Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit

Fathers' experiences of nurses' roles and care practices during their preterm infant's stay in the neonatal intensive care unit

INTRODUCTION

Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents.

AIM

Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU.

DESIGN

Qualitative study using ethnographic data collection techniques.

METHODS

Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis.

RESULTS

Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities.

CONCLUSION

Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial.

RELEVANCE TO CLINICAL PRACTICE

Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities.

REPORTING METHOD

Adherence to the COREQ guidelines.

Evaluation of a new tool - "Step by step with my baby" - to support parental involvement in the care of preterm infants

BACKGROUND AND AIMS

Parental guidance is essential for supporting parental involvement, maintaining the quality and safety of infant care, and limiting parental stress. The efficiency of a new tool to support parental empowerment - "Step by step with my baby" - was evaluated. The perception of this tool by parents and nurses was studied.

METHODS

This was a prospective, observational study conducted from September 2019 to December 2020 at a level-3 neonatal center. A total of 79 newborns (<33 weeks of gestational age or small for gestational age), 84 parents, and 94 nurses were included. The new tool that was evaluated is in the form of a drawing of flowers to be colored according to the parents' ability to care for their newborn. Six domains were explored and given a score (total of 35 points) according to the parents' ability to care for each item: behavior, skin-to-skin contact, carrying, oral and tube feeding, and routine care. The use and relevance of this tool were evaluated by parents and caregivers.

RESULTS

At a mean of 19 days of life, parents required caregiver support regardless of the skill domain (6/35). After 26 days, the mean score increased to 19.4 (p < 0.05). Parents felt autonomous in changing diapers and monitoring temperature but always required help for skin-to-skin contact, carrying, and feeding with or without a tube. The progression was not affected by the presence of siblings, the distance from home, and staying in the parental hospital room. For 67 % of the parents, the tool gave them a better understanding of their newborn and helped them be more confident (69 %) without feeling judged (81 %). These feelings were upheld by nurses.

CONCLUSIONS

This tool was efficient for evaluating parents' autonomy and helped them take ownership of the care provided.

Developmental care education in Australian surgical neonatal intensive care units: A cross-sectional study of nurses' perceptions

Background

Nurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses' perceptions of developmental care.

Objective

To determine perceptions and attitudes towards developmental care in a specialty neonatal setting.

Design

Cross-sectional study.

Settings

Two surgical neonatal intensive care units in Australia.

Participants

Registered nurses permanently employed at the study sites between May 2021 to April 2022.

Methods

A modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses' perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)].

Results

Of 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3-8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1-6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1-6.2].

Conclusions

The results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Providing "Compassionate Care" in the Neonatal Intensive Care Unit Through Infant and Family Needs-Based Care

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..

[Average prematurity: medical and developmental aspects]

Children born with moderate prematurity are at increased risk of neonatal morbidity, rehospitalization during the first year, and subsequent medical and neurodevelopmental disorders. Care in a specialized environment, at best without separation of mother and child, is necessary. Early developmental support, particularly through skin-to-skin contact, breastfeeding and couplet care, is recommended.

Parent-led neonatal pain management-a narrative review and update of research and practices

Introduction

Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills.

Methods

In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research.

Results

Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change.

Conclusion

Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.

Neonatal family-centered care: evidence and practice models

Although advances in neonatology have reduced the mortality rate of high-risk infants, sick newborns or pre-mature infants undergo more intensive monitoring, pain-ful procedures, and lengthy hospitalization, leading to pro-longed separation from their parents. In recent decades, the importance of parent-infant closeness early in life has become more apparent, especially in preterm infants who are prone to neurodevelopmental deficits. There is an increasing body of evidence regarding the benefits of family-centered care (FCC) in neonatal intensive care units. Key aspects related to neonatal FCC include the parents' presence in the ward and their participation in infants' daily care and decision-making processes. In addition, an environment that supports a private and comfortable space for each family member and infant, such as a single-family room, should be provided. To successfully implement FCC in neonatal intensive care units, the culture of care and hospital policies should be changed to successfully implement FCC in neonatal intensive care units, and appropriate training for medical staff is also required.

Father's perceptions and care involvement for their very preterm infants at French neonatal intensive care units

Objectives

We aimed to evaluate (1) fathers' perceptions and care involvement for their very premature infants and their views of the hospitalization period based on parental reports and (2) their evolution over time.

Methods

We used an online parental survey to assess answers from parents of very preterm infants who were successfully discharged from French neonatal units. We analysed answers from February 2014 to January 2019 to an anonymous internet-based survey from the GREEN committee of the French Neonatal Society. Responses were compared for period 1 (P1, 1998 to 2013) and period 2 (P2, 2014 to 2019).

Results

We analyzed 2,483 surveys, 124 (5%) from fathers and 2,359 (95%) from mothers. At birth, 1,845 (80%) fathers were present in the hospital, but only 879 (38%) were near the mother. The presence of fathers in the NICU increased from P1 to P2 (34.5% vs. 43.1%, p = 0.03). Nearly two thirds of fathers accompanied their infants during transfer to the NICU (1,204 fathers, 60.6%). Fathers and mothers had similar perceptions regarding relationships with caregivers and skin-to-skin contact with their infants. However, more fathers than mothers felt welcome in the NICU and in care involvement regarding requests for their wishes when they met their infant (79% vs. 60%, p = 0.02) and in the presentation of the NICU (91% vs. 76%; p = 0.03). Mothers and fathers significantly differed in the caring procedures they performed (p = 0.01), procedures they did not perform but wanted to perform (p < 0.001), and procedures they did not perform and did not want to perform (p < 0.01).

Conclusion

Most fathers were present at the births of their very preterm infants, but fewer fathers were near the mother at this time. Less than two thirds of fathers accompanied their infants to the NICU. There should be further changes to better meet the specific needs of the fathers of infants requiring care in the NICU. Continuing assessment with an online questionnaire may be useful to monitor changes over time in father's involvement in NICUs.

Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence

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.

Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences

BACKGROUND

In recent decades, modern neonatal intensive care has improved, increasing the survival of extremely preterm children. Few studies have examined the experiences of parents of extremely preterm children from a long-term perspective.

AIM

To describe parents' experiences of parenting extremely preterm children during their childhood and transition to adulthood.

STUDY DESIGN

A qualitative interview study with a descriptive design.

SUBJECTS

Thirteen parents of eleven children born at 24 gestational weeks in Sweden, 1990-1992, participated in individual semi-structured interviews.

