Well-baby Care Research Articles

Linking Inter-professional Newborn and Contraception Care (LINCC) trial: Protocol for a stepped wedge cluster randomized trial to link postpartum contraception care with routine Well-Baby Visits

BackgroundPregnancies conceived within 18 months of a prior delivery (termed short inter-pregnancy interval [IPI]) place mothers and infants at high risk for poor health outcomes. Despite this, nearly one third of U.S. women experience a short IPI. ObjectiveTo address the gap in the current model of postpartum (PP) contraception care by developing and implementing a novel approach to link (co-schedule) PP contraception care with newborn well-baby care to improve access to timely PP contraception. MethodsThe LINCC Trial will take place in seven clinical locations across five community health centers within the U.S. PP patients (planned n = 3150) who are attending a Well-Baby Visit between 0 and 6 months will be enrolled. The LINCC Trial aims to leverage the Electronic Health Record to prompt providers to ask PP patients attending a Well-Baby Visit about their PP contraception needs and facilitate co-scheduling of PP contraception care with routine newborn care visits. The study includes a cluster randomized, cross-sectional stepped wedge design to roll out the intervention across the seven sites. The outcomes of the study include receipt of most or moderately effective methods of contraception by two and six months PP; and rate of short IPI pregnancies. Implementation outcomes will be assessed at baseline and 6 months after site enters intervention period. ConclusionsThe LINCC Trial seeks to evaluate the effectiveness and feasibility of a linked care model in comparison to usual care.

Growth patterns of children under 5 years old in rural area northern of Abha, Aseer Region, Saudi Arabia.

Measuring and monitoring physical growth is a key element in assessing children's health. The physical and mental development of a growing child are indicators of good health and nutrition. This study aimed to explore the patterns of growth parameters among children under 5 years old attending primary health care centres (PHCCs) in rural northern Abha. Feeding habits during the first 2 years of life were also assessed. This study was conducted on 1-5 April 2022 in all (PHCCs) in Billasamr and Ballahmar, two neighbourhoods of northern Abha. The investigator designed a form for collecting each child's age (months), weight (kilograms), gender, birth order, number of family members, type of feeding (exclusive breastfeeding, exclusive bottle feeding, or mixed feeding), and duration of exclusive breastfeeding. Gender affected the body weight of Saudi infants, as boys weighed significantly more than age-matched girls. Birth order also affected body weight. During the first and third years of life, Saudi children's body weight was not significantly affected by feeding type. During the second and fifth years of life, formula-fed children weighed more than breastfed or combination-fed children. However, during the fourth year of life, body weight was highest in combination-fed children. Growth patterns over time, established from multiple data points, must be used in conjunction with other medical and family history to evaluate appropriate growth. Recording and tracking body size, especially recumbent length and weight, as part of well-baby care is critical for any assessment of child wellbeing and health status.

Factors in Infancy That May Predict Autism Spectrum Disorder.

The global increase in the prevalence of ASD (Autism Spectrum Disorder) is of great medical importance, but the reasons for this increase are still unknown. This study sought to identify possible early contributing factors in children who were later diagnosed with ASD. In this retrospective cohort study, postnatal records of 1105 children diagnosed with ASD were analyzed to determine if any signs of ASD could be found in a large database of births and well-baby care programs. We compared the recordings of typically developing children and analyzed the differences statistically. Rapid increases in weight, height, and head circumference during early infancy predict the development of ASD. In addition, low birth weight, older maternal age, and increased weight and height percentiles at six months of age together predict the development of ASD. At two years of age, these four parameters, in addition to impaired motor development, can also predict the development of ASD. These results suggest that the recent increase in ASD prevalence is associated with the "obesity epidemic" and with recommendations of supine sleeping to prevent Sudden Infant Death Syndrome, associated with atypical neural network development in the brain.

