Infant Well-being Research Articles

Nurse Perceptions of Babywearing for Neonates With Neonatal Abstinence Syndrome in the Neonatal Intensive Care Unit.

Infants diagnosed with neonatal abstinence syndrome (NAS) often spend several weeks in a neonatal intensive care unit (NICU) and have difficulty being consoled. Infant carriers may be used to help with irritability, while allowing the adult user to be more mobile, through the practice of babywearing (the facilitated holding of an infant using a soft cloth infant carrier worn on the body). To examine the experience of babywearing infants diagnosed with NAS while admitted in the NICU from the perspective of the nurses who care for them. Nurses (N = 18; mean age = 35.44 years, SD = 9.45) were recruited and interviewed using a semistructured interview method from a 38-bed NICU in the Southwestern United States. A thematic content analyses using an open coding scheme yielded 6 themes that fell into 2 categories: (1) benefits of babywearing infants with NAS in the NICU (Infant Consoling, Adult Multitasking, Caregiver-Infant Trust); and (2) suggestions to maximize babywearing in the NICU (Infection Control, Reoccurring Infant Carrier Education, and Reduced Patient Load). Many NICUs incorporate kangaroo care (or skin-to-skin contact) as a treatment option; however, NICU staff cannot participate in kangaroo care. Babywearing is a practical alternative for nurses and support staff. Nurses supported the practice of babywearing as a means to improve the well-being of infants with NAS while also allowing for increased efficiency in nursing tasks. More prospective studies are needed that evaluate the carryover effects and long-term impact of babywearing for infants diagnosed with NAS.

Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Perceptions of Surrogacy Within the Socio-Cultural Context of Nigeria.

Background: Surrogacy might be a reproductive process that brings joy and fulfilment to many, but it also brings with it numerous ethical and legal concerns; it raises questions about the fundamental human rights, welfare and wellbeing of women and infants, especially within a context where it is barely regulated. This article examines the perception of surrogacy within the socio-cultural context of Nigeria. It brings to the fore various socio-cultural concerns that question the influence of surrogacy as a reproductive process on womanhood, motherhood and parenthood. It discusses, by analysing the narratives of the participants, how the surrogacy process is a dereliction of the sacredness and cultural sanctity of the family system, most especially in an African context. Methods: Fifteen (15) stakeholders (traditional birth attendants, medical gynaecologists and legal professionals within the social, medico-legal framework of reproductive health) in Nigeria were engaged in in-depth interviews to unravel the challenges which surrogacy might be facing or encountering as an ART in Nigeria. Results: There are various social, traditional, cultural, and religious beliefs that police the reproductive sphere of Nigeria, which have grave implications on fertility treatment. These socio-cultural and religious factors do not provide a fertile ground for surrogacy to thrive in Nigeria. Hence, it is important that the socio-cultural framing of reproducing in Nigeria become receptive to modern medical reproductive alternatives and innovations. Conclusions: For surrogacy to permeate the reproductive terrain of the country there is a need to jettison several socio-cultural and religious sentimental beliefs policing reproduction in Nigeria.

Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women

BackgroundImproving the health of women before pregnancy and throughout a woman’s lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S.MethodsThis is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25–50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change.DiscussionThis study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention.Trial registrationClinicalTrials.gov NCT04514224.Date of registration: August 14, 2020. Retrospectively Registered.

Perceptions of Surrogacy Within the Yoruba Socio-Cultural Context of Ado-Ekiti, Nigeria

Background: Surrogacy might be a reproductive process that brings joy and fulfilment to many but it also brings with it numerous ethical and legal concerns; it raises questions about the fundamental human rights, welfare and wellbeing of women and infants especially within a context where it is barely regulated. This article examines the perception of surrogacy within the Yoruba socio-cultural context in Ado-Ekiti, Nigeria. It brings to the fore various socio-cultural concerns that questions the influence of surrogacy as a reproductive process on womanhood, motherhood and parenthood. It discusses by analysing the narratives of participants how surrogacy process is a dereliction of the sacredness and cultural sanctity of the family system, most especially in an African context. Methods: 15 stakeholders (traditional birth attendants and gynaecologists) were engaged in an in-depth interview to unravel the challenges surrogacy might or is encountering within the socio-cultural context of Ado-Ekiti. Results: There are various social, cultural and religious beliefs that police the reproductive sphere of the Yoruba socio-cultural group, which has grave implications on fertility treatment. These socio-cultural and religious factors do not provide a fertile ground for surrogacy to thrive within the study location. Hence, it is important that the socio-cultural framing of reproduction within this cultural context become receptive to medical reproductive solutions and innovations if at all the processes are to thrive or at least become less stigmatised. Conclusions: The process of surrogacy is very complex and people’s attitude towards the practice is greatly influenced by their culture, religion and social belief systems about what is considered appropriate for procreation. Also, it is important to have clear-cut policy regulating surrogacy and all forms of ARTs in Nigeria, as this will protect women and infants, as well as, ensure that they are not to exposed abuse, commercialization and exploitation.

