Infant Contact Research Articles

When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19.

The World Health Organization (WHO) has provided detailed guidance on the care of infants of women who are persons under investigation (PUI) or confirmed to have COVID‐19. The guidance supports immediate post‐partum mother–infant contact and breastfeeding with appropriate respiratory precautions. Although many countries have followed WHO guidance, others have implemented infection prevention and control (IPC) policies that impose varying levels of post‐partum separation and discourage or prohibit breastfeeding or provision of expressed breast milk. These policies aim to protect infants from the potential harm of infection from their mothers, yet they may fail to fully account for the impact of separation. Global COVID‐19 data are suggestive of potentially lower susceptibility and a typically milder course of disease among children, although the potential for severe disease in infancy remains. Separation causes cumulative harms, including disrupting breastfeeding and limiting its protection against infectious disease, which has disproportionate impacts on vulnerable infants. Separation also presumes the replaceability of breastfeeding—a risk that is magnified in emergencies. Moreover, separation does not ensure lower viral exposure during hospitalizations and post‐discharge, and contributes to the burden on overwhelmed health systems. Finally, separation magnifies maternal health consequences of insufficient breastfeeding and compounds trauma in communities who have experienced long‐standing inequities and violence, including family separation. Taken together, separating PUI/confirmed SARS‐CoV‐2‐positive mothers and their infants may lead to excess preventable illnesses and deaths among infants and women around the world. Health services must consider the short‐andlong‐term impacts of separating mothers and infants in their policies.

Pediatric pain treatment and prevention for hospitalized children.

Introduction:Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population.Objectives:To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses.Methods:This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice.Results:Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation.Conclusion:Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.

Herpes Zoster Presentation, Management, and Prevention: A Modern Case-Based Review.

Herpes zoster (HZ) is a common cutaneous entity with protean clinical presentations, management options, complication rates, and prevention strategies, all of which are rife with dogma. During an inpatient consultation for HZ, have you ever been approached by a frantic staff or family member, worried that a pregnant, elderly, or infant contact will be 'infected' if they get too close? Have your patients ever asked you about their risk of having HZ twice, or claimed that they have frequent 'recurrences'? In what timeline should antiviral therapy be employed? Is there evidence for prednisone or gabapentin in acute HZ treatment? Who should be vaccinated against HZ and what are the benefits and risks? In case-based form, these and other complex but common scenarios will be examined using clinical and viral mechanistic clues, along with updated treatment and prevention guidelines, to provide a modern HZ case management compendium, comprehensive of the diverse age and health populations now presenting with this condition.

Delivery room skin‐to‐skin contact for preterm infants—A randomized clinical trial

To investigate the effects of 60minutes delivery room skin-to-skin contact (DR-SSC) compared with 5minutes visual contact (VC) on mother-child interaction (MCI), salivary cortisol, maternal depression, stress and bonding at 6months corrected age. A single-centre randomized controlled trial conducted in a German level III NICU. Eighty-eight preterm infants (25-32weeks of gestational age) were randomized after initial stabilization to either 60minutes DR-SSC or 5minutes VC. Forty-five infants were allocated to DR-SSC, 43 to VC. Delivery room skin-to-skin contact dyads showed a higher quantity of maternal motoric (18 vs 15, P=.030), infant's vocal (7 vs 5, P=.044) and motoric (20 vs 15, P=.032) responses. Moreover, the combined score of maternal and infant responsive behaviour was higher (86 vs 71, P=.041) in DR-SSC dyads. DR-SSC mothers had lower risk of both, early postpartum depression (15% vs 45%, P=.003) and impaired bonding (Score 3 vs 5, P=.031). In addition to regular intermittent kangaroo mother care, DR-SSC promotes MCI and decreases risk of maternal depression and bonding problems. Thus, DR-SSC may have positive effects on preterm development.

Infant contact in day-care centres in Vietnam: A cross-sectional study to understand infant infection risk.

