High-risk Newborn Care Research Articles

IJCM_72A: A study on newborn care practices and associated factors influencing their health in urban slums of Kurnool city, Andhra Pradesh.

Background: Neonate is essential time for child to grow. Worldwide, Neonatal mortality are estimated to be about 3 million due to insufficient care. In 2021, 2.3 million neonates have died in first four weeks of life, roughly 6400 neonatal deaths per day. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality. Newborn care practice interventions can prevent neonatal deaths. Understanding the community and traditional newborn care practices is necessary to implement effective programme for promotion of newborns health. Hence present study was done to describe selected newborn care practices in urban slums of Kurnool. Objectives: To assess Newborn-Care Practices and to determine the relationship between Newborn-Care Practices and selected socio-demographic variables. Methodology: A Community-based, Cross-sectional study was done among 220mothers who were residing in urban slums of Kurnool City, Data were collected between October 2023 to November 2023 using Semi-structured questionnaire by Simple Random sampling technique. IEC permission was obtained. Written informed consent was obtained from participants. Data were analyzed using SPSS-Version23. Results: Mothers who were practicing delayed-bathing were observed in the age group 18-24 years 135(61.36%)followed by 25-30 years 60(27.2%),the difference was statistically significant(x2=9.84)(p=0.043),Safe cord care practices were observed more among 18-24 years132(60%),it was found to be statistically significant(x2=23.5)(p=<0.001). Early initiation of breast feeding was more common among age group 18-24 years93(42.2%), it was found to be statistically significant(x2=6.51)(p=0.039). Conclusion: The practice of essential newborn care still needs to improve in Bareilly; There is strong need to implement community-based interventions to improve the newborn care practices & to reduce the high-risk newborn care practices like unsafe cord care, delayed breast feeding, early bathing, Prelacteal feeding & discarding colostrum need through health workers.

Promoción de la autoeficacia en madres con hijos/as que egresan de unidades de cuidado intensivo neonatal

IntroductionThe mothers of newborns who are discharged from a neonatal intensive care unit (NICU) experience stress and anxiety due to the specialized care their child requires at home, affecting their perception of maternal self-efficacy. Objectiveto evaluate the effect of the nursing intervention called Hospital Discharge Plan (HDP) on the promotion of self-efficacy in mothers of newborns discharged from the NICU. MethodQuantitative study, quasi-experimental design with pre-test/post-test in a single group, using the Parental Evaluation Scale applied to a convenience sample of 72 mothers of high-risk newborns from a NICU located in the city of Villavicencio (Colombia). The first measurement was taken between days 3 and 4 before discharge and at 15 days’ post-discharge. Data processing was carried out using the statistical program SPSS, version 21. The intervention was based on the four concepts of self-efficacy by Barbara Resnick. ResultsThe perception of maternal self-efficacy before the intervention showed a median of 8.9 points (RI 7.6-9.5); after the intervention it showed a median of 9.6 points (RI of 10-8.7); a statistically significant p-value < 0.001 was obtained before and after the intervention with the Wilcoxon rank test. ConclusionsEducation and follow-up promoted the development of knowledge and skills in mothers for the care of high-risk newborns. This contributed to the experience of mastery and vicarious experience from the teaching-learning process and contact with the experience of other mothers, which contributes to the effective development of motherhood.

Promotion of self-efficacy in mothers with infants discharged from neonatal intensive care units

IntroductionThe mothers of newborns who are discharged from a neonatal intensive care unit (NICU) experience stress and anxiety due to the specialized care their child requires at home, affecting their perception of maternal self-efficacy. ObjectiveTo evaluate the effect of the nursing intervention called Hospital Discharge Plan (HDP) on the promotion of self-efficacy in mothers of newborns discharged from the NICU. MethodQuantitative study, quasi-experimental design with pre-test/post-test in a single group, using the Parental Evaluation Scale applied to a convenience sample of 72 mothers of high-risk newborns from a NICU located in the city of Villavicencio (Colombia). The first measurement was taken between days 3 and 4 before discharge and at 15 days’ post-discharge. Data processing was carried out using the statistical program SPSS, version 21. The intervention was based on the four concepts of self-efficacy by Barbara Resnick. ResultsThe perception of maternal self-efficacy before the intervention showed a median of 8.9 points (RI 7.6–9.5); after the intervention it showed a median of 9.6 points (RI of 10–8.7); a statistically significant p-value < 0.001 was obtained before and after the intervention with the Wilcoxon rank test. ConclusionsEducation and follow-up promoted the development of knowledge and skills in mothers for the care of high-risk newborns. This contributed to the experience of mastery and vicarious experience from the teaching-learning process and contact with the experience of other mothers, which contributes to the effective development of motherhood.

