Chylothorax, a lymphatic flow disorder characterized by an abnormal circulation of lymph fluid into the pleural cavity, is the most common cause of pleural effusions during the neonatal period. This condition affects 1/15,000 neonates every year. Affected neonates often manifest with respiratory distress, electrolyte imbalances, sepsis, and even immunodeficiencies. Mortality risk is highest among neonates undergoing cardiac surgery as well as those with associated hydrops fetalis. Conservative treatment options include bowel rest with administration of parenteral nutrition, followed with medium-chain triglyceride enteral feedings, and octreotide therapy. Severe or persistent cases require surgical intervention. This can involve a unilateral or bilateral pleurectomy and thoracic duct ligation, with or without pleurodesis. Early identification and successful treatment of this condition is contingent upon awareness of the most current evidence and a timely cross-disciplinary approach to care.
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- Go to article: Maternal Obesity and Breastfeeding A Review of the Evidence and Implications for Practice
A myriad of factors influence the sub-optimal breastfeeding rates in the U.S. Among these factors is maternal obesity (BMI > 30 kg/m2), which has been found to negatively impact breastfeeding initiation and duration for some women. Obesity increases women’s risk for various complications throughout the perinatal period, which may impact breastfeeding and the long-term health and well-being of women and their children. However, adequate lactation support that upholds a respectful consciousness regarding the potential breastfeeding challenges of women with obesity can assist these women to successfully meet their breastfeeding goals. This review summarizes the literature on the impact of maternal BMI on breastfeeding duration, and maternal and infant risk factors that may complicate lactation for women with obesity. Recommendations for assessing and supporting the needs of mothers with obesity to best achieve their breastfeeding goals are provided.
- Go to article: Mitigating Infant Medical Trauma in the NICU: Skin-to-Skin Contact as a Trauma-Informed, Age-Appropriate Best Practice
Mitigating Infant Medical Trauma in the NICU: Skin-to-Skin Contact as a Trauma-Informed, Age-Appropriate Best Practice
Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant’s traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant’s traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes.
Maintenance of electrolyte balance in the neonate is challenging in the context of illness or prematurity. Imbalances in potassium and phosphorus can occur in neonates, ranging from benign and clinically insignificant to those that can be life-threatening. An individualized approach to fluid and electrolyte management is based on the neonate’s gestational age, day of life, maintenance needs, deficits, and ongoing losses. This article reviews normal and abnormal potassium and phosphorus values along with management strategies. Using a case scenario, the reader can apply concepts outlined in this article to management of critically ill neonates with electrolyte disturbances.
After losing an infant, grieving mothers may still have to cope with postpartum issues, including lactation. This article reviews and addresses care options for lactation concerns after pregnancy, neonatal, or infant loss. Currently, lactation care and advice after loss varies greatly. Lactation consultants are instrumental in providing mothers with anticipatory guidance and evidence-based care. Implementing system-wide training and education regarding this topic will help families receive the information they need to deal with the physiological aftermath of infant loss.
Cystic fibrosis (CF) is the most common genetic disorder in Caucasian individuals, with an incidence of 1/2,500–3,500 live births. When CF was first described in 1938, most children died in infancy. Currently, the average lifespan is 28–47.7 years. Although new breakthroughs have occurred, CF is still incurable. Both early diagnosis and treatment by multidisciplinary teams are essential to optimize short- and long-term outcomes. It is imperative for neonatal clinicians to keep up to date on the most current research, treatment, and management of CF to provide the best outcomes. This article offers clinicians an updated review of the pathophysiology and clinical manifestations of CF, as well as current evidence-based diagnostics and treatment regimens.
The “golden hour” is the critically important first 60 minutes in an extremely low birth weight neonate’s life that can impact both short- and long-term outcomes. The golden hour concept involves several competing stabilization priorities that should be conducted systematically by highly specialized health care providers in both the hospital and transport settings for improvement in patient outcomes. Current literature supports utilizing an experienced team in the golden hour process to improve patient outcomes through standardization, improved efficiency, and positive team dynamics. Although a variety of teaching methods exist to train individuals in the care of extremely low birth weight infants, the literature supports the incorporation of low- or high-fidelity simulation-based training. In addition, initial and ongoing educational requirements of individuals caring for a golden hour-eligible infant in the immediate post-delivery phase, as well as ongoing care in the days and weeks to follow, are justified. Instituting standard golden hour educational requirements on an ongoing basis provides improved efficiency in team function and patient outcomes. The goal of this literature review was to determine whether implementation of golden hour response teams in both the inpatient and transport setting has shown improved outcomes and should be considered for neonatal intensive care units admitting or transporting golden hour eligible infants.
Despite advances in perinatal care in the past decade, sepsis and its complications continue to present problems for the neonate, remaining a major cause of neonatal morbidity and mortality. Sepsis research is focusing on how the neonate (host) responds to bacteria. The newborn may develop a systemic reaction to bacteria that induces the release of substances known as inflammatory mediators. Termed the systemic inflammatory response syndrome (SIRS), this reaction is believed to be responsible for the signs and symptoms of sepsis. This article introduces the neonatal nurse to SIRS, providing an overview of various inflammatory mediators and cytokines, their clinical consequences, and potential new therapies in the management of SIRS.