Obstacles Preventing Public Health Nurses from Discussing Children’s Overweight and Obesity with Parents

ABSTRACT We examined how well-baby care nurses perceive communication with parents regarding their children’s obesity and identified main communication barriers. Pediatric obesity is a significant public health concern, and health care personnel are among the first to detect overweight and the first to offer assistance to parents. Yet, research suggests that when nurses identify a weight problem in children, they may have trouble initiating this discussion. This qualitative study, using semi-structured interviews with 20 public health nurses, addressed potential obstacles nurses face when discussing young children’s weight. Lack of time and workload were the most significant barriers to meaningful conversation with parents. Instructing parents toward a healthy lifestyle, while specifically relating to the child’s weight, is perceived as part of the nurse’s role, but execution was flawed. Trust and good communication between the nurse and parents are seen as critical ingredients to provide future guidance around a child’s weight. Nurses want parents to feel comfortable to discuss children’s weight problems, but are worried that such a discussion may impair previously established trust. Nurses should receive comprehensive training to address childhood obesity, including specific communication skills to implement when discussing this stigmatized and sensitive topic.

Grandi Byen—Integrated Responsive Parenting, Nutrition, and Hygiene for Child Growth and Development: Protocol for a Randomized Controlled Trial

Objectives Grandi Byen—to grow well in Haitian Creole—tests the effectiveness of a multicomponent intervention encompassing nutrition, responsive parenting, and WASH (water, sanitation and hygiene) during the complementary feeding period on child growth and neurobehavioral development.MethodsThis study is a three-arm, longitudinal randomized controlled trial. Mothers/caregiver and their infants (ages 6–8 months at baseline) living in Cap-Haitien, Haiti (N = 600 dyads) will be randomly and equally assigned into the following groups: 1) standard well-baby care (control); 2) nutrition intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (one egg per day for 6 months + 12-week psychoeducational intervention on responsive parenting, nutrition, and WASH practices).ResultsPrimary outcomes for this study are child growth (length-for-age-, weight-for-age-, and weight-for-length Z scores) and development (cognitive, language, motor, and social-emotional). Secondary outcomes that are hypothesized as mediators to the primary outcomes are child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) and parent-specific outcomes (responsive parenting and parental mental health). Targeted genomics will also highlight potential interactions between host genetics, enteric pathogens, gut microbiota, and overall child development. Findings will demonstrate the reproducibility and feasibility of egg-based interventions, while testing their impact on reducing child stunting and suboptimal development. Additionally, the multicomponent intervention will demonstrate whether stimulating care and WASH education induces any incremental benefits on child nutrition and developmental outcomes.ConclusionsThis project shifts from the norm of single-component nutrition interventions (e.g., single nutrient supplements and other food-based interventions) in child health research. The Grandi Byen concept approaches child well-being holistically by addressing poor child growth and development through nutrition along with proximal environmental and psychosocial determinants of child development.Funding SourcesEunice Kennedy Shriver National Institute of Child Health and Development (NICHD).

Predictors of maternal self-efficacy and the mediating role of postpartum fatigue for Jewish and Arab women in Northern Israel

ObjectiveThe study aims to investigate positive and negative social interactions as predictors of maternal self-efficacy and to examine the mediating role of postpartum fatigue. DesignParticipants included 450 Arab and Jewish mothers of healthy one-month-old infants who visited 14 well-baby care clinics located in northern Israel. The study used a prospective longitudinal cohort design. Participants completed the first questionnaire and agreed to a follow-up phone interview three months later. Both ethnic groups had a response rate of 90% for the follow-up interview. The questionnaire included six scales that measured socioeconomic status and demographics, obstetric characteristics, social networks and support, negative social interactions, fatigue and maternal self-efficacy (MSE). The phone interview was a shorter version of the written questionnaire focusing on MSE and fatigue. Maternal self-efficacy four month after birth was examined with social support, negative interactions and fatigue, using multiple linear regressions within each ethnic group. FindingsIn both groups, negative social interactions decreased perceptions of maternal self-efficacy. Women who reported higher social support after birth experienced a greater sense of maternal self-efficacy four months after birth, though the association was stronger among Jewish women. Post-partum fatigue affects Arab and Jewish mothers differently. Among Arab mothers, fatigue at one month mediates MSE as well as the relationship between social support and negative interactions at four months. Among Jewish mothers, these factors are directly related to MSE, with no mediation effect. Implications for practiceThe correlations found between social interactions, fatigue and maternal self-efficacy can be useful in providing appropriate care that includes information and parental support. Health professionals working with postpartum women must assess degree of postpartum fatigue and negative postpartum social interactions as well as social support during the postpartum period.

