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Gates K, Chahin S, Damashek A, Dickson C, Lubwama G, Lenz D, Bautista T, Kothari C. The Relation of Maternal Psychosocial Risk Factors to Infant Safe Sleep Practices. Matern Child Health J 2024; 28:1061-1071. [PMID: 38460074 DOI: 10.1007/s10995-023-03880-5] [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] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVES Sleep-related infant deaths are a common and preventable cause of infant mortality in the United States. Moreover, infants of color are at a greater risk of sleep-related deaths than are White infants. The American Academy of Pediatrics (AAP) published safe sleep guidelines to minimize the number of sleep-related infant deaths; however, many families face barriers to following these guidelines. Research on the role of psychosocial risk factors (i.e., depression, stress, domestic violence, substance use) in mothers' engagement in safe sleep practices is limited. The present study examined the role of maternal psychosocial risk factors on maternal safe sleep practices and the moderating effects of maternal race on this relationship. METHODS Participants in this study were mothers (N = 274) who were recruited from a Midwestern hospital postpartum. Data on the participants' psychosocial risk factors, and safe sleep practices were collected via telephone interview 2-4 months following the birth of their infant. RESULTS Predictive models indicated that depression and stress impacted mothers' engagement in following the safe sleep guidelines. Specifically, higher levels of maternal depression predicted greater likelihood of co-sleeping, regardless of mothers' race. Higher levels of maternal stress also predicted lower engagement in safe sleep behaviors for White mothers only. CONCLUSION FOR PRACTICE Early interventions to address stress and depression may help to increase maternal adherence to the AAP's safe sleep guidelines. Additional research on the underlying mechanisms of depression and stress on maternal safe sleep engagement is needed.
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Affiliation(s)
- Kalani Gates
- Department of Psychology, Western Michigan University, 1903 W. Michigan, Kalamazoo, MI, 49008, USA
| | - Summer Chahin
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage St., Kalamazoo, MI, 49007, USA
| | - Amy Damashek
- Department of Psychology, Western Michigan University, 1903 W. Michigan, Kalamazoo, MI, 49008, USA.
| | - Cheryl Dickson
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 300 Portage St., Kalamazoo, MI, 49007, USA
| | - Grace Lubwama
- Kalamazoo Community Foundation, 402 E. Michigan, Kalamazoo, MI, 49007, USA
| | - Debra Lenz
- Kalamazoo County Health and Community Services Department, 311 E. Alcott St., Kalamazoo, MI, 49006, USA
| | | | - Catherine Kothari
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49008, USA
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Salm Ward TC. "Things changed very quickly": Maternal intentions and decision-making about infant sleep surface, location, and position. Birth 2024; 51:373-383. [PMID: 37921270 DOI: 10.1111/birt.12793] [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: 06/05/2023] [Revised: 08/27/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Approximately 3400 infants die suddenly and unexpectedly each year in the United States; many of these deaths include modifiable risk factors (such as a non-supine position, sleeping on a soft surface, or loose bedding or items in the environment). Interventions have been successful at improving parental knowledge about recommendations to reduce risk of sleep-related infant deaths, as well as improving intention to adopt recommendations. However, follow-up studies have found a disconnect between knowledge/intentions to adhere to recommendations and actual practices. Exploring maternal decision-making about infant sleep practices can better elucidate the disconnect between knowledge of infant sleep recommendations and the practice of it, and thus, inform more effective safe sleep interventions. The purpose of this study was to gain a more in-depth understanding of decision-making around infant sleep practices, and barriers and facilitators to adopting safe infant sleep recommendations. METHODS Semi-structured in-home interviews were conducted with 22 families (20 mothers and 2 mother-father dyads) of infants up to 6 months of age. RESULTS Thematic analysis of the transcripts revealed six themes: Plans changed when baby came, Trying things to figure out what works (infant preferences), Safety concerns, What's comfortable for me (maternal preferences), They say…(advice), and Trying to be careful. CONCLUSION These results suggest that knowledge of infant sleep recommendations alone is not enough to ensure adherence and that decision-making is a dynamic and ongoing process affected by multiple factors. Findings have implications for timing and content of risk reduction efforts, as well as for data collection in research studies.
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Perkin MR, Ussher M, Goldsmith LP, Flohr C, Roberts A, Cornelius V, Wahlich C, Willis K, Boyle RJ. BabyBathe study protocol: A randomised controlled feasibility trial to change baby bathing practice during the first months of life. Clin Exp Allergy 2024; 54:353-355. [PMID: 38462778 DOI: 10.1111/cea.14464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Michael R Perkin
- Population Health Research Institute, St. George's University of London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St. George's University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lucy P Goldsmith
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College, London, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St. George's University of London, London, UK
| | - Kathryn Willis
- Population Health Research Institute, St. George's University of London, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
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Noveir SD, Galamgam J, Cheng CE. Prevalence of potential contact allergens in best-selling baby cleansers. Pediatr Dermatol 2024; 41:468-471. [PMID: 38413219 DOI: 10.1111/pde.15570] [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: 12/04/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Abstract
Many baby cleansers are promoted as hypoallergic products; however, these claims are not typically validated. This study assessed the 50 best-selling baby cleansers from online retailer Amazon for potential allergens. We found that the presence of most marketing claims, including "hypoallergenic" or "allergy-tested," did not correlate with the number of potential allergens in a cleanser. Furthermore, the total number of marketing claims of a cleanser was positively correlated with the number of allergens, highlighting the discordance between marketing claims and allergen content in baby cleansers.
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Affiliation(s)
- Sasan D Noveir
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Jayden Galamgam
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Carol E Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
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Hammel GDSC, Simas LTL, Rodrigues LF, Zamberlan C, Lomba L, Backes DS. Mothers' perception of the care of newborn in the home environment. Rev Bras Enferm 2024; 77:e20230080. [PMID: 38655978 PMCID: PMC11034376 DOI: 10.1590/0034-7167-2023-0080] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/15/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES to identify mothers' perceptions about caring for newborns in the home environment, from the perspective of complexity thinking. METHODS qualitative, exploratory and descriptive research, carried out between November/2022 and February/2023. Data were collected through individual interviews with 21 mothers from southern Brazil who cared for newborns at home and analyzed using the thematic analysis technique. RESULTS the four thematic axes resulting from the data analysis: Living amidst order and disorder; embracing singularities; dealing with the certain and the uncertain; support network in the (re)organizing process demonstrate that the mother caring for a newborn in their home environment experiences a distinct and plural adaptive process, which must be welcomed and understood by health professionals who work within the family environment. FINAL CONSIDERATIONS the care of newborns in a home environment, in the perception of mothers, requires differentiated attention and a formal or informal support network that considers the unique specificities of each woman/mother in the personal, family and social spheres. Therefore, in addition to the social support network, it is important to rethink home intervention approaches.
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Affiliation(s)
| | | | | | | | - Lurdes Lomba
- Escola Superior de Enfermagem. Coimbra, Portugal
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Arezi E, Maleki A, Jafari E. The Effect of Media Distractions on Women During Breastfeeding and Infant Care: A Descriptive Cross-Sectional Study. Breastfeed Med 2024; 19:284-290. [PMID: 38526564 DOI: 10.1089/bfm.2023.0264] [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] [Indexed: 03/26/2024]
Abstract
Background: In modern world, the pervasive use of media technologies has seen a significant increase across various domains. The study aimed to assess the level of distraction among lactating women during feeding and infant care, along with exploring associated factors. Methods: This cross-sectional study included 120 lactating mothers who visited comprehensive health centers in Zanjan City in 2023. The inclusion criteria were lactating mothers older than 18 years, who were within 42 days postpartum. A multistage sampling method was used for participant selection. Data were gathered using a standard maternal distraction questionnaire and analyzed using descriptive statistics, independent t-tests, and analysis of variance (ANOVA) test with a confidence level of 95%. Results: The study found that smartphone use (69.7%) was the most common source of distraction for mothers during breastfeeding, while reading books (17.5%) was the least distracting. In addition, 85% of mothers watched television while caring for their babies (except during breastfeeding), and a significant percentage used landline phones (92.5%) and mobile phones (79.2%). It was noted that older mothers tended to be less distracted during feeding or baby care compared with young mothers. Furthermore, maternal attention during baby feeding increased with higher education levels and having more children (p < 0.05). Conclusion: The study concludes that young mothers with lower levels of education experience significantly high levels of distraction while caring for their babies or breastfeeding. Given the substantial availability of media products, interventions are needed to raise mothers' awareness about the importance of maintaining eye contact with their babies and implementing strategies for managing distractions.
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Affiliation(s)
- Elahe Arezi
- Department of Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Azam Maleki
- Social Determinants of Health Research Center, Health and Metabolic Diseases Research Institute, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Elham Jafari
- Department of Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
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de Visme S, Korevaar DA, Gras-Le Guen C, Flamant A, Bevacqua M, Stanzelova A, Trinh NTH, Ciobanu DA, Carvalho AA, Kyriakoglou I, Fuentes M, Refes Y, Briand-Huchet E, Sellier AL, Harrewijn I, Cohen JF, Chalumeau M. Inconsistency Between Pictures on Baby Diaper Packaging in Europe and Safe Infant Sleep Recommendations. J Pediatr 2024; 264:113763. [PMID: 37778411 DOI: 10.1016/j.jpeds.2023.113763] [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: 06/01/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To describe the level of inconsistency between pictures on baby diaper packaging and safe infant sleep recommendations (SISRs) in Europe. STUDY DESIGN We attempted to identify all packaging of baby diapers sold in 11 European countries for infants weighing less than 5 kg through internet searches from July 2022 through February 2023. For each type of package, we extracted whether there was a picture depicting a baby, whether the baby was sleeping, and whether the picture of the sleeping baby was inconsistent with ≥1 of 3 SISRs: (i) nonsupine sleeping position, (ii) soft objects or loose bedding, or (iii) sharing a sleep surface with another person. Data were aggregated at the country level, and a random-effects meta-analysis of proportions was used to obtain summary estimates. The outcome was the summary estimate of the proportion of pictures that were inconsistent with SISRs. RESULTS We identified 631 baby diaper packaging types of which 49% (95% CI: 42-57; n = 311) displayed a picture of a sleeping baby. Among those 311 packages, 79% (95% CI 73-84) were inconsistent with ≥1 SISR, including a nonsupine sleeping position, 45% (95% CI 39-51), soft objects or loose bedding such as pillows or blankets, 51% (95% CI 46-57), and sharing a sleep surface with another person, 10% (95% CI 4-18). CONCLUSIONS Pictures on baby diaper packaging in Europe are often inconsistent with SISRs. The prevention of sudden unexpected death in infancy requires action from manufacturers and legislators to stop parents' exposure to misleading images that may lead to dangerous practices.