OUTCOME MEASURES

Data were analyzed using qualitative reflexive thematic analysis.

RESULT

Five themes forming a timeline were created in the analytic process: parenthood, at the NICU, young childhood, adolescence, and adulthood. Various aspects affecting parenthood were described throughout the timeline, and occasionally the parents experienced difficulties dealing with their children's special physical and/or mental needs. Today, some families have established a functioning situation despite their children's physical and/or mental difficulties, while some still struggle with their children's everyday life.

CONCLUSION

Having an extremely preterm family member profoundly affects the whole family for various lengths of time. Parents expressed a need for support from both healthcare and school throughout their children's childhood and in their transition to adulthood, although the need varies between parent-child pairs. By studying the parents' experiences, their need for support can be further recognized and understood, and developed and improved accordingly.

Effect of early directed implementation of family-integrated care measures on colonisation with Enterobacteriaceae in preterm neonates in NICU

BACKGROUND

Hospital-acquired strains (HASs) and multiresistant strains in neonatal intensive care unit often harbour virulence and resistance mechanisms, carrying the risk of invasive infections. We describe colonisation with Enterobacteriaceae in neonates receiving early directed versus routine family-integrated care (FIC) within the first month of life.

METHODS

A prospective cohort study included neonates with a gestational age below 34 weeks. During the first period, neonates were admitted to an open bay unit with transfer to the single-family room if available; feeding with the mother's own breast milk (MOBM) was introduced within 24 hours, and skin-to-skin contact (SSC) within 5 days of life (the routine care group). During the second period, following a wash-in of 2 months, care in a single-family room within 48 hours, the introduction of MOBM within two and SSC in 48 hours were applied (the intervention group). Enterobacteriaceae isolated from neonatal stool, breast milk and parental skin swabs were genotyped, Simpson's Index of Diversity (SID) calculated, and extended-spectrum beta-lactamases (ESBL) detected.

RESULTS

In 64 neonate-parents' groups, 176 Enterobacteriaceae, 87 in routine care and 89 in the intervention group were isolated; 26 vs 18 were HAS and one vs three ESBL positive, respectively. In the intervention group compared with the routine care group, SSC and MOBM feeding was started significantly earlier (p<0.001); during the first week of life, time spent in SSC was longer (median hours per day 4.8 (4-5.1) vs 1.9 (1.4-2.6), p<0.001) and the proportion of MOBM in enteral feeds was higher (median (IQR) 97.8% (95.1-100) vs 95.1% (87.2-97.4), p=0.011). Compared with the routine care group, the intervention group had higher SID and a reduction of HAS by 33.1% (95% CI 24.4% to 42.4%) in time series analysis.

CONCLUSIONS

Early implementation of FIC measures may hold the potential to increase diversity and reduce colonisation with HAS Enterobacteriaceae.

Concepts of family-centered care at the neonatal and paediatric intensive care unit: A scoping review

BACKGROUND

Understanding family-centred care (FCC) concepts is critical for its implementation in any context. The researchers synthesised studies on FCC in neonatal and paediatric critical care units in order to present its concepts and gaps in the literature to guide further research in the area.

METHOD

The study used the JBI methodology, and the PRISMA-ScR guidelines confirmed the final report. The search for material, with the use of library sources, used Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Google Scholar, and Wiley Library online for papers published in English from 2015 to 2019 and updated to 2023.

RESULTS

From 904 references, 61 studies were identified for inclusion. The majority of the studies (29; 55.77%) were qualitative ethnography and phenomenology. Four themes and ten subthemes emerged from the data to support the main concepts of FCC.

CONCLUSION

To guide its useful integration and implementation, more research on family-centred care in neonatal and paediatric intensive care units, involving families, staff, and managers, should be undertaken.

PRACTICE IMPLICATION

Findings presented in this review may provide a guide for nurses to adjust nursing interventions for critically ill neonates and children in intensive care units.

Virtual Visitation in a Neonatal Intensive Care Unit: Insights From 5 Years Using a PDSA Model to Improve Family-Centered Care

This 5-year study evaluated a virtual visitation implementation initiative in a neonatal intensive care unit. Our objectives were to (1) use the Plan-Do-Study-Act methodological framework to implement a virtual visitation program, (2) investigate whether implementation of virtual visitation could be done with no patient harm and minimal workflow disruption, (3) foster a top-down participatory structure for decision making, and (4) evaluate parent use and satisfaction. The study involved a qualitative and quantitative description of cycles and results. Routine collection of outcome data allowed problems that arose as a result of changing practices to be quickly and efficiently addressed. The study results suggested that the virtual visitation implementation initiative in a neonatal intensive care unit using Plan-Do-Study-Act cycles helped create an environment of trust and provided benefits. A steady increase in the use of virtual visitation by parents and their extended families indicated utilization. During the COVID-19 pandemic, virtual visitation helped families feel connected with each other and their neonate, despite being in separate locations.

[Representations of skin-to-skin care among parents and caregivers in neonatology]

A study looked at the representations of skin-to-skin contact among parents and caregivers in seven neonatal units in France and Belgium. Their ways of understanding skin-to-skin contact have some common elements, without completely overlapping. The work carried out could prove useful for professionals who, thanks to it, would be likely to obtain a better understanding and adhesion of the families to the practice of this relational care.

Skin-to-skin SDF positioning: The key to intersubjective intimacy between mother and very preterm newborn-A pilot matched-pair case-control study

Background

Skin-to-skin contact (SSC) has been widely studied in NICU and several meta-analyses have looked at its benefits, for both the baby and the parent. However, very few studies have investigated SSC' benefits for communication, in particular in the very-preterm newborn immediately after birth.

Aims

To investigate the immediate benefits of Supported Diagonal Flexion (SDF) positioning during SSC on the quality of mother-very-preterm newborn communication and to examine the coordination of the timing of communicative behaviors, just a few days after birth.

Subjects and study design

Monocentric prospective matched-pair case-control study. Thirty-four mothers and their very preterm infants (27 to 31 + 6 weeks GA, mean age at birth: 30 weeks GA) were assigned to one of the two SSC positioning, either the Vertical Control positioning (n = 17) or the SDF Intervention positioning (n = 17). Mother and newborn were filmed during the first 5 min of their first SSC.

Outcome measures

Infants' states of consciousness according to the Assessment of Preterm Infants' Behavior scale (APIB). Onset and duration of newborns' and mothers' vocalizations and their temporal proximity within a 1-s time-window.

