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Flierman M, Bossen D, de Boer R, Vriend E, van Nes F, van Kaam A, Engelbert R, Jeukens-Visser M. Parents' information needs during the first year at home with their very premature born child; a qualitative study. PEC INNOVATION 2024; 4:100270. [PMID: 38495319 PMCID: PMC10940942 DOI: 10.1016/j.pecinn.2024.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
Objective To obtain insights into parents' information needs during the first year at home with their very preterm (VP) born infant. Methods We conducted semi-structured interviews with parents of VP infants participating in a post-discharge responsive parenting intervention (TOP program). Online interviews were audiotaped and transcribed verbatim. Inductive thematic analysis was performed by two independent coders. Results Ten participants were interviewed and had various and changing information needs during the developmental trajectory of their infant. Three main themes emerged; (1) Help me understand and cope, (2) Be fully responsible for my baby, and (3) Teach me to do it myself. Available and used sources, such as the Internet, did not meet their information needs. Participants preferred their available and knowledgeable healthcare professionals for reassurance, tailored information, and practical guidance. Conclusion This study identified parents' information needs during the first year at home with their VP infant and uncovered underlying re-appearing needs to gain confidence in child-caring abilities and autonomy in decision-making about their infants' care. Innovation This study provides valuable information for healthcare professionals and eHealth developers to support parental self-efficacy during the first year after preterm birth.
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Affiliation(s)
- Monique Flierman
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Faculty of Health, Amsterdam university of applied sciences, Amsterdam, the Netherlands
| | - Daniel Bossen
- Faculty of Health, Amsterdam university of applied sciences, Amsterdam, the Netherlands
| | - Rosa de Boer
- Faculty of Health, Amsterdam university of applied sciences, Amsterdam, the Netherlands
| | - Eline Vriend
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Fenna van Nes
- Faculty of Health, Amsterdam university of applied sciences, Amsterdam, the Netherlands
| | - Anton van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical center, Amsterdam, the Netherlands
| | - Raoul Engelbert
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Faculty of Health, Amsterdam university of applied sciences, Amsterdam, the Netherlands
| | - Martine Jeukens-Visser
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
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van Wyk L, Majiza AP, Ely CSE, Singer LT. Psychological distress in the neonatal intensive care unit: a meta-review. Pediatr Res 2024:10.1038/s41390-024-03599-1. [PMID: 39327462 DOI: 10.1038/s41390-024-03599-1] [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] [Received: 03/28/2024] [Revised: 08/14/2024] [Accepted: 09/07/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Parental psychological distress (PD) (anxiety, depression, stress and post-traumatic stress syndrome) can adversely affect parents' own physical and mental health as well as their children's long-term health and development. Numerous studies have addressed PD in mothers of infants admitted to NICU, with interventions proposed, but few have addressed the impact on fathers or other family members. The present review examined systematic reviews that addressed PD in NICU and potential interventions. METHODS A meta-review was performed by searching various databases between 2000 and May 2024. RESULTS Fifty-four studies were included. The incidence of maternal PD varied depending on the screening tool used (13-93%), as did paternal PD (0.08-46%). The incidence of PD in sexual, racial and gender minorities, siblings, grandparents and those in lower-middle income countries is not known. Numerous screening tools were used with a wide variety of cut-off values. Various intervention programmes were evaluated and showed contradictory evidence regarding their effect on PD. DISCUSSION Routine screening should be implemented together with a combination of interventional programmes, specifically family-centred interventions. More research is required for PD in siblings, sexual and gender minority parents as well as parents living in low middle income countries. IMPACT STATEMENT Psychological distress is high in NICU, affecting parents and siblings. Maternal psychological distress may have long lasting effects on infant health and differs from that of fathers, who require as much attention as mothers Little is known about emotional stress in siblings and sex and gender minority group peoples Few interventions showed conclusive effectiveness in reducing psychological distress with combination interventions showing more effectiveness than single interventions.
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Affiliation(s)
- Lizelle van Wyk
- Department Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
| | - Athenkosi P Majiza
- Department Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Cordelia S E Ely
- Department Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Lynn T Singer
- Departments of Population and Quantitative Health Sciences, Pediatrics, Psychiatry and Psychological Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Eriksson E, Lundqvist P, Jönsson L. Fathers' Experiences Six Months After their Preterm Infant's Discharge from the NICU. Compr Child Adolesc Nurs 2024:1-10. [PMID: 39320934 DOI: 10.1080/24694193.2024.2406209] [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: 01/22/2024] [Accepted: 08/24/2024] [Indexed: 09/26/2024]
Abstract
Although fathers experience emotional stress both during the care period and after discharge, there is limited research focusing exclusively on fathers' experiences after their time in a neonatal intensive care unit. Their experiences are important for tailoring support to fathers based on their individual needs. This paper is part of a longitudinal study in which parents were followed by means of questionnaires and individual interviews during a two-year period after discharge from hospital-based neonatal home care. A qualitative content analysis with an inductive approach was used to elucidate the experiences of fathers six months after their preterm infant's discharge. Twelve fathers participated in the study. The following categories emerged and constituted the result: "Vivid memories from the NICU," "Struggling with new challenges in life" and "Transition to home still in their thoughts." The approach and attitude of health-care professionals may contribute to fathers' involvement during the care period, as fathers tend to set their own feelings aside.
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Weiss EM, Gray MM, Ko LK, Duenas DM, Oslin E, Kraft SA. Development of the Better Research Interactions for Every Family (BRIEF) intervention to support recruitment for neonatal clinical trials: an intervention mapping guided approach. Trials 2024; 25:610. [PMID: 39267164 PMCID: PMC11395641 DOI: 10.1186/s13063-024-08446-6] [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] [Received: 03/27/2024] [Accepted: 09/02/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Recruitment for neonatal clinical trials can be particularly challenging. Low enrollment rates bias the research population and decrease generalizability of findings. We identified a critical need for an intervention to improve how researchers recruit for neonatal clinical trials. Working within the US neonatal research context, we developed the Better Research Interactions for Every Family (BRIEF) Intervention, which had two overarching goals: to improve the recruitment experience for all parents, focusing on minoritized populations, and to increase participation, focusing on decreasing disparities in research participation. METHODS We used intervention mapping (IM) to guide all steps of intervention development. IM is a planning framework that provides a systematic process and detailed protocol for step-by-step decision-making for intervention development, implementation, and evaluation. RESULTS We performed IM's six steps. In step 1, we convened two stakeholder groups, a parent panel and an expert panel, who provided guidance through development of all BRIEF components. Through a recent systematic review, empirical data collected by our team, and consultations with the panels, we identified key determinants (barriers and facilitators) of low enrollment rates and research team members as change agents. In step 2, we iteratively refined our list of key factors to include and linked determinants of behavior changes to these performance objectives. In step 3, we chose three theories (social cognitive theory, theory of information processing, and the trans-theoretical model), methods from identified practical applications suitable for the population (research team members) and the context (busy research NICU teams). In step 4, we developed and refined the intervention components, including self-guided pre-work and a single in-person session. In step 5, we identified the Darbepoetin plus slow-release intravenous iron trial as our partner study in which to pilot BRIEF. In step 6, we developed a multi-stage evaluation plan that included five distinct levels of outcomes. CONCLUSIONS This manuscript shares our rationale and processes for the creation of a research team member-facing intervention aiming to improve recruitment processes for neonatal clinical trials. Our approach can inform those aiming to improve recruitment for neonatal clinical trials and those who may be considering use of IM within similar contexts.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 4800 Sand Point Way NE, M/S FA.2.113 Neonatology, Seattle, WA, 98105, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Megan M Gray
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 4800 Sand Point Way NE, M/S FA.2.113 Neonatology, Seattle, WA, 98105, USA
| | - Linda K Ko
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 4800 Sand Point Way NE, M/S FA.2.113 Neonatology, Seattle, WA, 98105, USA
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, 4800 Sand Point Way NE, M/S FA.2.113 Neonatology, Seattle, WA, 98105, USA
| | - Stephanie A Kraft
- Department of Bioethics and Decision Sciences, Geisinger College of Health Sciences, Danville, PA, USA
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Catapano F, Steinwurtzel R, Parravicini E, Wool C. A qualitative analysis of parents' experiences while their neonates with congenital heart disease require intensive care. Front Pediatr 2024; 12:1425320. [PMID: 39301041 PMCID: PMC11410620 DOI: 10.3389/fped.2024.1425320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
Objective To better understand the experience of parents with neonates with congenital heart diseases (CHD) admitted to a neonatal intensive care unit (NICU) in order to identify challenges faced by parents and discover support strategies helpful in positive coping. Study design Prospective cohort study of parents of neonates with CHD. Parents completed a questionnaire with open ended questions regarding their experience and feeling during the hospitalization within one week of the child discharge from the NICU. Krippendorff's content analysis was used to examine data. Results Sixty-four parents participated. Three themes were highlighted - Dialectical parental experiences, Suboptimal Parental Experiences and Positive Parental Experiences - describing the state of being and feelings that these parents face. Through this analysis, we were able to develop clinical considerations and identify coping strategies. Conclusion The understanding of parental experience and challenges when dealing with their child admitted in the NICU is crucial to identify coping strategies to promote adaptation and enhance the development of positive coping mechanisms.
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Affiliation(s)
- Francesca Catapano
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Rochelle Steinwurtzel
- Department of Neonatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Elvira Parravicini
- Department of Neonatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Charlotte Wool
- Stabler Department of Nursing, York College of Pennsylvania, York, PA, United States
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Brødsgaard A, Bjerregaard M, Knudsen JB. Parents' Shared Experiences of Separation From Their Newborns After Birth in Denmark. J Obstet Gynecol Neonatal Nurs 2024; 53:534-542. [PMID: 38823787 DOI: 10.1016/j.jogn.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE To explore parents' shared experiences of separation from their newborns after birth in Denmark. DESIGN Phenomenological hermeneutic design. SETTING A NICU in the Capital Region of Denmark. PARTICIPANTS Four sets of parents (N = 8) with prematurely born neonates who were admitted to the NICU. METHODS We used dyadic interviews for data collection. We applied a phenomenological hermeneutic approach inspired by Ricoeur's theory of interpretation to analyze the data. RESULTS Two overarching themes emerged that reflected two distinct temporal phases of separation. Initial separation caused an experience of becoming parents at different paces. Separation based on care needs (i.e., the NICU vs. maternity unit) left parents at the juncture between separation and closeness. CONCLUSION Separation from their newborns complicated parents' transitions into parenthood. Their sense of unity was undermined when different units assumed responsibility for the mother and newborn. This challenged family-centered care. Our findings indicate the need to minimize separation through initiatives such as zero separation and couplet care.
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Schwab I, Wullenkord R, Ohnhäuser T, Dresbach T, Scholten N. Achieving sufficient milk supply supports mothers to cope with premature birth. Acta Paediatr 2024; 113:2039-2047. [PMID: 38863298 DOI: 10.1111/apa.17320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
AIM To explore whether and how expressing breast milk is perceived as helpful in coping with negative emotions due to premature birth by mothers of very low birth weight (VLBW) infants. METHODS Qualitative interviews and a retrospective cross-sectional questionnaire with mothers of VLBW infants were conducted and analysed using an exploratory sequential mixed-method design. Hypotheses were built using qualitative content analysis and quantitatively tested using multivariate regression analysis. RESULTS Interviews with 12 mothers and questionnaires of 518 mothers were analysed. Coping with prematurity by expressing milk was seen as a way to maintain the caregiving role for the mothers, where three relevant factors arouse: making up for what happened, providing the best for their infant and fear of low milk supply. Quantitative analysis showed that mothers with a high milk supply (Coef. = 1.1, p < 0.000) and more feelings of guilt due to premature birth (Coef. = -0.1; p = 0.015) perceived expressing breast milk significantly more as a resource for coping. CONCLUSION This study adds knowledge on how expressing breast milk for their VLBW infant may support mothers in coping with premature birth, by revealing the association with milk supply and feelings of guilt due to premature birth.
