1
|
Arwehed S, Axelin A, Björklund LJ, Thernström Blomqvist Y, Heiring C, Jonsson B, Klingenberg C, Metsäranta M, Ågren J, Lehtonen L. Nordic survey showed wide variation in discharge practices for very preterm infants. Acta Paediatr 2024; 113:48-55. [PMID: 37540833 DOI: 10.1111/apa.16934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/06/2023]
Abstract
AIM We aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units. METHODS Medical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments. RESULTS We received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay. CONCLUSION Discharge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.
Collapse
Affiliation(s)
- Sofia Arwehed
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Anna Axelin
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Lars J Björklund
- Department of Clinical Sciences, Lund, Paediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Christian Heiring
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Baldvin Jonsson
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marjo Metsäranta
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University, Hospital and University of Turku, Turku, Finland
| |
Collapse
|
2
|
Linnér A, Blomqvist YT, Jonsson K, Lilliesköld S, Norman M. Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence. Neonatology 2023; 121:46-55. [PMID: 37844545 PMCID: PMC10836739 DOI: 10.1159/000533900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Infant- and family-centered developmental care can reduce adverse outcomes in both infants and parents. Parents' experiences of the care and staff treatment remain to be evaluated. METHODS Parents of infants admitted to neonatal units in Sweden from July 2020 to May 2022 responded to a questionnaire with standardized questions about in-hospital care. Exposures were hospital, gestational age, length of hospital stay, unit level, and bed density. The proportions of parents rating aspects of neonatal care as excellent, defined as five on a Likert scale, and the determinants of excellence were described. The results were benchmarked with ratings in adult somatic care. RESULTS A total of 4,475/13,108 (34%) parents responded. The ratings of excellent care varied by question from 65% to 90%. The largest variation in excellence between neonatal units (range 43-80%) was found for "participation and involvement." The proportion of excellence was significantly lower among parents of extremely preterm infants. Confidence in the staff was lower in parents of extremely preterm infants than in parents of term infants (56% vs. 83%). Longer hospital stays affected the experience of neonatal care adversely, whereas level of care and bed density were overall unrelated to the parental experience. Parents in neonatal care rated the care as excellent to a higher extent than patients cared for in adult medicine. CONCLUSION A majority of parents rated neonatal care in Sweden as excellent. The less frequent ratings of excellence among parents of extremely preterm infants indicate that more could be done to optimize parental involvement and support.
Collapse
Affiliation(s)
- Agnes Linnér
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kristina Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Siri Lilliesköld
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
3
|
Ahlqvist-Björkroth S, Thernström Blomqvist Y, Nyberg J, Normann E, Axelin A. Improving NICU staff decision-making with parents in medical rounds: a pilot study of reflective group dialogue intervention. Front Pediatr 2023; 11:1249345. [PMID: 37772036 PMCID: PMC10523391 DOI: 10.3389/fped.2023.1249345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction The communication skills of healthcare professionals play a crucial role in successful shared decision-making with parents in neonatal intensive care. Improving communication skills can be achieved through practice and reflection on personal experiences after authentic interaction events with parents. The process of reflection typically involves three phases: description, reflection, and critical reflection. In this study, our aim was to explore the acceptability of the Reflective Group Dialogue intervention and its effectiveness in supporting the reflective process. Methods This qualitative pilot study was conducted in the neonatal intensive care unit at Uppsala University Children's Hospital, Sweden. The sample consisted of nine medical rounds with seven families, five neonatologists, seven registered nurses, and five assistant nurses. Purposive sampling was used to collect the data. The intervention comprised four elements: (1) before the intervention, a recorded presentation on shared decision-making was given to the entire unit staff, (2) an observation of a normal medical round discussion with parents, (3) an interview with parents about their experience after the same round, and (4) a reflective discussion with the participating health care professionals after the round. The parent interviews and reflective discussions were audio-recorded and transcribed verbatim. They were analyzed using thematic analysis as a theoretical strategy. Results Both parents and staff widely accepted the intervention and found it beneficial. We identified four discussions that remained in the descriptive phase of the reflection process, four that reached the reflective phase, and one that reached the critical reflection phase. The descriptive discussions were characterized by using a single perspective to reflect, often based on personal opinions. The reflective discussions included analyzing interaction sequences from both staff and parent perspectives and were primarily based on actual observations of communication during medical rounds. The critical discussion led to a new awareness of current practices concerning parental involvement in decision-making. These discussions also utilized "what-if" thinking to evaluate potential new practices and their pros and cons. Conclusions The intervention seems promising as it was perceived as beneficial by the recipients and facilitated reflection in most cases. However, to enhance the feasibility of the intervention, some improvements are discussed.
Collapse
Affiliation(s)
- Sari Ahlqvist-Björkroth
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | - Jenni Nyberg
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Erik Normann
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anna Axelin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Departmentof Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
4
|
Starke V, Diderholm B, Heyman M, Blomqvist YT. Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences. Early Hum Dev 2023; 183:105819. [PMID: 37393662 DOI: 10.1016/j.earlhumdev.2023.105819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
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.
Collapse
Affiliation(s)
- Veronica Starke
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Maria Heyman
- Department of Women's and Children's Health, Uppsala University, Sweden
| | | |
Collapse
|
5
|
Norrgrann M, Hörnfeldt M, Latheef F, Blomqvist YT, Larsson A, Paulsson M, Diderholm B. Lipid Peroxidation and Antioxidative Capacity Are Unaltered in Transitional Breast Milk Exposed to Light from Women Giving Birth to Preterm Infants before 32 Weeks of Gestation. Nutrients 2023; 15:2818. [PMID: 37375721 DOI: 10.3390/nu15122818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Breast milk (BM) is the primary nutrition for infants and has a high content of lipids. Preterm infants receive expressed BM via tube feeding, and they are frequently treated with phototherapy. When parenteral nutrition (PN) is exposed to light and/or phototherapy, lipid peroxidation (LPO) increases. By light-protecting PN, morbidity and mortality are reduced in preterm infants through the reduction of oxidative stress. We aimed to investigate whether light-protecting breast milk could reduce LPO. Twelve mothers giving birth to a preterm infants of less than 32 weeks of gestational age were included. Transitional BM was collected and divided into three study groups; light-protected, ward light and phototherapy light. Baseline samples were collected after expression and the exposures started within one hour. Feeding syringe samples were exposed to light for 30 up to 360 min. Nasogastric tube samples were run through a tube under the same light conditions. Samples were stored in -80 °C until analyses of malondialdehyde (MDA), 4-hydroxynonenal (4-HNE) and total antioxidant capacity (TAC). There were no significant differences in MDA, 4-HNE or TAC levels observed between the different study groups. This study indicates that the light exposure of expressed transitional BM does not affect LPO and the levels of MDA, 4-HNE or TAC.