Development of a Project-Based Learning Program on High-Risk Newborn Care for Nursing Students and Its Effects: A Quasi-Experimental Study.

Project-based learning (PjBL) allows nursing students to participate in real problem-solving, construct knowledge, and improve their nursing skills in the process of accomplishing meaningful projects. This study was conducted to develop a PjBL program on high-risk newborn care for nursing students and evaluate its effects. A quasi-experimental study using a nonequivalent control group pretest–posttest design was employed between June and December 2021. The participants were 45 nursing students (24 in the experimental group and 21 in the control group). A PjBL program involving the creation of an educational video clip about high-risk newborn care for nursing students was developed, and the experimental group took part in PjBL. The participants’ nursing competency for high-risk newborns, self-leadership, and practicum-related stress were assessed. In the experimental group, nursing competency for high-risk newborns increased and practicum-related stress decreased to a greater extent than in the control group. However, the change in self-leadership was not significantly different between the experimental and control groups. PjBL effectively improved students’ nursing competency for high-risk newborns and decreased their practicum-related stress. PjBL will be utilized to enhance nursing students’ expertise in high-risk newborn care.

Beyond the First Wave: Consequences of COVID-19 on High-Risk Infants and Families.

The novel coronavirus disease 2019 (COVID-19) pandemic is affecting care for high-risk newborns in ways that will likely be sustained beyond the initial pandemic response. These novel challenges present an urgent imperative to understand how COVID-19 impacts parent, family, and infant outcomes. We highlight three areas that warrant targeted attention: (1) inpatient care: visitation policies, developmental care, and communication practices; (2) outpatient care: high-risk infant follow-up and early intervention programs; and (3) parent psychosocial distress: mental health, social support, and financial toxicity. Changes to care delivery in these areas provide an opportunity to identify and implement novel strategies to provide family-centered care during COVID-19 and beyond. Key Points The COVID-19 pandemic is influencing care delivery for high-risk newborns and their families.Rapid changes to care delivery are likely to be sustained beyond the initial pandemic response.We have an urgent imperative to understand how COVID-19 impacts infant, parent, and family outcomes.

A study to assess the effectiveness of video assisted teaching on knowledge and reported practice among mothers regarding the post discharge care of high risk babies of the selected hospital, Bangalore

The divine gifts- the newborns are at higher risk of the mortality and severe morbidity than the infants and during childhood period. The essential of the high risk newborn care are crucial to ensure optimal neonatal health outcomes. The aims of present study: 1. to compare the knowledge among mothers regarding the post discharge care of high risk babies between the study and control group.2. To compare the reported practice among mothers regarding the post discharge care of high risk babies between study and control group.3. To determine the correlation between knowledge and practice regarding post discharge care of high risk babies in study and control group.4. To determine the association of knowledge with selected baseline variables5. To determine the association of practice with selected baseline variables. A quantitative, true experimental design was adopted by using computer randomized table and generated sampling technique, 40 mothers were selected in which 20 in each study and control group. An interview schedule to collect the baseline variables, structured questionnaires to assess the knowledge and reported checklist to assess the practice of mothers were made. The collected data was analyzed by using descriptive and inferential statistics. It revealed that mean knowledge scores in experimental group were 15.59 and SD was 1.85 and in control group mean was 11 and SD was 2.79, whereas the mean practice scores in experimental group were 8.35 and SD was 0.93 and in the control group mean was 6.15 and SD was 0.933. The findings of the study shows that, the experimental group has mean knowledge score of 15.95 1.85 was higher than the control group mean knowledge score 11±2.79, whereas the experimental group has mean practice score of 8.350.933 was greater than the control group mean practice score 6.150.933. It depicts that; VAT was an effective method to enhance the knowledge and reported practice regarding post discharge care of high risk babies among mothers.

Nurses' experiences in the care of high-risk newborns: a phenomenological study.