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Affiliation(s)
- Isabella Schwab
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ricarda Wullenkord
- CITEC Center for Cognitive Interaction Technology, University Bielefeld, Bielefeld, Germany
| | - Tim Ohnhäuser
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Bonn, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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8
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Warren KF, Dail RB, Dawson RM, Boghossian NS, Felder TM. When a baby is born, so is a parent: Understanding the effects of preterm birth on Black parents through the lens of the NIMHD framework. Nurs Outlook 2024; 72:102246. [PMID: 39116649 DOI: 10.1016/j.outlook.2024.102246] [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: 01/29/2024] [Revised: 06/29/2024] [Accepted: 07/06/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery. PURPOSE The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health. METHODS We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities. DISCUSSION This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse. CONCLUSION In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.
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Affiliation(s)
- Karen F Warren
- University of South Carolina, College of Nursing, Columbia, SC.
| | - Robin B Dail
- University of South Carolina, College of Nursing, Columbia, SC
| | - Robin M Dawson
- University of South Carolina, College of Nursing, Columbia, SC
| | - Nansi S Boghossian
- University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Tisha M Felder
- University of South Carolina, College of Nursing, Columbia, SC
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Lazzerini M, Bua J, Vuillard CLJ, Squillaci D, Tumminelli C, Panunzi S, Girardelli M, Mariani I. Characteristics of intervention studies on family-centred care in neonatal intensive care units: a scoping review of randomised controlled trials. BMJ Paediatr Open 2024; 8:e002469. [PMID: 39103175 DOI: 10.1136/bmjpo-2023-002469] [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: 12/20/2023] [Accepted: 02/10/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Different definitions of family-centred care (FCC) exist in the newborn setting, and many FCC interventions have been tested, while a comprehensive review synthesising characteristics of existing intervention studies is still lacking. OBJECTIVE This review aims at summarising the characteristics of randomised controlled trials (RCTs) on FCC interventions in neonatal intensive care units. METHODS We searched PubMed, Embase, Web of Science and the Cochrane Library up to 31 January 2022, and reference lists of included studies and other reviews. Interventions were grouped into five categories according to a previous Cochrane review: (1) family support, (2) educational, (3) communication, (4) environmental interventions and (5) family-centred policies. Subgroup analyses by time period (RCTs published before vs after 2016) and by country income (based on the World Bank Classification) were conducted. RESULTS Out of 6583 retrieved studies, 146 RCTs met the eligibility criteria, with 53 (36.3%) RCTs published after 2016. Overall, 118 (80.8%) RCTs were conducted in high-income countries, 28 (19.1%) in middle-income countries and none in low-income countries. Only two RCTs were multicountry. Although mothers were the most frequent caregiver involved, fathers were included in 41 RCTs (28.1%). Very few studies were conducted in at-term babies (nine RCTs); siblings (two RCTs) and other family members (two RCTs), maternity care units (two RCTs). The role of health professionals was unclear in 65 (44.5%) RCTs. A large variety of intervention combinations was tested, with 52 (35.6%) RCTs testing more than 1 category of interventions, and 24 (16.4%) RCTs including all 5 categories. CONCLUSION There is a large and rising number of RCTs on FCC interventions in neonatal intensive care units, with specific research gaps. The large variety of FCC interventions, their high complexity, the need to tailor them to the local context and major gaps in implementation suggest that implementation research is the current priority.
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Affiliation(s)
- Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
- Maternal Adolescent Reproductive and Child Health Care Centre, Faculty of Epidemiology and Population Health, LSHTM, London, UK
| | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Domenica Squillaci
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristina Tumminelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Silvia Panunzi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Martina Girardelli
- Department of Paediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Guttmann KF, Raviv GN, Fortney CA, Ramirez M, Smith CB. Parent Perspectives on Communication Quality in the Neonatal Intensive Care Unit. Adv Neonatal Care 2024; 24:382-388. [PMID: 38975667 PMCID: PMC11334642 DOI: 10.1097/anc.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Though prior literature has demonstrated that communication in the Neonatal Intensive Care Unit (NICU) needs to be improved, in-depth descriptions of parents' views of NICU communication are lacking. PURPOSE We sought (1) to explore parent perceptions of communication in the NICU and (2) to understand parents' communication needs and preferences. METHODS We conducted in-depth semi-structured cognitive interviews utilizing concurrent probes with parents of 10 patients in our urban level IV Neonatal Intensive Care Unit over a period of 4 months (July 2021-October 2021). Interview questions were derived from the Quality of Communication scale. We conducted thematic analysis of interview transcripts modeled after work by Braun and Clarke. RESULTS Four overarching themes were identified: Strengths, Challenges, People, and Coping Strategies. Parents reported a range of communication quality in the NICU. Results revealed that the first 48 hours of NICU hospitalization represent a period of vulnerability and uncertainty for parents. Parents value clear yet hopeful communication about a baby's clinical status and expected course. IMPLICATIONS FOR PRACTICE AND RESEARCH We hope that the concrete findings from this study can both inform practice in the NICU now and influence practice guidelines to include such components as emphasis on the first 48 hours, desire for proactive information sharing, and the importance of including hope.
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Affiliation(s)
- Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Guttmann and Ms Raviv); The Ohio State University College of Nursing Martha S. Pitzer Center for Women, Children, and Youth, Columbus, Ohio (Dr Fortney); Research Division, Hebrew Home at Riverdale, Riverdale, New York, USA (Dr Ramirez); Division of Hematology and Medical Oncology, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith); Brookdale Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith and Dr Guttmann)
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Li X, Lin Y, Huang L, Lin H, Cheng X, Li S, Hu R, Liao J. Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial. Intensive Crit Care Nurs 2024; 83:103697. [PMID: 38583413 DOI: 10.1016/j.iccn.2024.103697] [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] [Received: 12/23/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To examine the effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit. DESIGN Prospective randomized controlled parallel-group clinical trial. SETTING Maternal and Child Health Hospital, Fujian, China. METHODS The control group received routine neonatal intensive care unit care, while the intervention group received a web neonatal intensive care unit diary based on routine care. Outcomes, including anxiety, depression, and post-traumatic stress disorder symptoms, quality of life, sleep quality, care ability, and cortisol and melatonin levels, were evaluated at T1 (Time 1, before the intervention), T2 (Time 2, immediately after the intervention), and T3 (Time 3, 1 month after the intervention). RESULTS Seventy pairs of parents of preterm infants in the neonatal intensive care unit were randomly allocated to two groups: intervention (n = 35) and control (n = 35). The anxiety scores in the intervention group were significantly lower at T2 and T3 than those in the control group (P < 0.001). The care ability scores in the intervention group were significantly higher at T2 and T3 (P < 0.001). The prevalence of post-traumatic stress disorder at T3 was significantly different between the groups (P = 0.040). No significant differences were observed in the quality of life or sleep quality between the groups at T2 and T3 (P > 0.05). No significant differences were observed in cortisol and melatonin levels between the groups (P > 0.05). CONCLUSIONS Web neonatal intensive care unit diaries effectively relieved anxiety symptoms, reduced the prevalence of post-traumatic stress disorder, and enhanced the care abilities of parents of preterm infants in the neonatal intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE Web neonatal intensive care unit diary can be considered in clinical practice as a convenient psychological intervention method, especially among parents of preterm infants in the neonatal intensive care unit.
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Affiliation(s)
- Xiaoting Li
- The School of Nursing, Fujian Medical University, Fuzhou, China; Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Ying Lin
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Long Huang
- Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
| | - Huimin Lin
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiao Cheng
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Sijia Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Rongfang Hu
- The School of Nursing, Fujian Medical University, Fuzhou, China.
| | - Jinhua Liao
- The School of Nursing, Fujian Medical University, Fuzhou, China; The Nursing National Experimental Learning Demonstration Center, Fujian Medical University, Fuzhou, China.
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12
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Karvonen KL, Smith O, Chambers-Butcher B, Afulani P, Mathis-Perry T, Rangwalla K, McLemore M, Rogers EE. Parent and staff focus groups to address NICU racial inequities: "There's radical optimism in that we're in a different time and we're not doing it alone". J Perinatol 2024:10.1038/s41372-024-02063-6. [PMID: 39025956 DOI: 10.1038/s41372-024-02063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES To understand local mechanisms of racial inequities and generate recommendations from community members regarding how to promote racial equity in the Neonatal Intensive Care Unit (NICU). METHODS In an urban tertiary care NICU, 4 semi-structured in-person focus groups with follow-up audio diaries were conducted with NICU parents and staff from 2022-2023 with support from interpreters, a psychologist, and a family advocate. Researchers coded transcripts independently and thematic analysis was utilized to generate and refine themes. RESULTS 16 racially diverse and multidisciplinary staff and parents participated, and six themes emerged from the data. Mechanisms of racial inequities included power dynamics, interpersonal and institutional dehumanization, and societal inequities. Recommendations included redistributing power, transforming space and staff to promote humanism, and mitigating harm through peer support and resource allocation. CONCLUSION Focus groups are a promising strategy to identify interventions to address racial inequities. Future research should focus on intervention implementation and evaluation.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
- California Preterm Birth Initiative, San Francisco, CA, USA.
| | - Olga Smith
- Independent Researcher, Antioch, CA, USA
| | - Brittany Chambers-Butcher
- California Preterm Birth Initiative, San Francisco, CA, USA
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, USA
| | - Patience Afulani
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Khuzaima Rangwalla
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Monica McLemore
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- California Preterm Birth Initiative, San Francisco, CA, USA
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13
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Cigdem Z, Guler S, Yavas Celik M. Restriction of visits to neonatal intensive care units in the COVID-19 pandemic. J Eval Clin Pract 2024. [PMID: 38976629 DOI: 10.1111/jep.14092] [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: 04/26/2024] [Revised: 06/07/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
AIMS The aim of this study, it examine how visits to neonatal intensive care units were made during the COVID-19 process and how mothers were affected by this process. METHODS In this phenomenological study, interviews were conducted with semi-structured questions and face-to-face interviews with the participants. While collecting the data, both observation and interview techniques were used. A content analysis technique was used to analyse the data. RESULTS The findings of the study were gathered under two themes: 'mothers' recommendations about visits in neonatal intensive care units' and 'mothers' fear of transmitting COVID-19'. CONCLUSION As a result, visitor restrictions implemented during the pandemic period hurt on newborns. During the pandemic period, visitor restrictions were imposed in neonatal intensive care units around the world. Unfortunately, in our study, it was determined that this restriction was made. This situation may have adversely affected the mother-infant attachment and the growth and development of the baby and may have led to irreversible problems. Therefore, newborn nurses should give more importance to mother-infant interaction and continue their treatment and care without separating infants from their mothers.
