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Brown A, Tornberg ÅB, Kristensson Hallström I. Parents' lived experience of early risk assessment for cerebral palsy in their young child using a mobile application after discharge from hospital in the newborn period. Ann Med 2024; 56:2309606. [PMID: 38300887 PMCID: PMC10836479 DOI: 10.1080/07853890.2024.2309606] [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: 02/28/2022] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION General Movement assessment (GMA) is considered the golden standard for early identification of infants with a high risk of developing cerebral palsy (CP). The aim of this study was to explore parents' lived experience of early risk assessment for CP using a mobile application for home video recording after discharge from hospital stay in the newborn period. METHODS An inductive qualitative design using a hermeneutical phenomenological approach was chosen, and fourteen parents with children at risk of CP were interviewed at home. The hermeneutical phenomenological approach describes humans' lived experiences of a specific phenomenon with a possibility of deeper understanding of the expressed statements. The interviews were analyzed using the fundamental lifeworld existential dimensions as guidelines for describing the parents' lived experience. RESULTS The overall understanding of the parents' experience was 'Finding control in an uncontrolled life situation'. During the often-long hospitalizations, the parents struggled with loss of control and difficulty in understanding what was going on. The use of the mobile application followed by a swift result made them feel in control and have a brighter view of the future. CONCLUSIONS The findings suggest that the mobile application did not seem to worry the parents. Instead, it provided the parents with a sense of active participation in the care and treatment of their child. The mobile application should be accompanied with clear instructions and guidelines for the parents and details about how and when the result is given.
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Affiliation(s)
- Annemette Brown
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Pediatrics and Adolescence Medicine, Nordsjælland University Hospital, Capital Region of Denmark, Denmark
- Department of Neurology and Physiotherapy, Nordsjællands Hospital, Capital Region of Denmark, Denmark
| | - Åsa B. Tornberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Craig AK, Munoz-Blanco S, Pilon B, Lemmon M. Communicating with Parents About Therapeutic Hypothermia and Hypoxic Ischemic Encephalopathy: Integrating a Palliative Care Approach into Practice. Clin Perinatol 2024; 51:711-724. [PMID: 39095105 DOI: 10.1016/j.clp.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Parents of newborns with hypoxic ischemic encephalopathy (HIE) can face communication challenges in the neonatal intensive care unit. Both specialty palliative care and primary palliative care trained clinicians can assist parents as they navigate traumatic experiences and uncertain prognoses. Using evidence-based frameworks, the authors provide samples of how to communicate with parents and promote parent well-being across the care trajectory. The authors demonstrate how to involve parents in a shared decision-making process and give special consideration to the complexities of hospital discharge and the transition home. Sustained investment to guide the development of effective communication skills is crucial to support families of infants with HIE.
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Affiliation(s)
- Alexa K Craig
- Division of Pediatric Neurology, Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland; Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.
| | - Sara Munoz-Blanco
- Department of Pediatrics, Johns Hopkins School of Medicine; Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, USA; Division of Pediatric Palliative Care, Department of Pediatrics, Johns Hopkins Children's Center, 1800 Orleans Street, Baltimore, MD 21287, USA
| | | | - Monica Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University School of Medicine, DUMC 3936, Durham 27710, USA; Division of Pediatric Neurology and Developmental Medicine, Department of Population Health Sciences, Duke University School of Medicine, DUMC 3936, Durham 27710, USA
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Bäcke P, Axelin A, Ågren J, Thernström Blomqvist Y. Parent-infant closeness and care practices during therapeutic hypothermia in Swedish neonatal intensive care units. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:101010. [PMID: 39094471 DOI: 10.1016/j.srhc.2024.101010] [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: 03/09/2024] [Revised: 06/14/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES The aim of this study was to investigate care practices among Neonatal Intensive Care Units (NICU) providing Therapeutic hypothermia (TH), and more specific to investigate staff's experiences of parental participation, presence, and possibilities of being close with their infant during TH. METHODS A descriptive, qualitative, and quantitative study. All Swedish NICUs providing TH (n = 10) participated. Data were collected during January-April 2021 via a questionnaire followed by a semi-structured interview with the registered nurse and the neonatologist responsible for TH at each unit. Descriptive statistics were calculated, and a qualitative content analysis was performed. RESULTS All NICUs allowed parents unlimited stay with their infants and were keen to support parental presence, which was a prerequisite for promoting parent-infant closeness. Standardized routines regarding the infants' care space and course of action were described as time-efficient and staff-saving, which freed up time to focus on the families. CONCLUSION Standardized routines regarding the care space setup and the medical and caring approach, as well as the NICU environment and practices around the families, can promote or curb the possibilities of parent-infant closeness. Well-established care practices and good environmental conditions with flexibility regarding the family's needs are therefore required.
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Affiliation(s)
- Pyrola Bäcke
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden; Uppsala University, Department of Womeńs and Childreńs Health, S-751 85 Uppsala, Sweden.
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Kinakvarngatan 10, 20520 Turku, Finland.
| | - Johan Ågren
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden; Uppsala University, Department of Womeńs and Childreńs Health, S-751 85 Uppsala, Sweden.
| | - Ylva Thernström Blomqvist
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden; Uppsala University, Department of Womeńs and Childreńs Health, S-751 85 Uppsala, Sweden.
