age of the newborns was 37.0 weeks. There was no significant difference between the HR and RR medians of the term and preterms in the incubator undraped and clad measurements (p > 0.05). At the first measurement, the SpO2 medians of the incubator-covered term and preterms were significantly higher than those of the incubator-covered term and preterms (p = 0.001). (4) Conclusions: The vital signs of the neonates demonstrated variable responses in the measurements when their incubators were covered vs. when they were not covered. However, more research on the effect of the light-dark cycle on their vital signs is required.
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Affiliation(s)
- Kenan Çetin
- Neonatal Intensive Care Unit, Siverek State Hospital, Şanlıurfa 63600, Türkiye
| | - Behice Ekici
- School of Nursing, Maltepe University, Istanbul 34857, Türkiye
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Liebowitz M, Kramer KP, Rogers EE. All Care is Brain Care: Neuro-Focused Quality Improvement in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:399-420. [PMID: 37201988 DOI: 10.1016/j.clp.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Neonates requiring intensive care are in a critical period of brain development that coincides with the neonatal intensive care unit (NICU) hospitalization, placing these infants at high risk of brain injury and long-term neurodevelopmental impairment. Care in the NICU has the potential to be both harmful and protective to the developing brain. Neuro-focused quality improvement efforts address 3 main pillars of neuroprotective care: prevention of acquired injury, protection of normal maturation, and promotion of a positive environment. Despite challenges in measurement, many centers have shown success with consistent implementation of best and potentially better practices that may improve markers of brain health and neurodevelopment.
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Affiliation(s)
- Melissa Liebowitz
- Envision Physician Services, St. Francis Hospital, 6001 East Woodmen Road, Colorado Springs, CO 80923, USA
| | - Katelin P Kramer
- Department of Pediatrics, University of California, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA; University of California, Benioff Children's Hospital, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA.
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA; University of California, Benioff Children's Hospital, 550 16th Avenue, 5th Floor, San Francisco, CA 94143, USA. https://twitter.com/eerogersmd
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8
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Howden A, McFerran KS, Thompson GA. Reflective Lullaby Writing with two mother--infant dyads who recently experienced an admission to a neonatal intensive care unit. NORDIC JOURNAL OF MUSIC THERAPY 2022. [DOI: 10.1080/08098131.2022.2115531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Amy Howden
- The Faculty of Fine Arts and Music, University of Melbourne, Melbourne, Australia
| | | | - Grace Anne Thompson
- The Faculty of Fine Arts and Music, University of Melbourne, Melbourne, Australia
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Lovey O, Bickle-Graz M, Morisod Harari M, Horsch A, Schneider J. The Joint Observation in Neonatology and Neurodevelopmental Outcome of Preterm Infants at Six Months Corrected Age: Secondary Outcome Data from a Randomised Controlled Trial. CHILDREN 2022; 9:children9091380. [PMID: 36138689 PMCID: PMC9497992 DOI: 10.3390/children9091380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate the impact of a standardised joint observation (JOIN) performed in the neonatal intensive care unit (NICU) on the neurodevelopment of preterm infants at six months corrected age (CA) compared with a preterm control group. In this monocentric interventional randomised controlled trial, we allocated 76 mothers and their preterm neonates to either JOIN, an early one-session intervention, or standard care during the NICU hospitalisation. The neurodevelopment of the preterm infants was assessed by standardised developmental tests at six months CA and compared between the intervention and the control groups. This randomised controlled trial was registered on clinicaltrials.gov (NCT02736136) in April 2016. Sixty-five infants underwent neurodevelopmental assessment at six months CA. There were no significant differences between the two groups in neurodevelopmental outcome measures. The JOIN intervention was not associated with significant improvement in neurodevelopment at six months CA in preterm infants.
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Affiliation(s)
- Oriane Lovey
- Medicine School, University of Lausanne, 1015 Lausanne, Switzerland
| | - Myriam Bickle-Graz
- Department of Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 2, 1011 Lausanne, Switzerland
| | - Mathilde Morisod Harari
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Antje Horsch
- Department of Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 2, 1011 Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, 1010 Lausanne, Switzerland
| | - Juliane Schneider
- Department of Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 2, 1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-314-91-95
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Zheng W, Chotipanvithayakul R, Ingviya T, Xia X, Xie L, Gao J. Sensory stimulation program improves developments of preterm infants in Southwest China: A randomized controlled trial. Front Psychol 2022; 13:867529. [PMID: 36046409 PMCID: PMC9421138 DOI: 10.3389/fpsyg.2022.867529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Preterm infants are prone to growth and developmental delay, especially social-emotional development. Sensory stimulation may benefit developmental outcomes for these vulnerable infants. This study aims to determine whether 5-integrated sensory stimulation (5-ISS) improves preterm infant social-emotional development. A randomized, parallel trial was conducted from November 2018 to January 2020 at three tertiary hospitals in Kunming, China. Preterm infants were eligible if gestational ages were from 28 to 36 weeks based on ultrasound results when discharged from neonatal wards. Two hundred preterm infants (male n = 110, female n = 90) were randomly allocated to the 5-ISS intervention group (n = 98) and the standard care group (n = 102). Social-emotional development was assessed with the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE). Temperament was assessed with the Infant Behavior Questionnaire-Revised. Anthropometry, which included weight, length, and head circumference, was measured at corrected ages of 1, 3, and 6 months. Demographic and clinical characteristics were similar between the intervention and the standard care groups. At 1- and 3-month corrected age, no significant differences between the two groups were observed in terms of infant development and temperament. At 6 months, significant disparities were found in the social-emotional development scale (mean difference −0.29, 95% CI: −0.58, < -0.001, p = 0.01), infant length (mean difference 0.70, 95% CI: < 0.001, 1.4, p = 0.03), distress to limitation (p = 0.04), and sadness (p = 0.03). A mixed model revealed that the 5-ISS intervention positively affected social-emotional development, length, distress to limitation, and sadness for preterm infants. Integrated sensory stimulation has benefits on social-emotional development, temperament, and length for preterm infants. This program provides a feasible method to promote social-emotional development for preterm infants.
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Affiliation(s)
- Wenjing Zheng
- Department of Pediatrics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rassamee Chotipanvithayakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- Research Center for Kids and Youth Development, Prince of Songkla University, Hat Yai, Thailand
- *Correspondence: Rassamee Chotipanvithayakul,
| | - Thammasin Ingviya
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
- Research Center for Applied Medical Data Analytics, Prince of Songkla University, Hat Yai, Thailand
| | - Xiaoling Xia
- Department of Pediatrics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lu Xie
- Department of Neonatology, Kunming University Affiliated Maternal and Child Health Hospital, Kunming, China
| | - Jin Gao
- Department of Neonatology, Kunming Children Hospital, Kunming, China
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Richter M, Fehringer K, Smith J, Pineda R. Parent-infant interaction in the NICU: Challenges in measurement. Early Hum Dev 2022; 170:105609. [PMID: 35752043 PMCID: PMC10072234 DOI: 10.1016/j.earlhumdev.2022.105609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/04/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues. AIM To improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues. METHOD Twenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34-48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS. RESULTS Seventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01). CONCLUSION It remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.
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Affiliation(s)
- M Richter
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, 1540 Alcazar St, Los Angeles, CA 90089, United States of America
| | - K Fehringer
- Self-employed, Ridgeway, CO 81432, United States of America
| | - J Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St Louis, MO, United States of America
| | - R Pineda
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, 1540 Alcazar St, Los Angeles, CA 90089, United States of America; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States of America; Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, United States of America; Center for the Changing Family, University of Southern California, Los Angeles, CA, United States of America.
