Care Of Preterm Infants Research Articles

The effect of Web-based preterm infant care training on mothers’ self-confidence

The internet can be used as an alternative method in infant care education for mothers of preterm infants. This study was conducted to examine the effect of the Web-based infant care training program given to mothers of preterm infants on the self-confidence levels of mothers. This nonrandomized controlled study with a posttest design was conducted in Ministry of Health training and research hospital and university hospital. The study group comprised 84 mothers and their infants (intervention group: N = 42; control group: N = 42). Mothers with preterm infants in the intervention group participated in the Web-based program. The self-confidence of the mothers was evaluated before and after the training. The mothers’ Pharis self-confidence scale mean scores were higher than the control group, but there was no significant difference. Web-based education program can be an alternative method that can be used in the education of mothers with preterm infants.

Mother-NICU: An approach to reducing the Neonatal Mortality.

Respected Mam, Pakistan ranks 3rd on highest newborn deaths by WHO. 75% of all neonatal occur during the first week of life, with the most common causes being preterm birth, birth asphyxia, infections and birth defects.(1) Kangaroo Mother Care (KMC) is one of the best options to provide care for premature babies in low socioeconomic countries (LSIC).It involves continuous skin-to-skin contact of the infant with the mother and feeding of exclusively breast milk. It reduces neonatal mortality, improves weight gain, reduces hospital stay and promotes mother-infant attachment. Currently, WHO recommends initiation of continuous KMC sessions when an infant has stabilized (2), which is usually after the first week of life in which most neonatal deaths happen. Previously studies showed that immediate KMC (iKMC) during incubator care before stabilization improves the survival of preterm (LBW) low birth weight infants (3, 4). A recent multicenter trial(5) was conducted WHO KMC study group in five LSIC to study the efficacy of iKMC among LBW infants. The results showed significant improvement (25%) in neonatal survival. The trial was stopped early owing to the finding of reduced mortality among infants receiving iKMC. For the provision of iKMC, establishment of mother- Neonatal Intensive Care Units (M-NICU) is essential. In standard NICU, the mother is only a visitor but in M-NICU, she is a permanent resident with mother’s beds alongside the baby’s warmer/incubator. This facilitates longer iKMC sessions and she becomes an active caregiver to the baby. (6) Currently there are only 17 established KMC wards in Pakistan where UNICEF provides necessary equipment and training to healthcare staff. The establishment of M-MICU’s reduce the neonatal mortality rate in LSIC like Pakistan. It involves the collaboration of administration and funding stakeholders to convert existing NICU to M-NICU’s. Team work of Gynae/Obs and Neonatology departments is needed to provide post-delivery care to mothers in M-NICU’s, KMC training to health care staff, surrogates for mothers who are unable to provide iKMC due to major post-op complications and awareness campaigns to make the concept of KMC more acceptable in our society. Continue...

Difficulties in monitoring of premature infants in outpatient facilities (third stage of nursing)

Premature birth remains an urgent problem of modern healthcare around the world. At the same time, the improvement of neonatal care for premature babies has led to a significant decrease in infant mortality and an increase in the survival rate of children with very low and extremely low body weight. Nursing and monitoring such children requires a special approach. A premature baby has one or more reasons for the early development of chronic pathology and needs a long-term, differentiated, continuous monitoring, provided a clear continuity of all stages of nursing.The article presents the results of observation of premature babies in 20 polyclinics of Saint Petersburg in the first year of life at the time of the study. The authors analyzed medical histories (form 112/y) of 88 children born prematurely (from 22 to 36 weeks of gestation). It has been determined that most often the dispensary observation groups include children with pathology of the central nervous system, organs of vision, and surgical pathology. Insufficient coverage with vaccine prophylaxis (from 33 to 78% for various vaccine-preventable infections) was revealed not only with additional drugs for the risk group, but also with the main vaccinations of the National Calendar. Monitoring premature babies, their rehabilitation and habilitation are the responsibility of the third (outpatient) level of nursing. However, the lack of uniform approaches to dispensary observation, rehabilitation treatment of premature babies, the lack of clear routing create difficulties in the management of such children in a polyclinic. The authors proposed options for solving this important problem in order to increase the efficiency of the primary pediatric care for premature babies at the place of residence of the child.

