Care Of Preterm Infants Research Articles

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.

A Study to Assess the Knowledge on Kangaroo Mother Care Among Post Natal Mothers of Low-Birth-Weight Babies at Selected Hospital of Vrindavan, Mathura, U.P.

Abstract: According to the statistical assessment nearly 20 million low-birth-weight (LBW) babies are born each year, because of either preterm birth or impaired prenatal growth, mostly in less developed countries. They contribute substantially to a high rate of neonatal mortality whose frequency and distribution correspond to those of poverty. Kangaroo mother care (KMC) is an effective way to meet baby’s needs for warmth, breastfeeding, protection from infection, stimulation, safety and love. Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. KMC facilitates the initiation and establishment of breastfeeding in small infants and it normalize infant physiology improves weight gain and provide sense of security to the baby. It has been demonstrated that Kangaroo Mother Care is associated with increased survival and reduced hospital. Objectives 1) To assess the level of knowledge among the post-natal mothers of low-birth-weight babies regarding kangaroo mother care in selected hospital of Vrindavan. 2) To correlate the knowledge regarding Kangaroo Mother Care among the post-natal mothers of low-birth-weight babies with selected demographic variables. Methodology: This study was conducted to assess knowledge among the post-natal mothers regarding Kangaroo mother care in selected Hospital in Vrindavan, Mathura and the descriptive study design was selected. Population selected was post-natal mothers and sample size were 60.the consent was taken. The subjects were selected by convenient sampling technique. The structured questionnaires were distributed to the mothers of selected Low birth weight babies to assess their level of regarding Kangaroo Mother Care after obtaining an informed consent. Data was collected by using Structured Knowledge Questionnaire. A significant association was found between knowledge score and type of family and dietary habit whereas no significant association was found with age, religion, occupation of father, educational status of mother, family income and residential status Results: The study revealed that the level of knowledge among the mothers is 42(70%) had inadequate knowledge and 12(20%) had moderately adequate knowledge and 06(10%) had adequate knowledge regarding Kangaroo Mother Care. The chi-square test revealed that there was no significant association with age, occupation, monthly income, place of living, type of marriage, type of family, number of children and but there was significant association between religion. Keywords: Kangaroo mother care, Postnatal, Practice

Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit.

The aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the rate, frequency, and duration of kangaroo care (KC) in the neonatal intensive care unit (NICU) compared with preterm infants of higher SES or primarily English-speaking families. Participants were infants born <32 weeks' gestational age (GA), N = 116. We defined SES by the infants' health insurance (private/higher vs public/lower) and language by the language mothers used to communicate with clinical staff (English vs Other language). SES or language groups were compared on (1) rate of KC infants experienced during hospitalization per visitation days, (2) frequency of KC per visitation days, and (3) duration of KC events per day. Infants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant. Our findings revealed disparities in the rate, frequency, and duration of KC experienced in the NICU as a function of both SES and language. Such disparities reduced infants' access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize these disparities.

Exploring Internal Facilitators' Experience With NeoECHO to Foster NEC Prevention and Timely Recognition Through the iPARIHS Lens.