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Affiliation(s)
- Zerrin Cigdem
- Department of Nursing, Faculty of Health Sciences, Istanbul Topkapı University, Gaziantep, Turkey
| | - Selver Guler
- Department of Nursing, Faculty of Health Sciences, Kilis 7 Aralık University, Kilis, Turkey
| | - Melike Yavas Celik
- Department of Midwifery, Faculty of Health Sciences, Gaziantep University, Gaziantep, Turkey
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Franco Fuenmayor ME, Fawcett A, Schwartz KE, Horner S, Balasundaram M, Burke BL, Bean KA, Russell LN, Simonton E, Machut KZ, Fry JT. Understanding family-centered care in the NICU: a scoping review protocol. JBI Evid Synth 2024; 22:1379-1386. [PMID: 38385497 DOI: 10.11124/jbies-23-00252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This scoping review will aim to identify and categorize the definitions of neonatal intensive care unit (NICU) family-centered care (FCC) and its associated concepts. It also aims to identify and categorize the practices and interventions that comprise NICU FCC, and catalog the metrics used to evaluate NICU FCC. INTRODUCTION FCC has been identified as an important element of care for neonates and infants admitted to the NICU, and there is clear evidence that the incorporation of families in care improves clinical outcomes. However, FCC has been linked to numerous associated terms and concepts and lacks a unifying definition or framework, thus limiting the ability to categorize, prioritize, and identify practices and interventions to optimize both institutional approaches for individual centers and for the field at large. INCLUSION CRITERIA Studies that include or apply at least one FCC concept or its associated terms will be considered eligible for inclusion. Studies not related exclusively to the NICU will be excluded. METHODS The review will follow the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Several electronic databases and sources of gray literature will be searched from 1992 to the present day. The review will include only full-text studies in English and will be independently screened by a minimum of 2 authors. Data will be extracted using a modified JBI data extraction tool and presented using narrative summaries; concept mapping; and categorization of practices, interventions, and metrics.
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Affiliation(s)
- Maria E Franco Fuenmayor
- Department of Pediatrics, Division of Neonatology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea Fawcett
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical and Organizational Development, Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine E Schwartz
- Division of Neonatal-Perinatal Medicine, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Susan Horner
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Malathi Balasundaram
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Barbara Lawlor Burke
- Patient Family Experience Department, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine A Bean
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Laura N Russell
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jessica T Fry
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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15
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Landsem IP, Handegård BH. Parental reports of hospital- and community-based follow-up services, self-efficacy, and symptoms of depression a few months after discharge of a prematurely born child. BMC Public Health 2024; 24:1630. [PMID: 38898436 PMCID: PMC11186226 DOI: 10.1186/s12889-024-19079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Many parents report the transition from hospital to home as challenging after the birth of a preterm-born child. This study investigates parental perceptions of community-based follow-up services after hospital discharge, alterations in parental self-efficacy during the early months at home, the prevalence of depressive symptoms among parents, and the relationship between these factors and both NICU experiences and children's regulative behaviors. METHODS In this second phase of a descriptive study, 110 parents returned a digital questionnaire when their child was four months corrected for prematurity. Parents were recruited while hospitalized with their child, in one of eight Norwegian neonatal intensive care units (NICUs). Thus, the study provides insight into follow-up services across a broad geographical range. Parents' perception of self-efficacy was reported on the Karitane Parenting Confidence Scale, and depressive symptoms were evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Children's regulative behavior was reported on the 6-month version of the Ages and Stages Questionnaire: Social and Emotional (ASQ: SE). Using SPSS, associations between variables were investigated in multiple regression analysis in addition to descriptive analysis. Additionally, the examination of repeated measures of parental self-efficacy involved the application of linear mixed models. RESULTS Parents reported improved perception of self-efficacy from postdischarge to the children's age of four months (F (1,167) = 1233.2, p < 0.001). On average, fathers' self-efficacy improved more than that of mothers. Parents' perception of being well informed prior to discharge from hospital predicted improved self-efficacy (F [1, 29] = 10.4, p = 0.003). Reports of depressive symptoms were at a similar level as previously reported among new parents, as 10.4% of mothers and 6.7% of fathers reported EPDS scores ≥ 10 points. Parents' reports on ASQ: SE show that 15% of the children scored above the recommended cutoff score for three- to nine-month-old children. The parent-reported benefit of follow-up services showed considerable variation. The importance of specific knowledge about prematurity among public health nurses and physicians was frequently mentioned, and public health nurses were perceived as coordinators and mediators of various services. CONCLUSIONS Parents reported improved self-efficacy, and depressive symptoms at similar levels as new parents in general, a few months after discharge from hospital. Childrens' regulatory behavior were reported at levels comparable with term-born infants.
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Affiliation(s)
- Inger Pauline Landsem
- Health Research Faculty, Institute of Health and Caring Sciences, UIT the Arctic University of Norway, Tromsø, Norway.
| | - Bjørn Helge Handegård
- Health Research Faculty, UIT the Arctic University of Norway, RKBU North, Tromsø, Norway
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16
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Hoeben H, Obermann-Borst SA, Stelwagen MA, van Kempen AAMW, van Goudoever JB, van der Schoor SRD, van Veenendaal NR. 'Not a goal, but a given': Neonatal care participation through parents' perspective, a cross-sectional study. Acta Paediatr 2024; 113:1246-1256. [PMID: 38436526 DOI: 10.1111/apa.17179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
AIM To explore parents' perspectives regarding participation in neonatal care, with focus on the family integrated care (FICare) model utilised as a tool to enhance parent-infant closeness. Additionally, we describe experiences in different architectural settings. METHODS An online survey, categorised by four FICare pillars, was distributed through social media to parents of newborns hospitalised to Dutch neonatal wards between 2015 and 2020. Quantitative findings were summarised using descriptive statistics, while open-ended responses were thematically analysed. RESULTS Among the 344 respondents (98% mothers), most reported feeling involved in care (315/340). However, 79% also felt separated from their infant (265/337). Irrespective of architectural settings, parents reported incomplete implementation of FICare pillars: 14% was invited to educational sessions (parent education), 51% discussed family-specific care plans (staff education), 21% was facilitated in connecting with veteran parents (psychosocial support) and 22% received couplet-care (environment). Although 65% of parents were invited to attend clinical rounds, 32% actively participated in decision making. Thematic analysis revealed fundamentals for feeling welcome on the ward, peer-to-peer support, psychosocial support and participation in clinical rounds. CONCLUSION Overall, parents expressed satisfaction with participation in neonatal care. However, structural implementation of FICare lacks. Regardless of architecture, expanding parent participation beyond presence requires attention.
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Affiliation(s)
- Hannah Hoeben
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, The Netherlands
- Emma Children's Hospital Department of Pediatrics, Amsterdam UMC, University of Amsterdam, VU University, Amsterdam, The Netherlands
| | | | | | | | - Johannes B van Goudoever
- Emma Children's Hospital Department of Pediatrics, Amsterdam UMC, University of Amsterdam, VU University, Amsterdam, The Netherlands
| | - Sophie R D van der Schoor
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, The Netherlands
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nicole R van Veenendaal
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, The Netherlands
- Emma Children's Hospital Department of Pediatrics, Amsterdam UMC, University of Amsterdam, VU University, Amsterdam, The Netherlands
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17
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Moreno-Sanz B, Alferink MT, O'Brien K, Franck LS. Family integrated care: State of art and future perspectives. Acta Paediatr 2024. [PMID: 38738866 DOI: 10.1111/apa.17272] [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: 10/29/2023] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
Family integrated care (FICare) represents a contemporary approach to health care that involves the active participation of families within the healthcare team. It empowers families to acquire knowledge about the specialised care required for their newborns admitted to neonatal intensive care unit (NICU) and positions them as primary caregivers. Healthcare professionals in this model act as mentors and facilitators during the hospitalisation period. This innovative model has exhibited notable enhancements in both short- and long-term health outcomes for neonates, alongside improved psychological well-being for families and heightened satisfaction among healthcare professionals. Initially designed for stable premature infants and their families, FICare has evolved to include critically ill premature and full-term infants. Findings from recent studies affirm the safety and feasibility of FICare as a NICU-wide model of care, benefiting all infants and families. The envisioned expansion of FICare focusses on sustainability and extending its implementation, recognising the necessity for tailored adaptations to suit varying diverse cultural and socio-economic contexts.
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Affiliation(s)
- Bárbara Moreno-Sanz
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research-IdIPAZ, Madrid, Spain
| | - Milène Tirza Alferink
- Division of Pediatrics/Neonatology, OLVG, Location East and West, Amsterdam, The Netherlands
| | - Karel O'Brien
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
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18
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Romanis EC, Adkins V. Artificial placentas, pregnancy loss and loss-sensitive care. JOURNAL OF MEDICAL ETHICS 2024; 50:299-307. [PMID: 37932017 DOI: 10.1136/jme-2023-109412] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
In this paper, we explore how the prospect of artificial placenta technology (nearing clinical trials in human subjects) should encourage further consideration of the loss experienced by individuals when their pregnancy ends unexpectedly. Discussions of pregnancy loss are intertwined with procreative loss, whereby the gestated entity has died when the pregnancy ends. However, we demonstrate how pregnancy loss can and does exist separate to procreative loss in circumstances where the gestated entity survives the premature ending of the pregnancy. In outlining the value that can be attached to pregnancy beyond fetal-centric narratives, we illustrate how pregnancy loss, separate to procreative loss, can be experienced. This loss has already been recognised among parents who have experienced an unexpected early ending of their pregnancy, resulting in their child being cared for in neonatal intensive care unit. Artificial placentas, however, may exacerbate these feelings and make pregnancy loss (without procreative loss) more visible. We argue that pregnancy is an embodied state in which gestation is facilitated by the body but gestation itself should be recognised as a process-and one that could be separable from pregnancy. In demarcating the two, we explore the different ways in which pregnancy loss can be understood. Our objective in this paper goes beyond contributing to our philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding the artificial placenta. We make recommendations including the need for counselling and careful consideration of the language used when an artificial placenta is used.
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Affiliation(s)
- Elizabeth Chloe Romanis
- Centre for Ethics and Law in the Life Sciences, Durham Law School, Durham University, Durham, UK
| | - Victoria Adkins
- School of Law and Criminology, University of Greenwich, London, UK
- School of Law and Social Sciences, Royal Holloway University of London, Egham, UK
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Torbert N, Taladay C, Kauer T, Hackenburg L, Weaver MS, Kellas JK. Providing "Compassionate Care" in the Neonatal Intensive Care Unit Through Infant and Family Needs-Based Care. Am J Perinatol 2024; 41:e863-e869. [PMID: 36451625 DOI: 10.1055/s-0042-1758725] [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: 12/05/2022]
Abstract
OBJECTIVE Provision of compassionate care to infants and their families in the neonatal intensive care unit (NICU) is a key component of competent critical care. Although recognized as an essential aspect of NICU care, compassionate care for infants and families in a NICU setting has been underexplored. This study defined and described compassionate care according to NICU staff. STUDY DESIGN Voice-recorded, face-to-face individual interviews occurred with NICU nurses (n = 45), NICU nurse practitioners (n = 15), and neonatologists (n = 9) from two NICUs in the midwestern United States. Semantic content analysis was used. Consolidated criteria for Reporting Qualitative research guidelines were followed. RESULTS Three dynamic and interactive qualitative themes emerged: excellent standard of intensive care, commitment, and engaged family communication. A conceptual framework entitled patient and family needs-based care was developed from the qualitative interviews. CONCLUSION The framework developed from this study supports the therapeutic journey of NICU infants and families by integrating a focus on compassionate personalized care within the context of keen clinical and communication skillsets that staff have gained throughout their NICU careers. KEY POINTS · While clinical competence is emphasized as a practice standard, compassion remains a core care value.. · A working definition of compassionate care and the description of its defining pillars has been underexplored.. · This study describes the perspectives of NICU staff on the actionable components of compassionate care for ill infant and their families..