First intention high-frequency jet ventilation for periviable infants.

Ventilation of periviable infants born at 22-23 weeks gestation remains a challenge in neonatology. This review highlights the evidence surrounding the use of first intention high-frequency jet ventilation (HFJV) in infants born near the limits of viability with a review of pulmonary fetal development and a focused overview of HFJV strategies including an in-depth analysis of the management strategies used in the initial randomized trials. A paucity of recent trials exists, with no randomized control trials assessing the use of first intention HFJV performed in the last 25 years. A retrospective observational cohort trial of the use of HFJV for infants born at less than 750 g has been recently published demonstrating the efficacy of HFJV for this population even with 2.0-mm endotracheal tubes. The lack of recent randomized trials contributes to the controversy surrounding the use of first intention HFJV. Although new research is needed in the area, this review includes the ventilation strategy of an experienced center with a focus on the use of first intention HFJV for the care of premature infants born less than 24 weeks gestation.

Effects of a Neonatal Supportive Positioning Training Video Program for Preterm Infants on the Knowledge and Performance of Nurses in Neonatal Intensive Care Units

The purpose of this study is to develop and apply a neonatal supportive positioning (NSP) training video program for premature infants, using a position support mat for nurses in neonatal intensive care units (NICUs), and to verify its effect on nurses' performance. Thirty-five NICU nurses were included in the study. For the pre-test, preliminary check-ups were conducted, questionnaires about NSP knowledge on preterm infants were distributed, and NSP performance using neonatal dolls were video recorded for each participant. PowerPoint presentations and videos were used to educate participants on NSP. Furthermore, a 20-minute one-on-one training session was conducted using an NPS kit. Two weeks after the training, we repeated the process of distributing questionnaires about NSP knowledge and recording nurses' performance videos using neonatal dolls. Questionnaires and videos collected before and after the training were compared. After NSP training, the mean knowledge score of the participants improved significantly from 23.71±3.62 to 29.51±2.29(Z=-5.09, p<.001). The performance score for postural supportive positioning was 38.03±7.46 before training and 80.06±9.85 after receiving training, indicating a high-performance score after NSP training (Z=-5.16, p<.001). Our NSP training video program increased nurses' NSP knowledge and performance. Continuous training NICU nurses on NSP, using a standardized training video program, can help improve the care of premature infants.

Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm.

Progressive improvements in perinatal care and respiratory management of preterm infants have resulted in increased survival of newborns of extremely low gestational age over the past few decades. However, the incidence of bronchopulmonary dysplasia, the chronic lung disease after preterm birth, has not changed. Studies of the long-term follow-up of adults born preterm have shown persistent abnormalities of respiratory, cardiovascular and cardiopulmonary function, possibly leading to a lower exercise capacity. The underlying causes of these abnormalities are incompletely known, but we hypothesize that dysanapsis, i.e. discordant growth and development, in the respiratory and cardiovascular systems is a central structural feature that leads to a lower exercise capacity in young adults born preterm than those born at term. We discuss how the hypothesized system dysanapsis underscores the observed respiratory, cardiovascular and cardiopulmonary limitations. Specifically, adults born preterm have: (1) normal lung volumes but smaller airways, which causes expiratory airflow limitation and abnormal respiratory mechanics but without impacts on pulmonary gas exchange efficiency; (2) normal total cardiac size but smaller cardiac chambers; and (3) in some cases, evidence of pulmonary hypertension, particularly during exercise, suggesting a reduced pulmonary vascular capacity despite reduced cardiac output. We speculate that these underlying developmental abnormalities may accelerate the normal age-associated decline in exercise capacity, via an accelerated decline in respiratory, cardiovascular and cardiopulmonary function. Finally, we suggest areas of future research, especially the need for longitudinal and interventional studies from infancy into adulthood to better understand how preterm birth alters exercise capacity across the lifespan.

Care with child development and André Bullinger's special look at prematurity.

