Mother-infant Unit Research Articles

Our First Steps: A QI Project to Reduce NICU Admissions of Infants With NAS.

In 2020, the rate of newborns diagnosed with neonatal abstinence syndrome (NAS) in the United States was 6.3 for every 1000 newborn hospitalizations. Resources used to care for this population, particularly NICU beds, are being overwhelmed. In 2020, the state of Ohio saw a rate of 9.5 newborns with NAS for every 1000 newborn hospitalizations. To determine if using the Eat, Sleep, Console (ESC) model of care to guide management of neonates with NAS instead of the Finnegan Scale would reduce the number of admissions of neonates diagnosed with NAS to the neonatal intensive care unit (NICU). The PDSA (Plan, Do, Study, Act) method was used in the planning and implementation of this pilot quality improvement project. Education regarding the ESC model of care was provided to the Mother/Infant Unit (MIU), with ongoing education and resources provided and readily available on the unit. Fifteen neonates were managed with ESC. Of the 5 who would have been admitted to the NICU for pharmacological treatment if Finnegan Scores were the determining factor for admission, 2 were discharged home from the MIU having been managed with ESC. The use of the ESC model of care can be a useful tool in the management and assessment of neonates with NAS. Resource allocation for care of this population must be assessed to provide optimal non-pharmacological interventions.

Risk Factors Influencing the Incidence of Low Birth Weight Infants at Wangaya Regional General Hospital, Denpasar City, Bali

Background. One of the main indicators of a child’s health status is the infant mortality rate. Indonesia ranks among the top 10 nations with the highest mortality rate for children under the age of 5. Every year, 72% of toddlers and infants died, and low birth weight (LBW) stands out as a significant contributing factor. The mortality rate for LBW infant is 20-35 times greater than that of infants with normal birth weight. Methods. This research uses a cross-sectional analytic observational study which was done in January 2023 at Wangaya Regional Hospital in Bali, Indonesia. Research subject were all of the newborns at Wangaya Hospital. Inclusion criteria including subject must be hospitalized in NICU, PICU, or Mother-Infant unit between September and December 2022. Sampling method used was total sampling. Bivariate analysis was done using chi squared test, and multivariate analysis was done using logistic regression test. Result. Amongst 317 samples taken, the proportion of LBW infants is 13.2%. Risk factors which lead to LBW including presence of antenatal care visit (p= 0.021), number of parities (p= 0.012), and maternal anemia (p= 0.026). It was also identified that mothers who did not undergo any antenatal care are at a higher risk of giving birth to a LBW infant (p= 0.024, OR 5.128 (95% CI 1.242 - 21.169). Conclusion. The risk of LBW can be reduced by pregnant mother doing regular antenatal care visits, taking blood supplement and foods that can increase hemoglobin level and limiting the number of pregnancies. Keywords: Low Birth Weight, Risk Factors, Antenatal Care, Anemia, Number of parities

Psychoanalytic Underpinnings of Socially-Shared Normativity.

Alongside social anthropology and discursive psychology, conversation analysis has highlighted numerous ways in which cultural forms of perceiving and acting in the world are primarily rooted in socially shared normativity. However, when consideration turns to the origins and purposes of human affect and emotion, ethnomethodology, and conversation analysis appear to face particular difficulties that arise from the over-arching focus on sense-making practices. This article considers the proposal that psychoanalytic thinking might inform our understanding of how socially shared normativity emerges during infancy and early childhood. First, a framework is sketched out that highlights the fact that from the beginning, an infant’s earliest experience is bound up with those procedures, practices, and social actions that make up what conversation analysts call members’ methods. Second, comparisons are drawn between conversation analysis and psychoanalytic accounts of early experience for infants during the first years of life. Discussion then moves to the Kleinian notion of object relations and the concept of projective identification. Essentially, this is a theoretical account of how “what-was-once-one” (the mother-infant unit) somehow differentiates resulting in the gradual emergence of the “individuated being.” What is often glossed over in this account is the discursively embedded nature of projective identification; a process that is itself interdependent with the embodiment that makes up the infant’s lived engagement with the world. Whatever might constitute consciousness emerges from somatic, embodied, material-physical, tactile/affective experience – that is, a fundamentally social milieu. Ultimately, this raises the question of how transformation (i.e., from the social to the individual) occurs. One answer may be Winnicott’s idea of the transitional space, where the “good-enough” parent is said to be somebody, who can “contain” both negative and positive identifications coming from the infant, transform and re-project such identifications, but in modified form. In this way, the infant begins to recognize/experience what it is they are “feeling.” Such projective identifications are conveyed within and through the prevailing discourses that constitute all social practices. Concluding comments note that conversation analysis may find in psychoanalytic thinking a framework for understanding the interdependence between affect and action, given that in psychoanalytic thought, we find a thoroughly relational conception of human nature.

