Baby Dyad Research Articles

Mother–baby dyads enrolled in PMTCT care in western Kenya: characteristics and implications for ART programmes

The objective of the study was to establish the mother–baby pair characteristics that contribute to vertical transmission of HIV and elucidate on remediation. We assessed for factors increasing the odds of HIV transmission in children born to HIV-infected mothers in western Kenya. We used a retrospective study which reviewed routinely collected data of 1 028 mother–baby pairs enrolled in a prevention of mother-to-child transmission (PMTCT) programme in western Kenya from January to December 2015. We compared the transmission rates amongst mothers known to have a positive HIV status before conception (known positives/KPs) versus the transmission amongst those who were newly diagnosed during maternal and child health (MCH) clinic attendance (new positives/NPs). We compared the socio-demographic and clinical characteristics of the mothers using chi square and Kruskal–Wallis tests at 95% confidence interval (CI). We assessed for factors associated with the infants’ HIV status using a logistic regression model. The results revealed that 60% (622) of the mothers were KPs, and that KPs and NPs had mother-to-child transmission (MTCT) rates of 5.5% and 20.7% respectively. Close to 90% of the NP Mothers were at an early HIV clinical stage at enrolment and 40% were enrolled after delivery. The infants of NPs were enrolled at a mean age of 18.3 weeks compared to 6.6 weeks for the infants of the KPs. On adjusted multivariable analysis, child's age at enrolment (AOR = 1.05, 95%CI = 1.036–1.064) and mother's status at conception (AOR = 1.96, 95%CI = 1.042–3.664) were significantly associated with the infant's HIV status. None of the HIV infected infants had received nevirapine prophylaxis. Most of the mothers enrolling into the PMTCT programme have a known HIV-positive status, however, NPs are the largest contributors to continued MTCT.

Predictors of breastfeeding duration in a predominantly M\u0101ori population in New Zealand

BackgroundAlthough breastfeeding duration in New Zealand’s indigenous Māori is shorter than in non-Māori, we know little about barriers or motivators of breastfeeding in this community. The aim of this analysis was to identify predictors for extended duration of breastfeeding amongst participants drawn from predominantly Māori communities in regional Hawke’s Bay.MethodsMother/baby dyads were recruited from two midwifery practices serving predominantly Māori women in mostly deprived areas, for a randomised controlled trial comparing the risks and benefits of an indigenous sleeping device (wahakura) and a bassinet. Questionnaires were administered at baseline (pregnancy) and at one, three and six months postnatal. Several questions relating to breastfeeding and factors associated with breastfeeding were included. The data from both groups were pooled to examine predictors of breastfeeding duration.ResultsMāori comprised 70.5% of the 197 participants recruited. The median time infants were fully breastfed was eight weeks and Māori women were more likely to breastfeed for a shorter duration than New Zealand European women with an odds-ratio (OR) of 0.45 (95% CI 0.24, 0.85). The key predictors for extended duration of breastfeeding were the strong support of the mother’s partner (OR = 3.64, 95% CI 1.76, 7.55) or her mother for breastfeeding (OR = 2.47, 95% CI 1.27, 4.82), longer intended duration of maternal breastfeeding (OR = 1.02, 95% CI 1.00, 1.03) and being an older mother (OR = 1.07, 95% CI 1.02, 1.12). The key predictors for shorter duration of breastfeeding were pacifier use (OR = 0.28, 95% CI 0.17, 0.46), daily cigarette smoking (OR = 0.51, 95% CI 0.37, 0.69), alcohol use (OR = 0.54, 95% CI 0.31, 0.93) and living in a more deprived area (OR 0.40, 95% CI 0.22, 0.72).ConclusionsBreastfeeding duration in this group of mainly Māori women was shorter than the national average. Increasing the duration of breastfeeding by these mothers could be further facilitated by ante and postnatal education involving their own mothers and their partners in the support of breastfeeding and by addressing pacifier use, smoking and alcohol use.

Cognitive Breastfeeding Counseling: A Single Session Helps Improve LATCH Score.

