Journal of Perinatal & Neonatal Nursing最新文献

Purpose: Early detection and management of hypertensive disorders during pregnancy and postpartum are essential. This systematic review and meta analysis aimed: (1) to examine the state of 24-hour ambulatory blood pressure (ABP) use, and (2) in a subset of studies, evaluate 24-hour ABP parameters in the prediction and identification of Hypertensive Disorders of Pregnancy (HDP).

Methods: A comprehensive literature search was conducted in March of 2022 for English language studies published after 2000. In a subset of studies in this review, we conducted a meta analysis summarizing 24-hour, day, and night standardized mean difference (hedge's g) in systolic and diastolic blood pressure during pregnancy for individuals later diagnosed with HDP and those without.

Results: A total of 69 articles met all established criteria and were included in this systematic review, and a subgroup of studies that reported HDP outcomes (n=14) were included in the meta analysis. Out of the 69 studies, 31 (45.61%) used 24-hour ABP devices that are not validated for pregnant individuals. Birthing individuals diagnosed with HDP had elevated 24-hour, day, and night systolic and diastolic blood pressure during second and third trimesters of pregnancy.

Conclusion: A noticeable gap exists in the utilization of validated 24-hour ABP devices for pregnant and postpartum populations. Variations exist regarding the timing of 24-hour ABP measurements, particularly across trimesters.

Implications for practice: 24-hour ABP monitoring could serve as one of the tools to identify and manage pregnant individuals at risk of HDP and ultimately reverse the current trend in maternal mortality.

Background: With the increasing survival rates of premature infants and their associated respiratory problems, noninvasive ventilation has gained popularity in neonatal intensive care units. On the other hand, this equipment can be stressful for infants. Objective: This study aimed to compare the effects of white noise and sound reduction on the behavioral responses of premature infants under noninvasive ventilation. Methods: This study was a randomized controlled crossover trial. Forty-two infants who met the inclusion criteria received white noise and noise reduction in a randomized sequence with a 30-minute washout period between conditions. During the noise reduction condition, infants were placed in the fetal position with earplugs. During the white noise condition, nature sounds from the White Noise Baby Sleep app were played into the incubator. Infant behavioral responses were recorded using the Anderson Behavioral State Scale on 3 consecutive days before, during, and after the intervention. Results: The independent t test showed no statistically significant difference between the 2 groups at baseline. The repeated measures analysis of variance test showed that the mean behavioral response scores of preterm infants in the sound reduction group and the white noise group differed significantly across the 3 stages on all 3 days. However, the results of mixed-effects model indicated that the sound reduction group experienced a significant decrease in behavioral response compared to the white noise group. Conclusion: Therefore, the present study suggests that sound reduction is a more effective nonpharmacological method for improving behavioral responses and reducing restlessness of premature infants under noninvasive ventilation.

Objective: This study aims to examine neonatal intensive care unit (NICU) nurses' perceptions of artificial intelligence (AI) technologies, particularly language models, and their impact on nursing practices.

Background: AI is rapidly spreading in healthcare, transforming nursing practice. Understanding the role of AI in NICUs in the discharge process is crucial for understanding nurses' perceptions of these technologies.

Methods: The qualitative, phenomenological study used semi-structured interviews. Data were collected in a public hospital in Gaziantep from January to June 2024. Fifteen NICU nurses participated. Data were analyzed using content analysis.

Results: Most nurses found AI to be a valuable tool for saving time and simplifying information delivery in clinical processes. However, concerns were raised about AI potentially reducing human interaction and weakening the use of professional judgment. Serious concerns about AI's reliability and ethical implications were also expressed.

Conclusions: AI is considered a potentially supportive tool in nursing practice, but its integration must consider the ethical implications and impact on the use of professional judgment. Nursing is based on human interactions and AI should be considered an additive tool to enhance care.

Implications for practice and research: AI integration in nursing requires careful and balanced implementation. Future research should delve deeper into the ethical dimensions of AI and its long-term effects on nursing practices.

Background: Although data exists demonstrating widespread antibiotic use across other critically ill neonatal populations, there are limited data regarding the frequency of empiric antibiotic use among neonates with critical congenital heart defects (CCHD). The purpose of this study is to describe prevalence of antibiotic treatment in the first 28 days of life in a cohort of neonates with CCHDs.

Methods: A secondary analysis of retrospective electronic health record data of neonates admitted to a Pennsylvania pediatric hospital for cardiac surgery (2016-2020). Descriptive statistics were generated to show antibiotic treatment days and indications for use. Pearson Chi-Square and multivariable regression models were used to analyze predictors.