Reduction in Length of Stay and Morphine Use for NAS With the "Eat, Sleep, Console" Method.

To reduce average length of stay (ALOS) in infants with neonatal abstinence syndrome (NAS) transferred to the inpatient floor from the mother-infant unit. Secondarily, we aimed to reduce morphine exposure in these infants. Using quality improvement methodology, we redesigned our approach to NAS on the inpatient floor. Key interventions included transitioning from a modified Finnegan Neonatal Abstinence Scoring System to the "Eat, Sleep, Console" method for withdrawal assessment, reeducation on nonpharmacologic interventions, and adding as-needed morphine as initial pharmacotherapy. Data for infants ≥35 weeks' gestation with confirmed in utero opioid exposure and worsening symptoms of NAS requiring transfer to the inpatient floor were obtained, including ALOS, number of morphine doses, and total morphine amount administered. Infants with conditions requiring nothing by mouth for >12 hours or morphine initiation in the ICU were excluded. ALOS for infants (baseline n = 40; intervention n = 36) with NAS transferred to the inpatient floor decreased from 10.3 to 4.9 days. Average morphine administered decreased from 38 to 0.3 doses per infant. No infant in the intervention period required scheduled morphine. The percent of all infants transferred to the floor for NAS requiring any morphine decreased from 92% at baseline to 19% postimplementation. There were no observed adverse events or NAS-related readmissions in the intervention period. Transitioning to the Eat, Sleep, Console assessment with re-enforcement of nonpharmacologic care and use of as-needed morphine as initial pharmacotherapy resulted in a notably decreased ALOS and near elimination of postnatal opioid treatment of infants with NAS managed on our inpatient floor.

Quality Improvement Intervention to Promote Tobacco Cessation by Identifying and Assisting Mothers in the Mother-Infant Unit with Standardized Clinical Intake and Referral to a Tobacco Cessation Program

Quality Improvement Intervention to Promote Tobacco Cessation by Identifying and Assisting Mothers in the Mother-Infant Unit with Standardized Clinical Intake and Referral to a Tobacco Cessation Program

Segurança do paciente no contexto da maternidade: revisão integrativa

O objetivo é conhecer a produção científica nacional e internacional a respeito da temática segurança do paciente nocontexto da maternidade. Trata-se de uma revisão integrativa realizada na Biblioteca Virtual de Saúde utilizando comodescritores: segurança do paciente / patient safety / seguridad del paciente e maternidade / maternity / maternidades.Os critérios de inclusão foram: artigos disponíveis na íntegra, online, em português, inglês ou espanhol, publicados noperíodo de 2010 a 2016 que apresentassem informações relevantes. Inicialmente encontrou-se 34 artigos. Após leituraflutuante dos títulos e resumos, selecionou-se 17 estudos para análise textual. Após categorização e análise dosestudos, emergiram as categorias: organização dos serviços de saúde na maternidade, atuação da equipe de saúdefrente a qualidade e segurança do atendimento na maternidade e satisfação/insatisfação das mulheres com oatendimento recebido durante a permanência na unidade materna. Foi possível observar nas produções científicas queo cuidado seguro nas unidades materno-infantil depende do bom planejamento e organização da instituição, dacomunicação eficiente entre os trabalhadores e da satisfação das mulheres e seus familiares com atenção recebidadurante a sua permanência na unidade.Palavras-chave: Segurança do Paciente; Maternidade; Saúde da Mulher.
 AbstractThe aim is to know the national and international scientific production on the subject of patient safety in the context ofmaternity. This is an integrative review carried out in the Virtual Health Library using as descriptors: patient safety /patient safety / patient safety and maternity / maternity / maternity. Inclusion criteria were: articles available in full,online, in Portuguese, English or Spanish, published in the period from 2010 to 2016 that presented relevantinformation. Were initially found 34 articles. After floating reading of the titles and abstracts, we selected 17 studies fortextual analysis. After categorizing and analyzing the studies, the following categories emerged: organization of healthservices in the maternity unit, health team performance in relation to quality and safety of maternity care, andsatisfaction/dissatisfaction among women with the care received during the stay in the maternity unit. It was possibleto observe in the scientific productions that the safe care in the mother-infant units depends on the good planning andorganization of the institution, the efficient communication between the workers and the satisfaction of the womenand their families with the attention received during their stay in the unit.Keywords: Patient Safety; Maternity; Women's Health.