To describe nurses' experience in the care of high-risk newborns. This is a descriptive study with a qualitative approach, based on Merleau-Ponty's phenomenology and performed at the Fernando Magalhães Maternity Hospital in the state of Rio de Janeiro, through interviews with 30 nurses who work in neonatal care, according to the phenomenological thinking of Maurice Merleau- Ponty. Three categories emerged: "experienced body of the nurse practitioner on the high-risk newborn"; "experienced world of the nurse practitioner on the high-risk newborn"; and "time spent by the nurse practitioner with the high-risk newborn". The study allowed us to describe, through the participants' speeches, that the care of the high-risk newborn is broad, that is, objective, subjective and carried out with advanced technologies, their experiences and scientific improvement are composed of shared practice and theory with the family, professionals and beginners in the neonatal universe, favoring a differentiated and humanized care.

Newborn Care Practices in Rural Communities of Nawalparasi District, Nepal

Most of the new born deaths in the developing countries occur due to lack of access to care, as majority of the deliveries occur at home. Even deliveries conducted in health facilities are prone to suffering from traditional care practice after discharge from health facilities. Most of these deaths could be avoided with changes in antenatal, delivery and newborn care practices. This study was conducted to explore the newborn care practices related to cord care, thermal care and breast feeding in rural setting and to identify socio-demographic, antenatal and delivery care factors associated with these practices. A cross sectional study in rural setting of Nawalparasi district included 296 women who had delivered live baby at home or discharged within 24 hours of delivery from hospital proceeding four months of data collection. Chi squire test was applied to compare sociodemographic, antenatal and delivery care factors associated with cord care, thermal care and breast feeding practices. Of the total 296 mother interviewed, only 65.54% have completed ANC visit at least 4 times and 29.05% have received counselling on newborn care during pregnancy. More than half deliveries (53.38%) were home deliveries and Clean Home Delivery Kit was used only one third (39.91%) of these deliveries. Of the three selected newborn care practices, clean cord keeping practice was found in only one fourth (25.70%) of deliveries. However early initiation of breast feeding and delayed bathing practice was found in about half of the deliveries (51.35% and 58.45% respectively). There is strong need to implement the community-based interventions to improve the new born care practices in community level and to reduce the high-risk newborn care practices like unsafe cord care, delayed breast feeding, early bathing, prelacteal feeding and discarding colostrum need through the community level health workers and volunteers.&#x0D; Key words: Newborn care, Safe cord care, Early breast feeding, Thermal care, Delayed bathing.

Effects of Team-based Problem-based Learning Combined with Smart Education: A Focus on High-risk Newborn Care

This study was conducted to examine the effects of team-based problem-based learning combined with smart education among nursing students. A quasi-experimental non-equivalent control group, pre-posttest design was used. The experimental group (n=36) received problem-based learning combined with smart education and lectures 7 times over the course of 7 weeks (100 minutes weekly). Control group (n=34) only received instructor-centered lectures 7 times over the course of 7 weeks (100 minutes weekly). Data were analyzed using the x 2 test, the Fisher exact test, and the independent t-test with SPSS for Windows version 21.0. After the intervention, the experimental group reported increased learning motivation (t=2.70, p=.009), problem-solving ability (t=2.25, p=.028), academic self-efficacy (t=4.76, p<.001), self-learning ability (t=2.78, p<.001), and leadership (t=2.78, p=.007) relative to the control group. Team-based problem-based learning combined with smart education and lectures was found to be an effective approach for increasing the learning motivation, problem-solving ability, academic self-efficacy, self-learning ability, and leadership of nursing students.

Flash Cards In The NICU: A Novel Approach To Resident Education

Purpose Ongoing restrictions to resident work hours along with fewer NICU rotations during residency limit the time residents are involved in the care of high risk newborns. The work pace and work flow of the NICU is highly efficient to address the needs of an often fragile and unstable patient population, but limits the amount of time that can be spent educating residents. Resident satisfaction and morale in the NICU is low due to an imbalance of service and education time. Innovative strategies that provide effective and …

Epidemiological trends among preterm infants with apnea. A twelve-year database review

ObjectivesThis study sought to characterize trends in the diagnosis of apnea, associated comorbidities and complications, and 30-day readmission rates in preterm singleton infants. Subjects and methodsThe study design was a retrospective, longitudinal, observational study. 2003–2014 New York State Statewide Planning and Research Cooperative System and New York City Vital Statistics databases were merged identifying preterm live singleton births. Hospitalizations of preterm newborns with and without apnea were compared; multivariable logistic regression and log-linear Poisson regression models applied. ResultsOf 1,384,013 singleton births, 7.5% were identified as preterm. While relative risk of preterm birth rates declined (RR = 0.987, 95% CI = 0.982–0.991), the diagnosis of apnea increased significantly (RR = 1.069, 95% CI = 1.049–1.089). Multivariable analysis identified two apnea predictors, gastric reflux (OR = 3.19, 95% CI = 2.80–3.63) and early gestational age (OR = 0.83 for 1 week GA increase, 95% CI = 0.82–0.84). Preterm newborns with apnea were more likely to be readmitted within the first 30 days and total charges were 5.4 times higher. ConclusionsWhile the preterm birth rate has declined the rate of diagnosis of apnea with associated comorbidities and complications has increased. Given the additional findings of higher 30-day readmission rates and charges, more multidisciplinary research appears warranted to identify ways to optimize the quality of high risk newborn care.