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van Gils RHJ, Wauben LSGL, Helder OK. Body size measuring techniques enabling stress-free growth monitoring of extreme preterm infants inside incubators: A systematic review. PLoS One 2022; 17:e0267285. [PMID: 35452486 PMCID: PMC9033282 DOI: 10.1371/journal.pone.0267285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Growth monitoring of preterm infants is essential for assessing the nutritional effects on their growth. The current growth monitoring techniques are too stressful, however, for the smallest preterm infants. We performed a systematic review to summarize studies on stress-free techniques for measuring the body size of preterm infants inside incubators other than the traditional calliper and tape measure-based instruments. Methods We searched four online literature databases: Embase, Medline, Web of Science Core Collection, and Cochrane, using search terms related to patients (neonates, infants, children) and body size measuring techniques. By means of expert judgement we assessed the techniques’ suitability for stress-free body size measurement of an infant lying in an incubator. As a criterion for suitability, we used an imaginary ideal technique. Results Twenty-six studies were included in this review. In 24 studies, the technique for body size measurement was related to 3D technology, and the majority of these studies acknowledged clinical superiority of 3D over 2D data. Two 3D techniques were assessed as suitable for stress-free measurement of preterm infants inside incubators. The first technique used a commercially available 3D handheld scanner which needed 3D postprocessing to derive measurement data. The second technique used a self-developed stereoscopic vision system. Conclusions 3D volumetric parameters have higher clinical value for growth monitoring than 2D. In addition, contactless 3D measurements enable stress-free growth monitoring of even the smallest preterm infants. However, the time-consuming 3D postprocessing challenges the usability of 3D techniques. Regrettably, none of the identified suitable 3D techniques met all our requirements of an ideal all-in-one body size measuring technique for extreme preterm infants. Handheld 3D scanning might have the best properties for developing this ideal technique.
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Affiliation(s)
- Ronald H. J. van Gils
- Division of Neonatology, Department of Pediatrics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Create4Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Institute of Engineering & Applied Science, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- * E-mail:
| | - Linda S. G. L. Wauben
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Onno K. Helder
- Department of Create4Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Mother-Infant Dyadic Synchrony in the NICU Context. Adv Neonatal Care 2022; 22:170-179. [PMID: 35703926 DOI: 10.1097/anc.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dyadic synchrony is a co-constructed social process relating to the back and forth interactions between mothers and infants that are strongly associated with neurodevelopment, self-regulation, and attachment. In the neonatal intensive care unit (NICU), this process may become interrupted because of the physiological state of the infant, the emotional state of the mother, and the physical environment of the NICU. PURPOSE In applying Feldman's Biobehavioral Model of Synchrony, this empirical review deconstructs the process of dyadic synchrony in the NICU context and provides a conceptual approach to guide both research and clinical practice. METHODS First, we examine the theoretical and empirical literature to explicate the primary structural and biophysiological components of synchrony and relate these constructs to the extant research on premature infants. Next, we synthesize the maternal, infant, and contextual factors that facilitate or inhibit the ontogenesis of dyadic synchrony in the NICU. The final section highlights the state of the science in dyadic synchrony in the NICU including gaps and recommendations for future research. FINDINGS An empirical review synthesis presents a visual conceptual framework to illustrate multiple processes that depict maternal, infant, and contextual influences of mother-infant synchrony in the NICU. IMPLICATIONS FOR PRACTICE/RESEARCH Despite the challenges posed to mother-infant relationships in the NICU, high-quality mother-infant interactions are possible, dyadic synchrony can emerge, and premature infants can develop secure attachments. Clinicians and researchers can apply this conceptual framework of mother-infant dyadic synchrony in the NICU to promote evidence-based research and clinical practice.
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Nunes CRDN, Freitas NFD, Arruda JRP, Bartholomeu MDD, Valadares GC, Rodrigues TM, Azevedo VMGDO, Bouzada MCF. Association between early onset of skin-to-skin contact and mother-infant interaction at hospital discharge and six months of corrected age among preterm infants. Early Hum Dev 2022; 165:105525. [PMID: 34996020 DOI: 10.1016/j.earlhumdev.2021.105525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare mother-infant interaction between hospital discharge and at six months of corrected age of infants born ≤32 weeks and investigate the association between the onset of skin-to-skin contact and the difference in mother-infant interaction between discharge and six months of corrected age (CA) among preterm infants. MATERIAL AND METHODS Prospective observational study, in which 72 mother-infant dyads were evaluated. Preterm newborns (born with gestational age ≤ 32 weeks of gestational age) from two public maternity hospitals were assessed by means of video macro analysis of the mother-infant interaction according to the parameters adopted by the Mother-Baby Observation Protocol 0-6 (POIMB), at hospital discharge and at six months of corrected gestational age. Such variables as socioeconomic conditions, depression and maternal anxiety were controlled. Multivariate model was built. RESULTS Onset skin-to-skin contact within three days of life increased by 1.30 points for the best interactive infant behavior at discharge for the six months of CA. In addition, in relation to the tuning of the mother-infant dyad, the initiation of skin-to-skin contact at 20 days of life reduced 1.0 point significantly. Multiparous mothers or those exposed to cigarette smoke performed worse in the development of the dyad. CONCLUSION The preterm newborn should initiate skin-to-skin contact early and, whenever possible, by the third day of life to favor mother-infant interaction.
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Affiliation(s)
| | - Nathalia Faria de Freitas
- Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Ave. Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | | | | | - Gislene Cristina Valadares
- Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Ave. Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Thalyta Magalhães Rodrigues
- Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Ave. Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | | | - Maria Cândida Ferrarez Bouzada
- Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Ave. Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
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15
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Artese C, Ferrari F, Perugi S, Cavicchioli P, Paterlini G, Mosca F. Surveying family access: kangaroo mother care and breastfeeding policies across NICUs in Italy. Ital J Pediatr 2021; 47:231. [PMID: 34857018 PMCID: PMC8638249 DOI: 10.1186/s13052-021-01164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies on the application of developmental care initiatives in Italian NICUs are rather scarce. We aimed to assess parental access to the NICUs and facilities offered to the family members and to test "the state of art" regarding kangaroo mother care (KMC) and breastfeeding policies in level III Italian NICUs. METHODS A questionnaire both in paper and in electronic format was sent to all 106 Italian level III NICUs; 86 NICUs (i.e., 80% of NICUs) were completed and returned. The collected data were analysed. In addition, a comparison between the 2017 survey results and those of two previous surveys conducted from 2001 to 2006 was performed. RESULTS In total, 53 NICUs (62%) reported 24-h open access for both parents (vs. 35% in 2001 and 32% in 2006). Parents were requested to temporarily leave the unit during shift changes, emergencies and medical rounds in 55 NICUs (64%). Some parental amenities, such as an armchair next to the crib (81 units (94%)), a room for pumping milk and a waiting room, were common, but others, such as family rooms (19 units (22%)) and adjoining accommodation (30 units (35%)), were not. KMC was practised in 81 (94%) units, but in 72 (62%), i.e., the majority of units, KMC was limited to specific times. In 11 (13%) NICUs, KMC was not offered to the father. The average duration of a KMC session, based on unit staff estimation, was longer in 24-h access NICUs than in limited-access NICUs. KMC documentation in medical records was reported in only 59% of questionnaires. Breastfeeding was successful in a small proportion of preterm infants staying in the NICU. CONCLUSION The number of 24-h access NICUs doubled over a period of 13 years. Some basic family facilities, such as a dedicated kitchen, rooms with dedicated beds and showers for the parents, remain uncommon. KMC and breastfeeding have become routine practices; however, the frequency and duration of KMC sessions reported by NICU professionals still do not meet the WHO recommendations.
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Affiliation(s)
- Claudia Artese
- Neonatology and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Fabrizio Ferrari
- Neonatology and Neonatal Intensive Care Unit, University of Modena and Reggio Emilia Hospital, Via del Pozzo 71, 41125, Modena, Italy.
| | - Silvia Perugi
- Neonatology and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Paola Cavicchioli
- Neonatal Intensive Care Unit, Hospital "Dell'Angelo" Venezia Mestre, Venice, Italy
| | - Giuseppe Paterlini
- Department of Mother's and Child' Health, Neonatology and Neonatal Intensive Care Unit, Poliambulanza Foundation Hospital Institute, Brescia, Italy
| | - Fabio Mosca
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Foundation, University Hospital, Milan, Italy
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16
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Mannering H, Yan C, Gong Y, Alrifai MW, France D, Chen Y. Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study. J Med Internet Res 2021; 23:e27261. [PMID: 34637393 PMCID: PMC8530253 DOI: 10.2196/27261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/18/2021] [Accepted: 10/08/2021] [Indexed: 01/29/2023] Open
Abstract
Background Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post–COVID-19 era. Objective This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre– to the intra–COVID-19 era. Methods In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre–COVID-19, n=386; intra–COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre–COVID-19 as the period of September-December 2019 and intra–COVID-19 as the period of March-June 2020. These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Results Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU.
