Infant Care Research Articles

Preterm Infant Care Practice among Nurses in Neonatal Care Units of Selected Hospitals of Nepal: A Cross-Sectional Study

Introduction. Preterm infants (PTIs) are vulnerable to morbidity, disability, and mortality. They require meticulous care for survival and development in neonatal care units (NCUs). PTI care in NCUs is a collaborative and team effort among different health professionals. However, nurses have a key role for quality care. This study aimed to assess nurses’ PTI care practices across different hospitals in Nepal. Methods. A descriptive cross-sectional study was conducted in NCUs of six randomly selected public hospitals in Nepal. After obtaining ethical approval, structured observation was completed among 40 NCU nurses using a practice checklist. After observation, a self-report questionnaire was administered among 102 nurses. Both descriptive and inferential statistics were used for data analysis. Results. The observation and self-reported mean infant care practices were 73.7% and 70.7%, respectively. The overall practice median score and the interquartile range (IQR) were 4.0 (3.5–4.3) with the highest score of (4.5 [4.1–4.7]) for daily supportive care and the lowest score of (2.8 [2.1–3.5]) for pain management. The care practice was strongly associated with the nurse-infant ratio (adjusted odd ratio (aOR) = 18.52, confidence interval (CI) = 5.83–58.77, and p=<0.001) and training status (aOR = 4.95, CI = 1.59–15.39, and p=0.006). Conclusion. Nurses have adequate practice of thermal care, safe oxygen administration, nutritional care, and infection prevention in NCUs, whereas lacking is found regarding developmental supportive care components (sleep promotion and a supportive sensory environment), parental support, and pain management practices. Consideration of the proper nurse-infant ratio and continued professional development opportunities are essential for practice enhancement in NCUs. These findings might be useful to identify the gaps in PTI care practice in NCUs.

Comprehensive care for late preterm infants: fostering integrated follow-up

Late preterm infants, although they are born closer to full term than extremely preterm infants, still face unique challenges due to their premature birth. Understanding these potential outcomes and providing appropriate support is key to ensuring their optimal development. A tailored follow-up program, guided by an interdisciplinary team of healthcare professionals, aims to provide early identification, continuous monitoring, and individualized care for late preterm infants. The core components of this program include developmental assessments, medical surveillance, parent education and support, and a family-centered approach. A well-structured late preterm follow-up program not only promotes the overall health and well-being of late preterm infants but also help these babies to achieve their full potential.

ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis

Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented. The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members. The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.

Unveiling Maternal Narratives and Experiences in Lesotho: Insights into Breastfeeding Choices, Practices, And Hurdles

This research investigated maternal and infant care in Lesotho, with an emphasis on exclusive breastfeeding practices during the first year of life. A quantitative, descriptive survey included 97 mothers attending healthcare facilities. The findings highlighted a prevalent preference for exclusive breastfeeding in the initial three months, which decreases during the following 3 months. Yet around 7% introduced complementary foods or fluids early on and many did not breastfeed exclusively until the 6-month recommended period. The majority began breastfeeding within the recommended one-hour post-delivery window. Distinct decision-making dynamics emerged: nearly half of the mothers made autonomous feeding decisions, around a quarter collaborated with the child’s father or partner, and 11.3% involved extended family in these choices. Colostrum's recognized value as a new-born’s first nutrient source aligned with global health recommendations. However, the early introduction of other foods indicates a need to explore mothers’ beliefs and knowledge about feeding practices further. Common breastfeeding challenges encompassed issues like sore nipples and perceived milk insufficiency, underlining the importance of educational support. Healthcare professionals, especially nurses, played a key role in offering guidance and support on breastfeeding. The frequent practice of immediate skin-to-skin contact post-birth emphasized the trend towards promoting early bonding and breastfeeding initiation. Furthermore, the community’s positive reception to public breastfeeding signalled societal acceptance. In conclusion, this study illuminates the nuances of breastfeeding practices and decision-making in Lesotho, providing insights for interventions and policies to enhance maternal and child health in the country.