Collapse
Affiliation(s)
- Moa Norrgrann
- Department of Women's and Children's Health, Uppsala University, University Children's Hospital, 751 85 Uppsala, Sweden
| | - Malin Hörnfeldt
- Department of Women's and Children's Health, Uppsala University, University Children's Hospital, 751 85 Uppsala, Sweden
| | - Faiza Latheef
- Department of Women's and Children's Health, Uppsala University, University Children's Hospital, 751 85 Uppsala, Sweden
| | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University, University Children's Hospital, 751 85 Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, University Children's Hospital, 751 85 Uppsala, Sweden
| | - Barbro Diderholm
- Department of Women's and Children's Health, Uppsala University, University Children's Hospital, 751 85 Uppsala, Sweden
| |
Collapse
|
6
|
Lindgren EB, Thernström Blomqvist Y, Diderholm B, Grandahl M. To Feel Abandoned in an Insecure Situation: Parents' Experiences of Separation From Their Newborn Due to the Mother Being COVID-19 Positive. Adv Neonatal Care 2023:00149525-990000000-00058. [PMID: 36999904 PMCID: PMC10371055 DOI: 10.1097/anc.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in changes in neonatal care, sometimes resulting in a separation between parents and their newborn. Knowledge about parents' experiences of this separation is limited. PURPOSE To explore parents' experiences of separation from their newborn due to COVID-19. METHODS Interviews with parents (n = 11) separated from their newborn. RESULTS The parents' experiences of being separated from their newborn were expressed under 3 themes: "To create a sense of safety in an insecure situation"; "Unexpected start to parenthood"; and "To be reunited." Parents felt abandoned and alone, even if they had support from significant others. Although they considered the separation as undesired, wanting to be with their newborn infant, it was secondary to not wanting to infect the infant with COVID-19. Furthermore, lacking information about a potentially lethal virus adds to the uncertainty that comes with having a newborn. The separation affected the whole family, some for a long time afterward. IMPLICATIONS FOR PRACTICE AND RESEARCH If a new situation with potentially life-threatening effects, like the COVID-19 pandemic, occurs again, considering the experiences of these parents is paramount. Precautions should be taken to minimize the potential harm. If a separation between newborns and parents is inevitable, parents need preparation and transparent information prior to the separation and before the reunion. Well-thought-out policies must be in place to minimize the impact of a separation on both parties. Parents should be able to have a deputy parent present during an undesired but necessary separation from their newborn.
Collapse
|
7
|
Sjömar J, Ottesen H, Banik G, Rahman AE, Thernström Blomqvist Y, Rahman SM, Målqvist M. Exploring caregivers' experiences of Kangaroo Mother Care in Bangladesh: A descriptive qualitative study. PLoS One 2023; 18:e0280254. [PMID: 36689433 PMCID: PMC9870098 DOI: 10.1371/journal.pone.0280254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) is an evidence-based intervention recommended by the World Health Organization (WHO) to reduce preterm mortality and morbidity. The aim of this study was to explore caregivers' experiences of providing KMC in hospital settings and after continuation at home in Bangladesh in order to assess enablers and barriers to optimal implementation. METHODS Interviews with fifteen caregivers were conducted using an interview guide with semi-structured questions in August 2019 and March 2020. Convenience sampling was used to select hospitals and participants for the study. The inclusion criteria were being a caregiver currently performing KMC in the hospital or having been discharged one week earlier from the KMC ward. The interviews were audio recorded, transcribed verbatim, and translated. The data were analyzed using thematic analysis with an inductive approach. RESULTS Three themes were identified as regards the caregivers' experiences of providing KMC: conducive conditions, an empowering process, and suboptimal implementation. The results showed that there are supporting circumstances for caregivers performing KMC in Bangladesh, including social support structures and positive attitudes to the method of care. It also appeared that the caregivers felt strengthened in their roles as caregivers by learning and performing KMC. However, the implementation of KMC was suboptimal due to late initiation of KMC, difficulties with keeping the baby skin-to-skin, and pain after cesarean section hampering skin-to-skin practice. CONCLUSIONS The social and cultural conditions for the caregivers to perform KMC as well as the empowerment the parents felt in their roles as caregivers when performing KMC are facilitating factors for this method of care. Initial separation and late initiation of KMC, as well as disregard for the mothers' needs for care and support, were barriers to optimal practice leading to missed opportunities. These facilitators and barriers need to be addressed in order to succeed in scaling up the national KMC program.
Collapse
Affiliation(s)
- Johanna Sjömar
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| | - Hedda Ottesen
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| | - Goutum Banik
- Maternal and Child Health Division, International Centre for Diarrhoeal Research, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Research, Bangladesh
| | | | | | - Mats Målqvist
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| |
Collapse
|
8
|
Bäcke P, Thies-Lagergren L, Blomqvist YT. Neonatal resuscitation after birth: Swedish midwives' experiences of and perceptions about separation of mothers and their newborn babies. Eur J Midwifery 2023; 7:10. [PMID: 37213413 PMCID: PMC10193297 DOI: 10.18332/ejm/162319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION This study aimed to investigate midwives' experiences of and perceptions about mother-baby separation during resuscitation of the baby following birth. METHODS A qualitative study was conducted using an author-designed questionnaire. Fifty-four midwives from two Swedish birth units with different working methods regarding neonatal resuscitation - at the mother's bedside in the birth room or in a designated resuscitation room outside the birth room - completed the questionnaire. Data were analyzed using qualitative content analysis. RESULTS Most midwives had experience of removing a newborn baby in need of critical care from the birth room, thus separating the mother and baby. The midwives identified the difficulties and challenges involved in carrying out emergency care in the birth room after birth and had divergent opinions about what they considered possible in these birth situations. They agreed on the benefits, for both mother and baby, in performing emergency care in the birth room and avoiding a separation altogether, if possible. CONCLUSIONS There are good opportunities to reduce separation of mother and baby after birth; training, knowledge, education and the right environmental conditions are important factors in successfully implementing new ways of working. It is possible to work towards reducing separation and this work should continue and strive to eliminate separation as far as possible.
