Advances in Neonatal Care最新文献

Background: As national rates of opioid use disorder (OUD) continue to persist, the resulting impact on the affected mother-infant dyad is immense. While there is concrete evidence in support of breastfeeding in women receiving medication for OUD, gaps in widespread support for breastfeeding in this population remain, leading to continued breastfeeding disparities.

Purpose: Explore the multilevel barriers and facilitators to breastfeeding for mothers receiving medication for OUD.

Methods: Semi-structured interviews were completed with a total of 29 participants (N = 14 mothers, N = 3 family members, and N = 12 providers). We used three levels of the socio-ecological model, including the individual, microsystem, and macrosystem, to guide our multiple case study analysis. Qualitative, latent content analysis was used to focus on identifying and understanding barriers and facilitators to breastfeeding across these various levels.

Results: Participants across groups identified barriers to breastfeeding at all three socio-ecological model levels, while facilitators were only identified at the individual and microsystem levels. Across the different levels of the socio-ecological model, six subthemes emerged: (1) breastfeeding knowledge and readiness; (2) infant factors; (3) support; (4) daily routines; (5) organizational environment; and (6) policies.

Implications for practice and research: Application of the socio-ecological model to identify barriers and facilitators to breastfeeding may inform approaches that are sustainable and more likely to improve rates of breastfeeding over time for mothers receiving medication for OUDs.

Background: Parents having infants treated in the neonatal intensive care unit (NICU) may experience negative psychosocial effects if they perceive high levels of stress.

Purpose: To investigate associations between perceived stress among parents with infants treated in the NICU and sociodemographic characteristics (educational level), clinical factors (labor week, birthweight, previous miscarriage), dyadic adjustment, illness perception, and healthcare satisfaction.

Methods: In this descriptive, correlational, cross-sectional study, parents ( N = 259) of infants treated in the NICU were recruited by convenience sampling. Study questionnaires, "Parent-Infant Descriptive Information Form, Perceived Stress Scale, Brief Illness Perception Questionnaire, Dyadic Adjustment Scale, and PedsQL Healthcare Satisfaction Scale" were administered to parents. Correlation and regression analyses were conducted.

Results: Perceived stress level of the parents was high. Parents' perceptions of their infants' illness, satisfaction with healthcare, and dyadic adjustment accounted for 77.8% of their perceived stress.

Implications for practice and research: Interventions that promote coping with stress, enhance dyadic adjustment, and increase healthcare satisfaction for parents may promote parents' mental health and may also be crucial to maintain a positive infant-parent relationship. Moreover, because parents reported less stress when they had a positive perception of their infants' diseases, parents should be encouraged to ask questions about their infant's diagnosis, and clinicians should provide anticipatory guidance.

Background: Kangaroo care (KC) is essential for both the infant's health and the mother's well-being.

Purpose: The purpose of this quality improvement (QI) project is to implement a practice change that aligns the neonatal intensive care unit's (NICU) KC policy with the most recent World Health Organization guidelines, potentially improving the outcomes of preterm and very low birth-weight infants. The aims were to revise the unit's current KC policy, create a pamphlet for parent distribution regarding KC awareness, and increase the number of KC sessions by 20% and the duration in minutes of KC sessions by 50% for eligible infant-mother dyads following implementation of the updated policy.

Methods: A framework developed and published by Guenther et al guided intervention readiness and delivery action sequence in this project. The assessment was made through successful workgroup participation consisting of 5 direct care registered nurses and the project leader. Pre-/post-practice change improvement interventions were assessed by comparing KC-eligible daily census, if KC was performed, and the average duration of individual KC sessions in minutes.

Results: After the implementation of an updated policy and distribution of a newly created KC parent pamphlet, there was a 58.1% increase in the number of KC sessions offered and a 140% increase in duration.

Implications for practice research: Expanding the role of KC in the NICU may decrease an infant's NICU-associated morbidities, thereby decreasing healthcare costs. This project's findings may serve as a model for other units to expand their KC practices.