Results

In comparison with the Vertical group, very preterm newborns in the SDF Intervention Group spent less time in a drowsy state and more in deep sleep. At 3.5 days of life, newborns' vocal production in SSC did not differ significantly between the two groups. Mothers offered a denser vocal envelope in the SDF group than in the Vertical group and their vocalizations were on average significantly longer. Moreover, in a one-second time-frame, temporal proximity of mother-very preterm newborn behaviors was greater in the SDF Intervention Group.

Conclusion

Although conducted on a limited number of dyads, our study shows that SDF positioning fosters mother-very preterm newborn intimate encounter during the very first skin to skin contact after delivery. Our pioneer data sheds light on the way a mother and her very preterm vocally meet, and constitutes a pilot step in the exploration of innate intersubjectivity in the context of very preterm birth.

Comprehensive and Innovative Clinical Tools for Nurses and Parents to Help Promote Family and Sibling Adaptation in the NICU

Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant's NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents' and siblings' adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families' adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families.

Usefulness of the Parental Electronic Diary During Medical Rounds in a NICU

Parental involvement in the care of their baby in family rooms in neonatal intensive care units (NICUs) can be improved. This could be done with an electronic medical report completed by the parents, which is then linked to the patient record system. The parents selected for this study completed an electronic diary during their stay in the NICU, while the staff answered a questionnaire about their opinion on the usefulness of the parents' diary. The length of stay, length of time the baby spent in Kangaroo care, breastfeeding, time given to breastfeeding, feeling of tiredness, the capability of identifying the newborn's signals, and parents' opinion on the diary were variables in the study. The NICU staff's opinion about the usefulness of the diary in decision-making was sought using a questionnaire. Eleven mothers and three fathers completed the diary. The median time for staying in the ward was 20 hours/day. The median time in Kangaroo care was 3 hours/day. The majority of mothers were breastfeeding on average 5 times per day. The commonest length of time for breastfeeding was 1 to 2 hours/day. The parents felt somewhat tired during their stay. All parents recognized their child's signals mostly or all the time. Most parents were happy with the diary. The nursing staff's opinions on the usefulness of the diary too were uniformly positive, whereas the doctors' opinions varied from positive to critical in nature. In conclusion, the diaries provided us with new information about parents' perceptions in the NICU. The nurses found the diary useful whereas the doctors were more critical.

Early Physiotherapy Intervention Program for Preterm Infants and Parents: A Randomized, Single-Blind Clinical Trial

Background: The early developmental interventions might be designed with a preventative approach to improving the development of at-risk preterm infants. The present study aimed to evaluate the effectiveness of an early physiotherapy intervention on preterm infants’ motor and global development, and on parents’ stress index. Methods: 48 infants were enrolled and randomized into two groups. Infants allocated to the intervention group received an early physiotherapy intervention, based on parental education sessions and tactile and kinesthetic stimulation during the NICU period, as well as a home-based activity program. The intervention commenced after 32 weeks post-menstrual age and ended at 2 months corrected age. Infants allocated to the control group received the usual care based on the NIDCAP-care. Results: No differences were found between groups on the Alberta Infant Motor Scale at 2- or 8-months corrected age. Infants in the intervention group showed more optimal fine motor, problem-solving, personal-social, and communication development at 1 month corrected age. Conclusions: The results showed no effect on the early physiotherapy intervention. Results might be related to the dose or intensity of the intervention, but also to the poor parental compliance. ClinicalTrials.gov NCT03313427.

What Did the Neonatal Integrative Developmental Care Model and Routine Developmental Care Affect on Stress of Premature Babies?

BACKGROUND: Neonatal integrative developmental care model (NIDCM) is a holistic model of premature baby care referring to seven basic neuroprotective developmental cares (DCs) by involving the family. AIM: This study aimed to assess the effect of the application of NIDCM on the stress response of premature babies. METHODS: The research design used was quasi-experimental with a non-equivalent control group pre- and post-test. The study was conducted in the neonatal care room of Dr. Wahidin Sudirohusodo Makassar Hospital from January 2020 to April 2021. The sample was 76 subjects consisting of 38 premature babies (19 controls and 19 interventions) and 38 mothers (19 controls and 19 interventions). The collected samples were taken to the Medical Research Laboratory of Universitas Hasanuddin (HUMRC) for testing. Furthermore, baby stress was assessed from salivary cortisol levels by enzyme linked immunosorbent assay. In addition, the effect of initial cortisol, final cortisol, and birth weight on changes in salivary cortisol in premature babies was determined using the Chi-square test. RESULTS: Neither NIDCM intervention nor routine DC has been shown to descriptive statistically decrease the stress response of premature babies in the neonatal care room, some of which are even increased. However, specifically in premature babies with a birth weight of <1800 g, NIDCM showed a better effect in lowering cortisol after treatment than regular DC. CONCLUSIONS: The application of NIDCM intervention reduces the stressor felt by the babies in the neonatal care room, besides the condition of babies with a birth weight of fewer than 1800 g needs special attention with the NIDCM intervention.

Nursing care of infants born extremely preterm

With improving survival at the lowest gestations an increasing number of tiny and vulnerable infants are being cared for, and optimal outcomes require an approach to care that takes their specific characteristics into account. These include immature organ function and a risk for iatrogenic injury, and parental/familial strain due to the high degree of uncertainty, infant-mother separation, and long hospital stay. While the challenges in providing nursing care to these infants are obvious it is also clear that this field has tremendous potential to influence both short and long-term outcomes of this population. This mini-review discusses aspects of the nursing care provided to infants born at the very lowest gestations and their families, with focus on doing less harm by establishing an adequate care environment, actively promoting parental closeness and care-giving, and conservative skin care.

Enhancing Parents' Well-Being after Preterm Birth-A Qualitative Evaluation of the "Transition to Home" Model of Care

There are few programs available aimed at preventing short- and long-term negative consequences after preterm birth and covering the entire care continuum. The “Transition to Home (TtH)” model is such a program, offering structured, individual support for families with preterm infants before and after hospital discharge. This study gathers and examines the parents’ views of receiving support from an interprofessional team under the TtH model of care during hospitalization and after discharge. Using a qualitative explorative design, 39 semi-structured interviews with parents were analyzed thematically. From this analysis, three main themes were identified: (1) TtH and the relevance of continuity of care; (2) Enhancement of parents’ autonomy and self-confidence; (3) Perception of interprofessional collaboration. Within these themes, the most relevant aspects identified were continuity of care and the appointment of a designated health care professional to anchor the entire care continuum. Emotional support complemented by non-medical approaches, along with strength-based and family resource-oriented communication, also emerged as key aspects. Continuous, family-centered care and well-organized interprofessional collaboration promote the well-being of the family after a premature birth. If the aspects identified in this study are applied, the transition from hospital to home will be smoothened for the benefit of affected families.