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Affiliation(s)
- Sophie de Visme
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; CHU de Nantes, INSERM, Department of General Pediatrics and Pediatric Emergencies, CIC1413, Nantes Université, Nantes, France
| | - Daniel A Korevaar
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christèle Gras-Le Guen
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; CHU de Nantes, INSERM, Department of General Pediatrics and Pediatric Emergencies, CIC1413, Nantes Université, Nantes, France; CHU de Nantes, Department of General Pediatrics and Pediatric Emergencies, Nantes Université, Nantes, France
| | - Alix Flamant
- Department of General Pediatrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Martina Bevacqua
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Stanzelova
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Independent Researcher, Galway, Ireland
| | - Nhung T H Trinh
- Department of Pharmacy, PharmacoEpidemiology and Drug Safety Research Group, University of Oslo, Oslo, Norway
| | - Dalia-Alexandra Ciobanu
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Children's Hospital "Doctor Victor Gomoiu", Bucharest, Romania
| | - Ana Araújo Carvalho
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Centro Hospitalar e Universitário de Lisboa Central, Hospital Dona Estefânia, Paediatric Department, Lisboa, Portugal
| | - Ifigeneia Kyriakoglou
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Fuentes
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Pediatric Emergencies, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Yacine Refes
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France
| | - Elisabeth Briand-Huchet
- Naître et Vivre, National Association for the Support of Bereaved Parents and the Fight Against Sudden Unexpected Death in Infancy, Paris, France
| | | | - Inge Harrewijn
- Department of Neonatal Pediatrics and Intensive Care, Montpellier University Hospital, University of Montpellier, Montpellier, France.
| | - Jérémie F Cohen
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Martin Chalumeau
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
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Geist BK, Bammer-Zimmer R. Effects of Early Toilet Training and Elimination Communication With Respect to Diaper Types. Clin Pediatr (Phila) 2023; 62:901-907. [PMID: 36852780 DOI: 10.1177/00099228221145268] [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] [Indexed: 03/01/2023]
Abstract
To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P < .001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P < .001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P < .001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years.
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Shaikh SK, Chamberlain L, Nazareth-Pidgeon KM, Boggan JC. Quality improvement initiative to improve infant safe sleep practices in the newborn nursery. BMJ Open Qual 2022; 11:bmjoq-2022-001834. [PMID: 35922090 PMCID: PMC9352977 DOI: 10.1136/bmjoq-2022-001834] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
The American Academy of Pediatrics recommends that healthcare professionals model their safe infant sleeping environment recommendations, yet adherence to safe sleep practices within our community hospital mother–baby unit was low. We used quality improvement (QI) methodology to increase adherence to infant safe sleep practices, with a goal to improve the proportion of infants sleeping in an environment that would be considered ‘perfect sleep’ to 70% within a 1-year period. The project occurred while the hospital was preparing for Baby Friendly certification, with increased emphasis on rooming in and skin to skin at the same time. Multiple Plan–Do–Study–Act cycles were performed. Initial cycles targeted nurse and parental education, while later cycles focused on providing sleep sacks/wearable blankets for the infants. While we did not meet our goal, the percentage of infants with ‘perfect sleep’ increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results. This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.
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Affiliation(s)
- Sophie Kay Shaikh
- Pediatrics, Duke University Health System, Durham, North Carolina, USA
| | | | | | - Joel C Boggan
- Medicine, Duke University, Durham, North Carolina, USA
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Abstract
Introduction Ethnic Malaysian Chinese used to observe the 1-month postpartum confinement period at home and many families would engage a traditional postpartum carer to help care for the mother and newborn. A recent trend has been the development of confinement centres (CCs) which are private non-healthcare establishments run by staff not trained in health care. Concerns about hygiene in CCs arose after infections were reported. We describe the practice of hand hygiene observed in CCs, the availability of resources for hygiene, and the prevalence of health-related problems in CCs. Methods This is a cohort study of ethnic Chinese mothers intending to breastfeed their healthy infants. They were recruited post-delivery along with a comparison group who planned to spend their confinement period at home. After their 1-month confinement period, they were contacted for a structured telephone interview about their experience. To avoid any alteration in behaviour, mothers were not told at recruitment that they had to observe hygiene practices. Multiple logistic regression was used to assess the effect of place of confinement on rates of infant health problems. Results Of 187 mothers, 88(47%) went to 27 different CCs while 99(53%) stayed at home. Response rates for the 1-month interviews were 88%(CC) versus 97%(home). Mothers in CC group stayed in one to four-bedded rooms and 92% of them had their baby sleeping separately in a common nursery described to have up to 17 babies at a time; 74% of them spent less than six hours a day with their babies; 43% noticed that CC staff had inadequate hand hygiene practices; 66% reported no hand basins in their rooms; 30% reported no soap at hand basins; 28% reported inexperienced or inadequate staff and 4% reported baby item sharing. Among the mothers staying at home, 35% employed a traditional postpartum carer for her baby; 32% did not room-in with their babies, but only 11% spent less than 6 hours a day with their babies. Of mothers who employed traditional postpartum carers, 32% did not know if their carer washed hands after changing diapers and 18% reported that their carer did not. Health problems that were probably related to infection (HPRI) like fever and cough were similar between the groups: 14%(CC) versus 14%(home) (p = 0.86). Multiple logistic regression did not show that CCs were a factor for HPRI: aOR 1.28 (95% CI 0.36 to 4.49). Three mothers reported events that could indicate transmission of infection in CCs. Conclusion We found unsatisfactory hygiene practices in CCs as reported by mothers who spent their confinement period there. Although we were not able to establish any direct evidence of infection transmission but based on reports given by the mothers in this study, it is likely to be happening. Therefore, future studies, including intervention studies, are urgently needed to establish an appropriate hygiene standard in CCs as well as the best method to implement this standard. Training CC staff with hygiene knowledge so that they can be empowered to contribute to the development of these standards would be important.
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Affiliation(s)
- Siew Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
- * E-mail:
| | - Wai Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
| | - May Loong Tan
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
| | - Jacqueline Judith Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
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11
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Zheng Y, Xia Y, Ye W, Zheng C. The Effect of Skin-to-Skin Contact on Postoperative Depression and Physical Recovery of Parturients after Cesarean Section in Obstetrics and Gynecology Department. Comput Math Methods Med 2022; 2022:9927805. [PMID: 35103074 PMCID: PMC8800602 DOI: 10.1155/2022/9927805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 11/13/2021] [Indexed: 12/17/2022]
Abstract
The effect of skin-to-skin contact (SSC) on postpartum depression and physical rehabilitation of cesarean section women was explored. 280 parturients undergoing cesarean section were selected and were rolled into two groups randomly. The parturients in the control group (Con group, 140 cases) received routine care, and those in the experimental group (Exp group, 140 cases) received SSC on the basis of routine care. The postpartum depression and physical recovery of parturients in two groups were compared. It was found that, in the Exp group, the number of pregnant women with no or with very mild depression was much more 85% vs. 55%), the number of women with adequate lactation was more (53 cases vs. 27 cases), the first lactation time (FLT) was dramatically shorter (41.25 ± 4.81 h vs. 58.43 ± 5.43 h), the breastfeeding success rate (BFSR) and breastfeeding rate (BFR) were obvious higher, the days for uterine involution was much shorter (6.96 ± 1.13 days vs. 9.47 ± 1.75 days), the descent of uterine fundus 24 hours after delivery (24 h-DUF) was obviously larger (3.17 ± 0.26 mm vs. 1.56 ± 0.43 mm), the duration of lochia (DOL) was remarkably shorter (33.21 ± 5.32 days vs. 25.32 ± 3.54 days), and the Visual Analogue Scale (VAS) score was lower (4.88 ± 0.32 points vs. 3.41 ± 0.53 points), showing statistical differences for all above indicators (P < 0.05). It suggested that SSC could effectively relieve the postpartum depression of uterine parturients, promote the lactation, increase the BFR, facilitate uterine involution, and alleviate chronic uterine inflammation and postpartum pain, showing high clinical application and promotion value.