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Affiliation(s)
- Hannah Mannering
- Department of Computer Science, Loyola University, Baltimore, MD, United States
| | - Chao Yan
- Department of Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mhd Wael Alrifai
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - You Chen
- Department of Computer Science, Vanderbilt University, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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17
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Bembich S, Risso FM, Stan N, Lamba D, Banova C, Pagnini A, Bin M, Trappan A, Sanson G. Preterm Newborn Adaptive Responses to Daily Nursing during Neonatal Intensive Care Unit Stay, Associate with Neurodevelopment, 2 Years Later. Am J Perinatol 2021. [PMID: 34666394 DOI: 10.1055/s-0041-1736535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate if adaptive responses of very preterm newborns to neonatal intensive care unit (NICU) daily nursing, specifically bathing and weighing procedures are associated with their neurodevelopment after 2 years. STUDY DESIGN Twenty-six very preterm newborns, with a gestational age <32 weeks, were enrolled. Infants' adaptive responses to daily nursing were evaluated, at 30 to 32 to 35 postmenstrual age (PMA) weeks by an observational sheet. Neurodevelopment was assessed at 24 months of corrected age by the Bayley Scales of Infant and Toddler Development, third edition. Autonomic, motor, and self-regulatory responses to NICU nursing were analyzed by Spearman's correlation coefficient and multivariate linear regression with Bayley's cognitive, language, and motor scales. RESULTS Significant (p < 0.05) positive correlations of self-regulatory and autonomic responses to nursing with all Bayley's scales were found at 30- and 32-week PMA. At 35-week PMA, only self-regulatory responses had significant positive correlations with all Bayley's scales. When adjusted for birth weight and sex, the significant associations were confirmed only at 30- and 32-week PMA. CONCLUSION Very preterm newborn adaptive responses to NICU daily nursing reveal to be positively related to forthcoming neurodevelopment 2 years later, as early as the 30-week PMA. Helping preterm babies to adapt to daily NICU nursing may promote their future neurobehavior. KEY POINTS · Preterm adaptation to nursing was studied.. · Adaptation positively relates to neurodevelopment.. · Such relation is detected since 30-week PMA..
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Affiliation(s)
- Stefano Bembich
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico “Burlo Garofolo,” Trieste, Italy
| | - Francesco M. Risso
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico “Burlo Garofolo,” Trieste, Italy
| | - Nicoleta Stan
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Domitilla Lamba
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Carolina Banova
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico “Burlo Garofolo,” Trieste, Italy
| | - Arianna Pagnini
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico “Burlo Garofolo,” Trieste, Italy
| | - Maura Bin
- Division of Child Neuropsychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo,” Trieste, Italy
| | - Antonella Trappan
- Division of Neonatology and Neonatal Intensive Care Unit, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico “Burlo Garofolo,” Trieste, Italy
| | - Gianfranco Sanson
- Department of Medical, Surgical and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
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18
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Nishino T, Ito N, Tomori S, Shimada S, Kodera M, Morita K, Takahashi K, Mimaki M. Effects of Temperature and Position Change on Neonatal Brain Regional Oxygen Saturation in Tub Bathing: A Prospective Study. Pain Ther 2021; 10:1269-1282. [PMID: 34263424 PMCID: PMC8279383 DOI: 10.1007/s40122-021-00290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/29/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION A major goal in neonatal medicine is to reduce stress as much as possible in routine care. Bathing is one of the important routine cares for neonates, but it makes a big environmental change for them. We aimed to examine whether water temperature, room temperature, and position changes in tub bathing serve as noxious stimuli to neonates. METHODS This prospective trial was performed in full-term and non-low-birth-weight neonates admitted to the hospital between July 2020 and March 2021. Those with underlying diseases, fetal distress, infection, and other medical conditions were excluded. Measurements were taken during the neonates' first tub bath since birth, which was performed by a trained nurse. Changes in regional oxygen saturation (rSO2), determined using near-infrared spectroscopy, and water and room temperature, were examined at five different time points: upon entering the bath, head washing, position change, exiting the bath, and during the 3 min after bathing. RESULTS In total, 17 neonates were analyzed. No changes in rSO2 due to head washing or position change were observed; however, rSO2 significantly decreased upon entering (78.5 ± 4.1% vs. 75.7 ± 4.1%, p < 0.001) and exiting the bath (75.8 ± 5.7% vs. 74.4 ± 5.4%, p < 0.04). The rate change in rSO2 upon entering the bath showed a significant inverse correlation with water temperature (r = - 0.53, p < 0.03), and there were no significant correlations between rSO2 and water or room temperature upon exiting the bath. There was no change in body skin temperature before and after bathing, but rSO2 gradually decreased during the 3 min after bathing. CONCLUSIONS Neonates may perceive certain temperatures during bathing as noxious stimuli. Therefore, methods to minimize stress associated with bathing should be implemented to reduce the difference between water temperature and room temperature during bathing. TRIAL REGISTRATION This trial has been registered at UMIN repository with the trial number UMIN000041045 ( https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046500 ). The date of the final dataset was April 01, 2021.
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Affiliation(s)
- Tomohiko Nishino
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Naoki Ito
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Shinya Tomori
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Satoshi Shimada
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Misaki Kodera
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kiyoko Morita
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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Chandebois L, Nogue E, Bouschbacher C, Durand S, Masson F, Mesnage R, Nagot N, Cambonie G. Dissemination of newborn behavior observation skills after Newborn Individualized Developmental Care and Assessment Program (NIDCAP) implementation. Nurs Open 2021; 8:3547-3557. [PMID: 33956404 PMCID: PMC8510744 DOI: 10.1002/nop2.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/06/2021] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Design Prospective observational study. Methods Twelve nurses viewed 20‐min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme. Results Despite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.
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Affiliation(s)
- Laurence Chandebois
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Catherine Bouschbacher
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Sabine Durand
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Florence Masson
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Renaud Mesnage
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Nicolas Nagot
- Clinical Research and Epidemiology Unit, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France.,Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
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20
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Dean S, Long M, Ryan E, Tarnoviski K, Mondal A, Lisanti AJ. Assessment of an Educational Tool for Pediatric Cardiac Nurses on Individualized Family-Centered Developmental Care. Crit Care Nurse 2021; 41:e17-e27. [PMID: 33791757 DOI: 10.4037/ccn2021213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prevention of neurodevelopmental sequelae is a high priority in the care of infants with congenital heart defects. Individualized family-centered developmental care has been identified as a promising approach to promote infant neurodevelopment during hospitalization. OBJECTIVE To educate nurses on the concept of individualized family-centered developmental care and its application to nursing practice and to reduce perceived barriers to its implementation. METHODS Two evidence-based visual educational tools called "developmental care flowers" were created and implemented in the inpatient and procedural units of a cardiac center. Each flower petal represented a core component of individualized family-centered developmental care: cue-based care, patient positioning, supportive environment, and parent engagement. Surveys were administered before and after the educational intervention to assess changes in nurses' knowledge and perceptions of individualized family-centered developmental care. RESULTS Nurses reported that the developmental care flowers improved their understanding of individualized family-centered developmental care. The educational tools reduced some perceived barriers to implementation of this care model and increased nurse-reported inclusion of parents in care. Qualitative feedback from staff members regarding the tools was positive and acknowledged that individualized family-centered developmental care should be an ongoing priority. CONCLUSIONS The inpatient and procedural developmental care flowers are useful tools for educating nurses about individualized family-centered developmental care. They could be revised into more interactive tools that might be used to educate parents and further support the integration of this care concept into nursing practice.
