The mother and her newborn: mutual caregivers

Effect evaluation of kangaroo mother care in Liping area, Guizhou province,China

BACKGROUD

Kangaroo mother care (KMC) refers to the mother and baby after the birth of the early start of continuous skin contact way of a newborn care, which is a simple operation, easy controlled and with low cost, no large or high consumption of equipment.So it is very suitable for developing in areas where medical resources are relatively scarce, such as GuiZhou province where is a relatively poor province in China with many ethnic minorities.

METHODS

This study selected the pregnant women who gave birth in Liping County, Guizhou Province, China, as the research object, to explore the impact of kangaroo mother care on the physiologic status of newborns in liping county, Guizhou Province.

RESULTS

A total of 347 hospitalized parturient women were divided into the KMC group and the control group. The results showed that the KMC group showed obvious advantages in stabilizing newborn vital signs, health indicators, promoting the success rate of breastfeeding and reducing newborn pain.

CONCLUSIONS

Research shows that kangaroo mother care is beneficial to postpartum maternal and infant health, and has advantages suitable for local characteristics, which is worth further promotion in minority areas of Guizhou Province.

The importance of skin-to-skin contact for early initiation of breastfeeding in Nigeria and Bangladesh

Background

Skin–to–skin contact (SSC) between mother and newborn offers numerous protective effects, however it is an intervention that has been under–utilized. Our objectives are to understand which newborns in Bangladesh and Nigeria receive SSC and whether SSC is associated with the early initiation of breastfeeding.

Methods

Demographic and Health Survey (DHS) data were used to study the characteristics of newborns receiving SSC for non–facility births in Nigeria (DHS 2013) and for both facility and non–facility births in Bangladesh (DHS 2014). Multivariable logistic regression was used to study the association between SSC and early initiation of breastfeeding after controlling for key socio–demographic, maternal and newborn–related factors.

Results

Only 10% of newborns in Nigeria and 26% of newborns in Bangladesh received SSC. In the regression models, SSC was significantly associated with the early initiation of breastfeeding in both countries (OR = 1.42, 95% CI 1.15–1.76 for Nigeria; OR = 1.27, 95% CI 1.04–1.55, for Bangladesh). Findings from the regression analysis for Bangladesh revealed that newborns born by Cesarean section had a 67% lower odds of early initiation of breastfeeding than those born by normal delivery (OR = 0.33, 95% CI 0.26–0.43). Also in Bangladesh newborns born in a health facility had a 30% lower odds of early initiation of breastfeeding than those born in non–facility environments (OR = 0.70, 95% CI 0.53–0.92). Early initiation of breastfeeding was significantly associated with parity, urban residence and wealth in Nigeria. Geographic area was significant in the regression analyses for both Bangladesh and Nigeria.

Conclusions

Coverage of SSC is very low in the two countries, despite its benefits for newborns without complications. SSC has the potential to save newborn lives. There is a need to prioritize training of health providers on the implementation of essential newborn care including SSC. Community engagement is also needed to ensure that all women and their families regardless of residence, socio–economic status, place or type of delivery, understand the benefits of SSC and early initiation of breastfeeding.

Psychometric Properties of an Instrument to Measure Mother-Infant Togetherness After Childbirth

BACKGROUND AND PURPOSE

The purpose of this research was to evaluate the psychometric properties of a new instrument to measure mother-infant togetherness, Mother-Infant Togetherness Survey (MITS).

METHODS

Stage 1 examined content validity. Stage 2 pretested the readability and understandability and further examined content validity. Stage 3 examined women's ability to accurately self-report on the Delivery Events subscale. Stages 4 and 5 examined construct validity.

RESULTS

Good content validity was obtained at the scale/subscale level (CVI = .91-1.00). Internal consistency reliability was evaluated at the scale/subscale level (α = .62-.89). Construct validity was supported with known groups testing and factor analysis.

CONCLUSION

Study findings provide support for the reliability and validity of the MITS. Future research should be done to improve the internal consistency reliability of the Postpartum Events subscale.