The Swedish approach to nurturing extremely preterm infants and their families: A nursing perspective

Nurturing extremely premature infants is a complicated task that not only necessitates a systematic approach to the immature physiology and its medical management, but also to the needs of the family. Infants born at 22-24 weeks require many weeks of intensive care including a long duration of mechanical ventilation, numerous stressful medical interventions, and for the parents to spend a lot of time in the Neonatal Intensive Care unit (NICU). This paper aims to outline the Swedish nursing approach to nurturing these infants and their families. The nursing care is structured so the parents are the primary caregivers supported by the staff and is based on: timely expression and provision of mother's own breast milk, early and prolonged skin-to-skin contact and close collaboration with the family. While this presentation is based on a single-center's experience, it well represents the general features of nursing provided to extremely preterm infants in Swedish NICUs.

Improving Family-Centered Care for Infants in Neonatal Intensive Care Units: Recommendations From Frontline Healthcare Professionals

BACKGROUND

Family-centered care is a philosophy and healthcare delivery model adopted by many neonatal intensive care units (NICUs) worldwide, yet practice varies widely.

PURPOSE

The aim of this study was to synthesize recommendations from frontline NICU healthcare professionals regarding family-centered care.

METHODS

Data were obtained from the baseline phase of a multicenter quasi-experimental study comparing usual family-centered NICU care (baseline) with mobile-enhanced family integrated care (intervention). Members of the NICU clinical care team completed a family-centered care survey and provided free-text comments regarding practice of family-centered care in their NICU and recommendations for improvement. The comments were analyzed using a directed content analysis approach by a research team that included NICU nurses and parents.

RESULTS

Of the 382 NICU healthcare providers from 6 NICUs who completed the survey, 68 (18%) provided 89 free-text comments/recommendations about family-centered care. Almost all comments were provided by nurses (91%). Six main themes were identified: language translation; communication between staff and families; staffing and workflow; team culture and leadership; education; and NICU environment. The need for greater resources for staffing, education, and environmental supports was prominent among the comments, as was team culture and staff-parent communications.

IMPLICATIONS FOR PRACTICE

The NICU healthcare professionals identified a range of issues that support or impede delivery of family-centered care and provided actionable recommendations for improvement.

IMPLICATIONS FOR RESEARCH

Future research should include economic analyses that will enable determination of the return on investment so that NICUs can better justify the human and capital resources needed to implement high-quality family-centered care.

Parents' friends and families in neonatal intensive care units: A cross-national qualitative study on staff perceptions and experiences

AIMS AND OBJECTIVES

This study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs).

BACKGROUND

In NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these 'important others' can be present and involved.

DESIGN

This qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry.

METHODS

Seven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist.

RESULTS

The overarching theme showed that 'important others' were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised 'important others' as the parents' territory, but that 'important others'' presence and involvement needed to be negotiated with staff. Although the staff regarded 'important others' as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of 'important others' was an essential step forward in achieving family centred care.

CONCLUSIONS

The findings indicate that 'important others'' involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of 'important others'.

RELEVANCE TO CLINICAL PRACTICE

There is a need for more staff resources to enable and support the participation of 'important others'. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their 'important others'.

Effects of Live Music Therapy on Autonomic Stability in Preterm Infants: A Cluster-Randomized Controlled Trial

Unbuffered stress levels may negatively influence preterm-infants’ autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm infants and their parents and enhance family-centered care. Accordingly, we aimed to compare the effects of combined MT and SSC and SSC alone on ANS stabilization in preterm infants. In a single-center, cluster-randomized trial design, ten two-month time-clusters were randomized to either combined MT and SSC or SSC alone. Families of preterm infants were offered two sessions of the allocated condition in the NICU, and a three-month follow up session at home. The primary outcome variable was stabilization of the ANS, defined by change in the high frequency (HF) power of heart rate variability (HRV) during the second session. Secondary outcomes included other HRV measures, parent–infant attachment, and parental anxiety at each session. Sixty-eight families were included. MT combined with SSC improved infants’ ANS stability, as indicated by a greater increase in HF power during MT compared to SSC alone (mean difference 5.19 m²/Hz, SE = 1.27, p < 0.001) (95% confidence interval 0.87 to 2.05). Most secondary outcomes were not significantly different between the study groups. MT contributes to preterm-infants’ autonomic stability, thus laying an important foundation for neuro-behavioral and psycho-emotional development. Studies evaluating longer-term effects of MT on preterm infants’ development are warranted.

Parents' Experiences of Immediate Skin-to-Skin Contact After the Birth of Their Very Preterm Neonates

OBJECTIVE

To explore parents' experiences of immediate skin-to-skin contact after the birth of their very preterm neonates and their perceptions regarding care and support from staff.

DESIGN

A descriptive qualitative study.

SETTING

Birth and neonatal units within a university hospital in Sweden.

PARTICIPANTS

Six parent couples who co-cared for their very preterm neonates with skin-to-skin contact throughout the first 6 hours after birth.

METHODS

We analyzed individual interviews using reflexive thematic analysis as described by Braun and Clarke.

RESULTS

The parents' experiences of immediate skin-to-skin contact with their very preterm neonates were represented by the following three themes: A Pathway to Connectedness, Just Being in a Vulnerable State, and Creating a Safe Haven in an Unknown Terrain. Skin-to-skin contact helped the parents attain their roles as essential caregivers and provided a calming physical sensation that promoted parents' feelings of connectedness with their newborns. When parents provide skin-to-skin contact at birth, staff members need to recognize and address their vulnerability. A good relationship with nursing staff, which was mediated through staff behaviors and availability, facilitated skin-to-skin contact.

CONCLUSION

Skin-to-skin contact initiated at birth with very preterm neonates was a valuable and empowering experience for parents and enhanced early bonding between parents and their newborns. Staff members should recognize that skin-to-skin contact between parents and neonates is an interactive process that has challenges. Future research is warranted to understand the needs of nursing staff who provide initial care in the postpartum period. Furthermore, we recommend the implementation of maternal-neonatal couplet care.

