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Tomlinson C, Haiek LN. Breastfeeding and human milk in the NICU: From birth to discharge. Paediatr Child Health 2023; 28:510-526. [PMID: 38638537 PMCID: PMC11022875 DOI: 10.1093/pch/pxad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/20/2022] [Indexed: 04/20/2024] Open
Abstract
It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.
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Affiliation(s)
- Christopher Tomlinson
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
| | - Laura N Haiek
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
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Machry H, Joseph A, White R, Allison D. Designing for Family Engagement in Neonatal ICUs: How Is the Interior Design of Single-Family Rooms Supporting Family Behaviors, From Passive to Active? HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:238-260. [PMID: 37157783 DOI: 10.1177/19375867231168651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE Understand how the interior design of single-family rooms (SFRs) in neonatal intensive care units (NICUs) can support family engagement behaviors. BACKGROUND Family members are integral contributors to infant care in NICUs, impacting infant development. While at the NICU, parents are encouraged to participate in a process called family engagement, where they are expected to move from passive to active caregivers, in preparation for their role after discharge. While family engagement is affected by the built environment, no studies have investigated this relationship in any depth. NICU settings morphed to involve families through the SFR design model, but the interior environment of SFRs have not been sufficiently explored as a resource to support specific family engagement behaviors. METHODS We interviewed family and staff and observed family engagement behaviors in SFRs at two NICUs. Behaviors were observed and described in terms of their location, number of people, and design elements involved. Built environment characteristics were collected through physical assessments, and interviews elicited participants' perceptions about design factors impacting family behaviors inside SFRs. Data analysis followed grounded theory segments and pattern matching. RESULTS Three behavioral patterns and five themes were identified showing how SFRs' private bathrooms, family storage, family zone partitions, positive distractions, and information boards can support families' home-like, educational, collaborative, and infant care behaviors. CONCLUSIONS The interior design of SFRs can be a resource to family engagement in the NICU. Future research should operationalize SFR features found in our study to measure and validate their impact on family engagement outcomes.
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Affiliation(s)
- Herminia Machry
- School of Architecture and Design, University of Kansas, Lawrence, KS, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, SC, USA
| | - Robert White
- Regional Newborn Program, Beacon Children's Hospital, South Bend, IN, USA
| | - David Allison
- Graduate Program in Architecture and Health, School of Architecture, Clemson University, SC, USA
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Unintended Consequences of the Neonatal Intensive Care Unit Environment: Integrative Review of Single-Family Room Unit Design. Adv Neonatal Care 2022; 23:151-159. [PMID: 35939818 DOI: 10.1097/anc.0000000000001023] [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 Recent trends in neonatal intensive care unit design have been directed toward reducing negative stimuli and creating a more developmentally appropriate environment for infants who require intensive care. These efforts have included reconfiguring units to provide private rooms for infants. PURPOSE The purpose of this integrative review was to synthesize and critically analyze negative outcomes for patients, families, and staff who have been identified in the literature related to single-family room (SFR) care in the neonatal intensive care unit. METHODS/SEARCH STRATEGY The electronic databases of CINAHL, ProQuest Nursing & Allied Health, and PubMed databases were utilized. Inclusion criteria were research studies in English, conducted from 2011 to 2021, in which the focus of the study was related to unit design (SFRs). Based on the inclusion criteria, our search yielded 202 articles, with an additional 2 articles found through reference list searches. After screening, 44 articles met our full inclusion/exclusion criteria. These studies were examined for outcomes related to SFR unit design. FINDINGS/RESULTS Our findings revealed both positive and negative outcomes related to SFR unit design when compared with traditional open bay units. These outcomes were grouped into 4 domains: Environmental Outcomes, Infant Outcomes, Parent Outcomes, and Staff Outcomes. IMPLICATIONS FOR PRACTICE AND RESEARCH Although SFR neonatal intensive care unit design improves some outcomes for infants, families, and staff, some unexpected outcomes have been identified. Although these do not negate the positive outcomes, they should be recognized so that steps can be taken to address potential issues and prevent undesired outcomes.