Social regulation of the stress response in the transitional newborn: a pilot study

The purpose of the study was to explore relationships between caregiver holding and feeding behaviors and the transitional newborn infant's cortisol response. Behaviors of 46 mothers, fathers, and their term transitional newborn infants were measured with the Index of Mother-Infant Separation (IMIS). Repeated measures of infant salivary cortisol were used to calculate area under the curve. A higher percentage of observations in which mother was holding infant was related to lower infant total cortisol during the first 6 hours after birth (r = -.24, p = .05, one-tailed).

Early skin-to-skin contact and breast-feeding behavior in term neonates: a randomized controlled trial

AIM

To evaluate if early skin-to-skin contact (SSC) improves breast-feeding (BF) behavior and exclusive BF (EBF) rates in term infants at 48 h of age.

METHODS

Term infants born by normal delivery were randomized at birth to either early SSC (n = 20) or conventional care (controls; n = 21). SSC was continued for at least 2 h after birth. Subsequently, one BF session of the infants was video recorded at about 48 h of life. The primary outcome, infants' BF behavior at 48 h of life, was assessed using the modified infant Breast-Feeding Assessment Tool (BAT; a score consisting of infant's readiness to feed, sucking, rooting and latching, each item scored from 0 to 3) by three independent masked observers. The secondary outcomes were EBF rates at 48 h and 6 weeks of age and salivary cortisol level of infants at 6 h of age.

RESULTS

Baseline characteristics including birth weight and gestation were comparable between the two groups. There was no significant difference in the BAT scores between the groups [median: 8, interquartile range (IQR) 5-10 vs. median 9, IQR 5-10; p = 0.6]. EBF rates at 48 h and at 6 weeks were, however, significantly higher in the early-SSC group than in the control group [95.0 vs. 38.1%; relative risk (RR): 2.5, 95% confidence interval (95% CI): 1.4-4.3 and 90 vs. 28.6%; RR: 3.2, 95% CI: 1.6-6.3].

INTERPRETATION

Early SSC did not improve BF behavior at discharge but significantly improved the EBF rates of term neonates.

Effect of early skin-to-skin contact on mother-preterm infant interaction through 18 months: randomized controlled trial

BACKGROUND

Preterm birth often negatively influences mother-infant interaction. Skin-to-skin contact postbirth has positive effects on maternal feelings toward their preterm infants and on infant development and family interaction. However, little is known about the long-term effects of skin-to-skin contact on mother-late preterm infant interaction when skin-to-skin contact was experienced early postbirth and intermittently throughout the next five days.

OBJECTIVE

The purpose of this report was to examine the effect of skin-to-skin contact on mother-late preterm infant interaction through 18 months.

DESIGN

Randomized controlled trial with follow-up.

SETTING

Two hospitals in the United States of America.

PARTICIPANTS

100 mothers and their late preterm infants, 32 to <37 weeks' gestation, were recruited. Mother-preterm infant interactions were assessed in 69, 70, and 76 dyads at 6, 12, and 18 months.

METHODS

Mothers and their preterm infants were videotaped during a feeding session at 6 and 12 months, and a teaching session at 6, 12, and 18 months. Their interactions were then scored using the Nursing Child Assessment Satellite Feeding Scale and Teaching Scale.

RESULTS

Skin-to-skin contact and control dyads had comparable feeding scores at 6 and 12 months. Skin-to-skin contact infants had lower infant teaching scores at six months, a difference that disappeared thereafter.

CONCLUSIONS

These inconclusive results call for additional studies with larger doses of skin-to-skin contact, larger sample sizes, and other outcome measures of mother-late preterm infant interactions. Such measures include the Parent-Child Early Relational Assessment and behavioral coding during play.

Concept clarification of neonatal neurobehavioural organization

AIM

This paper is a report of a concept analysis of neonatal neurobehavioural organization for healthy full-term infants.

BACKGROUND

The neonatal period is an opportune time for researchers and clinicians to assess and intervene for optimal neurobehavioural organization. Yet there is inconsistency and lack of clarity in a scientifically grounded definition of neonatal neurobehavioural organization. Clarification of the concept will strengthen research findings that influence practice for optimal infant development.

METHOD

A concept analysis of the literature between 1939 and 2007 (n = 57) was conducted using Penrod and Hupcey's principle-based concept analysis and Morse's concept clarification.