Cloacal exstrophy is an extremely rare and devastating complex of congenital abnormalities resulting in multiple debilitating morbidities. Infants with this disorder require numerous surgical interventions to repair gastrointestinal, genitourinary, spinal, and orthopedic malformations. Treatment involves the combined efforts of many medical and nursing specialists. This article discusses the embryology, clinical presentation, and management (both early and long term) of cloacal exstrophy, with emphasis on gender reassignment issues and quality of life.
- Go to article: Developmentally Supportive Care in the Neonatal Intensive Care Unit: An Occupational Therapist’s Role
Developmentally Supportive Care in the Neonatal Intensive Care Unit: An Occupational Therapist’s Role
The role of a pediatric occupational therapist (OT) in the NICU is to provide comprehensive services, including evaluation, treatment, education, decision making, family support, and discharge planning. It may also include early intervention services or outpatient pediatric rehabilitation services. This article will address the need for developmentally supportive care in the NICU, and specifically addresses the role of an OT in this setting. It will explain how crucial collaboration between team members can be in providing quality, comprehensive care for these neonates. In addition, it will address the important role of the parent in this setting for developmentally supportive care while in the NICU and follow-up intervention upon discharge.
Calcium, the most abundant ion in the neonate, plays a role in bone formation, blood coagulation, muscle contractility, and nerve conduction. Calcium levels are regulated via a negative feedback loop by the parathyroid hormone, calcitonin, and vitamin D. Calcium levels in the neonate must be monitored carefully to avoid complications that affect the central nervous system as well as the cardiac and musculoskeletal systems.
- Go to article: Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: Team Education and Family Engagement
Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: Team Education and Family Engagement
The number of babies born extremely low birth weight surviving to be discharged home after experiencing the NICU continues to improve. Unfortunately, early sensory development for these babies occurs in an environment vastly different from the intended in-utero environment and places them at high risk of long-term neurodevelopmental and neurocognitive challenges. Our goal in the NICU must transition from simply discharge home to supporting the neurosensory development necessary for a thriving lifetime. To accomplish a goal of thriving families and thriving babies, it is clear the NICU interprofessional team must share an understanding of neurosensory development, the neuroprotective strategies safeguarding development, the neuropromotive strategies supporting intended maturational development, and the essential nature of family integration in these processes. We share the educational endeavors of 11 center collaboratives in establishing the foundational knowledge necessary to support preterm babies and their families.
- Go to article: Difference in Mortality and Morbidity Between Extremely and Very Low Birth Weight Neonates
Purpose: The aim of the present study was to evaluate the mortality and morbidity of extremely low (ELBW < 1,000 g) and very low birth weight neonates (VLBW: 1,000–1,500 g) hospitalized in a referral NICU of a Children’s hospital. Design: A retrospective study was conducted in records of the Neonatal Unit of a tertiary care Children’s hospital in Greece from January 2009 to March 2019. Sample: All neonates with birth weight ≤1,500 grams, who were all outborn, were reviewed. Main Outcome Variable: Mortality and morbidity, including respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, early onset sepsis, late onset sepsis, retinopathy of prematurity (ROP), ROP treated with laser and neurological findings were investigated. Results: A total of 444 neonates (52 percent males) were analyzed. Among them, 187 (42 percent) were ELBW and 257 (58 percent) were VLBW. The mean gestational age was lower in ELBW neonates compared to VLBW (26.3 ± 2.3 vs. 29.7 ± 2.4 weeks, respectively; p < .001). Mortality was significantly higher in ELBW compared to VLBW neonates (26.7 percent vs. 7.0 percent, p < .001). Morbidity was significantly higher in ELBW compared to VLBW for respiratory distress syndrome (p < .001), bronchopulmonary dysplasia (p < .001), intraventricular hemorrhage (p < .001), periventricular leukomalacia (p < .001), necrotizing enterocolitis (p = .05), early onset sepsis (p < .001) and late onset sepsis (p = 0.001). Similarly, the incidence of ROP and ROP treated with laser was higher in ELBW compared to VLBW neonates (p < .001). Severe neurological findings during follow-up were more prevalent in ELBW compared to VLBW neonates. Finally, the incidence of eye disorders was higher in ELBW compared to VLBW (p = .05). Conclusion: Our results confirmed that ELBW have higher mortality and morbidity than VLBW neonates. Efforts should be made in order to ameliorate perinatal and neonatal care to reduce the burden of prematurity.