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Affiliation(s)
- Ying Zheng
- Operating Room, The Maternity & Children Care Hospital of Lishui City, Lishui, Zhejiang, 323000, China
| | - Yanping Xia
- Operating Room, The Maternity & Children Care Hospital of Lishui City, Lishui, Zhejiang, 323000, China
| | - Weijuan Ye
- Gynecological Ward, The Maternity & Children Care Hospital of Lishui City, Lishui, Zhejiang, 323000, China
| | - Congxia Zheng
- Nursing Department, The Maternity & Children Care Hospital of Lishui City, Lishui, Zhejiang, 323000, China
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van Veenendaal NR, van der Schoor SRD, Broekman BFP, de Groof F, van Laerhoven H, van den Heuvel MEN, Rijnhart JJM, van Goudoever JHB, van Kempen AAMW. Association of a Family Integrated Care Model With Paternal Mental Health Outcomes During Neonatal Hospitalization. JAMA Netw Open 2022; 5:e2144720. [PMID: 35072721 PMCID: PMC8787602 DOI: 10.1001/jamanetworkopen.2021.44720] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE During newborn hospitalization in the neonatal unit, fathers often feel anxious and excluded from their child's caregiving and decision-making. Few studies and interventions have focused on fathers' mental health and their participation in neonatal care. OBJECTIVE To study the association of a family integrated care (FICare) model (in single family rooms with complete couplet-care for the mother-newborn dyad) vs standard neonatal care (SNC) in open bay units with separate maternity care with mental health outcomes in fathers at hospital discharge of their preterm newborn and to study whether parent participation was a mediator of the association of the FICare model on outcomes. DESIGN, SETTING, AND PARTICIPANTS This prospective, multicenter cohort study was conducted from May 2017 to January 2020 as part of the fAMily Integrated Care in the Neonatal Ward Study, at level-2 neonatal units in the Netherlands (1 using the FICare model and 2 control sites using SNC). Participants included fathers of preterm newborns admitted to participating units. Data analysis was performed from January to April 2021. EXPOSURE FICare model in single family rooms with complete couplet-care for the mother-newborn dyad during maternity and/or neonatal care. MAIN OUTCOMES AND MEASURES Paternal mental health was measured using the Parental Stress Scale: NICU, Hospital Anxiety and Depression Scale, Post-partum Bonding Questionnaire, Perceived (Maternal) Parenting Self-efficacy Scale, and satisfaction with care (EMpowerment of PArents in THe Intensive Care-Neonatology). Parent participation (CO-PARTNER tool) was assessed as a potential mediator of the association of the FICare model with outcomes with mediation analyses (prespecified). RESULTS Of 309 families included in the fAMily Integrated Care in the Neonatal Ward Study, 263 fathers (85%) agreed to participate; 126 fathers were enrolled in FICare and 137 were enrolled in SNC. In FICare, 89 fathers (71%; mean [SD] age, 35.1 [4.8] years) responded to questionnaires and were analyzed. In SNC, 93 fathers (68%; mean [SD] age, 36.4 [5.5] years) responded to questionnaires and were analyzed. Fathers in FICare experienced less stress (adjusted β, -10.02; 95% CI, -15.91 to -4.13; P = .001) and had higher participation scores (adjusted odds ratio, 3.424; 95% CI, 0.860 to 5.988; P = .009) compared with those in SNC. Participation mediated the beneficial association of the FICare model with fathers' depressive symptoms (indirect effect, -0.051; 95% CI, -0.133 to -0.003) and bonding with their newborns (indirect effect, -0.082; 95% CI, -0.177 to -0.015). CONCLUSIONS AND RELEVANCE These findings suggest that the FICare model is associated with decreased paternal stress at discharge and enables fathers to be present and participate more than SNC, thus improving paternal mental health. Supporting fathers to actively participate in all aspects of newborn care should be encouraged regardless of architectural design of the neonatal unit.
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands
- Emma Children’s Hospital, Amsterdam University Medical Centres, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Birit F. P. Broekman
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | - Femke de Groof
- Department of Pediatrics and Neonatology, NoordWest ZiekenhuisGroep, Alkmaar, the Netherlands
| | | | | | - Judith J. M. Rijnhart
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, the Netherlands
| | - J. Hans B. van Goudoever
- Emma Children’s Hospital, Amsterdam University Medical Centres, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
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13
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Abstract
BACKGROUND Feeding difficulty is the most common cause of delayed hospital discharge and readmission of late preterm infants. Frequent and adequate feedings from birth are protective against dehydration, hypoglycemia, and jaundice. The National Perinatal Association's feeding guidelines provide the foundation for late preterm infant standards of care. Feeding at least every 3 hours promotes nutritional status and neurologic development. One feeding assessment every 12 hours during the hospital stay can ensure quality of infant feeding. PROBLEM At a large urban hospital, medical record reviews were completed to evaluate nursing care practices consistent with the hospital's late preterm infant care standard policy. Feeding frequency and nurse assessment of feeding effectiveness were far below acceptable targets. A quality improvement team was formed to address inconsistency with expected practice. METHODS The project included an investigation using the define, design, implement, and sustain method of quality improvement. Parent education, nurse education, and visual cues were developed to sustain enhanced nursing practice. RESULTS Late preterm infants who received feedings at least every 3 hours increased from 2.5% (1 of 40) to 27% (11 of 40); (M = 0.275, SD = 0.446), p = 0.001. Documented breastfeeding assessments increased from 2% (5 of 264) to 8% (10 of 126), p = 0.001. Documented bottle-feeding assessments increased from 15% (39 of 264) to 31% (53 of 172), p < 0.001. Intervention time was cut short due to reprioritization of efforts in response to the COVID-19 pandemic. CONCLUSION Interventions and implementation of this process improvement is easy to replicate through attainable and sustainable goals directed toward improved outcomes for late preterm infants.
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Masuke R, Msuya SE, Mahande JM, Diarz EJ, Stray-Pedersen B, Jahanpour O, Mgongo M. Effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Northern Tanzania: Cohort study. PLoS One 2021; 16:e0250562. [PMID: 33983950 PMCID: PMC8118559 DOI: 10.1371/journal.pone.0250562] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/11/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Childhood undernutrition is a major public health problem especially in low and middle-income countries (LMIC). The prevalence of early introduction of complementary feeding, low meal frequency, and low dietary diversity are frequent in LMICs. The effect of inappropriate complementary feeding practices on the nutritional status of children is not well documented in East African countries including Tanzania. Therefore, this study aimed at determining the effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Tanzania. METHODOLOGY A retrospective cohort study was done using the Pasua and Majengo cohorts of mother-child pairs in urban Moshi who were enrolled from 2002 to 2017. About 3355 mother-child pairs were included in the analysis. Appropriate complementary feeding practices were assessed using WHO IYFP indicators such as age at introduction of solid, semi-solid, or soft foods, minimum dietary diversity, and minimum meal frequency. Nutritional status (stunting, wasting, and underweight) was determined. Multilevel modeling was applied to obtain the effect of inappropriate complementary feeding practices on the nutritional status of children and to account for the clustering effect of mothers and children and the correlation of repeated measures within each child. RESULTS Majority of the children (91.2%) were given soft/semi-solid/solid foods before six months of age, 40.3percent had low meal frequency, and 74percent had low dietary diversity. Early introduction of complementary food at age 0-1 month was statistically significantly associated with higher risks of wasting and underweight (ARR 2.9, 95%CI 1.3-6.3; and ARR 2.6, 95% CI 1.3-5.1 respectively). Children with low minimum meal frequency had higher risks of stunting, wasting, and underweight (ARR 2.9, 95%CI 2.3-3.6; ARR 1.9, 95%CI 1.5-2.5 and ARR 1.9, 95%CI 1.5-2.4 respectively). Children with low minimum dietary diversity were more likely to be stunted than is the case with their peers who received the minimum dietary diversity (ARR 1.3, 95% CI 1.01-1.6). CONCLUSION There were a high proportion of children, which were fed inappropriately; Inappropriate complementary feeding practices predisposed children to undernutrition. Our study supports the introduction of complementary feeding, providing minimum dietary diversity, and minimum feeding frequency at six months of age as important in improving the nutritional status of the children.
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Affiliation(s)
- Rachel Masuke
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| | - Sia E. Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Community Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Johnson M. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ester J. Diarz
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Babill Stray-Pedersen
- Better Health for African Mother and Child, Moshi, Tanzania
- Division of Women, Oslo University Hospital, Rikshospitalet, Norway
| | - Ola Jahanpour
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Melina Mgongo
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Better Health for African Mother and Child, Moshi, Tanzania
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15
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Abstract
BACKGROUND There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. OBJECTIVES To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. SELECTION CRITERIA We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. AUTHORS' CONCLUSIONS We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).
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Affiliation(s)
- Rashmi R Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Mari Jeeva Sankar
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Ramesh Agarwal
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
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Rao SPN, Minckas N, Medvedev MM, Gathara D, Y N P, Seifu Estifanos A, Silitonga AC, Jadaun AS, Adejuyigbe EA, Brotherton H, Arya S, Gera R, Ezeaka CV, Gai A, Gobezayehu AG, Dube Q, Kumar A, Naburi H, Chiume M, Tumukunde V, Medhanyie AA, Plange-Rhule G, Shabini J, Ohuma EO, Tadele H, W/Gebriel F, Hadgu A, Alamineh L, Mehta R, Molyneux E, Lawn JE. Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences. BMJ Glob Health 2021; 6:e004347. [PMID: 33716220 PMCID: PMC7959239 DOI: 10.1136/bmjgh-2020-004347] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is disrupting health systems globally. Maternity care disruptions have been surveyed, but not those related to vulnerable small newborns. We aimed to survey reported disruptions to small and sick newborn care worldwide and undertake thematic analysis of healthcare providers' experiences and proposed mitigation strategies. METHODS Using a widely disseminated online survey in three languages, we reached out to neonatal healthcare providers. We collected data on COVID-19 preparedness, effects on health personnel and on newborn care services, including kangaroo mother care (KMC), as well as disruptors and solutions. RESULTS We analysed 1120 responses from 62 countries, mainly low and middle-income countries (LMICs). Preparedness for COVID-19 was suboptimal in terms of guidelines and availability of personal protective equipment. One-third reported routine testing of all pregnant women, but 13% had no testing capacity at all. More than 85% of health personnel feared for their own health and 89% had increased stress. Newborn care practices were disrupted both due to reduced care-seeking and a compromised workforce. More than half reported that evidence-based interventions such as KMC were discontinued or discouraged. Separation of the mother-baby dyad was reported for both COVID-positive mothers (50%) and those with unknown status (16%). Follow-up care was disrupted primarily due to families' fear of visiting hospitals (~73%). CONCLUSION Newborn care providers are stressed and there is lack clarity and guidelines regarding care of small newborns during the pandemic. There is an urgent need to protect life-saving interventions, such as KMC, threatened by the pandemic, and to be ready to recover and build back better.