Analysis of Professional Quality Cultivation Strategies for Infant and Child Care Service Talents from the Perspective of Collaboration of Medical Care, Parenting, and Education, and Integration of Industry and Education

The collaboration of medical care, parenting, and education aims to integrate nursing, midwifery, infant and child care services, and management with speech and hearing rehabilitation technology, among other elements related to the infant care industry chain. This integration targets pediatrics talent training in nine infant care positions, including nursing, infant health care and management, and child rehabilitation, to ensure that the capabilities and quality of professional talents can meet the health care needs of infants and young children. This article briefly explains the background of the “collaboration of medical care, parenting, and education, and integration of industry and education.” It analyzes the necessity of cultivating infant and child care service talents based on the perspective of “collaboration of medical care, parenting, and education, and integration of industry and education.” Based on this perspective, we conducted an in-depth study of the cultivation of professional qualities of infant and child care service talents.

Mother’s disintegrative responses in the context of infant care: Clinical and empirical evidence of the role of empathy and parity.

Mother’s disintegrative responses in the context of infant care: Clinical and empirical evidence of the role of empathy and parity.

Comparative Analysis of Ridge, LASSO, and Elastic Net Regularization Approaches in Handling Multicollinearity for Infant Mortality Data in South Sulawesi

Infant mortality rate is a crucial indicator for assessing the health and infant care quality in a region. In the effort to reduce infant mortality rates, regression analysis serves as a tool to identify influential factors. However, regression analysis often encounters the challenge of multicollinearity, which involves high correlation among predictor variables. To address this issue, various regularization techniques can be applied, such as ridge regression, least absolute shrinkage and selection operator (LASSO), and elastic net. Ridge regression aims to control coefficient variance, while LASSO directs some coefficients to zero, functioning as variable selection. Elastic net combines the strengths of both methods by merging ridge and LASSO regularization. The objective of this research is to evaluate the performance of ridge regression, elastic net, and LASSO methods in handling multicollinearity issues, utilizing infant mortality rate data in South Sulawesi Province. The results indicate that the elastic net method outperforms both Ridge and LASSO methods. The best-performing model is obtained through elastic net with a coefficient of determination value of 60.81%, whereas ridge and LASSO methods yield coefficient of determination values of 54.11% and 58.18%, respectively. This demonstrates that the application of the elastic net method is capable of producing more accurate results in modeling the variables within the analysis of infant mortality rate data compared to other methods.

Palliative Care for Infants in the Neonatal Intensive Care Unit: A Scoping Review.

This scoping review aimed to explore the characteristics of neonatal palliative care in the neonatal intensive care unit, including the features, contents, and experiences of infants, parents, and nurses during palliative care. Five databases (PubMed, Cochrane, CINAHL, Research Information Sharing Service, and Korean Studies Information Service System) were searched to identify relevant articles published between 2011 and 2020. From the systematic search and review process, 13 studies that met the eligibility criteria were selected for the analysis. From the literature review, 2 key principles were found to facilitate neonatal palliative care: family-centered care and integrative care in the neonatal intensive care unit. In addition, the themes found in this review included (1) providing comfortable care to dying infants with respect to infants and offering parents choices, (2) therapeutic communication, (3) support with respect, and (4) bereavement care for parents of dying infants in the neonatal intensive care unit. Caregivers require effective communication, manpower support, emotional support, educational programs, and well-defined protocols. The evidence mapped and synthesized in this review indicates the need to facilitate the provision of palliative care in the neonatal intensive care unit in line with the unique needs of infants, parents, and nurses.

Relationship between ETCO2 and PaCO2 under Changing Capnogram in Ventilated Infants with NAVA: An Observational Study.