Background: The lack of physical contact during therapeutic hypothermia (TH) is challenging for parents of newborns with hypoxic ischemic encephalopathy. Holding is often avoided due to concerns for effects on infant temperature and for dislodging equipment.

Purpose: We assessed the effect of holding during TH on maternal and infant salivary cortisol levels and on infant vital signs.

Methods: Prospective crossover study with infants randomized to a 30-minute session of holding on day-2 versus day-3 of TH. "No-holding" occurred on the alternate day at the same time. Pre- and post-holding salivary cortisol levels were compared between holding and no-holding conditions. Vital signs were collected at 2-minute intervals. Data was analyzed using mixed-effects models.

Result: Thirty-four mothers and infants were recruited. The median gestational age was 39 weeks, 16 (94%) had moderate encephalopathy and all were on morphine during TH. Salivary cortisol levels decreased after holding for infants on day-2 ( P = .02) and mothers on day-2 and day-3 ( P = .01). Infants held on day-2, but not on day-3, had lower heart rates, respiratory rates, and mean arterial pressures. Temperature and oxygen saturations were stable on both days.

Implications for practice and research: We demonstrate positive effects of holding during TH as evidenced by lower salivary cortisol for both mother and infant and decreased heart rate, respiratory rate, and blood pressure for the infant on day-2. Further research is needed to replicate these results, to understand the lack of infant response on day-3 and to assess correlation with cumulative morphine exposure.

Background: Preterm infants face many stressful experiences in the neonatal intensive care unit (NICU). Critical aspects of brain growth and development may be affected by stressor exposure. Longer term neurodevelopmental effects may result.

Purpose: The aims were to examine relationships between NICU stressor scores and childhood behavior and neurodevelopment at 4 years of age in a cohort of preterm infants.

Methods: We measured daily stress events with the Neonatal Infant Stress Scale (NISS) in 83 preterm infants over the first 6 weeks of life. Twenty-five of these children were followed up at 4 years of age the Child Behavior Checklist (CBCL) and the Battelle Developmental Index-Screening Test (BDI-2 ST).

Results: The cumulative NISS score was significantly correlated with both childhood scales in unadjusted models, but the CBCL and BDI-2 ST were not correlated with each other, suggesting they measured different constructs. Gestational age (GA) and time until full enteral feeding were the only consistent infant variables significantly associated with the CBCL scales and were selected as covariates in the regression models. Only the Score for Neonatal Physiology with Perinatal Extension (SNAPPE-II) was significantly associated with the BDI-2 ST personal-social, motor, communication, and total scales and was selected as the covariate in the regression models. Hierarchical regressions on CBCL internalizing, externalizing, and total behavior scores and BDI-2 ST scales showed relationships between the NISS and both scales, but other factors influenced these relationships, including GA, SNAPPE-II, and length of time to enteral feeding.

Implications for practice and research: The amount and nature of neonatal stress may have impacts on neurodevelopment at 4 years of age. Limitations were the small sample size. Further larger studies of neonatal stress and neurodevelopment are warranted. Practice implications would be to ensure efforts to reduce unnecessary stress during the NICU stay and to provide developmental support as these children grow.

Background: Brain magnetic resonance imaging (MRI) is an important diagnostic tool for infants with possible brain abnormalities. While sedation may be necessary for high quality images, it carries risks of complications. The sedation rate for MRI procedure varies widely, ranging from 0% to 100%, influenced by infant characteristics and institutional practices, with an increasing focus on non-sedated or minimally sedated approaches to reduce risks.

Purpose: We studied sedation utilization in infants undergoing MRI scanning before and after implementing an MRI bundle.

Methods: This cohort study utilized a pre- post-intervention design. An MRI bundle, including a process map, a safety checklist and a questionnaire collecting detailed information on sedation, were developed for our off-unit MRI suite. Pre-intervention group included infants scanned March 2018 to February 2019, and Post-intervention group March 2019 to February 2022. We hypothesized that sedation rates would significantly decrease following the intervention.