Objective:To assess different ways of caring for preterm infants’ development and for their families in neonatal units, with emphasis on the studies by André Bullinger.Data source:A review of the literature in the databases PubMed, SciELO, and the Cairn.info portal, which publishes reviews in human sciences in French. Also, the books and articles of André Bullinger, available only in French, were reviewed.Data synthesis:This review includes the Kangaroo Method, which is based on skin to skin contact and the encouragement of breastfeeding; the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synaptic Developmental Theory and aiming to positively change the neonatal environment, having the preterm newborn as the actor of their own development and the mother as a regulator; and the Bullinger Approach, which uses a sensory-motor perspective to approach child development, including preterm infants’ development.Conclusions:The Kangaroo Method has changed child developmental care in countries with limited financial resources. NIDCAP was shown to be efficient, although only a few long-term studies have been conducted on the subject. The Bullinger Approach is well diffused in European neonatal units, with promising results for the prevention of neurodevelopmental disabilities, especially those related to orality

Individual, Social and Institutional Vulnerabilities in the Premature Infant Care at Home

The prematurity carries some difficulties for families during the preterm infant hospitalization, as well as, after hospital discharge. In this context, is required a specific knowledge about the preterm biological characteristics, family’s life conditions, health care, and social context. This study aims to analyze parent’s experiences on daily home care for preterm infants focusing on individual, social and institutional vulnerabilities. Descriptive qualitative study was developed through the hermeneutic perspective approach, in South of Brazil with six families, who had babies discharged from Neonatal Intensive Care Unit. Non-structured interviews were recorded in the home visit with 12 participants (parents) and genogram and ecomap were applied. Emerged as core theme: Parents’ feelings related to preterm care at home and their interaction with health services. During the first month after discharge, parents were emotionally vulnerable. There is a lack of connection between parents and Primary Health Care, what increases institutional vulnerability. After discharge, parents have experienced an individual, social, and institutional vulnerability. To minimize their institutional vulnerability, the health services need to be organized in a network offering qualified follow-up. Applying the Health Policy to care for premature infant, consequently, reducing the individual vulnerability and recognize social vulnerabilities related to premature infant care.

Retinopathy of prematurity: risk factors for its development in two neonatal intensive care units in Paraná-Brazil.

Evaluate the patients in two neonatal intensive care units in Paraná/Brazil and identify the risk factors for the development of retinopathy of prematurity. We performed a prospective cohort study on premature infants with gestational age ≤32 wk and/or with birth weight ≤1500 g who were admitted to the neonatal intensive care unit of Hospital do Trabalhador and Hospital Infantil Waldemar Monastier. These hospitals admit patients referred from other maternity hospitals in the state of Paraná. The study duration was 12 mon. The incidence of retinopathy of prematurity was higher in the Hospital Infantil Waldemar Monastier than in the Hospital do Trabalhador for premature infants who needed to be transported from their birthplace to the intensive care unit (52.2% vs. 29.6%). The following risk factors were associated with the development of the disease: longer hospitalization, low gestational age at birth, longer oxygen use, vasoactive drugs use, no antenatal corticosteroids use, intracranial hemorrhage, and any glycemic disorder. Low birth weight was an independent risk factor for the development of retinopathy of prematurity. Early neonatal care and transportation of premature infants may influence the occurrence and prognosis of retinopathy of prematurity.

Analysis of research on developmentally supportive care for prematurity in neonatal intensive care unit: a scoping review

PurposeThe purpose of this study was to identify the gaps in research related to developmentally supportive care in the neonatal intensive care unit (NICU). The ultimate goal was to explore directions of further research on developmentally supportive care for premature patients.MethodsThe Arksey and O'Malley scoping review method was used. Articles on developmentally supportive care for preterm infants in the NICU, written in English or Korean, were identified through electronic search engines. A total of 279 papers were identified in the initial search, of which 22 full-text papers were included in this review.ResultsSeveral nursing studies have been published in the past 5 years. The important elements of developmentally supportive care were family-centered care and management of the NICU environment. The primary developmentally supportive care interventions were training programs to promote the care competency of NICU nurses.ConclusionIt is necessary to actively develop comprehensive developmental support interventions that consider the various elements of developmentally supportive care for preterm infants. Additional studies should be done to develop programs that provide direct intervention for premature infant and their families.