This observational study evaluated the validity of end-tidal CO2 (ETCO2) as a surrogate for arterial PCO2 (PaCO2) in infants on neurally adjusted ventilatory assist (NAVA), particularly considering the influence of variable spontaneous breathing on capnography waveforms. The study involved 16 infants, analyzing 50 paired ETCO2 and PaCO2 values. Deming regression analysis highlighted a notably stronger correlation for maximum ETCO2 (r2 = 0.6783, p <0.0001) compared to mean ETCO2 (r2 = 0.5686, p <0.0001) and demonstrated a significantly weaker association for minimum ETCO2 (r2 = 0.1838). These findings emphasize the superior predictive value of maximum ETCO2 in estimating PaCO2, advocating its reliable use in clinical monitoring, especially given the dynamic capnography associated with NAVA's variable pressures. The results suggest ETCO2's potential to enhance noninvasive respiratory management, reduce the frequency of blood sampling, and improve overall care for infants requiring mechanical ventilation.

Family Management Skills Reported by Parents of Preterm Infants in the NICU Using the Self- and Family Management Framework (SFMF).

Across the globe, family-integrated care (FICare) has become an evidence-based standard in which parents deliver the majority of infant care in the neonatal intensive care unit (NICU). Because of extensive barriers to parent presence, adaptations to FICare may be required for successful implementation. Family management theory may provide structure to the Parent Education of FICare and help nurses guide parents' skill development as equal care members. To identify family management skills employed by NICU parents using the Self- and Family Management Framework (SFMF). We conducted secondary analyses of qualitative interview data from NICU parents (n = 17) who shared their experiences of using family management skills to care for their infant. We categorized skills according to 3 main self- and family management processes: Focusing on Infant Illness Needs; Activating Resources; and Living With Infant Illness. Parents reported several family management skills currently identified in the SFMF, as well as new skills such as conflict management, power brokerage, and addressing resources related to social determinants of health. Parent activation of resources was critical to sustaining parent focus on the infant's illness needs. By teaching skills that parents reported as helping them manage infant care, neonatal nurses may better facilitate parent integration into the care team. Future researchers can incorporate the skills identified in this study into the design of family management interventions that facilitate FICare implementation in the United States.

The Safety of Body Wraps on Skin-to-Skin Care in the Neonatal Population: A Pilot Study.

Despite well-established benefits of skin-to-skin care (SSC) for preterm infants and parents, standardized guidelines for implementation do not exist. Furthermore, the literature offers little evidence-based information to guide best practice. To discover whether SSC using a body wrap to hold preterm infants would increase the duration of SSC, decrease parental stress during SSC, and minimize adverse events to ensure that body wraps are safe and feasible. Twenty-nine dyads of parents and preterm infants younger than 34 weeks postmenstrual age were enrolled. The first 15 dyads to meet inclusion criteria were assigned to a standard of care group for SSC with no body wrap. The remaining 14 dyads were assigned to an experimental group for SSC with a body wrap. Each dyad performed 2 SSC holds. Parents completed the Parental Stressor Scale and Parent Feedback Form. Adverse events were also documented. No statistically significant differences were found between the 2 groups in total SSC time ( P = .33), the number of adverse events ( P = .31 for major events; P = .38 for minor events), average parental stress ( P = .22), and parental confidence performing SSC ( P = .18). This study found that SSC with a body wrap is safe for preterm infants in a neonatal intensive care unit (NICU). This is the first study to explore the use, safety, and effectiveness of body wraps during SSC with preterm infants in an NICU. Future research should be conducted with larger sample sizes to further evaluate the safety and efficacy.

Self-collection of samples for group B streptococcus testing during pregnancy: a systematic review and meta-analysis