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Affiliation(s)
- Nicholas Torbert
- Division of Neonatology, Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital Medical Center, Omaha, Nebraska
| | - Cassidy Taladay
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Trevor Kauer
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Lucas Hackenburg
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital Medical Center, Omaha, Nebraska
| | - Jody Koenig Kellas
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
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Tajik F, Mahmoodi M, Azodi P, Jahanpour F. Nurse-mother communication and support: Perceptions of mothers in neonatal units. Heliyon 2024; 10:e29325. [PMID: 38644893 PMCID: PMC11033110 DOI: 10.1016/j.heliyon.2024.e29325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Having a hospitalized neonate is a stressful experience for parents, especially mothers. Thus, in recent years, a paradigm shift occurred in the neonatal units, focusing on the needs of parents and supporting them in addition to caring for neonates. The aim of this study was to evaluate the nurse-mother communication and support in neonatal units in Bushehr, Iran. Method This descriptive cross-sectional study was performed in neonatal units of 6 hospitals in Bushehr, Iran, in 2022. Using the census method, all eligible mothers who met the inclusion criteria were included in this study. Data collection tools included demographic information form, nurse-parent support tool and nurse-parent communication questionnaire. The collected data were analyzed by SPSS version 24 using descriptive statistics, independent t-test, one-way ANOVA and Pearson correlation test. Results The total mean score of nurse-parent support tool was 3.72 ± 0.72 and the total mean score of nurse-parent communication questionnaire was 59/27 ± 12/82. Caregiving support had the highest mean score (4.07 ± 73 0.73) and emotional support had the lowest (3.42 ± 91 0.91). Also, a statistically significant difference was seen between the admitted unit variable and the mean score of nurse-mother communication and support. Additionally, there was a statistically significant difference between the mechanical ventilation status of the neonate and the mean score of nurse-mother support. A significant positive correlation was seen between the neonatal gestational age and the mean score of nurse-mother communication. Conclusions The total mean score of nurse-parent support and communication was moderate. Therefore, nursing support and communication need to be improved. Planning is needed to enhance the role of neonatal nurses and strengthen their support and communication skills in line with the family-centered care approach.
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Affiliation(s)
- Farnoosh Tajik
- Department of Pediatric and Neonatal nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
- MSc in Pediatric Nursing, Nursing and Midwifery Department, Member of Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Marzieh Mahmoodi
- Biostatistics and Epidemiology Department, Health and Nutrition Faculty, Clinical Research Development Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Parviz Azodi
- Paramedical Sciences Department, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Faezeh Jahanpour
- Nursing and Midwifery Department, Bushehr University of Medical Sciences, Bushehr, Iran
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Bua J, Dalena P, Mariani I, Girardelli M, Ermacora M, Manzon U, Plet S, Travan L, Lazzerini M. Parental stress, depression, anxiety and participation in care in neonatal intensive care unit: a cross-sectional study in Italy comparing mothers versus fathers. BMJ Paediatr Open 2024; 8:e002429. [PMID: 38589039 PMCID: PMC11002394 DOI: 10.1136/bmjpo-2023-002429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/06/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND This study aimed at documenting the levels of stress, depression, anxiety and participation in care among mothers versus fathers of newborns hospitalised in a third-level neonatal intensive care unit (NICU) in Northern Italy. METHODS Parental stress, depression and anxiety were assessed by the Parental Stressor Scale in NICU (PSS:NICU), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Participation in care was evaluated with the Index of Parental Participation. Differences between mothers and fathers were assessed with the Mood's median test and z-test, respectively for continuous and discrete variables. Multivariate analyses controlling for potential confounders were performed to confirm gender differences. RESULTS 191 parents (112 mothers and 79 fathers) were enrolled. Mothers reported significantly higher median scores for stress (2.9 vs 2.2, p<0.001) and trait anxiety (37 vs 32, p=0.004) and higher depression rates (EPDS ≥12: 43.8% vs 19.0%, p<0.001). 'High stress' (PSS:NICU ≥3) was reported by 45.5% of mothers compared with 24.1% of fathers (p=0.004). The frequency of the three conditions simultaneously was significantly higher among mothers (20.0% vs 3.8%, p=0.016), with the vast majority of mothers (76.0%) suffering from at least one condition compared with less than half of fathers (45.3%, p<0.001). Participation in care was more frequent in mothers (median score: 19 vs 15, p<0.001), with the exception of activities related to advocacy (median 5 vs 4, p=0.053). In a multivariate analysis, gender differences in mental health outcomes did not change. CONCLUSIONS Routine screening of mental distress among parents of infants in NICU is warranted, and gender differences need to be acknowledged in order to deliver tailored support and to promote collaboration with the family of vulnerable newborns. Knowledge and skills on how to prevent and cope with mental distress of parents should be part of the core curriculum of staff working in NICU.
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Affiliation(s)
- Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Paolo Dalena
- Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
- University of Trieste, Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Martina Girardelli
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Maddalena Ermacora
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Ursula Manzon
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Sabrina Plet
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Laura Travan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
- Maternal Adolescent Reproductive and Child Health Care Centre, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
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Rodrigo R, Amir LH, Forster DA. Parents' Views on Prolonged Maternal Hospital Stay With Sick Newborn Infants in a Tertiary Neonatal Unit in Sri Lanka. Adv Neonatal Care 2024; 24:162-171. [PMID: 38545806 DOI: 10.1097/anc.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Mothers of infants in most Sri Lankan neonatal units are required to be "inpatients" during the entirety of their infant's stay. This traditional practice is closely aligned to the relatively newer model of family-integrated care. PURPOSE Exploration of parent's views regarding the expectation for mothers to remain in hospital for the entire duration of their infant's neonatal unit stay. METHODS Cross-sectional study of parents of infants admitted to the University neonatal unit of Colombo North Teaching Hospital, Ragama, Sri Lanka, using self-administered questionnaires in 2017. RESULTS We found that 40% (19/48) of mothers and 43% (16/37) of fathers preferred that mothers traveled from home, rather than being inpatients continuously, in order to care for older children, receive psychological support from family, and also due to other practical inconveniences of living in the hospital. The main barriers to women being able to travel from home were the need to safely provide expressed human milk for their hospitalized infants and current hospital administrative and societal attitudes. IMPLICATIONS FOR PRACTICE AND RESEARCH We found that a considerable number of parents with infants in the neonatal intensive care unit in Sri Lanka would like the option of the mother being able travel from home, rather than being confined to hospital. To facilitate this option, changes in hospital protocols and further research into storage and transportation of expressed mother's milk will be required. Improving facilities in hospital and providing more opportunities for families to interact with infants in neonatal intensive care unit will encourage mothers to remain in hospital continuously.
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Affiliation(s)
- Ranmali Rodrigo
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Melbourne, Victoria, Australia (Drs Rodrigo, Amir, and Forster); Department of Paediatrics, University of Kelaniya, Ragama, Sri Lanka (Dr Rodrigo); Department of Paediatrics, Mercy Hospital for Women, Heidelberg, Melbourne, Australia (Dr Rodrigo); and Midwifery and Maternity Services Research, The Royal Women's Hospital, Parkville, Melbourne, Australia (Dr Forster)
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23
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Weber A, Bakas T, Schulman-Green D, Voos KC, Rice JB, Bailey R, Reigel A, Oudat Q, Holmes M, Tubbs-Cooley HL, Kaplan HC. Family Management Skills Reported by Parents of Preterm Infants in the NICU Using the Self- and Family Management Framework (SFMF). Adv Neonatal Care 2024; 24:119-131. [PMID: 38127650 PMCID: PMC10978294 DOI: 10.1097/anc.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Across the globe, family-integrated care (FICare) has become an evidence-based standard in which parents deliver the majority of infant care in the neonatal intensive care unit (NICU). Because of extensive barriers to parent presence, adaptations to FICare may be required for successful implementation. Family management theory may provide structure to the Parent Education of FICare and help nurses guide parents' skill development as equal care members. PURPOSE To identify family management skills employed by NICU parents using the Self- and Family Management Framework (SFMF). METHODS We conducted secondary analyses of qualitative interview data from NICU parents (n = 17) who shared their experiences of using family management skills to care for their infant. We categorized skills according to 3 main self- and family management processes: Focusing on Infant Illness Needs; Activating Resources; and Living With Infant Illness. RESULTS Parents reported several family management skills currently identified in the SFMF, as well as new skills such as conflict management, power brokerage, and addressing resources related to social determinants of health. Parent activation of resources was critical to sustaining parent focus on the infant's illness needs. IMPLICATIONS FOR PRACTICE AND RESEARCH By teaching skills that parents reported as helping them manage infant care, neonatal nurses may better facilitate parent integration into the care team. Future researchers can incorporate the skills identified in this study into the design of family management interventions that facilitate FICare implementation in the United States.
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Affiliation(s)
- Ashley Weber
- Author Affiliations: University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Weber and Bakas and Mr Oudat); New York University Rory Meyers College of Nursing, New York City, New York (Dr Schulman-Green); Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Voos, Mr Bailey, and Mss Reigel and Holmes); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Dr Rice); The Ohio State University, Columbus, Ohio (Dr Tubbs-Cooley); and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kaplan)
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Siva N, Phagdol T, S Nayak B, Glane Mathias E, Edward S Lewis L, Velayudhan B, Shankar N R, D'Souza P. Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: Systematic review and meta-analysis evidence available from India. Stress Health 2024; 40:e3301. [PMID: 37596955 DOI: 10.1002/smi.3301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/21/2023]
Abstract
The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J-Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta-analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy.
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Affiliation(s)
- N Siva
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Tenzin Phagdol
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Edlin Glane Mathias
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Leslie Edward S Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Ravi Shankar N
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Preethy D'Souza
- Social Research Institute, UCL Institute of Education, University College London, London, UK
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25
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Weiss EM, Donohue PK, Wootton SH, Stevens E, Merhar SL, Puia-Dumitrescu M, Mercer A, Oslin E, Porter KM, Wilfond BS. Motivations for and against Participation in Neonatal Research: Insights from Interviews of Diverse Parents Approached for Neonatal Research in the United States. J Pediatr 2024; 275:113923. [PMID: 38492913 PMCID: PMC11399325 DOI: 10.1016/j.jpeds.2024.113923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To describe parents' motivations for and against participation in neonatal research, including the views of those who declined participation. STUDY DESIGN We performed 44 semi-structured, qualitative interviews of parents approached for neonatal research. Here we describe their motivations for and against participation. RESULTS Altruism was an important reason parents chose to participate. Some hoped participation in research would benefit their infant. Burdens of participation to the family, such as transportation to follow up (distinct from risks/burdens to the infant), were often deciding factors among those who declined participation. Perceived risks to the infant were reasons against participation, but parents often did not differentiate between baseline risks and incremental risk of study participation. Concerns regarding their infant being treated like a "guinea pig" were common among those who declined. Finally, historical abuses and institutional racism were reported as important concerns by some research decliners from minoritized populations. CONCLUSIONS Within a diverse sample of parents approached to enroll their infant in neonatal research, motivations for and against participation emerged, which may be targets of future interventions. These motivations included reasons for participation which we may hope to encourage, such as altruism. They also included reasons against participation, which we may hope to, as feasible, eliminate, mitigate, or at least acknowledge. These findings can help clinical trialists, regulators, and funders attempting to improve neonatal research recruitment processes.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan H Wootton
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Emily Stevens
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Amanda Mercer
- Counselor Education Department, Portland State University, Portland, OR
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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26
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Karimi M, Bakht R, Tapak L, Refaei M, Basiri B. The effect of empowerment counseling on stress and self-esteem of mothers with hospitalized premature infants. J Reprod Infant Psychol 2024; 42:315-326. [PMID: 35642688 DOI: 10.1080/02646838.2022.2081674] [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] [Received: 12/20/2021] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to investigate the effect of counselling on stress and self-esteem of mothers with hospitalized premature infants. MATERIALS AND METHODS This parallel randomized clinical trial was conducted on 80 primigravida mothers aged 18-40 years, gestational age of 28-34 weeks in 2021 in Iran. The women were randomly assigned to two groups by blocked randomization. The data were collected using a demographic information questionnaire, Paternal Stress Scale and Rosenberg self-esteem questionnaire. Individual counselling based on the GATHER model was carried out within two consecutive weeks in four sessions. Data were analyzed with SPSS 24. RESULTS There was no significant difference between the two groups in demographic variables, stress, and self-esteem before the intervention (P>0.05). There was a substantial difference in the mean score of self - esteem 9.52±3.22 and 16.75±6.39 (P<0.001), stress 154.65±32.15and 61±10.98 (P<0.001) and different dimensions of stress between the control and intervention groups after the intervention. The most significant reduction occurred in the dimension of appearance and behaviour of the infant (cohen d=3.146). CONCLUSIONS The results show counselling with an empowerment approach based on the GATHER model is effective in reducing stress and increasing self-esteem of mothers of premature infants admitted to the intensive care unit.