Mothers’ experiences of the relationship between body image and exercise, 0–5 years postpartum: A qualitative study

The relationship between body image and exercise in early motherhood is an important yet understudied determinant of mother and infant wellbeing. To address this, we report on a qualitative study of early mothers’ lived experiences of the relationship between body image and exercise in the first five years post-birth. Twenty-one mothers (0–5 years postpartum) completed individual, semi-structured online/phone interviews (M interview time =47.25 min), to elicit narratives about peripartum body image and its relationship with exercise. Thematic analysis was conducted according to the Braun and Clarke framework. Three key themes, and several subthemes, were identified: 1.body image in early motherhood is diverse, dynamic and individual, 2.postpartum exercise forms part of early motherhood adjustment, and 3.body image and exercise form an important, intricate relationship in early motherhood. Women’s narratives indicated three body image/exercise patterns, each characterised by different behaviours and motivations. Mothers who reported exercising, or avoiding exercising, for reasons related to body dissatisfaction appeared at greatest risk of negative outcomes from body-related distress and maladaptive exercise patterns. Conversely, mothers reporting higher body appreciation described more adaptive exercise behaviours. This research provides important information for the development of interventions to support positive body image and healthful exercise in early motherhood.

Effect of Technology-Supported Interventions on Prenatal Gestational Weight Gain, Physical Activity, and Healthy Eating Behaviors: a Systematic Review and Meta-analysis

This review characterizes the effect of technology-supported interventions on prenatal gestational weight gain (GWG), physical activity, and healthy eating behaviors and describes intervention characteristics that may influence intervention effectiveness. A systematic search was conducted using PubMed, Web of Science, and CINHAL and identified prenatal technology-supported randomized controlled trials (RCT) targeting GWG, physical activity, and/or healthy eating behaviors (N = 21). Authors aggregated effect sizes to estimate overall effectiveness and calculated means of effect sizes as a function of intervention characteristics (i.e., delivery mode, type of technology, frequency of technology, correspondence between technology tool and targeted behavior). Random effects models revealed technology-supported RCTs had small effects on GWG (d = 0.23), physical activity (d = 0.38), energy intake (d = 0.38), and eating behaviors (d = 0.16). RCTs using technology with face-to-face sessions, tracking tools, and incorporating devices daily were associated with slightly larger effects, particularly for physical activity and healthy eating behaviors. Although there are small effects of technology-supported interventions on lowering GWG and improving physical activity and healthy eating behaviors, these effects may be improved by particular intervention characteristics such as delivery mode (e.g., technology plus face-to-face), type of technology (e.g., tracking tools), and frequency of technology prescribed (e.g., daily). Given the challenges and barriers of promoting prenatal GWG regulation, physical activity, and healthy eating behaviors, leveraging the use of technology to implement interventions may be a useful strategy to optimize maternal and infant well-being.

A New 3-Day Standardized Eyeblink Conditioning Protocol to Assess Extinction Learning From Infancy to Adulthood.

