The Effects of Education and Mother Engagement on Maternal Self-Confidence and Bonding for Infants Hospitalized With Surgical Gastrointestinal Problems in Turkiye.

Background: Ventilator Associated Pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after child is intubated and ventilated mechanically; VAP is the second most common hospital-acquired infection in pediatric Intensive Care Units, which linked to increased morbidity, mortality, lengths of stay in the hospital and intensive care unit with high costs.Aim of Study: The current study aimed to explore the risk factors of VAP among infants in Intensive Care Units.Subjects and Methods: A descriptive exploratory design was used to achieve the current study.Setting: The current study conducted at Pediatric Intensive Care Units at Pediatric University Hospital and Specialized Pediatric Hospital which affiliated to Cairo University Hos-pitals.Sample: A convenience sample of 54 mechanically ven-tilated infants for more than 48 hours enrolled in the study.Tools: The required data was collected by using risk factors assessment sheet and standardized observational checklists which consist of three parts: General infection control measures, nasogastric tube feeding and endotracheal tube suctioning.Results: The current study results revealed that, more than half of infants were less than 6 months of age, nearly two-thirds are males, and near to three quarters of infants developed VAP. Prior antibiotic use, sedatives administration, absence of routine oral care, previous non-invasive ventilation, reintubation, length of stay on mechanical ventilation and PICUs, coma, inadequate general infection control measures, inadequate endotracheal tube suctioning technique, supine position, inadequate nasogastric tube feeding technique, presence of nasogastric tube and oral route of endotracheal tube were statistically significant risk factors associated with VAP. More than half of VAP infants died during period of hospitalization.Conclusion: Prior antibiotic use was the only independent risk factor for incidence of VAP; and sedatives administration, absence of routine oral care, previous non-invasive ventilation, reintubation, length of stay on mechanical ventilation and PICUs were the major risk factors of VAP among infants in pediatric Intensive Care Units.Recommendations: Inservice training program should be conducted for pediatric intensive care nurses about prevention of VAP among infants. Also, similar studies should be con-ducted on large sample and different settings.

The improving prognosis of children with cancer has partially been attributed to the increasing importance of pediatric intensive care units (PICU). We analyze whether outcome of these patients on a PICU improved during the last decade and which factors may influence the outcome in our hospital. The charts of all oncology patients admitted to the PICU between 1998 and 2009 have been reviewed retrospectively. The survival of patients admitted for life threatening complications has been correlated with basic data, organ failure and the PRISM score. The results of 2 consecutive treatment periods (1998-2003 and 2004-2009) were compared. 644 admissions of 226 patients were recorded. 79 admissions were performed because of potentially life threatening complications (Group A), 236 for monitoring (B) and 329 admissions for interventions (C). 62% of Group A patients and all Group B and C patients were discharged alive. Poor outcome was associated with admission >28 days after initial diagnosis, PRISM >10, organ failure >2 organs, sepsis, allogeneic stem cell transplantation, need for mechanical ventilation or for catecholamines. The PICU survival rate of Group A patients admitted between 2004 and 2009 (78%) was higher than in the period between 1998 and 2003 (48%). PICU provides essential services to support the pediatric oncology ward. Although children with cancer may have had benefit from advances in pediatric intensive care over the past decade, specific scoring systems for early identification of children with cancer needing PICU treatment are required. These systems might further improve PICU outcome in critical ill pediatric cancer patients.

Introduction Mother’s bond to the infant in the postpartum period plays an important role in the subsequent mother–infant relationship and the infant’s socio-emotional functioning. Several maternal characteristics, such as attachment style and psychological flexibility, may contribute to the quality of mother–infant bonding, though literature examining these variables is still scarce. The present study aimed to examine the impact of mother’s attachment on mother–infant bonding in the first month postpartum and the mediating role of psychological flexibility on that association. Methods Participants were 226 mothers of an infant up to 9 months old, who reported on their own attachment style (in terms of anxiety, comfort with proximity, trust in others), psychological flexibility (in terms of openness to experience, behavioural awareness, valued action) and mother–infant bonding. Results Results showed that mother’s attachment anxiety predicted a bond with the infant directly and indirectly via mother’s psychological flexibility, specifically through behavioural awareness and valued action. Trust in others had an impact on mother–infant bonding through behavioural awareness, whereas comfort with proximity influenced mother–infant bond indirectly, via valued action. Finally, mothers’ civil status, schooling and number of children were relevant to better understand the variance of our mediating and dependent variables. Discussion Our findings highlight the importance of mother’s attachment and psychological flexibility in promoting the quality of mother–infant bonding, which can inform future intervention programmes targeting modifiable factors, such as psychological flexibility, to promote early positive parent–infant relationships, particularly for single, first-time mothers, with higher levels of education.