Developmental Care of Premature Newborns: A Success Story from Evidence-based Research

Nursing is useful to the society through the efforts to prevent health problems and through the care, the support and the comfort it provides to the public. In addition, nursing contributes to the advancement of knowledge about experiences of health and illness. Indeed, from the phenomena at the field experience, theoretical work and research in human health play a role in the development of the discipline and the nursing profession. The importance of research for nursing is particularly evident in a context in which evidence-based practice is being promoted, an unavoidable reality in the health field. However, research results do not translate so easily into practice, and it is often argued that there is a gap between the availability of research results and professional practice. Filling this gap cannot depend solely on the world of research and the availability of evidence. It also considers the practice environment and its ability to take into account the available results. This article aims at clarifying the link between the status of discipline, the nursing profession and care in order to establish the need for a better link between knowledge, research and the practice of nursing. It also seeks to briefly recall how knowledge and research contribute to the advancement of a discipline while having the potential and the power to improve practice. More specifically, an example of evidence will highlight how research findings can influence practice and care, outlining briefly how research on investigating the effect of variation in light and noise in neonatal departments in West especially in USA, Canada, Australia, France, etc, have improved the practice of nursing and how nursing theories can contribute not only to the advancement of nursing discipline, but also to the improvement of the provided cares. Levine's conservation model and the theory of promoting pre-term infant health served as a theoretical framework for experimentation to improve the practice of caring for pre-term infants, hence the obligation for nursing staff to pay attention to them and try to integrate them into their interventions.

Mathematical modeling of the hematocrit influence on cerebral blood flow in preterm infants.

Premature birth is one of the most important factors increasing the risk for brain damage in newborns. Development of an intraventricular hemorrhage in the immature brain is often triggered by fluctuations of cerebral blood flow (CBF). Therefore, monitoring of CBF becomes an important task in clinical care of preterm infants. Mathematical modeling of CBF can be a complementary tool in addition to diagnostic tools in clinical practice and research. The purpose of the present study is an enhancement of the previously developed mathematical model for CBF by a detailed description of apparent blood viscosity and vessel resistance, accounting for inhomogeneous hematocrit distribution in multiscale blood vessel architectures. The enhanced model is applied to our medical database retrospectively collected from the 254 preterm infants with a gestational age of 23–30 weeks. It is shown that by including clinically measured hematocrit in the mathematical model, apparent blood viscosity, vessel resistance, and hence the CBF are strongly affected. Thus, a statistically significant decrease in hematocrit values observed in the group of preterm infants with intraventricular hemorrhage resulted in a statistically significant increase in calculated CBF values.

46 ‘Born Too Soon’ Virtual Simulation for Ambulance Services On Premature Babies Born Unexpectedly in the Community

Premature infants are at risk of death or neurodevelopmental impairment unless prompt effective care is delivered The aim of the study was to introduce a recurring virtual simulation workshop for WMAS on optimizing the initial care for vulnerable premature infants born unexpectedly in the community.Our local WMAS lead identified a training need through informal feedback from paramedics about the lack of training and confidence in dealing with premature births. Our workshop, designed to address this need, begins with an overview of prematurity. A simulation session follows, demonstrating basic Neonatal Life Support skills using equipment available to pre-hospital teams, focussing on thermoregulation. It concludes with a question-and-answer session. To enhance pre-hospital thermal care, we also put forward a successful business case for heated gel mattresses to be introduced across the WMAS and incorporated training for its use in the workshop.Two virtual training workshops have been delivered so far. In 2020, seven paramedics attended, and two completed the feedback and found the session valuable. After advertising, a second workshop was delivered in March 2021. Over 330 WMAS personnel registered, 219 attended and 132 gave feedback. There were representatives of various grades from 16 hubs across the region. Before the session, 12.2% of participants reported feeling somewhat confident/confident attending unplanned premature births of infants &lt;32 weeks’ gestation. Following the session, this improved to 66.7% of participants. Attendees commented on how ‘useful’, ‘fabulous’ and ‘fantastic’ they found the session. The sharp rise in interest in this virtual workshop confirms the training need whilst the positive feedback highlights the effectiveness of the virtual simulation workshop. With enhanced technical support, we will improve the learning experience of participants in the future. This project also led to the successful introduction of heated gel mattresses which are now carried on every WMAS ambulance. We expect that with increased staff training and confidence, the incidence of babies admitted with hypothermia following an unexpected birth in the community will improve with time. Our vision is to expand this project to other regions to empower pre-hospital staff to support premature infants born unexpectedly in the community and improve outcomes.