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Affiliation(s)
- Marzieh Karimi
- Department of Mother and Child Health, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rafat Bakht
- Department of Mother and Child Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health ND Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mansoureh Refaei
- Department of Mother and Child Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behnaz Basiri
- Department of Pediatrics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Weiss EM, Porter KM, Oslin E, Puia-Dumitrescu M, Donohue PK, Merhar SL, Stephens E, Mercer A, Wilfond BS. Experiences and preferences for learning about neonatal research: insights from parent interviews. J Perinatol 2024; 44:404-414. [PMID: 38001157 PMCID: PMC10939889 DOI: 10.1038/s41372-023-01790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Parents struggle with being asked to participate in neonatal research. Past work has largely failed to include views of minoritized parents, low-socioeconomic status parents, and those who declined research. We aimed to describe parents' preferences related to learning about eligibility for neonatal research. METHODS Qualitative interviews of parents who were asked to enroll their infant in neonatal research. Themes related to parental experiences and preferences for learning about neonatal research were identified using content analysis. RESULTS Many parents desired greater involvement of their clinical team. Emotions at the time of recruitment were critically important to parents' experience, where were deeply impacted by interpersonal relationships with research staff. DISCUSSION Increased involvement of the clinical team and greater sensitivity to the stressors around parent and infant conditions at the time of recruitment for neonatal research should be considered by those attempting to improve recruitment for neonatal research.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Emily Stephens
- McGovern Medical Center at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Amanda Mercer
- Counselor Education Department, Portland State University, Portland, OR, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Worrall S, Christiansen P, Khalil A, Silverio SA, Fallon V. Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress. Front Psychiatry 2024; 15:1323773. [PMID: 38463430 PMCID: PMC10921229 DOI: 10.3389/fpsyt.2024.1323773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction It is well established that a premature birth increases the likelihood of developing anxiety during the postpartum period, and that the environment of the neonatal intensive care unit (NICU) might be a contributing factor. Mothers of earlier premature infants may experience these anxieties to a higher degree compared to mothers of later premature infants. The aim of this study was to explore the association between prematurity and postpartum-specific anxiety, and the relationship between postpartum-specific anxiety and stress in the NICU. Materials and methods Mothers (N = 237) of infants aged between birth and 12 months completed an online survey containing the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). Structural equation modeling was used to analyze the relationship between gestational age and postpartum-specific anxiety, with one-way ANOVAs used to analyze this relationship with respect to categories of gestational age. Hierarchical regression models analyzed the relationship between postpartum-specific anxiety and stress in the NICU. Results For the PSAS-RSF, Practical Infant Care Anxieties (p = 0.001), Maternal Competence and Attachment Anxieties (p = 0.033), and Infant Safety and Welfare Anxieties (p = 0.020) were significantly associated with week of gestation. Practical Infant Care and Infant Safety and Welfare Anxieties were significantly higher for mothers of late premature infants, compared to mothers of term infants (p < 0.001; p = 0.019). There were no significant between-group differences with respect to Maternal Competence and Attachment Anxieties. After controlling for potential confounders, Infant Safety and Welfare Anxieties were significantly associated with increased stress in the NICU (p < 0.001) as measured by the PSS:NICU. Conclusions Our findings highlight the need for interventions for mothers with premature infants, which specifically target anxieties reflected in the PSAS-RSF, such as routine care and increasing maternal self-efficacy.
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Affiliation(s)
- Semra Worrall
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, Liverpool Women’s NHS Foundation Trust, Liverpool, United Kingdom
- Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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29
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Carew M, Redley B, Bloomer MJ. Competing Tensions: Nurse Perceptions of Family-Centered Care and Parents' Needs in Neonatal Care. Adv Neonatal Care 2024; 24:35-42. [PMID: 38193725 DOI: 10.1097/anc.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Family-centered care is founded upon collaboration between parents and healthcare professionals, caring for a child and parents as one entity. The unfamiliar neonatal environment and complexity of care can make family-centered care challenging. PURPOSE To explore neonatal nurses' perceptions of family-centered care and parents' cultural needs. METHODS This was a qualitative descriptive study using interviews to gather data from registered nurses, and analyzed using inductive content analysis. RESULTS Ten neonatal nurses participated in online interviews, lasting an average of 25 minutes. Parents' cultural needs were poorly understood and assumed synonymous with family-centered care. While all acknowledged the importance of family-centered care, most described tasks to parent-infant bonding, rather than a broader embodiment of family-centered care. In time of uncertainty, emergent clinical priorities took priority over a family-centered approach to care. Cultural care was poorly understood, and care tasks associated with supporting parent-infant bonding suggest further work is necessary to promote embodiment of family-centered care beyond individual tasks. While emergent clinical priorities and neonate well-being will always be the priority, finding a way to respond that concords with the ethos of family-centered care is also essential. IMPLICATIONS FOR PRACTICE AND RESEARCH Clear and consistent leadership is needed to demonstrate greater embodiment of family-centered care, which includes cultural care for parents. Strong leadership and targeted education are key to supporting this change. Further research is warranted to examine and observe practice, in particular how parents' cultural needs are assessed and integrated into family-centered care in neonatal settings.
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Affiliation(s)
- Maddison Carew
- Maternity Unit, Bass Coast Health, Wonthaggi, Victoria, Australia (Ms Carew); School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia (Ms Carew and Prof Redley); Health Complaints Commissioner, Melbourne, Victoria, 3000, Australia (Prof Redley); and School of Nursing and Midwifery, Griffith University, Nathan, Queensland, and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, and Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia (Prof Bloomer)
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30
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Cupit C, Paton A, Boyle E, Pillay T, Anderson J, Armstrong N. Parenting through place-of-care disruptions: A qualitative study of parents' experiences of neonatal care. Health Expect 2024; 27:e13933. [PMID: 39102689 PMCID: PMC10726285 DOI: 10.1111/hex.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Neonatal care is complex, involving multiple people and technologies within a community of care. When preterm babies are cared for far from home and/or transferred between units, the whole community of care (and particularly parent participation) is disrupted. Although previous studies have captured subjective experiences of parents, there has been little research exploring the material practices undertaken by parents as a consequence of place-of-care decisions, or the social organisation of those practices. METHODS As part of a wider study exploring optimal place-of-care, semistructured interviews were conducted between July 2018 and October 2019 with 48 parents (36 families) with one or more preterm babies (born at 27-31 weeks gestation) cared for in a neonatal unit in the last 12 months. FINDINGS We highlight parents' labour-intensive and stressful work to: (1) parent in the neonatal care community (an oversight role that goes beyond contemporary notions of 'involvement'); (2) create continuity amid place-of-care disruptions; and (3) adapt to the managerial logics of neonatal care settings. Our analysis focuses on the work generated by managerial systems that organise place-of-care decision-making and other efficiency-focused practices. Parents are absorbed into negotiating institutional systems and diverted from routine parenting activities. CONCLUSION Those involved in the organisation and management of neonatal care should take account of how managerial systems impact parents' workload, ability to participate in their baby's community of care and, ultimately, on the wellbeing and development of babies and their families. PATIENT OR PUBLIC CONTRIBUTION The OPTI-PREM study embedded parents' experiences of neonatal care into the research, through a discrete workstream that employed qualitative methodology to capture parents' experiences-as reported in this paper. The OPTI-PREM project was also supported by a Bliss volunteer parent panel, which was involved in designing and overseeing the research. Bliss 'champion[s] the right for every baby born premature or sick to receive the best care by supporting families, campaigning for change and supporting professionals and enabling life-changing research' (https://www.bliss.org.uk/about-us/about-bliss). A representative of Bliss is a co-author of this manuscript, and a parent representative (named in the Acknowledgements) provided feedback during its preparation.
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Affiliation(s)
- Caroline Cupit
- Department of Population Health SciencesUniversity of LeicesterLeicesterUK
| | - Alexis Paton
- Centre for Health and SocietyAston UniversityBirminghamUK
| | - Elaine Boyle
- Department of Population Health SciencesUniversity of LeicesterLeicesterUK
| | - Thillagavathie Pillay
- Research Institute for Health Related SciencesUniversity of WolverhamptonWolverhamptonUK
| | | | - Natalie Armstrong
- Department of Population Health SciencesUniversity of LeicesterLeicesterUK
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Abstract
Newborns with hyperbilirubinemia have traditionally received phototherapy in hospital. Hospital stays for infants, however, may negatively affect parent-infant bonding and induce anxiety and feelings of powerlessness in mothers. This study examined parent's experiences of providing phototherapy to their neonates at home instead. A descriptive qualitative study based on 15 interviews (8 mothers and 7 fathers) with parents of 8 children who had been randomised to home phototherapy was conducted during spring 2018 in Örebro county, Sweden. Inductive content analysis was used. The overall experience of home phototherapy was positive, and five categories were identified describing their experiences: continuing life at home, adjusting to having a newborn, feeling secure, experiencing parenthood and accessing information. The findings support the use of home phototherapy. Parents felt secure at home with their infants and emphasised the importance of clear information and round-the-clock access to hospital staff.
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Affiliation(s)
- Miriam Pettersson
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Cheng A, Molinaro M, Ott M, Cristancho S, LaDonna KA. Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S65-S71. [PMID: 37983398 DOI: 10.1097/acm.0000000000005355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE Learning to navigate difficult clinical conversations is an essential feature of residency training, yet much of this learning occurs "on the job," often without the formative, multisource feedback trainees need. To generate insight into how on-the-job training influences trainee performance, the perspectives of parents and health care providers (HCPs) who engaged in or observed difficult conversations with Neonatal Intensive Care Unit (NICU) trainees were explored. METHOD The iterative data generation and analysis process was informed by constructivist grounded theory. Parents (n = 14) and HCPs (n = 10) from 2 Canadian NICUs were invited to participate in semistructured interviews informed by rich pictures-a visual elicitation technique useful for exploring complex phenomena like difficult conversations. Themes were identified using the constant comparative approach. The study was conducted between 2018 and 2021. RESULTS According to participants, misalignment between parents' and trainees' communication styles, HCPs intervening to protect parents when trainee-led communication went awry, the absence of feedback, and a culture of sole physician responsibility for communication all conspired against trainees trying to develop communication competence in the NICU. Given beliefs that trainees' experiential learning should not trump parents' well-being, some physicians perceived the art of communication was best learned by observing experts. Sometimes, already limited opportunities for trainees to lead conversations were further constricted by perceptions that trainees lacked the interest and motivation to focus on so-called "soft" skills like communication during their training. CONCLUSIONS Parents and NICU staff described that trainees face multiple barriers against learning to navigate difficult conversations that may set them up to fail. A deeper understanding of the layered challenges trainees face, and the hierarchies and sociocultural norms that interfere with teaching, may be the start of breaking down multiple barriers trainees and their clinician supervisors need to overcome to succeed.