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Affiliation(s)
- Spencer Dean
- Spencer Dean is an advanced practice provider, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Meghan Long
- Meghan Long is a clinical nurse, Cardiac Center, Children's Hospital of Philadelphia
| | - Edie Ryan
- Edie Ryan is a cardiac catheterization lab supervisor, Children's Hospital of Philadelphia
| | - Kelly Tarnoviski
- Kelly Tarnoviski is a clinical nurse, Cardiac Center, Children's Hospital of Philadelphia
| | - Antara Mondal
- Antara Mondal is a biostatistician, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Amy Jo Lisanti
- Amy Jo Lisanti is a nurse scientist-clinical nurse specialist, Cardiac Nursing, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, and an adjunct assistant professor, University of Pennsylvania School of Nursing, Philadelphia
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21
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Levesque V, Johnson K, McKenzie A, Nykipilo A, Taylor B, Joynt C. Implementing a Skin-to-Skin Care and Parent Touch Initiative in a Tertiary Cardiac and Surgical Neonatal Intensive Care Unit. Adv Neonatal Care 2021; 21:E24-E34. [PMID: 32604127 DOI: 10.1097/anc.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Skin-to-skin care (SSC) has been integrated as an essential component of developmental care for preterm infants. Despite documented benefits, SSC is not routinely practiced in the cardiac and surgical neonatal intensive care unit, with a predominantly term population, due to staff apprehension, patient factors and acuity, and environmental constraints. PURPOSE The purpose of this quality improvement project was to increase SSC, parental holds, and parent touch events for infants in our cardiac and surgical neonatal intensive care unit. When traditional SSC was not possible, alternative holds and alternative parent touch (APT) methods were encouraged. METHODS Quality improvement and qualitative descriptive methodology were utilized to assess baseline, develop education and practice changes, and evaluate the use of SSC, holds, and APT methods at 12 and 18 months postintervention. Implementation included educational tools and resource development, simulations, peer champions, in-class teaching, and team huddles. Decisions around the type of hold and parent touch were fluid and reflected complex infant, family, staff, and physical space needs. FINDINGS Given its initial scarcity, there was an increased frequency of SSC and variety of holds or APT events. Staff survey results indicated support for the practice and outlined persistent barriers. IMPLICATIONS FOR PRACTICE Skin-to-skin care, holds, and APT practices are feasible and safe for term and preterm infants receiving highly instrumented and complex cardiac and surgical care. IMPLICATIONS FOR RESEARCH Future research regarding the intervention's impact on neurodevelopmental outcomes of infants and on parent resilience in the surgical and cardiac neonatal intensive care unit is warranted.
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22
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Muelbert M, Alexander T, Pook C, Jiang Y, Harding JE, Bloomfield FH. Cortical Oxygenation Changes during Gastric Tube Feeding in Moderate- and Late-Preterm Babies: A NIRS Study. Nutrients 2021; 13:nu13020350. [PMID: 33503882 PMCID: PMC7911983 DOI: 10.3390/nu13020350] [Citation(s) in RCA: 2] [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: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/05/2022] Open
Abstract
Smell and taste of food can trigger physiological responses facilitating digestion and metabolism of nutrients. Controlled experimental studies in preterm babies have demonstrated that smell activates the orbitofrontal cortex (OFC) but none have investigated the effect of taste stimulation. Using cotside Near-Infrared Spectroscopy (NIRS), we measured changes in OFC cerebral oxygenation in response to gastric tube feeds five and 10 days after birth in 53 assessments of 35 moderate- to late-preterm babies enrolled in a randomized trial. Babies were randomly assigned to receive smell and taste of milk before gastric tube feeds (intervention group, n = 16) or no exposure (control group, n = 19). The majority of babies were born at 33 weeks of gestation (range 32–34) and 69% were boys. No differences in OFC cerebral oxygenation were observed between control and intervention groups. Gastric tube feeds induced activation of the OFC (p < 0.05), but sensory stimulation alone with smell and taste did not. Boys, but not girls, showed activation of the OFC following exposure to smell of milk (p = 0.01). The clinical impact of sensory stimulation prior to tube feeds on nutrition of preterm babies, as well as the impact of environmental inputs on cortical activation, remains to be determined.
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Affiliation(s)
- Mariana Muelbert
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (M.M.); (T.A.); (C.P.); (Y.J.); (J.E.H.)
| | - Tanith Alexander
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (M.M.); (T.A.); (C.P.); (Y.J.); (J.E.H.)
- Neonatal Unit, Kidz First, Middlemore Hospital, 2025 Auckland, New Zealand
| | - Chris Pook
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (M.M.); (T.A.); (C.P.); (Y.J.); (J.E.H.)
| | - Yannan Jiang
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (M.M.); (T.A.); (C.P.); (Y.J.); (J.E.H.)
| | - Jane Elizabeth Harding
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (M.M.); (T.A.); (C.P.); (Y.J.); (J.E.H.)
| | - Frank Harry Bloomfield
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (M.M.); (T.A.); (C.P.); (Y.J.); (J.E.H.)
- Correspondence: ; Tel.: +64-9-923-6107
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Anggrahini SM, Notobroto HB, Irwanto I, Suryawan A. Structural Model of Maternal Behavior in Community Setting to Prevent Low Birth Weight in East Nusa Tenggara, Indonesia. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v56i1.24610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Low birth weight (LBW) is still a magnitude problem in Indonesia with a multifactorial causes. Studies revealed that one of cause of LBW-infants birth is mother's behavior in treating her pregnancy, including traditional pregnancy care practices. The purpose was to develop the structural model on community setting that might describe the LBW infants-birth. A case-control study on 50 post-partum mothers with LBW and 50 with normal birthweight infants was held in Kupang, East Nusa Tenggara, Indonesia, November 2016 - May 2017. Mother who have spontaneous birth, singleton, and received integrated ANC were inlcuded. Several data such as maternal characteristics, pregnancy knowledge, perceived behavioral control (PBC), maternal health status, obedience to traditional pregnancy care, were collected using questionnaire and medical records tracing. Statistical analysis was performed using path analysis from SmartPLS 3.2.7 and considered significant path when the coefficients were not zero with P value <0.05. Outer and inner model analysis showed two significant paths, both are come from maternal characteristic that influence the LBW infants-birth through pregnancy knowledge (0.489, P=0.000) and PBC (0,425, P=0,000). In the first path, PBC affect maternal health status (0.217, P=0.021) which in turn will cause LBW (0.201, P=0.001). The second path, PBC affect the obedience to traditional pregnancy care (0.474, P=0.000) and then influence to LBW (0.316, P=0.000). As conclusion, maternal characteristics, pregnancy knowledge, PBC, maternal health status, and obedience to traditional pregnancy care are key points that might be used as a significant variables in preventing LBW-infants birth.
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Duffy N, Hickey L, Treyvaud K, Delany C. The lived experiences of critically ill infants hospitalised in neonatal intensive care: A scoping review. Early Hum Dev 2020; 151:105244. [PMID: 33130369 DOI: 10.1016/j.earlhumdev.2020.105244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neonatal intensive care saves lives, but the environment in which this occurs is complex and has been shown to negatively disrupt some aspects of an infant's early development. Identifying these negative effects has relied on measuring physiological and behavioural responses. Little research has sought to understand and learn from what an individual infant can communicate about their lived experience. AIM To examine what is known of the lived experiences of infants hospitalised in neonatal intensive care. STUDY DESIGN A scoping review using the revised Arksey and O'Malley framework was undertaken. Relevant studies, exploring an infant's experience of hospitalisation were identified through a comprehensive, systematic literature search. RESULTS 4955 articles were retrieved, 88 full texts reviewed, and 23 studies included. We identified no studies that assessed the experience from the infant's perspective. The infant experience was explored using quantitative methodology, characterising, and describing the experience in measurable physiological, behavioural, and neurodevelopmental terms or through the lens of medical outcomes. The environment is described as too loud and too bright and infants are exposed to high levels of medical handling, impacting on physiology, behaviour, sleep, feeding, and both short- and longer-term outcomes. CONCLUSION The studies captured in this review focused on quantitative, measurable outcomes as a proxy for the experience as it might be felt, interpreted, and processed by an infant. Medical focus has been crucial to advance the field of neonatology, but the review highlights an important gap; the need to explore and better understand the infant's experience through their eyes.