- Go to article: “Going Beyond the Call of Doula”: A Grounded Theory Analysis of the Diverse Roles Community-Based Doulas Play in the Lives of Pregnant and Parenting Adolescent Mothers
“Going Beyond the Call of Doula”: A Grounded Theory Analysis of the Diverse Roles Community-Based Doulas Play in the Lives of Pregnant and Parenting Adolescent Mothers
This article presents some of the most salient qualitative results from a larger program evaluation of pregnant and parenting adolescents who participated in a community-based doula program. Using grounded theory analysis, seven problem-solving strategies emerged that doulas apply in helping pregnant and parenting adolescents navigate multiple social and health settings that often serve as barriers to positive maternal- and child-health outcomes. The ethnographic findings of this study suggest that the doulas provide valuable assistance to pregnant and parenting adolescents by addressing social-psychological issues and socio-economic disparities. “Diverse role-taking” results in doulas helping pregnant adolescents navigate more successfully through fragmented social and health service systems that are less supportive of low-income adolescents, who are often perceived to be draining scarce resources. The findings have implications for the roles of community-based doulas assigned to low-income adolescents of color seeking to overcome obstacles and attain better educational and economic opportunities.
- Go to article: Knowledge, Attitudes, Practices, Barriers and Facilitators to Skin-To-Skin Contact Among Arabian Mothers and Health Care Providers in Arab Countries: A Systematic Scoping Review
Knowledge, Attitudes, Practices, Barriers and Facilitators to Skin-To-Skin Contact Among Arabian Mothers and Health Care Providers in Arab Countries: A Systematic Scoping Review
Skin-to-skin contact (SSC) occurs when a naked full-term neonate is placed on their mother’s bare abdomen or chest within 10 minutes of birth or soon after. Due to its multiple benefits for both the mother and the neonate, SSC is highly recommended by the World Health Organization. However, implementation of SSC in the Arab world is limited.
To undertake a systematic review to identify the knowledge, attitudes, practice, barriers and facilitators to SSC implementation among Arabian mothers and the health care providers in Arab countries.
A systematic scoping review using the JBI three-step search strategy was used to systematically review quantitative and qualitative evidence.
A total of eight studies were included. Around 82% of mothers would like to have more education about SSC. The majority of mothers (n = 254, 79%) expressed a positive attitude towards SSC, however more than three quarters did not correctly practice SSC. Among the healthcare providers, the mean knowledge score about SSC was 14.42 (95% CI = −0.21 to 29.06, I2 = 96%). This review found evidence for barriers to SSC implementation including lack of education, lack of guidelines and cultural beliefs.
Arabian mothers had positive attitudes towards SSC, but the practice was poor due to lack of education and the lack of protocols and guidelines. The knowledge and practice of Kangaroo Mother Care (KMC) were poor among health care providers (HCPs) despite holding a positive attitude. Assessment of knowledge, attitude, and practice among Arab mothers and HCPs is needed to develop a robust educational programme to raise awareness with regards to SSC.
Toxoplasma gondii, a parasite, has three modes of transmission: oral intake of raw or undercooked meat or contaminated fruits and vegetables, ingestion of materials contaminated with cat feces, and transplacental infection. The focus of this article is congenital toxoplasmosis, which is transmitted to the fetus across the placenta.
When primary infection of the mother occurs during pregnancy, there is a 40 percent chance of fetal infection; rate of transmission and severity of infection are related to gestational age at the time of infection. The brain and retina are often affected, and there can be a wide range of clinical disease. Amniocentesis or cordocentesis provides the most accurate diagnosis.
At birth, 80–90 percent of infants with congenital toxoplasmosis are asymptomatic. But further testing may reveal retinal and central nervous system abnormalities, and there is a risk of long-term sequelae. Chorioretinitis, hydrocephalus, intracranial calcifications, and convulsions are the typical presentation of classic congenital toxoplasmosis. Serology is the most common method of diagnosing neonatal infection, but more complex tests are also utilized. The prognosis for the untreated infant is poor; however, when antibiotic therapy is started early, the rate of sequelae is reduced significantly.
Resuscitations in the delivery room or the nursery cause significant stress for caregivers. Diligent preparation will improve the efficacy and safety of life-saving interventions and increase staff comfort. When establishment of an airway and delivery of positive pressure ventilation and chest compressions fail to result in return of spontaneous circulation, pharmacotherapeutic interventions should be considered. Epinephrine is first-line pharmacotherapy for severe bradycardia or cardiac arrest, increasing coronary arterial pressure and blood flow during chest compressions. Despite limited data regarding dosing and efficacy, the first dose of epinephrine may be delivered through the endotracheal tube during attainment of venous access (preferably a low-lying umbilical venous catheter in the delivery room). Intravenous dosing is preferred, and any facility caring for newborns must ensure optimized logistics including readily available dosing guidance and optimal flush volumes. After provision of epinephrine, additional medications may be considered, especially for resuscitations occurring outside of the immediate perinatal period, including normal saline, glucose, adenosine, atropine, and calcium. Clinicians must understand the indications, dosing, and monitoring parameters for these medications and ensure rapid availability for resuscitation. Every second truly counts in a neonatal resuscitation, and optimal understanding and preparation will ensure delivery of pharmacotherapy to optimize both patient outcomes and staff comfort.
This article presents a case study on the organization of maternity health care in Switzerland. Switzerland has a costly health care system with high intervention rates within an obstetric-led maternity care model. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. However, in this model, midwives are both marginalized and underused.