Collapse
Affiliation(s)
- Pyrola Bäcke
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Li Thies-Lagergren
- Midwifery Research – Reproductive, Perinatal and Sexual Health, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
9
|
Bäcke P, Bruschettini M, Blomqvist YT, Sibrecht G, Olsson E. Interventions for the Management of Pain and Sedation in Newborns Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: A Systematic Review. Paediatr Drugs 2023; 25:27-41. [PMID: 36481984 PMCID: PMC9810674 DOI: 10.1007/s40272-022-00546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Newborn infants undergoing therapeutic hypothermia (TH) are exposed to multiple painful and stressful procedures. The aim of this systematic review was to assess benefits and harms of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing TH for hypoxic-ischemic encephalopathy. METHODS We included randomized and observational studies reporting any intervention (either drugs or non-pharmacological interventions) to manage pain and sedation in newborn infants (> 33 weeks' gestational age) undergoing TH. We included any dose, duration and route of administration. We also included any type and duration of non-pharmacological interventions. Our prespecified primary outcomes were analgesia and sedation assessed using validated pain scales in the neonatal population; circulatory instability; mortality to discharge; and neurodevelopmental disability. A systematic literature search was conducted in the PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, and Web of Science databases, with no language restrictions. Included studies underwent risk-of-bias assessment (Cochrane risk-of-bias tool and ROBINS-I) and data extraction performed by two authors independently. The plan had been to use effect measures such as mean difference for continuous outcomes and risk ratio for dichotomous outcomes, however the included studies are presented in a narrative synthesis due to their paucity and heterogeneity. RESULTS Ten studies involving 3551 infants were included-one trial and nine observational studies. Most studies examined the use of phenobarbital or other antiepileptic drugs with primary outcomes related to seizure activity. The single trial that was included compared pentoxifylline with placebo. Among the primary outcomes, six studies reported circulatory instability and five reported mortality to discharge without relevant differences; two studies reported on neurodevelopmental disability and one study reported on pain scale. Three studies were ongoing. CONCLUSIONS We found limited evidence to establish the benefits and harms of the interventions for the management of pain and sedation in newborn infants undergoing TH. Long-term outcomes were not reported. Given the very low certainty of evidence-due to imprecision of the estimates, inconsistency and limitations in study design (all nine observational studies with overall serious risk of bias)-for all outcomes, clinical trials are required to determine the most effective interventions in this population. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42020205755.
Collapse
Affiliation(s)
- Pyrola Bäcke
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden ,Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Matteo Bruschettini
- Department of Pediatrics, Lund University, Lund, Sweden ,Cochrane Sweden; Research and Education, Skåne University Hospital, Lund, Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden ,Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Greta Sibrecht
- Newborns’ Infectious Diseases Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden.
| |
Collapse
|
10
|
Abdurajan S, Ågren J, Alt J, Axelin A, Bäcke P, Balashova E, Thernström Blomqvist Y, Burckhard Z, Burnsed J, Cornaz Buros S, Chavez-Valdez R, Chen M, Dickie J, Dietz R, Dingman A, Doucette L, El-Dib M, Shibiny H, Flock D, Ganal S, Gorse K, Guo J, Harrison S, Herrmann J, Ionov O, Jackson T, Janesko-Feldman K, Jantzie L, June A, Kathiresh S, Kirtbaya A, Klein A, Kochanek P, Kuter N, Marlicz M, Martin LJ, Matysik W, Munster C, Northington FJ, Quilinan N, Rais R, Schöberlein A, Sharafutdinova D, Suvorov MSI, Suvorova J, Szakmar E, Tiemeier E, Tran P, Trigo NF, Turnbill V, Ushakova L, Vagni V. Proceedings of the 14th International Newborn Brain Conference: Neuroprotection strategies in the neonate. J Neonatal Perinatal Med 2023; 16:S21-S31. [PMID: 37599541 DOI: 10.3233/npm-239002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
|
11
|
Bäcke P, Bruschettini M, Sibrecht G, Thernström Blomqvist Y, Olsson E. Pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia. Cochrane Database Syst Rev 2022; 11:CD015023. [PMID: 36354070 PMCID: PMC9647594 DOI: 10.1002/14651858.cd015023.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Newborn infants affected by hypoxic-ischemic encephalopathy (HIE) undergo therapeutic hypothermia. As this treatment seems to be associated with pain, and intensive and invasive care is needed, pharmacological interventions are often used. Moreover, painful procedures in the newborn period can affect pain responses later in life, impair brain development, and possibly have a long-term negative impact on neurodevelopment and quality of life. OBJECTIVES To determine the effects of pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia. Primary outcomes were analgesia and sedation, and all-cause mortality to discharge. SEARCH METHODS We searched CENTRAL, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the trial register ISRCTN in August 2021. We also checked the reference lists of relevant articles to identify additional studies. SELECTION CRITERIA We included randomized controlled trials (RCT), quasi-RCTs and cluster-randomized trials comparing drugs used for the management of pain or sedation, or both, during therapeutic hypothermia: any opioids (e.g. morphine, fentanyl), alpha-2 agonists (e.g. clonidine, dexmedetomidine), N-Methyl-D-aspartate (NMDA) receptor antagonist (e.g. ketamine), other analgesics (e.g. paracetamol), and sedatives (e.g. benzodiazepines such as midazolam) versus another drug, placebo, no intervention, or non-pharmacological interventions. Primary outcomes were analgesia and sedation, and all-cause mortality to discharge. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies identified by the search strategy for inclusion. We planned to use the GRADE approach to assess the certainty of evidence. We planned to assess the methodological quality of included trials using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria (assessing randomization, blinding, loss to follow-up, and handling of outcome data). We planned to evaluate treatment effects using a fixed-effect model with risk ratio (RR) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. MAIN RESULTS: We did not find any completed studies for inclusion. Amongst the four excluded studies, topiramate and atropine were used in two and one trial, respectively; one study used dexmedetomidine and was initially reported in 2019 to be a randomized trial. However, it was an observational study (correction in 2021). We identified one ongoing study comparing dexmedetomidine to morphine. AUTHORS' CONCLUSIONS We found no studies that met our inclusion criteria and hence there is no evidence to recommend or refute the use of pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia.