Background: Infant contact information (skin-to-skin contact between infants and others) is important to understand Streptococcus pneumoniae transmission patterns. A few studies have investigated infant contact patterns by asking the mother/guardian to record all contacts a child makes in one day. However, this approach does not capture contact behaviour in day-care. Our study describes the frequency and nature of physical contacts of infants in day-care to understand infant infection risk in day-care in Nha Trang, Vietnam. Methods: This cross-sectional study enrolled infants aged <12 months, attending 10 randomly selected day-care centres in Nha Trang. Physical contacts of each infant for one day at the day-care centre were observed. The mean number of infants' contacts and factors associated with contact numbers were assessed using negative binomial regression. Results: In total 14 infants, aged 6-11 months, were enrolled, and a total of 96 contacts were recorded. The mean number of contacts an infant made in one day was 6.9. Infants who walked independently (age-adjusted rate ratio 1.68, 95% confidence interval 1.06-2.68) and those cared for in a larger group (1.99, 1.42-2.79) had more contacts at day-care. About 50% of infants made contact with at least one person from a commune different from the infant's, and 50% made contact with at least one other infant at day-care. Conclusion: This study found that day-care attendance may be one factor that increases contact rates of infants in Nha Trang and diversifies those contacts in terms of age and geographical spread. In this study, day-care attendance not only increased contact rates beyond those usually experienced by young children cared for at home but specifically increased contact rates with other children and adults from other communes. Day-care may play a key role in the transmission of respiratory pathogens like Streptococcus pneumoniae to infants.

Infant contact in day-care centres in Vietnam: A cross-sectional study to understand infant infection risk

Background: Infant contact information (skin-to-skin contact between infants and others) is important to understand Streptococcus pneumoniae transmission patterns. A few studies have investigated infant contact patterns by asking the mother/guardian to record all contacts a child makes in one day. However, this approach does not capture contact behaviour in day-care. Our study describes the frequency and nature of physical contacts of infants in day-care to understand infant infection risk in day-care in Nha Trang, Vietnam. Methods: This cross-sectional study enrolled infants aged <12 months, attending 10 randomly selected day-care centres in Nha Trang. Physical contacts of each infant for one day at the day-care centre were observed. The mean number of infants’ contacts and factors associated with contact numbers were assessed using negative binomial regression. Results: In total 14 infants, aged 6-11 months, were enrolled, and a total of 96 contacts were recorded. The mean number of contacts an infant made in one day was 6.9. Infants who walked independently (age-adjusted rate ratio 1.68, 95% confidence interval 1.06-2.68) and those cared for in a larger group (1.99, 1.42-2.79) had more contacts at day-care. About 50% of infants made contact with at least one person from a commune different from the infant’s, and 50% made contact with at least one other infant at day-care. Conclusion: This study found that day-care attendance may be one factor that increases contact rates of infants in Nha Trang and diversifies those contacts in terms of age and geographical spread. In this study, day-care attendance not only increased contact rates beyond those usually experienced by young children cared for at home but specifically increased contact rates with other children and adults from other communes. Day-care may play a key role in the transmission of respiratory pathogens like Streptococcus pneumoniae to infants.

Infant contact in day-care centres in Vietnam: A cross-sectional study to understand infant infection risk

Background : Infant contact information (skin-to-skin contact between infants and others) is important to understand Streptococcus pneumoniae transmission patterns. A few studies have investigated infant contact patterns by asking the mother/guardian to record all contacts a child makes in one day. However, this approach does not capture contact behaviour in day-care. Our study describes the frequency and nature of physical contacts of infants in day-care to understand infant infection risk in day-care in Nha Trang, central Vietnam. Methods : This cross-sectional study enrolled infants aged less than 12 months, attending 10 randomly selected day-care centres in Nha Trang. Physical contacts of each infant for one day at the day-care centre were observed and recorded. The mean number of contacts of infants and its factors were assessed using negative binomial regression. Results : In total 14 infants, aged 6 to 11 months, were enrolled, and a total of 96 contacts were observed. The mean number of contacts an infant made in one day was 6.9. Infants who walked independently (age-adjusted rate ratio 1.68, 95% confidence interval 1.06-2.68) and those cared for in a larger group (1.99, 1.42-2.79) had more contacts at day-care. About 50% of infants made contact with at least one person from a commune different from the infant's, and 50% made contact with at least one other infant at day-care. Conclusion : This study found that day-care attendance may be one factor that increases contact rates of infants in Nha Trang and diversifies them in terms of age and geographical spread. In this study, day-care attendance not only increased contact rates beyond those usually experienced by young children cared at home but specifically increased the contact rates with other children and adults from other communes. Day-care may play a key role in the transmission of respiratory pathogens like Streptococcus pneumoniae to infants.