Results: Seventy-four neonates were included. Fifty neonates (68%) received antibiotics for reasons other than postoperative prophylaxis. Two (3%) had confirmed bacteremia.

Conclusions: Antibiotic administration was prevalent in this cohort. Future work should elucidate population prevalence of empirical antibiotic use, identify potential consequences, and design interventions to prevent overuse.

Background: Enteral and oral feeding are crucial for infants with a gestational age <32 weeks during hospitalization, with potential for improved outcomes through optimized feeding practices.

Purpose: To shorten the time to achieve full enteral and oral feeding volumes in infants with a gestational age <32 weeks.

Methods: This pre-post-intervention study focused on patients with a gestational age <32 weeks in Shenzhen City, 44 bed NICU. Quality improvement interventions included workflow enhancements, breastfeeding education, and oral motor strategies. Analysis of feeding times and hospital stays was conducted using SPSS software, alongside a provider survey to project feasibility.

Results: Statistical significant improvements were seen in full enteral feeding time for infants under 28 weeks gestation and full oral feeding time for those between 28 and 30 weeks. Length of stay did not show significant differences between period. Providers unanimously found the intervention feasible and acceptable.

Implications: Quality improvement interventions can expedite achievement of full feeding volumes in preterm infants, with potential for enhanced feeding outcomes.

Purpose: To conduct an integrative review of extant literature on prison nursery programs in the United States.

Background: About 4-10% of U.S. women entering prison are pregnant. In response, several state prisons have developed nurseries to promote maternal-infant outcomes and reduce recidivism. Unfortunately, little is known about the current state of the science related to prison nurseries.

Methods: Guided by Whittemore and Knafl's methodology, a literature search was conducted in June 2023 for peer-reviewed articles using PubMed, CINAHL, MedLINE, SCOPUS, PsycINFO, socINDEX, and Academic Search Complete. Broad keywords were used ("prison" or "incarceration" or "inmate") and ("nursery" or "nursery residential center"). Included articles were U.S.-based, peer-reviewed, and specific to prison nurseries.

Results: The search yielded 216 articles, 10 of which were included for final review and synthesis. Using the Johns Hopkins Evidence Level and Quality Guide, the level of evidence ranged from low to moderate. Themes include (1) benefits to maternal-child attachment and bonding, (2) institutional barriers and challenges to maternal-child attachment and bonding and (3) beneficial maternal justice and custodial outcomes.

Conclusions: Prison nurseries are a promising intervention to promote mother-infant outcomes. These programs promote positive maternal-infant attachment and bonding, help mothers maintain custody of their children, and reduce recidivism.

Implications for practice: There is a need to standardize nursery program characteristics to maximize benefits and promote equity. Better investment in longitudinal, quasi-experimental, and qualitative research is needed.

Background: Extensive time spent on documentation in electronic health records (EHRs) impedes patient care and contributes to nurse burnout. Artificial intelligence-based clinical decision support tools within the EHR, such as ChatGPT, can provide care plan recommendations to the perinatal nurse. The lack of explicit methodologies for effectively integrating ChatGPT led to our initiative to build and demonstrate our ChatGPT-4 prompt to support nurse care planning.

Methods: We employed our process model, previously tested with 22 diverse medical-surgical patient scenarios, to generate a tailored prompt for ChatGPT-4 to produce care plan suggestions for an exemplar patient presenting with preterm labor and gestational diabetes. A comparative analysis was conducted by evaluating the output against a "nurse-generated care plan" developed by our team of nurses on content alignment, accuracy of standardized nursing terminology, and prioritization of care.

Results: ChatGPT-4 delivered suggestions for nursing diagnoses, interventions, and outcomes comparable to the "nurse-generated care plan." It accurately identified major care areas, avoided irrelevant or unnecessary recommendations, and identified top priority care. Of the 24 labels generated by ChatGPT-4, 16 correctly utilized standardized nursing terminology.

Conclusion: This demonstration of the use of our ChatGPT-4 prompt illustrates the potential of leveraging a large language model to assist perinatal nurses in creating care plans. The next steps are improving the accuracy of ChatGPT-4-generated standardized nursing terminology and integrating our prompt into EHRs. This work supports our broader goal of enhancing patient outcomes while mitigating the burden of documentation that contributes to nurse burnout.

Purpose: This study evaluates whether delaying the first bath affects late preterm infants' skin barriers, body temperatures, and comfort.

Background: Late preterm infants' skin is drier and has a limited water retention capacity compared to term infants and adults. It is important to determine timing of care for this population with limited competencies.