Quality improvement effort to reduce hypothermia among high-risk infants on a mother-infant unit.

Commentary on: Andrews C, Whatley C, Smith M, et al. Quality-Improvement Effort to Reduce Hypothermia Among High-Risk Infants on a Mother-Infant Unit. Pediatrics. 2018;141(3):e20171214 Hypothermia, especially in low birthweight (LBW) and late preterm infants (LPIs), is associated with neonatal mortality and morbidity 1, 2. This quality improvement study investigated the use of multiple thermoregulation interventions to prevent hypothermia in this population. Previous clinical trials have shown evidence for the use of multiple combined thermoregulation interventions compared to individual interventions in isolation 3, 4. In this study, several thermoregulatation strategies were implemented, including of a plastic-lined knit hat, delaying baths until at least 12 hours of age, conducting all assessments in the first 12 hours of life under a radiant warmer and the clear identification of at risk infants. It showed that these strategies decreased the hypothermic rates in LBW and LPIs sequentially over the three PDSA cycles. These results strength the evidence base that multiple thermoregulation interventions are superior to single intervention approaches in the prevention of neonatal hypothermia. This study is of importance as LBW and LPIs are an understudied group, in particular in the area of quality improvement activities. Most studies to date surrounding the prevention of hypothermia have been restricted to neonatal intensive care units 3. This study is, however, limited in its generalisability, as the study was performed in a small hospital nursery unit where the strategies were easily communicated amongst the relatively small numbers of staff. This may be more difficult to implement in larger institutions where there is a greater turnover of nursery staff. The study did not take into account seasonal variations, which may have had an effect in the environmental temperatures affecting the rates of hypothermia, as well as other potential unmeasured differences. The study did not report timing of temperature measurements, numbers of times per day temperatures were routinely measured and the environment in which the infant was in when identified as hypothermic e.g., during kangaroo care or in a cold room. Collection of data around medical interventions precipitated by the diagnosis of hypothermia would have strengthened the study. There were also a number of benefits identified in this study. The results from the third PDSA cycle, implementing several thermoregulations strategies in combination, significantly decreased the rates of hypothermia in the study population subgroup (LBWs and LPIs). The implementation of these simple, low-cost strategies had a clinically meaningful decrease in hypothermic rates. In other highly resourced settings, these approaches may have a similar effects on hypothermia rates in LBW and LPIs. This has the potential to decrease further medical complications in this group, e.g., hypoglycaemia, decrease the likelihood of maternal–infant separation, and reduce healthcare costs. Further large, multi-centre trials are warrented in the area of thermoregulation strategies in the population of LBW and LPIs. This could go on to further develop universal strategies to be implemented throughout mother–infant nurseries to significantly reduce hypothermic rates in newborn infants, thereby decreasing morbidity and reducing healthcare costs. https://ebneo.org/2018/06/quality-improvement-effort-to-reduce-hypothermia-among-high-risk-infants-on-a-mother-infant-unit/ None. None.

Quality-Improvement Effort to Reduce Hypothermia Among High-Risk Infants on a Mother-Infant Unit.

Neonatal hypothermia is common in low birth weight (LBW) (<2500 g) and late-preterm infants (LPIs) (34 0/7-36 6/7 weeks' gestation). It can be a contributory factor for newborn admission to a NICU, resulting in maternal-infant separation and increased resource use. Our objective was to study the efficacy of a quality-improvement bundle of hypothermia preventive measures for LPIs and/or LBW infants in a mother-infant unit. We conducted plan-do-study-act (PDSA) cycles aimed at decreasing environmental hypothermia for LPIs and/or LBW infants in a mother-infant unit with no other indications for NICU-level care. Interventions included using warm towels after delivery, a risk identification card, an occlusive hat, delayed timing of first bath, submersion instead of sponge-bathing, and conducting all assessments under a radiant warmer during the initial hours of life. We implemented these interventions in 3 PDSA cycles and followed hypothermia rates by using statistical process control methods. The baseline mean monthly hypothermia rate among mother-infant unit LPIs and/or LBW infants was 29.8%. Postintervention, the rate fell to 13.3% (-16.5%; P = .002). This decrease occurred in a stepwise fashion in conjunction with the PDSA cycles. In the final, full-intervention period, the rate was 10.0% (-19.8%; P = .0003). A special-cause signal shift was observed in this final period. Targeted interventions can significantly reduce hypothermia in otherwise healthy LPIs and/or LBW newborns and allow them to safely remain in a mother-infant unit. If applied broadly, such preventive practices could decrease preventable hypothermia in high-risk populations.

