Journal of Perinatal & Neonatal Nursing最新文献

Purpose: To evaluate the effectiveness of an educational-behavioral intervention for mothers of hospitalized preterm infants in reducing maternal stress and anxiety, and improving parent-infant bonding when compared to a group receiving standard care.

Background: Guidelines for family-centered care interventions that are culturally appropriate, and effective in improving maternal well-being and child outcomes, are sparse.

Methods: This study was a prospective phase-lag interventional study, conducted at a neonatal intensive care unit. Participants were mothers of preterm infants (≤32 weeks and birth weight <1500 g). The intervention was a group-based 4-week educational-behavioral program. Pre- and posttests were conducted at recruitment and after 6 weeks using the Parental Stress Scale: Neonatal Intensive Care Unit, the State-Trait Anxiety Inventory, and the Postpartum Bonding Questionnaire.

Results: Twenty-seven mothers in the intervention group and 29 mothers in the control group completed the assessments. The posttest assessments showed significantly lower scores in anxiety (state anxiety: M [SD] 27.2 [3.09] vs 48.9 [11.75], P < 0.01); trait anxiety: M [SD] 26.1 [3.86] vs 40.8 [10.38], P< 0.01), lower stress scores (M [SD] 1.75 [0.35] vs 2.61 [0.33], P < 0.001), and fewer mothers with postpartum bonding disorder (2 [7%] vs 11 [38%], P < 0.001) in the intervention group when compared to the control group.

Conclusion: The educational-behavioral intervention was effective in reducing maternal stress and anxiety, and improving postpartum bonding in mothers of hospitalized preterm infants.

Implications for research and practice: This intervention is easily implemented for mothers of hospitalized preterm infants. Future research can evaluate the effect of the intervention on long-term maternal well-being and infant development.

Aim: This study aimed to examine the effect of smell on preterm infants according to the waiting time (20, 30 and 40 sec) after alcohol-based hand sanitizer was applied to the hands.

Methods: The research was conducted in a single-group pretest-posttest quasi-experimental design, was obtained from 25 preterm infants in 32- 37 gestation weeks. The heart rate (HR), oxygen saturation (SpO 2 ), respiratory rate (RR), near-infrared spectroscopy (NIRS) value and stress levels of preterm infants were evaluated before and after the application of sanitizer.

Result: Significant differences in stress level, HR, and RR (p < 0.05) were found when waiting 20 and 30 seconds after applying hand sanitizer, but not when waiting 40 seconds. When the SpO 2 averages were compared, a significant decrease was found in only for 20 seconds of waiting (p < 0.05). No significant differences was found for cerebral NIRS values (p > 0.05) for any time differences.

Conclusion: As a result, waiting 40 seconds after applying hand sanitizer did not lead to increased stress levels or deterioration in cardiorespiratory status. Therefore, waiting at least 40 seconds before initiating contact is recommended.

Purpose: This scoping review explores the impact of face-to-face Breastfeeding Peer Counselor (BFPC) interventions on exclusive breastfeeding (EBF) prevalence at six months, maternal self-efficacy, and satisfaction.

Background: BFPCs are recognized as key figures in increasing EBF rates and improving health outcomes, especially within at-risk and underserved communities.

Methods: A scoping review was conducted on literature published between January 2019 and March 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). 493 records were identified, of which 282 were selected based on title and abstract. Two reviewers critically appraise 85 full-text articles using the Joanna Briggs Institute (JBI) quality assessment tools. Discrepancies were resolved with two additional reviewers. Finally, 20 high-quality studies were included in the review.

Results: Prenatal home visits and group support have been associated with an increase of EBF initiation rates. Postnatal home interventions with at least a two-month follow-up significantly improved EBF prevalence at six months.

Discussion and conclusions: BFPCs' cultural proximity to mothers builds trust and facilitates breastfeeding knowledge acquisition and problem-solving. Home visits provide closeness and emotional support, while community groups offer a trusted environment for mothers to share their concerns and challenges.

Implications for research: The social learning facilitated by BFPCs underscores the importance of their integration into healthcare systems. However, global standardization of BFPC training and practice is essential for their worldwide expansion. Future studies should employ validated tools to assess maternal self-efficacy and satisfaction. Additionally, research should explore the impact of BFPCs in developed countries.