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Affiliation(s)
- Anita Cheng
- A. Cheng is a neonatologist and assistant professor, Department of Pediatrics, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0002-6787-7275
| | - Monica Molinaro
- M. Molinaro is a banting postdoctoral fellow, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; ORCID: https://orcid.org/0000-0002-5629-5974
| | - Mary Ott
- M. Ott is a researcher, Centre for Education Research & Innovation, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-4010-6558
| | - Sayra Cristancho
- S. Cristancho is associate professor and scientist, Centre for Education Research & Innovation, Department of Surgery and Faculty of Education, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0002-8738-2130
| | - Kori A LaDonna
- K.A. LaDonna is associate professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-4738-0146
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Pricoco R, Mayer-Huber S, Paulick J, Benstetter F, Zeller M, Keller M. Impact of a family-centred clinical care programme on short-term outcomes of very low-birth weight infants. Acta Paediatr 2023; 112:2368-2377. [PMID: 37551158 DOI: 10.1111/apa.16944] [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: 04/19/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
AIM We evaluated the effects of a family-centred clinical care pathway and case management programme on short-term clinical outcome in a cohort of very low-birth weight (VLBW) infants. METHODS The programme, named NeoPAss, was developed at the Department of Neonatology Children's hospital Passau in 2013. Short-term outcomes of infants were compared to matched controls from the Bavarian neonatology surveillance database before (n = 111; 2008-2012) and after implementation (n = 170; 2014-2017). RESULTS After implementation the rate of late-onset sepsis was significantly lower (2.5% vs. 10.7%, p = 0.005) and the length of stay was significantly shorter (VLBW 28 to 31 weeks' gestational age (GA) 47.5 vs. 53.1 days, p = 0.047; <28 weeks' GA 79.4 vs. 91.9 days, p = 0.007) in the intervention group compared to controls. Infants were discharged with significantly lower weight (mean 2351 vs. 2539 g, p = 0.013). There was no statistically significant difference in the rate of intraventricular haemorrhage (3.7% vs. 8.2%), necrotizing enterocolitis (0.6% vs. 1.9%) and bronchopulmonary dysplasia (0% vs. 6.9%). CONCLUSION Our data confirm that of other studies demonstrating a beneficial effect of family-centred care programmes and provides evidence that structured parental involvement is not associated with increased risk of infection in a VLBW cohort.
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Affiliation(s)
- Rafael Pricoco
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Johannes Paulick
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Michael Zeller
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
- Kinderklinik Dritter Orden, Passau, Germany
| | - Matthias Keller
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
- Kinderklinik Dritter Orden, Passau, Germany
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Wege M, von Blanckenburg P, Maier RF, Knoeppel C, Grunske A, Seifart C. Do parents get what they want during bad news delivery in NICU? J Perinat Med 2023; 51:1104-1111. [PMID: 37336635 DOI: 10.1515/jpm-2023-0134] [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: 03/29/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Little is known about parents' preferences in breaking bad news (BBN) in neonatology. The study was aimed at comparing parents' experiences with their first BBN discussion with a neonatologist/pediatric surgeon to their personal preferences. METHODS We conducted a quantitative survey amongst 54 parents of hospitalized preterm or term infants with severe diseases in two medium-size and one small German neonatal units. Parents answered self-rated questions on how they perceived BBN during their infant's hospital stay, asking for procedure and perception of BBN, their preferences and satisfaction with BBN. RESULTS Overall satisfaction with BBN was moderate to high (median (min-max): 8 (1-10) on a 1-10-Likert scale). A compassionate way of disclosure correlated highest with overall satisfaction with BBN. Thorough transmission of information in an easy to understand manner emerged as another crucial point and correlated significantly to satisfaction with BBN, too. The study revealed that it was highly important for parents, that physicians had good knowledge of the infant and the course of his/her disease, which was only met in a minority of cases. Moreover, there was a major discrepancy between expected and observed professional competence of the delivering physicians. Additionally, physicians did not set aside sufficient time for BBN and parents reported a lack of transporting assurance and hope. CONCLUSIONS In BBN physicians should draw greatest attention to ensure understanding in parents, with good knowledge of child and disease and sufficient time in a trustworthy manner. Physicians should focus on transporting competence, trust and gentleness.
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Affiliation(s)
- Mirjam Wege
- Children's Hospital, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Rolf Felix Maier
- Children's Hospital, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Carmen Knoeppel
- Children's Hospital, Hospital Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | | | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics, Philipps University of Marburg, Marburg, Germany
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Wege M, von Blanckenburg P, Maier RF, Seifart C. Does Educational Status Influence Parents' Response to Bad News in the NICU? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1729. [PMID: 38002820 PMCID: PMC10670369 DOI: 10.3390/children10111729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
Communication in neonatal intensive care units and the relationship between families and staff have been reported to influence parental mental well-being. Research has also shown an impact of parental educational level on their well-being. However, whether different educational levels result in different reactions to breaking bad news (BBN) by physicians remains unanswered so far. We therefore examined the impact of parental level of education on their mental state after a BBN conversation and their relation to physicians. A prospective quantitative survey was conducted amongst 54 parents whose preterm or term infants were hospitalized in three German neonatal units. Parental education was classified as low (lower secondary/less (1), n: 23) or high (higher secondary/more (2), n: 31). Parents answered questions about certain aspects of and their mental state after BBN and their trust in physicians. The two groups did not differ significantly in their mental condition after BBN, with both reporting high levels of exhaustion and worries, each (median (min;max): (1): 16 (6;20) vs. (2): 14 (5;20), (scaling: 5-20)). However, lower-educated parents reported a lower trust in physicians (median (min;max): (1): 2 (0;9) vs. (2): 1 (0;6), p < 0.05 (scaling: 0-10)) and felt less safe during BBN (median (min;max): (1): 15 (9;35) vs. (2): 13 (9;33), p < 0.05). Only among higher-educated parents was trust in physicians significantly correlated with the safety and orientation provided during BBN (r: 0.583, p < 0.05, r: 0.584, p < 0.01). Concurrently, only among less-educated parents was safety correlated with the hope conveyed during BBN (r: 0.763, p < 0.01). Therefore, in BBN discussions with less-educated parents, physicians should focus more on giving them hope to promote safety.
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Affiliation(s)
- Mirjam Wege
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany;
| | - Rolf Felix Maier
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics, Philipps University of Marburg, 35033 Marburg, Germany;
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Linnér A, Blomqvist YT, Jonsson K, Lilliesköld S, Norman M. Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence. Neonatology 2023; 121:46-55. [PMID: 37844545 PMCID: PMC10836739 DOI: 10.1159/000533900] [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: 05/21/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Infant- and family-centered developmental care can reduce adverse outcomes in both infants and parents. Parents' experiences of the care and staff treatment remain to be evaluated. METHODS Parents of infants admitted to neonatal units in Sweden from July 2020 to May 2022 responded to a questionnaire with standardized questions about in-hospital care. Exposures were hospital, gestational age, length of hospital stay, unit level, and bed density. The proportions of parents rating aspects of neonatal care as excellent, defined as five on a Likert scale, and the determinants of excellence were described. The results were benchmarked with ratings in adult somatic care. RESULTS A total of 4,475/13,108 (34%) parents responded. The ratings of excellent care varied by question from 65% to 90%. The largest variation in excellence between neonatal units (range 43-80%) was found for "participation and involvement." The proportion of excellence was significantly lower among parents of extremely preterm infants. Confidence in the staff was lower in parents of extremely preterm infants than in parents of term infants (56% vs. 83%). Longer hospital stays affected the experience of neonatal care adversely, whereas level of care and bed density were overall unrelated to the parental experience. Parents in neonatal care rated the care as excellent to a higher extent than patients cared for in adult medicine. CONCLUSION A majority of parents rated neonatal care in Sweden as excellent. The less frequent ratings of excellence among parents of extremely preterm infants indicate that more could be done to optimize parental involvement and support.
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Affiliation(s)
- Agnes Linnér
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kristina Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Siri Lilliesköld
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Itoshima R, Tuura K, Toome L, Varendi H, Saik P, Axelin A, Lehtonen L, Ahlqvist-Björkroth S. Depressive symptoms in mothers of preterm infants before and during COVID-19 restrictions in neonatal intensive care units. Acta Paediatr 2023; 112:2164-2171. [PMID: 37354112 DOI: 10.1111/apa.16886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
AIM Little is known about the specific restriction measures used in intensive care units (NICUs) during the COVID-19 pandemic and their impact on parental well-being. Hence, this study aimed to assess the association between restriction measures and mothers' post-partum depressive symptoms. METHODS This comparative cohort study included mothers who gave birth before 35 weeks of gestation in Estonia. The outcome measure was mothers' post-partum depressive symptoms at the time of infant discharge, evaluated using the Edinburgh Postnatal Depression Scale (EPDS). In addition to the pandemic itself, the number of restriction measures in the NICUs was analysed as a potential explanatory factor for depressive symptoms. RESULTS The study included 55 mothers before the pandemic in 2018-2019 and 54 mothers during the COVID-19 pandemic in 2021. No significant difference was found in the median EPDS scores between the cohorts: 7.0 [interquartile range (IQR): 4.0-12.0] and 8.0 (IQR: 5.0-12.8) respectively. The number of restriction measures was not associated with mothers' EPDS scores in either unadjusted or adjusted models. CONCLUSION The COVID-19 pandemic or the number of restriction measures used in Estonian NICUs did not associate with mothers' post = partum depressive symptoms.
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Affiliation(s)
- Ryo Itoshima
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
| | - Kirsi Tuura
- Department of Psychology and Language Pathology, University of Turku, Turku, Finland
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia
| | - Heili Varendi
- Neonatal Unit, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Pille Saik
- Department of Neonatology, West-Tallinn Central Hospital, Tallinn, Estonia
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Sari Ahlqvist-Björkroth
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychology and Language Pathology, University of Turku, Turku, Finland
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Ahn HY, Ko HJ, Jo HJ. Development and Effects of Mobile-Application-Based Parenting Support Program for Premature Infants' Mothers. Healthcare (Basel) 2023; 11:2639. [PMID: 37830676 PMCID: PMC10572298 DOI: 10.3390/healthcare11192639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Premature infants are separated from their parents after birth and are admitted to the neonatal intensive care unit. Separation of babies from mothers causes various problems. Therefore, as the number of premature infants increases every year, educational programs to continuously support baby care are needed. METHODS In this study, a nonequivalent control group non-synchronized design was employed. The subjects of the study were 52 mothers of premature infants (16 in the app-based program group, 18 in the electronic document group, and 18 in the control group) using a portal site for parents from February to April 2023. The app-based program and electronic document group followed a parenting support program for two weeks. RESULTS There were significant differences in maternal confidence between the app-based, electronic document, and control groups (F = 7.354, p = 0.002). CONCLUSIONS Providing necessary information and emotional support through professional counseling centers' app-based programs for premature infants' mothers, and providing interaction through member community bulletin boards, are proposed to form an effective educational program.