Necrotizing enterocolitis (NEC) remains a major complication in the neonatal population. Standard practices regarding the care of premature infants and attitudes toward NEC prevention strategies vary across neonatal intensive care units (NICUs). Evidence-based best practice dissemination was presented through the NEC-Zero bundle. To close gaps between evidence and practice, a telehealth-delivered intervention (ie, NeoECHO) was provided to NICUs. The purpose of this study was to enable adoption of best practice for NEC prevention using NeoECHO through describing the local volunteer unit leaders', or internal facilitators' (IFs'), experiences in participating in NeoECHO and identifying the extent to which the facilitation activities within the NeoECHO experience were consistent with constructs from the integrated Promoting Action on Research Implementation in Health Services (iPARHIS) framework. The design of this study was qualitative descriptive. Six IFs were recruited in the Southwest. After 6 NeoECHO sessions, individual interviews were conducted and transcribed verbatim. Content analysis was applied. Codes were informed by the iPARIHS framework. Major themes were (1) Innovation: Quality Improvement Projects, Bundles of Care, and Huddle; (2) Recipient: Reluctant Stakeholders and Technical Modalities; (3) Context: Buy-In, Timing, Resources, Leadership, and Blame; (4) Facilitation: Betterment, Buddy System, Passionate Care, and Empowerment; and (5) Adoption: Continuous Quality Improvement, Evidence-Based Practice, and Honest Discussions. NeoECHO fostered a learning community to share current practices, policies, and strategies for NEC prevention, but the IFs were essential to foster local participation. The long-term impacts of NeoECHO are the focus of current research.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Midwives’ and mothers’ perspectives on skin-to-skin care of premature and low-birthweight infants in Puntland, Somalia

Background: More than 2.5 million children die yearly due to prematurity and low birthweight. Skin-to-skin care provides a thermal-control environment that offers protection from infection and eases breast milk feeding to the advantage of the new-born. Aim: This study aimed to explore barriers and facilitating factors for introducing skin-to-skin care of premature and low-birthweight infants based on input from mothers and midwives in Puntland, Somalia. Methods: Qualitative semi-structured interviews with four mothers and four midwives were analysed using qualitative content analysis. Results: The findings are presented in four categories: enabled by support and hands-on information to the mother and her family; aided by collaboration with the mother’s family to overcome the mother’s resistance; impeded by limited time, lack of resources and unavailable guidelines; and hindered by traditional and social beliefs. Both mothers and midwives emphasised the importance of information and education concerning skin-to-skin care of premature and low-birthweight infants. Family members and midwives facilitated skin-to-skin contact as the care model. The degree to which the midwives provided information to the mothers and their family members depended on how the two latter groups received and acted on such information and education. Lack of motivation by mothers, their families or midwives were barriers to skin-to-skin contact as a care model. Conclusion: Standardised guidelines, preferably culturally tailored for low socioeconomic groups, for midwives’ use when informing mothers and families on skin-to-skin contact as a care model for premature and low-birthweight infants would empower women, families and midwives to facilitate the practice in Puntland, Somalia.

Learning needs of health visitors and family nurses in the care of preterm infants in Scotland

In Scotland and across the UK, health visitors and family nurses provide ongoing assessment and care for the preterm infant and their family following discharge from hospital. This study demonstrates that health professionals in Scotland feel underprepared for this responsibility and that the causes of are multifaceted. Practitioners highlight areas of concern that will guide educational providers to consider amendments to their curricula or provision of continuing professional development.

Developmentally Supportive Care Among Neonatal Intensive Care Unit Nurses in South Korea: Knowledge, Perceived Importance, Perception, and Perceived Competence.

The concept of developmentally supportive care in preterm infants is of considerable significance in the neonatal intensive care unit (NICU) setting with regard to preventing complications from preterm birth and promoting optimal growth and development. To provide high-quality developmentally supportive care, NICU nurses must possess high levels of knowledge, importance, perception, and competence. The purpose of this study was to investigate South Korean NICU nursing staff's level of knowledge concerning developmentally supportive care, as well as the perceived importance, perception, and perceived competence regarding this concept. This study employed a cross-sectional descriptive design. Between June 1 and 19, 2020, 160 nurses completed a self-report questionnaire pertaining to developmentally supportive care, which covered the aspects of knowledge, perceived importance, perception (including attitudes, perceived behavioral control, subjective norms, and intentions), and perceived competence. The levels of knowledge, attitude, and intention as a subfactor of perception, and perceived competence pertaining to developmentally supportive care were not high. There was no significant difference in the knowledge and perceived competence of skilled nurses compared with novice nurses. However, skilled nurses recognized that they could provide better developmentally supportive care than novice nurses. Perceived competence was positively correlated with perceived importance and perception. Systematic educational programs that can enhance developmentally supportive care competence should be provided to NICU staff nurses. These must clarify the importance of developmentally supportive care and improve NICU nurses' knowledge, attitudes, self-efficacy, and intentions.