Crack and motor development of babies living in an assistance shelter

Introduction: The baby motor development happens naturally with the complex interaction of the body, performing tasks in its context. When the body suffers negative external influence, such as the use of drugs by the mother during pregnancy, and develops in an environment different from home, such as shelters, it is questionable how the motor development would be. Objective: To evaluate the motor development of babies living in welfare shelters, children of crack users during pregnancy; to verify if there is an association of motor delay in these babies; and to describe the environment in which they were inserted. Methods: This is a cross-sectional study, with a convenience sample. There were 29 babies between three and 16 months old. Twenty-two of them were exposed to crack during pregnancy (Crack Group) and the remaining seven were not (Non-Crack Group). All were living in a specific shelter. To assess broad motor development, the Alberta Infant Motor Scale (AIMS) was used. The Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) was used to assess home environment opportunities. Results: In the crack group, the developmental delay was confirmed in 36.4% cases and suspected in 18.2%. Most babies in the crack group were typical (45.5%). There was no statistically significant association between crack group and developmental delay, nor with age and sex. Conclusion: The development of babies in the crack group was similar to the non-crack group and the opportunities in the environment were reasonable for the baby development.

Maternal Stress, Depression, and Attachment in the Neonatal Intensive Care Unit Before and During the COVID Pandemic: An Exploratory Study

The main aim of the present study was to investigate the effects of the COVID-19 pandemic on the mothers' postnatal depression, stress, and attachment during their stay in the Neonatal Intensive Care Unit (NICU). Twenty mothers of very premature infants born before 32weeks of gestational age were recruited at the Geneva University Hospital between January 2018 and February 2020 before the COVID-19 pandemic started. Mothers were screened for postnatal depression after their preterm infant's birth (Edinburgh Postnatal Depression Scale, EPDS), then for stress (Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU), and attachment (Maternal Postnatal Attachment Scale, MPAS) at infant's term-equivalent age. Data were compared with 14 mothers recruited between November 2020 and June 2021 during the COVID-19 pandemic. No significant differences were found in the scores for depression, stress, and attachment between the two groups. However, a non-statistically significant trend showed a general increase of depression symptoms in mothers during the COVID-19 pandemic, which significantly correlated to the attachment and stress scores. Moreover, the PSS:NICU Sights and Sounds score was significantly positively correlated with EPDS scores and negatively with the MPAS score only in the During-COVID group. To conclude, we discussed a possible dampened effect of the several protective family-based actions that have been adopted in the Geneva University Hospital during the health crisis, and we discussed the most appropriate interventions to support parents in this traumatic period during the COVID-19 pandemic.

Women's dissatisfaction with inappropriate behavior by health care workers during childbirth care in France: A survey study

BACKGROUND

Quality care during childbirth requires that health care providers have not only excellent skills but also appropriate and considerate attitudes and behavior. Few studies have examined the proportion of women in Western countries expressing dissatisfaction with such inappropriate or inconsiderate behavior. This study evaluated this proportion in a sample presumably representative of French maternity units.

METHODS

This prospective multicenter study, using data from a selfadministered questionnaire, took place in 25 French maternity units during one week in September 2018. The primary outcome measure was mothers' self-reported dissatisfaction with blatantly inappropriate behavior (ie, inappropriate attitude, inadequate respect for privacy, insufficient gentleness of care, and/or inappropriate language) by health care workers in the delivery room. The secondary outcome was their self-reported dissatisfaction with these workers' inconsiderate behavior (ie, unclear and inappropriate information, insufficient participation in decision-making, or deficient consideration of pain).

RESULTS

Of 803 potentially eligible women, 627 completed the questionnaire after childbirth; 5.62% (35/623, 95% CI: 3.94-7.73) reported dissatisfaction with blatantly inappropriate behaviors and 9.79% (61/623, 95% CI: 7.57-12.40) with inconsiderate behaviors. The main causes of dissatisfaction reported by women in this survey were the inadequate consideration of their pain and the failure to share decision-making.

CONCLUSIONS

Most of the women were satisfied with how health care workers behaved towards them in the delivery room. Nonetheless, health care staff must be aware of women's demands for greater consideration of their expressions of pain and of their voice in decisions.

Potential Risk Factors for Autism in Children Requiring Neonatal Intensive Care Unit

BACKGROUND

The etiology of autism spectrum disorder (ASD) is complex and involves the interplay of genetic and environmental factors.

AIM

We sought to identify potential prenatal, perinatal, and neonatal risk factors for ASD in a unique population of children who had perinatal complications and required care in a neonatal intensive care unit (NICU).

METHODS

This prospective cohort study included 73 patients discharged from a NICU who received long-term follow-up at the largest children's hospital in Brazil. Potential risk factors were compared between 44 children with a diagnosis of ASD and 29 children without using the Mann-Whitney U test. Proportions were analyzed using the chi-square test. Simple and multiple logistic regression tests were performed.

RESULTS

Of 38 factors analyzed, the following 7 were associated with ASD: family history of neuropsychiatric disorders (p = 0.049); maternal psychological distress during pregnancy (p = 0.007); ≥ 26 days in the NICU (p = 0.001); feeding tube for ≥ 15 days (p = 0.014); retinopathy of prematurity (p = 0.022); use of three or more antibiotics (p = 0.008); and co-sleeping until up to 2 years of age (p = 0.004).

CONCLUSION

This study found associations between specific risk factors during critical neurodevelopmental periods and a subsequent diagnosis of ASD. Knowledge of the etiologic factors that may influence the development for ASD is paramount for the development of intervention strategies and improvement of prognoses.

Kangaroo position during neonatal ground ambulance transport: Parents' experiences

BACKGROUND

Kangaroo mother care including skin-to-skin care aims to overcome the negative effects of separating parents and infants and to increase the quality of care for infants and parents in need of neonatal care. In most cases where inter-hospital transport is needed, the infant is placed in a transport incubator, which increases the risk of separation due to ambulance service restrictions that imply that parents are not allowed to accompany these transport trips.

AIM

To illuminate parents' experiences of holding their infant in a kangaroo position during neonatal ground ambulance transport.

STUDY DESIGN

A qualitative design with an inductive approach.

METHODS

A total of 11 open interviews with Swedish parents were conducted two to seven days after their infant had been transferred in a kangaroo position between hospitals. The transcribed interviews were analysed using qualitative content analysis.