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Grass B, Erlach M, Rathke V, Cippa G, Hagmann C, Brotschi B. Parents' Experiences of Therapeutic Hypothermia for Neonates With Hypoxic-Ischemic Encephalopathy (HIE): A Single-Center Cross-Sectional Study. Qual Manag Health Care 2024; 33:94-100. [PMID: 37482641 DOI: 10.1097/qmh.0000000000000414] [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: 07/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The purpose of the study is to assess parental experiences of therapeutic hypothermia for moderate to severe hypoxic-ischemic encephalopathy with the goal of improving local clinical practice guidelines and fostering family-integrated care in neonates with hypoxic-ischemic encephalopathy. METHODS This single-center retrospective cross-sectional study included neonates and their parents registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2021. Based on a literature review, an anonymous survey of parents of neonates with hypoxic-ischemic encephalopathy was developed and conducted using an online survey tool. Descriptive statistics were used to analyze the survey results. RESULTS The overall response rate to this survey was 64% (46/72). Sufficient information about hypoxic-ischemic encephalopathy was reported by 78% (36/46) of parents and sufficient information about the process of therapeutic hypothermia by 87% (40/46) of parents. The majority of parents indicated the need for, and at least a satisfactory perception of, professional (91%; 42/46) and emotional (87%; 40/46) support. Parents identified fostering family involvement and regular family communication that focuses on family integrated care as areas for improvement. CONCLUSIONS There is still an unmet need for multidisciplinary teams to provide professional, empathetic, high quality, and family-integrated care to families with a neonate receiving therapeutic hypothermia for moderate or severe hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Beate Grass
- Author Affiliations: Division of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland (Drs Grass, Cippa, Hagmann, and Brotschi and Mss Erlach and Rathke); University of Zurich, Zurich, Switzerland (Drs Grass, Hagmann, and Brotschi); and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (Drs Grass, Hagmann, and Brotschi)
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Kokkonen Nassef S, Blennow Bohlin M, Jirwe M. Experiences of parents whose school-aged children were treated with therapeutic hypothermia as newborns: A focus group study. Nurs Open 2023; 10:7411-7421. [PMID: 37752681 PMCID: PMC10563413 DOI: 10.1002/nop2.1994] [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: 12/19/2022] [Revised: 06/26/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
AIM To describe parents' past and present experiences of their newborn infant's therapeutic hypothermia (TH) treatment after perinatal asphyxia 10-13 years after the event. BACKGROUND Newborn infants are treated with TH following perinatal asphyxia to improve neurodevelopmental outcomes. DESIGN A qualitative descriptive design using focus groups (FGs). METHODS Twenty one parents to 15 newborn infants treated with TH between 2007 and 2009 participated in five FGs. The FGs were transcribed verbatim and analysed using framework approach. The SRQR checklist was followed for study reporting. RESULTS Two main categories were identified: hardships and reliefs during TH treatment and struggles of everyday life. Both categories include three subcategories, the first: (1) concern and gratitude for the unrecognized treatment, (2) insufficiency of information and proposed participation and (3) NICU nurses instilled security and hope. The second with subcategories: (1) unprocessed experiences of the TH treatment, (2) later challenges at school and (3) existential and psychological challenges in everyday life. CONCLUSION TH of their newborns affected the parents psychologically not only during the treatment, but lasted months and years later. Information and communication with health care professionals and school management were inefficient and inadequate. The parents' concerns could be prevented by an improved identification and understanding of the problems and the needs of the infants and their families before discharge. RELEVANCE FOR CLINICAL PRACTICE Through more personalized and efficient preparation and communication by the nursing staff before discharge, many of the parents' worries and problems could be reduced. Check-up of parents' needs of psychosocial support before and after discharge and offering counselling should become routine. Also, nurses at Well-Baby Clinics and in school health care should receive knowledge about TH treatment and the challenges the children and the parents experience. PATIENT OR PUBLIC CONTRIBUTION Participation of parents was limited to the data provided through interviews.
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Affiliation(s)
- Sari Kokkonen Nassef
- Department of Clinical Science, Intervention and Technology, Division of PaediatricsKarolinska InstitutetStockholmSweden
| | - Mats Blennow Bohlin
- Department of Clinical Science, Intervention and Technology, Division of PaediatricsKarolinska InstitutetStockholmSweden
- Department of NeonatologyKarolinska University HospitalStockholmSweden
| | - Maria Jirwe
- Department of Health SciencesThe Swedish Red Cross UniversityStockholmSweden
- Department of Neurobiology, Care Sciences and Society, Division of NursingKarolinska InstitutetStockholmSweden
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Korğalı EÜ, Tunç G. The levels of postpartum depression, anxiety, and hopelessness of the mothers of infants receiving therapeutic hypothermia in NICU. CHILDRENS HEALTH CARE 2023. [DOI: 10.1080/02739615.2022.2160331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Elif Ünver Korğalı
- Department of Pediatrics, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Gaffari Tunç
- Department of Pediatrics, Department of Neonatology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
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Chandrasekaran SA, John HB, Ross BJ, Arumugam A, Balan I, Samuel R. Torn between two worlds: parental experiences of neonatal follow-up for infants with hypoxic ischaemic encephalopathy in India-a qualitative study using interpretative phenomenological analysis. BMJ Open 2022; 12:e063732. [PMID: 36424107 PMCID: PMC9693659 DOI: 10.1136/bmjopen-2022-063732] [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] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to understand the barriers and facilitators of a neonatal follow-up programme, as perceived by parents of infants born with hypoxic ischaemic encephalopathy (HIE). DESIGN This study applied a qualitative study design using interpretative phenomenological analysis. It included focus group discussions, face-to-face in-depth interviews and telephonic interviews. Data were analysed using thematic content analysis. SETTING Neonatal follow-up clinic of a tertiary hospital in South India. The study was conducted between March and December 2020. PARTICIPANTS Five fathers and eight mothers of infants with HIE. RESULTS Parents of children with HIE are torn between two worlds-an atmosphere of support and one of criticism. Three main themes were identified: (1) neonatal intensive care unit (NICU) stay: distressful versus reassuring experiences; (2) parenthood: supportive versus unsupportive environments; and (3) neonatal follow-up: adherence versus non-adherence. CONCLUSION Parents of children with HIE experience sociocultural barriers in the NICU, after discharge and during the follow-up period. These lead to a complex array of emotional and physical consequences that affect parenting and follow-up care.