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Affiliation(s)
- Suman P N Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - Nicole Minckas
- Institute for Global Health, University College London, London, UK
| | - Melissa M Medvedev
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - David Gathara
- Kenya Medical Research Institute-, Wellcome Trust Research Program, Nairobi, Kenya
| | - Prashantha Y N
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfrida Camelia Silitonga
- Department of Reproductive, Maternal, Newborn, Child and Adolescent Health, World Health Organization, Country Office Indonesia, Jakarta, Indonesia
| | - Arun Singh Jadaun
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Helen Brotherton
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council Unit The Gambia, at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rani Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Chinyere V Ezeaka
- Department of Pediatrics, University of Lagos and Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Abdou Gai
- Medical Research Council Unit The Gambia, at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Queen Dube
- Department of Pediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Helga Naburi
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Msandeni Chiume
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Victor Tumukunde
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Araya Abrha Medhanyie
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Gyikua Plange-Rhule
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Josephine Shabini
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamayo, Tanzania
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Henok Tadele
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amanuel Hadgu
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | - Rajesh Mehta
- Regional Office, South East Asia, World Health Organisation, New Delhi, India
| | - Elizabeth Molyneux
- Department of Pediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Xu S, Rwei AY, Vwalika B, Chisembele MP, Stringer JSA, Ginsburg AS, Rogers JA. Wireless skin sensors for physiological monitoring of infants in low-income and middle-income countries. Lancet Digit Health 2021; 3:e266-e273. [PMID: 33640306 DOI: 10.1016/s2589-7500(21)00001-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/21/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022]
Abstract
Globally, neonatal mortality remains unacceptability high. Physiological monitoring is foundational to the care of these vulnerable patients to assess neonatal cardiopulmonary status, guide medical intervention, and determine readiness for safe discharge. However, most existing physiological monitoring systems require multiple electrodes and sensors, which are linked to wires tethered to wall-mounted display units, to adhere to the skin. For neonates, these systems can cause skin injury, prevent kangaroo mother care, and complicate basic clinical care. Novel, wireless, and biointegrated sensors provide opportunities to enhance monitoring capabilities, reduce iatrogenic injuries, and promote family-centric care. Early validation data have shown performance equivalent to (and sometimes exceeding) standard-of-care monitoring systems in premature neonates cared for in high-income countries. The reusable nature of these sensors and compatibility with low-cost mobile phones have the future potential to enable substantially lower monitoring costs compared with existing systems. Deployment at scale, in low-income countries, holds the promise of substantial improvements in neonatal outcomes.
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Affiliation(s)
- Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA; Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alina Y Rwei
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA; Department of Chemical Engineering, Delft University of Technology, Delft, Netherlands
| | | | | | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA; Department of Chemistry, Northwestern University, Evanston, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA; Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA; Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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18
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Fanta M, Cherie HA. Magnitude and determinants of appropriate complementary feeding practice among mothers of children age 6-23 months in Western Ethiopia. PLoS One 2020; 15:e0244277. [PMID: 33382749 PMCID: PMC7774947 DOI: 10.1371/journal.pone.0244277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Appropriate complementary feeding has the potential to prevent 6 percent of all under five deaths particularly in developing countries. However, infant and young child feeding practices in Ethiopia are suboptimal. Data on complementary feeding practices in Horro district are also lacking. Therefore, this study aimed to determine magnitude and determinants of appropriate complementary feeding practice among mothers of children age 6–23 months in Horro district, Western Ethiopia. Methods Community based cross sectional study was conducted from February to March 2016 in six kebeles of Horro district, Western Ethiopia. A total of 325 mothers of children age 6–23 months were included in the study. Data were collected using pre-tested interviewer administered structured questionnaire; entered into EPI-INFO version 3.5.4 and analyzed using SPSS version 20. Odds ratio was calculated with 95% CI to identify determinants of appropriate complementary feeding practice. P-values less than 0.05 were considered as statistically significant. Results The magnitude of appropriate complementary feeding practice in the study area was 9.91%. Lower age of child (6-11months) [AOR: 0.195, 95% CI: (0.045–0.846)], having no formal education [AOR = 0.115:95% CI: (0.002, 0.290)] and giving birth for the first time [AOR = 0.271:95% CI: (0.011, 0.463)] were factors negatively associated with appropriate complementary feeding practice. Conclusion Only one tenth of mothers practiced appropriate complementary feeding. This strongly calls for sustained nutrition education targeting uneducated mothers, mothers who gave birth for the first time and those with very young children to improve the practice.
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Affiliation(s)
- Marga Fanta
- Department of Applied Human Nutrition, Bahir Dar Institute of Technology, Bahir Dar, Ethiopia
| | - Hirut Assaye Cherie
- Department of Applied Human Nutrition, Bahir Dar Institute of Technology, Bahir Dar, Ethiopia
- * E-mail:
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19
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Solís-García G, Gutiérrez-Vélez A, Pescador Chamorro I, Zamora-Flores E, Vigil-Vázquez S, Rodríguez-Corrales E, Sánchez-Luna M. [Epidemiology, management and risk of SARS-CoV-2 transmission in a cohort of newborns born to mothers diagnosed with COVID-19 infection]. An Pediatr (Barc) 2020; 94:173-178. [PMID: 33431332 PMCID: PMC7833088 DOI: 10.1016/j.anpedi.2020.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. METHODS Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.
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Affiliation(s)
- Gonzalo Solís-García
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Ana Gutiérrez-Vélez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | - Elena Zamora-Flores
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Sara Vigil-Vázquez
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Manuel Sánchez-Luna
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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20
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Abstract
IMPORTANCE The death of a healthy term infant may signal patient safety and quality issues. Various initiatives aim to encourage clinicians to learn from these events, but little evidence exists regarding how exposure to an unexpected newborn death may alter clinician practice. OBJECTIVE To examine the association between an unexpected newborn death and changes in obstetric and newborn procedures that may be used in response to potential fetal distress or newborn complications. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used difference-in-differences analysis of 2011 to 2017 US vital statistics data from 477 US counties experiencing an unexpected newborn death during the study period. All in-hospital live births in the 477 counties during the study period were included. Data were analyzed from September 2019 to September 2020. EXPOSURES The death of an infant aged 0 to 7 days following an unremarkable pregnancy owing to causes other than birth defects, accidents/assaults, or sudden infant death syndrome. MAIN OUTCOMES AND MEASURES Primary outcomes included binary variables capturing intervention in labor/delivery (induction, augmentation, cesarean delivery, forceps/vacuum) and procedures to avert and mitigate newborn complications (assisted ventilation, surfactant replacement therapy, antibiotics for suspected sepsis, neonatal intensive care unit admission). RESULTS The main sample included 5.72 million births (2.54 million during preexposure time). Mean (SD) maternal age was 27.3 (5.8) years; 67% of mothers were White, and 12% were Black. Associations varied across the 4 estimated models. Following an unexpected newborn death, there was no significant increase in the probability of cesarean delivery in the full sample model (0.28 percentage points [pp]; 95% CI, -0.01 to 0.57 pp), but a significant increase in the other 3 models, with values ranging from 0.55 pp (95% CI, 0.21 to 0.88 pp) in the full sample model with matching to 0.66 pp (95% CI, 0.13 to 1.19 pp) in the 1-hospital county subsample with matching. There was a significant increase in the probability of newborn assisted ventilation in the full sample model with matching (0.46 pp; 95% CI, 0.08 to 0.83 pp), but no significant increase in the other 3 models, with estimates ranging from 0.33 pp (95% CI, -0.04 to 0.71 pp) to 0.69 pp (95% CI, -0.02 to 1.40 pp). An unexpected newborn death was not associated with a significant increase in antibiotic use in the full sample models (without matching: 0.19 pp; 95% CI, -0.00 to 0.39 pp; with matching: 0.22 pp; 95% CI: -0.02 to 0.46 pp), but was associated with a significant increase in both of the 1-hospital county subsample models (without matching: 0.38 pp; 95% CI, 0.02 to 0.73 pp; with matching: 0.39 pp; 95% CI, 0.01 to 0.77 pp). CONCLUSIONS AND RELEVANCE In some study models, an unexpected newborn death was associated with statistically significant increases in subsequent use of procedures to avert and mitigate fetal distress and newborn complications, which could reflect increases in identifying and proactively addressing serious potential complications or increased clinician caution applied across all cases. Future research should address whether these changes affect patient outcomes.
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Affiliation(s)
- Dan Han
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - Aayush Khadka
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jessica Cohen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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21
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Affiliation(s)
- Virginie Rigourd
- 37072 Neonatal Department, APHP Necker Enfants Malades Hospital, Paris, France
- 37072 Human Milk Bank Ile de France, APHP Necker Enfants Malades Hospital, Paris, France
| | - Alexandre Lapillonne
- 37072 Neonatal Department, APHP Necker Enfants Malades Hospital, Paris, France
- EHU 7328 PACT, Paris Descartes University, Paris, France
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22
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Popofsky S, Noor A, Leavens-Maurer J, Quintos-Alagheband ML, Mock A, Vinci A, Magri E, Akerman M, Noyola E, Rigaud M, Pak B, Lighter J, Ratner AJ, Hanna N, Krilov L. Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth. J Pediatr 2020; 226:64-70. [PMID: 32791077 PMCID: PMC7416110 DOI: 10.1016/j.jpeds.2020.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the impact of separation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-positive mother-newborn dyads on breastfeeding outcomes. STUDY DESIGN This observational longitudinal cohort study of mothers with SARS-CoV-2 PCR-and their infants at 3 NYU Langone Health hospitals was conducted between March 25, 2020, and May 30, 2020. Mothers were surveyed by telephone regarding predelivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to coronavirus disease-2019 (COVID-19). RESULTS Of the 160 mother-newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. There was no significant difference in the predelivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads both in the hospital (P < .001) and at home (P = .012). Only 2 mothers in each group reported expressed breast milk as the hospital feeding source (5.6% of unseparated vs 4.1% of separated). COVID-19 was more commonly cited as the reason for change in the separated group (49.0% vs 16.7%; P < .001). When the dyads were further stratified by symptom status into 4 groups-asymptomatic separated, asymptomatic unseparated, symptomatic separated, and symptomatic unseparated-the results remained unchanged. CONCLUSIONS In the setting of COVID-19, separation of mother-newborn dyads impacts breastfeeding outcomes, with lower rates of breastfeeding both during hospitalization and at home following discharge compared with unseparated mothers and infants. No evidence of vertical transmission was observed; 1 case of postnatal transmission occurred from an unmasked symptomatic mother who held her infant at birth.