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Affiliation(s)
- Natalie Duffy
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Medical Education, University of Melbourne, Melbourne, Australia.
| | - Leah Hickey
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Karli Treyvaud
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia; Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Delany
- Department of Medical Education, University of Melbourne, Melbourne, Australia; Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia
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Jeba J A, Kumar S S, Sosale S. Effect of Tactile-Kinesthetic Stimulation on Weight in Preterm Neonates in Neonatal Intensive Care Unit. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-2039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Bembich S, Trappan A, Galimberti A, Taglieri J, Scolz S, Risso FM, Sanson G. The role of weighing-bathing sequence and postmenstrual age in eliciting adaptive/maladaptive responses in very low birth weight preterm infants. J SPEC PEDIATR NURS 2020; 25:e12292. [PMID: 32291889 DOI: 10.1111/jspn.12292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/19/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE In the neonatal intensive care unit, preterm infants are exposed to several stressful stimuli. Inappropriate stimulation led to high risk for short- and long-term neurocognitive disabilities. This study aimed to evaluate whether the sequence of execution of weighing/bathing nursing procedures and postmenstrual age (PMA) have any effect on preterm infants' stress responses. DESIGN AND METHODS Prospective cross-sectional study on a sample of 21 preterm infants. Responses to the procedures were assessed using an observational sheet based on Als's Synactive Theory of Development. Autonomic and motor responses were scored according to five-point Likert scales. The order of execution of weighing/bathing nursing procedures and PMA were documented. Effects of weighing/bathing execution sequence and PMA on autonomic and motor response scores were analyzed by linear multiple regression analysis. RESULTS The sequence of execution had a significant effect on the autonomic score during weighing (p = .035), evidencing more stress when weighing was executed first. A higher level of stress response on the autonomic score during both weighing (p = .015) and bathing (p = .018) procedure was independently associated with a lower infant PMA. CONCLUSIONS AND PRACTICE IMPLICATIONS The real-time recognition of adaptive/maladaptive responses allows nurses to personalize their approach to preterm infants, taking into account PMA and adjusting the appropriate sequence of execution of weighing/bathing nursing procedures.
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Affiliation(s)
- Stefano Bembich
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Antonella Trappan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Alice Galimberti
- Department of Medicine, Surgery, and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Jessica Taglieri
- Department of Medicine, Surgery, and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
| | - Sabrina Scolz
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCSS "Burlo Garofolo", Trieste, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery, and Health Sciences, School of Nursing, University of Trieste, Trieste, Italy
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Lau C. To Individualize the Management Care of High-Risk Infants With Oral Feeding Challenges: What Do We Know? What Can We Do? Front Pediatr 2020; 8:296. [PMID: 32582596 PMCID: PMC7297031 DOI: 10.3389/fped.2020.00296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
The increase in preterm infants' survival over the last 30 years has shed light over their inability to feed by mouth safely and efficiently. With adverse events such as increased risks for oxygen desaturation, bradycardia, penetration/aspiration, infants' hospitalization in neonatal intensive care units (NICUs) are understandably prolonged. Unfortunately, this leads to delayed mother-infant reunion, maternal stress, breastfeeding obstacles, and increased medical costs. Such impediments have stimulated clinicians and researchers to better understand the underlying causes and develop evidence-based solutions to assist these infants. However, it is notable that the research-to-practice translation of this knowledge has been limited as there are still no validated guidelines or protocols as how to best diagnose and care for these infants. This report revisits the immature physiologic functions at the root of these infants' oral feeding difficulties, the current practices, and the recent availability of evidence-based efficacious tools and interventions. Taking advantage of the latter, it presents a renewed perspective of how management strategies can be tailored to the specific needs of individual patients.
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Affiliation(s)
- Chantal Lau
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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Pires CDS, Marba STM, Caldas JPDS, Stopiglia MDCS. PREDICTIVE VALUE OF THE GENERAL MOVEMENTS ASSESSMENT IN PRETERM INFANTS: A META-ANALYSIS. ACTA ACUST UNITED AC 2020; 38:e2018286. [PMID: 32401947 PMCID: PMC7212559 DOI: 10.1590/1984-0462/2020/38/2018286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/13/2019] [Indexed: 11/24/2022]
Abstract
Objective: To discuss the predictive value of the General Movements Assessment for the
diagnosis of neurodevelopment disorders in preterm newborns. Data source: We conducted a systematic literature review using the following databases:
Scientific Electronic Library Online (SciELO), National Library of Medicine,
National Institutes of Health (PubMed), and Excerpta Medica Database
(EMBASE). The articles were filtered by language, year of publication,
population of interest, use of Prechtl’s Method on the Qualitative
Assessment of General Movements, and presence of variables related to the
predictive value. The Quality Assessment of Diagnostic Accuracy Studies 2
was used to assess the methodology of the included studies. Sensitivity,
specificity, Diagnostic Odds Ratio, positive and negative likelihood ratio,
and parameter of accuracy were calculated. Data synthesis: Six of 342 articles were included. The evaluation of Writhing Movements is a
good indicator for recognizing cerebral palsy, as it has high values for the
sensitivity and accuracy parameters. The evaluation of Fidgety Movements has
the strongest predictive validity for cerebral palsy, as it has high values
in all measures of diagnostic accuracy. The quality assessment shows high
risk of bias for patient selection and flow and timing of the evaluation.
Therefore, the scale has potential to detect individuals with
neurodevelopment disorders. However, the studies presented limitations
regarding the selection of subjects and the assessment of neurological
outcomes. Conclusions: Despite the high predictive values of the tool to identify neurological
disorders, research on the subject is required due to the heterogeneity of
the current studies.
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KAYNAK S. YENİDOĞAN YOĞUNBAKIM ÜNİTESİNDE GELİŞİMSEL BAKIM. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.700450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Neri E, Genova F, Monti F, Trombini E, Biasini A, Stella M, Agostini F. Developmental Dimensions in Preterm Infants During the 1st Year of Life: The Influence of Severity of Prematurity and Maternal Generalized Anxiety. Front Psychol 2020; 11:455. [PMID: 32292365 PMCID: PMC7119226 DOI: 10.3389/fpsyg.2020.00455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/26/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The literature has recognized premature birth as a risk factor for infant development and maternal anxiety. This study investigated the impact of the severity of birth weight, as well as of maternal anxiety at 3 months of infants' corrected age, on infants' outcomes during the 1st year postpartum. Moreover, it described the longitudinal trajectories of developmental outcomes, additionally exploring the impact of anxiety. METHODS The study compared 147 mothers and their 147 newborns, differentiated in 25 Extremely Low Birth Weight (ELBW), 41 Very Low Birth Weight (VLBW), and 81 Full-Term (FT) infants. At 3, 9, and 12 months (corrected age in the case of preterm infants) the level of infants' development was investigated according to the 5 quotients (Locomotor, Personal and Social, Hearing and Language, Eye-hand Co-ordination and Performance) of the Griffiths Mental Development Scales (GMDS-R). During the assessment of 3 months, mothers fulfilled Penn State Worry Questionnaire (PSWQ) to evaluate the presence of generalized anxiety. RESULTS Among the 5 GMDS-R quotients, significant effect of severity of birth weight emerged only for Performance quotient: preterm infants (ELBW at 3 months; VLBW at 12 months) showed lower scores than FT ones. Moreover, this quotient decreased from 3 to 9 and to 12 months for VLBW and FT infants, while it was stable for ELBW ones. A significant interaction between severity of birth weight and maternal anxiety emerged for Hearing and Language and Locomotor quotients. In the first case, scores for ELBW infants, independently from maternal anxiety, decreased from 9 to 12 months. The same results emerged for VLBW infants, in the case of non-anxious mothers. Regarding Locomotor quotient, mean scores decreased from 3 to 9 and to 12 months for all groups in the case of non-anxious mothers. Conversely, when mothers were anxious, this decrease emerged only for VLBW infants. Lastly, ELBW, VLBW and FT showed difference in the growth and slope of the trajectories of different quotients. CONCLUSION The severity of birth weight for preterm infants, also in interaction with maternal anxiety, had significant and specific impact on different dimensions of infants' development. Clinical implications of these results underline the need for individualized interventions.
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Affiliation(s)
- Erica Neri
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Federica Genova
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Fiorella Monti
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Elena Trombini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Augusto Biasini
- Donor Human Milk Bank Italian Association (AIBLUD), Milan, Italy
| | - Marcello Stella
- Paediatric and Neonatal Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy
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31
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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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Sleep Promotion for Preterm Infants in the NICU. Nurs Womens Health 2020; 24:24-35. [PMID: 32083554 DOI: 10.1016/j.nwh.2019.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/09/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022]
Abstract
Sleep is a crucial human physiologic need. Preterm infants in the NICU are exposed to noxious stimuli that often disrupt and shorten their sleep periods. Sleep disruption may have a negative effect on clinical outcomes, growth, and development and may also delay hospital discharge. Increasing evidence suggests that sleep quality is critical for brain development and synaptic plasticity and is associated with long-term neurodevelopmental outcomes. The purpose of this article is to discuss the importance of sleep in preterm infants, describe tools commonly used to assess infant sleep and identify different sleep-wake states, and identify interventions that promote sleep in preterm infants in the NICU. Nurses play a vital role in implementing appropriate interventions that promote preterm infants' sleep.