Collapse
Affiliation(s)
- Pyrola Bäcke
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| | - Greta Sibrecht
- Newborns' Infectious Diseases Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
12
|
Bäcke P, Bruschettini M, Blomqvist YT, Olsson E. Interventions for the management of Pain and Sedation in Newborns undergoing Therapeutic hypothermia for hypoxic-ischemic encephalopathy (IPSNUT): protocol of a systematic review. Syst Rev 2022; 11:101. [PMID: 35606836 PMCID: PMC9128112 DOI: 10.1186/s13643-022-01982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical research has shown that therapeutic hypothermia after neonatal hypoxic-ischemic injury improves survival without disability. There is no consensus regarding pain relief or sedation during therapeutic hypothermia in newborns; however, therapeutic hypothermia seems to be associated with pain and stress, and adequate analgesia and sedation are central to maximize the effect of therapeutic hypothermia. Pain needs to be adequately managed in all patients, especially the newborn infant due to the potential short- and long-term negative effects of inadequately treated pain in this population. METHODS We will perform a systematic review of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy. We will include randomized, quasi-randomized controlled trials and observational studies. The use of pharmacological or non-pharmacological interventions will be compared to other pharmacological and or non-pharmacological interventions or no intervention/placebo. The primary outcomes for this review will be analgesia and sedation assessed with validated pain scales, circulatory instability, mortality to discharge, and moderate-to-severe neurodevelopmental disability. We will search the following databases: CINAHL, ClinicalTrials.gov , Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Two independent researchers will screen the records for inclusion, extract data using a data extraction form, and assess the risk of bias in the included trials. DISCUSSION The result of this review will summarize the knowledge regarding the management of pain and sedation in infants treated with therapeutic hypothermia and potentially provide clinicians with guidance on the effective and safe methods. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020205755.
Collapse
Affiliation(s)
- Pyrola Bäcke
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Matteo Bruschettini
- Department of Pediatrics, Lund University, Lund, Sweden.,Cochrane Sweden, Research and Development, Skåne University Hospital, Lund, Sweden
| | - Ylva Thernström Blomqvist
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden.
| |
Collapse
|
13
|
Abstract
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.
Collapse
Affiliation(s)
- 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
| | - Johan Ågren
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Victoria Karlsson
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
14
|
Bäcke P, Bruschettini M, Sibrecht G, Thernström Blomqvist Y, Olsson E. Pharmacological interventions for pain and sedation management in newborn infants undergoing therapeutic hypothermia. Hippokratia 2021. [DOI: 10.1002/14651858.cd015023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pyrola Bäcke
- Neonatal Intensive Care Unit; University Hospital; Uppsala Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
- Cochrane Sweden; Lund University, Skåne University Hospital; Lund Sweden
| | - Greta Sibrecht
- Newborns' Infectious Diseases Department; Poznan University of Medical Sciences; Poznan Poland
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit; University Hospital; Uppsala Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Faculty of Medicine and Health, School of Health Sciences; Örebro University; Örebro Sweden
| |
Collapse
|
15
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
16
|
Abstract
BACKGROUND Human milk is recommended as the only nutritional source during the first 6 months of life. For preterm infants, the benefits of human milk are even more important and can alleviate the negative influences of preterm birth. RESEARCH AIM To describe how Swedish human milk donors experienced the donation process. METHOD A prospective mixed methods mail survey was designed. It was sent to human milk donors (N = 72) at two Swedish hospitals. Quantitative data are presented with descriptive statistics and qualitative data were analyzed using qualitative content analysis. RESULTS The infants were between newborn and 17 weeks of age when the participants started their human milk donations, and the duration of the donation period lasted 1-24 weeks. The overall theme identified was the participants' strong desire to help infants, often expressed as being involved in saving infants' lives. Many participants experienced difficulties getting the information needed to become human milk donors; for others, expressing milk required both time and energy that they could otherwise spend with their own newborn infants. CONCLUSION Donating human milk can be experienced as a demanding and strenuous task. Therefore, it is important that women who donate human milk receive the practical help from health care staff that they feel they need. Furthermore, information and knowledge about the possibility of donating human milk, and how important human milk is for preterm and/or sick infants, are important in order to increase the number of women willing to donate human milk.
Collapse
Affiliation(s)
- Emma Olsson
- 6233 Department of Pediatricsm, Faculty of Medicine and Health, Örebro University, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden
| | - Barbro Diderholm
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden.,8097 Department of Women's and Children's Health, Uppsala University, Sweden
| | - Ylva Thernström Blomqvist
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden.,8097 Department of Women's and Children's Health, Uppsala University, Sweden
| |
Collapse
|
17
|
Gerhardsson E, Oras P, Mattsson E, Blomqvist YT, Funkquist EL, Rosenblad A. Developing the Preterm Breastfeeding Attitudes Instrument: A tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive care. Midwifery 2020; 94:102919. [PMID: 33422884 DOI: 10.1016/j.midw.2020.102919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care. DESIGN The study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme. SETTING AND PARTICIPANTS A total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis. MEASUREMENTS AND FINDINGS Higher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the pre- and the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeeding- and skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (rs = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Neonatal intensive care units need to increase their efforts to support breastfeeding. An important factor for mothers when establishing breastfeeding is support from well-trained professionals with a positive attitude to breastfeeding. The PreBAI could be a useful tool for identifying attitudes among HCPs before and after attending a breastfeeding training programme.