A Quality-Improvement Initiative to Reduce NICU Transfers for Neonates at Risk for Hypoglycemia.

Neonatal hypoglycemia is a common problem, often requiring management in the NICU. Nonpharmacologic interventions, including early breastfeeding and skin-to-skin care (SSC), may prevent hypoglycemia and the need to escalate care. Our objective was to maintain mother-infant dyads in the mother-infant unit by decreasing hypoglycemia resulting in NICU transfer. Inborn infants ≥35 weeks' gestation with at least 1 risk factor for hypoglycemia were included. Using quality-improvement methodology, a bundle for at-risk infants was implemented, which included a protocol change focusing on early SSC, early feeding, and obtaining a blood glucose measurement in asymptomatic infants at 90 minutes. The primary outcome was the overall transfer rate of at-risk infants to the NICU. Secondary outcomes were related to protocol adherence. Balancing measures, including the rate of symptomatic hypoglycemia and sepsis evaluations, were monitored. Statistical process control charts using standard interpretation rules were used to monitor for improvement in key aims. For infants at risk for hypoglycemia, the NICU transfer rate decreased from 17% to 3% overall. Documented early feeding and SSC in at-risk newborns increased. The percent of at-risk infants transferred to the NICU who did not require intravenous dextrose decreased from 5% at baseline to 0.7% after intervention. There were no adverse outcomes observed in the period before or after the intervention. The implementation of a quality-improvement intervention promoting SSC and early feeding in at-risk infants was associated with a decreased rate of transfer to the NICU for hypoglycemia.

Using 24-Hour Weight as Reference for Weight Loss Calculation Reduces Supplementation and Promotes Exclusive Breastfeeding in Infants Born by Cesarean Section.

To promote exclusive breastfeeding, supplements are not recommended without medical indications such as clinical evidence of dehydration. Loss of ≥10% of birth weight (BW) often triggers supplementation due to nursery staff's concern for dehydration. Studies have demonstrated that transplacental passage of maternal intrapartum intravenous fluids for anesthesia may inflate BW. Researchers have proposed using newborn's 24-hour weight (24HW), after fluid diuresis, as preferred reference for weight loss calculation. The mother-infant unit at Hartford Hospital, a Baby-Friendly Hospital, implemented this recommendation into routine practice in March 2014. This study was conducted to evaluate this practice change's safety and effectiveness in decreasing supplementation. We performed a retrospective chart review on healthy full-term newborns delivered by C-section in 12 months before (n = 404) and a 12-month period after (n = 263) incorporating the 24HW into routine practice. Overall supplementation rate, maximum weight loss, length of stay (LoS), and peak transcutaneous bilirubin (TcB) were compared. Overall supplementation rate decreased from 43.6% pre- to 27.4% postintervention and in first-time mothers from 51.9% to 31.0%. Among infants losing ≥10% of BW, the supplementation rate decreased from 63.9% to 26.2%. There was no significant increase in maximum weight loss, peak TcB level, or LoS overall or in those with ≥10% weight loss from birth. Routine use of 24HW as the reference for newborn weight loss calculation reduced supplementation and did not increase untoward effects during the hospital stay.

Chorioamnionitis and Management of Asymptomatic Infants ≥35 Weeks Without Empiric Antibiotics.