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Küçük Alemdar D, İnal S. The Effect of Individualized Developmental Care Practices in Preterm Infants. Complement Med Res 2019; 27:97-104. [DOI: 10.1159/000504357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/25/2019] [Indexed: 11/19/2022]
Abstract
Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.
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Pineda R, Roussin J, Heiny E, Smith J. Health Care Professionals' Perceptions about Sensory-Based Interventions in the NICU. Am J Perinatol 2019; 36:1229-1236. [PMID: 30577058 PMCID: PMC6635089 DOI: 10.1055/s-0038-1676536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The main objective of this article is to define perceptions of health care professionals regarding current use of sensory-based interventions in the neonatal intensive care unit (NICU). STUDY DESIGN A multidisciplinary group of NICU health care professionals (n = 108) defined the types of sensory-based interventions used in their NICU, the postmenstrual age (PMA) sensory-based interventions are administered, conditions under which sensory-based interventions are used, and personnel who administer sensory-based interventions. RESULTS The most commonly reported tactile intervention was infant holding (88% of respondents), the most common auditory intervention was recorded music/singing (69% of respondents), the most common kinesthetic intervention was occupational and physical therapy (85% of respondents), and the most common vestibular intervention was infant swings (86% of respondents). Tactile interventions were initiated most often at 24 to 26 weeks PMA (74% of respondents), auditory interventions at 30 to 32 weeks (60% of respondents), kinesthetic interventions at 30 to 32 weeks (76% of respondents), vestibular interventions at 33 to 34 weeks (86% of respondents), and visual interventions at 32 to 36 weeks (72% of respondents). Conditions under which sensory-based interventions were administered, and personnel who provided them, varied across settings. CONCLUSION Varied use of sensory-based interventions in the NICU were reported. While this study was limited by biased sampling and the identification of health care professionals' perceptions but not real-world practice, this information can be used to build a comprehensive approach to positive sensory exposures in the NICU.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri,Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica Roussin
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Elizabeth Heiny
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Joan Smith
- Department of Quality, Safety and Practice Excellence, Saint Louis Children’s Hospital, St. Louis, Missouri
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Maeda T, Sekiguchi K, Wasada R, Ihara K. Caffeine not associated with irritable behaviour in very low-birth-weight infants. Early Hum Dev 2019; 137:104835. [PMID: 31473373 DOI: 10.1016/j.earlhumdev.2019.104835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
This paper is an examination of irritable behaviour in very low-birth-weight infants in relation to caffeine or aminophylline. We assessed tremulous movement (a sub-score of General Movements Optimality Score) in 18 caffeine-treated subjects and 18 aminophylline-treated subjects. Caffeine, unlike aminophylline, was not associated with irritable behaviour at standard dose.
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Affiliation(s)
- Tomoki Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan.
| | - Kazuhito Sekiguchi
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Rieko Wasada
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
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Rubio-Grillo MH. Performance of an occupational therapist in a neonatal intensive care unit. Colomb Med (Cali) 2019; 50:30-39. [PMID: 31168167 PMCID: PMC6536043 DOI: 10.25100/cm.v50i1.2600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/03/2017] [Accepted: 01/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The following article constitutes an effort to make explicit an experience in neonatology within the framework of the exercise of occupational therapy, a discipline belonging to the health sciences. The occupational therapist (OT) in the Neonatal Intensive Care Unit in which he participates in an interdisciplinary health group. Exalts the interaction of person-environment-occupation-performance. Encourage self-regulation of the baby. Encourages family participation in co-participation in routine activities. OBJECTIVE To determine the realities and knowledge about the practice of OT in the Neonatal Intensive Care Unit (NICU) by the occupational therapist in the interaction between the baby, the occupation, the caregivers and the environment of the NICU. METHODS A systematic exploratory review of the performance of the OT in the NICU was made. RESULTS The results transcended the thematic variables, the theories, the methods, the approaches, the characteristics of the baby, the occupations, and the contexts of the management of the premature baby. CONCLUSION The education in concepts concerning the occupation of the baby, the interaction with her/his environment and her/his caregivers, the procedures, the guide for the stimulation as the modification of the physical, temporal and social environment facilitate the self-regulation of the baby and we will all be working in pro of your recovery.
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Affiliation(s)
- María Helena Rubio-Grillo
- Universidad del Valle, Facultad de Salud, Escuela de Rehabilitación Humana, Grupo SINERGIA, Cali, Colombia
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Schneider J, Borghini A, Morisod Harari M, Faure N, Tenthorey C, Le Berre A, Tolsa JF, Horsch A. Joint observation in NICU (JOIN): study protocol of a clinical randomised controlled trial examining an early intervention during preterm care. BMJ Open 2019; 9:e026484. [PMID: 30928952 PMCID: PMC6475149 DOI: 10.1136/bmjopen-2018-026484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Preterm birth may generate significant distress among the parents, who often present with difficulties in appropriating their parental role. Parental stress and low perceived parental self-efficacy may interfere with the infant's socioemotional and cognitive development, particularly through disrupted parent-infant interactions. Perceived parental self-efficacy represents the belief of efficacy in caring for one's own infant and successful incarnation of the parental role, as well as the perception of one's own abilities to complete a specified task. Interventions to support parental role, as well as infant development, are needed, and parental self-efficacy represents a useful indicator to measure the effects of such early interventions. METHODS AND ANALYSIS This study protocol describes a randomised controlled trial that will test an early intervention in the neonatal intensive care unit (NICU) (JOIN: Joint Observation In Neonatology) carried out by an interdisciplinary staff team. Mothers of preterm neonates born between 28 and 32 6/7 weeks of gestational age are eligible for the study. The intervention consists of a videotaped observation by a clinical child psychologist or child psychiatrist and a study nurse of a period of care delivered to the neonate by the mother and a NICU nurse. The care procedure is followed by an interactive video guidance intended to demonstrate the neonate's abilities and resources to his parents. The primary outcome will be the difference in the perceived maternal self-efficacy between the intervention and control groups assessed by self-report questionnaires. Secondary outcomes will be maternal mental health, the perception of the parent- infant relationship, maternal responsiveness and the neurodevelopment of the infant at 6 months corrected age. ETHICS AND DISSEMINATION Ethical approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 496/12). Results from this study will be disseminated at national and international conferences, and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02736136, Pre-results.
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Affiliation(s)
- Juliane Schneider
- Woman-Mother-Child, Clinic of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ayala Borghini
- Child and Adolescent Psychiatry, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Psychomotricity Institute, University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Mathilde Morisod Harari
- Child and Adolescent Psychiatry, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Noemie Faure
- Woman-Mother-Child, Clinic of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Chloé Tenthorey
- Woman-Mother-Child, Clinic of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Aurélie Le Berre
- Woman-Mother-Child, Clinic of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean-François Tolsa
- Woman-Mother-Child, Clinic of Neonatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
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Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran. J Pediatr Nurs 2019; 45:e79-e88. [PMID: 30630639 DOI: 10.1016/j.pedn.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 12/29/2018] [Accepted: 12/29/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides comprehensive newborn focused family-centered care in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to investigate nurses' and physicians' experiences of implementing the NIDCAP model to optimize its implementation for both caregivers, infants, and families in the NICU. DESIGN & METHODS A purposes sample of 11 nurses and four physicians participated in this qualitative study. Data were collected by face-to-face and semi-structured interviews and analysis were guided by principles of thematic analysis as per Graneheim and Lundman (2004). RESULTS Six themes and 20 sub-themes were constructed during data analysis. These included; NIDCAP as a milestone, Helping to rebuild the core of the family, Caregiver excellence, Realism towards the feasibility of NIDCAP, Proper managerial position of NIDCAP specialists in the health system, and Caring for the caregiver. CONCLUSIONS The findings of this study highlight how NIDCAP provides a comprehensive and effective care model for premature infants, with the goal to promote neonatal growth and development while also facilitating the self-efficacy of caregivers. Implementation of the NIDCAP model requires attention to be paid to social context, infrastructure, adjustment of the program according to the facilities and resources of each country, and the needs of caregivers. PRACTICE IMPLICATIONS Health care resources are required to sustain NIDCAP specialists and a favorable environment as the necessary conditions for its multidimensional application across NICU units around the world.