Grandi Byen\u2014supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: study protocol for a randomized controlled trial

BackgroundPoor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development.MethodsWe will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions.DiscussionThis study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally.Trial registrationNCT04785352. Registered March 5, 2021 at https://clinicaltrials.gov/

2020 edition of the Rourke Baby Record: What is new in preventive care of children up to 5 years of age?

To update primary care providers practising well-child and well-baby clinical care on the evidence that contributed to the recommendations of the 2020 edition of the Rourke Baby Record (RBR). Pediatric preventive care literature was searched from June 2016 to May 2019, primary research studies were reviewed and critically appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and recommendations were updated where there was support from the literature. Notable changes in the 2020 edition of the RBR include the recommendations to limit or avoid consumption of highly processed foods high in dietary sodium, to ensure safe sleep (healthy infants should sleep on their backs and on a firm surface for every sleep, and should sleep in a crib, cradle, or bassinette in the parents' room for the first 6 months of life), to not swaddle infants after they attempt to roll, to inquire about food insecurity, to encourage parents to read and sing to infants and children, to limit screen time for children younger than 2 years of age (although it is accepted for videocalling), to educate parents on risks and harms associated with e-cigarettes and cannabis, to avoid pesticide use, to wash all fruits and vegetables that cannot be peeled, to be aware of the new Canadian Caries Risk Assessment Tool, to note new red flags for cerebral palsy and neurodevelopmental problems, and to pay attention to updated high-risk groups for lead and anemia screening. The RBR endeavours to guide clinicians in providing evidence-informed primary care to Canadian children. The revisions are rigorously considered and are based on appraisal of a growing, albeit still limited, evidence base for pediatric preventive care.

Newborn screening for cystic fibrosis: Role of primary care providers in caring for infants with positive screening results.

To explore primary care providers' (PCPs') preferred roles and confidence in caring for infants receiving a positive cystic fibrosis (CF) newborn screening (NBS) result, as well as management of CF family planning issues, given that expanded NBS has resulted in an increase in positive results. Mailed questionnaire. Ontario. Ontario FPs, pediatricians, and midwives identified by Newborn Screening Ontario as having had an infant with a positive CF NBS result in their practice in the previous 6 months. Primary care providers' preferred roles in providing well-baby care for infants with positive CF screening results. Overall, 321 of 628 (51%) completed surveys (208 FPs, 68 pediatricians, 45 midwives). For well-baby care for infants confirmed to have CF, 77% of PCPs indicated they would not provide total care (ie, 68% would share care with other specialists and 9% would refer to specialists completely); for infants with an inconclusive CF diagnosis, 50% of PCPs would provide total care, 45% would provide shared care, and 5% would refer to a specialist; for CF carriers, 89% of PCPs would provide total care, 9% would provide shared care, and 2% would refer. Half (54%) of PCPs were extremely or very confident in providing reassurance about CF carriers' health. Only 25% knew how to order parents' CF carrier testing; 67% knew how to refer for prenatal diagnosis. Confidence in reassuring parents about the health of CF carrier children was associated with providing total well-baby care for CF carriers (risk ratio of 1.50; 95% CI 1.14 to 1.97) and infants with an inconclusive diagnosis (risk ratio of 3.30; 95% CI 1.34 to 8.16). Most PCPs indicated willingness to treat infants with a range of CF NBS results in some capacity. It is concerning that some indicated CF carriers should have specialist involvement and only half were extremely or very confident about reassuring families about carrier status. This raises issues about possible medicalization of those with carrier status, prompting the need for PCP education about genetic disorders and the meaning of genetic test results.