Associative learning can be observed from the neonatal period onward, providing opportunities to examine changes in basic learning and memory abilities. One method that is suitable to study associative learning is classical eyeblink conditioning (EBC) which is dependent on the cerebellum. Extinction learning can be systematically investigated in this paradigm by varying the context during learning and extinction. Because of methodological difficulties and ethical challenges, no studies have compared extinction learning using EBC across human development. Our goal was to test feasibility of a 3-day delay EBC paradigm that can be used from infancy to adulthood. Acceptance/safety was tested especially for infancy by investigating attrition rates and parental report on infant wellbeing. On a paradigm side, we tested if the paradigm leads to successful acquisition and extinction. An air puff served as unconditional stimulus (US) and a tone as conditional stimulus (CS). On day 1 during acquisition, participants received 36 US–CS pairings in context A. On day 2, participants received 12 acquisition trials in context A to consolidate association learning, followed by 48 extinction trials (tone alone presentations) in context B. Renewal was assessed on day 3 and incorporated 12 CS alone trials presented in both the acquisition context and the extinction context. Eyeblink responses were videotaped and coded offline. The protocol was tested with 12–36-months-old infants (N = 72), adolescents (N = 8), and adults (N = 8). Concerning the acceptance/safety side, attrition ranged from 21 to 58% in infant samples due to the complex preparation of the children for the paradigm. However, attrition is equal to or lower than other infant learning paradigms. Parents of infant samples were very interested in the paradigm and reported low levels of infant stress, exhaustion, and negative feelings during the sessions. Data quality was very high, and no participant had to be excluded because of insufficient data. Concerning the paradigm side, participants showed successful acquisition and extinction as a group. The procedure is ethically sound, feasible, tolerated by many infants, and acceptable among parents. The data show successful acquisition and extinction rates, making the paradigm a valuable tool for investigating developmental changes in extinction learning over the lifespan.

Prevalence and Associated Factors of Low Birth Weight among Term Newborns in Dilla Town, Southern Ethiopia.

Introduction Birth weight has emerged as the pointer of infant wellbeing and the fundamental focus of infant health policy. Low birth weight predisposes newborns to loads of health disarray like underweight, stunting, hypoglycemia, hypothermia, mental retardation, physical, and neurodevelopment problems which results in high rates of morbidity and mortality. This study aimed to assess the prevalence and associated factors of low birth weights in term newborns. Objective This study designed to assess the prevalence and associated factors of low birth weight among term newborns in Dilla town, Southern Ethiopia. Materials and Methods Institutional based cross-sectional study design was used on 472 term newborns. The study setting includes three health centers (Dilla, Wallemi, and Tumetecha) within Dilla town and Dilla University referral hospital from September 1, 2018, to January 30, 2019. The study subjects were mothers with term newborns delivered in the above institutions and those delivered at home and received care within the first 24 hours after delivery in the above health care settings. Results A total of 161 (34.1%) of the term newborns were low birth weight. Divorced mothers, rural residents, maternal age <20 years old, unwanted and unintended pregnancy, no ANC follow-up, no dietary counsel, no foliate supplementation, and cigarette smoking have shown an association with low birth weight of neonates. Conclusions Even though the method of sampling used in this study has its confines, the prevalence of low birth weight in this study was higher than the estimate in Ethiopia. Therefore, it is recommended that special attention should be given to pregnant mothers to get adequate rest, additional diet, and antenatal services available and accessible to all pregnant women.

The downstream effects of COVID-19: a call for supporting family wellbeing in the NICU.

Parents of NICU infants are a vulnerable population from a psychological perspective, and often experience high levels of acute stress, depression, anxiety, and post-traumatic stress. The added burden of the current SARS CoV-2 disease (COVID-19) pandemic is likely to exacerbate these issues, with potential implications for the wellbeing of infants and families in the short- and long-term. In this paper, we propose utilizing the stress contagion framework and consider how psychosocial stress can “spill over” into the parent-infant relationship domain, which can impact child development and family wellbeing longer term. As the effects of the pandemic will likely persist well beyond the acute stage, we offer advocacy points and general guidelines for healthcare professionals to consider in their quest to mitigate stress and build resilience in NICU families.