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Giving parents support: a randomized trial of peer support for parents after NICU discharge. J Perinatol 2022; 42:730-737. [PMID: 35260824 PMCID: PMC9184279 DOI: 10.1038/s41372-022-01341-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/01/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peer support during inpatient hospitalization has been recommended for NICU parents and can improve maternal mental health. Less is known about the impact of peer support after NICU discharge on parental mental health and infant healthcare utilization. METHODS Three hundred families of infants approaching discharge from a Level IV NICU were randomized to receive a care notebook (control) or care notebook plus peer support for 12 months (intervention). Participants reported on measures of stress, depression, anxiety, self-efficacy, and infant healthcare utilization. Analysis compared outcomes between control and treatment groups. RESULTS Parental depression, anxiety, stress, and self-efficacy improved significantly for all participants, yet there were no differences between control and intervention groups. Infant ED visits, hospitalizations, immunization status, and developmental status at 12 months did not differ between groups. CONCLUSIONS Peer support after NICU discharge did not improve self-reported parental mental health measures or infant healthcare utilization. CLINICAL TRIAL REGISTRATION NCT02643472.
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Cojocaru L, Crimmins S, Sundararajan S, Goetzinger K, Elsamadicy E, Lankford A, Turan OM, Turan S. An initiative to evaluate the safety of maternal bonding in patients with SARS-CoV-2 infection. J Matern Fetal Neonatal Med 2020; 35:3540-3546. [PMID: 32998572 DOI: 10.1080/14767058.2020.1828335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the last two decades, the world faced three epidemics caused by novel coronaviruses, namely, SARS-CoV in 2002, MERS-CoV in 2012, and the ongoing SARS-CoV-2 that started in late 2019. Despite a growing understanding of SARS-CoV-2 virology, epidemiology, and clinical management strategies, other aspects, such as mode of delivery, vertical transmission, and maternal bonding, remain controversial. The question we faced upon the decision to separate the neonates of SARS-CoV-2 positive mother is whether we follow the principle of "do no harm"? METHODS This is a quality improvement project that analyzed all cases of SARS-CoV-2 positive pregnancies that delivered at a major health care system from March 1, 2020 to June, 1 2020. The article was prepared following Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. Data were prospectively collected and entered into the Research Electronic Data Capture (REDCap). Maternal bonding was defined by events such as rooming-in, skin to skin contact (STSC), and breastfeeding. Descriptive analysis was performed using the same software platform. INTERVENTION We compared neonatal transmission rates between those neonates who experienced bonding versus those who were separated. RESULTS A total of 1989 women were screened for SARS-CoV-2, from which 86 tested positive. Out of 31 analyzed pregnancies, five women (16%) were admitted to ICU and required mechanical ventilation. From the remaining 26 (84%), 17 (65%) opted for rooming-in, 12 (46%) for STSC, and 16 (61%) fed the infants with breastmilk (11 direct breastfeedings and five pumped the breast milk). All neonatal tests for SARS-CoV-2 returned negative. CONCLUSION Our results have illustrated that maternal bonding appears safe in neonates born to mothers that are SARS-CoV-2 positive.
