Infant Well-being Research Articles

Clinical Study on Plant Galactagogue Worldwide in Promoting Women's Lactation: a Scoping Review.

Human milk is recommended by the World Health Organization (WHO) for the general well-being of infants. However, many mothers face an insufficient milk supply to breastfeed their children. Galactagogue, in particular, plant galactagogue, serves as a method to promote lactation. This in-depth review examines the evidence supporting different plants' galactagogic activity through clinical studies around the globe. A scoping review approach was adopted to establish the research questions, and define the findings, selection and analysis of the study. This scoping review highlights and compiles the clinical research performed globally involving plant galactagogue to better inform the medical practitioners, lactation consultants, nursing mothers, communities and relevant personnel on practicing, guidelines, policymaking and research. In general, a total of 1041 research publications were retrieved from different global bibliographic databases, of which only 13 articles were retained for analysis after applying the exclusion criteria. A total of 14 types of plants have undergone clinical studies in the past decade to verify their galactagogic activity. All but two showed a positive effect on promoting milk production. There were 42 articles categorised as excluded studies. The category includes review articles, surveys, case reports, introductory articles of regional plant galactagogue and preclinical studies, which involves animal testing and the studies exploring other issues related to plant galactagogue. The findings demonstrate that there is a significant research gap on the plant galactagogue using clinical studies. More clinical research is necessary to identify and verify the efficacy of various types of plant galactagogue for the benefit of humankind.

Support Seeking in the Postpartum Period: Content Analysis of Posts in Web-Based Parenting Discussion Groups.

BackgroundThe transition from pregnancy to motherhood is a major developmental phase that can be challenging for both women and their families. For new mothers, the postpartum period is recognized as a critical period for increased risk of both physical and mental health concerns. For this reason, it is imperative that women receive accurate, evidence-based information during this time.ObjectiveThis study aims to explore the conversations of new mothers on a web-based parenting forum to investigate what topics or concerns are being discussed.MethodsA leading Australian web-based support forum for women before and after birth was used to obtain a sample of posts from the mothers of infants aged 0-12 months. Quantitative data (word frequencies and sentiment analysis) and qualitative data (post content) were extracted from discussion threads and examined to determine sentiments and theoretical storylines.ResultsIn total, 260 posts were sampled. Infant care was the most prominent overarching topic discussed, with feeding and sleep being the most discussed subtopics. Discussions about maternal care were much less frequent but included questions about birth recovery, breastfeeding concerns, and interconception. A pattern of behavior emerged within the posts. This pattern resembled a cycle of learning across five phases: help seeking, solution ideation, testing and skill development, consolidation, and empowerment and improved mental well-being. A dynamic interplay was observed as mothers navigated new concerns or developmental changes.ConclusionsEngagement in web-based forums to seek help and support during the postpartum period was common, with infant health and well-being being the primary concerns for new mothers during this time. The identification of a maternal learning cycle within the forum underscores the contributory role of web-based communities in maternal peer social support, information seeking, and early parenting practices.

Development of a Mobile Application of Internet-Based Support Program on Parenting Outcomes for Primiparous Women.

Primiparous women usually experience various parenting problems after childbirth that have negative effects on the well-being of mothers and infants. Although e-Support technology could provide an innovative and easily accessible intervention approach, mobile-phone interventions remain limited for Chinese primiparous women. Therefore, a new mobile application (APP) called the “Internet-based Support Program” (“ISP”) was designed, incorporating the self-efficacy theory and the social-exchange theory for Chinese first-time mothers to improve their levels of maternal self-efficacy (MSE), social support, and satisfaction, as well as to reduce their postpartum depression symptoms. The research was conducted to develop and optimize the “ISP” APP for new mothers via a theory-, evidence-, and person-based approach. Five modules of “learning forum”, “communication forum”, “ask-the-expert forum”, “baby home forum”, and “reminder forum” were included in the APP to meet various parenting needs of first-time mothers; and its contents and functions were validated by the experts and primiparous women. The majority of participants gave positive feedback on the APP’s perceived ease of use and usefulness. The “ISP” APP was the first designed for Chinese primiparous women, and a multicenter randomized controlled trial (RCT) will be conducted to measure its effectiveness on parenting outcomes.