Collapse
Affiliation(s)
- Emma Gerhardsson
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden.
| | - Paola Oras
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
| | - Elisabet Mattsson
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
| | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
| | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
| | | |
Collapse
|
18
|
Mörelius E, Olsson E, Sahlén Helmer C, Thernström Blomqvist Y, Angelhoff C. External barriers for including parents of preterm infants in a randomised clinical trial in the neonatal intensive care unit in Sweden: a descriptive study. BMJ Open 2020; 10:e040991. [PMID: 33277288 PMCID: PMC7722364 DOI: 10.1136/bmjopen-2020-040991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Performing randomised controlled trials (RCTs) in neonatal intensive care is challenging in many ways. While restrictive inclusion criteria or busy study protocols are obvious barriers, external barriers leading to termination of a study are seldom discussed. The aim of this study was to describe barriers for inclusion of families in neonatal intensive care in an RCT aiming to evaluate the effects of continuous skin-to-skin contact on mood and sleep quality in parents of preterm infants, as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge. DESIGN A descriptive study. SETTING Three out of seven tertiary neonatal intensive care units in Sweden participated in a two-arm RCT that was terminated because of low inclusion rate. PARTICIPANTS Before termination of the study, 11 out of 242 families assessed for eligibility were included for participation. RESULTS The major barriers for inclusion in this RCT were external due to (1) lack of intensive care beds in the neonatal ward, causing medically stable infants to be transferred back to the referring hospital quicker than expected, (2) moving directly from the delivery room to a family room without passing an open bay intensive care room or (3) transferring from one neonatal ward to another with the same care level to increase availability of intensive care beds where needed. Other barriers were the inclusion criteria 'single-birth' and 'Swedish-speaking parent'. CONCLUSIONS The major barriers for including participants were external constituted by transferals between neonatal wards and cities due to lack of intensive care beds. This is a multifactorial issue related to organisational structures. However, since this affects the possibilities to perform research this study highlights some suggestions to consider when planning prospective intervention studies within a neonatal setting. TRIAL REGISTRATION NUMBER NCT03004677.
Collapse
Affiliation(s)
- Evalotte Mörelius
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Emma Olsson
- School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Pediatrics, University Hospital Örebro, Örebro, Sweden
| | | | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Neonatal Intensive Care Unit, Uppsala University Hospital, Uppsala, Sweden
| | - Charlotte Angelhoff
- Crown Princess Victoria's Child and Youth Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
19
|
Olsson E, Carlsen Misic M, Dovland Andersen R, Ericson J, Eriksson M, Thernström Blomqvist Y, Ullsten A. Study protocol: parents as pain management in Swedish neonatal care - SWEpap, a multi-center randomized controlled trial. BMC Pediatr 2020; 20:474. [PMID: 33046026 PMCID: PMC7549219 DOI: 10.1186/s12887-020-02356-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND During the first period of life, critically ill as well as healthy newborn infants experience recurrent painful procedures. Parents are a valuable but often overlooked resource in procedural pain management in newborns. Interventions to improve parents' knowledge and involvement in infants' pain management are essential to implement in the care of the newborn infant. Neonatal pain research has studied a range of non-pharmacological pain alleviating strategies during painful procedures, yet, regarding combined multisensorial parent-driven non-pharmacological pain management, research is still lacking. METHODS/DESIGN A multi-center randomized controlled trial (RCT) with three parallel groups with the allocation ratio 1:1:1 is planned. The RCT "Parents as pain management in Swedish neonatal care - SWEpap", will investigate the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, during routine metabolic screening of newborn infants (PKU-test). DISCUSSION Parental involvement in neonatal pain management enables a range of comforting parental interventions such as skin-to-skin contact, breastfeeding, rocking and soothing vocalizations. To date, few studies have been published examining the efficacy of combined multisensorial parent-driven interventions. So far, research shows that the use of combined parent-driven pain management such as skin-to-skin contact and breastfeeding, is more effective in reducing behavioral responses to pain in infants, than using the pain-relieving interventions alone. Combined parental soothing behaviors that provide rhythmic (holding/rocking/vocalizing) or orogustatory/orotactile (feeding/pacifying) stimulation that keep the parent close to the infant, are more effective in a painful context. In the SWEpap study we also include parental live lullaby singing, which is an unexplored but promising biopsychosocial, multimodal and multisensory pain alleviating adjuvant, especially in combination with skin-to-skin contact and breastfeeding. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04341194 ) 10 April 2020.
Collapse
Affiliation(s)
- Emma Olsson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden.
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Martina Carlsen Misic
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jenny Ericson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Department of Pediatrics, Falun Hospital, Falun, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alexandra Ullsten
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden
| |
Collapse
|
20
|
Grundvig Nylund A, Gonzalez Lindh M, Ahlsson F, Thernström Blomqvist Y. Parents experiences of feeding their extremely preterm children during the first 2-3 years - A qualitative study. Acta Paediatr 2020; 109:976-981. [PMID: 31621108 DOI: 10.1111/apa.15060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/28/2019] [Accepted: 10/15/2019] [Indexed: 11/28/2022]
Abstract
AIM To describe parents of extremely preterm children experiences regarding feeding of their children during the first 3 years of the child's life. METHODS This is a qualitative study involving interviews conducted with 12 parents of nine children who had been cared for at one neonatal intensive care unit in Sweden. The interviews were conducted between May and September 2018; the data were analysed using qualitative content analysis. RESULTS All parents experienced some difficulties with their child's eating development and described feeding their child as sometimes both difficult and frustrating. Variation in when these difficulties arose made it hard for the parents to obtain the individual support they wanted and needed. Parents experienced a need for more support - from both staff members and parents with similar experiences - during and after their child's stay at the NICU. CONCLUSION All parents participating in the study experienced difficulties during some phase of their child's feeding development. They expressed the need for more specialised support both during and after their child's time at the hospital.
Collapse
Affiliation(s)
- Anna Grundvig Nylund
- Department of Neuroscience, Speech and Language Pathology Uppsala University Uppsala Sweden
- KOM‐X County Council of Gävleborg Region Hospital Gävle Sweden
| | - Margareta Gonzalez Lindh
- Department of Neuroscience, Speech and Language Pathology Uppsala University Uppsala Sweden
- Centre for Research and Development (CFUG) County Council of Gävleborg Uppsala University Gävle Sweden
- Speech Pathology Department Gävle Hospital Gävle Sweden
| | - Fredrik Ahlsson
- Neonatal Intensive Care Unit University Hospital Uppsala Sweden
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit University Hospital Uppsala Sweden
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| |
Collapse
|
21
|
Blomqvist YT, Gradin M, Olsson E. Pain Assessment and Management in Swedish Neonatal Intensive Care Units. Pain Manag Nurs 2019; 21:354-359. [PMID: 31889663 DOI: 10.1016/j.pmn.2019.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/26/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
Abstract
AIMS To investigate registered nurses' (RNs') and physicians' knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden. DESIGN Descriptive and explorative study using an online questionnaire. METHODS A researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden. RESULTS Most NICUs had pain assessment guidelines, but there was a discrepancy regarding interprofessional discussions of pain assessments. A total of seven different pain assessment instruments were reported from the included NICUs and RNs were reportedly those who usually performed the pain assessments. Most respondents expressed a positive attitude toward pain assessment but recognized a lack of intervention after the assessment. Forty-six percent (n = 11) of the physicians said they had sufficient knowledge of assessing pain using pain assessment instruments, versus 75% (n = 110) of the RNs. Difficulties assessing pain in certain populations of infants, such as the most premature infants and infants receiving sedative medicines, were recognized. CONCLUSIONS RNs in this study reported that their pain assessments did not lead to appropriate pain management interventions. They were thus discouraged from further pain assessments or advocating for ethical pain management. An interprofessional team effort is needed to effectively assess and manage pain in neonates.