BackgroundSample self-collection for reproductive tract infection diagnosis has been found to offer greater convenience, privacy, autonomy, and expanded access to testing in non-pregnant adults. This review aimed to determine whether sample self-collection is as accurate as provider-collection for detection of group B streptococcus colonisation in pregnancy and whether a strategy of self-collection compared to provider-collection might improve maternal and neonatal health outcomes.MethodsWe searched CINAHL Plus, Medline, EMBASE, Maternity and Infant Care Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews in June 2022. Eligible studies compared self-collected and provider-collected samples taken from the same participants or participants randomised to either self-collection or provider-collection for reproductive tract infection testing using the same test and testing method in pregnant individuals. We included trials and observational studies. Reviewers assessed risk of bias using the QUADAS-2 checklist and independently extracted data. Sensitivity and specificity for group B streptococcus colonisation of self-collected compared to provider-collected samples were pooled using a bivariate, random-effects, meta-analytic model. This review was registered with PROSPERO (CRD42023396573).ResultsThe search identified 5909 references, of which eleven diagnostic accuracy group B streptococcus studies were included (n = 3269 participants). No studies assessed the effects of self-collection in pregnancy on health outcomes. All studies had high or unclear risk of bias. Pooled sensitivities of self-collected samples for group B streptococcus detection were 82% (95% CI: 66–91%; I2 = 68.85%) in four trials (n = 1226) and 91% (95% CI: 83–96%; I2 = 37.38%) in seven non-randomised studies (n = 2043). Pooled specificities were 99% (95% CI: 98–99%; I2 = 12.08%) and 97% (95% CI: 94–99%; I2 = 72.50%), respectively.ConclusionsSelf-collected samples for group B streptococcus detection in pregnancy had high specificity compared to provider-collection, but lower sensitivity, particularly for included trials. Studies investigating the effect of self-collection on health outcomes, and further higher quality trials comparing accuracy of self-collection to provider-collection, are required.

Health professionals' and women's knowledge and experiences of caring for small gestational age (SGA) infants in Pakistan

BackgroundIn Pakistan, every third baby is born small for gestational age (SGA). Early antenatal detection of SGA helps with birth planning and initial treatment of mother and baby, thereby reducing complications. Screening and diagnosis of SGA however are challenging, especially in low and middle-income countries where access to technological advances may be limited and there is a lack of routine antenatal screening. AimsTo explore the current practices, knowledge, and experiences of caring for SGA infants with women and health professionals in Pakistan. DesignA cross-sectional survey with healthcare professionals and focus groups or interviews with health professionals and mothers of SGA babies were undertaken. Survey data were analysed descriptively and integrated with the qualitative data using thematic data analysis. Subjects78 completed surveys were returned and eight FGDs and five interviews were undertaken with 77 participants – 67 healthcare professionals (gynecologists/obstetricians, neonatologists, Lady Health Workers, and Lady Health Visitors) and 10 mothers of SGA infants aged under 12 months. ResultsThe survey highlighted a general lack of training on SGA for all health care professionals, but particularly amongst community staff who often act as primary caregivers for women. Five qualitative themes described the challenges and issues faced in the management, treatment, and prevention of SGA in Pakistan: Lack of policies and training, Lack of resources, Lack of access to healthcare, Not following the guidance, and Lack of data and reporting. ConclusionsA whole system approach to improve service provision and outcomes is needed. This should include epidemiological research, country-specific policies, training for healthcare professionals and awareness raising amongst women and community members.

Contemporary women towards ancient customs and superstitions regarding pregnancy, childbirth, and postpartum

The aim of the study was to investigate whether contemporary women believe in ancient customs and superstitions related to pregnancy, childbirth, postpartum, and infant care. A cross-sectional study was conducted using online surveys. The study involved 120 women aged 21 to 69 years. The Scale of Attitudes towards Superstitions related to Pregnancy, Childbirth, and Newborn Care, and the Attitudes to Fertility and Childbearing Scale were used for data collection. No significant relationship was found between place of residence, age, and education and the belief in perinatal superstitions among the surveyed women. However, it can be stated that the greater the belief in superstitions among the surveyed women, the more they value a child. The topic of contemporary women’s belief in ancient advice, customs, and superstitions related to pregnancy, childbirth, postpartum, and infant care seems to be an interesting area of exploration. In further analyses, it would be worthwhile to ensure greater diversity of the respondents in terms of sociodemographic characteristics and to consider qualitative research model.