Community healthcare professional visits are important determinants of knowledge and practices regarding newborn care among mothers

Objective: This study assessed the knowledge, practices, and factors related to essential newborn care among mothers in a rural community in northern part of India and test its association with accredited social health activists (ASHAs) visits during antenatal and postnatal care. Methods: The study represents the formative phase of the community intervention trial for reducing neonatal mortality implemented in Ballabgarh block of Faridabad district, Haryana, India. Mothers who delivered within 1–6 months in 2012 in rural Ballabgarh before the interview were interviewed at home for knowledge and practices (KP) related to cord care, breastfeeding, thermal care, baby handling, and healthcare seeking including danger signs and free ambulance services. A KP score of 14 was derived from these domains and a score above 9 was taken as adequate. A logistic regression was used to test the hypothesis that ASHA visits were related to the higher knowledge among mothers when adjusted for other confounders. Results: Of the 1298 mothers, 42.3% (39.7–45.1) did not apply anything on umbilicus; 8.7% (7.3–10.4) were kept in skin-to-skin contact; 65% (62.3–67.6) were exclusively breastfed for 1st month; and 29.7 (27.2–32.3) first bathed their baby within 3 days to. 41% (38.7–44.1) of mothers were rated to have adequate KP. The KP score was significantly less in mothers who delivered at home (adjusted odds ratio [AOR]: 1.78; 95% confidence interval [CI]: 1.22–2.59), or underwent cesarean section (AOR: 1.67; 95% CI: 1.12–2.53) or did not have contact with ASHA (AOR: 1.64; 95% CI: 1.17–2.29). Conclusion: There is a considerable KP gap in the community. Strengthening and scaling up of ASHA visits could prove to be beneficial for modifying high-risk newborn care norms and practices.

Challenges in Surgical Care of High Risk Newborns.

Challenges in Surgical Care of High Risk Newborns.

Human Milk Analysis Using Mid-Infrared Spectroscopy.

The composition of human milk is known to vary with length of gestation, stage of lactation, and other factors. Human milk contains all nutrients required for infant health but requires fortification to meet the needs of low-birth-weight infants. Without a known nutrient profile of the mother's milk or donor milk fed to a baby, the composition of the fortified product is only an estimate. Human milk analysis has the potential to improve the nutrition care of high-risk newborns by increasing the information about human milk composition. Equipment to analyze human milk is available, and the technology is rapidly evolving. This pilot study compares mid-infrared (MIR) spectroscopy to reference laboratory milk analysis. After obtaining informed consent, we collected human milk samples from mothers of infants weighing <2 kg at birth. Duplicate samples were analyzed for macronutrients by MIR and by reference laboratory analysis including Kjeldahl for protein, Mojonnier for fat, and high-pressure liquid chromatography for lactose. Intraclass correlation coefficients, Bland-Altman scatter plots, and paired t tests were used to compare the two methods. No significant differences were detected between the macronutrient content of human milk obtained by MIR vs reference laboratory analysis. MIR analysis appears to provide an accurate assessment of macronutrient content in expressed human milk from mothers of preterm infants. The small sample size of this study limits confidence in the results. Measurement of lactose is confounded by the presence of oligosaccharides. Human milk analysis is a potentially useful tool for establishing an individualized fortification plan.

High-Risk Newborn Care in Uganda

High-Risk Newborn Care in Uganda

Decisions for life made in the perinatal period: who decides and on which standards?

Central to the purpose of perinatal medicine and neonatal care are three clinical aims: to save the lives of infants with treatable conditions, to minimise needless suffering and indignity, and...