Collapse
Affiliation(s)
- Ylva Thernström Blomqvist
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Gradin
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| |
Collapse
|
22
|
Norman M, Källén K, Wahlström E, Håkansson S, Skiöld B, Navér L, Domellöf M, Abrahamsson T, Stigson L, Thernström Blomqvist Y, Nyholm A, Holmström G, Björklund L, Wallin‐Gyökeres A. The Swedish Neonatal Quality Register - contents, completeness and validity. Acta Paediatr 2019; 108:1411-1418. [PMID: 31006126 DOI: 10.1111/apa.14823] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/07/2019] [Accepted: 04/16/2019] [Indexed: 11/28/2022]
Abstract
AIM To describe the Swedish Neonatal Quality Register (SNQ) and to determine its completeness and agreement with other registers. METHODS SNQ collects data for infants admitted to neonatal units during the first four postnatal weeks. Completeness and registers' agreement were determined cross-linking SNQ data with Swedish population registers (the Inpatient, Medical Birth and Cause of Death Registers) for a study period of five years. RESULTS In total, 84 712 infants were hospitalised. A total of 52 806 infants occurred in both SNQ and the population registers; 28 692 were only found in the population registers, and 3214 infants were only found in SNQ. Between gestational weeks 24-34, completeness of SNQ was 98-99%. Below and above these gestational ages, completeness was lower. Infants missing in SNQ were term or near-term in 99% of the cases, and their diagnoses indicated conditions managed in maternity units, or re-admissions for acute infections, managed in paediatric units. For most diagnoses, the agreement between SNQ and population registers was high, but some (bronchopulmonary dysplasia and grade of hypoxic-ischaemic encephalopathy) were often missing in the population registers. CONCLUSION SNQ completeness and agreement against other registers, especially for preterm infants, is excellent. SNQ is a valid tool for benchmarking, quality improvement and research.
Collapse
Affiliation(s)
- Mikael Norman
- Department of Clinical Science, Intervention and Technology Division of Pediatrics Karolinska Institutet Stockholm Sweden
- Department of Neonatal Medicine Karolinska University Hospital Stockholm Sweden
- Swedish Neonatal Quality Register (SNQ) Västerbotten county council Umeå Sweden
| | - Karin Källén
- Swedish Neonatal Quality Register (SNQ) Västerbotten county council Umeå Sweden
- Centre for Reproductive Epidemiology Lund University Lund Sweden
| | | | - Stellan Håkansson
- Swedish Neonatal Quality Register (SNQ) Västerbotten county council Umeå Sweden
- Department of Clinical Sciences Division of Pediatrics Umeå University Umeå Sweden
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/25/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
|
24
|
Angelhoff C, Blomqvist YT, Sahlén Helmer C, Olsson E, Shorey S, Frostell A, Mörelius E. Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial. BMJ Open 2018; 8:e021606. [PMID: 30068615 PMCID: PMC6074633 DOI: 10.1136/bmjopen-2018-021606] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge. METHODS AND ANALYSIS A randomised intervention study with two arms-intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents' gender. ETHICS AND DISSEMINATION The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89-31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings. TRIAL REGISTRATION NUMBER NCT03004677.
Collapse
Affiliation(s)
- Charlotte Angelhoff
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | | | - Charlotte Sahlén Helmer
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | - Emma Olsson
- Department of Pediatrics and Centre for Health Care Sciences, Örebro University, Örebro, Sweden
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Anneli Frostell
- Division of Psychology, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
| |
Collapse
|
25
|
Norén J, Nyqvist KH, Rubertsson C, Blomqvist YT. Becoming a mother - Mothers' experience of Kangaroo Mother Care. Sex Reprod Healthc 2018; 16:181-185. [PMID: 29804764 DOI: 10.1016/j.srhc.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/06/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe mothers' experiences of providing their preterm infants with Kangaroo Mother Care (KMC). STUDY DESIGN A qualitative descriptive design. SETTING Two level III neonatal intensive care units (NICUs) in Sweden. PARTICIPANTS Thirteen mothers of preterm infants. METHODS The mothers were interviewed when their infant had reached a corrected age of 4 months ± 2 weeks. The interviews were recorded and transcribed and data were analyzed using qualitative content analysis. RESULTS The mothers described the skin-to-skin contact with, and closeness to, the preterm infant as something they valued, and involuntary physical separation as something they had to accept and adapt to. Providing the infant with breast milk by expressing and tube feeding was experienced as time-consuming and as impinging on the skin-to-skin contact. CONCLUSION Mothers want to stay close to their preterm infant. The NICU environment and staff can facilitate KMC by providing a private space for parents and infants, and enable mothers to breastfeed and express breast milk by giving them support based on science and proven experience.