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Affiliation(s)
- Stephanie Popofsky
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Asif Noor
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY; Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY.
| | | | | | - Ann Mock
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Alexandra Vinci
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Eileen Magri
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Meredith Akerman
- Department of Biostatistics, NYU Long Island School of Medicine, Mineola, NY
| | - Estela Noyola
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Mona Rigaud
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Billy Pak
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Jennifer Lighter
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Grossman School of Medicine, New York, NY
| | - Adam J Ratner
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Division of Pediatric Infectious Diseases, NYU Grossman School of Medicine, New York, NY; Department of Microbiology, NYU Grossman School of Medicine, New York, NY
| | - Nazeeh Hanna
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY; Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
| | - Leonard Krilov
- Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY; Division of Pediatric Infectious Diseases, Department of Pediatrics, NYU Long Island School of Medicine, Mineola, NY
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23
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Sierra-Zúñiga M, Holguin Betancourt C, Mera-Mamián AY, Delgado-Noguera M, Calvache JA. Construction and validation of an instrument to measure knowledge of mothers and caregivers on complementary feeding of infants. Rev Chil Pediatr 2020; 91:711-721. [PMID: 33399636 DOI: 10.32641/rchped.vi91i5.1078] [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] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/09/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Adequate nutrition during the first two years of life is crucial for the full development of human potential. Inadequate, early, or late introduction of complementary feeding has consequences in the short- and long-term. Complementary feeding depends largely on the knowledge of the caregiver who, in Latin American countries, is usually the mother. OBJECTIVE To create and validate an ins trument to measure knowledge about complementary feeding. SUBJECTS AND METHOD Observational study in which 80 community mothers and 12 expert pediatricians participated. It was carried out in two stages, the creation of the instrument (following the 7 phases proposed by Sampieri) and the va lidation through the evaluation of the apparent validity, construct and content validity, internal con sistency, and intra-observer reliability. RESULTS A self-administered instrument was created that ini tially included 14 questions about maternal and caregiver's knowledge. During the validation of the construct, 3 domains were identified and four questions were eliminated. In the content validation, 10 questions of the final instrument scored higher than 9 (on a scale of 0-10) in the characteristics of quality, vocabulary, relevance, and topicality. The global internal consistency of the instrument was moderate (Cronbach's alpha: 0.64) and the intra-observer reliability was acceptable (k: 0.21-0.40) for 80% of its items. CONCLUSIONS the first self-administered instrument validated in the region to measure the knowledge of mothers and caregivers about complementary feeding is presented. It will allow to design and develop strategies in relation to maternal and caregiver's knowledge of comple mentary feeding.
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Abstract
BACKGROUND/SIGNIFICANCE Infants born extremely premature (<1500 g) often experience lengthy stays in the challenging environment of the neonatal intensive care unit (NICU) separated from their parents. PURPOSE The purpose of this study was to explore nurses' knowledge, attitude, and use of maternal voice as a therapeutic intervention for preterm infants in the NICU. METHODS Neonatal nurses (n = 117) completed an online survey about the use of maternal voice in their individual units. Questions included: (1) previous knowledge surrounding use of maternal voice in the NICU; (2) their attitudes about using maternal voice recordings and/or live maternal speech as an intervention; (3) whether their unit had the necessary equipment and environment conducive to using the therapy; (4) average amount of time parents were in the NICU with their neonate; and (5) in what situations they would personally encourage the use of maternal recordings (during procedures, rounds, etc). RESULTS Of those responding, 73.3% of nurse (n = 117) respondents agreed they were willing to incorporate maternal recordings into caregiving, with 80.8% indicating they were open to learning and employing different therapies to improve parental involvement in infant care. IMPLICATIONS FOR PRACTICE When the appropriate equipment is available, neonatal nurses are interested and willing to use alternative therapies that incorporate parental participation into direct caregiving as well as utilizing maternal voice recordings. IMPLICATIONS FOR RESEARCH Further research with larger, more diverse samples is needed to determine the current knowledge, attitudes, and practices of maternal voice recordings by NICU nurses. Future research can also focus on barriers to utilization of the therapy during daily care.
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Affiliation(s)
- Selena Williamson
- School of Nursing, University of Connecticut, Storrs, and Hartford Hospital, Connecticut (Ms Williamson); and School of Nursing, University of Texas Health Science Center at San Antonio (Dr McGrath)
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Wade C, Frazer JS, Qian E, Davidson LM, Dash S, Te Water Naudé A, Ramakrishan R, Aluvaala J, Lakhoo K, English M. Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis. Lancet Child Adolesc Health 2020; 4:750-760. [PMID: 32735783 PMCID: PMC7507957 DOI: 10.1016/s2352-4642(20)30182-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/30/2023]
Abstract
Background Increasing numbers of neonates are undergoing painful procedures in low-income and middle-income countries, with adequate analgesia seldom used. In collaboration with a multi-disciplinary team in Kenya, we aimed to establish the first evidence-based guidelines for the management of routine procedure-related neonatal pain that consider low-resource hospital settings. METHODS We did a systematic review by searching MEDLINE, Embase, CINAHL, and CENTRAL databases for studies published from Jan 1, 1953, to March 31, 2019. We included data from randomised controlled trials using heart rate, oxygen saturation (SpO2), premature infant pain profile (PIPP) score, neonatal infant pain scale (NIPS) score, neonatal facial coding system score, and douleur aiguë du nouveau-né scale score as pain outcome measures. We excluded studies in which neonates were undergoing circumcision or were intubated, studies from which data were unextractable, or when pain was scored by non-trained individuals. We did a narrative synthesis of all studies, and meta-analysis when data were available from multiple studies comparing the same analgesics and controls and using the same outcome measures. 17 Kenyan health-care professionals formed our clinical guideline development panel, and we used the Grading of Recommendations, Assessment, Development and Evaluation framework and the panel's knowledge of the local health-care context to guide the guideline development process. This study is registered with PROSPERO, CRD42019126620. FINDINGS Of 2782 studies assessed for eligibility, data from 149 (5%) were analysed, with 80 (3%) of these further contributing to our meta-analysis. We found a high level of certainty for the superiority of breastfeeding over placebo or no intervention (standardised mean differences [SMDs] were -1·40 [95% CI -1·96 to -0·84] in PIPP score and -2·20 [-2·91 to -1·48] in NIPS score), and the superiority of oral sugar solutions over placebo or no intervention (SMDs were -0·38 [-0·61 to -0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2). We found a moderate level of certainty for the superiority for expressed breastmilk over placebo or no intervention (SMDs were -0·46 [95% CI -0·87 to -0·05] in heart rate and 0·48 [0·20 to 0·75] in SpO2). Therefore, the panel recommended that breastfeeding should be given as first-line analgesic treatment, initiated at least 2 min pre-procedure. Given contextual factors, for neonates who are unable to breastfeed, 1-2 mL of expressed breastmilk should be given as first-line analgesic, or 1-2 mL of oral sugar (≥10% concentration) as second-line analgesic. The panel also recommended parental presence during procedures with adjunctive provision of skin-to-skin care, or non-nutritive sucking when possible. INTERPRETATION We have generated Kenya's first neonatal analgesic guidelines for routine procedures, which have been adopted by the Kenyan Ministry of Health, and have shown a framework for clinical guideline development that is applicable to other low-income and middle-income health-care settings. FUNDING Wellcome Trust Research Programme, and the Africa-Oxford Initiative.
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Affiliation(s)
- Cian Wade
- Medical Sciences Division, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | | | - Evelyn Qian
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Suzanne Dash
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Rema Ramakrishan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| | - Jalemba Aluvaala
- KEMRI Wellcome Trust, Nairobi, Kenya; Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; KEMRI Wellcome Trust, Nairobi, Kenya
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Sánchez T, Peirano D, Pipino C, Brockmann PE. [Bad sleeping habits in infants: Risk factor for sudden infant death syndrome. Pilot study]. Rev Chil Pediatr 2020; 91:529-535. [PMID: 33399729 DOI: 10.32641/rchped.vi91i4.1400] [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] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 05/11/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The American Academy of Pediatrics recommends, through the implementation of the "Back to Sleep (BTS)" campaign, the supine sleeping position for infant sleeping since it prevents to prevent Sudden Infant Death Syndrome (SIDS). OBJECTIVE To describe the sleeping position of a group of infants and the risk factors associated with sudden infant death syndrome (SIDS). SUBJECTS AND METHOD Prospective pilot study, including infants < 45 days of life in well-child care visits at a medical center. EXCLUSION CRITERIA Preterm-born infant (gestational age < 37 weeks) and/or comorbidities (pulmonary, metabolic, cardiologic). A brief parental questionnaire was conducted regarding general demographic data and sleep habits. The questioner was based on the BISQ - Spanish version, due to the lack of validated instruments for infants < 3-month-old. RESULTS We included a sample of 100 infants between 16.78 ± 12.88 days old (57% girls). Mothers were the main information source (84%). 79% of the infants slept in supine position, 19% slept on their sides, and 2% in prone position. Regarding the place where the infants slept, 66% did in their crib in the parents' room and 31% slept in parents' bed. 74% of infants fell asleep while being fed. 28% of infants were exposed to passive smoking at home. 91% of parents were informed about safe sleep positions, reporting that pediatricians were the main source of information (54%). Conclu sion: We found a high percentage of infants < 45 days of life who slept in an unsafe position, and frequently co-sleep with their parents. Thus, it is important to implement local SIDS prevention campaigns to reinforce safe infant sleep.