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Affiliation(s)
| | - Hima B John
- Neonatology, Christian Medical College, Vellore, India
| | | | - Asha Arumugam
- Neonatology, Christian Medical College, Vellore, India
| | - Indira Balan
- Neonatology, Christian Medical College, Vellore, India
| | - Reema Samuel
- Psychiatry, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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Koivula K, Isokääntä S, Tavast K, Toivonen I, Tuomainen I, Kokki M, Honkalampi K, Sankilampi U, Kokki H. Psychiatric Symptoms, Posttraumatic Growth, and Life Satisfaction Among Parents of Seriously Ill Infants: A Prospective Case-Controlled Study. J Clin Psychol Med Settings 2022; 29:453-465. [PMID: 35344125 PMCID: PMC9184431 DOI: 10.1007/s10880-022-09868-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 02/01/2023]
Abstract
We evaluated psychiatric symptoms, posttraumatic growth, and life satisfaction among the parents (n = 34) of newborns (n = 17) requiring therapeutic hypothermia or urgent surgery (interest group). Our control group included 60 parents of healthy newborns (n = 30). The first surveys were completed soon after diagnosis or delivery and the follow-up surveys 1 year later (participation rate 88% in the interest group and 70% in the control group). General stress was common in both groups but was more prevalent in the interest group as were depressive symptoms, too. Anxiety was more common in the interest group, although it showed a decrease from the baseline in both groups. Life satisfaction had an inverse correlation with all measures of psychiatric symptoms, and it was lower in the interest group in the early stage, but similar at 12 months due to the slight decline in the control group. Mothers in the interest group had more anxiety and depressive symptoms than fathers in the early stage. Mothers had more traumatic distress than fathers at both time points. Half of the parents experienced substantial posttraumatic growth at 12 months. In conclusion, the serious illness of an infant substantially affects the well-being of the parents in the early stages of illness and one year after the illness.
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Affiliation(s)
- Krista Koivula
- Department of Pediatrics, Kuopio University Hospital (KYS), Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland.
| | - Siiri Isokääntä
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kati Tavast
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Iines Toivonen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Iina Tuomainen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Merja Kokki
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital (KYS), Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland
| | - Hannu Kokki
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Ingram J, Beasant L, Odd D, Chakkarapani E. 'Opportunity to bond and a sense of normality': Parent and staff views of cuddling babies undergoing therapeutic hypothermia in neonatal intensive care: 'CoolCuddle'. Health Expect 2022; 25:1384-1392. [PMID: 35332621 PMCID: PMC9327856 DOI: 10.1111/hex.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/30/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Currently, parents whose sick babies are undergoing three days of cooling therapy for hypoxic–ischaemic encephalopathy in neonatal intensive care units (NICUs) are not permitted to cuddle their cooled babies, due to concerns of warming the baby or dislodging breathing tubes or vascular catheters. Parents want to stay and care for their cooled babies and have reported that bonding is adversely affected when they are not permitted to hold them. Design and Participants Qualitative interviews with 21 parents of cooled babies in NICU (11 mothers and 10 fathers) and 10 neonatal staff (4 consultants and 6 nurses) explored their views and experiences of an intervention to enable parents to cuddle their cooled babies (CoolCuddle). Thematic analysis methods were used to develop the themes and compare them between parents and staff. Results Five themes were produced. Three themes were comparable between parents and staff: Closeness, a sense of normality and reassurance and support. An additional parent theme reflected their mixed feelings about initial participation as they were apprehensive, but felt that it was an amazing opportunity. Parents and staff described the closeness between parents and babies as important for bonding and breastfeeding. Fathers particularly appreciated the opportunity to hold and bond with their infants. Parents valued the reassurance and support received from staff, and the cuddles helped them feel more normal and more like a family at a very stressful time. In a final staff theme, they discussed the skills, number of staff and training needed to undertake CoolCuddle in NICU. Conclusions Parents cuddling their babies during cooling therapy enhanced parent–infant bonding and family‐centred care in NICU and was positively received. Adverse perinatal mental health, impaired mother–infant bonding and their effects on the establishment of breastfeeding may be ameliorated by introducing CoolCuddle. Patient Contribution Our parent advisors contributed to the interview topic guides and endorsed the themes from the analysis.