Recomendaciones para el cuidado y la atención de los recién nacidos prematuros en tiempos de la pandemia de COVID-19: Revisión integrada de la literatura.

Objective: To describe recommendations for the care and handling of preterm infants in the COVID-19 pandemic scenario. Methods: Integrated Literature Review (ILR) conducted in 2020 in databases in the Virtual Health Library (VHL) by extracting scientific productions from the databases: MEDLINE, SCIELO, PUBMED and LILACS, with a final sample of 14 publications. Results: Among the recommendations found in the studies analyzed, regarding childbirth, it is recommended to choose the best time, route and place, prioritizing the use of a negative pressure room. After delivery, newborns should have the umbilical cord clamped, be cleaned and dried as soon as possible, and isolated and tested early. After initial care, the use of a mask and hand hygiene is recommended before each meal or other close contact with the newborn. Ideally, suspected or contaminated RN should be kept in isolation and constantly monitored, with a quarantine period of at least 14 days. Conclusions: The knowledge of nurses and other health care professionals about prevention and control measures for newborn infection with COVID-19 is critical to the prevention, control, and reduction of the impact of the pandemic on the neonatal population. Keywords: Coronavirus infections, COVID-19, Nursing Care, Neonatal Nursing and Premature Birth Infections

Difficulties for Mothers: Premature Baby Care at Home

Difficulties for Mothers: Premature Baby Care at Home

A Case of an Infant with Hydrops Fetalis and Hypoxic–Ischemic Encephalopathy Treated with Therapeutic Hypothermia

Hydrops fetalis (HF) is a serious fetal condition. Infants born with HF are often critically unwell, requiring resuscitation and prolonged intensive care admission. Despite medical advances, morbidity and mortality remain high. Therapeutic hypothermia is the standard of care for term and late preterm infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE), as it improves neurodevelopmental outcomes in surviving infants. To our knowledge, the use of therapeutic hypothermia has not previously been reported in infants with HF. We report the case of a term infant with undiagnosed HF, who required resuscitation and received 72 hours of therapeutic hypothermia for moderate HIE. We describe the cardiovascular instability encountered during therapeutic hypothermia and how it was successfully managed. She responded well to treatment and was discharged home bottle-feeding, with normal neurology and a normal brain magnetic resonance imaging scan. From this case, therapeutic hypothermia in infants with HF and HIE is feasible and can be beneficial in carefully selected HF infants meeting cooling criteria.

Automation of oxygen titration in preterm infants: Current evidence and future challenges

For the preterm infant with respiratory insufficiency requiring supplemental oxygen, tight control of oxygen saturation (SpO2) is advocated, but difficult to achieve in practice. Automated control of oxygen delivery has emerged as a potential solution, with six control algorithms currently embedded in commercially-available respiratory support devices. To date, most clinical evaluations of these algorithms have been short-lived crossover studies, in which a benefit of automated over manual control of oxygen titration has been uniformly noted, along with a reduction in severe SpO2 deviations and need for manual FiO2 adjustments. A single non-randomised study has examined the effect of implementation of automated oxygen control with the CLiO2 algorithm as standard care for preterm infants; no clear benefits in relation to clinical outcomes were noted, although duration of mechanical ventilation was lessened. The results of randomised controlled trials are awaited. Beyond the gathering of evidence regarding a treatment effect, we contend that there is a need for a better understanding of the function of contemporary control algorithms under a range of clinical conditions, further exploration of techniques of adaptation to individualise algorithm performance, and a concerted effort to apply this technology in low resource settings in which the majority of preterm infants receive care. Attainment of these goals will be paramount in optimisation of oxygen therapy for preterm infants globally.