Maternity Behavior and Infant Care of Coastal Communities on the Prevention of Neonatal Mortality

Background: Infant mortality is one of the targets of health problems in sustainable development. The vast majority of infant deaths are preventable, with high-quality, evidence-based interventions in the form of data. Based on the results of the Indonesian Demographic and Health Survey (SDKI) infant mortality in 2017 was 24/1,000 KH with neonatal mortality of 15/1,000. There was a decrease in the infant mortality rate (IMR) in 2017, compared to the IMR in 2012 which amounted to 32/1,000 KH and 19/1,000 KH neonatal. This study aims to analyze the behavior of childbirth and infant care through the behavior of local wisdom so as to prevent neonatal death. Methods: This study uses a quantitative observational method through a Case Control Study Design approach. The population in this study were all mothers in the coastal area of the Konawe Islands Regency. Results: Birth behavior and baby care at risk provide opportunities for neonatal events. Health agencies need to increase education to the public about risk factors, causes of neonatal death and efforts to prevent neonatal death to mothers and expectant mothers and their families to pay attention to pregnant and postpartum women. Conclusion: For the community, it is necessary to regulate the age of marriage with efforts to control it from the local government

A Feasibility Study to Test the NICU Paternal Needs Inventory.

There has been little research exploring paternal needs while experiencing a neonatal intensive care unit (NICU) stay. Some tools exist to measure paternal needs, but do not incorporate items to capture important information about how fathers cope with stress differently, and may have different needs. Therefore, an instrument is needed to measure and prioritize what needs are important to fathers to help facilitate the development of nursing interventions to help fathers cope with the NICU environment. The purpose of this study was to conduct a feasibility study before large-scale pilot testing the instrument, the NICU Paternal Needs Inventory (NPNI), so we could then determine what are the physical, emotional, and psychological needs of fathers. A nonexperimental, quantitative, and descriptive design was used to address the study's aims. Fathers were recruited from a level IV NICU and asked to complete an online survey (consisting of a demographic survey and the NPNI). Needs rated 100% were knowing infant's progress, directions on caring for infant, flexible visitation, and assurance receiving the best care. The remainder showed a wide range of responses suggesting that needs of fathers are individual and varied. Use of the NPNI to evaluate a father's unique and individual needs would allow for the nurse to develop father-specific, individualized interventions. Findings support that the NPNI is feasible to accomplish measuring fathers' needs, but a larger study is needed to test the reliability and validity of this tool.

Experience and perceptions of healthcare providers on clinical management and care of near-miss infants: a qualitative content analysis

IntroductionNeonatal Near Miss (NNM) refers to neonates with severe complications who almost died but survived immediately after birth. In Ethiopia, the prevalence of NNM has been assessed using a validated Neonatal Near-Miss Assessment Scale. However, understanding the experiences and perceptions of healthcare providers in the clinical management and care of NNM infants remains unexplored. The aim was to investigate the determinants contributing to the survival of neonatal near-miss babies and to identify any barriers encountered, as reported by the experiences of healthcare providers in public hospitals of Amhara Regional State, northwest Ethiopia.MethodsSemi structured interviews were used to collect data from 25 midwives, nurses, and pediatricians with at least six months of prior experience in one of the labor wards or neonatal intensive care units at one of the four public health hospitals in the Amhara Regional state of northwest Ethiopia included in a large intervention study assessing a NNM scale. Purposeful sampling was used, selecting participants based on their experiences related to the aim of this study. The participants had a varying level of education and years of experience to care for NNM infants. The average age of the healthcare providers was 31 years, with 7 years of work experience. The transcripts of the interviews with the healthcare providers were analyzed using qualitative content analysis.ResultsThe experience and perceptions of healthcare providers was described in the main category “A sense of hopelessness when caring for the baby” capturing a broader emotional and professional aspect, while the subcategories “Unclear responsibilities discharging one’s mission”, “Provision of kangaroo mother care” and “Quick action required at birth” are more specific and practical. Healthcare providers perceived a sense of hopelessness when caring for the NNM infant, particularly providing Kangaroo Mother Care (KMC) and quick actions when required at birth to save the life of the infant.ConclusionUnclear responsibilities and a sense of hopelessness could have acted as barriers, hindering the ability of healthcare providers to fulfill their mission of taking swift actions and providing KMC to NNM infants, thus impacting their ability to save the lives of these infants. Healthcare providers’ and parents’ attitudes must be changed towards hope rather than hopelessness when caring for NNM infants.