The article focuses on the distribution of power and knowledge between midwives, women, and the medical profession. The varying power structures that shape the maternity care system in Switzerland are examined, using a case study approach that draws on Foucault’s concepts of the gaze, surveillance, disciplinary power, and the docile body. This article critically analyzes the model of maternity care received by women in Switzerland and how it negatively impacts on both women’s personal and midwives’ professional autonomy while simultaneously driving up costs.
A better understanding of the underlying power structures operating within the maternity care system may facilitate the implementation of more midwifery-led care currently being endorsed by the Swiss Midwifery Association and some government agencies. This could result in reduced cost and lower intervention rates with reduced associated morbidity.
- Go to article: A Pilot Study of an Educational Intervention to Increase Postpartum Medical Visit Attendance in Home-Visited Mothers
A Pilot Study of an Educational Intervention to Increase Postpartum Medical Visit Attendance in Home-Visited Mothers
Socioeconomically disadvantaged women experience barriers to attending postpartum medical visits (PMV). This three-phase pilot study explored the feasibility, acceptability, and preliminary effectiveness of an educational intervention to increase PMV attendance in mothers enrolled in early childhood home visiting. Phases 1 and 2 occurred prior to the COVID-19 pandemic, and Phase 3 occurred during the pandemic. Home visitor implementation of the intervention with mothers was feasible and acceptable in all phases. All mothers who received the intervention reported PMV attendance. Overall, 81% of mothers reported they discussed all questions with healthcare providers at the PMV. These findings provide preliminary effectiveness for a brief educational intervention in increasing PMV attendance in home-visited mothers.
Hemoglobin plays an important physiologic role, one that begins early in fetal development. The focus of this article is hemoglobin physiology. Developmental erythropoiesis, developmental stages of hemoglobin, and postnatal erythropoiesis and hemoglobin production are discussed. The function of hemoglobin, its affinity for oxygen, and the clinical significance of the oxyhemoglobin dissociation curve are also explored.
Epilepsy affects approximately 1 percent of the population and roughly 1 million women of childbearing age. Estimates suggest that 0.3–0.7 percent of pregnancies occur in women with epilepsy. Epilepsy itself increases the risk of congenital malformation and medications add to this risk. Also, approximately one-half of the use of medications for epilepsy are used for other indications, possibly increasing exposure in some women. As controlled trials with these medications are not performed during pregnancy, data has been accumulated primarily through databases and case studies. This review is intended to update the practitioner about the use and concerns of antiepileptic medications in the presnant woman and the potential effects on the fetus and neonate.
Critical appraisal of the evidence is the third step in the evidence-based practice process. This column, the third in a multipart series to describe the critical appraisal process, focuses on critical appraisal of randomized control trials.
Simulation is an effective teaching methodology to enhance clinical thinking and reasoning skills among nursing students and practicing nurses. The opportunity to practice in a safe environment maintains a structure that promotes learning at all levels. There are various levels of fidelity as well as cost to facilitate simulation in the neonatal setting. This at times hinders the ability to incorporate simulation into educational practices. The purpose of this article is to provide a discussion on simulation practices in the neonatal setting, an overview of low-cost neonatal simulation exemplars, and implications for practice.
Management of congenital diaphragmatic hernia has changed dramatically over the past couple of decades. Until the early 1980s, it was felt that the abdominal contents should be returned to the abdomen as soon as possible to allow the lungs to expand. It is now known that it is not the defect that causes respiratory distress, but the infant’s hypoplastic lungs and accompanying pulmonary hypertension. Advances in treatment and technology have contributed to changes in management. Ultrasonography now allows for early prenatal detection. Prenatal treatment modalities include in utero tracheal ligation and maternal antenatal steroids. Postnatal modalities have expanded to include permissive hypercapnia, high-frequency ventilation, inhaled nitric oxide, pharmacologic support, exogenous surfactant, and extracorporeal membrane oxygenation. Liquid ventilation and lobar lung transplantation have also been tried. In spite of these advances, the overall survival rate remains about 63 percent.
Osteopenia, rickets, and fractures from nutrient deficiencies can occur during infancy, particularly in preterm infants. Bone mass accretion during the first year of life is equal to or greater than that achieved at any other stage of life, including adolescence. Optimizing calcium and bone status during infancy can have immediate benefits in maintaining calcium homeostasis and preventing disturbances in bone mineralization and can provide long-term benefits by helping infants to later reach their maximum genetic potential for peak bone mass, a prerequisite for the prevention of osteoporosis and its complications. Dietary calcium requirements during infancy generally reflect the need to achieve normal growth and bone mineralization because 99 percent of total body calcium is present in the skeleton. Knowledge of physiologic factors that determine infant calcium requirements and the bioavailability of calcium from various dietary sources is important to ensuring bone health during infancy. Also key are the practical issues related to optimizing calcium nutriture in infants born at term and prematurely.