Infant delivery and maternal stress during the COVID-19 pandemic: a comparison of the well-baby versus neonatal intensive care environments.

ObjectiveTo describe impact of COVID-19 pandemic on stress and mood of new mothers, in particular in neonatal intensive care unit (NICU); a secondary objective was to assess whether customary social gender distancing practiced by ultra-religious Jews and Muslims offers built-in anti-stress protection.MethodsCross-sectional, observational survey of mothers of 52 normal newborn nursery (NNB) and 52 NICU infants. In all, 86 filled all the 6 questionnaires (Demographics, COVID-19 virus experience, Mental Health Inventory, Neonatal Satisfaction Survey, Parental Stressor Scale, and Questionnaire of Coping Strategies).ResultsMost mothers stated that COVID-19 pandemic had hurt social and family relationships, maternal role, and expressed stress and loneliness. Mothers of NICU infants had higher degree of helplessness. Religious social distancing was not protective. Background tendency to coping poorly with stress and depression most highly predicted stress.ConclusionCOVID-19 pandemic harms psychosocial well-being of most mothers. Detection of high-risk individuals is necessary to provide appropriate support.

Clinical impact of neonatal hypoglycemia screening in the well-baby care.

Objectives:To determine the proportion of well-appearing newborns screened for hypoglycemia; yield of specific screening criteria; and impact of screening on breastfeeding.Study Design:Retrospective study of well-appearing at-risk infants born ≥36 weeks’ gestation with blood glucose measurements obtained ≤72 hours of age.Results:Of 10,533 eligible well newborns, 48.7% were screened for hypoglycemia. Among tested infants, blood glucose <50 mg/dL occurred in 43% and 4.6% required intensive care for hypoglycemia. Blood glucose <50 mg/dL was associated with lower rates of exclusive breastfeeding (22% versus 65%, p <0.001). Infants screened due to late preterm birth were most frequently identified as hypoglycemic; the fewest abnormal values occurred among appropriate-weight, late term infants of non-diabetic mothers.Conclusion:Hypoglycemia risk criteria result in screening a large proportion of otherwise well newborns and negatively impact rates of exclusive breastfeeding. The risks and benefits of hypoglycemia screening recommendations should be urgently addressed.

Early Clinical Features of Cerebral Palsy in Children Without Perinatal Risk Factors: A Scoping Review

BackgroundThe early identification of cerebral palsy (CP) in the primary care context is often problematic and referral for diagnosis often delayed. This study aimed to identify clinical features associated with the early detection of CP that can be used by the primary care provider. MethodsWe performed a scoping review by searching six electronic databases. We included English language articles that addressed the diagnosis of CP and/or its differential diagnosis in children and ways of detecting CP before the diagnosis is established (i.e., early clinical signs of CP) via (1) questions on the patient's clinical history, (2) developmental screening and/or health questionnaires, or (3) physical or neurological examination. ResultsIncluded studies (n = 41; 27 overview studies and 14 original studies) were grouped into the three themes. Most of the overview articles relied on expert opinion, and all original studies included patients at high risk of developing CP. The most commonly identified features from each theme were early hand preference on clinical history, delayed or absent achievement of motor developmental milestones on developmental screening, and persistent primitive reflexes on neurological examination. ConclusionsOverall, the literature on the early observable clinical signs that should prompt referral for investigation of possible CP in the specific context of well-baby care surveillance was sparse and inconsistent. Further research should focus on evaluating the contribution of readily identifiable clinical features.

Sex effect on growth faltering in an indigenous ethnic minority population of infants in Israel.

