The transition home of extremely premature babies: An integrative review

Changes in parents' health concerns by post-preterm birth period in South Korea: a cross-sectional study

PURPOSE

This study aimed to examine the health concerns of parents regarding their premature infants and to identify changes in these concerns during perinatal period and after discharge.

METHODS

This was a retrospective study performed at a single tertiary center that enrolled 119 premature infants who were discharged from the neonatal intensive care unit (NICU) and visited the outpatient pediatrics department between December 2018 and October 2021. Data on the concerns of 176 parents regarding enrolled premature infants' health from before birth to 1 week after NICU discharge were obtained from outpatient records. The t test and with the chi-squared test were used to analyze the data for this study.

RESULTS

The consistently greatest focus of parents' health concerns was the respiratory system. The second focus of parents' health concerns before discharge was the central nervous system. However, during the first week after NICU discharge, the gastrointestinal system was the second-most frequent focus of parents' health concerns among parents of infants without diseases related to prematurity and infants with older gestational ages.

CONCLUSION

The results of this study offer insights into the health concerns among parents of premature infants. Parental health concerns about premature infants vary over time, from before birth to post-discharge, necessitating supportive interventions to enhance parental understanding of their child's health status.

Perspectives on Telehealth Use with the Neonatal Population: Policy, Practice, and Implementation Considerations

Telehealth has proven to be a valuable approach to providing care to the neonatal population, including supporting families during the transition to home, facilitating remote monitoring of fragile neonates, and connecting neonatal experts with infants and caregivers in underserved or remote communities. Clinicians engaging in telehealth need to be aware of policies and regulations that govern practice as well as the potential health equity issues that may present themselves.

Parent Experiences in the NICU and Transition to Home

Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6-8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.

“Breastfeeding at Night Is Awesome” Mothers’ Intentions of Continuation of Breastfeeding Extreme and Very Preterm Babies upon Discharge from a Kangaroo Mother Care Unit of a Tertiary Hospital in South Africa

Kangaroo mother care (KMC) is effective in increasing mothers’ initiation and maintenance of breastfeeding (BF) for extreme and very preterm (VLBW) infants. Although South Africa has implemented KMC for more than two decades, little is known about mothers’ perspectives on KMC. The purpose of this study was to describe the BF intentions and practices of mothers of VLBW infants at home following discharge and assess the role long stay in KMC has on their decision to BF beyond discharge. This qualitative study was conducted at the KMC unit of a tertiary hospital in Pretoria, South Africa. Focus group interviews were conducted with 38 mothers of VLBW infants who had transitioned from neonatal intensive care (NICU) to KMC. We analysed transcripts following the five steps for qualitative thematic data analysis. Mothers were knowledgeable of the importance and value of BF preterm infants and conceded that breast milk has advantages over formula. Mothers had positive feelings toward BF their preterm infants. The stay in KMC increased the direct BF of their preterm infants, mothers’ BF efficacy, and had a positive influence on mothers’ intentions to continue BF following discharge and to exclusively breastfeed for six months. Their BF intentions, efficacy, and practices were influenced by the skilful BF counselling, training, and support they received from the nursing staff. High intention to BF among these mothers is suggestive of their knowledge and confidence in BF for their VLBW infants. It is important that nursing staff in NICU and KMC appreciate the significant role they play in mothers’ readiness and confidence to breastfeed beyond discharge.

Parental Participation in Preterm Infant Feeding in the Neonatal Intensive Care Unit

PURPOSE

To identify factors associated with parental participation in the feeding care of hospitalized preterm infants and determine associations between parental participation in feeding and infant neurobehavioral outcomes.

STUDY DESIGN AND METHODS

Secondary analysis of data collected during a larger study of preterm infants. Parental participation in gavage and oral feeding was measured as a proportion of all feeding opportunities. Neurobehavioral outcomes were measured using a neurobehavioral assessment and feeding milestones. Other data were collected from the electronic health record.