Understanding the Impact of Maternal HIV Infection on the Health and Well-Being of Mothers and Infants in South Africa: Siyakhula Collaborative Workshop Report

The Siyakhula study is an ongoing, observational cohort study in Pretoria, South Africa, that aims to understand how maternal HIV infection and perinatal environmental factors shape development and health in infants who are HIV-exposed (in utero and during breastfeeding) but remain uninfected themselves (HEU). The Siyakhula Collaborative Workshop, which took place at the Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies at Kalafong Hospital in Pretoria, South Africa on November 15–16, 2018, brought together a group of international health scientists, clinicians, and stakeholders, including women with lived experience, to build capacity for research and training on the impact of HIV infection on women’s and infants’ health across geographical and disciplinary boundaries. The workshop sought to summarise the state of knowledge on the effects of being HEU on infant development and health in the first two years of life, identify gaps in existing research on modifiable exposures that may be associated with poor infant development, and develop ideas for novel research and interventions to lessen or prevent adverse health outcomes in pregnant or breastfeeding people living with HIV. These proceedings summarise the pre-workshop consensus process that was used to identify priority areas to discuss during small-group breakout sessions, as well as the themes and key challenges that emerged from these discussions during the workshop.

Locating Infant and Early Childhood Mental Health at the Heart of Social Work.

Infant and early childhood mental health (IECMH)-an interdisciplinary field dedicated to advancing understanding of early relationships, socioemotional development, and cultural and contextual influences on caregiving-offers essential tools for social workers to support the well-being of infants, toddlers, preschoolers, and their families. Even though social worker Selma Fraiberg was a founder of the field, and social workers are central to the work of assessment and intervention with young children and their caregivers in many settings, few schools of social work offer training in IECMH, and few social workers are familiar with its core principles, scholarship, and intervention approaches. In this article, faculty members from four U.S. social work programs address the vital role of IECMH in social work training, research, and practice as well as issue a call to the field to recover and renew commitment to a practice perspective and knowledge base with roots in social work. Twenty-five years ago, Social Work published a similar call, but the request has gone largely unheeded. The authors examine the changing landscape and argue that it is more important and timelier than ever for social workers to learn and integrate the relationship-based approach to promotion, prevention, intervention, and treatment offered by IECMH.

Impact of Pan-Ethnic Expanded Carrier Screening in Improving Population Health Outcomes: Proceedings from a Multi-Stakeholder Virtual Roundtable Summit, June 25, 2020.

Impact of Pan-Ethnic Expanded Carrier Screening in Improving Population Health Outcomes: Proceedings from a Multi-Stakeholder Virtual Roundtable Summit, June 25, 2020.

Caregiver-infant and toddler interactions during diapering: Caregiver responsiveness and child well-being and involvement.

The findings of this empirical research provide new information about the importance of caregiver interactions during care routines, specifically diaper changing, in supporting infant and toddler involvement and well-being. This correlational study involved observations of 144 separate diapering cycles by 31 caregivers with 74 infants and toddlers in 30 infant and toddler classrooms in a U.S. Midwest city. Based on these observations, caregiver responsiveness was found to be significantly related to both child involvement and child well-being. Another feature of caregivers' behavior, caregiver encouragement, was significantly associated with child well-being, but not child involvement. The study results suggest that caregivers' behaviors, specifically responsiveness and encouragement, during diapering are vital proximal processes in the moment-to-moment interactions between a caregiver and child. Thus, responsiveness and encouragement in care routines should be emphasized in infant care settings and be a focus for caregiver professional development, including pre- and in-service training. Although training related to diapering is often restricted to health concerns, the findings suggest that specific caregiver-child interactions during this care routine may support or hinder children's well-being and involvement in the moment. Caregiver responsiveness to children's cues in this context may enhance children's opportunities to practice involvement in bidirectional relationships and support children's well-being.

Child and family health nurses' roles in the care of infants and children: A scoping review.