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Affiliation(s)
- Liviu Cojocaru
- Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Crimmins
- Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sripriya Sundararajan
- Department of Pediatrics. Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine Goetzinger
- Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emad Elsamadicy
- Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allison Lankford
- Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ozhan M Turan
- Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sifa Turan
- Division of Maternal-Fetal Medicine. Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
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van Veenendaal NR, van Kempen AA, Franck LS, O'Brien K, Limpens J, van der Lee JH, van Goudoever JB, van der Schoor SR. Hospitalising preterm infants in single family rooms versus open bay units: A systematic review and meta-analysis of impact on parents. EClinicalMedicine 2020; 23:100388. [PMID: 32548575 PMCID: PMC7284081 DOI: 10.1016/j.eclinm.2020.100388] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Many parents develop stress-related symptoms and depression when their preterm infant is hospitalised in the neonatal intensive care unit (NICU) after birth. We reviewed the evidence of parent well-being with preterm infants hospitalised in single family rooms (SFRs) or in open bay neonatal units (OBUs). METHODS For this systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP) databases from inception through 22 November 2019 using controlled terms and text words related to prematurity and NICU-design. We included randomised and non-randomised studies comparing outcomes in parents with preterm infants admitted to SFRs or OBUs. Methodological quality was assessed using Cochrane Collaboration's Risk of Bias Tool for randomised controlled trials and the Risk of Bias Tool for Non-Randomised Studies of Interventions (ROBINS-I). Outcomes included: parental stress, satisfaction, participation (presence/involvement/skin-to-skin care), self-efficacy, parent-infant-bonding, depression, anxiety, post-traumatic stress, empowerment, and degree of family-centred care. Summary estimates were calculated using random effects models with standardised mean differences (SMDs). PROSPERO registration: CRD42016050643. FINDINGS We identified 614 unique publications. Eleven study populations (1, 850 preterm infants, 1, 549 mothers and 379 fathers) were included. All but one study were at serious to critical risk of bias. SFRs were associated with higher levels of parental presence, involvement, and skin-to-skin care. Upon discharge, SFRs were associated with lower stress levels (n = 828 parents, SMD-0·30,95%CI -0·50;-0·09, p<0·004, I2=46%), specifically NICU-related stress (n = 573, SMD-0·42,95%CI -0·61;-0·23, p<0·0001, I2=0%). In majority of studies higher levels of empowerment, family-centred care, and satisfaction was present with SFRs. No differences were found for anxiety, parent-infant bonding, or self-efficacy. Depression was high (up to 29%) but not different between settings. No studies described post-traumatic stress. INTERPRETATION Single family rooms seem to facilitate parental presence, involvement, skin-to-skin care, and reduce NICU-related parental stress.
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Key Words
- AA, at admission
- BA, before-after study
- BDI, Beck Depression Inventory
- CI, confidence interval
- EPDS, Edinburgh Postnatal Depression Scale
- FCC, Family-Centred Care
- FCCS, Family-Centred Care Survey
- MPAS, Maternal Postnatal Attachment Scale
- Mo, months
- NA, not applicable
- NICU, Neonatal Intensive Care Unit
- NR, not reported
- NRPI, non-randomised prospective intervention study
- NRRI, non-randomised retrospective intervention study
- OBU, Open Bay Unit
- PES, Parent Expectations Scale
- PG, Press Ganey NICU Survey
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis
- PROSPERO, International Prospective Register of Systematic Reviews
- PSI, Parental Stress Index
- PSS-NICU, Parental Stressor Scale – NICU
- RCT, Randomised Controlled Trial
- ROBINS-I, Risk of Bias in Non-randomised Studies of Interventions
- RoB, Risk of Bias
- SD, standard deviation
- SFR, Single Family Room
- SMD, standardised mean difference
- SPSQ, Swedish Parental Stress Index
- STAI, State-Trait Anxiety Inventory
- Wks, weeks
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, Netherlands
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
| | | | - Linda S. Franck
- School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Karel O'Brien
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Jacqueline Limpens
- Medical Library Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Johannes B. van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
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Feeley N, Robins S, Genest C, Stremler R, Zelkowitz P, Charbonneau L. A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design. BMC Pediatr 2020; 20:38. [PMID: 31996178 PMCID: PMC6988355 DOI: 10.1186/s12887-020-1929-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/15/2020] [Indexed: 01/05/2023] Open
Abstract
Background The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants. Purpose To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs. Methods A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge. Results Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy. At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education. Conclusions Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.
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Affiliation(s)
- Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital, 3755 Côte-Ste-Catherine Rd, B- 621, Montréal, Québec, H3T 1E2, Canada. .,Ingram School of Nursing, McGill University, Montréal, Canada.