FINDINGS

The concept analysis within and across multiple disciplines revealed: (1) a view of the concept as a holistic phenomenon with multiple dimensions; (2) no agreement on the ideal instrument to operationally define the concept; and (3) consistency in implied meaning, but great variability in terminology. Neonatal neurobehavioural organization was defined as the ability of the neonate to use goal-directed states of consciousness, in reciprocal interaction with the caregiving environment, to facilitate the emergence of differentiating, hierarchical, and coordinated neurobehavioural systems, with ever-increasing resiliency and capacity to learn from complex stimuli.

CONCLUSION

A clear conceptual definition will help the international community to communicate effectively within and between disciplines and to apply evidence-based research findings. It will encourage the development of valid and reliable instruments to capture the concept's multiple dimensions and direct attention to the infant's experience, which sculpts early neurobehavioural organization.

Non-pharmacological techniques for pain management in neonates

Significant progress in understanding the physiology, clinical correlates, and consequences of neonatal pain have resulted in greater attention to pain management during neonatal intensive care. A number of nonpharmacological therapies have been investigated, including nonnutritive sucking, with and without sucrose use, swaddling or facilitated tucking, kangaroo care, music therapy, and multi-sensorial stimulation. Although the efficacy of these approaches is clearly evident, they cannot provide analgesia for moderate or severe pain in the neonate. Further, some of these therapies cannot be effectively applied to all populations of critically ill neonates. Acupuncture, an ancient practice in Chinese medicine, has gained increasing popularity for symptom control among adults and older children. Acupuncture may provide an effective nonpharmacological approach for the treatment of pain in neonates, even moderate or severe pain, and should be considered for inclusion in a graduated multidisciplinary algorithm for neonatal pain management.

Newborn temperature during skin-to-skin breastfeeding in couples having breastfeeding difficulties

BACKGROUND

Kangaroo (skin-to-skin contact) care facilitates the maintenance of safe temperatures in newborn infants. Concern persists that infants will become cold while breastfeeding, however, especially if in skin-to-skin contact with the mother. This concern might be especially realistic for infants experiencing breastfeeding difficulties. The objective was to measure temperature during a study of mothers and infants who were having breastfeeding difficulties during early postpartum and were given opportunities to experience skin-to-skin contact during breastfeeding.

METHOD

Forty-eight full-term infants were investigated using a pretest-test-posttest study design. Temporal artery temperature was measured before, after, and once during 3 consecutive skin-to-skin breastfeeding interventions and 1 intervention 24 hours after the first intervention.

RESULTS

During skin-to-skin contact, most infants reached and maintained temperatures between 36.5 and 37.6 degrees C, the thermoneutral range, with only rare exceptions.

CONCLUSIONS

The temperatures of study infants reached and remained at the thermoneutral range during breastfeeding in skin-to-skin contact. The data suggest that mothers may have the ability to modulate their infant's temperature during skin-to-skin contact if given the opportunity. Hospital staff and parents can be reassured that, with respect to their temperature, healthy newborn infants, with or without breastfeeding difficulties, may safely breastfeed in skin-to-skin contact with their mothers.

Early relationship environments: physiology of skin-to-skin contact for parents and their preterm infants

Skin-to-skin care involves the mother placing her diaper-clad infant upright between her breasts in direct skin contact. The practice has evolved worldwide to be an intervention strategy in neonatal intensive care units for premature infants and their mothers. Few adverse outcomes have been noted in thermoregulation, cardiovascular changes, or behavioral organization. Findings have been positively related to better infant physiologic and neurobehavioral outcomes, maternal breastfeeding success, and positive attachment relationships. The early, intimate, and physiologically stabilizing benefits of skin-to-skin care provide for a new conceptualization of the optimal environment for preterm infants in intensive care.

Randomized controlled trial of kangaroo care: cardiorespiratory and thermal effects on healthy preterm infants

PURPOSE

To determine the safety and effects on healthy preterm infants of three continuous hours of kangaroo care (KC) compared to standard NICU care by measuring cardiorespiratory and thermal responses.

DESIGN

Randomized controlled trial-pretest-test-posttest control group design.

SAMPLE

Twenty-four healthy preterm infants (33-35 weeks gestation at birth) nearing discharge. Eleven of the infants received KC; 13 received standard NICU care.