Child and family health nurses (CFHNs) work in a variety of settings with families to promote optimal growth and development in infants and children from birth to 5years. Literature is available about models of care that CFHNs use in their work, but there is limited information about how CFHNs enact care specifically for infants and children. The aim of this scoping review was to identify and contextualize existing knowledge of how CFHNs, both in Australia and internationally, care for infants and children. Arksey and O'Malley's (2005) framework was used to review 27 studies from Australia, Sweden, Finland, United Kingdom (UK), United States of America (USA), Ireland, Netherlands, Denmark and Canada. It was identified that CFHNs, equipped with a range of assessment tools for early intervention and health promotion, use a partnership approach when working with parents to promote the health and well-being of infants and children. The literature revealed the complexity of the roles undertaken by CFHNs when caring for infants and children. Review findings indicated that CFHNs' work is distinctive because it is conducted in home and community settings, is relational and salutogenic in nature and is also located in the domain of preventative health and early intervention.

Body image profiles and exercise behaviours in early motherhood. A latent profile analysis.

Early motherhood may impact body image, and its relationship to exercise, potentially affecting mother and infant wellbeing. This study examined whether duration of weekly exercise differed according to body image profile (BIP) based on relative levels of body dissatisfaction and body appreciation. Survey data from 262 women, 0-5 years postpartum, were analysed. Latent profile analysis identified "average", "dissatisfied" and "appreciative" BIPs. Significantly lower exercise was found in the dissatisfied compared to the appreciative BIP (p = 0.005), with marginally lower exercise in the dissatisfied compared to the average BIP (p = 0.029 with adjusted α = 0.02). This research has implications for designing targeted interventions supporting postpartum wellbeing.

Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study.

Introduction: The UNICEF (United Nations International Children Education Fund) and WHO (World Health Organization) recommend exclusive breastfeeding (EBF) for the first six months of life. EBF is considered to be an important practice for enhancing infant health and wellbeing. Breastfeeding offers a wide range of psychological and physical health benefits in the long-term and short-term for young children, infants, and mothers. This study aims to compare exclusive breastfeeding practice among primiparous and multiparous mothers including reasons for discontinuing exclusive breastfeeding and problems faced during breastfeeding.Methodology: This cross-sectional study was conducted in rural areas of Sindh, registered with the Maternal Newborn Health Registry (MNHR). The study used a systematic sampling technique for the enrollment of study participants. A survey questionnaire was used to collect data from mothers about the practices of EBF. A total of 397 mothers were interviewed and analyzed.Results: Among Primiparous mothers, 14.1% of mothers initiated breastfeeding within one hour of birth, while 22.4% of multiparous mothers, initiated breastfeeding within one hour of birth. The difference between the two is statistically insignificant (p-value=0.234). A high percentage of multiparous mothers exclusively breastfed their infants for six months (63.5%) as compared to primiparous mothers (51.5%). The most common reason for introducing pre-lacteal feed before six months among primiparous mothers is the lack of adequate milk production to fulfill baby needs; this was the case for 35.4% of mothers. On the other hand, the baby remaining hungry post breastfeeding was the major reason among multiparous mothers (44.0%) for introducing pre-lacteal feed before six months.Conclusion: This study helped in the identification of issues faced by primiparous and multiparous mothers during exclusive breastfeeding. Interventions for promoting EBF need to be tailored as per the need and challenges of the population.

Modular intervention to improve paternal involvement and support for better infant and young child feeding in a district of coastal South India: a randomized controlled trial protocol

Background: The major determinant to the well-being of infants and young children (IYC) is their feeding practices. These practices are the responsibility of both parents, meaning that fathers have an equal role to mothers. Fathers’ involvement can have an impact on the overall health of the children. Despite this, paternal involvement towards IYC feeding (IYCF) have not been studied adequately. Methods: This randomized control trial (n=120) will be conducted among fathers of infants (children aged <1 year) and young children (children aged 12-23 months) in selected households in Dakshina Kannada District of the southern Indian State of Karnataka. The study will be conducted after an initial baseline assessment on awareness, attitude and involvement of fathers in IYCF. Fathers with scores less than the 50 th percentile in the practice component will be categorized as fathers with poor involvement and will be potential participants for the trial. A visual module will be developed and validated for improving paternal involvement in IYCF. Using a simple randomization technique, the participants will be allocated to modular intervention and control group (1:1 allocation). Each participant in the intervention arm will be visited once a month to implement the module, for six months on a one-to-one basis. Following the intervention, a post-test assessment will be done for both groups to measure the level of paternal involvement in IYCF. Ethics and dissemination: Approval has been obtained from the Institutional Ethics Committee of Kasturba Medical College, Mangalore, India. The dissemination plans include scientific conferences and publication in scientific journals. Registration: The study is registered with Clinical Trial Registry of India ( CTRI/2017/06/008936).