Epidermolytic ichthyosis (EI) is a rare autosomal dominant genodermatosis that presents at birth as a bullous disease, followed by a lifelong ichthyotic skin disorder.1 Essentially, it is a defective keratinization caused by mutations of keratin 1 (KRT1) or keratin 10 (KRT10) genes, which lead to skin fragility, blistering, and eventually hyperkeratosis. Successful management of EI in the newborn period can be achieved through a thoughtful, directed, and interdisciplinary or multidisciplinary approach that encompasses family support. This condition requires meticulous care to avoid associated morbidities such as infection and dehydration. A better understanding of the disrupted barrier protection of the skin in these patients provides a basis for management with daily bathing, liberal emollients, pain control, and proper nutrition as the mainstays of treatment. In addition, this case presentation will include discussions on the pathophysiology, complications, differential diagnosis, and psychosocial and ethical issues.
- Go to article: Perinatal Music Therapy and Antenatal Music Classes: Principles, Mechanisms, and Benefits
Antenatal music activities are in the ascendant. Regarding evidence-based research, the article advocates 5 main aims: music therapeutic control of pre- and perinatal stress, anxiety, and depression; music-related mental and physical birth preparation comprising cognitive adjustment, emotional regulation, physical activity, relaxation and pain management, and social inclusion; music-associated bonding and self-efficacy; prenatal sound stimulation to trigger learning processes, pedagogical priming and brain maturation; music activities to facilitate the child’s acculturation and adaptive self-regulation. Underlying mechanisms such as neuroplasticity help to understand the multifaceted effects of music in pre- and perinatal care. Individual conditions and features of the mother and her child have to be taken into account and music interventions to be harmonized with complementary perinatal programs.
- Go to article: Central Diabetes Insipidus in a Preterm Neonate Unresponsive to Intranasal Desmopressin
Central or neurogenic diabetes insipidus (DI) is uncommon in the pediatric age group and rarely occurs in neonates. It should be suspected in any neonate presenting with excessive urine output and hypernatremia that persists despite increased fluid administration. Diabetes insipidus may be secondary to asphyxia, intraventricular hemorrhage, infection, and structural abnormalities or may be idiopathic or genetic. Diagnosis includes a careful history, laboratory testing, and magnetic resonance imaging. Management of neonatal DI involves a careful balance between fluid intake and pharmacologic treatment. In this article we report a case of an extremely low birth weight infant presenting with central DI possibly caused by abnormality of the pituitary gland. Persistent hypernatremia was the initial presentation. Increased fluids were given initially but were only partially helpful. Eventually subcutaneous desmopressin (DDAVP) was required. The infant was unresponsive to intranasal DDAVP and required subcutaneous DDAVP upon discharge.
BACKGROUND: Anxiety scores are higher in women being induced compared with women who are in spontaneous labor. There are limited published reports addressing anxiety associated with the induction of labor (IOL).
OBJECTIVES: The aim is to measure anxiety scores that are associated with IOL using two measuring scales and identify women’s characteristics and obstetrics variables that are associated with higher anxiety scores.
METHODS: A cross-sectional study was conducted between October 20, 2019, and October 20, 2020. Inclusion criteria required women to be 18 years or older, have a viable pregnancy, and have been admitted for IOL. Anxiety scores were measured using the visual analog scale for anxiety (VASA) first and then the State-Trait Anxiety Inventory (STAI). The factor analysis for mixed data was used to identify the independent variables that contributed the most to the variation among participants. These variables were then tested for association with the different anxiety variables using multivariate analysis of variance (MANOVA).
RESULTS: In this study, 300 women with a mean age of 28 years and a mean fetal gestational age of 39.4 weeks were recruited. A factor analysis with a principal component analysis method on the STAI state subscale revealed two components with high internal consistency, designated Component 1 and Component 2. Women had anxiety scores above the mean as measured on VASA (48.7%) and Component 1 (50.3%) and Component 2 (70.7%) of the STAI state subscale. There were statistically significant correlations between the two components of the STAI state subscale and VASA (Spearman’s rank correlation: VASA with STAI State Component 1 = −.239, p-value = 2.8 × 10−5; VASA with STAI State Component 2 = .296, p-value = 1.7 × 10−7). The three outcome anxiety variables (VASA and Components 1 and 2 of the STAI state subscale) in nonparametric MANOVA analysis showed significant associations with a prior history of subfertility (Wilk’s lambda test statistic = 3.668, df1 = 3, df2 = 296, p-value = .014) and higher parity (Wilk’s lambda test statistic = 2.100, df1 = 6, df2 = 590, p-value = .043).
CONCLUSION: High anxiety scores are prevalent among women who are being induced. The VASA and STAI state subscales are correlated, and VASA may be an alternative to the lengthy STAI. Antenatal identification of women at high risk may help in implementing strategies to reduce anxiety scores.
Breastfeeding should be encouraged for every baby with few exceptions, classic galactosemia being one of them. Classic galactosemia causes death in newborns and can be identified early with newborn screening, or through the careful assessments of physicians, midwives, and lactation consultants in the first 4 days of life. All practitioners that assess newborns within the first 4 days of life should have a clear understanding of when to halt breastfeeding and when to support continuation of breastfeeding while keeping babies safe.
Unplanned extubations (UEs) can have devastating effects on neonates. The purpose of this quality improvement project is to decrease the number of UEs in Lankenau Medical Center’s 22-bed Level III NICU. The UE rate had risen to 4.6 UEs per 100 ventilator days in 2016. Transitioning to a standardized bundle for intubated infants has decreased the UE rate to less than 2 per 100 ventilator days since 2018. The UE rate continues to be monitored for ongoing accountability and further staff education when rates increase.
