Management challenges for best practices of the Kangaroo Method in the Neonatal ICU

Multisensory stimulation bundles on sleep and neurobehavioral development in the first year after birth in very preterm infants: a randomized crossover controlled study protocol

BACKGROUND

Disrupted sleep is believed to contribute to short- and long-term neurodevelopmental problems in very preterm infants (VPIs). This study presents a protocol for an evaluator-blinded, randomized crossover trial. It aims to assess the sleep efficiency of hospitalized VPIs by providing multisensory stimulation bundles. Furthermore, it aims to observe the intervention impacts on sleep during hospitalization of the VPIs and their sleep and neurodevelopmental outcomes during the first year of post-discharge follow-up.

METHODS

The study will be conducted in the neonatology department of a tertiary pediatric teaching hospital. All the eligible VPIs will undergo two types of care in random order: "standard care" (2 weeks) and "standard care plus multisensory stimulation bundles," each lasting 2 weeks. A generated list of random numbers will be used for case sequence allocation. Sleep outcomes will be evaluated using the Actiwatch-2 Actigraph. Moreover, the amplitude-integrated electroencephalography and the Griffiths Mental Development Scales will be used to measure the neurodevelopmental outcomes during hospitalization and in the first year of follow-up of the VPIs.

DISCUSSION

The intervention protocol of this study differs from that of other traditional interventions by producing precise and consistent supportive stimulations, similar to maternal tactile, auditory, posture, and visual effects for hospitalized VPIs. This protocol could be an effective measure to facilitate sleep and early neurodevelopment of VPIs. The expected outcomes will help confirm the implementation and generalization of the multisensory stimulation bundles' care protocol in neonatology departments. We expect that the study will positively impact hospitalized VPIs, especially in their sleep and early neurodevelopmental outcomes. It will also provide a new perspective regarding parent and infant interaction strategies, particularly for newborn intensive care units that limit visits because of the global spread of COVID-19.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR 2200059099. Registered on 25 April 2022, https://www.chictr.org.cn/showproj.html?proj=166980 ; the Hospital Research Ethics Committee (approval number: SCMCIRB-K2021086-1, Version 01), approved on 21 January 2022.

Power relations and knowledge of neonatal teams in the Kangaroo Mother Care implementation and dissemination

OBJECTIVE

to analyze the power relations and knowledge among health teams that permeate the Kangaroo Mother Care implementation and dissemination in the state of Santa Catarina.

METHOD

socio-historical qualitative research, carried out in the state of Santa Catarina, from January to November 2019, based on interviews with 12 health professionals. Data were analyzed in the light of Foucault's genealogical proposal, with the help of Atlas.ti Cloud®.

RESULTS

the relationships of neonatal team members strengthened Kangaroo Mother Care actions in the state, articulating services and favoring health professionals' autonomy. However, Kangaroo nurses stand out in this process, and the hegemonic medical discourse often still represses the other professional categories.

CONCLUSION

professionals develop strategies to negotiate changes in the practice of care, moving between the plots of power and knowledge, sometimes exercising it, sometimes being passive to it.

Neurobehavioral signals in preterm infants in body weight check: a quasi-experimental study

OBJECTIVE

to describe and compare the frequency of neurobehavioral signs in preterm infants in traditional and humanized body weight check.

METHODS

a quantitative, quasi-experimental, cross-over study, carried out in a Neonatal Unit at a university hospital with a sample of 30 preterm newborns, randomly assigned and allocated in control group (traditional) and intervention group (humanized), with collection of general data, vital signs before and after procedures and footage.

RESULTS

there was a higher frequency of approach signs in humanized weight check compared to traditional check. Moreover, withdrawal signs were more frequent in traditional weight check compared to humanized check.

CONCLUSION

in this regard, humanized body weight check provided greater benefits to preterm infants, making it necessary to foster discussions about humanization of care, so that this practice can be performed routinely in health units.