Are there adverse outcomes for child health and development following caesarean section delivery? Can we justify using elective caesarean section to prevent obstetric pelvic floor damage?

Elective pre-labour Caesarean section (CS) delivery is widely regarded as the panacea for all pelvic floor dysfunction despite substantial epidemiological evidence that it is only partially protective. To demand a CS is also considered a right for the well-counselled patient, even without an elevated risk of incontinence or prolapse. In recent years there has been increasing data on possible adverse health outcomes for children delivered by CS over those delivered vaginally. This includes respiratory illness, atopic conditions, obesity, diabetes and other severe auto-immune diseases. Concern has also been raised over possible impacts on cognitive and neuropsychological development in these children. Often the response has been to dismiss these outcomes as a result of the indication for the CS birth such as antenatal compromise or maternal disease. However the marked increase in non-medical Caesarean delivery throughout many regions of the world has allowed us to better distinguish these contributing factors. This narrative review looks at some of the more recent evidence on adverse health and developmental outcomes associated with CS, particularly pre-labour CS and the implications for the long term health of our society. Epidemiological studies and animal research indicate an increased risk of negative impacts on child physical health and neuro-cognitive development aftercaesarean section delivery, particularly pre-labour Caesarean section, compared with vaginal delivery. This elevated risk persists after correction forobstetric and maternal factors. Caesarean section delivery can result in adverse outcomes for infant, maternal and societal wellbeing. Elective Caesarean section, purely to potentiallyminimise pelvic floor dysfunction, cannot be justified.

Mapping Evidence of Neonatal Resuscitation Training on the Practices of Unskilled Birth Attendants in Low-Resource Countries: Protocol for a Scoping Review.

BackgroundCompetence in neonatal resuscitation of the newborn is very critical to ensure the safety and well-being of newborn infants. The acquisition of neonatal resuscitation skills by birth attendants improves self-efficacy, thereby reducing neonatal mortality as a result of asphyxia. Approximately one-quarter of all neonatal deaths globally are caused by birth asphyxia. The need for neonatal resuscitation is most imperative in resource-constrained settings, where access to intrapartum obstetric care is inadequate.ObjectiveThis protocol describes the methodology of a scoping review on evidence of training in neonatal resuscitation and its association with practice in low-resource countries. The aim of the review is to map the available evidence of neonatal resuscitation training on the practices of unskilled birth attendants.MethodsThe scoping review will use the Population, Concept, and Context (PCC) framework proposed by Arksey and O’Malley, refined by Levac et al, and published by Joanna Briggs Institute, while following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was developed with the assistance of the college librarian. A number of databases of peer-reviewed research (PsycINFO and Wiley Online Library [via EBSCOhost], PubMed, MEDLINE with full text, Google Scholar [via ScienceDirect], and CINAHL Plus with full text [via EBSCOhost]) and databases committed to grey literature sources will be searched, and reference extraction will be performed. Two independent reviewers will screen and extract data, and discrepancies will be resolved by a third reviewer. The extracted data will undergo a descriptive analysis of contextual data and a quantitative analysis using appropriate statistical methods.ResultsData relating to neonatal resuscitation training and practices in low-resource settings will be extracted and included for analysis. We expect that the review will be completed 12 months from the publication of this protocol.ConclusionsThis scoping review will focus on the review of evidence and provide an insight into the existing literature to guide further research and identify implementation strategies to improve the practices of unskilled birth attendants through the acquisition of skills and self-efficacy in neonatal resuscitation. The results of this review will be presented at relevant conferences related to newborn and child health and neonatal nursing studies and published in a peer-reviewed journal.International Registered Report Identifier (IRRID)DERR1-10.2196/18935

A life course perspective on BMI in rural America.

Rural Americans are substantially more likely to be obese than their urban counterparts. A life course perspective offers insights into how growing up in rural areas may affect weight in young adulthood. Using data from the Panel Survey of Income Dynamics, this study follows the residential trajectories of 3157 respondents since birth. Living in a rural area during the critical period of early childhood (before age two) is predictive of higher BMI, while residence in later childhood and adolescence is not. Improving the health and wellbeing of rural mothers and infants could potentially help address the roots of rural obesity.

Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset.

BackgroundHigh stress prenatally contributes to poor maternal and infant well-being. The coronavirus disease 2019 (COVID-19) pandemic has created substantial stress for pregnant women.PurposeTo understand whether stress experienced by women pregnant at the beginning of the pandemic was associated with a greater prevalence of adverse perinatal outcomes.MethodsPregnant women across the USA aged ≥18 years old enrolled in a prospective cohort study during the pandemic onset (T1) in April–May 2020. This report focuses on the 1,367 participants who gave birth prior to July–August 2020 (T2). Hierarchical logistic regression models predicted preterm birth, small for gestational age infants, and unplanned operative delivery from T1 stress, sociodemographic, and medical factors.ResultsAfter controlling for sociodemographic and medical factors, preterm birth was predicted by high prenatal maternal stress, delivering an infant small for gestational age was predicted by interpersonal violence and by stress related to being unprepared for birth due to the pandemic, and unplanned cesarean or operative vaginal delivery was predicted by prenatal appointment alterations, experiencing a major stressful life event, and by stress related to being unprepared for birth due to the pandemic. Independent of these associations, African American women were more likely than other groups to deliver preterm.ConclusionPregnant women who are experiencing high stress during the COVID-19 pandemic are at risk of poorer perinatal outcomes. A longitudinal investigation is critical to determine whether prenatal maternal stress and resulting outcomes have longer-term consequences for the health and well-being of children born in the midst of the current pandemic.

Stressful life events and electronic cigarette use during pregnancy.

Smoking during pregnancy poses a significant health risk for infant well-being. Prior research has linked experiencing stressful life events (SLEs) during pregnancy to prenatal smoking. However, extant research has not assessed whether SLEs experienced during pregnancy are a risk factor for prenatal electronic cigarette use. This study investigates the association between SLEs and electronic cigarette use during the third trimester of pregnancy. We employ data on 70,626 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic and multinomial logistic regression models were used to examine the association between SLEs and electronic cigarette use during the third-trimester of pregnancy. The prevalence of electronic cigarette use increased alongside an accumulating history of SLEs (0 SLEs=0.4%; 1-2 SLEs=0.9%; 3-5 SLEs=1.9%; 6+ SLEs=5.0%). Logistic regression models found 6 or more SLEs were associated with 4.7 times higher odds of electronic cigarette use relative to 0 SLEs after adjusting for demographic and socioeconomic characteristics (AOR=4.705, 95% CI=2.960, 7.479). Study findings also showed that women who experienced greater levels of SLEs had a higher prevalence of using any nicotine products (i.e., exclusive electronic cigarette user, exclusive cigarette user, dual user), relative to being a non-smoker. Findings from multinomial logistic regression models revealed that a higher number of SLEs was associated with an increased relative risk of all smoking outcomes. Still, these associations were particularly pronounced in the case of exclusive electronic cigarette user (ARR=8.485, 95% CI=4.900, 14.692) and dual-use (ARR=8.348, 95% CI=4.113, 16.945) when participants experienced 6 or more SLEs (relative to 0 SLEs). Considering the potentially harmful ramifications of electronic cigarette use during pregnancy there is a need for interventions that reduce stressful experiences and decrease smoking during pregnancy.

Study of Road Traffic Accidental (RTA) deaths in and around Jamnagar Region of Gujarat

Paediatrics is a branch of medicine which is concerned with wellbeing of infants, children, adolescents, their physical, mental, and psychological development. Paediatric forensic autopsy is useful to evaluate us the natural and unnatural childhood deaths, their reasons, steps for prevention and their management, which is both useful to the branch of Forensic Medicine and the Medical researchers. A 3 year retrospective study was conducted in M.P. Shah Government Medical College, Jamnagar during the period of January 2014 to December 2016. Out of total 3743 autopsies performed, a total of 253 cases belonging to paediatric age-group were the material of the study. Accidental deaths are the most common manner of deaths and mostly affected age-group is 12-17 years. The leading cause of death are burns, drowning, road traffic accidents and snake bite. Accidental burns and suicidal hanging were more common in females in the age-group 12-17 years. Accidental drowning and RTA were common in the males. In the present study, snake bite envenomation was also one of the leading causes of unnatural deaths in children and was mostly seen in the age range of 2-10 years. In India, both natural and unnatural childhood deaths are emerging as major public health problem. Various educational programmes, preventive strategies, and dissemination of information are necessary to create awareness and is must to reduce the unnatural deaths. Keywords: Paediatric autopsy, Unnatural children deaths, Trauma, Manner of death.