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AlZubaidi AK, Ethawi Y, Schmölzer GM, Sherif S, Narvey M, Seshia M. Review of Biomedical Applications of Contactless Imaging of Neonates Using Infrared Thermography and Beyond. Methods Protoc 2018; 1:mps1040039. [PMID: 31164579 PMCID: PMC6481091 DOI: 10.3390/mps1040039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 11/16/2022] Open
Abstract
The sick preterm infant monitoring is an intriguing job that medical staff in Neonatal Intensive Care Units (NICU) must deal with on a daily basis. As a standards monitoring procedure, preterm infants are monitored via sensors and electrodes that are firmly attached to their fragile and delicate skin and connected to processing monitors. However, an alternative exists in contactless imaging to record such physiological signals (we call it as Physio-Markers), detecting superficial changes and internal structures activities which can be used independently of, or aligned with, conventional monitors. Countless advantages can be gained from unobtrusive monitoring not limited to: (1) quick data generation; (2) decreasing physical and direct contact with skin, which reduces skin breakdown and minimizes risk of infection; and (3) reduction of electrodes and probes connected to clinical monitors and attached to the skin, which allows greater body surface-area for better care. This review is an attempt to build a solid ground for and to provide a clear perspective of the potential clinical applications of technologies inside NICUs that use contactless imaging modalities such as Visible Light Imaging (VLI), Near Infrared Spectroscopy (NIRS), and Infrared Thermography (IRT).
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Affiliation(s)
- Abbas K AlZubaidi
- Biomedical Engineering Division, University of Saskatchewan, Campus Dr 9, Saskatoon, SK S7N 5A5, Canada.
| | - Yahya Ethawi
- Section of Neonatology, Winnipeg Regional Health Authority, Winnipeg, MB R3B 1E2, Canada.
| | - Georg M Schmölzer
- Section of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Sherif Sherif
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada.
| | - Michael Narvey
- Section of Neonatology, Winnipeg Regional Health Authority, Winnipeg, MB R3B 1E2, Canada.
| | - Molly Seshia
- Section of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB R3A 1S1, Canada.
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Sanchez V, Maladen-Percy M, Gustin J, Tally A, Gibb R, Ogle J, Kenneally DC, Carr AN. Improving Diaper Performance for Extremely Low-Birth-Weight Infants. Clin Pediatr (Phila) 2018; 57:4S-12S. [PMID: 29890862 DOI: 10.1177/0009922818780116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extremely low-birth-weight (ELBW) infants face significant diapering challenges compared with their full-term peers, due to immature musculature, nervous system, and skin development. Advances in medical care have increased an ELBW infant's rate of survival, which creates a growing need for diapers to better serve these infants. Aim of research. The objective of this study was to identify and confirm the requirements for optimal diaper performance from the neonatal intensive care unit nurses' perspective, as well as to assess in-hospital performance to determine if new features improved key developmental care parameters. METHOD Two surveys were shared among nurses to address study objectives. Study 1 (N = 151) was designed for neonatal intensive care unit nurses to identify key requirements for ELBW diapers and rate the performance of existing ELBW diapers. Study 2 (N = 99) assessed in-hospital performance of the test diaper compared with the usual diaper, under normal usage conditions. Findings/results. The majority of nurses agreed that ELBW diapers must fit appropriately between the legs so that hips and legs are not spread apart and that ELBW diapers need to be flexible between the legs for positioning. Of the nurses-infant pair responses, 93% ( P < .0001) preferred the test ELBW diaper over their usual diaper. CONCLUSION Findings suggest that nurses should be included in the product design process to ensure both their needs and the needs of an infant are being met. Nurses are considering how diaper features may affect both acute and long-term medical outcomes and this information provides necessary guidance to diaper manufacturers and designers when developing better-performing diapers.
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Affiliation(s)
| | | | | | - Amy Tally
- 1 Procter & Gamble, Cincinnati, OH, USA
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Silva LV, Araújo LBD, Azevedo VMGDO. Assessment of the neuropsychomotor development in the first year of life of premature infants with and without bronchopulmonary dysplasia. Rev Bras Ter Intensiva 2018; 30:174-180. [PMID: 29995082 PMCID: PMC6031416 DOI: 10.5935/0103-507x.20180023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/25/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the neuropsychomotor development in the first year of life of
premature infants with and without bronchopulmonary dysplasia. Methods A cross-sectional retrospective study was conducted between January 1, 2014,
and December 30, 2015, with premature infants weighing < 1,500g at birth
and diagnosed with bronchopulmonary dysplasia at the corrected ages of 6 and
9 months, assessed using the DENVER II Developmental Screening Test.
Quantitative variables were described as the means, medians and standard
deviations. Variables with normal distribution were tested using Student's
t test; otherwise, the Mann-Whitney test was used,
considering significance at p-value < 0.05. Qualitative variables were
expressed as frequencies and percentages. Logistic regression was used with
odds ratio analysis to evaluate the effects of other variables as risk
factors for changes in neuropsychomotor development. Results Infants with bronchopulmonary dysplasia showed greater developmental delay
compared with those without bronchopulmonary dysplasia (p-value = 0.001).
The factors associated with a higher incidence of changes in
neuropsychomotor development, in addition to bronchopulmonary dysplasia,
were antenatal steroid, gender, birth weight, 5-minute Apgar score, Score
for Neonatal Acute Physiology-Perinatal Extension, duration of oxygen
therapy, duration of mechanical ventilation and length of hospital stay.
Other variables may also have influenced the result, such as drug use by
mothers of infants with bronchopulmonary dysplasia. Conclusion Bronchopulmonary dysplasia associated with other pre- and postnatal factors
may be considered a risk factor for delayed neuropsychomotor development in
the first year of life in premature infants born weighing less than
1,500g.
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Affiliation(s)
- Letycia Vieira Silva
- Residência Multiprofissional e em Área Profissional da Saúde, Hospital de Clínicas, Faculdade de Medicina, Universidade Federal de Uberlândia - Uberlândia (MG), Brasil
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Valdés-de la Torre G, Martina Luna M, Braverman Bronstein A, Iglesias Leboreiro J, Bernárdez Zapata I. Medición comparativa de la intensidad de ruido dentro y fuera de incubadoras cerradas. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2018. [DOI: 10.1016/j.rprh.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nguyen LT, Cooperberg DB, Spear ML. Introduction of triggers for palliative care consultation improves utilization and satisfaction within a level four NICU. J Perinatol 2018; 38:574-579. [PMID: 29740184 DOI: 10.1038/s41372-018-0067-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/19/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We sought to explore the beliefs regarding palliative care team utilization, as well as increase consultation and awareness of the palliative care team's role in the NICU. STUDY DESIGN The study design in this Level 4 NICU included observational time series with multiple planned sequential interventions. Medical chart review was conducted to determine eligibility, and statistical process control charts were used to show performance over time. RESULTS Prior to implementation of the triggers, 26% received consultation, which increased to 46% after implementation. There was an increase in level of understanding, knowledge of team's role, and improved utilization. The time until initial consultation decreased from ~1.5 months to 1 week. CONCLUSIONS We observed a 20% increase in consultations. Key interventions included continual education, reminders, and clear postage of the trigger list. Written guidelines increase awareness of a palliative care team's role within a NICU, and provider satisfaction.