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Affiliation(s)
- Trinidad Sánchez
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dominga Peirano
- Escuela de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Camila Pipino
- Escuela de Medicina, Universidad de Los Andes, Santiago, Chile
| | - Pablo E Brockmann
- Departamento de Cardiología y Enfermedades Respiratorias del Niño, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Kim THM, Delahunty-Pike A, Campbell-Yeo M. Effect of Fathers' Presence and Involvement in Newborn Care in the NICU on Mothers' Symptoms of Postpartum Depression. J Obstet Gynecol Neonatal Nurs 2020; 49:452-463. [PMID: 32663437 DOI: 10.1016/j.jogn.2020.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine the prevalence of symptoms of postpartum depression (PPD) and examine how fathers' presence and involvement in the care of their newborns affect symptoms of PPD within the first 2 weeks after birth among mothers with newborns in the NICU. DESIGN Observational cohort study. SETTING Open-bay, 40-bed, tertiary level NICU in Eastern Canada. PARTICIPANTS Mothers (N = 105) of newborns who were anticipated to survive and required more than 5 days of hospitalization in the NICU. METHODS Participants completed the Postpartum Depression Screening Scale (PDSS) 14 days after they gave birth. They kept daily diaries to record the amount of time that fathers spent by the newborns' bedsides (i.e., presence) and actively caring for their newborns (i.e., involvement such as skin to skin). Participants completed daily diaries from the time of enrollment in the study until their newborns were discharged home. We analyzed the data using linear regression; score on the PDSS was the dependent variable, and fathers' presence and involvement were the independent variables. We adjusted for covariates. RESULTS The prevalence of positive screening for symptoms of major PPD was 24.1% (n = 20), and the prevalence of significant symptoms of PPD was 27.7% (n = 23). Participants reported that fathers were present in the NICU an average of 3.8 hours per day and were actively involved with their newborns 53% of the time. Fathers' involvement was significantly associated with lower scores on the PDSS (adjusted β = -3.85; 95% confidence interval [CI] [-6.10, -1.60]). A history of anxiety was significantly associated with greater scores on the PDSS (adjusted β = 12.06, 95% CI [2.07, 22.05]). Maternal age and income less than $50,000 CAD were marginally associated with greater scores on the PDSS (adjusted β = -0.86, 95% CI [-1.77, 0.05] and adjusted β = 10.69, 95% CI [-0.73, 22.11], respectively). The overall explained variance in the PDSS scores with the independent variables was R2 = 0.35. CONCLUSION Fathers' involvement in the care of their newborns in the NICU was significantly associated with fewer symptoms of PPD among mothers. We recommend research with targeted interventions to promote fathers' involvement in the NICU to potentially mitigate the symptoms of PPD among mothers of newborns in the NICU.
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Abstract
Thyroid hormone (TH) is indispensable for normal embryonic and fetal development. Throughout gestation TH is provided by the mother via the placenta, later in pregnancy the fetal thyroid gland makes an increasing contribution. Maternal thyroid dysfunction, resulting in lower or higher than normal (maternal) TH levels and transfer to the embryo/fetus, can disturb normal early development. (Maternal) thyroid dysfunction is mostly caused by autoimmune hypo- or hyperthyroidism, i.e. Hashimoto and Graves disease. Autoimmune hyperthyroidism is caused by stimulating TSH receptor antibodies (TSHR Ab), patients with autoimmune hypothyroidism may have blocking TSHR Ab. Maternal TSHR Ab cross the placenta from mid gestation and may cause fetal and transient neonatal hyper- or hypothyroidism. Anti-thyroid drugs taken for autoimmune hyperthyroidism cross the placenta throughout gestation, and may cause fetal and transient neonatal hypothyroidism. This review focusses on the consequences of maternal hypo- and hyperthyroidism for fetus and neonate, and provides a practical approach to clinical management of neonates born to mothers with thyroid dysfunction.
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Affiliation(s)
- A S Paul van Trotsenburg
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Endocrinology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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29
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Amatya S, Corr TE, Gandhi CK, Glass KM, Kresch MJ, Mujsce DJ, Oji-Mmuo CN, Mola SJ, Murray YL, Palmer TW, Singh M, Fricchione A, Arnold J, Prentice D, Bridgeman CR, Smith BM, Gavigan PJ, Ericson JE, Miller JR, Pauli JM, Williams DC, McSherry GD, Legro RS, Iriana SM, Kaiser JR. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol 2020; 40:987-996. [PMID: 32439956 PMCID: PMC7241067 DOI: 10.1038/s41372-020-0695-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 01/13/2023]
Abstract
There is limited information about newborns with confirmed or suspected COVID-19. Particularly in the hospital after delivery, clinicians have refined practices in order to prevent secondary infection. While guidance from international associations is continuously being updated, all facets of care of neonates born to women with confirmed or suspected COVID-19 are center-specific, given local customs, building infrastructure constraints, and availability of protective equipment. Based on anecdotal reports from institutions in the epicenter of the COVID-19 pandemic close to our hospital, together with our limited experience, in anticipation of increasing numbers of exposed newborns, we have developed a triage algorithm at the Penn State Hospital at Milton S. Hershey Medical Center that may be useful for other centers anticipating a similar surge. We discuss several care practices that have changed in the COVID-19 era including the use of antenatal steroids, delayed cord clamping (DCC), mother-newborn separation, and breastfeeding. Moreover, this paper provides comprehensive guidance on the most suitable respiratory support for newborns during the COVID-19 pandemic. We also present detailed recommendations about the discharge process and beyond, including providing scales and home phototherapy to families, parental teaching via telehealth and in-person education at the doors of the hospital, and telehealth newborn follow-up.
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Affiliation(s)
- Shaili Amatya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Tammy E Corr
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chintan K Gandhi
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kristen M Glass
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mitchell J Kresch
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Dennis J Mujsce
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christiana N Oji-Mmuo
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sara J Mola
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yuanyi L Murray
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Timothy W Palmer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Meenakshi Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ashley Fricchione
- Neonatal Intensive Care Unit, Department of Nursing, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jill Arnold
- Neonatal Intensive Care Unit, Department of Nursing, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Danielle Prentice
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Colin R Bridgeman
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Brandon M Smith
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Patrick J Gavigan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessica E Ericson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jennifer R Miller
- Division of Academic General Pediatrics, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jaimey M Pauli
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Duane C Williams
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - George D McSherry
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sarah M Iriana
- Division of Academic General Pediatrics, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffrey R Kaiser
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Hershey, PA, USA.
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Hershey, PA, USA.
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Hermes GDA, Eckermann HA, de Vos WM, de Weerth C. Does entry to center-based childcare affect gut microbial colonization in young infants? Sci Rep 2020; 10:10235. [PMID: 32581284 PMCID: PMC7314774 DOI: 10.1038/s41598-020-66404-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Entry to center-based childcare (CC) at three months of life can be an important challenge for infants as it includes major stressors such as long maternal separations and frequently changing caregivers. Stress and the new environment may in turn alter the composition of the gut microbiota with possible implications for future health outcomes. As part of an ongoing longitudinal study, we investigated whether CC, as compared to being cared for by the parents at home, alters the composition of the gut microbiota, while accounting for known covariates of the infant gut microbiota. Stool samples of infants who entered CC (n = 49) and control infants (n = 49) were obtained before and four weeks after CC entrance. Using Redundancy analysis, Random Forests and Bayesian linear models we found that infant gut microbiota was not affected in a uniform way by entry to CC. In line with the literature, breastfeeding, birth mode, age, and the presence of siblings were shown to significantly impact the microbial composition.
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Affiliation(s)
- Gerben D A Hermes
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Henrik A Eckermann
- Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem M de Vos
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.
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Lara-Cinisomo S, Akinbode TD. Research Recommendations on the Effects of Postpartum Depression and Pain on Infant Care and Development. J Obstet Gynecol Neonatal Nurs 2020; 49:416-422. [PMID: 32553591 DOI: 10.1016/j.jogn.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/29/2022] Open
Abstract
Postpartum depression is one of the most common complications of childbirth, and another is pain. A growing body of research shows that the severity and duration of postpartum pain can increase a woman's risk for postpartum depression. Postpartum depression and pain negatively affect maternal well-being, and postpartum depression has been associated with adverse outcomes in children. However, there is a dearth of information about the effects of postpartum depression and pain on infant care and development. The objectives of this commentary were to highlight the need to address this gap in the literature, offer a preliminary conceptual model to advance the field, and ignite new lines of inquiry to inform infant care and development.
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Goodarzi B, Walker A, Holten L, Schoonmade L, Teunissen P, Schellevis F, de Jonge A. Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review. PLoS One 2020; 15:e0234252. [PMID: 32511258 PMCID: PMC7279596 DOI: 10.1371/journal.pone.0234252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annika Walker
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lianne Holten
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - François Schellevis
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
INTRODUCTION Driven by international programs specifically targeting neonatal survival, a set of recommended care practices is being promoted in West Africa. Using data from a multi-centered anthropological study, we enquire as to how local practices integrate the recommendations disseminated by these programs. METHOD The surveys were conducted in rural localities in five countries : Benin, Burkina Faso, Mali, Mauritania, and Togo. In every site, the investigations combined ethnography of newborn care and in-depth interviews in maternity homes and homes. RESULTS The care of newborns is based on a set of local social representations and logics, where medical recommendations are integrated heterogeneously. In maternity wards, health professionals face difficulties in implementing recommended practices, and make various conciliations when faced with local material and social constraints. In private homes, the "messages" promoting life-saving care for newborns punctuate conversations, but lead to various interpretations and variations in care. DISCUSSION The irregular integration of medical recommendations in neonatal care is analyzed around three areas: the divergence of intentions around the birth, the dissonances between the recommended care and the local conceptions of the newborn, the influence of intra-family power relations. Considering the complexity of the changes in neonatal care, we argue for the implementation of programs that respect local cultures, and for health professionals to skillfully accommodate conflicting constraints.