Factors Affecting the Implementation of Developmental Care in the Care of Premature Babies in NICU Nurses: A Systematic Review

Introduction: Developmental care-based preterm infant care management that aims to protect the neurological system and reduce adverse effects has developed over the last few decades. The study aimed to explore the factors that influence the implementation of developmental care among NICU nurses.Methods: The study was systematically identified by searching an electronic database using keywords "preterm infant" AND "developmental care" AND "nursing care" AND "NICU" and consisted of 2130 articles from Scopus, Science Direct, goggle scholar, ProQuest, and PubMed. Data sources were limited to articles published from 2015 to 2020 and those published in English. Thirteen studies were included in this systematic review. The inclusion criteria were nurses caring for preterm infants at the NICU, a cross-sectional descriptive study of quantitative or qualitative research.Results: Thirteen articles indicated that the developmental care implementation among NICU nurses was influenced by positive, perceptions knowledge, attitudes of developmental care. Professional skills are the most substantial impact on developmental care implementation to improve nurses' nursing development and increase the competence of individual nurses.Conclusion: Positive perceptions about organizational support and developmental care are needed. The training care program also benefits to nurses by increase self-confidence in implementing developmental care for premature babies.

Advancing the Evidence Base in the Care of Term and Late Preterm Infants.

Advancing the Evidence Base in the Care of Term and Late Preterm Infants.

Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China

ObjectiveTo describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC...

Effect of Preterm Birth on Cardiac and Cardiomyocyte Growth and the Consequences of Antenatal and Postnatal Glucocorticoid Treatment.

Preterm birth coincides with a key developmental window of cardiac growth and maturation, and thus has the potential to influence long-term cardiac function. Individuals born preterm have structural cardiac remodelling and altered cardiac growth and function by early adulthood. The evidence linking preterm birth and cardiovascular disease in later life is mounting. Advances in the perinatal care of preterm infants, such as glucocorticoid therapy, have improved survival rates, but at what cost? This review highlights the short-term and long-term impact of preterm birth on the structure and function of the heart and focuses on the impact of antenatal and postnatal glucocorticoid treatment on the immature preterm heart.

Development and Testing of Instrument to Assess Preterm Infant Care Practice in Neonatal Care Units

Background: Preterm infants (PTIs) are vulnerable to morbidity, mortality, disability. They require special treatment and care in neonatal care units (NCUs) for survival and developmental potential. Nurses have the significant responsibility for providing quality care to these infants. To find out the care status, it is necessary to have a valid and reliable instrument.Objective: The study was conducted to develop and test an instrument to assess PTI care practice by nurses in NCUs.Methods: The instrument was developed based on literature review and the finding of the focus group discussion (FGD). The instrument was developed in August 2020 and pretested among 30 nurses working in NCUs of two private teaching hospitals of Kathmandu during September 2020. Measures were used to ensure the validity of the instrument. The content validity index (CVI) scores for items and scale were calculated from the scores given by the eight experts. The Cronbach alpha (α) was calculated considering the acceptable α-value &gt; 0.7. Results: The instrument having four domains, 47 items and 5 sub-items was developed to assess PTI care practice. The instrument had a satisfactory CVI score for each item (&gt;0.75) and overall scale (&gt;0.9). The Cronbach alpha value for the subscales were between 0.79 and 0.88 and the overall scale was &gt;0.93. Conclusion: The instrument to assess preterm infant care practice provided by nurses in NCU was developed with adequate theoretical and contextual background. Necessary validity and reliability processes and criteria were also employed. Therefore, the instrument might be useful to assess the PTI care practice of nurses in NCUs in Nepalese context.