Management of asymptomatic infants ≥35 weeks' gestation born to mothers with chorioamnionitis remains controversial, with many clinicians considering the need for changes to the current guidelines. The study objective was to evaluate the outcomes of asymptomatic chorioamnionitis-exposed neonates without the use of immediate empirical antibiotics. A retrospective data review was conducted from May 2008 to December 2014, including asymptomatic infants ≥35 weeks' gestation with a maternal diagnosis of clinical chorioamnionitis. A total of 240 asymptomatic infants with chorioamnionitis exposure were identified. The majority of asymptomatic chorioamnionitis-exposed infants, 162 (67.5%), remained well in the mother-infant unit with a median stay of 2 days. There were 78 (32.5%) infants admitted to the NICU and exposed to antibiotics due to abnormal laboratory data or development of clinical symptoms. Of those infants admitted to the NICU, 19 (24%) received antibiotics for <72 hours, 47 (60%) were treated for culture-negative clinical sepsis, and 12 (15%) for culture-positive sepsis, with a median NICU stay of 7 days. Nonroutine use of empirical antibiotics in asymptomatic newborns ≥35 weeks' gestation with maternal chorioamninonitis prevented NICU admission in two-thirds of these infants. This prevented unnecessary antibiotic exposure, increased hospitalization costs, and disruption of mother-infant bonding and breastfeeding. Laboratory evaluation and clinical observation without immediate antibiotic administration may be incorporated into a management approach in asymptomatic chorioamnionitis-exposed neonates. Additional studies are needed to establish the safety of this approach.

Breastfeeding practices in children under 6 months of age: a community based study in urban field practice area of a medical college in central Gujarat, India

Background: Early and exclusive breastfeeding (EBF) is recognized as one of the most effective interventions for child survival particularly to address childhood morbidity and mortality. In spite of the countless benefits, the prevalence of EBF in India, according to the NFHS-3 (2005-2006), at 6 months was only 46.4%. Constraints to EBF are breastfeeding problems, delivery by caesarean section, perceived or real breast milk insufficiency, resumption of official work by the mother, and cultural practices. The objective of the study was to assess current breastfeeding practices of mothers having children less than 6 months of age and to assess the correct positioning, attachment and effective suckling as practiced by these mothers. Methods: An observational, cross-sectional study was done in urban field practice area of a medical college in Central Gujarat from August 2015 to September 2015. Thirty two mother-infant units were observed for baby’s position, attachment and effective suckling using standard IMNCI guideline. Data thus collected were analysed using Microsoft Excel. Results: Out of the criteria for correct attachment, only two children fulfilled all 4 criteria which were classified as having ‘good attachment’. The assessment for proper positioning revealed that only around 13% infants fulfilled all 4 criteria for good positioning. Almost half of the infants were suckling effectively . Conclusions: Based on the findings of the study, it is recommended that each mother should be observed for mother’s and infant’s positioning and attachment at the onset of breastfeeding and if needed given counselling on correct breastfeeding practices.

Best Practices for Transitioning from the Birthing Unit to the Mother–Infant Unit

Poster Presentation Purpose for the Program As we sought to obtain Baby Friendly Hospital designation, we had the opportunity to evaluate our practices in transitioning women from the birthing unit to the mother/infant unit. We discovered two critical practices that were suboptimal and lacked supporting evidence for best patient outcomes: nurse‐to‐nurse hand‐off and the mother/infant admission process. To improve patient outcomes and satisfaction, our team recognized that these two practices were interdependent and required a synergistic problem solving approach for change. Proposed Change The traditional practice of telephone hand‐off was time consuming, inefficient for nurses with multiple demands, did not engage the woman and family, and was not conducive to a seamless transition from one unit to another. Importantly, this transition process, which routinely separated well newborns from healthy postpartum mothers for admission care, had the potential to interfere with bonding and breastfeeding success. An interprofessional team led by the councils of the birthing and mother/infant units recognized the relationship between these processes and the need to align them with Baby Friendly and family‐centered care practices. They developed, implemented, and evaluated an evidence‐based practice project that transitioned the mother/infant dyad from the birthing unit to the postpartum room for admission care while integrating face‐to‐face interprofessional bedside hand‐off. Implementation, Outcomes, and Evaluation The councils were instrumental in identifying, developing, and evaluating these practice changes. Before piloting, women and nurses were surveyed regarding the current processes and then again after implementation. During the pilot period, more than 130 mother/infant dyads were transitioned directly to the postpartum room for admission care with no adverse outcomes related to the process. In addition, unit council representatives also collaborated with provider stakeholders to develop and pilot the interprofessional face‐to‐face bedside hand‐off process. They developed a notification strategy and utilized technology to provide consistent information among team members. Since full implementation of these practices, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores have shown significant improvement as well as breastfeeding initiation and rooming in rates. Implications for Nursing Practice The benefit of a seamless transition process that allows mothers and newborns to stay together from birth until discharge is well documented. Nurses have a responsibility to examine current practices, move away from nurse‐centric traditions, and initiate those that move toward evidence‐based, patient‐centric best practices.