RESULTS

Parental participation in feeding was low. There were associations between parental participation in gavage feeding and infant sex, insurance type, maternal race, infant gestational age at birth, and birthweight. There were associations between parental participation in oral feeding and infant sex, insurance type, maternal race, and study group. Greater parental participation in feeding was associated with earlier achievement of some feeding milestones.

CLINICAL IMPLICATIONS

Parental participation in feeding can decrease the time required for infants to achieve feeding milestones, possibly leading to decreased length of hospitalization. Nurses should encourage parents to participate in caregiving for their preterm infants. Interventions are needed to remove barriers to parental participation in caregiving.

A biopsychosocial model of NICU family adjustment and child development

BACKGROUND

Although infants in Neonatal Intensive Care Units (NICU) are at risk for developmental impairments and parents are at risk for emotional distress, factors that explain outcomes remain unknown. Here, we developed the first biopsychosocial model to explain family adjustment after NICU discharge.

METHODS

Participants included 101 families at The Children's Hospital of Philadelphia Neonatal Follow-Up Program who had been discharged 1.5-2.5 years prior. We gathered data using validated assessments, standardized assessments, and electronic medical records.

RESULTS

Our structural equation model, informed by the Double ABC-X Model, captured the dynamic relationships among infant, parent, couple, and family factors. Infant medical severity, posttraumatic stress, couple functioning, and family resources (e.g., time, money) were key for family adjustment and child development.

CONCLUSIONS

Interventions that target parental posttraumatic stress, couple dynamics, parental perception of time for themselves, and access to financial support could be key for improving NICU family outcomes.

A telehealth nursing intervention to improve the transition from the neonatal intensive care unit to home for infants & caregivers: Preliminary evaluation

PURPOSE

The purpose of this nurse-led telehealth intervention was to support caregivers and infants during the difficult period of transition from the neonatal intensive care unit (NICU) to home.

METHODS

The Baby Steps project was designed using quality improvement methodology, and was implemented in April 2020 at a stand-alone pediatric institution in South Florida. Using a nurse-led telehealth model, follow-up nursing care was provided in the home setting for two weeks after discharge. Any infant cared for in the NICU and discharged to a home setting in the state of Florida was eligible for services. Encounters included assessment, anticipatory guidance, connection with community resources, and general support. Caregiver satisfaction, unplanned emergency care use, and 30-day readmissions were assessed.

RESULTS

Within the first 18 months of the program, a total of 378 infants were enrolled, and 74.6% received follow-up services in the home setting (n = 282). Caregivers reported high satisfaction with the program (100% strongly agree or agree). There was a 46% decrease in 30-day readmissions from baseline rates, and a substantial decrease in use of emergency care services within a month of discharge as compared to infants discharged during the same time period who did not receive services (30.9% vs.13.8%).

DISCUSSION

This nurse-led intervention was found to be a feasible and highly satisfactory approach to improve NICU patient outcomes and support caregivers during transition from hospital to home.

PRACTICE IMPLICATIONS

Nurses can provide post-discharge telehealth support, which not only improves caregiver satisfaction but also decreases readmissions and emergency care use among NICU patients.

Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit

AIM

We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU).

METHODS

This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother-infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files.

RESULTS

The infants were born at a mean age of 29.8 ±3.1 weeks. Greater family-centred care during early hospitalisation (p=0.01) and greater breastfeeding self-efficacy in the period before discharge (p=0.04) were significantly associated with higher readiness for discharge. The unit design was not a significantly associated with readiness for discharge.

CONCLUSION

The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.