Trauma and Parenting Beliefs: Exploring the Ethnotheories and Socialization Goals of Palestinian Mothers

Parenting beliefs are important to infant wellbeing, but there is a lack of research into their role in war conditions. We examined (1) how maternal traumatic experiences (war events and childhood abuse) and mental health would be associated with parenting beliefs about good childrearing practices (ethnotheories) and desirable child characteristics (socialization goals) and (2) whether parenting beliefs mediate the impact of traumatic experiences and mental health on mother–infant interaction and infant development. Palestinian mothers (N = 510) participated during pregnancy and at four and 12 months postpartum. They reported current traumatic war events, emotional and physical abuse in their own childhood and mental health (posttraumatic stress disorder, depression, and anxiety symptoms), their ethnotheories and socialization goals and the quality of dyadic mother–infant interactions and infant developmental skills (language, fine-motor, and gross-motor). High maternal exposure to traumatic war events was associated with higher autonomy-enhancing—and lower relatedness-enhancing—socialization goals. Conversely, maternal childhood abuse was associated with higher relatedness-enhancing—and lower autonomy-enhancing—socialization goals. High maternal exposure to traumatic war events was associated with high levels of positive dyadic interaction, whereas high emotional and physical abuse and mental health problems were associated with low levels of positive dyadic interaction. Parenting beliefs did not mediate the impact of maternal traumatic experiences and mental health on dyadic interaction or infant development. The nature of maternal traumatic experiences was central for the socialization goals in unique and specific ways. The findings emphasize the meaningfulness of parenting values, goals, and practices among mothers caring for their infants in war conditions.

Probiotic treatment for women with gestational diabetes to improve maternal and infant health and well-being.

Gestational diabetes mellitus (GDM) is carbohydrate intolerance first recognised during pregnancy and associated with complications for mothers and babies. Probiotics are naturally occurring micro-organisms, which when ingested in adequate amounts, may confer health benefits. Evidence of the role of probiotics as treatment for GDM is limited. To evaluate the safety and effectiveness of probiotics in treating women with GDM on maternal and infant outcomes. We searched the Cochrane Pregnancy and Childbirth's Trials Register ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) (24 July 2019), and reference lists of retrieved studies. Randomised controlled trials (RCTs) comparing the use of probiotics versus placebo/standard care for the treatment of GDM. Two review authors independently assessed study eligibility, extracted data, checked data accuracy, and assessed risk of bias of included trials. The certainty of evidence for selected maternal and infant/child outcomes was assessed using GRADE. Nine RCTs (695 pregnant women with GDM) comparing probiotics versus placebo were identified. The overall risk of bias in the nine RCTs was low to unclear and the evidence was downgraded for imprecision due to the small numbers of women participating in the trials. The trials were carried out in hospitals and universities in Iran (seven trials), Thailand (one trial) and Ireland (one trial). All trials compared probiotics with placebo. Maternal outcomes We are uncertain if probiotics have any effect compared with placebo on hypertensive disorders of pregnancy, (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.64 to 3.53; participants = 256; studies = 3; low-certainty evidence) and mode of birth as caesareans (average RR 0.64, 95% CI 0.30 to 1.35; participants = 267; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: mode of birth as vaginal/assisted and subsequent development of type 2 diabetes. We are uncertain if probiotics have any effect compared with placebo on induction of labour (RR 1.33, 95% CI 0.74 to 2.37; participants = 127; studies = 1; very low-certainty evidence). For other secondary maternal outcomes, we are uncertain if there are differences between probiotics and placebo for: postpartum haemorrhage; weight gain during pregnancy intervention and total gestational weight gain; fasting plasma glucose and need for extra pharmacotherapy (insulin). Probiotics may be associated with a slight reduction in triglycerides and total cholesterol. In probiotics compared with placebo, there was evidence of reduction in markers for insulin resistance (HOMA-IR) and HOMA-B; and insulin secretion. There was also an increase in quantitative insulin sensitivity check index (QUICKI). Probiotics were associated with minor benefits in relevant bio-markers with evidence of a reduction in inflammatory markers high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and marker of oxidative stress malondialdehyde; and an increase in antioxidant total glutathione, but we are uncertain if there is any difference in total antioxidant capacity. No trials reported secondary outcomes: perineal trauma, postnatal weight retention or return to pre-pregnancy weight and postnatal depression. Infant/child/adult outcomes We are uncertain if probiotics have any effect, compared with placebo, on the risk of large-for-gestational-age babies (RR 0.73, 95% CI 0.35 to 1.52; participants = 174; studies = 2; low-certainty evidence) or infant hypoglycaemia (RR 0.85, 95% CI 0.39 to 1.84; participants = 177; studies = 3; low-certainty evidence) because the certainty of evidence is low and the 95% CIs span possible benefit and possible harm. No trials reported primary outcomes of: perinatal (fetal/neonatal) mortality; or neurosensory disability. For other secondary outcomes, we are uncertain if there is any difference between probiotics and placebo in gestational age at birth, preterm birth, macrosomia, birthweight, head circumference, length, infant hypoglycaemia, and neonatal intensive care unit (NICU) admissions. There was evidence of a reduction in infant hyperbilirubinaemia with probiotics compared with placebo. No trials reported secondary outcomes: infant adiposity, and later childhood adiposity. There were no adverse events reported by any of the trials. Low-certainty evidence means we are not certain if there is any difference between probiotic and placebo groups in maternal hypertensive disorders of pregnancy, caesareans; and large-for-gestational-age babies. There were no adverse events reported by the trials. Due to the variability of probiotics used and small sample sizes of trials, evidence from this review has limited ability to inform practice. Well-designed adequately-powered trials are needed to identify whether probiotics may improve maternal blood glucose levels and/or infant/child/adult outcomes; and whether they can be used to treat GDM.