- Go to article: Women’s Birth Preparedness and Complication Readiness in Nigeria: A Systematic Review and Meta-Analysis
Women’s Birth Preparedness and Complication Readiness in Nigeria: A Systematic Review and Meta-Analysis
INTRODUCTION: Globally, efforts are being made to reduce the menace of maternal death in order to achieve the sustainable development goal. Maternal death has been associated with inadequate Birth Preparedness and Complication Readiness (BPCR), especially in low- and middle-income countries. Therefore, this review assessed birth preparedness and complication readiness in Nigeria.
METHODS: A systematic review and meta-analysis of published research articles on birth preparedness and complication readiness in Nigeria were done using PubMed, EMBASE, and MEDLINE databases. All published articles from inception to November 2018 were included in the review. A total of 8,913 published articles were identified from an electronic search, and a total of 4,440 studies were included in this review, while only 12 articles met the inclusion criteria and were included in the meta-analysis.
RESULTS: The pooled prevalence of “good BPCR” for all studies yielded an estimate of 58.7% (95% CI 43.9%–72.7%). The I 2 statistic was 98%, indicating statistically significant heterogeneity among the studies. The percentage of women with good birth preparedness and complication readiness increases with the year of publication, such that women have tended to be more aware of good birth preparedness and complication readiness in recent years. More than half of the women had knowledge of obstetric danger signs (52.0%, 95% CI 39.5%–64.4%, 10 studies), arranged for transportation (59.5%, 95% CI 36.2%–80.7%, 11 studies), or saved money (63.4%, 95% CI 44.7%–80.2%, 11 studies) as part of the BPCR.
PROSPERO REGISTRATION NUMBER: The study protocol was registered with PROSPERO number CRD42019123220.
CONCLUSION: Women in Nigeria are better prepared for birth preparedness and complication readiness in recent years. Therefore, interventions to promote more adequate birth preparedness and complication readiness among women are recommended.
Delayed cord clamping is a collaboration between the obstetric team and the neonatal team. Although the optimal timing for clamping the umbilical cord after birth continues to be subject to study, delaying clamping for at least 30–60 seconds, with the newborn held at or below the level of the uterus/placenta supports normal physiology and has proven benefits. Practical issues such as thermoregulation and equipment can be overcome with team collaboration and prebriefing planning. Neonatal nurses who attend deliveries are perfectly poised to influence this practice and improve short- and long-term outcomes for their patients.
Newly discovered genes and advances in genetic screening programs prompt many questions reflecting the kinds of ethical dilemmas that go hand in hand with life-changing discoveries. Neonatal genetic screening has been a standard of care for some time, but as our knowledge in the field of genetics expands, should we continue with the same approach? What newborn genetic screening tests should be mandatory, and what are the long-range consequences associated with testing? This article reviews genetic modes of inheritance, outlines and explains the most common newborn screening tests, and enumerates the ethical issues associated with these screening procedures. The role of the neonatal nurse in the newborn genetic screening process is discussed.
Maternal smoking during pregnancy and maternal smoking postnatally are important public health concerns worldwide. Smoking adversely affects the woman's general health and is causally related to pregnancy complications and serious health outcomes for the child, such as stillbirth, preterm delivery, low birth weight, and sudden infant death. The purpose of this research was to examine maternal smoking through a quantitative descriptive survey of 164 women, 120 who were pregnant and 44 who were postnatal. Women experienced barriers to quitting smoking, including dealing with stress, being exposed to smokers, not being ready to quit, not knowing how to quit, not looking for or not being able to find information about smoking or quitting smoking, and lacking adequate social and healthcare provider support. On the other hand, women revealed characteristics that suggest they might have had improved potential for quitting smoking, including having negative feelings about smoking, having cut down on smoking, smoking at a low level, having made quit attempts, thinking it would not be hard to quit smoking, being in the preparation stage of behavioral change, and thinking their healthcare providers (HCPs) would help them if they decided to quit. Taken together, those findings suggest that HCPs could offer important assistance to help women achieve smoking cessation. However, more research needs to be conducted to clarify the role and effectiveness of various HCPs in smoking cessation interventions and to identify measures to strengthen their provision of such interventions.
Congenital hypothyroidism (CH) is a disorder of thyroid hormone deficiency which develops secondary to incomplete thyroid development or inadequate thyroid hormone production. State-mandated newborn screening throughout the United States has increased the detection rate of CH, allowing for early intervention. Although the overall mortality rate of CH is low, delayed or omitted treatment can lead to devastating neurocognitive outcomes. As such, CH is regarded as the leading cause of preventable intellectual disability in children. Early identification, facilitated by astute neonatal nursing and medical care, is contingent upon an active working knowledge of the disease process and awareness of the limitations of the newborn screen.