Retrospective study of pediatric autopsy findings in a tertiary care center: an evaluation

Paediatrics is a branch of medicine which is concerned with wellbeing of infants, children, adolescents, their physical, mental, and psychological development. Paediatric forensic autopsy is useful to evaluate us the natural and unnatural childhood deaths, their reasons, steps for prevention and their management, which is both useful to the branch of Forensic Medicine and the Medical researchers. A 3year retrospective study was conducted in M.P. Shah Government Medical College, Jamnagar during the period of January 2014 to December 2016. Out of total 3743 autopsies performed, a total of 253 cases belonging to paediatric age-group were the material of the study. Accidental deaths are the most common manner of deaths and mostly affected age-group is 12-17 years. The leading cause of death are burns, drowning, road traffic accidents and snake bite. Accidental burns and suicidal hanging were more common in females in the age-group 12-17 years. Accidental drowning and RTA were common in the males. In the present study, snake bite envenomation was also one of the leading causes of unnatural deaths in children and was mostly seen in the age range of 2-10 years. In India, both natural and unnatural childhood deaths are emerging as major public health problem. Various educational programmes, preventive strategies, and dissemination of information are necessary to create awareness and is must to reduce the unnatural deaths. Keywords: Paediatric autopsy, Unnatural children deaths, Trauma, Manner of death.

Variation and determinants of early initiation of breastfeeding in high and low neonatal mortality settings in India

Early initiation of breastfeeding (EIBF) is considered one of the most cost-effective interventions for infant survival and well-being. This study aimed to examine the variations in, and determinants of, early initiation of breastfeeding among women in high and low neonatal mortality rate (NMR) settings in India using data from the fourth round of the National Family Health Survey conducted in 2015-16. At 35%, EIBF was found to be disproportionately low in the high NMR group of states compared with 52% in the low NMR group, with the national average being 44%. The chance of EIBF significantly increased if childbirth was vaginal, delivery took place in a health institution, the mother received breastfeeding advice and the birth was a planned one in both high and low NMR settings. In the high NMR group of states, the probability of initiating breastfeeding immediately after birth improved to a great extent if childbirth was assisted by a trained person and if the mother was exposed to any type of mass media. There is an urgent need to increase the access of mothers to breastfeeding advice during pregnancy and to increase their exposure to mass media, particularly in high NMR states. In addition, achieving universal access to institutional deliveries and deliveries assisted by a skilled birth attendant, especially in high NMR settings, and promoting early breastfeeding, especially in the case of Caesarean deliveries, would further improve the level of EIBF in the country as a whole. These interventions can potentially increase the prevalence of early initiation of breastfeeding and help India attain the neonatal mortality rate target of Sustainable Development Goal 3.

Transition From the Neonatal Intensive Care Unit to Home: A Concept Analysis.

A successful transition from the neonatal intensive care unit to home is fundamental for the long-term health and well-being of preterm infants; however, the process parents' experience during their transition home is poorly understood. An improved understanding of this concept will allow nurses to offer families comprehensive and collaborative discharge preparation. To describe the defining attributes, antecedents, and consequences for the concept of transition in the context of the neonatal intensive care unit to home. Databases, MEDLINE, CINAHL, PsycINFO, and EMBASE were searched for articles containing "transition" in combination with "neonatal intensive care unit" or variants of these terms. The Walker and Avant method was used for this concept analysis. The defining attributes of transition in the context of the neonatal intensive care unit to home are "mix of emotions," "uncertainty," and "coming into parenthood." The principal antecedent is "hospital discharge preparation" and consequences include "feeding and medical needs," "family life changes," and "parental confidence." Gradually increasing parents' participation in their infant's care and forming a partnership and collaborative plan with families will help ease the uncertainty parents experience during their transition home. Further investigation is needed to determine how best to provide emotional support for parents during their transition home and to explore a feasible option for neonatal nurses to follow up with parents after hospital discharge.