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Affiliation(s)
- Jenny Ingram
- Centre for Academic Child Health, Population Health Sciences, University of Bristol, Bristol, UK
| | - Lucy Beasant
- Centre for Academic Child Health, Population Health Sciences, University of Bristol, Bristol, UK
| | - David Odd
- Population Medicine, Cardiff University School of Medicine, Wales, UK
| | - Ela Chakkarapani
- Neonatology, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Odd D, Okano S, Ingram J, Blair PS, Billietop A, Fleming PJ, Thoresen M, Chakkarapani E. Physiological responses to cuddling babies with hypoxic-ischaemic encephalopathy during therapeutic hypothermia: an observational study. BMJ Paediatr Open 2021; 5:10.1136/bmjpo-2021-001280. [PMID: 35510511 PMCID: PMC8679081 DOI: 10.1136/bmjpo-2021-001280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/14/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine whether parents cuddling infants during therapeutic hypothermia (TH) would affect cooling therapy, cardiorespiratory or neurophysiological measures. The secondary aim was to explore parent-infant bonding, maternal postnatal depression and breastfeeding. DESIGN Prospective observational study. SETTING Two tertiary neonatal intensive care units (NICU). PARTICIPANTS Parents and their term-born infants (n=27) receiving TH and intensive care for neonatal hypoxic-ischaemic encephalopathy. INTERVENTIONS Cuddling up to 2 hours during TH using a standard operating procedure developed in the study (CoolCuddle). MAIN OUTCOME MEASURES Mean difference in temperature, cardiorespiratory and neurophysiological variables before, during and after the cuddle. Secondary outcomes were parental bonding, maternal postnatal depression and breastfeeding. RESULTS During 70 CoolCuddles (115 cumulative hours), there were measurable increases in rectal temperature (0.07°C (0.03 to 0.10)) and upper margin of amplitude-integrated electroencephalogram (1.80 µV (0.83 to 2.72)) and decreases in oxygen saturations (-0.57% (-1.08 to -0.05)) compared with the precuddle period. After the cuddle, there was an increase in end-tidal CO2 (0.25 kPa (95% CI 0.14 to 0.35)) and mean blood pressure (4.09 mm Hg (95% CI 0.96 to 7.21)) compared with the precuddle period. From discharge to 8 weeks postpartum, maternal postnatal depression declined (13 (56.5%) vs 5 (23.8%), p=0.007); breastfeeding rate differed (71% vs 50%, p=0.043), but was higher than national average at discharge (70% vs 54.6%) and mother-infant bonding (median (IQR): 3 (0-6) vs 3 (1-4)) remained stable. CONCLUSION In this small study, CoolCuddle was associated with clinically non-significant, but measurable, changes in temperature, cardiorespiration and neurophysiology. No infant met the criteria to stop the cuddles or had any predefined adverse events. CoolCuddle may improve breastfeeding and requires investigation in different NICU settings.
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Affiliation(s)
- David Odd
- Population Medicine, Cardiff University, School of Medicine, Cardiff, UK
| | - Satomi Okano
- Neonatology, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.,Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jenny Ingram
- Centre for Academic Child Health, University of Bristol Medical School, Bristol, UK
| | - Peter S Blair
- Centre for Child and Adolescent Health, University of Bristol Medical School, Bristol, UK
| | - Amiel Billietop
- Neonatal Intensive Care Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Peter J Fleming
- Centre for Academic Child Health, University of Bristol Medical School, Bristol, UK
| | - Marianne Thoresen
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Ela Chakkarapani
- Neonatology, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK .,Translational Health Sciences, University of Bristol Medical School, Bristol, UK
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Pilon B, Craig AK, Lemmon ME, Goeller A. Supporting families in their child's journey with neonatal encephalopathy and therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101278. [PMID: 34561175 PMCID: PMC9627456 DOI: 10.1016/j.siny.2021.101278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neonates and families face challenges in hypothermic therapy, including trauma to parents, extreme emotions, and unfamiliarity with the medical system. Communication is an essential element to supporting parents while their children are in the NICU, and beyond, building the foundation for the ongoing relationship the family has with the medical system. Significant consideration needs to be given to the critical element of integrating the family into the care of a baby being treated with therapeutic hypothermia. Clinicians can promote healing of accumulated traumas of parents through ensuring parent's emotional safety, facilitating a trusting relationship, and promoting parent empowerment. Connecting parents with resources, especially peer support, is an essential part of a hospital stay. In this chapter, we explore best practices to support families during and after hypothermic therapy.
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Affiliation(s)
- Betsy Pilon
- Hope for HIE, PO Box 250472, West Bloomfield, MI, 48325, USA.
| | - Alexa K. Craig
- Neonatal and Pediatric Neurology, Tufts University School of Medicine, Maine Medical Partners Pediatric Neurology, 55 Spring St, Scarborough, ME, 04074, USA
| | - Monica E. Lemmon
- Division of Pediatric Neurology, Durham, NC, USA,Developmental Medicine, Durham, NC, USA,Department of Pediatrics, Durham, NC, USA,Population Health Sciences, Durham, NC, USA,Duke University School of Medicine, Durham, NC, USA,Margolis Center for Health Policy, Duke University, DUMC 3936, Durham, NC, USA
| | - Annie Goeller
- Hope for HIE, PO Box 250472, West Bloomfield, MI, 48325, USA.
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Bäcke P, Hjelte B, Hellström Westas L, Ågren J, Thernström Blomqvist Y. When all I wanted was to hold my baby-The experiences of parents of infants who received therapeutic hypothermia. Acta Paediatr 2021; 110:480-486. [PMID: 32564441 DOI: 10.1111/apa.15431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Abstract
AIM The knowledge is limited about how parents experience the time when their infant is receiving therapeutic hypothermia (TH) after severe perinatal asphyxia. The aim of this study was to explore parents' experience of closeness and involvement in their infant's care while in the neonatal intensive care unit (NICU) with their newborn undergoing TH. METHODS Face-to-face, semi-structured interviews were conducted with parents (n = 11) whose infants (n = 8, aged 3-5 years at the time of the study) underwent TH at a level III Swedish NICU during 2013-2016. The interviews were analysed using qualitative content analysis. RESULTS All the parents shared the trauma of being both physically and psychologically separated from their infant. They all described a need for information and emotional support, and reported that the NICU staff had influenced the extent to which they as parents had been able to be near and actively participate in the care. Parents described the wish to be closer to their infant and to be more actively involved in their infant's care. CONCLUSION Strategies to enable parent-infant closeness and active guidance from staff might help alleviate the emotional stress of parents and promote their participation during TH.