Skin-to-skin contact and what women want in the first hours after a caesarean section

ObjectiveTo explore women's experience of skin-to-skin contact and what women want in the first two hours after a caesarean. DesignAudio recorded interviews were conducted with women as a part of a larger video ethnographic research study where video recordings, observations, field notes, focus groups and further in-depth interviews were conducted. SettingA metropolitan hospital in Sydney, Australia. ParticipantsTwenty-one women who had a caesarean section were involved in interviews around six weeks postpartum. AnalysisThe transcribed interviews were thematically analysed. FindingsWomen wanted their baby to stay with them and have skin-to-skin contact, even if they felt apprehensive about providing this care. An overarching theme was, ‘I want our baby’. Several subthemes also emerged: ‘I felt disconnected when I was separated from my baby’, ‘I want to explore my naked baby’, ‘I want my partner involved‘, and ‘It felt right’. Key ConclusionsDespite the challenges of providing skin-to-skin contact in the operating theatre and recovery, health professionals and institutions should recognise the importance of advocating for what women want including keeping women, their partners and babies together and encouraging continuous maternal and infant contact and skin-to-skin contact.

Breastfeeding and skin-to-skin contact as non-pharmacological prevention of neonatal hypoglycemia in infants born to women with gestational diabetes; a Danish quasi-experimental study

ObjectiveTo investigate the effect on infant blood glucose levels of an intervention consisting of early, frequent breastfeeding and two hours of immediate uninterrupted skin-to-skin contact following birth of term infants born to mothers with diet-treated gestational diabetes (GDM). Study designQuasi-experimental study design with a historical control group (n = 132) and an intervention group (n = 401) testing a procedure to prevent neonatal hypoglycemia. Main outcome measuresData collection on blood glucose levels, hypoglycemia incidence with a cut-off of <2.5 mmol/l, breastfeeding within the first two hours after birth, breastfeeding frequency within the first six hours, and amount of formula given to hypoglycemic infants. ResultsMean blood glucose levels in the intervention group at two and four hours were within safe limits: 3.37 mmol/l (95% CI: [3.30, 3.44]) and 3.40 mmol/l (95% CI: [3.34, 3.46]), respectively. Infants suffering a hypoglycemic event within four hours after birth decreased from 22.7% (n = 30/132) in the control group to 10.2% (n = 41/401) in the intervention group. The mean number of breastfeeds in the intervention group (six hours) was 2.41 compared to 1.34 in the control group (seven hours), an increase of 80%. Only 41 of 401 infants in the intervention group were interrupted in immediate interaction with their mother because of hypoglycemia. We failed to obtain sufficient data on skin-to-skin contact. ConclusionMaintaining skin-to-skin contact for infants of mothers with diet-treated GDM, monitoring blood glucose levels until obtaining two values >2.4 mmol/l and encouraging early frequent breastfeeding is a safe strategy to prevent hypoglycemia.

Mitigating Infant Medical Trauma in the NICU: Skin-to-Skin Contact as a Trauma-Informed, Age-Appropriate Best Practice.

Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant's traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant's traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes.

Worldwide prevalence of mother-infant skin-to-skin contact after vaginal birth: A systematic review.