SAFETY AND QUALITY OF INTRAVENOUS LIPIDS FOR NEWBORNS: EFFECTS ON CRITICAL DISEASES AND METABOLIC DISORDERS (PART II)

Premature birth and its complications cause stress in newborns, which restrains their physical growth for several weeks after birth and is associated with chronic morbidity and neurological disability in the future. Preterm infants face such difficulties as respiratory distress, cardiovascular disease, gastrointestinal dysfunction and very low birth weight. Most complications in newborns are associated with oxidative stress that develops during the early period of growth. The formation of free radicals entails oxidative damage to many organs and systems of the body and is the main factor responsible for the development of typical diseases of preterm infants, such as bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, and respiratory distress syndrome.&#x0D; Premature infants depend on adequate early parenteral nutrition, which not only guarantees they will survive but also ensures positive health outcomes later in life. Early use of intravenous lipids helps to prevent essential fatty acid deficiencies, provides energy and substrates for cell membrane synthesis, which are important for the growth and development of infants with very low and extremely low birth weight. This publication represents data on the effect of intravenous lipids on critical conditions and metabolic disorders in newborns. Literature sources are analyzed and the existing evidence of the possible influence of lipid emulsions on critical diseases in newborns is presented: intraventricular hemorrhage; necrotizing enterocolitis, patent ductus arteriosus and thrombocytopenia; glucose metabolism (hypo- and hyperglycemia); hyperbilirubinemia and chronic liver damage. The literature review is aimed at finding optimal strategies for the use of lipid emulsions in intensive care of newborns to improve the quality of care for premature infants. The purpose of this work is to analyze the results of published studies and systematize data on the feasibility and safety of lipid emulsions used in newborns with critical diseases of the perinatal period.

Risk factors for death in Welsh infants with a congenital anomaly

ObjectivesTo investigate risk factors associated with death of infants with a congenital anomaly in Wales, UK.DesignA population-based cohort study.SettingData from the Welsh Congenital Anomaly Register and Information Service (CARIS) linked...

Nasal continuous positive airway pressure levels for the prevention of morbidity and mortality in preterm infants.

Nasal continuous positive airway pressure levels for the prevention of morbidity and mortality in preterm infants.

What Support Systems do Women Caring for Preterm Infants at Home Require in Urban Ghana? A Qualitative Study.

Caring for preterm infants and ensuring their survival beyond neonatal intensive care units remain a challenge in many low-income settings. While studies highlight the difficulties of caring for preterm infants at home, few have focused on the forms, sources, and accessibility to support systems. This study explored the forms of support systems women caring for preterm infants at home in urban Ghana require, and their accessibility to such support systems. An explorative cross-sectional qualitative study was conducted. A total of 19 women who were caring for preterm infants aged 2-6months at home were purposively sampled. In-depth interviews were conducted and thematic content analysis used to analyse the data. Women reported four main forms of support which they require: psychosocial support, practical support, material support and spiritual support. However, accessibility to these support systems was highly unequal, often depended on one's social status and the quality of one's family and interpersonal relationships prior to giving birth to a preterm infant. Women caring for preterm infants at home require a variety of support systems; but effective accessibility remains a challenge for many in urban settings. Interventions to strengthen community and home-based support for women caring for preterm infants at home, including use of social media-based peer support groups, are urgently needed.

Effect of Infant Care Training on Maternal Bonding, Motherhood Self-Efficacy, and Self-Confidence in Mothers of Preterm Newborns.