| | - Stephanie Robins
- Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte Ste-Catherine Road, Montreal, Quebec, H3T 1E4, Canada
| | - Christine Genest
- Faculty of Nursing, University of Montreal, 2375 Côte Ste-Catherine Road, Montréal, Québec, H3T 1A8, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital Senior Investigator, Lady Davis Institute for Medical Research, 4333 Côte Ste-Catherine Road, Montréal, Québec, H3T 1E4, Canada
| | - Lyne Charbonneau
- Neonatology, Jewish General Hospital, 3755 Côte-Ste-Catherine Rd, Montréal, Québec, H3T 1E2, Canada
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Cheong JLY, Burnett AC, Treyvaud K, Spittle AJ. Early environment and long-term outcomes of preterm infants. J Neural Transm (Vienna) 2019; 127:1-8. [PMID: 31863172 DOI: 10.1007/s00702-019-02121-w] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
Abstract
Prematurity is associated with an increased risk of long-term health and neurodevelopmental problems. Key perinatal and neonatal factors that affect these outcomes have long been studied. However, more recently, there has been an appreciation of the importance of environmental factors in long-term outcomes of preterm babies, particularly in light of the rapid maturation of the brain during these babies' early days of life. Breastmilk and breastfeeding is the gold standard for infant feeding, including preterm babies. The benefits are well established in regard to protection from serious complications like necrotising enterocolitis. Although theoretically plausible, the benefits for neurodevelopment are less clear. Noise, pain and the environment of the neonatal intensive care can also affect infant neurodevelopment. It is established that noise and pain have deleterious effects. However, the benefits of single-room vs open-bay neonatal units remain under debate. Developmental care practices, of which there are many, are increasingly embraced worldwide. There are benefits both for the parents and the baby, however, the evidence is difficult to pool due to the heterogeneity of studies and study populations. Finally, it is important to remember the importance of the role of parents in shaping long-term neurodevelopment of the high-risk preterm newborn. Increasingly, positive parenting and parents' mental health are shown to have long lasting advantages for preterm infants. A deeper understanding of early environmental factors is key to developing future interventions to optimise outcomes of preterm newborns.
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Affiliation(s)
- Jeanie L Y Cheong
- Level 7, Newborn Research, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Alice C Burnett
- Level 4, Victorian Infant Brain Studies, Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Karli Treyvaud
- Department of Psychology and Counselling, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Alicia J Spittle
- Level 7, Department of Physiotherapy, University of Melbourne, 161 Barry Street, Parkville, VIC, 3052, Australia
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Integration of Maternity and Neonatal Care to Empower Parents. J Obstet Gynecol Neonatal Nurs 2019; 49:65-77. [PMID: 31809695 DOI: 10.1016/j.jogn.2019.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the transition from a traditional hospital design with separate maternity and neonatal departments to a design in which maternity and neonatal health care infrastructures are integrated to empower parents. DESIGN A descriptive, qualitative analysis. SETTING A mother and child center in a teaching hospital in Amsterdam. PARTICIPANTS Six staff members who were involved in the transition. METHODS We analyzed the content of all relevant policy reports and other related documents that were produced during the transition from April 2010 to October 2014. This content was supplemented with in-depth, semistructured interviews with the six participants. We used thematic analysis and Bravo et al.'s model of patient empowerment to analyze the documents and the qualitative interview data. RESULTS We identified eight themes. At the health care system level, the four themes were Joint Vision and Goal, Integration of Three Wards Into One With Single-Family Rooms, Reorganization of the Health Care Team, and New Equipment. At the health care provider level, the three themes were Training for Extension of Professional Goals, Intensified Coaching for Parents, and Implementing Patient Centeredness. The single theme at the patient level was Opinions and Experiences of Parents. CONCLUSION We found a good fit between the new design and Bravo et al.'s model of patient empowerment. Challenges that remain include the adaptation of staff training programs and further development of the infrastructure in collaboration with staff and parents. The experiences of parents and staff members will be evaluated in future studies.
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McGowan EC, Vohr BR. Impact of Nonmedical Factors on Neurobehavior and Language Outcomes of Preterm Infants. Neoreviews 2019; 20:e372-e384. [PMID: 31261104 DOI: 10.1542/neo.20-7-e372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Preterm infants are at increased risk for adverse neurodevelopmental outcomes. The impact of maternal, NICU, and social environmental factors on early neurobehavior and language outcomes of preterm infants is recognized. There is a need for health care professionals to have a clear understanding of the importance of facilitating positive mother-infant relationships, and to address not only the infant's sensory and language environment, but also focus on adverse maternal mental health and social adversities to optimize infant outcomes.