Relações de poder e saber da equipe neonatal na implantação e disseminação do Método Canguru

RESUMO Objetivo: analisar as relações de poder e saber, entre a equipe de saúde, que permeiam a implantação e disseminação do Método Canguru no estado de Santa Catarina. Método: pesquisa sócio-histórica, com abordagem qualitativa, realizada no estado de Santa Catarina, no período de janeiro a novembro de 2019, a partir de entrevistas com 12 profissionais de saúde. Os dados foram analisados à luz da proposta genealógica de Foucault, com auxílio do software Atlas.ti Cloud®. Resultados: as relações da equipe neonatal fortaleceram as ações do Método Canguru no estado, articulando os serviços e favorecendo a autonomia dos profissionais de saúde. Entretanto, a enfermeira Canguru se destaca nesse processo, e o discurso médico hegemônico, muitas vezes, ainda reprime as demais categorias profissionais. Conclusão: os profissionais desenvolvem estratégias para negociar as mudanças na prática do cuidado, transitando entre as tramas do poder e saber, ora o exercendo, ora sendo passivo a ele.

Sinais neurocomportamentais em prematuros na verificação do peso corporal: estudo quase-experimental

RESUMO Objetivos: descrever e comparar a frequência dos sinais neurocomportamentais em prematuros na verificação do peso corporal de forma tradicional e humanizada. Método: estudo quantitativo, quase-experimental, tipo cross-over, realizado em uma Unidade Neonatal de um hospital universitário com amostra de 30 recém-nascidos prematuros, randomicamente assinalados e alocados no grupo controle (tradicional) e no grupo intervenção (humanizada), com a coleta de dados gerais, sinais vitais antes e depois dos procedimentos e filmagem. Resultados: observou-se uma frequência maior dos sinais de aproximação na verificação do peso de forma humanizada em relação à tradicional. Além disso, os sinais de retraimento se mostraram mais frequentes na verificação do peso de forma tradicional em comparação à humanizada. Conclusão: desse modo, a verificação do peso corporal de forma humanizada proporcionou maiores benefícios aos prematuros, tornando-se necessário estimular discussões sobre a humanização da assistência, para que esta prática possa ser realizada de forma rotineira nas unidades de saúde.

Implementation science in maternity care: a scoping review

BACKGROUND

Despite wide recognition that clinical care should be informed by the best available evidence, this does not always occur. Despite a myriad of theories, models and frameworks to promote evidence-based population health, there is still a long way to go, particularly in maternity care. The aim of this study is to appraise the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care. This is achieved by clarifying if and how implementation science theories, models, and frameworks are used.

METHODS

To map relevant literature, a scoping review was conducted of articles published between January 2005 and December 2019, guided by Peters and colleagues' (2015) approach. Specifically, the following academic databases were systematically searched to identify publications that presented findings on implementation science or the implementation process (rather than just the intervention effect): Business Source Complete; CINAHL Plus with Full Text; Health Business Elite; Health Source: Nursing/Academic Edition; Medline; PsycARTICLES; PsycINFO; and PubMed. Information about each study was extracted using a purposely designed data extraction form.

RESULTS

Of the 1181 publications identified, 158 were included in this review. Most of these reported on factors that enabled implementation, including knowledge, training, service provider motivation, effective multilevel coordination, leadership and effective communication-yet there was limited expressed use of a theory, model or framework to guide implementation. Of the 158 publications, 144 solely reported on factors that helped and/or hindered implementation, while only 14 reported the use of a theory, model and/or framework. When a theory, model or framework was used, it typically guided data analysis or, to a lesser extent, the development of data collection tools-rather than for instance, the design of the study.

CONCLUSION

Given that models and frameworks can help to describe phenomenon, and theories can help to both describe and explain it, evidence-based maternity care might be promoted via the greater expressed use of these to ultimately inform implementation science. Specifically, advancing evidence-based maternity care, worldwide, will require the academic community to make greater explicit and judicious use of theories, models, and frameworks.

REGISTRATION

Registered with the Joanna Briggs Institute (registration number not provided).