BackgroundDespite the World Health Organization’s (WHO) recommendation for immediate skin-to-skin contact (SSC) after birth, separation of mothers and infants seems to be common practice in many hospitals. It is unknown how common the practice of SSC is worldwide. Therefore, we aimed to determine the reported prevalence of SSC for healthy mothers and infants immediately after normal birth.MethodsWe systematically searched CINAHL, Medline, ProQuest Central, PubMed and the Cochrane Library for articles published between January 2007 and October 2017 using the keywords "kangaroo care" or "skin to skin contact" or "breastfeeding initiation" or "breast crawl" or "maternal infant contact" or "maternal newborn contact" or "baby friendly hospital initiative" or "ten steps for successful breastfeeding”.ResultsAfter an initial screening of 5266 records, 84 full text articles were assessed for eligibility, and 35 of these met the inclusion criteria. The studies were from 28 countries representing all six WHO world regions. There was a wide range in the practice of SSC for mother-infant dyads around the world: from 1% to 98%. Only 15 studies clearly defined SSC. Most of the studies were from high-income countries, and these reported higher rates of SSC than studies from low and middle-income countries.ConclusionThere was a great heterogeneity in the definition of SSC as well as study designs, which makes cross-county comparison difficult. National studies reporting SSC rates are lacking. Future studies and guidelines to enhance SSC practice should include a standardised set of indicators and measurement tools that document SSC starting time and duration of SSC.

Effect of early maternal and infant skin contact on breast feeding in newborns

Objective To explore the effects of immediate skin contact in 90 minutes after birth on the start-up time of breast-feeding, so as to provide reference for clinical practice in promoting breast-feeding. Methods A total of 160 neonates delivered in the Department of Obstetrics and Gynecology of the First Hospital of Peking University from October 2016 to August 2017 were randomly divided into control group and observation group with 80 neonates in each group. The control group was given neonatal daily care after delivery. The observation group received early maternal infant skin contact at least 90 min after delivery. When feeding signals were present, mothers were encouraged to start breastfeeding. In the control group, 14 cases were lost in the late stage, and 5 cases in the observation group. The start-up time of breast-feeding, exclusive breast-feeding and duration of first breast-feeding were compared between the two groups. Results There was no significant difference between the two groups in the time of foraging, the time of connection, the time of sucking, the time of finishing sucking, the duration of first breast feeding, the rate of breast feeding completed within 90 minutes, and the rate of 3-month exclusive breast feeding (P>0.05) . The rate of starting breast-feeding within 30 minutes, breast-feeding before discharge and exclusive breast-feeding before discharge in the observation group were higher than those in the control group, and the differences were statistically significant (P<0.05) . Conclusions Early maternal infant skin contact within 90 min after delivery can improve the rate of breast-feeding, promote early onset of breast-feeding and the success of breast-feeding. It is worthy of adoption and application. Key words: Infant, newborn; Breast feeding; Skin contact

Making Worlds in a Waking Dream: Where Bion Intersects Friston on the Shaping and Breaking of Psychic Reality.

With the publication of Wilfred Bion’s text ‘Learning from Experience,’ psychoanalysis was afforded a new schema for understanding the processes and implications involved in an infant’s contact with their caregivers. As a result, our conception of some of the most fundamental phenomena of psychic life was significantly enriched. By proposing his theory of alpha-functioning, Bion mapped out how meaningful connexions to the internal and external worlds become established in the mind. In contrast, and through working clinically with psychotic patients, Bion revealed how these ties can catastrophically come undone. It is with these ideas, as well as their links to a corresponding set of neuroscientific constructs relating to the Markov blanket and principally developed by Karl Friston, that this paper is concerned. Through an investigation of the psychic functioning originally dubbed ‘dream-work-alpha,’ the paper’s first section focuses on how Bion conceived of the creation of a ‘contact-barrier’ that allows for the differentiation of consciousness from an unconscious mind. Casting the ramifications of this organisation in sharp relief, the psychotic disorganisation of the contact-barrier is then explored. The discussion subsequently broadens to incorporate contemporary theories from free energy neuroscience that bear significant and illuminating relations to the psychoanalytic ideas espoused by Bion over half a century ago. Finally, through posing a series of three questions with accompanying discussions, a superimposition of these theoretical schemas is attempted. These suggestions directly address, (1) whether there is an intimate connexion between the interoceptive contact-barrier and the exteroceptive Markov blanket, (2) whether a disobjectalising of the contact-barrier may be reflected as a tear in the functional fabric of the Markov blanket, and (3) what the clinical implications are of working at the level of the projected surface. Ultimately, the aim of the paper is to expose relevant points of contact within and between the varying conceptual frameworks; frameworks that ultimately derive from disciplines that are both concerned with examining the underlying mechanisms of the mind-brain.