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Affiliation(s)
- Elisabeth C McGowan
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
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Weber A, Harrison TM. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. Nurs Outlook 2019; 67:169-189. [PMID: 30611546 PMCID: PMC6450772 DOI: 10.1016/j.outlook.2018.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023]
Abstract
In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati College of Nursing, 310 Proctor Hall, 3110 Vine St, Cincinnati, OH 45221, USA
| | - Tondi M. Harrison
- The Ohio State University, Newton Hall, College of Nursing, 1585 Neil Avenue, Columbus OH, 43210 USA
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Hospitalising preterm infants in single family rooms versus open bay units: a systematic review and meta-analysis. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:147-157. [DOI: 10.1016/s2352-4642(18)30375-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 02/07/2023]
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Liu LX, Mozafarinia M, Axelin A, Feeley N. Parents' Experiences of Support in NICU Single-Family Rooms. Neonatal Netw 2019; 38:88-97. [PMID: 31470371 DOI: 10.1891/0730-0832.38.2.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE This study aimed to explore support for mothers and fathers in single-family rooms (SFRs) of a NICU. DESIGN A qualitative descriptive design was employed. SAMPLE A convenience sample of 15 parents (nine mothers, six fathers) were recruited from a Level III NICU. METHOD During their infants' hospitalization, each parent recorded their thoughts and feelings regarding support whenever appropriate over a period of 48 hours using Handy Application to Promote Preterm infant happY-life (HAPPY), an android recording application. RESULTS Parents felt supported when staff facilitated their learning in a collaborative manner, fostered their optimism, and provided situational assistance. Continuity and consistency of care and presence were important characteristics of supportive nursing care. Though SFRs offered privacy for parents to learn and to be with their infants, the design limited parental access to nursing and medical staff, which sometimes prevented parents from receiving adequate support and partaking in decision making concerning their infants' care.
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Abstract
Within the neonatal intensive care unit (NICU), parent engagement and empowerment are of critical importance, particularly when infants are at risk of developing severe complications, such as necrotizing enterocolitis (NEC). Stakeholders within the NICU, including the fragile patients, families, clinicians, staff, and administration, benefit when parents are a valued member of their baby's care team. The 2017 NEC Symposium explored the experiences of families whose infants were impacted by NEC, the barriers to effective partnership, and promising solutions. Parents want to participate in their baby's care, and crave honest, timely, comprehensive information regarding their baby's health and potential outcomes. Clinicians and staff should implement a specific set of Family-Centered Care policies and practices within the NICU to foster a culture of collaboration with parents of premature and fragile infants.
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Affiliation(s)
- Erin Umberger
- NEC Society, 7647 North Fresno St, P.O. Box 28912, Fresno, California 93729-8912
| | - Jennifer Canvasser
- NEC Society, 7647 North Fresno St, P.O. Box 28912, Fresno, California 93729-8912.
| | - Sue L Hall
- St. John's Regional Medical Center, Oxnard, California
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15
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Parent-Infant Closeness, Parents' Participation, and Nursing Support in Single-Family Room and Open Bay NICUs. J Perinat Neonatal Nurs 2018; 32:E22-E32. [PMID: 30358674 DOI: 10.1097/jpn.0000000000000359] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.