Elementos de segurança e compreensão de orientações na alta em Unidades de Terapia Intensiva Neonatal

RESUMO Objetivo: Comparar elementos de segurança e a compreensão de orientações na alta da Unidade Terapia Intensiva Neonatal entre hospitais público e privado. Método: Estudo transversal, desenvolvido em duas Unidades Terapia Intensiva Neonatal do Centro-Oeste do Brasil. Foram empregados o Checklist para segurança do paciente no preparo para alta da Unidade Terapia Intensiva Neonatal e a Escala de Avaliação da Compreensão do Paciente sobre Orientações de Alta a uma amostra (n=105) de cuidadores dos neonatos. Realizou-se análise estatística descritiva e inferencial. Resultados: O item do Checklist “cuidados com a pele e higienização corporal” obteve maior conformidade no setor privado (96,9%) que no público (73,2%) (p-valor<0,000) e a compreensão de orientações de alta teve média geral de 62,9±8,3 pontos, sem diferença significativa entre os locais. Conclusão: O atendimento a elementos de segurança e a compreensão de orientações na alta foram equânimes entre os hospitais.

Safety elements and understanding of guidelines at discharge from Neonatal Intensive Care Units

ABSTRACT Objective: To compare safety elements and the understanding of guidelines at discharge from the Neonatal Intensive Care Unit between public and private hospitals. Method: Cross-sectional study, developed in two Neonatal Intensive Care Units in the Midwest of Brazil. The Checklist for patient safety in preparing for discharge from the Neonatal Intensive Care Unit and the Assessment Scale of Patient Understanding about Discharge Guidelines were used for a sample (n=105) of caregivers of newborns. Descriptive and inferential statistical analysis was performed. Results: The Checklist item “skin care and body hygiene” had greater conformity in the private sector (96.9%) than in the public sector (73.2%) (p-value<0.000) and the understanding of discharge guidelines had an overall mean of 62.9±8.3 points, with no significant difference between the locations. Conclusion: Compliance with safety elements and understanding of guidelines at discharge were equal among hospitals.

Mothers' experiences of caring for preterm babies at home: qualitative insights from an urban setting in a middle-income country

Background

Preterm delivery is the birth of a baby before 37 weeks of gestation. This global phenomenon is a critical issue of concern especially in developing countries that are resource-constrained when it comes to the management of preterm babies. Complications associated with prematurity contribute significantly to under-five mortality and are linked with feelings of despair, grief, and anxiety among mothers.

Methods

This was a qualitative descriptive study in an urban setting in the Greater Accra region of Ghana. Eleven mothers whose babies had been discharged from the neonatal intensive care unit in a major hospital and resided in Accra were interviewed in their homes using a semi-structured interview guide. Data were audiotaped, transcribed verbatim, and analyzed inductively by content analysis.

Results

All the mothers had formal education and the mean maternal age was 27.9 years. The majority of the mothers were multiparous. The gestational age at birth ranged from 32 to 34 weeks and the average birth weight of their babies was 1.61 kg. Four major themes emerged which included: Around the clock care; mothers’ self-perceptions and attitudes of significant others; mothers’ health and wellbeing; and support. Most of the mothers experienced physical exhaustion from the extra demands involved with care, had negative emotions, and unmet social needs.

Conclusions

The findings indicate that home management of preterm babies poses multiple stressors and is associated with poor psychological and physical wellbeing among mothers. Hence, the need for extensive education and identification of other social support systems to augment facility-based care for mothers and their preterm babies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03872-9.

Exploring the knowledge of community-based nurses in supporting parents of preterm babies at home: A survey-based study

Aim

This study aimed to investigate the confidence levels, knowledge base and learning needs of community‐based nurses relating to the care of preterm babies and parents, to explore what education is required and in what format.

Design

An online survey methodology was used.

Methods

A 32‐item questionnaire was distributed via social media platforms to community‐based nurses in Australia.

Results

Descriptive analysis was undertaken relating to knowledge base, confidence levels, previous training, learning and resource needs and barriers to education. It was deemed vital to expand confidence and knowledge in this area. Gaps in learning resources were identified and a need for more training in topics such as developmental outcomes, feeding, expected milestones, weight gain, growth trajectories and supporting parents. Online resources were the preferred format to teach key knowledge to community‐based health professionals, tailored to the specific features of preterm babies and support needs of parents.