If a tongue-tie is to be revised, what is the best technique for accomplishing that? There is some debate in the field about whether scissors or laser is most effective. Both techniques seem efficacious. This section also addresses which professionals should be performing the revision. Our panelists represent a wide range of disciplines, so some refer, and others perform the revisions themselves.
Parenteral nutrition (PN) is frequently required by extremely preterm infants due to gastrointestinal immaturity and complications of prematurity. Parenteral nutrition-associated cholestasis (PNAC) and intestinal failure-associated liver disease (IFALD) are common complications of prolonged PN. Plant-based intravenous lipid emulsions, containing proinflammatory omega-6 fatty acids and phytosterols, may contribute to these conditions as well as other comorbidities such as bronchopulmonary dysplasia and retinopathy of prematurity. Intravenous lipid emulsions containing animal-based fats, such as fish oil, contain fewer proinflammatory omega-6 fatty acids and more anti-inflammatory omega-3 fatty acids and antioxidants. SMOFlipid, recently Food and Drug Administration (FDA)-approved for adult use, is a blend of plant- and animal-based lipid emulsions with a favorable omega-6:omega-3 ratio that may prevent the development and progression of PNAC/IFALD in infants. Careful review of data supporting this alternative intravenous lipid emulsion is required prior to widespread use in neonatal intensive care.
IN THEIR EFFORTS TO IMPROVE THE health outcomes of neonates and infants in the Neonatal Intensive Care Unit (NICU), neonatal nurses should understand the potential for harm that plastic medical devices pose to infants. Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer used to soften polyvinylchloride (PVC) that can leach from the plastic into the fluid or gas being delivered to the neonate. DEHP can harm the developing reproductive system. The U.S. Food and Drug Administration (FDA) has issued a public health notification recommendation that DEHP- free devices be considered for use in NICU patients.1 There are alternatives available. The purpose of this column is to inform neonatal nurses of the risk of DEHP exposure among infants and to make it simpler for them to implement change in reducing DEHP in their institution.
The historical evolution of infant feeding includes wet nursing, the feeding bottle, and formula use. Before the invention of bottles and formula, wet nursing was the safest and most common alternative to the natural mother’s breastmilk. Society’s negative view of wet nursing, combined with improvements of the feeding bottle, the availability of animal’s milk, and advances in formula development, gradually led to the substitution of artificial feeding for wet nursing. In addition, the advertising and safety of formula products increased their popularity and use among society. Currently, infant formula-feeding is widely practiced in the United States and appears to contribute to the development of several common childhood illnesses, including atopy, diabetes mellitus, and childhood obesity.
A descriptive study design was used to describe the decision of women having a cesarean surgery. The Cesarean Birth Decision Survey was used to collect data from 101 postpartum women who underwent a cesarean. Most of the surgeries were to primipara women who reported doctor recommendation and increased safety for the baby as the main reasons for the cesarean. Those women who had repeat cesarean surgery all cited their previous cesarean as the main reason for the current surgery. Women’s knowledge of cesarean surgery needs to be assessed early in pregnancy so that appropriate education may be provided. Accurate and ongoing information may decrease the number of women choosing a cesarean surgery.
Purpose: To compare kangaroo mother care (KMC) and conventional cuddling care (CCC) in premature and smallfor-gestational-age infants.
Design and Sample: Thirty mother-infant dyads in two Australian neonatal nurseries were randomly assigned to the KMC group or the CCC group. Both groups of mothers cuddled their babies for a minimum of two hours a day, five days a week while in the study, with the KMC group having skin-to-skin contact while the CCC group had contact through normal clothing.
Main Outcome Variable: The main outcome variables were infant weight gain, temperature maintenance during KMC and CCC, and length of hospital stay.
Results: The results showed no difference between groups on the Parental Stress Scale (NICU) or the Parental Expectations Survey. Infants in both groups experienced equivalent maintenance of or rise in temperature while out of the incubators, equal weight gain, equal length of stay in the hospital, and equal duration of breastfeeding.
Neonatal osteomyelitis is a rare and challenging diagnosis, particularly in the early onset period. Neonatal osteomyelitis is predominantly caused by Staphylococcus aureus with single bone involvement. Here, we report two cases of neonatal osteomyelitis in premature infants caused by Klebsiella pneumoniae with multiple bone lesions. Both cases presented with sepsis and meningitis and were initially diagnosed by incidental findings on plain films, with follow-up bone scan imaging. In both cases, diagnosis was timely and treatment was successful. These cases highlight the need to include neonatal osteomyelitis in the differential diagnosis when late-onset or prolonged neonatal sepsis is present, particularly because long-term outcome is dependent on rapid diagnosis and initiation of treatment.
Maintenance of electrolyte balance in the neonate is a challenge in the context of illness or prematurity. Neonatal providers’ approach to fluid management changes and adapts based on the newborn’s age, maintenance needs, deficits, and ongoing losses. Understanding the total body water content of the fetus and newborn is foundational to management of electrolyte disturbances. This article reviews common imbalances of sodium and chloride, identifies causes of imbalances, and discusses current evidence-based treatment options.