Effect of Delayed Cord Clamping Above Versus Below the Perineum on Preterm Neonatal Hematocrit [13OP

INTRODUCTION: The objective is to determine the difference in neonatal hematocrit when delayed cord clamping is performed above versus below the perineum. METHODS: Patients with anticipated preterm delivery between 30–36 6/7 weeks were randomized to 60 second delayed cord clamping either above or below the perineum after vaginal delivery. Primary outcome was difference in twenty-four hour neonatal hematocrit between groups. Secondary outcomes included Neonatal Intensive Care Unit (NICU) admissions, neonate's need for phototherapy or blood transfusion, one minute APGAR&lt;4 and five minute APGAR&lt;7. RESULTS: Of 103 patients consented to the study, 29 were ineligible prior to randomization and 13 did not complete to study. Sixty one patients completed the study (31 above and 30 below to perineum). There were no significant differences in maternal demographic characteristics or comorbidities. Mean gestational age was 35.5 (above) and 34.6 (below), P=.119. No statistical difference was found in neonatal hematocrit at 24-hours of life between the two groups; 51.5 above versus 52.6 below (P=.572). Correspondingly, none of the secondary outcomes were statistically different. CONCLUSION: When comparing delayed cord clamping above versus below the perineum in preterm deliveries greater than or equal to 30 weeks gestation, there is no difference in the neonatal hematocrit at 24 hrs of life or secondary neonatal outcomes. Delayed cord clamping can safely be performed above the perineum concomitant with skin to skin contact for vigorous preterm infants.

Evaluation of a Cocooning Program on Infant Pertussis Infection in the Northern Territory

AbstractSince 2008, the Northern Territory (NT) Guidelines recommended delivering dTpa vaccine to postnatal women and all other household and close infant contacts. We aim to determine whether this pertussis cocooning strategy reduced infections in young infants in the NT. Infants &lt; 12 months of age notified with pertussis and born at times when the cocooning strategy was in place (2009–2014) were compared with infants born preintervention (2002–2007). The proportion of cases of pertussis occurring in infants &lt; 12 months of age was significantly higher in the preintervention period (6.7%) compared with the cocooning period (3.3%, p = 0.0067).

Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship.

To examine changes that occur in infant and parent salivary oxytocin (OT) and salivary cortisol (SC) levels during skin-to-skin contact (SSC) and whether SSC alleviates parental stress and anxiety while also supporting mother-father-infant relationships. This randomized crossover study was conducted in the neonatal intensive care unit (NICU) with a sample of 28 stable preterm infants and their parents. Saliva samples were collected from infants, mothers, and fathers on Days 1 and 2 (1/parent) for OT and cortisol measurement pre-SSC, during a 60-min SSC session, and a 45-min post-SSC. Parental anxiety was measured at the same time points. Parent-infant interaction was examined prior to discharge on Day 3 via video for synchrony and responsiveness using Dyadic Mutuality Coding. Salivary OT levels increased significantly during SSC for mothers ( p < .001), fathers ( p < .002), and infants ( p < .002). Infant SC levels decreased significantly ( p < .001) during SSC as compared to before and after SSC. Parent anxiety scores were significantly related to parent OT and SC levels. Parents with higher OT levels exhibited more synchrony and responsiveness ( p < .001) in their infant interactions. This study addresses a gap in understanding the mechanisms linking parent-infant contact to biobehavioral responses. SSC activated OT release and decreased infant SC levels. Facilitation of SSC may be an effective intervention to reduce parent and infant stress in the NICU. Findings advance the exploration of OT as a potential moderator for improving responsiveness and synchrony in parent-infant interactions.