Early discharge and hospital-assisted home care is associated with better neurodevelopmental outcome in preterm infants

AimsTo compare hospital-assisted neonatal home care and standard hospital care for preterm newborns on neurodevelopment at 2 years corrected age, as well as duration of hospitalization, breastmilk rates, and readmissions before 1 year. MethodsThis observational study enrolled 415 inborn neonates <34+ 6 weeks that received home care (2008 to 2015) in the French University Hospital of Toulouse and 3186 neonates from the national cohort of infants discharged in 2011 that received standard hospital neonatal care (EPIPAGE 2). Neurodevelopment at 2 years was assessed with the Ages and Stages Questionnaire-3 (ASQ-3). ResultsAt two years corrected age, infants in home care had 61% less risk of overall low ASQ ≤220 (OR = 0.4 [0.3–0.5], p < 0.001) and 31–80% less risk of low scores in four out of five domains compared to standard care. Home care was associated with shorter hospital stays (− 9 days; p < 0.001), higher breastmilk rates at final discharge (OR = 3.6 [2.8–4.6], p < 0.001 for singletons and OR = 2.3 [1.6–3.1], p < 0.001 for multiples), and more breastmilk feeding for at least six months (OR = 1.8 [1.3–2.3], p < 0.001 for singletons, OR = 3.6 [2.1–6.3], p < 0.001 for multiples). Readmissions also occurred less frequently with home care than with standard care, except for twins (OR = 0.7 [0.6–0.8], p < 0.001). ConclusionHospital-assisted neonatal home care for preterm infants was associated with better neurodevelopment at 2 years corrected age, shorter duration of hospitalization, and higher rates of breastmilk feeding at 6 months.

Development of Incubation System for Premature Baby Care

The proposed work is focused at development of Incubation system for premature Baby Monitoring System based on the IoT. A prototype is developed which gives a reliable and efficient baby monitoring system that can play a vital role in providing better infant care. The system monitors vital parameters such as temperature, pulse rate, moisture condition and weight of the baby. This information can be accessed by their parents and doctors with alarm triggering system to initiate the proper control actions through IoT based Mobile application.

Premature newborns: Actual problems of raising and prevention of adverse consequences

The review summarizes the literature data on the perinatal pathology of premature infants, the frequency of their development in the following months and years of life of neuropsychiatric and somatic diseases. The results of experimental and clinical studies are presented, revealing the general pathogenetic mechanism oxidative stress, underlying bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, periventricular leukomalacia, open ductus arteriosus and persistent pulmonary hypertension. The interrelation of the processes of inflammation and oxidative stress, which play a leading role in the brain damage of the fetus and newborn, is considered. The literature data on the possibility of preventing severe complications in the antenatal period of development with the timely use of surfactant, magnesium sulfate and acetylcysteine are presented, It is emphasized that the first hours of a premature baby's life are a critical period for an individual approach to resuscitation, the beginning and effectiveness of drug therapy aimed at suppressing oxidative stress and systemic inflammation, which is confirmed by modern trends in optimizing the care of premature babies using pentoxifylline, erythropoietin, cortexin and melatonin.

Potential Psychological and Biological Mechanisms Underlying the Effectiveness of Neonatal Music Therapy during Kangaroo Mother Care for Preterm Infants and Their Parents.

Neonatal music therapy (MT) has become more accessible worldwide. Previous research suggests multiple benefits of MT for preterm infants and their caregivers; however, far too little attention has been paid to understanding the mechanisms of change in previous Neonatal Intensive Care Unit (NICU)-MT research so far. This perspective article describes potential mechanisms of MT interventions exposed during kangaroo mother care on the preterm infant’s response (behavioral and physiological outcomes) and the mother-infant relationship. The paper focuses on the hypothalamic–pituitary–adrenal axis’ role in stabilization of behavioral state, the autonomic nervous system’s role in stabilization of physiologic state, as well as co-regulation as a potential mechanism for the developing of the parent-infant relationship. Mechanisms play a pivotal role in understanding variables related to the therapy course and well as in generating new knowledge regarding treatment susceptibility and optimizing resources. Understanding of the mechanisms of how interventions may lead to specific outcomes plays an important role in addressing the issue of improvement of currently available approaches of MT used in the NICU.