Methods: A two-arm, three-center, and single- and evaluator-blind randomized controlled trial was conducted. The study is based on the CONSORT guidelines. The participants were recruited from September 2020 to September 2021. The first baths of participants in the intervention group were postponed until 48 hours after birth. Outcomes were measured before bathing and 1, 10, and 30 minutes after bathing.

Results: There was a statistically significant interaction between the groups and times for transepidermal water loss, body temperature, and comfort. The intervention group had a lower transepidermal water loss value at follow-up than the control group in the forearm and sternum. The control group had lower mean body temperatures and comfort levels.

Conclusion: When the first bathing of a late preterm infant is postponed by a minimum of 48 hours, it reduces damage to the skin barrier, body temperature is maintained, and the experience is more comfortable. Therefore, the first bath should be delayed for at least 48 hours after birth.

Implications for practice and research: The study can guide nurses to eliminate the uncertainty of the first bath applied for late preterm infants with a fragile structure in the neonatal intensive care setting and to eliminate the differences between clinics.

Purpose: This study established an app-based visitation program for mothers of infants admitted to the neonatal intensive care unit (NICU)-constrained by COVID-19 visitation restrictions-and assessed its impact on neonatal perception, maternal-infant attachment, and parental stress.

Background: High-risk infants in the NICU encounter heightened challenges, exacerbated by COVID-19 restrictions, leading to heightened maternal stress, impaired neonatal perception, and hindered mother-infant attachment.

Methods: A quasi-experimental study was conducted with 40 mothers (20 in the experimental group and 20 in the control group) unable to visit the NICU of a tertiary general hospital in South Korea. The experimental group utilized the Dodam-Dodam smartphone application, while the control group received neonatal information through telephone calls and text messages. Data collection occurred in July 2022 (control) and September 2022 (experimental) using research instruments (parent's neonatal perception, maternal-infant attachment, and parental stressor scale: NICU, visiting program satisfaction). Descriptive statistics and tests (χ2, Fisher's exact, Shapiro-Wilk, parametric independent t and paired t tests, and nonparametric tests: Mann-Whitney and Wilcoxon's signed-rank) were employed for analysis.

Results: The Dodam-Dodam application significantly impacted maternal-infant attachment parental stress scores and program satisfaction in the experimental group, except for neonatal perception.

Conclusions: The Dodam-Dodam application was more efficacious than traditional visiting programs in enhancing maternal-infant attachment, increasing maternal satisfaction and reducing parental stress within NICU settings amid restricted visitation.

Implications for practice and research: Recommendations include app-based NICU visitation, exploring app variations, studying diverse populations, and providing optimal information provision.

Background: The administration of vaccination, being an invasive procedure, can induce considerable pain in preterm infants.

Objective: This study was conducted to evaluate the effect of grasp reflex stimulation on pain and crying time during hepatitis B vaccine administration in infants.

Methods: This parallel randomized controlled trial was conducted between November 1, 2022, and April 1, 2023, at the Neonatal Intensive Care Unit of a public hospital in Turkey. The study included preterm infants whose parents provided both verbal and written consent. The control group (n = 31) underwent a routine vaccination procedure, while the experimental group (n = 28) underwent grasp reflex stimulation in addition to the routine vaccination procedure. Data were collected through the infant information form, stopwatch, and Premature Infant Pain Profile Scale-Revised (PIPP-R) form.

Results: The mean PIPP-R score during the procedure was 11.67 ± 2.05 in the experimental group and 15.51 ± 1.36 in the control group (P ≤ .001). After the procedure, the mean PIPP-R score was 10.89 ± 2.06 in the experimental group and 14.67 ± 1.55 in the control group (P ≤ .001). The mean duration of crying was 19.57 ± 6.17 in the experimental group and 27.12 ± 6.19 in the control group (P ≤ .001). The mean PIPP-R and crying time of the control group were higher.

Conclusion: Grasp reflex stimulation applied to preterm infants during vaccine administration decreased pain and crying time during and after the procedure. Grasp reflex stimulation can be applied as a care approach for procedures that may cause pain in infants and may help calm infants as part of pain management in nursing.

Implications for practice and research: The results of this study provide new information to the literature regarding the impact of grasp reflex stimulation on pain and the duration of crying induced by the hepatitis B vaccine in preterm infants. To our knowledge, this is the first study to confirm the effectiveness and feasibility of grasping reflex stimulation in hepatitis B vaccine administration in preterm infants. This study may contribute to future evidence-based studies. Grasping reflex stimulation can be tried as a parent-provided intervention in younger or older infants or in those who are critically ill.