Who\u2019s holding the baby? A prospective diary study of the contact patterns of mothers with an infant

BackgroundModels of infectious disease are increasingly utilising empirical contact data to quantify the number of potentially infectious contacts between age groups. While a growing body of data is being collected on contact patterns across many populations, less attention has been paid to the social contacts of young infants. We collected information on the social contacts of primary carers of young infants and investigated their potential for use as a proxy for contacts made by their infant.MethodsWe recruited primary carers of infants under one year of age residing in two geographically, demographically and socioeconomically distinct local government areas of Melbourne, Australia — Boroondara and Hume — including a sub-group of Turkish-speaking participants. Participants recorded their own contacts in a paper diary and noted whether their infant was present or absent. Information collected included times at an address; description of location; and details on people contacted at the location. Descriptive summary measures and distributions of contacts by location type, intensity, day of contact and by age are reported.ResultsOf the 226 participants recruited, 220 completed diaries were returned. Participant contact patterns were similar across all groups, with respect to the types of locations, intensity and day of contact, with some variation in the number of unique daily contacts. The infant was present at around 85% of locations at which the primary carer contacted other individuals. The majority of contacts occurring when the infant was present were in Own Home (32%), Retail and Hospitality (18%) and Transport (18%) settings. The mean daily number of unique contacts by infants was estimated as 9.1, 8.7 and 6.5 in Boroondara, Hume (English) and Hume (Turkish), respectively, with a similar age distribution across each of our surveyed groups.ConclusionsOur demonstration that contact patterns of mothers with infants are reasonably robust to socioeconomic and cultural differences is a step forward in modelling infectious disease transmission. With infants spending most of their time in the company of their mother, contact patterns of mothers are a useful proxy measure of infant contact patterns. The age distribution of contacts made by infants estimated in this study may be used to supplement population-wide contact information commonly used in infectious disease transmission models.

Epidemiological factors related to hospitalization due to influenza in children below 6 months of age

This study underlines the importance of increasing influenza immunization among household contacts of infants below 6months to prevent their influenza admission. What is Known: • Infants younger than 6months old are considered a high-risk population. • Vaccination against influenza is not licensed in infants below 6months. What is New: • Increasing vaccination coverage in elderly people could reduce infants' hospitalization rates. • Cocoon immunization strategy may reduce the admission of infants.

Survey of Household Contacts of Infants With Laboratory-confirmed Pertussis Infection During a National Pertussis Outbreak in England and Wales.

Highest rates of pertussis occur in infants <3 months of age, too young to be fully vaccinated. The 2012 national outbreak provided a valuable opportunity to study sources of infection for these infants at highest risk of severe complications and death. Households of infants <3 months of age with laboratory-confirmed pertussis between August 2012 and October 2013 were invited to complete a questionnaire with information on household members' demographics, relationship with the infant, chronology of cough onset where relevant and vaccination history. Contacts were also invited to provide an oral fluid sample for antipertussis toxin IgG testing. Individuals with laboratory evidence of infection and cough onset up to 3 months before infant onset were considered probable sources of infection. In total, 220 contacts from 63 families were included in the analysis. In 86% of households (54/63), at least one positive result was found with 44% (97/220) of all contacts testing positive. Around 29% (31/108) of noncoughers tested positive. A probable source of infection was found for 46% (29/63) of infant cases. Mothers were the probable source in 38% of cases, followed by siblings (31%) and fathers (10%). Household contacts play an important role in the transmission of pertussis to infants and when identified, mothers were the main sources of infection. Immunization during pregnancy has a key role in preventing infant disease through passive protection from birth and reduced maternal exposure.

Impact of skin-to-skin care on satisfaction and experience of cesarean mothers: A randomized, double-blinded clinical trial

Introduction: During the infancy period, it is vital to take a good care of mother and infant to promote their health. Furthermore, mothers' satisfaction is a good indicator to evaluate the quality of services. Objective: The aim is to examine the impact of skin-to-skin contact of infants by mother immediately after caesarean on the satisfaction of the mothers and to study the experience of mothers who received the care. Materials and Methods: This randomized, controlled, double-blinded clinical trial performed on the mothers who had cesarean in 2015 in Miandoab city, West Azerbaijan Province, Iran. One hundred and five participants were randomly divided into the experiment and control groups using randomized blocks method. Experiment group received skin-to-skin contact in the recovery room, and then, for 3 days, at 7 am, 1 pm, and 7 pm for 30 min. To measure the satisfaction of the mothers, a questionnaire, previously was approved, was applied. Experience of the mothers with the kangaroo mother care method only in the experiment group was measured. Results: Mean satisfaction of mothers in the experiment group was significantly higher than the control group (P