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Affiliation(s)
- Hye Young Ahn
- College of Nursing, Eulji University, Uijeongbu 11759, Republic of Korea;
| | | | - Hee Jee Jo
- College of Nursing, Eulji University, Uijeongbu 11759, Republic of Korea;
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Deindl P, Witting A, Dür M, Berger A, Klebermass-Schrehof K, Singer D, Giordano V, Fuiko R. Perceived stress of mothers and fathers on two NICUs before and during the SARS-CoV-2 pandemic. Sci Rep 2023; 13:14540. [PMID: 37666877 PMCID: PMC10477236 DOI: 10.1038/s41598-023-40836-9] [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] [Received: 03/28/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
Parents of very low birth weight (VLBW) infants in a neonatal intensive care unit experienced additional stress during the SARS-CoV-2 pandemic due to the related restrictions in hospital visiting policies. Our study aimed to compare parents' burdens before and during the pandemic. This survey included 121 parents of 76 VLBW infants in two European Level IV perinatal centers before and during the pandemic. We performed standardized parent questionnaires with mothers and fathers separately to evaluate their emotional stress and well-being. The pandemic worsened the emotional well-being of parents of VLBW infants, particularly of mothers. During the pandemic, mothers reported significantly higher state anxiety levels (48.9 vs. 42.9, p = 0.026) and hampered bonding with the child (6.3 vs. 5.2, 0 = 0.003) than before. In addition, mothers felt more personally restricted than fathers (6.1 vs. 5.2, p = 0.003). Fathers experienced lower levels of stress than mothers; they were equally burdened before and during the pandemic. Restrictions in visiting policies for families of VLBW infants during the SARS-CoV-2 pandemic have a significant negative impact on parental stress and should therefore be applied cautiously.
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Affiliation(s)
- Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Witting
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mona Dür
- Duervation, Krems, Austria
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Dominique Singer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Hua W, Zhou J, Wang L, Li C, Zheng Q, Yuwen W, Jiang L. 'It turned my life upside down': Parents' emotional experience of the transition with their preterm infant from birth to discharge Home-A qualitative study. Aust Crit Care 2023; 36:679-686. [PMID: 36464525 DOI: 10.1016/j.aucc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis' Transition Theory, parents might experience emotional change initiated by critical events during this transition. OBJECTIVES The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better. METHODS This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis. RESULTS The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents' experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge. CONCLUSIONS Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents' critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.
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Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Jingxin Zhou
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, PR China
| | - Liying Wang
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Chenxing Li
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Qiaomu Zheng
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Weichao Yuwen
- School of Nursing and Healthcare Leadership, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, 200092, Shanghai, PR China.
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O'Shea K, Harwood R, O’Donnell S, Baillie C. Does time to theater matter in simple gastroschisis? WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000575. [PMID: 37671120 PMCID: PMC10476109 DOI: 10.1136/wjps-2023-000575] [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: 02/06/2023] [Accepted: 07/18/2023] [Indexed: 09/07/2023] Open
Abstract
Objective A recent publication has suggested that expedited time to theater in gastroschisis results in higher rates of primary closure and decreases the length of stay (LOS). This study primarily aims to assess the impact of time to first management of neonates with gastroschisis on the LOS. Methods Neonates admitted between August 2013 and August 2020 with gastroschisis were included. Data were collected retrospectively, and neonates with complex gastroschisis were excluded. Variables including gestation, birth weight, time of first management, primary/delayed closure and use of patch were evaluated as possible confounding variables. The outcome measures were time to full feeds, time on parenteral nutrition (PN) and LOS. Univariate and multivariate linear regression analyses were performed. P<0.05 was regarded as significant. Results Eighty-six neonates were identified, and 16 were then excluded (eight patients with complex gastroschisis, eight patients with time to first management not documented). The median LOS for those who underwent primary closure was 21 days (interquartile range (IQR) =16-29) and for those who underwent silo placement and delayed closure was 59 days (IQR=44-130). The mean time to first management was 473 min (standard deviation (SD) =146 min), with only 20% of these infants being operated on at less than 6 hours of age. Univariate and multivariate analyses demonstrated no relationship between time to first management and LOS (r2=0.00, p=0.82) but did demonstrate a consistent positive association between time to first feed and LOS and delayed closure, resulting in a longer time to full feeds and a longer time on PN. Conclusions The time to first management was not associated with a change in LOS in these data. Further prospective evaluation of the impact of reducing the time to first feed on the LOS is recommended. Level of evidence IV.
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Affiliation(s)
- Kathryn O'Shea
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Rachel Harwood
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- Cellular and Molecular Physiology, University of Liverpool, Liverpool, UK
| | - Sean O’Donnell
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Colin Baillie
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Ahn HY, Jo HJ, Ko HJ. Effects of a Noncontact Visit Program in the NICU for the Prevention of COVID-19. Healthcare (Basel) 2023; 11:2152. [PMID: 37570392 PMCID: PMC10419116 DOI: 10.3390/healthcare11152152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND With the spread of COVID-19, neonatal intensive care units restricted visiting hours to prevent infection. As a result, mothers of high-risk newborns were restricted from making contact with their children. Various problems could be encountered for hospitalized children and mothers of high-risk newborns due to restrictions on visits in the neonatal intensive care unit. Therefore, during the pandemic, continuous nursing support for mothers of high-risk newborns was needed. METHODS In this study, a nonequivalent control group non-synchronized design was employed. The subjects of the study were 36 mothers of high-risk neonates (20 in the experimental group and 16 in the control group) in E University Hospital, D Metropolitan City, from July to September 2022. The experimental group received a 10 min program performed by a nurse from 7:00 p.m. to 9:00 p.m. three times per week. RESULTS There were significant differences in nurses' support between the experimental and control groups (F = 25.594, p < 0.001), changes over time (F = 16.178, p < 0.001), and time-group interactions (F = 9.663, p = 0.003). CONCLUSIONS It was interpreted that the real-time noncontact visitation program could transcend time and space for many mothers of high-risk newborn babies, who suffered psychologically due to restrictions and bans on visitations during the COVID-19 pandemic.
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Affiliation(s)
- Hye Young Ahn
- College of Nursing, Eulji University, Uijeongbu 11759, Republic of Korea
| | | | - Hyun Jeong Ko
- College of Nursing, Eulji University, Uijeongbu 11759, Republic of Korea
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Schonewille NN, Terpstra PA, van den Heuvel MEN, Van Pampus MG, van den Heuvel OA, Broekman BFP. Neonatal admission after lithium use in pregnant women with bipolar disorders: a retrospective cohort study. Int J Bipolar Disord 2023; 11:24. [PMID: 37450192 PMCID: PMC10348961 DOI: 10.1186/s40345-023-00306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Lithium is the preferred treatment for pregnant women with bipolar disorders (BD), as it is most effective in preventing postpartum relapse. Although it has been prescribed during pregnancy for decades, the safety for neonates and obstetric outcomes are a topic of ongoing scientific debate as previous research has yielded contradicting outcomes. Our study aims to compare (re)admission rates and reasons for admissions in neonates born to women with bipolar disorders (BD) with and without lithium exposure. METHODS A retrospective observational cohort study was conducted in a Dutch secondary hospital (two locations in Amsterdam). Women with BD who gave birth after a singleton pregnancy between January 2011 and March 2021 and their neonates were included. Outcomes were obtained by medical chart review of mothers and neonates and compared between neonates with and without lithium exposure. The primary outcome was admission to a neonatal ward with monitoring, preterm birth, small for gestational age (SGA), 5-minute Apgar scores, neonatal asphyxia, and readmission ≤ 28 days. RESULTS We included 93 women with BD, who gave birth to 117 live-born neonates: 42 (36%) exposed and 75 (64%) non-exposed to lithium. There were no significant differences in neonatal admission with monitoring (16.7 vs. 20.0%, p = 0.844). Additionally, preterm birth (7.1 vs. 5.3%), SGA (0.0 vs. 8.0%), 5-minute Apgar scores (means 9.50 vs. 9.51), neonatal asphyxia (4.8 vs. 2.7%) and readmission (4.8 vs. 5.3%) were comparable. Overall, 18.8% of BD offspring was admitted. Women with BD had high rates of caesarean section (29.1%), gestational diabetes (12.8%) and hypertensive disorders of pregnancy (8.5%). CONCLUSIONS In a sample of neonates all born to women with BD using various other psychotropic drugs, exposure to lithium was not associated with greater risk of neonatal admission to a ward with monitoring compared to non-exposure to lithium, questioning the necessity for special measures after lithium exposure. However, offspring of women with BD was admitted regularly and women with BD have high obstetric risk which require clinical and scientific attention.
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Affiliation(s)
- Noralie N Schonewille
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, The Netherlands.
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Amsterdam Public Health Program, Amsterdam, The Netherlands.
| | - Pleun A Terpstra
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, The Netherlands
| | | | - Maria G Van Pampus
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity, Impulsivity and Attention Program, Amsterdam, The Netherlands
| | - Birit F P Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Public Health Program, Amsterdam, The Netherlands
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Radeschi DJ, Senechal E, Tao L, Lv S, Shalish W, Sant'Anna G, Kearney RE. Comparison of Wired and Wireless Heart Rate Monitoring in the Neonatal Intensive Care Unit. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082891 DOI: 10.1109/embc40787.2023.10340972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
In the Neonatal Intensive Care Unit (NICU), infants' vital signs are monitored on a continuous basis via wired devices. These often interfere with patient care and pose increased risks of skin damage, infection, and tangling around the body. Recently, a wireless system for neonatal monitoring called ANNEⓇ One (Sibel Health, Chicago, USA) was developed. We designed an ongoing study to evaluate the feasibility, reliability and accuracy, of using this system in the NICU. Vital signals were simultaneously acquired by using the standard, wired clinical monitor and the ANNEⓇ device. Data from 10 NICU infants were recorded for 8 hours per day during 4 consecutive days. Initial analysis of the heart rate (HR) data revealed four problems in comparing the signals: 1) gaps in the signals - periods of time for which data were unavailable, 2) wired and wireless signals were sampled at different rates, 3) a delay between the sampled values of wired and wireless signals, and 4) this delay increased with time. To address these problems, we developed a pre-processing algorithm that interpolated samples in short gaps, resampled the signals to an equal rate, estimated the delay and drift rate between corresponding signals, and aligned the signals. Applications of the pre-processing algorithm to 40 recordings demonstrated that it was very effective. A strong agreement between wireless and wired HR signals was seen, with an average correlation of 0.95±0.04, a slope of 1.00, and a variance accounted for 89.56±7.62%. Bland-Altman analysis showed a low bias across the ensemble, with an average difference of 0.11 (95% confidence interval of -0.02 to 0.24) bpm.Clinical relevance- This algorithm provides the means for a detailed comparison of wired and wireless monitors in the NICU.
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Senechal E, Radeschi D, Tao L, Lv S, Jeanne E, Kearney R, Shalish W, Sant Anna G. The use of wireless sensors in the neonatal intensive care unit: a study protocol. PeerJ 2023; 11:e15578. [PMID: 37397010 PMCID: PMC10312156 DOI: 10.7717/peerj.15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background Continuous monitoring of vital signs and other biological signals in the Neonatal Intensive Care Unit (NICU) requires sensors connected to the bedside monitors by wires and cables. This monitoring system presents challenges such as risks for skin damage or infection, possibility of tangling around the patient body, or damage of the wires, which may complicate routine care. Furthermore, the presence of cables and wires can act as a barrier for parent-infant interactions and skin to skin contact. This study will investigate the use of a new wireless sensor for routine vital monitoring in the NICU. Methods Forty-eight neonates will be recruited from the Montreal Children's Hospital NICU. The primary outcome is to evaluate the feasibility, safety, and accuracy of a wireless monitoring technology called ANNE® One (Sibel Health, Niles, MI, USA). The study will be conducted in 2 phases where physiological signals will be acquired from the standard monitoring system and the new wireless monitoring system simultaneously. In phase 1, participants will be monitored for 8 h, on four consecutive days, and the following signals will be obtained: heart rate, respiratory rate, oxygen saturation and skin temperature. In phase 2, the same signals will be recorded, but for a period of 96 consecutive hours. Safety and feasibility of the wireless devices will be assessed. Analyses of device accuracy and performance will be accomplished offline by the biomedical engineering team. Conclusion This study will evaluate feasibility, safety, and accuracy of a new wireless monitoring technology in neonates treated in the NICU.
