Journal of Perinatal & Neonatal Nursing最新文献

Purpose: Implement and evaluate near-infrared (NIR) huddles for neonatal peripheral intravenous catheter (PIVC) insertion.

Methods: An implementation project investigated PIVC insertion attempts, site, inserter designation, dwell, and complications during 3 phases (baseline, education, and implementation). Implementation consisted of planning insertion site(s) and attempt frequency with an NIR device huddle. The primary effectiveness outcome was first-time insertion success. Secondary outcomes included: PIVC completion/failure, failure reason, complications. Implementation outcomes were compliance, utility, and acceptability. The association between study phase and primary outcome was assessed using logistic regression. Exploratory analyses investigated intrinsic and extrinsic risks for PIVC insertion failure.

Results: Over 5 months, data from 248 (33%) neonates with 771 admissions was collected. Fifty-nine (24%) neonates required multiple PIVCs; resulting in 370 cannulations (n = 94 baseline, n = 55 education, and n = 221 intervention phases). Median birthweight was 2909 grams (IQR 2033-3499), gestation was 37.3 weeks (IQR 33.9-38.9). Length of stay, weight, gestation, and previous PIVC events were similar across phases. Insertion success was lower during education (n = 15, 39.5%) than baseline (n = 29, 56.9%), but differences were not significant. Acceptability of huddle process was higher (mean = 7.5/10, SD 2.2) than NIR device (mean = 5.0/10, SD 3.7). First time insertion failure was higher for forearm compared to hand/wrist (OR 5.94; 95% CI 1.22-28.87).

Conclusion: The implementation of NIR-huddle failed to improve first-time insertion success, but PIVC dwell time and documentation were improved. Further research is needed to minimize harm and improve neonatal vascular access preservation.

Purpose: The purpose of this improvement initiative was to enhance cultural competence among healthcare providers within a Labor and Delivery Unit and Mother-Baby Unit through the implementation of an evidence-based LGBTQ+ competency bundle (CB).

Background: The lack of knowledge and cultural competence among healthcare providers for the LGBTQ+ population remain 1 of the leading causes of discrimination in healthcare and a barrier to achieving optimal health, safety, and well-being for individuals in this community. Conscious and unconscious bias of providers further leads to discrimination, oppression, and potential delivery of substandard care.

Discussion: The evidence-based LGBTQ+ CB consists of (1) cultural competency assessment using the Ally Identity Measure (AIM) survey, (2) provider training, (3) a sexual orientation/gender identity questionnaire within the electronic health record, and (4) resource bundle. The AIM survey was used to assess the knowledge and skills to support LGBTQ+ persons, awareness of LGBTQ+ oppression, and engagement in action among heterosexual allies to the LGBTQ+ community. AIM scores revealed an overall increase in knowledge and preparedness in providing support for the LGBTQ+ patient/family. The providers' "Knowledge and Skill" experienced the most increase in AIM scoring followed by "Openness and Support" and "Oppression Awareness," respectively.

Implications for practice: The implementation of the CB interventions increased health care providers' knowledge and understanding of LGBTQ individuals while reducing perceived bias.

Purpose: To explore the lived experiences and perspectives of 3 generations of African American women regarding breastfeeding within their historical and cultural contexts, and to identify factors influencing their breastfeeding decisions and practices.

Background: African American communities have a rich cultural heritage that includes infant nurturing. However, breastfeeding rates among African American mothers are comparatively low due to various societal factors, despite well-established health benefits. This disparity stems from historical trauma, socioeconomic inequities, and systemic barriers that disrupt community breastfeeding norms.

Methods: This study presents a secondary analysis of data from an original qualitative study. Semi-structured interviews were conducted with 35 African American women from 15 family dyads/triads across 3 generations. Data were reexamined using deductive thematic analysis, allowing for emergent themes.

Results: Six main themes emerged: intergenerational dynamics, tenacity/grit, self-empowerment, Blactivism, overcoming guilt, and a supportive breastfeeding ecosystem. These themes collectively form the framework of "(Re)Normalizing and Reclaiming Breastfeeding in African American Families," highlighting patients' resilience and agency in reclaiming breastfeeding practices.

Conclusions: This study provides valuable insights into the complex factors influencing breastfeeding decisions and experiences among African American women. Findings underscore the importance of intergenerational support, self-empowerment, community activism, and a nurturing ecosystem in renormalizing breastfeeding within the African American community.

Implications: Results can inform the development of culturally relevant interventions, policies, and support systems that promote breastfeeding equity and empowerment. Future research could focus on implementing and evaluating these strategies while addressing historical trauma and ongoing systemic barriers faced by African American women.

Background: Nosocomial infection (NI) is a serious health concern primarily for premature neonates and for term babies with illnesses requiring continued hospitalisation. Early diagnosis of NI using biomarkers is central to decreased neonatal mortality and morbidity. We aimed to evaluate the predictive value of C-reactive protein (CRP) as a marker of NI.

Methods: Sixty-four neonates, suspected of sepsis, admitted to the Department of Paediatrics and Neonatology with a negative workup for sepsis on their first day of admission were investigated for various haematological parameters, blood culture positivity, and CRP levels. The patients were then stratified into culture-positive and culture-negative groups. All the parameters analysed were compared between these 2 groups, and ROC curve analysis was performed to determine the value of CRP in predicting positive blood culture in NI.

Results: NI was seen in a total of 70.31% (n = 45) neonates based on blood culture-positive status. Compared to females, a greater number of male neonates were culture-positive (60% vs 40%). The mean birth-weight of the culture-positive group was significantly lower than the negative group (P = 0.03). The mean CRP levels were elevated in the positive group (98.5 ± 47.8) when compared to the negative group (32.2 ± 24.1; P < .001). Using the ROC curve,a cut-off value (45.05 mg/L) of CRP had sensitivity and specificity of 80.0% and 73.7% respectively in predicting blood culture-positive NI.

Conclusion: Serum CRP is a sensitive marker to diagnose NI in admitted neonates.

Implication for practice and research: CRP levels can aid in the diagnosis of clinical deterioration, and a treating physician can modify the regimen based on elevated CRP levels.

Purpose: The aim of the study is to determine the effect of the macronutrient content of breast milk on the anthropometric measurements of infants in the first 6 months.

Background: Breast milk contains essential macro- and micronutrients needed in the early stages of an infant's development. Current literature highlights the importance of understanding how breast milk's macronutrient content influences infant growth.

Methods: The study protocol has been published in PROSPERO (CRD42023425550). This study adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline. Studies published between January 1, 2016, and June 2, 2023, were reviewed across 6 databases. The Joanna Briggs Institute Cohort Studies checklist was used to assess methodological quality. Effect sizes were calculated using both fixed-effects and random-effects models.

Results: Six studies were included in the systematic review and meta-analysis. The meta-analysis indicated a significant relationship between lactose content in breast milk and infant weight gain, length growth, and head circumference, as well as between fat-lipid content and infant weight gain within the first 6 months (P < .05). No significant relationship was found between protein or carbohydrate content of milk and anthropometric measurements of infants in the first 6 months (P > .05).

Conclusion and implications: The findings suggest that macronutrient concentrations in breast milk are important determinants of infant growth. Further research with high level of evidence and standard methodological protocols is recommended to elucidate the relationships between breast milk content and infant growth.

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.