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Ahouangonou DS. [Lay knowledge and newborn care in Benin - home-made remedies for umbilical cord care going against recommendations]. Sante Publique 2020; 1:105-111. [PMID: 32374089 DOI: 10.3917/spub.200.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Driven by international programs specifically targeting neonatal survival, a set of recommended care practices is being promoted in West Africa. Using data from a multi-centered anthropological study, we enquire as to how local practices integrate the recommendations disseminated by these programs. METHOD The surveys were conducted in rural localities in five countries: Benin, Burkina Faso, Mali, Mauritania, and Togo. In every site, the investigations combined ethnography of newborn care and in-depth interviews in maternity homes and homes. RESULTS The care of newborns is based on a set of local social representations and logics, where medical recommendations are integrated heterogeneously. In maternity wards, health professionals face difficulties in implementing recommended practices, and make various conciliations when faced with local material and social constraints. In private homes, the "messages" promoting life-saving care for newborns punctuate conversations, but lead to various interpretations and variations in care. DISCUSSION The irregular integration of medical recommendations in neonatal care is analyzed around three areas: the divergence of intentions around the birth, the dissonances between the recommended care and the local conceptions of the newborn, the influence of intra-family power relations. Considering the complexity of the changes in neonatal care, we argue for the implementation of programs that respect local cultures, and for health professionals to skillfully accommodate conflicting constraints.
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Legrand Fosso A, Moluh S, Ngum B, Vougmo C, Amani A, Kananda G, Baye M, Essomba E, Banze Wa Nsensele L, Mbu R. [Using anthropology to improve newborn health care in Cameroon]. Sante Publique 2020; 1:45-52. [PMID: 32374093 DOI: 10.3917/spub.200.0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Policy directions in the health sector are based on research which provides insight into implemented actions and helps to formulate improvement recommendations for health. In Cameroon, an innovative experience of anthropological research on newborn health was followed by a process of appropriating findings by the Ministry of Public Health aiming at improving the quality of care. We suggest reporting this Cameroonian experience of interdisciplinary collaboration and involved research. METHOD Coinciding with the anthropological study on newborn care in hospital maternities and at home conducted by researchers in the field of anthropology from December 2016 to June 2017, a process of appropriating findings was carried out. This article accurately describes this process both at the peripheral level, during "reflexive returns" in investigated maternity hospitals, and at the central level within the framework of work conducted by the study's steering committee. It reports on the changes that have taken place as a result of the study both at the level of health structures and at the level of national policies and strategies with a view to improving the quality of newborns care. RESULTS The output of this process is twofold. At the peripheral level, activities of "reflexive returns" led to in situ changes of some harmful practices detrimental to the survival of the newborn, such as inappropriate use of the cradle in the birth room and lack of knowledge relative to the fight against hypothermia through the practice of skin-to-skin contact. At central level, changes concerned communication and strengthening policies and strategies of newborn care. CONCLUSION The contribution of anthropology in the production evidence-based data is of paramount importance for the implementation of strategies to improve the quality of neonatal care. It opens up new perspectives for the sustainable improvement of the quality of care for newborns.
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Abstract
INTRODUCTION In Mauritania, as in other West African countries, a series of actions has been taken to combat neonatal mortality. Considering the mixed success of these programs, we wondered how health workers are investing in neonatal care. METHOD An anthropological study was carried out in a locality in the Senegal River Valley. The surveys consisted of an ethnography of a health center, which resulted in detailed observations of care and interviews with health workers. RESULTS Our observations reveal that in the crucial minutes and hours following a normal birth, the attention of caregivers tends to turn away from the newborn. Recommended care such as keeping warm, examining and monitoring the newborn is not provided, while early breast-feeding occurs in a fluctuating manner. The newborn is quickly handed over to the family. Newborn care is thus "forgotten", both in the sequence of actions around childbirth and in the collective distribution of professional responsibilities. DISCUSSION Newborn care at birth remains poorly medicalized. We analyze the least involvement of health workers with newborns in two aspects : the perception of the uncertainty of neonatal survival, and the predominance of local childbearing. We are making proposals to put the spotlight back on the newborn in order to promote a better quality of neonatal care.
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Abstract
INTRODUCTION In Sub-Saharan Africa, despite the establishment of many health care programs, neonatal mortality rates remain extremely high. From a medical point of view, the main causes are obstetric, along with diarrhea and pneumonia. Understanding how these risks and pathogenic situations are constructed cannot be achieved without observing, analyzing, and understanding the underlying gestures and meaning systems. METHOD Rather than describing obvious inequalities in the access to health care, our study aimed at questioning the different actors' operational capacities and at considering what is actually possible to improve in the most common healthcare situations. More specifically, how are births, neonatal care, and popular practices carried out in the first days of the lives of these newborns? In five countries of West Africa, a "multi-sited" anthropological study was carried out to observe the first weeks of newborns. This study not only allowed for the methodical identification of care interactions at and around childbirth in peripheral health care services, but also the popular practices related to the socialization of the child in family settings. RESULTS Our fieldwork investigations show that neonatal risk corresponds to the combination of several sets of behavior. In obstetric services, for reasons linked to the symbolic status of the child as much as to a certain idea of the obstetric profession, the newborn remains marginal in the preoccupations of the midwives. This results in many dysfunctions (not warming the child, leaving the child in a drafty area, not feeding the child…) which constitute discontinuous risk factors.In the village and in the family, the newborn is at the center of many social practices - baths, rituals, ingestions of various "protective" products, period of seclusion, baptism… - which not only aim at conferring an identity and including the infant in the social group, but also build a set of infectious risks.Finally, while health actions build a translation space, no preventive dialogue has been established by healthcare personnel to inform people about the risks associated with certain social practices.Overall, these longitudinal follow-ups of newborns, as well as precise observations and interviews conducted with the actors on their reasons for acting, have made it possible to analyze the attitudes, gestures and social behaviors that constitute the concrete causes of neonatal risk. DISCUSSION Describing the practices that newborns "benefit from" during their first days is essential to concretely identify and analyze the risks and reasons for high neonatal mortality. The empirical and documented approach of anthropology is essential to carry out these studies. But, more importantly, this qualitative approach must be implemented in vivo and in situ in the health services and during the training of health personnel to create a reflexivity of the caregivers and to initiate professional practices concerned with newborns. In the same way, our studies open the way for precise and documented dialogues with families which will enable the indispensable follow-up care for the newborns and ensure adapted preventive care and coherence in the care provided by the healthcare structures, the families, and the collectivities.
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Abstract
Pacifier avoidance is recommended in the newborn nursery to optimize exclusive breast-feeding rates according to the Baby-Friendly Hospital Initiative. There are many reasons why parents may choose to provide a pacifier to their infant, particularly due to the association between pacifier use with sleep and risk reduction for sudden infant death syndrome. Early use of a pacifier does not likely cause direct harm to infants or lead to difficulty breast-feeding. Pediatricians should partner with families to share a clear message in support of establishing exclusive breast-feeding, ideally before introduction of a pacifier. [Pediatr Ann. 2020;49(5):e204-206.].
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Winkler LA, Stypulkowski A, Noon S, Babwanga T, Lutahoire J. A multi-year analysis of kangaroo mother care outcomes in low birth weight babies at a Nyakahanga Hospital in rural Tanzania. Afr Health Sci 2020; 20:498-508. [PMID: 33402938 PMCID: PMC7750084 DOI: 10.4314/ahs.v20i1.56] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) requires few specialized resources, reduces mortality, and can be implemented in low resource environments. It is now recommended for implementation around the globe. OBJECTIVES This paper discusses KMC use with low birth weight newborns at a Tanzania hospital providing valuable outcomes assessment of KMC use in rural areas of sub-Saharan Africa. METHODS The research used retrospective records (136 Low Birth Weight (LBW) and 33 Very Low Birth Weight (VLBW) neonates) supplemented by observations. Data included weights (longitudinal), survival period, and cause of death if it occurred. This hospital's KMC use and study data began when the mother-baby dyad was referred, usually birth day. RESULTS This KMC group demonstrated 70% survival, but 77% of deaths occur within 24 hours. After the first 24 hours, KMC survival rate was 92%. Even VLBW neonates (<1000 g) had 37.5% survival among the KMC program. Prematurity and respiratory distress caused nearly half of the deaths, but hypothermia (19% of deaths) and infection were factors also. CONCLUSION Our study indicates the value of KMC in rural low resource environments. Results are comparable to KMC programs in urban areas where newborns begin KMC after stabilization and better than outcomes reported for comparable populations not practicing KMC in rural sub-Saharan Africa.
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Affiliation(s)
- Linda A Winkler
- Department of Global Cultures, History, and Language, Wilkes University, Wilkes-Barre, PA, USA
| | | | - Shana Noon
- Passon School of Nursing, Wilkes University, Wilkes-Barre, PA, USA
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Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: A Prospective Study. Isr Med Assoc J 2020; 22:148-153. [PMID: 32147978] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Opposition to neonatal Hepatitis B vaccination is a growing trend in Israel. OBJECTIVES To assess the sociodemographic factors and attitudes associated with non-vaccination of term singleton newborns. METHODS This prospective, pair-matched, controlled trial was conducted in a tertiary university-affiliated hospital. Data on maternal sociodemographic parameters, delivery, and infant care practices were gathered. Knowledge and references of Hepatitis B virus (HBV) vaccination, vaccination schedule, and health government policies were assessed. A follow-up telephone survey was completed at the age of 7 weeks postpartum regarding vaccine catch-up rate. RESULTS Mothers in the study group were mostly Jewish white middle class married multiparous women with some higher education. Hepatitis B serology was not tested in most. Higher rates of rooming-in and exclusive breastfeeding were observed. Knowledge about HBV was stated, multiple sources of information were significantly associated with newborn non-vaccination. Many objected to the timing of the vaccine and its necessity. Multiple medical encounters are viewed as missed opportunities. CONCLUSIONS Multiple sources of vaccine information are associated with non-vaccination. Medical encounters prior and post-delivery should be used for vaccination education and may improve vaccination coverage.