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Affiliation(s)
- Eva Senechal
- Department of Experimental Medicine, McGill University, Montréal, Quebec, Canada
| | - Daniel Radeschi
- Department of Biomedical Engineering, McGill University, Montréal, Quebec, Canada
| | - Lydia Tao
- Department of Pediatrics, McGill University Health Center, Montréal, Quebec, Canada
| | - Shasha Lv
- Department of Pediatrics, McGill University Health Center, Montréal, Quebec, Canada
| | - Emily Jeanne
- Department of Experimental Medicine, McGill University, Montréal, Quebec, Canada
| | - Robert Kearney
- Department of Biomedical Engineering, McGill University, Montréal, Quebec, Canada
| | - Wissam Shalish
- Department of Experimental Medicine, McGill University, Montréal, Quebec, Canada
- Department of Pediatrics, McGill University Health Center, Montréal, Quebec, Canada
| | - Guilherme Sant Anna
- Department of Experimental Medicine, McGill University, Montréal, Quebec, Canada
- Department of Pediatrics, McGill University Health Center, Montréal, Quebec, Canada
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Lam JY, Howlett A, Stephen LM, Brindle ME. Parental perceptions and experiences of care in the surgical neonatal intensive care unit. Pediatr Surg Int 2023; 39:210. [PMID: 37261599 PMCID: PMC10234908 DOI: 10.1007/s00383-023-05484-0] [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] [Accepted: 05/07/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Parents endure significant stress when their newborns require surgery while in the neonatal intensive care unit (NICU). Our study aims to explore the surgical NICU experience from the parents' perspective and identify areas that may improve this experience. A secondary objective was to integrate their feedback to refine the implementation strategy of the neonatal enhanced recovery after surgery (ERAS®) guideline. METHODS In December 2019, five surgical NICU parents participated in a focus group. Conversation surrounded parents' perspectives and experiences of the surgical NICU. Inductive analysis was performed to identify data, themes, and concepts that emerged from the discussion. RESULTS Participants identified four major interrelated themes that impacted the surgical parents' NICU experience. These themes include (1) parental state, both physical and emotional, (2) the altered parental caregiver role which necessitates identifying alternative meaningful parental experiences, (3) the care team dynamic, incorporating consistency and effective communication, and (4) the discharge process which may be significantly eased through graduated, hands-on training. CONCLUSION Key elements of the neonatal ERAS® guideline address major themes and stressors identified by parents. The parental perspective may help clinicians appreciate the parent surgical NICU experience and assist in improving family-centered care to surgical infants and their families.
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Affiliation(s)
- Jennifer Y Lam
- Division of Pediatric Surgery, Western University, Children's Hospital-London Health Sciences Centre, B1-188, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada.
| | - Alexandra Howlett
- Section of Neonatology, University of Calgary, Alberta Children's Hospital, 28 Oki Dr. NW, Calgary, AB, T3B 6A8, Canada
| | - Lori M Stephen
- Section of Neonatology, University of Calgary, Alberta Children's Hospital, 28 Oki Dr. NW, Calgary, AB, T3B 6A8, Canada
| | - Mary E Brindle
- Section of Pediatric Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr. NW, Calgary, AB, T3B 6A8, Canada
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Väliaho A, Lehtonen L, Axelin A, Korja R. Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks-A Qualitative Descriptive Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050793. [PMID: 37238341 DOI: 10.3390/children10050793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
(1) Background. The birth of an infant at 23 to 24 weeks poses a significant challenge to healthy parent-infant bonding because of the high risk of infant loss and the prolonged separation. The aim of this study was to retrospectively explore the narratives of parents with children born at 23-24 weeks about their bonding formation and relational experiences. (2) Methods. This was a qualitative descriptive study conducted with Finnish parents of children born at 23 or 24 weeks of gestation. Twenty-nine mothers and eight fathers were retrospectively interviewed using a semi-structured interview about the bonding process with their infant during the period in the neonatal intensive care unit (NICU) and their later parent-child relationship. Parents' narratives were deductively analysed according to a framework previously developed for studying parental bonding. (3) Results. Our results showed that several parents described the bonding process as natural or even easy despite the traumatic start to parenthood. Support from NICU staff and providing opportunities for participation in infant care and parent-infant physical closeness were reported to enhance the bonding process. Our study identified earlier parenting experience as a new element supporting bonding. (4) Conclusions. According to our results, essential elements enhancing parent-infant bonding in NICU settings seem to be supporting parents psychologically, promoting parent-infant closeness, and encouraging parental participation in the infants' care, even with the most immature infants.
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Affiliation(s)
- Anniina Väliaho
- Department of Psychology and Speech-Language Pathology, University of Turku, 20014 Turku, Finland
| | - Liisa Lehtonen
- Faculty of Medicine, University of Turku, 20014 Turku, Finland
- Department of Pediatrics and Adolescence Medicine, Turku University Hospital, The Wellbeing Services County of Southwest Finland (Varha), 20521 Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, 20014 Turku, Finland
| | - Riikka Korja
- Department of Psychology and Speech-Language Pathology, University of Turku, 20014 Turku, Finland
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Orr E, Ballantyne M, Gonzalez A, Jack SM. Providers' perspectives of the neonatal intensive care unit context and care provision for adolescent parents: an interpretive description. BMC Pregnancy Childbirth 2023; 23:259. [PMID: 37069591 PMCID: PMC10107570 DOI: 10.1186/s12884-023-05553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The neonatal intensive care unit (NICU) is a complex care environment, with the NICU patient population among the most vulnerable in a hospital setting. Adolescent parents are a unique group within the broader NICU parent population and admission of their infant to the NICU contributes to an already complex situation as adolescent pregnancy and parenting is often associated with a range of psychosocial challenges. How the NICU care context influences care provision for adolescent parents is a significant gap in the NICU parenting and support discourse. Therefore, this study aimed to explore health and social care providers' perspectives of the NICU care context and how providers perceive the context as influencing the experiences of adolescent parents in the NICU. METHODS This was a qualitative, interpretive description study design. In-depth interviews were conducted with providers, including nurses and social workers, caring for adolescent parents in the NICU. Data was collected between December 2019 and November 2020. Data were analyzed concurrently with data collection. Constant comparison, analytic memos, and iterative diagramming techniques were used to challenge developing analytic patterns. RESULTS Providers (n = 23) described how the unit context influenced care provision as well as experiences for adolescent parents. We learned that having a baby in the NICU was perceived by providers as a traumatic experience for parents - impacting attachment, parenting confidence and competence, and mental health. Environmental factors - such as privacy and time - and perceptions that adolescent parents are treated differently in the NICU were also seen as influencing this overall experience. CONCLUSIONS Providers involved in the care of adolescent parents in the neonatal intensive care unit described the distinctiveness of this group within the broader parent population and how quality of care may be impacted by contextual factors as well as experiences of age-related stigma. Further understanding of NICU experiences from the parents' perspectives are warranted. Findings highlight opportunities for strengthened interprofessional collaboration and trauma- and violence-informed care strategies within the neonatal intensive care environment to mitigate the potential negative influence of this experience and improve care for adolescent parents.
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Affiliation(s)
- Elizabeth Orr
- Department of Nursing, Brock University, Faculty of Applied Health Sciences, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada.
| | - Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Kılıç ST, Taşgıt A. Sociodemographic factors affecting depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic. JOURNAL OF NEONATAL NURSING : JNN 2023; 29:375-386. [PMID: 35965613 PMCID: PMC9359935 DOI: 10.1016/j.jnn.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Purpose This study aimed to determine the sociodemographic factors affecting the depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic. Design and Methods: This descriptive cross-sectional study was conducted between March and October 2021. The sample consisted of 93 parents. Data were collected using a descriptive questionnaire, the Depression Anxiety Stress Scale (DASS- 42), and Coping Style Scale (CSS). Results Participants had mean DASS "depression," "anxiety," and "stress" subscale scores of 13.69 ± 8.86, 12.11 ± 8.37, and 19.09 ± 9.24, respectively. They had mean CSS "self-confident," "optimistic," "helpless," "submissive coping," and "seeking of social support" subscale scores of 2.71 ± 0.65, 2.57 ± 0.59, 2.29 ± 0.62, 2.25 ± 0.49, and 2.38 ± 0.52, respectively. Fathers had lower mean CSS "helpless" and "submissive" subscale scores than mothers. Participants who were briefed about their babies' condition by nurses had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with higher education had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with spouses with bachelor's or higher degrees had a higher median CSS "optimistic" subscale score than those with literate spouses or spouses with primary school degrees. Participants who were worried about the "no visitors" policy had a lower median CSS "self-confident" subscale score than those who were not. Conclusions Parents who are not allowed to see their babies due to the "no visitors" policy during the COVID-19 pandemic experience more psychosocial problems. Though not a result of the present study, the "no visitors" policy seems to affect the mother-infant attachment adversely. Practice implications Healthcare professionals should brief parents about what a neonatal intensive care unit is like. They should also warn them that they may not be too happy about how their baby looks before seeing them. Therefore, they should use therapeutic communication techniques to talk to them and explain the situation in a way they can understand. Moreover, they should provide parents with psychological empowerment training programs to help them adopt active coping strategies to deal with challenges in times of crisis.
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Affiliation(s)
- Sevcan T. Kılıç
- Gerontology Department, ÇankırıKaratekin University, Çankırı, Turkey,Corresponding author. Gerontology Deparment, Çankırı Karatekin University, Çankırı, 18200, Turkey
| | - Asena Taşgıt
- Health Ministry of Turkish Republic Ankara City Hospital, Turkey
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Risanger LI, Kofoed PE, Noergaard B, Vahlkvist S. Parents’ Perception of Staff Support in a Father-Friendly Neonatal Intensive Care Unit. CHILDREN 2023; 10:children10040673. [PMID: 37189922 DOI: 10.3390/children10040673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
Healthcare professionals, especially nurses, play a central role in supporting parents during their stay in neonatal intensive care units (NICUs). Fathers often have their own support needs; however, studies have shown that these needs are rarely met to the same degree as those of the mothers. We developed a “father-friendly NICU” with the aim of providing good-quality care to the entire family. To evaluate the impact of this concept, we adopted a quasi-experimental design; using the Nurse Parent Support Tool (NPST), we investigated the differences in the fathers’ (n = 497) and mothers’ (n = 562) perception of the nursing support received on admission and discharge between before and after the intervention. In the historical control and intervention groups, the fathers’ median NPST scores at admission were 4.3 (range, 1.9–5.0) and 4.0 (range, 2.5–4.8), respectively (p < 0.0001); at discharge, these scores were 4.3 (range, 1.6–5.0) and 4.4 (range, 2.3–5.0), respectively (difference not significant). In the historical control and intervention groups, the mothers median NPST scores at admission were 4.5 (range, 1.9–5.0) and 4.1 (range, 1.0–4.8), respectively (p < 0.001); at discharge, these scores were 4.4 (range, 2.7–5.0) and 4.4 (range, 2.6–5), respectively (difference not significant). The parental perception of support did not increase after the intervention; however, the parents reported a high level of staff support both before and after the intervention. Further studies should focus on parental support needs during the different phases of hospitalization (i.e., admission, stabilization, and discharge).
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Affiliation(s)
- Linn Iren Risanger
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
- H.C. Andersens Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Betty Noergaard
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Signe Vahlkvist
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
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