RESULTS

The emerged overarching category was "an uninterrupted closeness chain." The parents experienced that holding their infant during the transport extended the time they were close to their infant. Using the kangaroo position during ground ambulance transport also created a feeling of being important as a parent, as their participation during transport was appreciated. Parents' experiences were allocated into three categories: "Strengthen the feeling of being important as a parent," "promote security and create a positive environment for the baby" and "the professionals' attitude promotes security."

CONCLUSION AND RELEVANCE FOR CLINICAL PRACTICE

This knowledge about parents' experiences is important in the continued work to develop interventions that focus on promoting zero separation in neonatal care. Using kangaroo position in a safety harness during ambulance transport enhances zero separation and closeness. To encourage the implementation of kangaroo position during ambulance transport, further research is needed to address parents' experiences of zero separation during transport of infants to a higher level of care.

When can I hold my baby? An audit of time to first cuddle for preterm babies (<32 weeks) pre introduction and post introduction of a Family-Integrated Care model

AIM

The audit examined time to first cuddle between preterm babies (born < 32 weeks) and their parent pre- and post-introduction of a family-integrated care model. Secondary outcomes included time to full feeds and length of neonatal intensive care stay.

BACKGROUND

Parental separation due to neonatal intensive care unit admission is known to negatively affect parental and baby wellbeing.

DESIGN

A "before-after" design compared outcomes for babies admitted pre- (2015) and post (2018)-implementation of the model in a Western Australian neonatal intensive care unit.

METHODS

A retrospective medical record audit included babies from two gestational age groups in 2015 and 2018, born ≤27 + 6 weeks and 28-31 + 6 weeks. SQUIRE checklist guided reporting of the audit.

RESULTS

One hundred fifty-three babies were included in the audit, 79 from 2015 (≤27 + 6 weeks n = 39 and 28-31 + 6 weeks n = 40) and 74 from 2018 (≤27 + 6 weeks n = 35 and 28-31 + 6 weeks n = 39). Babies in both years were born at similar median gestational ages with comparable birthweights. Babies born ≤27 + 6 weeks in 2018 were cuddled earlier (median = 141 h old) compared with those in 2015 (median = 157 h old). Median time to reach full feeds decreased and was significant in the ≤27 + 6-week group: 288 h (12 days) in 2015 to 207.5 h (8.6 days) in 2018. Length of stay was longer for the ≤27 + 6-week gestation 2018 group (median = 64 days) and 28-31 + 6-week gestation 2018 group (median = 22 days).

CONCLUSION

Family-integrated care models may decrease the time to first cuddle and full feeds. Further research on outcomes such as breastfeeding, infant weight gain and length of stay can extend existing knowledge.

RELEVANCE TO CLINICAL PRACTICE

Family-integrated care models may offer benefits to families of hospitalised preterm babies and investigating barriers to its implementation and creation of solutions to overcome barriers warrants attention.

State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review

Introduction: Parents' active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. This scoping review synthesizes the available research to provide an overview of the state of the art in parent-delivered pain-relieving interventions. Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care. Results: There is a strong evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. These parent-delivered interventions are safe, valid, and ready for prompt introduction in infants' pain care globally. Research into parents' motivations for, and experiences of, alleviating infant pain is scarce. More research on combined parent-delivered pain alleviation, including relationship-based interventions such as the parent's musical presence, is needed to advance infant pain care. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of combining these interventions and to address parent involvement in low-income and low-tech settings. Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain management for infants' procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and parent but also of health care.

Effects of Early Vocal Contact in the Neonatal Intensive Care Unit: Study Protocol for a Multi-Centre, Randomised Clinical Trial

Preterm infants are at risk for developing altered trajectories of cognitive, social, and linguistic competences compared to a term population. This is mainly due to medical and environmental factors, as they are exposed to an atypical auditory environment and simultaneously, long periods of early separation from their parents. The short-term effects of early vocal contact (EVC) on an infant’s early stability have been investigated. However, there is limited evidence of its impact on the infant’s autonomic nervous system maturation, as indexed by heart rate variability, and its long-term impact on infant neurodevelopment. Our multi-centric study aims to investigate the effects of EVC on a preterm infant’s physiology, neurobehaviour, and development. Eighty stable preterm infants, born at 25–32 weeks and 6 days gestational age, without specific abnormalities, will be enrolled and randomised to either an intervention or control group. The intervention group will receive EVC, where mothers will talk and sing to their infants for 10 min three times per week for 2 weeks. Mothers in the control group will be encouraged to spend the same amount of time next to the incubator and observe the infant’s behaviour through a standard cluster of indicators. Infants will be assessed at baseline; the end of the intervention; term equivalent age; and 3, 6, 12, and 24 months corrected age, with a battery of physiological, neurobehavioral, and developmental measures. Early interventions in the neonatal intensive care unit have demonstrated effects on the neurodevelopment of preterm infants, thereby lowering the negative long-term effects of an atypical auditory and interactional environment. Our proposed study will provide new insight into mother–infant early contact as a protective intervention against the sequelae of prematurity during this sensitive period of development. Early intervention, such as EVC, is intuitive and easy to implement in the daily care of preterm infants. However, its long-term effects on infant neurodevelopment and maternal sensitivity and stress are still unclear. Trial Registration: NCT04759573, retrospectively registered, 17 February 2021.

Preterm Birth and the Development of Visual Attention During the First 2 Years of Life: A Systematic Review and Meta-analysis

Importance

Preterm birth is associated with an increased risk for long-lasting attention deficits. Early-life markers of attention abnormalities have not been established to date but could provide insights into the pathogenesis of attention abnormalities and could help identify susceptible individuals.

Objective

To examine whether preterm birth is associated with visual attention impairments in early life, and if so, in which attention functions and at which developmental period during the first 2 years of life.

Data Sources

PubMed and PsycINFO were searched on November 17, 2019, to identify studies involving visual attention outcomes in infants born preterm vs full term.

Study Selection

Peer-reviewed studies from the past 50 years met the eligibility criteria if they directly assessed visual attention outcomes until the age of 2 years in generally healthy infants born preterm or full term. The selection process was conducted by 2 independent reviewers.

Data Extraction and Synthesis

The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Random-effects models were used to determine standardized mean differences. The risk of bias was assessed both within and between studies.