Results: In the study, 229 infants in the Pre-Intervention group and 764 infants in the Post-Intervention group underwent MRI scanning. Sedation use decreased by 62%, from 29% pre-intervention to 18% post-intervention ( P = 0.0003). Post-intervention infants were 47.6% less likely to be sedated, adjusting for gestation-corrected age (OR 0.524 [0.369, 0.745]; P < 0.01). Each 1-week increase in gestation-corrected age was associated with a 7.1% increase in the odds of sedation, controlling for the intervention time-period (OR 1.071 [1.022, 1.122]; P = 0.004). The questionnaire was completed 72% of the time in the post-intervention group.

Implication for practice and research: A standardized approach and protocol development can significantly reduce sedation for neonatal MRI. This study offers guidance for future research and integrated care interventions across medical teams.

Background: Little is known about healthcare use and costs for commercially insured infants in the first year of life following a Neonatal Intensive Care Unit (NICU) hospitalization.

Purpose: To evaluate healthcare utilization and costs in the 12-months after a neonatal hospitalization among commercially insured infants, comparing infants with and without medically complex conditions.

Methods: This retrospective, cross-sectional, cohort study uses data from the IBM MarketScan Commercial database (2015-2019). The cohort included infants with and without medically complex conditions, hospitalized at birth in the NICU, discharged alive, and had 12-months continuous coverage. The primary outcomes are healthcare utilization (i.e., hospital readmissions, emergency department (ED) visits, and primary care and specialty outpatient visits) and out-of-pocket (OOP) costs.

Results: The analysis included 23,940 infants, of which 84% resided in urban areas, 48% were born term (>37 weeks) and 43% had a medically complex diagnosis. Medically complex infants exhibited higher rates of readmissions, ED visits, specialist utilization, and specialty services. Average OOP costs for medically complex infants was $1893, compared to $873 for noncomplex infants. Almost half (48%) of the cohort had costs that exceeded $500 in the first year of life.

Implications for practice and research: This study provides insights into the financial implications of post-NICU care for infants. Findings underscore the importance of considering medical complexity over gestational age when understanding healthcare use and spending patterns. Policymakers, healthcare providers, and families can use these insights to address the financial challenges associated with caring for infants with complex medical conditions beyond the NICU.

Background: Thermoregulation is paramount in preterm infant care, traditionally addressed through nurse-led incubator weaning protocols. Recent research has introduced infant-driven incubator protocols that are demonstrating promise.

Purpose: This study, conducted at a freestanding academic pediatric hospital in the mid-Atlantic, examined the impact of infant-led incubator weaning on a specific neonatal cohort. The primary hypothesis posited that infants in the infant-led weaning group would wean out of the incubator at earlier gestational ages and lower weights, while maintaining comparable or greater weight gain during the transition to open cribs.

Methods: A retrospective chart review compared 40 infants weighing less than 1500 g before and after a weaning protocol change.

Results: Infant-led weaning demonstrated lower weights at weaning to crib ( M = 1836.80 g) compared with nurse-led weaning ( M = 1975.9 g), with statistical significance ( t [36] = 2.27, P =  .02, Cohen's d = 0.74). Infants in the infant-led group had a lower weight change 5 days prior to weaning ( M =  141 g) compared with the nurse-led group ( M =  185 g), which is also statistically significant ( t [36] = 1.93, P =  .03, Cohen's d = 0.63). T-tests revealed no significant differences in gestational age at wean to crib, change in weight post-weaning, gestational age, or days to discharge.

Implications for practice and research: Infant-led weaning emerges as a safe alternative with potential benefits for preterm neonates and their families. While initial positive outcomes are evident, further research with a larger neonatal cohort is imperative to validate the efficacy of infant-led weaning as a successful alternative to traditional methods.