Antenatal counseling improves the rate of exclusive breastfeeding. But routine antenatal counseling may not be effective in achieving this. Cognitive behavioral therapy derived techniques may be more useful in improving breastfeeding outcomes. We did this study to test the effectiveness of a single session of cognitive counseling compared to routine counseling in the third trimester for improving LATCH score. Fifty mother-baby dyads were enrolled. Twenty-six mothers underwent cognitive counseling and 24 mothers underwent routine counseling. After birth, the LATCH scores were assessed within the first 24 hours in the newborn. A single session of cognitive breastfeeding counseling in the third trimester is effective in significantly improving the LATCH scores in the immediate newborn period.

Ethical Dilemmas and Team Dynamics in Providing Therapeutic Care for a Mother–Baby Dyad With HIV

Health care providers are grounded in the concept of providing patient-centered care in an environment of beneficence and nonmaleficence and promoting patient autonomy and truthfulness. Patients’ rights to truthful information, informed consent, and privacy as well as freedom from discrimination provide the framework for care delivery.

Identification of vulnerability within a child and family health service.

Objective The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits. Methods A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother-baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson's Chi-squared analysis. Results In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12-16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, and 74.6% of vulnerable newborns were offered a home visit. Children identified as vulnerable were more likely to have a home visit than those who were not (z for 95% CI=1.96; P<0.1). Conclusions Although the high reported prevalence of identified risk needs to be confirmed in further studies, identifying vulnerability allowed the offer of home visiting to be directed towards those most likely to benefit. What is known about the topic? Of the Australian child population, 10-20% are vulnerable to adverse health, developmental and wellbeing outcomes. Vulnerable infants are at a greater risk of becoming vulnerable children, adolescents and adults over the life course. Biological and psychosocial risk factors for vulnerability are well described. Families with the greatest need are often the least likely to access or receive support, and have lower utilisation of preventative health services despite evidence that support in the first few years of life can significantly improve long-term outcomes. What does this paper add? This paper provides a detailed description of vulnerabilities in a cohort of newborns and demonstrates that it is possible to assign risk of vulnerability within existing child and family health services using tools that identify biological and psychosocial risk factors. Identification of vulnerability risk allows prioritisation of services to those with the greatest need. What are the implications for practitioners? It is possible to identify vulnerability risk within child and family health services. This allows those families at risk of future adverse health, developmental and wellbeing outcomes to be prioritised to receive health services and supports.

Health education intervention promoting infant safe sleep in paediatric primary care: randomised controlled trial

BackgroundFew randomised controlled trials (RCTs) have been conducted to improve infant sleep practices. There is limited research on how best to integrate safe sleep information into routine paediatric anticipatory guidance...

Psicoterapia mãe-bebê: uma intervenção no contexto da prematuridade

This study aimed to describe a psychotherapeutic intervention performed with two mother-premature baby dyad during admission in Neonatal Intensive Care Unit (NICU), including its impact on the maternal mentalizing and mother-infant interaction. Data were obtained through the Socio-Demographic and Clinical Data Sheet, History of Mother Life Interview, Free Interaction Mother-Baby Film, Hospitalization History Interview and the record of interventions. A qualitative analysis was carried out through four thematic axes: (a) the environment of interventions; (b) the start period, of observation and mother-infant interaction; (c) the final period of communication between mother and researcher; and (d) maternal perceptions of the intervention. The results indicated that the intervention provided changes in maternal mentalizing and increased the maternal sensitivity to the baby’s initial needs with a positive repercussion on the mother-baby interaction. The study highlights the importance of structured interventions focusing on the early relations of mothers and premature babies in NICU. Keywords: intervention, prematurity, mentalizing, mother-infant interaction.

Differences in the Protective Effect of Exclusive Breastfeeding on Child Overweight and Obesity by Mother's Race.