Aplasia cutis congenita (ACC) is a rare condition that presents at birth as an absence of skin that does not usually involve underlying structures. Occurring in 3/10,000 live births, ACC is evenly distributed between males and females; the risk of ACC increases to 7 percent in consanguineous marriages. Up to 86 percent of lesions are found on the scalp in the midline vertex position. Lesions can also be found on the trunk and limbs, as with Adams-Oliver syndrome or accompanying epidermolysis bullosa. ACC is associated with chromosomal abnormalities and 35–50 percent of the time with trisomy 13 (Patau syndrome). This case study presents an infant with multiple ACC lesions of the scalp. The pathophysiology, treatment, potential long-term complications, and nursing considerations are discussed.
Modern western society and media often present the mother’s choices for her birth as paramount. Various gurus provide the mother with often conflicting advice. But the reality is that childbirth often becomes a medicalized event with many interventions and less than ideal outcomes. In many instances, the choices are made to suit health professionals and hospital routines rather than the mother. All the aforementioned are based on ideas and assumptions which predate evidence-based medicine and recent neuroscience. In reproductive biology, the newborn is an active participant and agent in birthing (Alberts, 1994). Based on this, the perspective which has been lacking is what is best for the baby; our choices should be primarily based on the basic biological needs of the infant.
- Go to article: Fetal Middle Cerebral Artery and Umbilical Artery Pulsatility Index Doppler Associations With Pregnancy Risk and Neonatal Outcomes
Fetal Middle Cerebral Artery and Umbilical Artery Pulsatility Index Doppler Associations With Pregnancy Risk and Neonatal Outcomes
OBJECTIVE: To evaluate the role of the middle cerebral artery (MCA) to the umbilical artery (UA) blood velocity waveform’s pulsatility index (PI) screening in proximity to delivery as a predictor of high-risk pregnancy and neonatal outcomes.
METHODS: The study used a nested case–control method, consisting of 34 women with high-risk pregnancies and 34 pregnant women who were classified as normal. The MCA/UA PI ratio was evaluated within 14 days before delivery. All subjects’ newborns were evaluated for neonatal outcomes, which included fetal distress, abnormal cardiotocography or fetal heart rate patterns, neonatal mortality, Apgar score, duration of hospitalization, and neonatal intensive care unit (NICU) admission. A cutoff point for MCA/UA PI ratio was assessed using the receiver operating characteristic curve. The correlations between the MCA/UA PI ratio and high-risk pregnancy and neonatal outcomes were assessed with multivariable linear regression based on the cutoff point obtained.
RESULTS: The MCA/UA PI ratio in high-risk pregnancy was significantly lower compared with normal pregnancy (p = .011). The MCA/UA PI ratio of ≤1.32 finding was 6.37 times higher in high-risk pregnancy (p = .017, AOR 6.37, 95% CI 1.40–28.97), 5.9 times higher in pregnancy with the neonate’s first-minute Apgar less than 7 (p = .031, AOR 5.90, 95% CI 1.18–29.61), and 18.62 times higher in neonates admitted to the NICU (p = .023, AOR 18.62, 95% CI 1.43–2702.94).
CONCLUSIONS: Low MCA/UA PI is associated with high-risk pregnancies and adverse neonatal outcomes, such as low first-minute Apgar score and NICU treatment.
- Go to article: Improving Exclusive Breastfeeding Behavior of Primipara Mothers With Lactation Education and Individualized Counseling Intervention
Improving Exclusive Breastfeeding Behavior of Primipara Mothers With Lactation Education and Individualized Counseling Intervention
New mothers often need support to establish and maintain breastfeeding, and they may find it difficult to access breastfeeding resources locally. Therefore, postpartum lactation education and counseling of primipara mothers were given by integrating into their routine follow-ups in the family health center. This study was conducted to determine the effect of lactation education and individual counseling intervention integrated into the routine follow-up visits of primipara mothers in family health centers on exclusive breastfeeding rates and breastfeeding behaviors during the first 6 months postpartum.
A two-factor, pretest–posttest, controlled, semi-experimental, prospective study was conducted. The study was conducted in three family health centers in a city on the north coast of Turkey. The interviews with the primipara mothers were performed between the 24th and 72nd hours and at the 1st, 3rd, 4th, 6th months postpartum.
The rates of giving exclusive breastfeeding to the infants in the first 6 months were 68% in the study group and 38% in the control group, exhibiting a statistically significant difference between the groups with regard to breastfeeding frequency (p =.001).
It was determined that the education and counseling integrated into the existing health system were effective in increasing the EBF rates and breastfeeding behaviors of primipara mothers in the first 6 months after birth.
Umbilical venous and arterial catheters are routinely used in the care of critically ill patients in neonatal intensive care settings. Providers caring for these vulnerable patients have a role in ensuring that catheter tips remain in an appropriate position. The ideal anatomic tip location for both types of umbilical catheters is reviewed, and the evaluation of this position via radiographic study is discussed. Umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) have their own different complications. Complications of a malpositioned catheter of either type can be life threatening; therefore, evaluation of catheter tip location is an important skill in the provision of neonatal intensive care.
In this column, the editor of The Journal of Perinatal Education discusses the need for continued education about promoting vaginal birth after cesarean. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.