Strip of the Month: January 2014

Strip of the Month: January 2014

Implementing AWHONN's Perinatal Staffing Guidelines: Curing the Staffing Blues and Transforming a Unit

Professional Issues Poster Presentation Purpose for the Program Improve patient outcomes, quality of care, and nurse satisfaction by following the updated staffing guidelines of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Proposed Change To transition to an all registered nurse (RN) staff while meeting staffing ratios in a defined time frame. Implementation, Outcomes, and Evaluation To meet AWHONN's professional perinatal staffing guidelines released in 2010, leadership advocated for an all RN staff for the mother–infant unit. This skill mix change involved finding new roles for 11 licensed practical nurses (LPNs) employed both in the nursery and caring for mother–baby couplets. Leadership collaborated with the human resources department to identify various departments within Bon Secours seeking LPNs. Informational sessions were held so they could stay within the organization. Leadership advocated for increased hours per patient day in the mother–infant unit so practice would comply with the recently updated AWHONN staffing guidelines. Transformation in the mother–infant unit over the past year has taken place after the implementation of the AWHONN guidelines. This is evidenced by increased Gallup RN satisfaction scores from 4.55 in 2011 to 4.88 in 2012. Certifications have increased from three certified nurses to 22 certified nurses and quality of care has risen. Patient satisfaction scores have also steadily increased. Implications for Nursing Practice Before this change, the RN was responsible for the outcome of care for six to eight couplets if the RN was caring for his/her own assignment of patients and directing care for the LPN's patients. Modification of our staffing guidelines decreased workload and individual responsibility, which allowed for unified teamwork. Now the RN has more time at the bedside and spends less time making daily and shift‐to‐shift staffing decisions.

Hospitalization-Based Treatment for Postpartum Depressed Mothers and Their Babies: Rationale, Principles, and Preliminary Follow-Up Data

This paper describes the rationale and treatment principles of a mother-infant unit for severely depressed mothers and their infants in Flanders (Belgium). The unit integrates systemic, psychodynamic, and cognitive behavioral treatment approaches, and aims at improvements on three levels: (1) improving mood and interpersonal relationships in depressed mothers, (2) fostering a positive motherinfant relationship, and (3) establishing a supportive environment outside the treatment setting for both mother and infant. In addition, we present preliminary data of a 3.5–year naturalistic follow-up study of postpartum depressed mothers (n = 41) admitted at this mother-infant unit between April 2003 and April 2005. Results showed that at 3.5–year follow-up a considerable subgroup of mothers (61%) were functioning relatively well, as indicated by low levels of depressive symptoms, anxiety and anger, negative affect, and relatively high levels of positive affect. Yet, in line with other studies, a relatively large subgroup of mothers (39%) continued to suffer from (severe) depression during follow-up. Using a Life History Calendar method, it was found that, compared to currently nondepressed mothers, mothers who were depressed at follow-up did not have more depressive episodes but had longer depressive episodes, received more psychotherapy after hospitalization, and experienced more negative life events during the 3.5–year follow-up period. Implications of these findings for future research and intervention strategies in postpartum depression are discussed.

Interactive Web-Based Breastfeeding Monitoring

Background: Strategies that promote higher exclusive breastfeeding rate and duration are highly recommended. To date, no study has tested the feasibility of Web-based monitoring among breastfeeding mothers. Goals: To develop an interactive Web-based breastfeeding monitoring system (LACTOR) and examine its feasibility, usability, and acceptability among breastfeeding mothers. Methods: A prospective, descriptive, mixed-methods study was conducted. Mothers who met the study inclusion criteria were recruited from mother infant units in 2 Midwestern hospitals in the United States. Mothers were asked to enter their breastfeeding data daily through the system for 30 days and then submit an online exit survey. This survey consisted of a system usability scale and mothers’ perceptions form. Twenty-six mother/infant dyads completed the study. Results: The Feasibility of LACTOR was established by mothers’ compliance in entering their breastfeeding data. The mean was 8.87 (SD = 1.21) daily entries, and the range was 6-13 times per day. Usability scale total mean score was 3.35 (SD = 0.33; scale range 0-4). Ninety-two percent of the mothers thought that they did not need to learn many skills before they started to use LACTOR and did not need any technical support. Mothers reported that the monitoring was beneficial and gave them the chance to track their infants’ feeding patterns and detect any problems early. Conclusions: This study demonstrated the feasibility of LACTOR, and it was user-friendly and acceptable among mothers. Further studies to test its effect on breastfeeding outcomes are needed.