Collapse
Affiliation(s)
- Josefine Norén
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden
| | | | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; University of Lund, Department of Health Science, Lund, Sweden
| | - Ylva Thernström Blomqvist
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
26
|
Blomqvist YT, Nyqvist KH, Rubertsson C, Funkquist E. Parents need support to find ways to optimise their own sleep without seeing their preterm infant's sleeping patterns as a problem. Acta Paediatr 2017; 106:223-228. [PMID: 27925691 DOI: 10.1111/apa.13660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/09/2016] [Accepted: 11/02/2016] [Indexed: 11/27/2022]
Abstract
AIM This study described how parents perceived their own sleep, and their infants', during neonatal intensive care unit (NICU) admission and after discharge. It also explored the infants' sleeping location at home. METHODS The study was conducted in the NICUs of two Swedish university hospitals. The parents of 86 infants - 86 mothers and 84 fathers - answered questionnaires during their infants' hospital stay, at discharge and at the infants' corrected ages of two, six and 12 months. The parents' own sleep was explored with the Insomnia Severity Index. RESULTS Mothers reported more severe insomnia than fathers during their infants' hospitalisation, and these higher insomnia severity scores were associated with more severe infant sleep problems at discharge (p = 0.027) and at two months (p = 0.006) and 12 months (p = 0.002) of corrected age. During the study period, 4%-10% of the parents reported severe or very severe infant sleeping problems. The bed-sharing rate was 75% after discharge and about 60% at the corrected age of 12 months. CONCLUSION Maternal insomnia during an infant's hospital stay was associated with later perceptions of sleep problems in their children. Parents need support to find solutions for optimal sleep without seeing their child's sleeping patterns as a problem.
Collapse
Affiliation(s)
- Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit 95 F Uppsala University Children's Hospital Uppsala Sweden
- Department of Women's and Children's Health University Hospital Uppsala Sweden
| | | | | | - Eva‐Lotta Funkquist
- Department of Women's and Children's Health University Hospital Uppsala Sweden
| |
Collapse
|
27
|
Larsson C, Wågström U, Normann E, Thernström Blomqvist Y. Parents experiences of discharge readiness from a Swedish neonatal intensive care unit. Nurs Open 2016; 4:90-95. [PMID: 28286665 PMCID: PMC5340163 DOI: 10.1002/nop2.71] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/12/2016] [Indexed: 11/05/2022] Open
Abstract
Aim The aim of this study was to describe how parents experienced the support at, and preparation for discharge from, the NICU and how they experienced the first time at home. Design A qualitative design with quantitative elements was applied. Methods A questionnaire study. Data were analysed using qualitative content analysis with quantitative elements. Results The majority of included parents felt adequately prepared for going home and sufficiently supported during the first period home. Negative experiences were related to lack of time for preparation, lack of support and information, especially about the infant's food intake, breastfeeding, and tube feeding, and lack of follow‐up counselling post discharge. This study supports that parents who are closely involved in their infant's care at the NICU, and who stay with the infant at the NICU around the clock, are well prepared for the transition to home.
Collapse
Affiliation(s)
| | - Ulrika Wågström
- Neonatal Intensive Care Unit University Hospital Uppsala Sweden
| | - Erik Normann
- Neonatal Intensive Care Unit University Hospital Uppsala Sweden; Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit University Hospital Uppsala Sweden; Department of Women's and Children's Health Uppsala University Uppsala Sweden
| |
Collapse
|
28
|
Oras P, Thernström Blomqvist Y, Hedberg Nyqvist K, Gradin M, Rubertsson C, Hellström-Westas L, Funkquist EL. Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants. Acta Paediatr 2016; 105:783-9. [PMID: 27100380 DOI: 10.1111/apa.13431] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/07/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Abstract
AIM This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored. METHODS A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28 + 0 to 33 + 6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records, and follow-up questionnaires were filled in by parents. RESULTS The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35 + 0 (32 + 1 to 37 + 5) weeks of postmenstrual age, and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p < 0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding. CONCLUSION A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.
Collapse
Affiliation(s)
- Paola Oras
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | | | - Maria Gradin
- Department of Paediatrics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | | | | | - Eva-Lotta Funkquist
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| |
Collapse
|
29
|
Oras P, Blomqvist YT, Nyqvist KH, Gradin M, Rubertsson C, Hellström-Westas L, Funkquist EL. Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks. J Hum Lact 2015; 31:377-85. [PMID: 25956792 DOI: 10.1177/0890334415586406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support. OBJECTIVE This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age. METHODS As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions. RESULTS In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8). CONCLUSION Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.
Collapse
Affiliation(s)
- Paola Oras
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Maria Gradin
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
30
|
Baylis R, Ewald U, Gradin M, Hedberg Nyqvist K, Rubertsson C, Thernström Blomqvist Y. First-time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units. Acta Paediatr 2014; 103:1045-52. [PMID: 24923236 DOI: 10.1111/apa.12719] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/23/2014] [Accepted: 06/09/2014] [Indexed: 11/29/2022]
Abstract
AIM Early parental bonding with preterm babies is particularly important, and the aim of our study was to explore when parents experienced what they regarded as important events for the first time while their infant was in the neonatal intensive care unit (NICU). METHODS The study was part of a longitudinal project on Kangaroo Mother Care at two Swedish university hospitals. The parents of 81 infants completed questionnaires during their infants' hospital stay. RESULTS Most parents saw and touched their infants immediately after birth, but only a few could hold them skin to skin or swaddle them. Other important events identified by parents included the first time they performed care giving activities and did so independently, interaction and closeness with the infant, signs of the infant's recovery and integration into the family. The timing of the events depended on the physical design of the NICU, whether parents' could stay with their infant round-the-clock and when they were allowed to provide care under supervision and on their own. CONCLUSION The design and routines of the NICU dictated when parents first interacted with their infants. Clinical guidelines that facilitate early contact with preterm babies can help parents to make the transition to their parental role.
Collapse
Affiliation(s)
- Rebecca Baylis
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Uwe Ewald
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | | | | | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Neonatal Intensive Care Unit; University Hospital; Uppsala Sweden
| |
Collapse
|
31
|
Strand H, Blomqvist YT, Gradin M, Nyqvist KH. Kangaroo mother care in the neonatal intensive care unit: staff attitudes and beliefs and opportunities for parents. Acta Paediatr 2014; 103:373-8. [PMID: 24286253 DOI: 10.1111/apa.12527] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/09/2013] [Accepted: 11/26/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare attitudes towards Kangaroo mother care (KMC) among staff in two high-tech neonatal intensive care units, which provided parents with different opportunities to get involved in their infants' care. METHOD Questionnaires were completed by healthcare staff in Unit A, which provided parents with unrestricted access so that they could provide continuous KMC, and Unit B, where parents could only practice KMC intermittently. RESULTS Unit A staff were more positive about the benefits and use of KMC, including its use in unstable infants, and rated their knowledge and practical skills more highly than staff in the other unit. Unit B staff also appreciated the method, but expressed more hesitation in using it with unstable infants. In particular, they stressed the need to adapt the physical environment of the NICU to enable parents to stay with their infants and practice the method. CONCLUSION Staff working in the NICU that gave parents unrestricted access were more positive about KMC than staff in the NICU that offered limited opportunities for parents to stay with their children. This finding suggests that it is important to eliminate unjustifiable obstacles to the presence of parents in the NICU, so that they can provide KMC.