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Affiliation(s)
- Pyrola Bäcke
- Neonatal Intensive Care Unit University Children's Hospital Uppsala Sweden
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Beatrice Hjelte
- Neonatal Intensive Care Unit University Children's Hospital Uppsala Sweden
| | - Lena Hellström Westas
- Neonatal Intensive Care Unit University Children's Hospital Uppsala Sweden
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Johan Ågren
- Neonatal Intensive Care Unit University Children's Hospital Uppsala Sweden
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit University Children's Hospital Uppsala Sweden
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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13
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Vyas SS, Ford MK, Tam EWY, Westmacott R, Sananes R, Beck R, Williams TS. Intervention experiences among children with congenital and neonatal conditions impacting brain development: patterns of service utilization, barriers and future directions. Clin Neuropsychol 2021; 35:1009-1029. [DOI: 10.1080/13854046.2020.1871516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Shruti S. Vyas
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Meghan K. Ford
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Emily W. Y. Tam
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
| | - Renee Sananes
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
- Division of Cardiology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ranit Beck
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tricia S. Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, The University of Toronto, Toronto, ON, Canada
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Danguecan A, El Shahed AI, Somerset E, Fan CPS, Ly LG, Williams T. Towards a biopsychosocial understanding of neurodevelopmental outcomes in children with hypoxic-ischemic encephalopathy: A mixed-methods study. Clin Neuropsychol 2020; 35:925-947. [DOI: 10.1080/13854046.2020.1833987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Ashley Danguecan
- Department of Psychology, Centre for Brain and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada
| | - Amr I. El Shahed
- Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Emily Somerset
- Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Linh G. Ly
- Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Tricia Williams
- Department of Psychology, Centre for Brain and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
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Nassef SK, Blennow M, Jirwe M. Parental viewpoints and experiences of therapeutic hypothermia in a neonatal intensive care unit implemented with Family-Centred Care. J Clin Nurs 2020; 29:4194-4202. [PMID: 32761952 DOI: 10.1111/jocn.15448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore parental experiences of therapeutic hypothermia (TH) in their newborn infant suffering from hypoxic ischaemic encephalopathy following perinatal asphyxia. BACKGROUND Since more than a decade, newborn infants are treated with TH following perinatal asphyxia to reduce mortality and disabilities and to improve neurological outcome. The infants' body temperature is lowered to 33.5°C for 72 hr, and the infant is usually cared for in an open incubator. The parents are not able to hold their infant skin to skin, which risks causing emotional reactions in parents and a loss of normal parent-infant bonding. DESIGN A qualitative descriptive design using semi-structured interviews. METHODS Up to 7 months after the event, interviews were conducted with 14 parents of seven infants who had received TH in a neonatal intensive care unit (NICU) in Sweden. The interviews were transcribed and analysed using framework approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. RESULTS From the interviews, an overall theme was found: Transition through a life-altering time, and three categories: (a) trepidation about prognosis, (b) transitioning into parenthood supported by the caring philosophy of family-centred care (FCC) and (c) rewarming as a milestone. CONCLUSIONS Parental experiences of TH are based on the immediate emotions and stress of uncertainty of the infant's prognosis. The values of FCC in the NICU append a natural transitioning into parenthood by parental involvement in nursing care and decisions. The rewarming of the infant is seen as a restart to more or less normal circumstances from the critical period of delivery and TH. RELEVANCE FOR CLINICAL PRACTICE The management of NICUs should update the awareness of and deepen knowledge about FCC. The emphasis ought to be on adequate information about TH and the values of FCC to parents in the NICU context.
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Affiliation(s)
| | - Mats Blennow
- Karolinska Institutet, Stockholm, Sweden.,Neonatal Intensive Care Unit, Karolinska University Hospital, Stockholm, Sweden
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16
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Cawley P, Chakkarapani E. Fifteen-minute consultation: Therapeutic hypothermia for infants with hypoxic ischaemic encephalopathy-translating jargon, prognosis and uncertainty for parents. Arch Dis Child Educ Pract Ed 2020; 105:75-83. [PMID: 31292147 DOI: 10.1136/archdischild-2017-314116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 03/09/2019] [Accepted: 06/18/2019] [Indexed: 11/03/2022]
Abstract
Hypoxic ischaemic encephalopathy may lead to death or severe long-term morbidity. Therapeutic hypothermia (TH) increases survival without impairments in childhood, but prognostic uncertainty may remain for years after birth. Clear and accurate communication is imperative but challenging. This article explores the predictive value of routinely performed assessments during TH, as well as the qualitative research relating to parental experience. This article will benefit paediatric trainees, consultants and nurse practitioners in providing: (1) the background information needed for initiating a conversation with parents regarding outcome and (2) optimising their communication with parents in translating jargon, prognosis and uncertainty.
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Affiliation(s)
- Paul Cawley
- Neonatal Intensive Care Unit, Southmead Hospital, Bristol, UK.,Neonatal Intensive Care Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Craig A, Deerwester K, Fox L, Jacobs J, Evans S. Maternal holding during therapeutic hypothermia for infants with neonatal encephalopathy is feasible. Acta Paediatr 2019; 108:1597-1602. [PMID: 30721531 DOI: 10.1111/apa.14743] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/18/2019] [Accepted: 02/01/2019] [Indexed: 11/26/2022]
Abstract
AIM Concerns for infant destabilisation often prohibit parental holding of infants during therapeutic hypothermia (TH). We assessed the feasibility of maternal holding during TH, as the inability to hold can impede bonding. METHODS Vital signs were assessed in stable infants before, at two-minute intervals during and 30 minutes after a single 30-minute holding session. The infant remained on the blanket throughout holding, and both infant and blanket were placed into the mother's arms on top of a thin foam insulating barrier. Mothers and nurses were surveyed about their experience. RESULTS Ten infants undergoing TH for neonatal encephalopathy had no equipment malfunctions or dislodgement. The mean temperature was 33.4°C prior to and 33.5°C (p = 0.18) after holding. There was no significant bradycardia (heart rate <80 beats per minute), hypotension (mean arterial pressure <40 mm Hg) or oxygen desaturation (<93%). Nurses either strongly agreed (75%) or agreed (25%) with the statement 'After assisting with the holding protocol, I feel that holding during cooling is safe'. Mothers (100%) strongly agreed that other parents would benefit from holding. CONCLUSION In a small sample of ten stable infants treated with TH for neonatal encephalopathy, holding resulted in no adverse events and positive feedback from mothers and nurses.