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Affiliation(s)
- Elena Fridman
- Department of Neonatology, Assuta Ashdod Medical Center, Ashdod, Israel
- Department of Clinical Biochemistry, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Abed N Azab
- Department of Clinical Biochemistry, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Kornfeld B, Wild BM. The Care of the Infant Being Placed for Adoption. Pediatr Ann 2020; 49:e61-e63. [PMID: 32045482 DOI: 10.3928/19382359-20200113-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adoption in the United States is a way for families to grow, and pediatricians will invariably take care of infants being placed for adoption. Reasons why an infant will be adopted are highly variable, as are the types of relationships that birth parents have with their infants. Care of the infant being placed for adoption in the nursery involves close attention to detail to ensure appropriate continuity of care and information as the infant transitions into their eventual medical home. Adoptive parents often seek additional information from their child's health care providers, and pediatricians should be equipped to provide guidance both prior to and after the adoption process. Office-based pediatricians should support adoptive parents with a longitudinal approach informed by best practices and principles of well-child care. [Pediatr Ann. 2020;49(2):e61-e63.].
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López-Medina MD, López-Araque AB, Linares-Abad M, López-Medina IM. Umbilical cord separation time, predictors and healing complications in newborns with dry care. PLoS One 2020; 15:e0227209. [PMID: 31923218 PMCID: PMC6953818 DOI: 10.1371/journal.pone.0227209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/14/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. Design A quantitative longitudinal observational analytical study by stratified random sample was adopted. Setting Public health system hospitals in southern Spain and at newborns’ homes. Participants Between April 2016 and December 2017, the study included 106 neonates born after 35–42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. Methods The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. Results The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16–7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01). Conclusion The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.
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Affiliation(s)
- María Dolores López-Medina
- Department of Nursing, Faculty of Health Sciences, Universidad de Jaén, Jaén, Spain
- San José Health Center, Northern Jaén Sanitary District, Linares, Jaén, Spain
- * E-mail:
| | | | - Manuel Linares-Abad
- Department of Nursing, Faculty of Health Sciences, Universidad de Jaén, Jaén, Spain
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Abstract
OBJECTIVE This ethnographic work seeks to understand the construction of gender and generational social relationships around the health of the newborn in both the care setting and in the family setting. METHOD An immersion of several weeks made it possible to collect data on the most common perceptions and practices that shape the daily lives of the various actors involved in the health of the newborn. The data was collected using participant observation, semi-structured interviews. Much additional data was collected through informal interviews. RESULTS In health institutions, people who play the role of caregiver are usually women. They come most often from the husband's family and are engaged in a role that can be assimilated to "care". In most cases, the involvement of husbands concerns the transport of the woman to the health center, the transport of food, the administrative procedures, the payment of prescriptions. In a family environment, caring for the newborn also follows sexual logic as well as generational logic that shows a better integration of biomedicine guidelines by young women. However, the data from the survey showed that men's involvement and women's involvement can not be defined according to a dual separation between masculine and feminine roles because social relations are constructed according to many other variables. CONCLUSION The health of the newborn is at the center of several normative registers that try to influence it in their own way. This necessarily plural reality often escapes public health programs.
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Kapoor D, Jajoo M. Providing Expressed Breast Milk to Preterm Neonates Admitted in an Extramural Neonatal Intensive Care Unit: Where do we stand? Indian Pediatr 2019; 56:1051-1052. [PMID: 31884438] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Provision of expressed breast milk (EBM) to premature neonates poses a great challenge in extramural Neonatal Intensive Care Units (NICUs). We conducted a questionnaire-based survey to identify the various challenges faced by the parents to provide EBM to their hospitalized premature infant. 40 preterm neonates (<34 wk gestation and <1500 g weight) planned to be started on EBM were included in the study. The median (range) duration after which EBM was received in NICU after the time it was asked for was 34.5 (13 to 40) hours, and it was received in a clean, sterile and covered container in only 8 (20%) cases. There were multiple hurdles in ensuring early availability of EBM in optimal condition. Sensitization and motivation of families regarding the importance of ensuring early administration of EBM to their prematurely delivered neonate may lead to substantial improvement in outcome of these neonates.
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Affiliation(s)
- Dipti Kapoor
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India.
| | - Mamta Jajoo
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India
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Abstract
PURPOSE OF REVIEW First-time parents often turn to friends and family for advice regarding feeding, sleeping, bathing, diapering and toilet training, and childhood illnesses. Unfortunately, parents may at times be given incorrect and potentially dangerous advice as several widely embraced parenting practices are no longer deemed appropriate. In addition, young children are cared for by family and friends - many of whom are older and may still subscribe to outdated parenting practices.Parents and grandparents are not the only ones who subscribe to child care myths and misconceptions. Pediatricians also believe in the effectiveness of some outdated child care practices. Although some of these parenting myths are relatively benign, others may indeed pose a significant health risk or safety hazard to a young child. The purpose of this article is to review 10 commonly held myths or misconceptions regarding infant care. RECENT FINDINGS In this review article, we not only highlight many of the studies that document which outdated health beliefs are still endorsed by parents and/or pediatricians, but also review the specific health risks associated with these parenting myths or misconceptions. SUMMARY It is important that pediatricians educate parents and other primary caregivers about the potential risks of following outdated parenting practices.
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Affiliation(s)
- Tamara Kahan
- Developmental & Behavioral Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park
| | - Andrew Adesman
- Developmental & Behavioral Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Pasek T. Clinical Practice Guidelines for the Use of Human Milk and Breastfeeding for the Hospitalized Infant/Child Beyond Immediate Neonatal Care. J Pediatr Nurs 2019; 49:106-107. [PMID: 31708263 DOI: 10.1016/j.pedn.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
There is a variety of portable ventilators on the market, each with its' own features. A clinician needs to understand the unique characteristics of the ventilators available in his or her region, as well as the nuances of primary and secondary settings for these portable home ventilators in order to create a comfortable breath that allows for adequate gas exchange for the patient. Understanding the interplay of the portable home ventilator and the ventilator circuit is also a key component of transitioning a patient to a portable home ventilator. This review details characteristics of some of the more commonly used machines in the United States, as well as the settings to be considered in supporting a child with chronic respiratory failure outside of the hospital. As more patients are being discharged from the hospital with mechanical home ventilation, new ventilators are being developed that expand upon features of current machines.
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Affiliation(s)
- Julie L Fierro
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States.
| | - Howard B Panitch
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States.
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Abstract
OBJECTIVE To explore parents' descriptions of and concerns about their infants' feeding in the first 6 months of life. DESIGN Descriptive study. SETTING Online survey. PARTICIPANTS We recruited 29 parents of infants younger than 7 months old from a variety of online local, regional, and international communities to complete a survey about their infants' feeding. MEASUREMENTS The survey included a combination of selection and open-text entry questions. Qualitative data from open-text questions were analyzed with directed content analysis to identify factors that influenced infant feeding. Two coders coded all data. RESULTS Concerns about feeding were common, and many parents made changes to facilitate feeding. Parents described characteristics of the infant (e.g., temperament), the task of feeding (e.g., milk flow), and factors external to the infant (e.g., breast anatomy) that affected feeding. Although some parents described feeling happy, calm, and bonded during feeding, others described feeling terrified, anxious, and worried. Health care providers played a significant role in helping parents navigate feeding, but they sometimes provided conflicting and even unsafe advice. CONCLUSION Understanding the experience of feeding from the parent perspective may help to identify targets for intervention to support parents and infants when feeding is difficult.
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Cree M, Jairath P, May O. A Hospital-Level Intervention to Improve Outcomes of Opioid Exposed Newborns. J Pediatr Nurs 2019; 48:77-81. [PMID: 31352111 DOI: 10.1016/j.pedn.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/27/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this quality improvement project was to determine if non-pharmacologic strategies such as a rooming-in approach to care for newborns at risk of developing neonatal abstinence syndrome (NAS) would reduce total length of stay (LOS) and reduce the need for pharmacologic treatment. DESIGN AND METHODS This was a quality improvement project utilizing a retrospective chart review. Records of newborns with in-utero methadone or buprenorphine exposure were reviewed who were born between January 2016-July 2017 and July 2017-August 2018 at Wellspan Health York Hospital. Starting in July 2017, newborns exposed to opioids who transitioned normally remained with their mothers for monitoring in the newborn nursery. Monitoring for withdrawal was continued on the pediatric floor after the mother's discharge from the post-partum floor. RESULTS The primary outcome of total LOS was reduced from 14 days to 10.1 days (p = 0.014). The total length of pharmacologic treatment decreased from 15.68 days to 9.71 days (p = 0.023). CONCLUSIONS A rooming-in approach to care including management on a pediatric floor can reduce total length of stay and the duration of pharmacologic treatment in newborns with NAS. Newborns with NAS can be safely managed in an inpatient pediatric floor. PRACTICE IMPLICATIONS Implementing a rooming-in approach to care of newborns at risk of developing NAS can improve outcomes through a decreased length of hospital stay and decreased duration of pharmacologic treatment. This approach improves access to critical care services by safely monitoring newborns with NAS on an inpatient pediatric floor.
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Affiliation(s)
- Melinda Cree
- Wellspan Health York Hospital, Division of Newborn Medicine, PA, United States of America.
| | - Puneet Jairath
- Wellspan Health York Hospital, Division of Newborn Medicine, PA, United States of America.
| | - Olivia May
- The University of Alabama Capstone College of Nursing, AL, United States of America.
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