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van Veenendaal NR, van der Schoor SRD, Limpens J, van Kempen AAMW, van Goudoever JB. Effect of single family rooms for preterm infants on neurodevelopment: study protocol for a systematic review. BMJ Open 2017; 7:e015818. [PMID: 28780548 PMCID: PMC5629655 DOI: 10.1136/bmjopen-2017-015818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Preterm infants are at an increased risk for neurodevelopmental delay. They have to endure many stressors in early life, including parent-infant separation, noise and painful procedures during hospitalisation in the highly technological environment of the modern neonatal ward. Currently, a shift is being noticed in the architectural design of neonatal wards towards single family rooms instead of the common open bay units. The influence of the hospital environment on health and specifically neurodevelopment in this vulnerable patient population remains under discussion. OBJECTIVES To assess the effect of single family rooms during hospitalisation primarily on neurodevelopment in preterm infants. Secondary outcome measures will be neonatal (ie, breastfeeding rates, sepsis, growth during hospital stay, length of hospital stay) and parental (ie, parental stress, satisfaction, participation, presence and self-efficacy). METHODS AND ANALYSIS The PRISMA-P 2015 (Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015) 17 items checklist was used for the generation of the protocol for this review. The following PICO was formulated: Population: preterm infants with need of hospitalisation in the neonatal ward; Intervention: single family rooms; Comparison: standard neonatal care in open bay units; Outcome: neurodevelopmental outcome of infants from 9 months onwards. If at least two studies, with low or moderate risk of bias, suitable for inclusion are found a meta-analysis will be performed. If quantitative synthesis is not appropriate the data will be presented descriptively. DISSEMINATION PLANS This will be the first review, systematically assessing the effect of single family rooms on neurodevelopmental outcome in preterm infants. Clinical practice could possibly be optimised to ameliorate neurodevelopment in this vulnerable patient population based on these insights. This systematic review will be published in an international peer-reviewed journal. REGISTRATION We registered this systematic review protocol with the PROSPERO (International Prospective Register of Systematic Reviews) on 2 November 2016 (registration number: CRD42016050643). ETHICS We will use data from patients enrolled in studies and/or trials already approved by the relevant ethical committees and therefore this systematic review requires no further permissions.
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Affiliation(s)
- Nicole R van Veenendaal
- Department of Pediatrics/Neonatology, OLVG location East, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Anne A M W van Kempen
- Department of Pediatrics/Neonatology, OLVG location East, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
There are both pros and cons to the practice of rooming-in in the hospital after birth. One concern with rooming-in is the impact this experience has on postpartum mothers. Although rooming-in has many benefits, a challenge that mothers face in the early postpartum period is balancing the needs of their newborns while getting adequate rest. To explore this further, semistructured interviews were conducted with 25 postpartum mothers during their hospital stay. The results revealed how postpartum mothers perceived their sleep quality, rooming-in experience, and overall satisfaction. The majority (60%) of the postpartum mothers in this study had a positive rooming-in experience. Nevertheless, many factors were identified as contributors to poor sleep quality as well as positive and negative rooming-in experiences.
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Jones L, Peters K, Rowe J, Sheeran N. The Influence of Neonatal Nursery Design on Mothers' Interactions in the Nursery. J Pediatr Nurs 2016; 31:e301-12. [PMID: 27311300 DOI: 10.1016/j.pedn.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/27/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED This study examined the influence of neonatal nursery design on interactions between nurses and mothers of infants in the nursery. DESIGN AND METHODS We used a natural quasi-experimental design, using semi-structured interviews and a structured measure of mothers' and nurses' perceptions of nursing care, to compare mothers (n=26 and n=40) and nurses (n=22 and n=29) in an open-bay (OB) nursery and a single family room (SFR) nursery. Thematic analysis was used to generate key themes from the interviews. RESULTS Mothers and nurses in both nursery designs talked about Valuing interactions; the importance of interactions between mothers and nurses. Mothers and nurses described SFRs as providing a space, My/their room, which enhanced mothers' sense of control and connection with the infant. SFRs were also associated with Changing the norms of interactions with nurses and other mothers, which created challenges in the desired quantity and quality of interactions for mothers and nurses. Nurses in the SFR nursery also reported Enhanced interactions, including improved confidentiality and personalized communication. Mothers in the OB nursery reported more supportive mothering actions from nurses than mothers in the SFR nursery. Both mothers and nurses in the OB nursery also talked about Our nursery community, which captured the value of having other nurses and mothers in the rooms. CONCLUSION Mothers and nurses perceived that the SFR nursery enhanced privacy and maternal closeness for mothers compared to the OB nursery. However, the SFR nursery design presented challenges to some interactions of value to nurses and mothers.
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Affiliation(s)
- Liz Jones
- Griffith University, Mount Gravatt, Queensland, Australia.
| | - Kathryn Peters
- Griffith University, Mount Gravatt, Queensland, Australia
| | - Jennifer Rowe
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Nicola Sheeran
- Griffith University, Mount Gravatt, Queensland, Australia
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