Main Outcomes and Measures

Five nascent indices of visual attention were analyzed, including very basic functions-namely, the abilities to follow and fixate on visual targets-and more complex functions, such as visual processing (ie, habituation), recognition memory (ie, novelty preference), and the ability to effortfully focus attention for learning.

Results

A total of 53 studies were included, with 69 effect sizes and assessing a total of 3998 infants (2047 born preterm and 1951 born full term; of the 3376 for whom sex was reported, 1693 [50.1%] were girls). Preterm birth was associated with impairments in various attention indices, including visual-following in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31), latency to fixate (Cohen d, -0.18; 95% CI, -0.33 to -0.02), novelty preference (Cohen d, -0.20; 95% CI, -0.32 to -0.08), and focused attention (Cohen d, -0.28; 95% CI, -0.45 to -0.11). In the neonatal period, preterm birth was associated with superior visual-following (Cohen d, 0.22; 95% CI, 0.03 to 0.40), possibly owing to the additional extrauterine exposure to sensory stimulation. However, this early association waned rapidly in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31).

Conclusions and Relevance

The findings suggest that preterm birth is associated with impingements to visual attention development in early life, as manifested in basic and then complex forms of attention. Advancements in neonatal care may underlie improvements found in the current era and accentuate several early protective factors.

Asynchronous video messaging promotes family involvement and mitigates separation in neonatal care

OBJECTIVE

To evaluate the parent and staff experience of a secure video messaging service as a component of neonatal care.

DESIGN

Multicentre evaluation incorporating quantitative and qualitative items.

SETTING

Level II and level III UK neonatal units.

POPULATION

Families of neonatal inpatients and neonatal staff.

INTERVENTION

Use of a secure, cloud-based asynchronous video messaging service to send short messages from neonatal staff to families. Evaluation undertaken July-November 2019.

MAIN OUTCOME MEASURES

Parental experience, including anxiety, involvement in care, relationships between parents and staff, and breastmilk expression.

RESULTS

In pre-implementation surveys (n=41), families reported high levels of stress and anxiety and were receptive to use of the service. In post-implementation surveys (n=42), 88% perceived a benefit of the service on their neonatal experience. Families rated a positive impact of the service on anxiety, sleep, family involvement and relationships with staff. Qualitative responses indicated enhanced emotional closeness, increased involvement in care and a positive effect on breastmilk expression. Seventy-seven post-implementation staff surveys were also collected. Staff rated the service as easy to use, with minimal impact on workload. Seventy-one percent (n=55) felt the service had a positive impact on relationships with families. Staff identified the need to manage parental expectations in relation to the number of videos that could be sent.

CONCLUSIONS

Asynchronous video messaging improves parental experience, emotional closeness to their baby and builds supportive relationships between families and staff. Asynchronous video supports models of family integrated care and can mitigate family separation, which could be particularly relevant during the COVID-19 pandemic.

The burden of early life stress on the nociceptive system development and pain responses

For a long time, the capacity of the newborn infant to feel pain was denied. Today it is clear that the nociceptive system, even if still immature, is functional enough in the newborn infant to elicit pain responses. Unfortunately, pain is often present in the neonatal period, in particular in the case of premature infants which are subjected to a high number of painful procedures during care. These are accompanied by a variety of environmental stressors, which could impact the maturation of the nociceptive system. Therefore, the question of the long-term consequences of early life stress is a critical question. Early stressful experience, both painful and non-painful, can imprint the nociceptive system and induce long-term alteration in brain function and nociceptive behavior, often leading to an increase sensitivity and higher susceptibility to chronic pain. Different animal models have been developed to understand the mechanisms underlying the long-term effects of different early life stressful procedures, including pain and maternal separation. This review will focus on the clinical and preclinical data about early life stress and its consequence on the nociceptive system.

The Evolution of an Interdisciplinary Developmental Round in a Surgical Neonatal Intensive Care Unit

BACKGROUND

Developmentally supportive environments are known to improve medical outcomes for hospitalized neonates and are considered the overarching philosophy for practice in the neonatal setting. Developmental rounds are a strategy incorporated by multidisciplinary teams to support development within and beyond the neonatal unit. Typically, they consist of bedside consultations and individualized developmentally supportive recommendations for families and clinicians. Globally, the use of developmental rounds has been described since the early 1990s. They are viewed as a measure to counter some of the barriers to developmental care implementation while buffering against the effect of an intensive care admission. To date, their use in the surgical neonatal intensive care unit (sNICU) has been minimally reported in literature.

PURPOSE

This article describes the focus and work of a developmental round team and strategy in the sNICU.

METHOD

A retrospective audit of developmental round key performance criteria undertaken over a 4-year period (2015-2018).

FINDINGS/RESULTS

More than 300 developmental consults and 2000 individualized developmental recommendations occurred annually. Parental presence during the developmental round increased by 10%, from 48% to 58%, during the audit period.

IMPLICATIONS FOR PRACTICE/IMPLICATIONS FOR RESEARCH

Literature has supported the use of developmental round interventions; however, minimal data have been reported to date. This article provides retrospective audit data of a developmental round intervention in the sNICU with a focus on data over 4 years to highlight key areas, including the structure and process, recommended educational standards for team members, and parental engagement, as key markers for developmental round efficacy. Future research should focus on the link between the developmental round intervention and long-term neonatal outcomes.

NURSES' PERCEPTIONS ABOUT THE FEEDING OF PRETERM NEWBORNS

ABSTRACT Objective: to analyze nurses' perceptions about the feeding of preterm newborns and their motivations in using feeding methods during hospitalization in the neonatology unit. Method: descriptive study with a qualitative approach. Data collection was carried out between July 2019 and January 2020, using semi-structured interviews with 30 nurses from a neonatology unit. The analysis of interview data was carried out using lexicographical textual analysis, the descending hierarchical classification, and similarity analysis through IRaMuTeQ - R Interface software. Results: 876 text segments were analyzed in the descending hierarchical classification, retaining 86.3% of the total for the creation of five classes that resulted from content participation. The similarity analysis of the words representing the nurses' perception about oral feeding and the choice of feeding method led to three central cores, represented by the words: think, give, bottle. Conclusion: Nurses recognize the importance of continuing education and training in the assessment of oral skills. The reason for choosing the feeding method is often based on criteria such as preference, speed, and ease.

