Journal of Perinatal & Neonatal Nursing最新文献

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.

Purpose: This sequential mixed-method study explores neonatal intensive care unit (NICU) nurses' awareness, attitudes, and perceptions regarding do-not-resuscitate (DNR) orders.

Methods: Quantitative surveys were conducted among 50 neonatal nurses, supplemented by qualitative focused group discussions involving 10 participants. Data collection included structured questionnaires assessing awareness and attitudes toward DNR orders, alongside qualitative interviews to capture their perceptions.

Results: The mean age of the participants was 33.88 ± 8.60 years, predominantly females (98.0%), young adults (44.0%), and holding degree in nursing (68.0%). Findings indicated that over half of the neonatal nurses had poor awareness (52%) and negative attitudes (50%) toward DNR orders. Factors such as being unmarried (adjusted odds ratio [AOR] = 0.01, confidence interval [CI] = 0.01-0.27), <5 years of NICU experience (AOR = 0.04, CI = 0.00-0.53), and not attending refresher course on End of Life Care (AOR = 0.87, CI = 0.00-0.99) significantly reduced odds of good awareness. Additionally, being Christian (AOR = 0.01, CI = 0.00-0.40), unmarried (AOR = 0.05, CI = 0.00-0.51), and <5 years of NICU experience (AOR = 0.03, CI = 0.00-0.38) were associated with significantly lower odds of positive attitude toward DNR orders. Qualitative insights highlight emotional challenges and feelings of inadequacy among nurses during DNR order discussions with parents.

Conclusion: The study highlights a need for comprehensive training and support for NICU nurses in navigating DNR order discussions effectively.

Practical implications: Hospitals must prioritize regular nurse training on DNR orders. NICU settings need counseling support. Nurses' training should emphasize empathy and effective communication for sensitive DNR discussions.

Precise: Most neonatal nurses lacked awareness and positive attitudes toward DNR orders, influenced by factors like marital status and NICU experience. Qualitative insights revealed emotional challenges in discussing DNR with parents.

Purpose: To summarize how nursing resources and missed nursing care are associated with hospital breastfeeding outcomes, including human milk provision.

Background: Nurses are the primary providers of breastfeeding support in the hospital. Nursing resources, eg, staffing and the work environment, enable nurses to carry out their work successfully. If resources are constrained, nurses may miss providing breastfeeding support. There is a gap in the literature about the relationships among nursing resources, missed nursing care, and breastfeeding outcomes.

Methods: The Cumulative Index to Nursing and Allied Health Literature and PubMed were searched with keywords such as: "nurse staffing," "nurse work environment," "missed nursing care," "breastfeeding," "human milk," and "lactation." We included peer-reviewed studies of US samples in English published between 2014 and 2022.

Results: Of 312 references, 8 met inclusion criteria: 5 quantitative and 3 qualitative. Better nurse staffing and breastfeeding support were associated with improved breastfeeding outcomes in the qualitative and quantitative literature. Missed care partially mediated the relationship between staffing and exclusive breast milk feeding rates. Better nurse work environments were associated with increased breastfeeding support and provision of human milk.

Conclusions: Empirical evidence supports an association between the nurse work environment, nurse staffing, breastfeeding support, and outcomes. Implications for practice and research: Poor staffing may be associated with decreased breastfeeding support and outcomes. Hospital administrators and nurse managers may consider improving nurse staffing and the work environment to improve breastfeeding outcomes. Future research should simultaneously examine staffing and the work environment and address breastfeeding outcome disparities.

Purpose: To examine Pinterest pins to discern the content, messaging and claims, and engagement with pins regarding formula hacking and homemade formula.

Background: The American Academy of Pediatrics and the Centers for Disease Control and Prevention discourage formula hacking (ie, preparing formula not according to directions to extend its use) and making homemade infant formula due to its associated health risks. Yet, caregivers are using social media platforms to find information on these topics.

Methods: This study conducted a content analysis of Pinterest pins related to formula hacking and homemade infant formula identified from the platform in January 2023 by using 14 search terms.

Results: A total of 63 pins were included in the sample. The topic of all (100.0%) pins was homemade formula. More than one-half (56.0%) of the 25 pins that provided a recipe included an unsafe ingredient, such as raw milk. The most frequently provided reasons to use homemade infant formula were in an emergency (38.2%) and when breastfeeding was not possible (38.2%). The most common claim was that homemade infant formula was healthy (59.6%). The total number of followers for the 63 pins was 861 636.

Conclusions: Pinterest is widely used by caregivers to find feeding information for their infants. Credible organizations should utilize Pinterest to disseminate safe infant feeding practices supported by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

Implications: The results will help nurses advocate for safe infant feeding and help them guide caregivers away from unsafe formula practices found on social media.

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.

Background: Breastfeeding provides the necessary nutrition and immune support for infants' growth, development, and defense mechanisms. The Theory of Planned Behavior is a commonly used framework to study factors influencing breastfeeding intentions.

Objective: This study aimed to create an instrument for assessing key breastfeeding factors that influence breastfeeding intentions through a systematic tool development and validation approach.

Methods: A set of items was developed based on the Theory of Planned Behavior constructs. A group of 6 experts in scale content was gathered to evaluate the items in 2 rounds until a consensus was reached. The scales were then tested and validated with a sample of 558 adult women of reproductive age without children in Louisiana. Structural equation modeling was used to determine the model fit.

Results: An exploratory factor analysis revealed a fixed-factor model, which was later confirmed through confirmatory factor analysis. The factors identified were perceived behavioral control, breastfeeding attitudes, breastfeeding support, breastfeeding norms, and breastfeeding intentions.

Conclusions: The model demonstrated an acceptable fit, with factors showing high internal reliability and content validity. The study highlighted the importance of addressing demographic differences to enhance breastfeeding practices among nulliparous women. The model could offer insights for developing targeted interventions to change breastfeeding behavior positively.

Background: Neonatal nursing has advanced from basic supportive measures to a specialized, anticipatory, and family-centered discipline, evolving alongside organized neonatal intensive care unit (NICU) systems and modern neonatology.

Purpose: This article aims to outline priority domains for the next era of neonatal nursing grounded in historical progress and contemporary practice needs.

Scope of commentary: Key drivers include: (1) structured NICU models and standardized resuscitation approaches focused on physiologic targets; (2) evidence-based developmental care that embeds parent partnership and individualizes neuroprotective routines; and (3) integration of pediatric/perinatal palliative care tailored to NICU ethics, symptom management, and communication.

Current challenges: Outcome disparities persist across regions and settings. Translation of digital tools and artificial intelligence (AI) into consistent bedside benefit is uneven. Climate-related heat and environmental instability heighten perinatal risk and strain fragile systems.

Implications for neonatal nursing: Priorities include scaling context-appropriate quality improvement and equitable access; strengthening family-centered neuroprotective care across the care continuum; embedding palliative competencies and shared decision-making; guiding safe, ethical adoption of data/AI tools; and advancing climate-resilient service planning.

Conclusions: Sustaining neonatal gains will require nurse-led leadership in equity, developmental partnership, ethical palliative practice, and judicious technology integration under mounting climate pressures.