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Affiliation(s)
| | | | - Leah Fox
- Maine Medical Center Portland ME USA
| | - Julia Jacobs
- Walter Reed National Military Medical Center Bethesda MD USA
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18
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Biskop E, Paulsdotter T, Hellström Westas L, Ågren J, Blomqvist YT. Parental participation during therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:77-80. [DOI: 10.1016/j.srhc.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/25/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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Craig AK, James C, Bainter J, Evans S, Gerwin R. Parental perceptions of neonatal therapeutic hypothermia; emotional and healing experiences. J Matern Fetal Neonatal Med 2019; 33:2889-2896. [PMID: 30585100 DOI: 10.1080/14767058.2018.1563592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Parents of infants who undergo therapeutic hypothermia experience emotional challenges that have not been fully characterized. Comprehensive understanding of the parental experience of hypothermia is needed to provide better care to the family of the infant. This study aimed to improve the understanding of the parental emotional experience of therapeutic hypothermia in the Neonatal Intensive Care Unit (NICU).Methods: Semistructured interviews were conducted in a group setting with parents matched into groups according to the severity of the infant's presenting encephalopathy. The interviews were transcribed and coded into principal and additional subthemes.Results: Families of 15 infants, who were between 2 months and 2 years at the time of the interview, participated. Infants had a mean gestational age of 40.0 weeks and 11 (73%) were male. Eleven (73%) were transferred from other hospitals following birth and eight (53%) had seizures. Emotional Experiences was a principal theme and included subthemes of traumatic experiences, Loss of normalcy, and Separation of parent and infant. The birth was frequently described as traumatic with descriptions of chest compressions, excessive blood loss and infants not crying. Trauma was also described in the parental observations of the shivering hypothermic infant. Parents highlighted the loss of normalcy in terms of their expected birth narrative and the loss of the early opportunity to breastfeed and hold their infant. Parents reported that the physical separation imposed by hypothermia adversely impacted their ability to bond with their infant. Healing Experiences was the other principal theme with subthemes identified as Incorporation of parents into NICU care, Reclaiming parenthood and Support from other hypothermia families. Parents reported feeling a connection to their infant when they were involved in medical rounds and when asked to participate in routine care of their infant. Occasionally, parents strongly advocated for their own participation in a particular aspect of their infant's care such as a diaper change and this was perceived as reinforcing their role as parent. Lastly, parents requested greater access to peer support from parents who had experienced therapeutic hypothermia.Conclusion: Parents of infants treated with hypothermia reported the experience of their unexpected adverse delivery and their baby subsequently being treated with therapeutic hypothermia as traumatic. This trauma can be compounded by the pale, still and shivering appearance of their newborn and the delay in bonding as a result of physical separation during hypothermia treatment. Parents described feeling connected to their infant in the context of performing routine care activities and desired greater access to peer support. The themes reported in this study could be used to inform high level NICU care and raise provider awareness of the parent experience.
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Affiliation(s)
- Alexa K Craig
- Department of Pediatric Neurology, Maine Medical Center, Portland, ME, USA
| | - Christine James
- Child and Adolescent Psychiatry, Family Health Centers of San Diego, San Diego, CA, USA
| | - Janelle Bainter
- Department of Neonatology, Maine Medical Center, Portland, ME, USA
| | - Scott Evans
- Department of Neonatology, Maine Medical Center, Portland, ME, USA
| | - Roslyn Gerwin
- Department of Child Psychiatry, Maine Medical Center, Portland, ME, USA
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A Qualitative Study of the Experiences of Norwegian Parents of Very Low Birthweight Infants Enrolled in a Randomized Nutritional Trial. J Pediatr Nurs 2018; 43:e66-e74. [PMID: 30077471 DOI: 10.1016/j.pedn.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/11/2018] [Accepted: 07/14/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to examine how parents of very low birth weight (VLBW) infants experienced having their newborn infant enrolled in a randomized controlled intervention trial (RCT). DESIGN AND METHODS A qualitative descriptive design was used. Data were collected through individual semi-structured interviews with 15 parents of 9 participating VLBW infants. The data were then made the object of an inductive qualitative content analysis. RESULTS The parents expressed trust in the competence and motivation of the researchers and were confident that participating in the project would do no harm, but instead would potentially benefit their infant. The parents felt privileged for being given the chance to participate, to commit to the project; they were willing to invest their time and effort in the project. Participation could be stressful for the parents, ranging from minor irritation to situations in which they felt overwhelmed and not entirely in control. Many families lived stressful lives, and participation, particularly the follow-up after being discharged, may have added to this. CONCLUSIONS Infant participation in an RCT can be a positive experience, making the parents feel that they are given a chance to both contribute and receive something special. Participation can also be stressful because of conditions both related and unrelated to the RCT. PRACTICE IMPLICATIONS We identified several issues that researchers in future trials with VLBW infants need to address to minimize parental stress. Recruitment to intervention studies within the immediate period around birth should be avoided, if possible.