The Role of Perinatal Anxiety and Depression in Breastfeeding Practices.

Objective: Maternal mental health difficulties are common during the perinatal period and have a negative impact on breastfeeding practices. Most research has focused on the role of postpartum depression, whereas maternal anxiety has been less studied, despite its high prevalence. A better understanding of the mental health variables that impact breastfeeding practices is necessary to support maternal and infant health and well-being. The aim of this study is to explore the association between breastfeeding practices and maternal mental health, with an emphasis on maternal anxiety. Materials and Methods: Two hundred twenty-nine women were followed from the third trimester of gestation to 3 and 6 months postpartum. The participants provided self-reports of depression, anxiety, and breastfeeding practices. Mental health symptoms were compared between participants who reported exclusive versus mixed breastfeeding at 3 months postpartum, and between mothers who maintained breastfeeding versus those who had weaned their infants at 6 months postpartum. Logistic regression analysis was used to explore the variables contributing to breastfeeding practices. Results: High levels of depressive symptoms during pregnancy were associated to nonexclusive breastfeeding at 3 months postpartum. At 3 months postpartum, both high levels of anxiety and depression were associated with nonexclusive breastfeeding at that time. Logistic regression analyses revealed that exclusive breastfeeding at 3 months postpartum predicted breastfeeding continuation at 6 months after childbirth. Conclusion: Both maternal depression and anxiety negatively impact breastfeeding practices. Early identification of maternal mental health problems during the perinatal period is relevant to promote maternal emotional well-being and to prevent breastfeeding difficulties.

Mass media exposure and maternal healthcare utilization in South Asia.

Maternal mortality remains a major population health problem in the developing world due in part to inadequate healthcare before, during, and after childbirth. Mass media has the potential to disseminate information about maternal healthcare that can improve well-being for mothers and infants, particularly among women with limited educational attainment. This study examines the impact of mass media exposure (e.g., television, radio, and newspaper) and sociodemographic factors on maternal healthcare utilization in four South Asian countries: India, Bangladesh, Nepal, and Pakistan. Analyses use 2014–2017 Demographic and Health Surveys, which are nationally representative of women aged 15–49 years. Results show that maternal healthcare utilization is significantly higher among women exposed to mass media across countries, even after controlling for mother's, husband's, and household sociodemographic factors. Women exposed to mass media are 46–86% more likely to receive antenatal care, 24–53% more likely to deliver their babies by skilled birth attendants, and 36–94% more likely to receive postpartum check-ups across countries. Mother's educational attainment moderates the association between mass media exposure and some maternal healthcare services in three of the four countries. Governments and public health organizations can consider mass media as a key intervention in promoting maternal health in developing contexts.

Sources, Production, and Clinical Treatments of Milk Fat Globule Membrane for Infant Nutrition and Well-Being.