Rates of Depressive and Anxiety Disorders in a Residential Mother–Infant Unit for Unsettled Infants

Depression and anxiety are known to be common among women presenting to residential mother-infant programmes for unsettled infant behaviour but most studies have used self-report measures of psychological symptomatology rather than diagnostic interviews to determine psychiatric diagnoses. The aim of the present study was to determine rates of depressive and anxiety disorders and rates of comorbidity among clients of the Karitane residential mother-infant programme for unsettled infant behaviour. one hundred and sixty seven [corrected] women with infants aged 2 weeks-12 months completed the Edinburgh Postnatal Depression Scale and were interviewed for current and lifetime history of depressive and anxiety disorders using the Structured Clinical Interview for DSM-IV diagnosis (Research version). A total of 25.1% of the sample met criteria for a current diagnosis of major depression, 31.7% had met criteria for major depression since the start of the pregnancy, and 30.5% of clients met criteria for a current anxiety disorder. Of note were the 21.6% who met criteria for generalized anxiety disorder or anxiety disorder not otherwise specified (worry confined to the topics of the baby or being a mother). High levels of comorbidity were confirmed in the finding that 60.8% of those with an anxiety disorder had experienced major or minor depression since the start of their pregnancy and 46.3% of those who had experienced depression since the start of their pregnancy also met criteria for a current anxiety disorder. There are high levels of psychiatric morbidity among clients attending residential mother-infant units for unsettled infant behaviour, highlighting the importance of providing multifaceted interventions in order to address both infant and maternal psychological issues.

The Response of Adult Orang-Utans to Flanged Male Long Calls: Inferences about Their Function

Flanged male orang-utans emit loud vocalizations called long calls. In this study, we examined the correlates of variation in long-calling rates among flanged male Sumatran orang-utans, as well as the ranging responses of adult females and flanged males to these long calls. Males that gave calls more often were more likely to approach calls by others. Results bolster a female attraction function of long calls. Flanged males did not significantly avoid or approach long calls. However, males called more when alone than when guarding a female mate, and adult females significantly approached long calls, especially those of the dominant male, and did so regardless of their reproductive state, allowing them to remain within earshot of calling males. The possible selective advantages of this response include avoidance of harassment and infanticide by males. These findings confirm the existence of some form of social organization above the mother-infant unit.

Effect of antireflux medication, placebo and infant mental health intervention on persistent crying: A randomized clinical trial

To assess the effect of medical antireflux treatment, and of an infant mental health consultation (IMHC), on persistent crying in infants and maternal distress. Infants under 9 months of age with persistent crying, and their mothers, were enrolled in a randomized placebo-controlled trial. At enrollment, a questionnaire on demographic and clinical details was completed by mothers, and maternal distress was measured (Experience of Motherhood Questionnaire; EMQ). Oesophageal 24-h pH monitoring was performed in all infants on day 2. At week 4, the cry chart and EMQ were repeated in conjunction with a final interview. One hundred and three infants (56 under 3 months of age; 55 male) who were randomized to active medication (ranitidine plus cisapride; n = 34), placebo (n = 29) or IMHC (n = 40) completed the trial. There was a significant reduction in crying duration from baseline to week 4 (253 +/- 96.5 min vs 159 +/- 92.3 min per 24 h; P < 0.001), without differences between treatment groups (AVOVA: F = 0.75; P = 0.48). There was a modest improvement in EMQ scores from 44.9 +/- 8.6 at day 1 to 42.8 +/- 9.4 at week 4; P = 0.006. The improvement in maternal stress was similar in all treatment groups (Kruskal-Wallis chi2 = 0.354; P = 0.84), but subsequent admission to a mother-infant unit was significantly less frequent in the IMHC group (P < 0.05). Antireflux medications and IMHC were not superior to placebo in treating infants with persistent crying. Although the reduction in maternal distress was similar in all treatment groups, the individualized IMHC reduced the need for subsequent admission to a mother-infant unit.