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21
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Williams TS, McDonald KP, Roberts SD, Westmacott R, Ahola Kohut S, Dlamini N, Miller SP. In their own words: developing the Parent Experiences Questionnaire following neonatal brain injury using participatory design. Brain Inj 2018; 32:1386-1396. [DOI: 10.1080/02699052.2018.1495844] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Tricia S Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- York University, Toronto, Ontario, Canada
| | - Samantha D Roberts
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Sara Ahola Kohut
- Medical Psychiatry Alliance, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, The University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Steven P Miller
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
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Exploring parent expectations of neonatal therapeutic hypothermia. J Perinatol 2018; 38:857-864. [PMID: 29740186 PMCID: PMC6486821 DOI: 10.1038/s41372-018-0117-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to assess the parent experience of therapeutic hypothermia (TH), specifically focusing on unmet expectations. STUDY DESIGN Open-ended questions were used in a focus group setting. We employed an inductive approach to develop thematic content from the transcribed recordings. RESULTS 30 parents of infants treated with TH participated. Within the principal theme of managing expectations, four sub-themes emerged. These included parental concerns about morphine use; specifically the association of morphine with end-of-life care and addiction. Parents perceived their role as key in the decision to implement TH and were emotionally burdened by this during and after TH. Parents recall intense fear for the infant's immediate survival and were not sufficiently reassured regarding survival. Parents also experience ongoing uncertainties about the long-term prognosis after TH. CONCLUSION The identification of these four areas in which parents have unmet expectations is important in order to improve the delivery of care.
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Naidon ÂM, Neves ET, Silveira AD, Ribeiro CF. GESTAÇÃO, PARTO, NASCIMENTO E INTERNAÇÃO DE RECÉM-NASCIDOS EM TERAPIA INTENSIVA NEONATAL: RELATO DE MÃES. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180005750016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: descrever a trajetória do parto, nascimento e internação do recém-nascido em unidade de terapia intensiva neonatal. Método: pesquisa qualitativa desenvolvida com 25 mães de recém-nascidos internados na terapia intensiva neonatal. A coleta de dados ocorreu nos meses de agosto a outubro de 2014, por meio de entrevista semiestruturada, abordando questões do pré-natal à internação do bebê. Os dados foram submetidos à análise de conteúdo temática. Resultados: a trajetória apontou complicações na gravidez, gestação não-planejada e a não vinculação com o profissional com quem estava realizando o pré-natal; necessidade de deslocamento para o parto e condições do nascimento revelaram importante impacto na vivencial das mães. Conclusões: Foram características da trajetória destas mulheres o início tardio do pré-natal e a fragilidade de vínculo com o profissional que realizou o pré-natal. Além disso, a dificuldade de acesso aos serviços de saúde para o parto culminou com o impacto de um nascimento de risco e internação na terapia intensiva.
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Exploring Parent Experience of Communication About Therapeutic Hypothermia in the Neonatal Intensive Care Unit. Adv Neonatal Care 2018; 18:136-143. [PMID: 29595551 DOI: 10.1097/anc.0000000000000473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The unique communication challenges faced by parents of infants undergoing therapeutic hypothermia have not been well characterized. PURPOSE To develop awareness of communication challenges experienced by families of infants treated with therapeutic hypothermia. METHODS Semistructured interviews were conducted in a group setting with parents matched into groups according to the severity of the infant's presenting encephalopathy. The interviews were transcribed and coded into principal and additional subthemes. RESULTS Thirty adults were interviewed including 15 mothers, 12 fathers, 2 grandmothers, and 1 grandfather. The 15 infants were between 2 and 24 months of age at the time of the interviews. The principal theme of communication included the following 3 subthemes; transparency, consistency, and delivery style. Parents reported a strong desire for improved early and transparent communication about therapeutic hypothermia, particularly during transfer from an outside hospital. Parents also reported a preference for consistent communication and highlighted parental touch of the hypothermic infant, obstetrical nurse-to-neonatal intensive care unit nurse communication, and parent and visitor presence in the infant's room as areas in need of greater communication consistency. Parents valued direct and compassionate communication styles that excluded medical jargon. IMPLICATIONS FOR PRACTICE All providers can implement recommendations for communication to parents of infants treated with therapeutic hypothermia by increasing transparency, developing greater consistency in the communication delivered, and employing a direct and compassionate style to improve the parental experience of therapeutic hypothermia. IMPLICATIONS FOR RESEARCH Further investigation is needed into the specific challenges parents face with a lack of transparent communication prior to the transfer of an infant for therapeutic hypothermia.
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Survey of Neonatal Intensive Care Unit Nurse Attitudes Toward Therapeutic Hypothermia Treatment. Adv Neonatal Care 2017; 17:123-130. [PMID: 27759568 DOI: 10.1097/anc.0000000000000339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The traumatic experiences of parents of babies treated with therapeutic hypothermia (TH) have been described. No research has assessed neonatal intensive care unit (NICU) nurse experience in providing care to hypothermic babies and emotional support to their parents. PURPOSE To assess NICU nurse attitudes to the provision of TH with respect to perceptions about baby pain/sedation, need for nurse and parent education, decision making about initiation of TH, and barriers to best care. METHODS A survey was electronically sent to 219 nurses at 2 affiliated academic level III NICUs: 1 rural and 1 urban location. There were 17 questions where responses were selected from a preset list and 7 opportunities for nurses to provide free text responses. FINDINGS The response rate was 38% (N = 83). Overwhelming similarities between the urban and rural institutions were found with NICU nurses expressing understanding of the indications for initiating TH, agreement that TH improves long-term outcomes and that the benefits of TH outweigh the risks. Nurses at the urban institution more frequently expressed concerns surrounding inadequate treatment of baby pain/sedation, and nurses at both institutions strongly emphasized the need for more nurse and parent education about TH and improved timeliness of decision making for initiation of TH. IMPLICATIONS FOR PRACTICE NICU nurses specifically want to learn more about outcomes of babies after treatment with TH and feel that parents need more education about TH. IMPLICATIONS FOR RESEARCH Research is urgently needed to better understand the implications of TH treatment for parent-baby bonding.