We examined sex effects on growth faltering in an indigenous population of Bedouin Arab infants born in Israel, an economically developed country. Retrospective cohort study. Height-for-age Z-score (HAZ) at age 6, 12, 18 and 24months was calculated for full-term, normal-birth-weight Bedouin infants born during years 2000-2009 and attending maternal and child health (MCH) clinics. Multivariate linear regression analysis (MLRA) was used to calculate the association between sex and HAZ, controlling for year of birth, birth weight (BW) and residence by type of settlement (established settlement (ES); non-established settlement (NES)). Bedouin are an indigenous poor community of semi-nomadic Arabs, with the highest infant mortality rate in Israel. Fifty per cent of Bedouin infants live in NES with inadequate access to running water, electricity, and rubbish and sewage disposal. All Bedouin receive free well-baby care in community-based MCH clinics. Full-term, normal Bedouin infants (n5426) born during 2000-2009 and attending computerized MCH clinics who had growth measurements at age 6, 12, 18 and 24months. At all ages, girls had significantly higher mean HAZ than boys (P < 0·05). Increasing birth year, residence in ES and increasing BW were positively associated with HAZ (P < 0·05) at all ages. In MLRA controlling for birth year, BW and type of settlement, sex still had a significant effect, with lower HAZ among boys at 6, 12, 18 and 24months of age (P < 0·001 at all ages). Our results indicated that sex effects on growth faltering can occur in an indigenous population with low socio-economic status within an economically developed country.

Parental interest in genomic sequencing of newborns: enrollment experience from the BabySeq Project

PurposeNewborn genomic sequencing (nGS) has great potential to improve pediatric care. Parental interest and concerns about genomics are relatively unexplored. Understanding why parents decline research consent for nGS may reveal implementation barriers. MethodsWe evaluated parental interest in a randomized trial of nGS in well-baby and intensive care unit nursery settings. Interested families attended an informational enrollment session (ES) with a genetic counselor prior to consenting. Reason(s) for declining participation and sociodemographic associations were analyzed. ResultsOf 3860 eligible approached families, 10% attended ES, 67% of whom enrolled. Of 1760 families queried for decline reasons, 58% were uninterested in research. Among 499 families considering research, principal reasons for decline prior to ES included burdensome study logistics (48%), feeling overwhelmed postpartum (17%), and lack of interest/discomfort with genetic testing (17%). Decliners after ES more often cited concerns about privacy/insurability (41%) and uncertain/unfavorable results (23%). ConclusionLow interest in research and study logistics were major initial barriers to postpartum enrollment and are likely generic to many postpartum research efforts. Concerns over privacy and result implications were most commonly cited in decliners after ES. Understanding parental concerns around research nGS may inform future integration of nGS into newborn screening, predictive testing, and pediatric diagnostics.

A Qualitative Study of Women's Recall of Content and Skills Developed in Group Prenatal and Well-Baby Care 2 Years Later.

Group prenatal and well-baby care is a system of health care visits that occur in a group setting. Each individual session lasts approximately 2 hours, allowing more time for education and support than can occur in an individual visit. Compared with individual care, research suggests that group care is associated with similar or better short-term outcomes, but no studies have yet examined potential long-term benefits beyond one year postpartum. The purpose of this qualitative descriptive study was to elicit women's recall about content covered in group prenatal and well-baby care and whether they were or were not continuing to use skills discussed during group prenatal and well-baby care 2 or more years after their group ended. Eligible women participated in group prenatal and/or well-baby care between 2008 and 2012, were aged at least 18 years, and were English-speaking. Of the 127 eligible women, 32 were reached and 17 agreed to participate. Women were interviewed on average 3 years after group prenatal or well-baby care ended using a semistructured interview guide. Transcripts were reviewed and coded by each team member. Final codes and themes were identified using an iterative review process among the research team. Three themes were identified: sustained change, transferable skills, and group as a safe haven. All women were still using strategies discussed during group and had made sustained improvements in nutrition, stress management, and/or in the quality of their interactions with their children, partner, or families. The group environment was described as a safe haven: a respectful, nonjudgmental space that allowed women to share and support each other while learning new skills. This is the first study to document that group prenatal and well-baby care is associated with long-term benefits in areas not yet reported in the literature: nutrition, family communication, and parenting.

Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma Region, Tanzania: a cross-sectional study, April\u2013July 2016

BackgroundIntegration of family planning (FP) services into non-FP care visits is an essential strategy for reducing maternal and neonatal mortality through reduction of short birth intervals and unplanned pregnancies.MethodsCross-sectional surveys were conducted across 61 facilities in Kigoma Region, Tanzania, April–July 2016. Multilevel, mixed effects logistic regression analyses were conducted on matched data from providers (n = 330) and clients seeking delivery (n = 935), well-baby (n = 272), pregnancy loss (PL; n = 229), and other routine (postnatal, HIV/STI, other; n = 69) services. Outcomes of interest included receipt of FP information and a modern FP method (significance level p < 0.05).ResultsClients had significantly greater odds of receiving FP information if the primary reason for seeking care was for PL versus (vs) any other types of care (aOR 1.97), had four or more pregnancies vs fewer (aOR 1.78), and had had a FP discussion with their partner vs no FP discussion (aOR 1.73). Clients had lower odds of receiving FP information if they were aged 40–49 vs 15–19 (aOR 0.50) and reported attending religious services at least weekly vs less frequently (aOR 0.61). Clients of providers who perceived that in-service training had helped vs had not helped job performance (aOR 2.27), and clients of providers having high vs low recent FP training index scores (aOR 1.58) had greater odds of receiving FP information.Clients had greater odds of receiving a modern method when they received information on two or more vs fewer methods (aOR 7.13), had had a FP discussion with their partner vs no discussion (aOR 5.87), if the primary reason for seeking care was for PL vs any other types of care (aOR 4.08), had zero vs one or more live births (aOR 3.92), made their own FP decisions vs not made own FP decisions (aOR 3.17), received FP information from two or more vs fewer sources (aOR 3.12), and were in the middle or high vs the low wealth tercile (aOR 1.99 and 2.30, respectively). Well-baby care clients, Other routine services clients, and married clients had significantly lower odds of receiving a method (aOR 0.14; aOR 0.08; and aOR 0.41, respectively) compared to their counterparts.ConclusionsStrategies that better integrate FP into routine care visits, encourage women to have FP discussions with their partners and providers, increase FP training among providers, and expand FP options and sources of information may help reduce the unmet need for FP, and ultimately lower maternal and neonatal mortality.

Universal infant health interventions and young adult outcomes.

Three recent studies have documented short- and long-run benefits of early-infancy health interventions in Norway, Sweden, and Denmark: Universal nurse home visiting (NHV) and well-baby center care decreased infant mortality and positively impacted long-run survival (DK, S), morbidity (DK, N), and educational and labor market outcomes (N). Using Danish conscription data, this paper examines intermediate outcomes to assess both potential mechanisms and the importance of selective survival for the long-run health effects of NHV. We do not find strong effects of NHV for young adult's height or obesity status, but we find that NHV increases treated individuals' probability of emigration. As emigrants in our sample are positively selected and as they are not part of the samples used in long-run analyses, this finding suggests that the established long-run health benefits of NHV may be lower bounds.