Objectives To examine the relationship between infant feeding and risk of child overweight and obesity across race and ethnicity in a diverse community-based cohort. Methods 2172 mother baby dyads were drawn from a prospective cohort constructed using data from electronic medical records linked to birth records. The primary exposure was exclusive breastfeeding at 2months of age; outcome was BMI Z-score and BMI≥85th percentile (overweight and obese) at 4years of age. Regression models were adjusted for confounding using covariance balanced propensity score and inverse probability weighting. Results At age 4, exclusively breast fed children had lower BMI Z-score (-0.109, SE=0.048) and a decreased odds of a BMI≥85th percentile (0.832; 95% CI 0.792, 0.994), when compared to those exclusively formula-fed or had mixed feeding. Race and ethnicity significantly moderated these associations. Sub-population analysis showed the effect was significant for BMI Z-score (p=0.0002) and BMI≥85th percentile (p<0.0001) only for children of NH white mothers. For children of NH black mothers exclusive breastfeeding was not associated with a significant difference in BMI Z-score, however there was an increased odds of overweight or obesity (p=0.0145). Conclusions The protective effect of breastfeeding against early childhood overweight and obesity may differ by race and ethnicity. This suggests that programs aiming to reduce obesity by increasing rates of breastfeeding may have limited impact for some groups and should be coupled with other racially and ethnically focused efforts to encourage healthy feeding practices in infancy and early childhood.

Risk factors for postpartum depression in women living with HIV attending prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi

ABSTRACTMothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument – PLWHA (HASI – P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04–0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14–5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132–78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother–baby dyad.

The Tenth Step of the BFHI: What midwives need to know about optimal support for mothers, post-discharge

This commentary discusses the 10th Step of the Baby-Friendly Hospital Initiative (BFHI), the only step that goes beyond the hospital to provide for the mother to receive breast-feeding support after she returns to the community. The reasons why such support is needed, and how this support has been provided in different settings, will be discussed. Post-discharge support for breast-feeding mothers takes many forms and is optimised when mothers can access both professional and peer support. The mother–baby dyad is best served by the right advice from the right person at the right time. Midwives who assist the new mother with information about easily accessible support in the community enable the care she has received during her short hospital stay and during any midwifery home visiting to continue when she is in an environment that may not be supportive of breast feeding.

The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population-based, cross-sectional study

BackgroundThe performance of maternity services is seen as a touchstone of whether or not we are delivering high-quality NHS care. Staffing has been identified in numerous reports as being a critical component of safe, effective, user-centred care. There is little evidence regarding the impact of maternity workforce staffing and skill mix on the safety, quality and cost of maternity care in the UK.ObjectivesTo understand the relationship between organisational factors, maternity workforce staffing and skill mix, cost and indicators of safe and high-quality care.Design and methodsData included Hospital Episode Statistics (HES) from 143 NHS trusts in England in 2010–11 (656,969 delivery records), NHS Workforce Statistics, England, 2010–11, Care Quality Commission Maternity Survey of women’s experiences 2010 and NHS reference costs 2010/11. Ten indicators were derived from HES data. They included healthy mother and healthy baby outcomes and mode of birth. Adjustments were made for background characteristics and clinical risk. Data were analysed to examine the influence of organisational factors, staffing and costs using multilevel logistic regression models. A production function analysis examined the relationship between staffing, skill mix and output.ResultsOutcomes were largely determined by women’s level of clinical risk [based on National Institute for Health and Care Excellence (NICE) guidance], parity and age. The effects of trust size and trust university status were small. Larger trust size reduced the chance of a healthy mother outcome and also reduced the likelihood of a healthy mother/healthy baby dyad outcome, and increased the chances of other childbirth interventions. Increased investment in staff did not necessarily have an effect on the outcome and experience measures chosen, although there was a higher rate of intact perineum and also of delivery with bodily integrity in trusts with greater levels of midwifery staffing. An analysis of the multiplicative effects of parity and clinical risk with the staffing variables was more revealing. Increasing the number of doctors had the greatest impact on outcomes in higher-risk women and increasing the number of midwives had the greatest impact on outcomes in lower-risk women. Although increased numbers of support workers impacted on reducing childbirth interventions in lower-risk women, they also had a negative impact on the healthy mother/healthy baby dyad outcomes in all women. In terms of maximising the capacity of a trust to deliver babies, midwives and support workers were found to be substitutes for each other, as were consultants and other doctors. However, any substitution between staff groups could impact on the quality of care given. Economically speaking, midwives are best used in combination with consultants and other doctors.ConclusionsStaffing levels have positive and negative effects on some outcomes, and deployment of doctors and midwives where they have most beneficial impact is important. Managers may wish to exercise caution in increasing the number of support workers who care for higher-risk women. There also appear to be limited opportunities for role substitution.Future workWide variations in outcomes remain after adjustment for sociodemographic and clinical risk, and organisational factors. Further research is required on what may be influencing unexplained variation such as organisational climate and culture, use of NICE guidelines in practice, variation of models of care within trusts and women’s choices.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants

Efficacy of burping in lowering colic and regurgitation episodes in healthy term babies lacks evidence in literature. We conducted a randomized controlled trial to compare efficacy of burping versus no-burping in 71 mother-baby dyads in community setting. Primary outcome was reduction in event rates of colic and regurgitation episodes over 3 months. Baseline characteristics were similar in two groups. Difference in incidence rates of colic between the control and burping group was 1.57 episodes/infant/100 weeks [95% confidence interval (CI): -0.63 to 3.76]. There was statistically no significant reduction in colic episodes between burping and non-burping study subjects during 3 months of follow-up (adjusted relative risk 0.64; 95% CI: 0.22-1.86, P-value 0.41). Incidence rate difference of regurgitation episodes/infant/week between burping and control group was 4.36 (95% CI: 4.04 to 4.69) and there was statistically significant increase in burping group (adjusted relative risk 2.05; 95% CI: 1.92-2.18, P-value < 0.0001). Although burping is a rite of passage, our study showed that burping did not significantly lower colic events and there was significant increase in regurgitation episodes in healthy term infants up to 3 months of follow-up.

Clinical presentation and management of neonatal abstinence syndrome: an update

Clinical presentation and management of neonatal abstinence syndrome: an update Alice Ordean,1 Brian C Chisamore21Department of Family Medicine, 2Department of Pediatrics, St Joseph&#39;s Health Centre, and University of Toronto, Toronto, ON, CanadaAbstract: Exposure to prescription medications and illicit drug use during pregnancy has been associated with neonatal abstinence syndrome. The clinical presentation consists of neurological respiratory, gastrointestinal, and vasomotor disturbances. All infants require observation and supportive care to ensure appropriate adaptation and growth in the newborn period. A smaller percentage may also require additional pharmacotherapy, depending on the specific gestational substance exposure. Women should be counseled antenatally about the possible neonatal effects, and mother&ndash;baby dyad care should be implemented for this particular patient population.Keywords: neonatal withdrawal, opioids, marijuana, cocaine, benzodiazepines, selective serotonin reuptake inhibitors

Abstracts fromThe Academy of Breastfeeding Medicine 18th Annual International MeetingPhiladelphia, PennsylvaniaNovember 21–24, 2013

Abstracts fromThe Academy of Breastfeeding Medicine 18th Annual International MeetingPhiladelphia, PennsylvaniaNovember 21–24, 2013

Implementing the Neonatal Assessment Nurse Role in the LDR: Improving Neonatal Outcomes While Supporting Family‐Centered Care

Paper Presentation Purpose for the Program Knowing the stabilization and bonding benefits of minimizing the separation of the mother–baby dyad at delivery, a nurse‐driven task force integrated the role of a neonatal assessment nurse (NAN) into the care delivery process. The task force discovered that inconsistent care practices, anecdotally reported by the medical providers, affected the quality of neonatal care and maternal satisfaction. The purpose of this project was to establish an innovative role designed to consistently provide transitional care at the mother's bedside for eligible newborns. Without funding to hire additional nurses into this position, a core group of nurses from all maternal child health units volunteered. Proposed Change Introduction of the NAN, as a dedicated clinical assignment, would positively facilitate the transition of life from fetus to neonate, decrease mother–neonate separation, increase rate of skin‐to‐skin contact, improve nurses’ perspective of neonatal care, decrease neonatal intensive care unit admissions, and improve maternal satisfaction. The NAN provides transitional care at the mother's bedside, thus changing the current practice of separating the infant from the mother to conveniently transfer the infant to where the work can be accomplished. Implementation, Outcomes, and Evaluation Hospital Institutional Review Board approval was obtained. Strategies for NAN success included detailed role description; patient care priorities; expectations when the labor and delivery room (LDR) had no neonatal patients; and a decisive evaluation plan for those infants requiring nonintensive yet supportive care and monitoring. A comprehensive process of didactic education and clinical orientation was individualized based on the nurse's expertise along the spectrum of neonatal care. Simulation scenarios served as teaching adjuncts and reinforced evidence‐based practices. The enthusiasm of the NAN‐identified nurses and creative staffing models developed by the maternal–child health units’ charge nurses ensured coverage for every shift, 7 days a week. The Caring Behaviors Inventory by Wu, Larrabee, and Putman (2006) was used before and after NAN to gain clinical nurses’ perspective about the care delivered to neonates who were less than 4 hours of age. This tool and survey, which focused on maternal perspective, were chosen because both aligned with the hospital's choice of Watson Caring Theory, which is the framework that currently guides our nursing practice. Implications for Nursing Practice The NAN role in the LDR presents an extended benefit of having a dedicated nurse to provide neonatal care in situations when transition time requires pulse oximeter monitoring and/or additional poststabilization assessments. With no literature available on this topic, publication of the positive results of this implementation plan will help others adopt similar roles specific to their settings.