This study aims to evaluate the effect of infant care training on maternal bonding, motherhood self-efficacy, and self-confidence in mothers of preterm newborns and examine the relationship between them. The study was conducted experimentally with pre-test and post-test control groups in the Maternity Hospital. The population of the study consisted of late preterm newborns and their mothers (N = 81) who met the inclusion criteria of the study. Data was collected with an information form, a maternal bonding scale (MBS), a perceived maternal parenting self-efficacy scale (PMP-SE), and a Pharis self-confidence scale (PSCS). Mothers of the infants in the experimental group were given preterm infant care training as a nursing initiative. In the study, the post-test MBS scores significantly increased in the experimental group, with a significant difference between all the sub-dimensions and the total scores of the PMP-SE post-test of mothers in both groups (p < 0.001). The post-test PSCS scores were significantly higher in the experimental group (p < 0.01). The correlation between MBS and PMP-SE (p < 0.05) mean scores of the mothers was positive, a correlation between PMP-SE and PSCS (p < 0.001) mean scores was positive and a correlation between PSCS and MBS (p < 0.05) mean scores was positive. The existence of a directly proportional relationship between the variables of maternal bonding, motherhood self-efficacy, and self-confidence may mean that motherhood self-efficacy can be increased and motherhood self-confidence can be enhanced by supporting maternal bonding. Further studies starting from the prenatal period are recommended.

Artificial intelligence technologies in predicting preeclampsia

The strategy for preserving reproductive potential in the Russian Federation is focused on the personalized women’s health care and based on preclinical identification of gynecological diseases and major obstetric syndromes at the stage of predicting adverse outcomes and subsequent preventive measures able to reduce maternal and perinatal morbidity and mortality, decrease women and neonatal disability as well as profoundly reduce extremely high costs on care of premature infants. The search for effectivepredictive methods of preeclampsia (PE) at the stage of preconception and in the first trimester of pregnancy is driven by the desire to identify women at greater risk of developing hypertensive disorders in order to take the necessary effective measures forpreventing placental pathology as early as possible, thereby preventing or reducing incidence rate of PE. At the same time, identifying a group of high-risk women would allow to rationally plan prenatal care, timely recognize emergence of multiple organdysfunction and immediately begin pathogenetic and symptomatic therapy. Taking into account the national and global experience of using predictive analytics software proving their success in reproductive medicine, it is reasonable to assume that converting prognosis into digital format by using artificial intelligence (AI) algorithms will open new opportunities for increasing accuracy of individual risk calculation for PE by meeting current paradigm of personalized preventive medicine. Our scientific review on domestic and international publications aims to inform a wide range of obstetricians-gynecologists about advances in AI technologies as well as prospects for machine learning to predict PE.

Supporting Feeding of Late Preterm Infants in the Hospital: A Quality Improvement Project.

Feeding difficulty is the most common cause of delayed hospital discharge and readmission of late preterm infants. Frequent and adequate feedings from birth are protective against dehydration, hypoglycemia, and jaundice. The National Perinatal Association's feeding guidelines provide the foundation for late preterm infant standards of care. Feeding at least every 3 hours promotes nutritional status and neurologic development. One feeding assessment every 12 hours during the hospital stay can ensure quality of infant feeding. At a large urban hospital, medical record reviews were completed to evaluate nursing care practices consistent with the hospital's late preterm infant care standard policy. Feeding frequency and nurse assessment of feeding effectiveness were far below acceptable targets. A quality improvement team was formed to address inconsistency with expected practice. The project included an investigation using the define, design, implement, and sustain method of quality improvement. Parent education, nurse education, and visual cues were developed to sustain enhanced nursing practice. Late preterm infants who received feedings at least every 3 hours increased from 2.5% (1 of 40) to 27% (11 of 40); (M = 0.275, SD = 0.446), p = 0.001. Documented breastfeeding assessments increased from 2% (5 of 264) to 8% (10 of 126), p = 0.001. Documented bottle-feeding assessments increased from 15% (39 of 264) to 31% (53 of 172), p < 0.001. Intervention time was cut short due to reprioritization of efforts in response to the COVID-19 pandemic. Interventions and implementation of this process improvement is easy to replicate through attainable and sustainable goals directed toward improved outcomes for late preterm infants.