Enacting Self and Scientific Personas: Models for Women Health Professionals in Dr. S. Josephine Baker’s Fighting for Life

In this essay, I call on scientific persona and autobiographical discourse theory to examine Dr. Sara Josephine Baker’s 1939 autobiography Fighting for Life. Through this framework, I consider how Baker and other U.S. women health professionals conceived of individual identity and collective persona during the early twentieth century. Baker helped to revolutionise well-baby and well-child care in the U.S., and in Fighting for Life, she relates the genesis and evolution of her ground-breaking work. Like her contemporaries, Baker was engaged in the research, practice, teaching, and administration of medicine and public health. Presently, scientific persona has been theorized as a conglomerate of dispositions, practices, and characteristics that are associated with scholar-practitioners of the human and natural sciences; it therefore offers a novel lens for the individual and collective fashioning of women health professionals like Baker whose work traversed disciplines and institutions. By considering how Fighting for Life, as autobiography, facilitates Baker’s conception of self and persona, I show that Baker adopts prevailing personas for women health professionals as well as women working in other fields. At the same time, Baker in her autobiography also emphasizes why and how these models transform in actual practice. Thus, scientific personas tend to emerge as subtle variations of previous forms, while Baker’s autobiography also bears witness to the rise of new personas for women health professionals, as demonstrated by her radical reconfiguration of expert knowledge and scientific motherhood.

Management of asymptomatic neonates born in the setting of chorioamnionitis: a safety comparison of the well-baby and intensive care setting

Evaluate the safety of a change in care setting for asymptomatic neonates born to mothers with chorioamnionitis from the neonatal intensive care unit to the well baby nursery.Local problem:The neonatal intensive care unit evaluation and management of babies born to mothers with chorioamionitis often involves separation of the mother-baby dyad and more invasive interventions. A single-center pre/post-intervention study of neonates born from January 2011 to November 2016, comparing safety outcomes in the neonatal intensive care unit (pre-intervention) and well baby nursery (post-intervention), following initiation of a triage protocol. A protocolized, systematic change was done in the practice location. Groups were similar for time to first antibiotic administration, sepsis symptom development and positive blood cultures. Length of stay (median 73.5 vs 64.4 h, P=0.0192) and % of neonates with intravenous fluid exposure (50.4% vs 7.6%, P<0.0001) were lower in the post-intervention group. Exclusive breastfeeding rates improved (pre-7.3% vs post-46.1%, P<0.0001). Asymptomatic neonates born to mothers with chorioamnionitis were safely treated in a well baby nursery under the guidance of a protocol for triage, thereby reducing NICU exposure for these neonates.

Gestational diabetes care and outcomes for refugee women: a population-based cohort study.

To determine the prevalence of adverse clinical outcomes, the rates of healthcare utilization, and the incidence of post-partum Type 2 diabetes in refugees with gestational diabetes (GDM), compared with other immigrants and non-immigrants. A population-based cohort study was conducted using healthcare databases in Ontario, Canada. Over 40000 women with GDM having singleton live births between 2002 and 2014 were identified. We identified GDM adverse outcomes such as macrosomia, pre-eclampsia and respiratory distress syndrome. Antenatal and newborn healthcare utilization were ascertained. Women were then followed for diagnosis of diabetes post-partum. Both refugees and other immigrants had a lower rate than non-immigrants of many adverse GDM outcomes, including pre-eclampsia [relative risk (RR) 0.65, 95% confidence interval (95% CI) 0.44-0.95 and 0.61, 95% CI 0.52-0.72, respectively], preterm birth (RR 0.87, 95% CI 0.75-0.995 and 0.85, 95% CI 0.80-0.91, respectively), and respiratory distress syndrome (RR 0.83, 95% CI 0.70-0.97 and 0.78, 95% CI 0.72-0.84, respectively). However, refugees were less likely to attend well-baby care in time for the first routine vaccination (RR 0.92, 95% CI 0.88-0.95). Incidence of post-partum diabetes was high in all groups, but refugee women were at increased risk (hazard ratio 1.23, 95% CI 1.11-1.37). Despite different circumstances leading to migration, refugees have a similar 'healthy immigrant effect' to other immigrants, with respect to adverse GDM outcomes. However, newborns of refugees were less likely to have well-baby care, and refugee women were also at especially high risk of developing diabetes post-partum. These are both important public health issues.