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Hazeldine B, Thyagarajan B, Grant M, Chakkarapani E. Survey of nutritional practices during therapeutic hypothermia for hypoxic-ischaemic encephalopathy. BMJ Paediatr Open 2017; 1:e000022. [PMID: 29637095 PMCID: PMC5842999 DOI: 10.1136/bmjpo-2017-000022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate current nutritional practices during and after therapeutic hypothermia (TH) for infants with hypoxic-ischaemic encephalopathy (HIE) in UK neonatal units. STUDY DESIGN Email survey of neonatal clinicians. SETTING UK neonatal units providing active TH. PATIENTS Neonates cooled for HIE. METHODS Email survey including questions regarding the timing of starting enteral feeds, volumes, frequency and parenteral nutrition (PN) use and availability of guidelines. RESULTS Forty-nine responses were received (49/69, 71%). The rate of enteral feeding during TH and rewarming was 59% (29/49). There was a significant linear trend for the increase in the proportion of units starting enteral feeds (p=0.001) during TH. As compared with post-TH period, significantly lower milk volumes were started during TH (median (range): 7.5 mL/kg/day (1.5-24) vs 17.5 mL/kg/day (7.5-30), p=0.0004). During TH, breast milk was primarily used by 52% of units predominantly as 2-3 hourly feeds, and volumes were increased as tolerated in 55% of units. Only 29% (14/49) of units used PN, with 86% (12/14) of those offering enteral feeds during PN. Guidelines for feeding during TH were available in 31% (15/49) of units. CONCLUSIONS Many neonatal clinicians offer enteral feeds predominantly using expressed breast milk, with or without PN, during TH, although with huge variability. The heterogeneity in the nutritional practice underscores the need for assessing the safety of both enteral and parenteral feeding during TH.
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Affiliation(s)
- Beth Hazeldine
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Balamurugan Thyagarajan
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Michellee Grant
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elavazhagan Chakkarapani
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
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Horsch A, Jacobs I, Gilbert L, Favrod C, Schneider J, Morisod Harari M, Bickle Graz M. Impact of perinatal asphyxia on parental mental health and bonding with the infant: a questionnaire survey of Swiss parents. BMJ Paediatr Open 2017; 1:e000059. [PMID: 29637108 PMCID: PMC5862159 DOI: 10.1136/bmjpo-2017-000059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare current mental health symptoms and infant bonding in parents whose infants survived perinatal asphyxia in the last 2 years with control parents and to investigate which sociodemographic, obstetric and neonatal variables correlated with parental mental health and infant bonding in the asphyxia group. DESIGN Cross-sectional questionnaire survey of parents whose children were registered in the Swiss national Asphyxia and Cooling register and of control parents (Post-traumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Mother-to-Infant Bonding Scale). RESULTS The response rate for the asphyxia group was 46.5%. Compared with controls, mothers and fathers in the asphyxia group had a higher frequency of post-traumatic stress disorder (PTSD) symptoms (p<0.001). More mothers (n=28, 56%) had a symptom diagnosis of either full or partial PTSD than controls (n=54, 39%) (p=0.032). Similarly, more fathers (n=31, 51%) had a symptom diagnosis of either partial or full PTSD than controls (n=19, 33%) (p=0.034). Mothers reported poorer bonding with the infant (p=0.043) than controls. Having a trauma in the past was linked to more psychological distress in mothers (r=0.31 (95% CI 0.04 to 0.54)) and fathers (r=0.35 (95% CI 0.05 to 0.59)). For mothers, previous pregnancy was linked to poorer bonding (r=0.41 (95% CI 0.13 to 0.63)). In fathers, therapeutic hypothermia of the infant was related to less frequent PTSD symptoms (r=-0.37 (95% CI -0.61 to -0.06)) and past psychological difficulties (r=0.37 (95% CI 0.07 to 0.60)) to more psychological distress. A lower Apgar score was linked to poorer bonding (r=-0.38 (95% CI -0.64 to -0.05)). CONCLUSIONS Parents of infants hospitalised for perinatal asphyxia are more at risk of developing PTSD than control parents.
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Affiliation(s)
- Antje Horsch
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Ingo Jacobs
- Department of Psychology, Sigmund Freud PrivatUniversität Berlin, Berlin, Germany
| | - Leah Gilbert
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Céline Favrod
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Juliane Schneider
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland.,Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mathilde Morisod Harari
- Department of Child and Adolescent Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Myriam Bickle Graz
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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The Risks and Benefits of Conducting Sensitive Research to Understand Parental Experiences of Caring for Infants With Hypoxic–Ischemic Encephalopathy. J Neurosci Nurs 2016; 48:151-9. [DOI: 10.1097/jnn.0000000000000187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakamanya S, Siu GE, Lassman R, Seeley J, Tann CJ. Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study. Disabil Rehabil 2014; 37:1470-6. [PMID: 25323396 PMCID: PMC4784505 DOI: 10.3109/09638288.2014.972582] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) ("birth asphyxia") in Uganda. METHODS Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software. FINDINGS Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences. CONCLUSION Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants. Implications for Rehabilitation Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers. Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking. Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants.
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Affiliation(s)
| | - Godfrey E. Siu
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe,
Uganda
- Child Health and Development Centre, Makerere University,
Kampala,
Uganda
| | - Rachel Lassman
- Institute for Women’s Health, University College London,
London,
UK
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe,
Uganda
- London School of Hygiene and Tropical Medicine,
London,
UK
| | - Cally J. Tann
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe,
Uganda
- Institute for Women’s Health, University College London,
London,
UK
- London School of Hygiene and Tropical Medicine,
London,
UK
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