MAIN OUTCOME VARIABLES

Heart rate, respiratory rate, oxygen saturation, and abdominal skin temperature were manually recorded every minute. Apnea, bradycardia, periodic breathing, and regular breathing were captured continuously on a pneumocardiogram printout. Three consecutive interfeeding intervals (three hours each) on one day constituted the pretest, test, and posttest periods.

RESULTS

Mean cardiorespiratory and temperature outcomes remained within clinically acceptable ranges during KC. Apnea, bradycardia, and periodic breathing were absent during KC. Regular breathing increased for infants receiving KC compared to infants receiving standard NICU care.

Axillary temperature in transitional newborn infants before and after tub bath

Twenty healthy newborn infants (mean 38.4 weeks gestation and 3,294 g) were studied to compare axillary temperatures before and after a deep-water tub bath. The bath was given in the mother's room in a plastic bassinet filled with 5 to 5 1/2 inches of warm water. Mean time was 4.4 hours postbirth. Mean infant temperature was 98.2 degrees F (36.8 degrees C) prebath and 98.0 degrees F (36.7 degrees C) postbath. Mean change was -0.2 degree F (-0.1 degree C) and was not significantly different. This significant absence of heat loss during tub baths suggests that infants need not be separated from their mothers and kept in nurseries under infrared warmers to prevent heat loss during their first bath.

Risk in mother-infant separation postbirth

The United States ranks poorly worldwide on infant mortality and breastfeeding, and recent trends are discouraging. The continuous rooming-in method of care is the general rule in European countries, which have low infant mortality and high breastfeeding rates; but this is a method of care (or an option) that the poor, and even some affluent, do not have available to them, or do not know how to go about obtaining, in the United States. The mother and infant are considered mutual caregivers, whose self-regulatory interaction postbirth is mutually beneficial, conducive to breastfeeding and cost effective. Newborn infants deprived of self-regulatory (on cue) access to their mothers are considered at increased physiological and developmental risk. Continuous rooming-in is recommended for study in a multisite, controlled clinical trial and then, if findings warrant, for implementation nationwide.

Nursing care for the emerging family: promoting paternal behavior

In the last decade, nursing care related to childbirth has expanded from a narrow emphasis on the physical health needs of the mother and infant to a broader focus on more family-related, socioemotional needs. One prominent feature of this family-centered approach is the recent movement toward designing services to promote the formation of the mother-infant attachment bond. It is argued in this paper, however, that to achieve a truly family-centered practice, nursing must make a comparable commitment to understanding and meeting the needs of the father in the emerging family. Evidence is reviewed that suggests the father's potential contribution to the infant's overall development has been misperceived or devalued and that the father's ability and willingness to assume a more active role in the infant's care may have been underestimated. Questions for future research that would lead to a better understanding of the father's role in the emerging family are raised.

Effects of tactile and kinesthetic stimulation on premature infants

Forty premature infants, divided equally into matched treatment and control groups, were studied to determine the effect of compensatory tactile and kinesthetic stimulation on clinical course. The treatment group received a 15-minute period of tactile and kinesthetic stimulation once daily on Days 1-10 postpartum; control group received routine care. Treated infants showed increased stooling frequency on Days 5-10, and increased feeding intake on Days 6-10. Treated infants gained increasingly more weight each day, but these differences did not reach statistical significance. These results suggest that single daily stimulation treatments in the first 10 days postpartum were sufficient to enhance the clinical course of premature infants.

Nonnutritive sucking during tube feedings: effect on clinical course in premature infants

Fifty-nine infants, 28--34 weeks' gestation, were assigned to treatment and control groups. Treatment infants were offered a pacifier during and following every tube feeding; control infants received routine care. The treatment began when an infant could tolerate room air and 10 cc of full-strength formula by tube; it ended when the infant was totally bottle fed. Treated infants showed readiness for bottle feeding 3.4 days earlier, i.e., with 27 fewer tube feedings each. Performance during the first bottle feeding was assessed with a feeding scale and was statistically similar for both groups. From study entry to first bottle feeding the treated infants gained 2.6 gm/day more and were discharged 4 days sooner. Complications differed between the two groups.