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Affiliation(s)
- Linda T Nguyen
- Pediatrics, Drexel University of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
| | - David B Cooperberg
- Pediatrics, Drexel University of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Michael L Spear
- Pediatrics, Drexel University of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
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Bosch-Alcaraz A, Falcó-Pegueroles A, Jordan I. A literature review of comfort in the paediatric critical care patient. J Clin Nurs 2018. [PMID: 29516623 DOI: 10.1111/jocn.14345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To investigate the meaning of comfort and to contextualise it within the framework of paediatric critical care. BACKGROUND The concept of comfort is closely linked to care in all health contexts. However, in specific settings such as the paediatric critical care unit, it takes on particular importance. DESIGN A literature review was conducted. METHODS A literature search was performed of articles in English and Spanish in international health science databases, from 1992-March 2017, applying the quality standards established by the PRISMA methodology and the Joanna Briggs Institute. RESULTS A total of 1,203 publications were identified in the databases. Finally, 59 articles which met the inclusion criteria were entered in this literature review. Almost all were descriptive studies written in English and published in Europe. The concept of comfort was defined as the immediate condition of being strengthened through having the three types of needs (relief, ease and transcendence) addressed in the four contexts of experience (physical, psychospiritual, social and environmental). Only two valid and reliable tools for assessing comfort were found: the Comfort Scale and the Comfort Behavior Scale. CONCLUSIONS Comfort is subjective and difficult to assess. It has four facets: physical, emotional, social and environmental. High levels of noise and light are the inputs that cause the most discomfort. Comfort is a holistic, universal concept and an important component of quality nursing care.
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Affiliation(s)
- Alejandro Bosch-Alcaraz
- Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.,Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Hospital Sant Joan de Déu, Barcelona, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
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Alemdar DK. Effect of recorded maternal voice, breast milk odor, and incubator cover on pain and comfort during peripheral cannulation in preterm infants. Appl Nurs Res 2018; 40:1-6. [DOI: 10.1016/j.apnr.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/17/2017] [Accepted: 12/14/2017] [Indexed: 11/28/2022]
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Schiller R, IJsselstijn H, Hoskote A, White T, Verhulst F, van Heijst A, Tibboel D. Memory deficits following neonatal critical illness: a common neurodevelopmental pathway. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:281-289. [PMID: 30169299 DOI: 10.1016/s2352-4642(17)30180-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 01/03/2023]
Abstract
Over the past decade, evidence has emerged that children growing up after neonatal critical illness, irrespective of underlying diagnosis, are at risk of memory impairment and academic problems. These difficulties are manifest even when intelligence is within the normal range. In this Review, we propose a common neurodevelopmental pathway following neonatal critical illness by showing that survivors of preterm birth, congenital heart disease, and severe respiratory failure share an increased risk of long-term memory deficits and associated hippocampal alterations. Rather than a consequence of underlying diagnosis, we suggest that this shared vulnerability is probably related to common conditions associated with neonatal critical illness, including hypoxia, neuroinflammation, stress, exposure to anaesthetics, or a complex interplay of these factors at different postconceptional ages. Future work should be aimed at improvement of early identification of patients at risk and evaluation of intervention modalities, such as exercise or cognitive training.
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Affiliation(s)
- Raisa Schiller
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Hanneke IJsselstijn
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Aparna Hoskote
- Cardiac Intensive Care, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Frank Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Clinical Medicine at the Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
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Alemdar DK, Özdemir FK. Effects of Covering the Eyes versus Playing Intrauterine Sounds on Premature Infants' Pain and Physiological Parameters during Venipuncture. J Pediatr Nurs 2017; 37:e30-e36. [PMID: 28751136 DOI: 10.1016/j.pedn.2017.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a need to assess the impact of initiatives to reduce exposure to environmental light and sound in preterm infants undergoing painful interventions in neonatal intensive care units. OBJECTIVES In this study, we aimed to identify the effect of covering the eyes and playing the intrauterine ambient sounds on premature infants' pain and physiological parameters during venipuncture. METHODS This was a randomized controlled trial. Ninety-four preterm infants were randomly divided into three groups: intrauterine sounds (n=32), covered eyes (n=32), and control (n=30) groups. Data were collected on the Preterm Infant Information Form, Preterm Infant Follow-up Form, and Neonatal Infant Pain Scale (NIPS), used to assess pain. RESULTS A significant difference was found between the intervention and control groups' NIPS score after venipuncture, which was primarily due to covered eyes' group. No significant difference was found between the intervention and control groups' NIPS score during venipuncture. In addition, no significant difference was found between the intervention and control groups of infants physiological parameters before, during, and after venipuncture. The practice of covering preterm infants' eyes during venipuncture positively affected their pain scores after venipuncture. CLINICAL IMPLICATIONS The effect of covering the eyes and playing the intrauterine ambient sounds in preterm infants may be recommended as simple, safe, and supportive stimuli that facilitate positive effects during painful procedures.
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Affiliation(s)
- Dilek Küçük Alemdar
- Giresun University, Faculty of Health Sciences, Midwifery Department, Piraziz, Giresun, Turkey.
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Dilworth-Bart JE, Poehlmann-Tynan JA, Taub A, Liesen CA, Bolt D. Longitudinal associations between self-regulation and the academic and behavioral adjustment of young children born preterm. EARLY CHILDHOOD RESEARCH QUARTERLY 2017; 42:193-204. [PMID: 29403148 PMCID: PMC5796547 DOI: 10.1016/j.ecresq.2017.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Much of the research to date about the structure of self-regulation in early childhood has been conducted with low medical risk samples, with the general conclusion that self-regulation can be separated into overlapping executive function and effortful control factors that differentially predict child outcomes. We examined the factor structure of 36-month self-regulation among children born prematurely (n = 168) and the extent to which self-regulation predicted maternal ratings of children's socioemotional and academic competence when they were six years of age. Statistical analyses revealed a single self-regulation factor for this high neonatal risk sample, and this self-regulation factor mediated associations between early sociodemographic risk and mothers' ratings of academic competence and externalizing problems. Our findings suggest that early intervention research with children born preterm should focus on promoting supportive early environments, particularly parental sensitivity to infant cues.
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Affiliation(s)
- Janean E Dilworth-Bart
- Department of Human Development and Family Studies, University of Wisconsin-Madison when this research was completed
| | - Julie A Poehlmann-Tynan
- Department of Human Development and Family Studies, University of Wisconsin-Madison when this research was completed
| | - Amy Taub
- Department of Human Development and Family Studies, University of Wisconsin-Madison when this research was completed
| | - Carolyn A Liesen
- Department of Human Development and Family Studies, University of Wisconsin-Madison when this research was completed
| | - Daniel Bolt
- Department of Human Development and Family Studies, University of Wisconsin-Madison when this research was completed
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Llaguno NS, Pedreira MDLG, Avelar AFM, Avena MJ, Tsunemi MH, Pinheiro EM. Polysomnography assessment of sleep and wakefulness in premature newborns. Rev Bras Enferm 2017; 68:1109-15. [PMID: 26676434 DOI: 10.1590/0034-7167.2015680616i] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/14/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. METHOD a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. RESULTS the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). CONCLUSION the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.
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Affiliation(s)
- Nathalie Sales Llaguno
- Curso de Enfermagem, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | - Ariane Ferreira Machado Avelar
- Departamento de Enfermagem Pediátrica, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Marta Jose Avena
- Departamento de Enfermagem Pediátrica, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Miriam Harumi Tsunemi
- Departamento de Bioestatística, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Eliana Moreira Pinheiro
- Departamento de Enfermagem Pediátrica, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Joosten K, de Goederen R, Pijpers A, Allegaert K. Sleep related breathing disorders and indications for polysomnography in preterm infants. Early Hum Dev 2017; 113:114-119. [PMID: 28711234 DOI: 10.1016/j.earlhumdev.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a range of breathing problems which occur and may persist in preterm infants, such as central apneas, obstructive apneas and periodic breathing. Preterm infants may also suffer from respiratory distress syndrome and chronic lung disease necessitating prolonged use of oxygen therapy after discharge from the hospital. Due to these persistent breathing pattern abnormalities in preterm infants, there is a higher risk of altered sleep and apparent life threatening events. Polysomnography can be a helpful tool to identify those infants who have abnormalities in their breathing pattern, to identify those infants who have an increased risk to get a sleep related breathing event at home and to decide about the discontinuation of oxygen therapy.
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Affiliation(s)
- Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Pediatric Intensive Care, Rotterdam, The Netherlands.
| | - Robbin de Goederen
- Dutch Craniofacial Center, Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angelique Pijpers
- Kempenhaeghe Academic Center for Epileptology, Sleep Medicine and Neurocognition, Heeze, The Netherlands
| | - Karel Allegaert
- Department of Pediatric Surgery, Erasmus University Medical Center - Sophia, Rotterdam, The Netherlands; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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