Don't Break Her Heart: Cardiac Telemetry for the Pregnant and Postpartum Patient

Paper Presentation Purpose for the Program When pregnant or postpartum patients are in need of telemetry monitoring, they often are separated from their newborns, or require the use of two nurses to attend to them because the units for perinatal services do not have telemetry access. As more patients with preexisting diseases become pregnant, this situation will only become more frequent. Proposed Change This nurse‐driven change involves the use of remote telemetry to monitor the obstetric patient. Communication standards and co‐nursing management plans were developed to enable this change. Implementation, Outcomes, and Evaluation Policy and procedures were developed based on a shared governance model of care. Outcomes have resulted in maintaining the postpartum mother–baby dyad and accomplishing remote telemetry for cardiac assessment. Implications for Nursing Practice This program allows for seamless maternal–newborn care. In addition, staff are engaged in collegial relationships and co‐management situations that were not available to them in the past.

‘Off everyone's radar’: Australian women's experiences of medically necessary elective caesarean section

Introductiondespite an exponential rise in the number of medically initiated elective caesarean sections over the last two decades, women's experiences of this birth mode remain largely unknown. The aim of this study was to address this gap by describing women's experiences of medically necessary elective caesarean section. Methodsa grounded theory approach was used to collect and analyse interview data collected from 28 Australian women who had an elective caesarean section for a medical reason, 14 of whom were also observed during their caesarean section. The analyses of the non-participant observations were used to contextualise the women's experiences. Findingsprior to having their baby, women expected to play an active part in their caesarean section and to be supported to take up their ‘mother’ role as soon as their baby was delivered. Postnatally however, they reported having felt invisible, superfluous and disregarded during the event. There was evidence that hospital routines and processes contributed to women feeling displaced and unimportant in their baby's birth. Three sub-categories were formed from the analysis of the data that together are represented by the in-vivo label ‘off everyone's radar’. These were ‘just another case on an operating list’, ‘striving to be included while trying to behave’ and ‘unable to be my baby's mum’. Discussionour findings suggest that when women are ignored during childbirth, any fear they hold may escalate into peritraumatic disassociation, which in turn has implications for women's postnatal mental and emotional health in the short and long term. In addition, the separation of the mother–baby dyad was found to have a devastating impact on maternal–newborn attachment that lasted well into the postnatal period. To optimise women's childbirth satisfaction and foster their attachment to their baby, both of which are essential for ongoing emotional well-being, it is vital that they are located at the centre of their birth experience and that if at all possible they are not separated from their newborn.

Literacy 8–12 months: what are babies learning?

Shared book reading in families is strongly linked with successful school literacy and thus with identity, belonging and participation in literate societies. From an ‘emergent’ perspective, literacy is recognised as beginning from birth. However, despite exceptions such as research into the UK program, ‘Bookstart’, most research into shared book reading does not focus on babies. In this paper, I report on interactions during shared book reading between 10 babies aged 8–12 months, and their mothers. A detailed examination of linguistic and paralinguistic features of the interactions in the ten mother–baby dyads showed varying individual patterns of language use, discourse structure and paralinguistic interaction. There were also differences in children's dispositions to engage in the activity. The findings from this study have important implications for parent support, prevention/intervention programs, and early childhood settings that include infants and toddlers.