Parental Autonomy in the Care of Premature Newborns and the Experience of a Neonatal Team: Observational Prospective Study.

The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low-birth weight newborn infants was modified during the implementation of a training program. This was an observational prospective study in the context of a quality improvement initiative. The Cuídame (meaning "Take Care of Me" in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5-20 vs 7, IQR 4-10.5 d; P<.001), feeding (median 53.5, IQR 34-68 vs 44.5, IQR 37-62 d; P=.049), and observation of neurobehavior (median 18, IQR 9-33 vs 11, IQR 7-16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7-23 vs 21, IQR 10-31 d; P=.02), diaper change (median 9.5, IQR 4-20 vs 14.5, IQR 9-32 d; P=.04), and infection prevention (median 1, IQR 1-2 vs 6, IQR 3-12; P<.001). Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention.

Comparison of Quality of Infant Care and Transition Difficulty to Motherhood Between Adolescent and Young Mothers

Background: Despite a lower teenage pregnancy rate in Iran compared to the global average, there is an anticipation of increased teenage pregnancy rates by 2025 due to changes in population policy programs. Objectives: This study aimed to compare the challenges faced during the transition to motherhood and the quality of infant care between adolescent mothers and young mothers in Karaj, Iran. Methods: This descriptive-analytical study was conducted in 2020, involving 160 adolescent and young mothers selected through multistage sampling in Karaj, Iran. The data were collected using demographic characteristics, a modified questionnaire assessing the challenges of the transition to parenthood, and an infant care checklist. Descriptive statistics, including frequency, percentage, mean, and standard deviation (SD), were reported. Data analysis was carried out using the chi-square test and Mann-Whitney U test. Results: The study showed no significant differences between adolescent and young mothers in terms of mean scores related to the challenges of the transition to parenthood, such as responsibility and commitment, pleasure and satisfaction, fondness and stability, and self-commitment (P ≥ 0.05). However, significant differences were observed between the 2 groups in the total score of infant care (33.07 ± 2.77 and 34.57 ± 2.65, P = 0.002), child disease care (10.63 ± 0.73 and 11.03 ± 1.20, P = 0.034), routine child care (5.38 ± 1.23 and 5.83 ± 1.28, P = 0.039), and maternal health (13.37 ± 1.60 and 14.29 ± 1.29, P &lt; 0.0001) for adolescents and young mothers, respectively. Conclusions: Based on the study’s results, teenage mothers might benefit from support programs provided by healthcare providers, particularly midwives and doctors, to enhance their abilities to care for their children.

Evaluating E-Module KPSP: A Research and Development Approach

Introduction: Media and learning resources are part of the components that influence learning. Utilizing and empowering e-modules to support learning is necessary, not only to increase the effectiveness and quality of education but, more importantly, to improve mastery of the material for both lecturers and students. Objective: The purpose of this research is to design learning media in the form of KPSP e-modules, which are used to support the learning process so as to increase student attractiveness and student understanding. Method: This study uses a research and development (R&amp;D) procedure. The subjects of this study were 58 Midwifery Diploma students for the 2021–2022 academic year. Result: The content aspect of the KPSP e-module is rated as "very feasible." the content aspect of the KPSP e-module is rated as "Very Feasible" in 91%. The media feasibility analysis portrays the KPSP e-module as a highly viable and effective learning tool. The percentage of media suitability as a whole is getting an average score of 85%, including the very feasible category. Conclusion: Based on the results of the research and discussion, it can be concluded that the average overall student perception results are 89% in the very good category. This indicates that the electronic module (e-module) is good and suitable for use as a distance learning medium in courses on caring for neonates, infants and toddlers