Research on milk fat globule membrane (MFGM) is gaining traction. The interest is two-fold; on the one hand, it is a unique trilayer structure with specific secretory function. On the other hand, it is the basis for ingredients with the presence of phospho- and sphingolipids and glycoproteins, which are being used as food ingredients with valuable functionality, in particular, for use as a supplement in infant nutrition. This last application is at the center of this Review, which aims to contribute to understanding MFGM’s function in the proper development of immunity, cognition, and intestinal trophism, in addition to other potential effects such as prevention of diseases including cardiovascular disease, impaired bone turnover and inflammation, skin conditions, and infections as well as age-associated cognitive decline and muscle loss. The phospholipid composition of MFGM from bovine milk is quite like human milk and, although there are some differences due to dairy processing, these do not result in a chemical change. The MFGM ingredients, as used to improve the formulation in different clinical studies, have indeed increased the presence of phospholipids, sphingolipids, glycolipids, and glycoproteins with the resulting benefits of different outcomes (especially immune and cognitive outcomes) with no reported adverse effects. Nevertheless, the precise mechanism(s) of action of MFGM remain to be elucidated and further basic investigation is warranted.

Development of an Outcome Measure of Observable Signs of Health and Well-Being in Infants With Orofacial Clefts.

To develop an outcomes instrument that assesses observations that can be reliably reported by caregivers and can be used to assess health of infants with a cleft lip or cleft lip and cleft palate (CL±P) and impacts of treatments. Cross-sectional, mixed methods study. Caregivers and health-care providers were recruited from 3 academic craniofacial centers and national advertisements. Most interviews were conducted by telephone, and surveys were completed online. Caregivers had a child less than 3 years of age with CL±P and spoke either English or Spanish. Health-care providers were members of a cleft team. Caregivers (n = 492) and health-care professionals (n = 75) participated in at least one component of this study. Caregivers and health-care providers participated in tasks related to instrument development: concept elicitation for items within relevant health domains, prioritization of items, and item review. We identified 295 observations of infant well-being across 9 health areas. Research staff and specialists evaluated items for clarity, specificity to CL±P, and responsiveness to treatment. Caregivers and health-care providers rated the resulting list of 104 observations and developed the final instrument of 65 items. In this phase of development of the Infant with Clefts Observation Outcomes (iCOO) instrument, items were developed to collect caregiver observations about indicators of children's health and well-being across multiple domains allowing for psychometric testing, sensitivity to changes associated with treatment, and documentation of the effects of treatment.

Implementing NIDCAP training in a low-middle-income country: Comparing nurses and physicians' attitudes

BackgroundThe Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides developmentally supportive environment for preterm infants and their families. Few studies evaluated staff perceptions about NIDCAP implementation and its effect on infant and parents and working conditions. AimsTo assess the perception and experience of NICU staff during the NIDCAP implementation. Study designCross-sectional anonymous online survey. Subjects57 NICU staff (29 nurses and 28 doctors) who were present at least one year prior to and during the implementation of NIDCAP training in a tertiary care center. Outcome measuresA standard questionnaire addressing attitude, perceived behavioral control, subjective norm, intention, behavior and NIDCAP impact related to NICU conditions was used after initiating developmental care activities and NIDCAP training in the unit from June 2014 to May 2018. ResultsForty-six doctors and nurses filled the questionnaire; they scored ≥3 out of 5 on all the questionnaire items. Nurses scored significantly higher than doctors (mean 4.00 ± 036) versus (3.57 ± 0.30) (p < 0.001) on the overall NIDCAP score. Specifically, nurses scores were significantly higher for attitude (p < 0.001), perceived behavioral control (p = 0.029); subjective norm (p = 0.011), intention (p = 0.024) and behavior (p < 0.001) questions. ConclusionThe implementation of NIDCAP in a low-middle income country was perceived as a positive experience for both nurses and doctors: It was thought to have improved infant care and wellbeing as well as the staff relationship with parents, however working conditions remained a challenge. More studies are needed to address areas of improvement for implementation.

NICU music therapy and mother-preterm infant synchrony: A longitudinal case study in the South of Brazil

ABSTRACT Introduction Having a hospitalised preterm baby is a traumatic experience that may affect parenting and parent-infant interaction. Music therapy in a neonatal intensive care unit (NICU) has been shown to foster the well-being of preterm infants and their mothers, but evidence about its effects on mother-infant interaction is still scarce. This case study explored the contributions of the Music Therapy Intervention for the Mother-Preterm Infant Dyad – MUSIP, to mother-preterm infant interaction. Method Participants were a mother and her extremely preterm son, hospitalised in a Brazilian NICU. The dyad participated in nine sessions of MUSIP, aimed at supporting maternal singing with the baby. In the NICU and then at home (4 months after discharge), the mother was interviewed and the mother-infant interaction was observed during two interactional contexts, breastfeeding and free interaction with singing. Results The video analysis showed that, during singing and right after singing, the dyad displayed more social behaviours and more synchronous co-occurrences. The thematic analysis of maternal interviews showed that MUSIP contributed to the mother’s and the infant’s empowerment and to mother-infant bonding. Discussion MUSIP empowered maternal competence to interact with the baby and facilitated synchrony, which may act as a protective factor for the infant’s development, for maternal well-being, and for mother-infant bonding.