Collapse
Affiliation(s)
- H Strand
- School Health Nurse; Katedralskolan; Uppsala Sweden
| | - YT Blomqvist
- Neonatal Intensive Care Unit; University Hospital; Uppsala Sweden
| | - M Gradin
- Neonatal Intensive Care Unit; University Hospital; Örebro Sweden
| | - KH Nyqvist
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| |
Collapse
|
32
|
Blomqvist YT, Ewald U, Gradin M, Nyqvist KH, Rubertsson C. Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units. Acta Paediatr 2013; 102:22-8. [PMID: 23072448 DOI: 10.1111/apa.12056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/11/2012] [Accepted: 10/11/2012] [Indexed: 11/30/2022]
Abstract
AIM To describe initiation and extent of parents' application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units. METHODS The duration of SSC was recorded in 104 infants' medical charts during their hospital stay, and the parents answered a questionnaire. RESULTS Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 24-78 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min. CONCLUSION Early initiation of SSC had positive impact on the extent of parents' application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.
Collapse
Affiliation(s)
| | - Uwe Ewald
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| | | | | | - Christine Rubertsson
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| |
Collapse
|
33
|
Abstract
BACKGROUND Kangaroo Mother Care (KMC) supports parents' role at the neonatal intensive care unit (NICU). To enhance parents' provision of KMC, it is essential to obtain knowledge of what parents perceive as supportive factors and barriers regarding their opportunities to perform KMC. AIM To identify factors that parents of preterm infants perceived as supportive factors or barriers for their performance of KMC and to explore the timing of and reasons for parents' discontinuation of KMC. METHODS A descriptive study performed at two NICUs in Sweden with 76 mothers and 74 fathers of preterm infants born at gestational ages ranging from 28 to 33 weeks. Data on infant characteristics were obtained from the infants' medical records. A questionnaire, based on scientific literature and the researchers' clinical experience, was completed by the mothers and the fathers separately, shortly after the infant's discharge from the hospital. The data were analyzed with qualitative content analysis and descriptive statistic. RESULTS Four categories were identified in parents' responses regarding support and barriers for their performance of KMC: Parent related factors, Time, Infants related factors and The NICU and home environment. The hospital staff and environment were described by the parents as both supportive and barriers for their application of KMC. Some mothers described the infants' feeding process as an obstacle to KMC. Sleeping with the infant skin-to-skin in the same position throughout the night could be difficult, as an uncomfortable sleeping position caused insufficient sleep. A majority of both mothers and fathers continued providing their infant with KMC to some extent after discharge. CONCLUSION Interventions for enhancing parents' opportunities for performing KMC should address both hospital staff attitudes and practices and the NICU environment.
Collapse
|
34
|
Blomqvist YT, Rubertsson C, Kylberg E, Jöreskog K, Nyqvist KH. Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role. J Adv Nurs 2011; 68:1988-96. [PMID: 22111919 DOI: 10.1111/j.1365-2648.2011.05886.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This article is a report on a descriptive study of fathers’ experiences of providing their preterm infants with Kangaroo Mother Care. BACKGROUND During neonatal intensive care, fathers describe the incubator as a barrier and the separation from their infant as stressful. Fathers consider it important to be close to the infant, and performing Kangaroo Mother Care makes them feel an important participant in their infants' care. METHOD Individual interviews conducted in 2009 with seven fathers who performed Kangaroo Mother Care were analysed using qualitative content analysis. RESULTS The fathers' opportunity for being close to their infants facilitated attainment of their paternal role in the neonatal intensive care unit. Kangaroo Mother Care allowed them to feel in control and that they were doing something good for their infant, although the infant's care could be demanding and stressful. As active agents in their infant's care, some fathers stayed with the infant during the whole hospital stay, others were at the neonatal intensive care unit all day long. Despite the un-wished-for situation, they adapted to their predicament and spent as much time as possible with their infants. CONCLUSION Fathers' opportunities for Kangaroo Mother Care helped them to attain their paternal role and to cope with the unexpected situation. The physical environment and conflicting staff statements influenced their opportunity for, and experience of, caring for their preterm infants.
Collapse
|
35
|
|
36
|
Abstract
AIMS To characterise the first infants receiving continuous Kangaroo Mother Care from birth to discharge in a Swedish neonatal intensive care unit and to investigate their mothers' experiences of this model of care. BACKGROUND Admission of a newborn infant to a neonatal intensive care unit commonly implies separation of the new mother from her infant. Kangaroo Mother Care is a model of neonatal care which supports the parental role as primary care-giver and contributes to minimising the separation between the infant and parents. DESIGN A retrospective survey design. METHOD A purposive sample consisting of 23 mother-infant pairs. Relevant infant data were obtained from their medical records. A questionnaire with questions about the infant's care and regarding Kangaroo Mother Care was designed for this study. RESULTS The infants were born at a gestational age of 31-41 weeks, birth weight ranging from 1715-3700 g. The mothers of these moderately preterm and ill newborn infants showed good acceptance of the idea of providing their infants with continuous Kangaroo Mother Care during their stay at the neonatal intensive care unit. The mothers' evaluations of this method were predominantly positive. Negative comments concerned lack of information about practical application of the method, and some mothers perceived their infants' care during the night as exhausting. No mother would have preferred not to perform continuous Kangaroo Mother Care or to terminate Kangaroo Mother Care earlier than they did. CONCLUSIONS These mothers accepted this model of care very well, provided that they received the help and support they required. RELEVANCE TO CLINICAL PRACTICE Mothers whose infants are admitted to an neonatal intensive care units in settings similar to the study setting should be offered opportunities to be present and provide Kangaroo Mother Care for their infants, to the extent that they are able and willing to do so and as permitted by the infant's medical condition and care.
Collapse
|