Aim: To evaluate the application of the principles of Patient and Family-centered Care Methodology: A cross-sectional study was conducted in the Pediatric and Neonatal Intensive care unit of a tertiary care hospital in Punjab, Pakistan. IRB approval was granted, and the study spanned a period from January 2019 to June 2019. A questionnaire was created to survey the pediatric patient's parents. Data analysis was done using SPSS 25. Results: A total of 158 responses were recorded. The majority of the parents felt that patient and family-centered care was not being applied to the admitted patients' management plans in the pediatric and neonatal ICUs. Conclusion: The treatment of patients in the pediatric and neonatal ICUs was not following the principles of patient and family-centered care. Therefore, further studies are required to improve the ease of access, alongside limiting the barriers to the patient and family-centered care in Pakistan. This way, patients can benefit from improved outcomes associated with PFCC. Keywords: Neonatal intensive care unit (NICU), intensive care unit (ICU), pediatric intensive care unit (PICU), patient and family-centered care (PFCC).

Near-Fatal Asthma: An Ounce of Prevention May be Worth More than a Pound of Cure

Effects of the nursing Mutual Participation Model of Care on parental stress in the pediatric intensive care unit--a replication.

The highly complex pediatric patients with congenital heart disease require interprofessional teamwork and collaboration to ensure high-quality outcomes with low mortality and morbidity (Congenit Heart Dis. 2013;8:3-19). The purpose of this study was to conduct an impact evaluation for a newly formed pediatric cardiac intensive care unit (PCICU) and to answer: Is there a difference between the pediatric intensive care unit and the PCICU on clinical outcome measures of pediatric cardiac postoperative patients and nursing resources? A retrospective pretest/posttest design was used with the independent variables being type of intensive care unit. The confounding variables included demographic data, clinical outcome data, registered nurse (RN) staffing data, and RN turnover data. The setting was a large, level I pediatric medical and surgical intensive care unit (ICU) located at a children's hospital within an academic medical center. The population was pediatric cardiac postoperative patients. Patients excluded were those older than 18 years or cases without a Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality Category score of 1 through 5. Owen's impact evaluation method and descriptive statistical measures, t test and Pearson χ test, were used for analysis. Demographic data were comparable between the pediatric intensive care unit (n = 296) and PCICU (n = 333). No statistical differences were found in several of the clinical outcome measures. Statistically significant differences were found in surgeon (P = .00) and RN nursing hours per patient day for all cardiac patients (P = .01). The PCICU time frame had a higher RN turnover rate. The majority of quality measures were not statistically different between the 2 ICUs. Even though statistical significance was not reached, the clinical impact of the PCICU's reduction in patient infections, mortality, and ICU length of stay was noted. This evaluation has provided organizational leaders the quality indicators and costs that have been impacted with the addition of interprofessional teamwork and coordination of care through the development of a PCICU.