Cessation of breastfeeding in mothers of preterm infants-A mixed method study.

Many women cease breastfeeding earlier than desired. This study examined the cessation of breastfeeding among mothers of preterm infants. Thus, the aim was to describe the cessation of breastfeeding in mothers of preterm infants up to 12 months after birth. This mixed methods study used a convergent design with both qualitative data, consisting of written comments, and quantitative data, on breastfeeding status and breastfeeding satisfaction. The data were collected from questionnaires sent to the mothers at three points during the first year after birth. In total, 270 mothers of preterm infants who breastfed at the time of discharge from the neonatal unit provided data for the study. The quantitative and qualitative data were analysed separately with statistical tests and hermeneutical analysis, respectively and then together according to the convergent mixed methods design. Four themes of the meanings of the cessation of breastfeeding were identified in the qualitative analysis: "Desire to regain the mother's and the infant's well-being", "The mothers interpretation that the infants actively ceased breastfeeding", "The mother's body and/or the infants' signals showing the way" and "The mother's own will and perceived external obstacles". Mothers who did not breastfeed as long as they wanted were more likely to report less satisfaction with breastfeeding, a shorter breastfeeding period, and less activity when ceasing breastfeeding. In comparison, mothers who breastfed as long as they wanted were more satisfied with breastfeeding, breastfed for a longer period of time and were more active in decision making in breastfeeding cessation. Maternal passivity or activity influenced the cessation of breastfeeding in mothers of preterm infants who breastfed at the time of discharge from the neonatal unit. Passive behaviour related to breastfeeding may result in early cessation of breastfeeding, and low breastfeeding satisfaction while active behaviour may increase breastfeeding length and satisfaction.

Progesterone vaginal ring as a new contraceptive option for lactating mothers: Evidence from a multicenter non-randomized comparative clinical trial in India

ObjectivesEvaluate and compare contraceptive efficacy, safety, continuation rates and duration of lactational amenorrhea (LA) in married lactating women (20–35 years) using the progesterone vaginal ring (PVR) or Copper-T380A intrauterine device (IUD) during the first postpartum year. Study designWe conducted a one-year multicenter, non-randomized, non-inferiority, open-label, comparative trial at 20 centers in India and compared efficacy, safety, continuation and LA plus feeding patterns and growth/well-being of participants’ infants. Women used four 3-month PVRs consecutively (lost PVRs were not replaced) and were to breastfeed at least four times/day. We used Pearl Index (PI) and Kaplan Meier (K-M) rates to analyze pregnancy and K-M for continuation. ResultsWe enrolled 789 women (459 PVR, 330 IUD). Neither PI nor K-M one-year pregnancy rates differed significantly between groups (PI: PVR-0.62; IUD-0.35); (K-M: PVR-0.7; IUD-0.4, p = 0.58). Continuation rates at 12 months were 78.5% (IUD) vs. 56.9% (PVR) (p < 0.001). Ring expulsions and menorrhagia were the most common discontinuation among PVR/IUD users respectively. The median duration of LA among PVR vs. IUD users was 405 vs. 120 days (p < 0.001). Both groups reported similar adverse events (PVR: 24.2%; IUD: 23.0%); there were no serious adverse events among PVR users. Infants from both groups fed 12–7 times/day and grew at expected rates. ConclusionsEfficacy and safety outcomes were comparable among women in both groups. Continuation rates for PVR, a woman-controlled method, were shorter than IUD rates while PVR users maintained LA significantly longer than IUD users. Infant breastfeeding and growth patterns/well-being were favorable in both groups. ImplicationsPVR, a user-controlled device, offers an additional contraceptive choice for lactating women for one-year postpartum use and can help to address the unmet need for contraception among postpartum women while encouraging breastfeeding to enhance infant growth and well-being.