Association between neonatal homecare for preterm infants and incidence of severe postpartum depression in mothers

BACKGROUND

Understanding the association between neonatal homecare and postpartum depression could contribute to the design of evidence-based interventions to prevent postpartum depression. We aimed to determine whether the change from inpatient stays in neonatal intensive care units to offering neonatal homecare was associated with a reduced incidence rate of severe postpartum depression among mothers who gave birth prematurely.

METHODS

We conducted a register-based population-wide study of all mothers who gave birth prematurely 1994-2017 to live-born infants and spent at least one night in the Neonatal Intensive Care Unit. We performed an interrupted time series analysis to investigate the incidence rate ratio of severe postpartum depression before and after the implementation of neonatal homecare. Neonatal homecare was implemented between 1994 and 2016.

RESULTS

The total population consisted of 46,456 mothers and the median age was 30 years and interquartile range of 27-34 years. Overall 4.5 % of the mothers were diagnosed with severe postpartum depression. Prior to neonatal homecare no change in the incidence of severe postpartum depression was found; (incidence rate ratio=1.01 [95 % confidence interval: 0.97-1.05] every half year, p=0.69). The implementation was associated with a level change with an incidence rate ratio reduction of 23 % (incidence rate ratio=0.77 [95 % confidence interval: 0.64-0.93], p=0.007).

LIMITATIONS

Limitations include potential underdiagnosis in early periods, lack of randomization, and different periods of implementation of neonatal homecare.

CONCLUSIONS

We found a possible association between the implementation of neonatal homecare and a 23 % reduced incidence rate of severe postpartum depression among mothers of preterm infants.

Care of hospitalized infants and their families during the COVID-19 pandemic: an international survey

This research study explored changes in family-centered care practices for hospitalized infants and families due to the COVID-19 pandemic. This exploratory descriptive study used a 49-item online survey, distributed to health care professionals working with hospitalized infants and families. The sample consisted of 96 participants from 22 countries. Prior to the COVID-19 pandemic, 87% of units welcomed families and 92% encouraged skin-to-skin care. During the pandemic, family presence was restricted in 83% of units, while participation in infant care was restricted in 32%. Medium-sized (20-40 beds) units applied less restriction than small (<20 beds) units (p = 0.03). Units with single-family rooms that did not restrict parental presence, implemented fewer restrictions regarding parents' active participation in care (p = 0.02). Restrictions to families were not affected by geographic infection rates or developmental care education of health care professionals. Restrictions during the pandemic increased separation between the infant and family.

Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy

BACKGROUND

Skin-to-skin contact (SSC) has been demonstrated to allow adequate thermal stability in high-technology settings with extremely preterm infants, while other aspects on how SSC influences basic physiological parameters have been less extensively investigated.

PURPOSE

To evaluate physiological stability during SSC and incubator care in a group of preterm infants born at a gestational age (GA) of 32 weeks or less and receiving respiratory support.

METHODS

Descriptive, observational study including 10 preterm infants (GA 22-32 weeks, postnatal age 2-48 days) were evaluated during SSC compared with flanking time periods in the incubator. Cerebral and systemic regional oxygen saturation (rSaO2), pulse oximetry (SpO2), heart rate (HR), and body temperature were recorded, and the fractional tissue oxygen extraction (fTOE) was calculated.

RESULTS

A total of 16 periods of SSC (mean duration 3 hours 30 minutes) were evaluated, 9 during nasal continuous positive airway pressure and 7 during mechanical ventilation. Cerebral rSaO2 was 68% ± 4% (SE) and 69% ± 4% during incubator care and SSC, respectively (P = .56). Somatic rSao2 was 64% ± 4% during incubator care and 66% ± 4% during SSC (P = .54). Also, fTOE, HR, and SpO2 was similar during the 2 modes of care. Body temperature increased during SSC (P < .01).

IMPLICATIONS FOR PRACTICE

The present study reveals no differences in cerebral and somatic tissue oxygenation between periods of SSC and care in the incubator. The findings indicate that SSC supports physiological stability also during management of very preterm infants receiving respiratory support.

IMPLICATIONS FOR RESEARCH

Further studies directed to further optimize SSC performance should enable its safe implementation at gradually lower gestational and postnatal ages.

The effects of education levels of developmental care in Australia: Perceptions and challenges

BACKGROUND

Developmental care consists of a range of clinical, infant-focused, and family-focused interventions designed to modify the neonatal intensive care environment and caregiving practices to reduce stressors on the developing brain. Since the inception of developmental care in the early 1980s, it has been recommended and adopted globally as a component of routine practice for neonatal care. Despite its application for almost 40 y, little is known of the attitude of neonatal nurses in Australia towards the intervention.

AIMS AND OBJECTIVES

The objective of this study was to establish Australian neonatal nurse perceptions of developmental care and explore associations between developmental care education levels of the nurses and personal beliefs in the application of developmental care.

DESIGN

This involves a cross-sectional survey design.

METHODS

An online questionnaire was completed by 171 neonatal nurses. Participants were members of the Australian College of Neonatal Nursing (n = 783). Covariate associations between key components of developmental care and respondents' geographical location, place of employment, professional qualifications, and developmental care education level were analysed. The reporting of this study is in accordance with the Enhancing the Quality and Transparency of Health Research Checklist for Reporting Results of Internet E-Surveys.

RESULTS

Differences were observed between groups for geographical location, place of employment, and professional qualification level. Rural nurses were less likely to support the provision of skin-to-skin care (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.2-1.8) than nurses in a metropolitsan unit. Nurses working in a neonatal intensive care unit and nurses with postgraduate qualifications were more likely to support parental involvement in care ([OR: 2.3, 95% CI: 0.9-6.2] and [OR: 2.1, 95% CI: 0.6-7.4], respectively). Rural respondents were more likely to have attended off-site education (OR: 3.6, 95% CI: 1.3-9.9) than metropolitan respondents.

CONCLUSION

The application of developmental care in Australia may be influenced by inadequate resources and inequitable access to educational resources, and similar challenges have been reported in other countries. Overcoming the challenges requires a focused education strategy and support within and beyond the neonatal intensive care unit.

Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study

OBJECTIVE

To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks.

DESIGN

Prospective national population-based EPIPAGE-2 cohort study.

SETTING

268 neonatology departments in France, March to December 2011.

POPULATION

Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge.

METHODS

The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model.

MAIN OUTCOME MEASURES

Severe symptoms of depression and anxiety in mothers of preterm infants.

RESULTS

Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety.

CONCLUSIONS

Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care.

TWEETABLE ABSTRACT

Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.