Assessing the outcome of pediatric intensive care

Prognosis of adult respiratory distress syndrome in pediatric patients

BackgroundThe subjective experience of giving birth to a child varies considerably depending on psychological, medical, situational, relational, and other individual characteristics. In turn, it may have an impact on postpartum maternal mental health and family relationships, such as mother–infant bonding. The objective of the study was to evaluate the relevance of the subjective birth experience (SBE) for mother–infant bonding difficulties (BD) in women with mental disorders.MethodsThis study used data from N = 141 mothers who were treated for postpartum mental disorders in the mother–baby day unit of the Psychosomatic University Clinic in Dresden, Germany. Patients' mental status at admission and discharge was routinely examined using a diagnostic interview (SCID I) and standard psychometric questionnaires (e.g., EPDS, BSI, PBQ). Both, the SBE (assessed by Salmon's Item List, SIL) as well as medical complications (MC) were assessed retrospectively by self-report. The predictive value of SBE, MC, as well as psychopathological symptoms for mother–infant BD were evaluated using logistic regression analyses.ResultsAbout half of this clinical sample (47.2%) reported a negative SBE; 56.8% of all mothers presented with severe mother–infant BD toward the baby. Mothers with BD showed not only significantly more depressiveness (EPDS: M = 16.6 ± 5.6 vs. 14.4 ± 6.2*), anxiety (STAI: M = 57.2 ± 10.6 vs. 51.4 ± 10.6***), and general psychopathology (BSI-GSI: M = 1.4 ± 0.7 vs. 1.1 ± 0.6**) compared to women without BD, but also a significantly more negative SBE (SIL: M = 79.3 ± 16.2 vs. 61.3 ± 22.9***). Moreover, the SBE was the most powerful predictor for BD in univariate and multiple logistic regression analyses [OR = 0.96*** (95% CI 0.94–0.98) vs. OR = 0.96** (95% CI 0.93–0.98)], even when univariate significant predictors (e.g., current psychopathology and MC during birth) were controlled.ConclusionsA negative SBE is strongly associated with mother–infant bonding in patients with postpartum mental disorders. It needs to get targeted within postpartum treatment, preferably in settings including both mother and child, to improve distorted mother–infant bonding processes and prevent long-term risks for the newborn. Furthermore, the results highlight the importance of focusing on the specific needs of vulnerable women prior to and during birth (e.g., emotional safety, good communication, and support) as well as individual factors that might be predictive for a negative SBE.

Performance of a 10 bed paediatric intensive care unit (PICU) in a university children's hospital was assessed in a prospective cohort study of unselected, consequtive admissions. Collected data included primary clinical specialty, PRISM score derived mortality risk, administration of PICU-dependent therapy and vital status at discharge. Effectiveness of care was determined by comparing severity of illness based predicted mortality with vital status at discharge. Efficiency was determined by the administration of at least one PICU-dependent therapy or mortality risk exceeding 1%. 593 patients were included, PICU mortality was 8.4%. The overall performance of the PRISM score based predictive model was found to be well (goodness-of-fit test X2(5) = 5.49, p=0.33; area under ROC-curve 0.92), indicating good effectiveness of care. Overall 489 of 593 (82.5%) admissions were efficient, as were 2393 of 3130 (76.5%) PICU days. In cardiovascular surgery patients 800 of 927 (86.3%) PICU days were efficient, in non-surgical patients 1421/1855 (76.6%), and in other surgery patients 172/347 (49.6%).

Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries

Successful Integration of Advanced Practice Providers Into a Pediatric Academic Community Intensive Care Unit

A point well taken

PurposePostpartum depression is a well-known risk factor, and postpartum anxiety and parity are potential risk factors, for mother–infant bonding disorder. However, few studies have focused on the relationships among these factors and mother–infant bonding. This cross-sectional study explored the associations between depression, anxiety and parity, and mother–infant bonding.Materials and MethodsJapanese mothers, both primiparas and multiparas, completed the Mother-to-Infant Bonding Scale (MIBS) and the Hospital Anxiety and Depression Scale (HADS) one month after childbirth. We performed a stepwise multiple regression analysis with the forward selection method to assess the effects of HADS anxiety and depression scores and parity as independent variables on mother–infant bonding as the dependent variable.ResultsA total of 2379 Japanese mothers (1116 primiparas and 1263 multiparas) took part in the study. MIBS score (2.89 ± 2.68 vs 1.60 ± 2.11; p < 0.0001) was significantly higher in primiparas than in multiparas. HADS anxiety (6.55 ± 4.06 vs 4.63 ± 3.41; p < 0.0001) and depression (6.56 ± 3.43 vs 5.98 ± 3.20; p < 0.0001) scores were also significantly higher in primiparas than in multiparas. A stepwise multiple regression analysis with the forward selection method revealed that HADS depression and anxiety scores and parity were significantly associated with MIBS score (p = 0.003, 0.015 and 0.023).ConclusionDepression, anxiety and primiparity were negatively associated with mother–infant bonding one month after childbirth.