Withdrawing Support for Withdrawing Support From Premature Infants With Severe Intracranial Hemorrhage

To the Editor. — The active withdrawal of life support from premature infants with severe intracranial hemorrhage based on quality-of-life (QoL) concerns is rare in the United States, occurring in <5% of cases in which care is actively withdrawn.1 It does occur, however, and is potentially supported by the American Academy of Pediatrics statement “Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns.”2 According to this statement, a decision to withdraw care may be justified for cases in which the “prognosis is uncertain but likely to be very poor …

Parental Refusal of Medical Treatment for a Newborn

When there is a conflict between parents and the physician over appropriate care due to an infant whose decision prevails? What standard, if any, should guide such decisions?This article traces the varying standards articulated over the past three decades from the proposal in Duff and Campbell's 1973 essay that these decisions are best left to the parents to the Baby Doe Regs of the 1980s which required every life that could be salvaged be continued. We conclude with support for the policy articulated in the 2007 guidelines of the American Academy of Pediatrics on non-intervention or withdrawal of intensive care for high-risk newborns.

Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns: In Reply

The members of the American Academy of Pediatrics Committee on Fetus and Newborn thank Mr Whittall and the Nuffield Council on Bioethics for their correspondence and for calling attention to the recent Nuffield report, “Critical Care Decisions in Fetal and Neonatal Medicine: Ethical Issues.”1 As Mr Whittall pointed out, the Nuffield report provides a practical framework to guide decisions based on gestational age for infants born before 25 weeks’ gestation. The American Academy of Pediatrics Neonatal Resuscitation Program (NRP) Steering Committee took a similar approach in its 2005 NRP guidelines.2 They cited the infant born before 23 weeks’ gestation as an example of the category of infants for whom resuscitation would not be indicated, and they cited the infant of ≥25 weeks’ gestation as an example of one for whom resuscitation is nearly always indicated. For infants of 23 and 24 weeks’ gestation, those with uncertain prognosis, they indicated that parental wishes should take precedence.The Committee on Fetus and Newborn considered such an approach (ie, defining the gestational age below which resuscitation should not be undertaken and another gestational age above which resuscitation should be routine), with decisions in the intermediate range guided primarily by the wishes of informed parents. However, we decided against this categorical approach for several reasons. First, the prognosis for extremely premature infants is influenced by other factors besides gestational age, such as fetal gender and corticosteroid exposure. Second, we avoided proposing gestational-age guidelines because we felt that these demarcation lines are not fixed but have moved over time and may continue to do so. Third, the concept of standard gestational-age cutoffs for active intervention is problematic because there is considerable center-to-center variability in outcome below 25 weeks’ gestation, both in mortality3–6 and morbidity7; ideally, decisions should be based on prognosis. However, much of the variability in outcome among centers results from differences in the attitudes and beliefs of medical staff regarding the potential for intact survival at very early gestation.8–12 In fact, it is not possible to isolate the impact of the attitudes of medical providers on prognosis from other factors that contribute to center-to-center variability in outcome in the United States and other medically advanced countries.The worldwide variation in potential outcome at the threshold of viability dwarfs the magnitude of center-to-center variability in the United States and United Kingdom. The guidelines of the Nuffield Council on Bioethics and the NRP Steering Committee may be reasonable for the United States and the United Kingdom in 2007, but these specific gestational-age boundaries would not be appropriate in many parts of the world where maternal-fetal medicine and neonatal intensive care are not as advanced.13To be truly useful, an approach using default gestational-age cutoffs to guide therapy would have to allow for consideration of other factors in addition to completed weeks of gestation. As an example, a female fetus at 24 weeks, 6 days, whose mother received betamethasone has a better prognosis than a male fetus at 24 weeks, 0 days, whose mother did not receive corticosteroid. In addition, the guidelines would need to be reappraised every few years as new outcome information becomes available.The Nuffield report is a thorough and scholarly document. Insofar as treatment decisions at the threshold of viability are sometimes made primarily on the basis of gestational age, the guidelines proposed in the Nuffield report are valid in medically advanced countries in the early 21st century. We commend the Nuffield Council on Bioethics for their efforts in producing this important document, and we welcome the discussion it has stimulated.

Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns

To the Editor .— The recently published policy statement of the American Academy of Pediatrics Committee on Fetus and Newborn tackles the difficult decisions that parents and health care professionals have to make about the treatment and care of extremely premature or very ill infants.1 Being prepared simultaneously was a report of the Nuffield Council on Bioethics titled “Critical Care Decisions in Fetal and Neonatal Medicine: Ethical Issues,”2 which was published in November 2006. The council's recommendations on withdrawing and withholding treatment have much in common with those of the American Academy of Pediatrics committee. Both bodies concluded that it is not always right to put …