Background: Positive sensory and movement experiences that the infant is exposed to in a safe and familiar environment help them cope with future stressors and support physiological regulation.

Aim: To evaluate the effect of mother-infant yoga on sleep, maternal-infant bonding, and breastfeeding self-efficacy.

Method: A randomized-controlled trial was conducted with 124 mother-infant pairs between March 2023 and January 2024. The intervention group practiced mother-infant yoga for 4 weeks, while the control group received routine care.

Results: After the intervention, the breastfeeding self-efficacy score was significantly higher in the yoga group (58.34 ± 6.27) than in the control group (46.32 ± 6.41; P < .001). Maternal-infant bonding scores were also significantly higher in the yoga group (20.44 ± 1.89 vs 18.36 ± 2.06; P = .009). Night sleep duration was significantly longer in the yoga group (8.35 ± 1.00 hours) compared to the control group (7.01 ± 1.32 hours; P < .001).

Conclusion: Mother-infant yoga significantly improved breastfeeding self-efficacy, maternal-infant bonding, and infant sleep duration. Further studies are warranted to explore its long-term effects and broader applicability.

Purpose: To examine the effect of the Premature Infant Oral Motor Intervention (PIOMI) on breastfeeding duration after discharge, as well as weight gain, up to 12 months of noncorrected age.

Background: Preterm infants face difficulties breastfeeding due to immature oral motor skills. Prehabilitative oral motor therapy during early preterm hospitalization may enhance breastfeeding initiation and duration post discharge.

Methods: The randomized controlled trial was carried out with 64 preterm infants, with intervention 1× day for 14 days while hospitalized, and follow-up measures made at 6, 9, and 12 months. The control group (n = 32) received standard routine care. The experimental group (n = 32) received PIOMI treatment.

Results: Breastfeeding duration in the experimental group was a mean of approximately 4 months longer when compared to the control group (P < .05). Additionally, the mean body weights of the preterm infants in the experimental group were significantly higher at 12 months than in the control group (P < .05).

Conclusions: Early prehabilitative therapy using PIOMI in the preterm period has long-term sustained positive effects on breastfeeding and weight gain post discharge.

Implications for practice and research: Evidence-based practices are required to support the breastfeeding of the premature infant. Future studies should continue to assess oral motor interventions on initiation and duration of breastfeeding, and the impact on early childhood development. Parent involvement in therapy should also be examined.

Purpose: This qualitative descriptive study examines racial disparities in human milk feeding by exploring nurses' experiences in providing support to Black parents during the immediate postpartum period.

Background: Racial disparities in human milk feeding are persistent, with Black families much less likely to breastfeed than White, non-Hispanic families. Although nurses are key providers in the immediate postpartum, their role in human milk feeding support for Black families is inadequately studied.

Methods: We conducted semi-structured interviews with 15 nurses who had 1 year or more of experience on the labor and delivery or postpartum units. Interviews followed an interview guide informed by the theory of planned behavior and critical race theory. Interviews were audio-recorded and analyzed using thematic analysis.

Results: Two main themes, each with 3 subthemes, were identified: Navigating Human Milk Feeding Support (On the Job Learning, Juggling the Workload, and Self-Doubt) and Enacting Racism (Stereotyping, Explicit Racism, and Evasive Discourse). Nurses described experiencing inadequate human milk feeding education and stressors related to understaffing, which pressured them to make decisions about how to allocate time related to lactation support.

Conclusions: Findings indicate that nurses may not offer adequate support due to their assumptions that Black parents are unlikely to engage in human milk feeding.

Implications for practice and research: Disrupting structural racism throughout nursing education, including anti-racist continuing education and changing unit and hospital policies, may help intrapartum and postpartum nurses provide equitable and optimal support.

Background: Venipuncture is a common and painful procedure in the neonatal intensive care unit (NICU), Thus, there is a necessity for cost-effective, safe, and nonpharmacological interventions to alleviate pain associated with frequent and painful procedures in infants.

Objective: This study aimed to investigate the effect of compassionate speech by nurses on the pain caused by venipuncture in premature infants.

Method: This quasi-experimental study was conducted on 65 premature infants admitted to the neonatal intensive care units of the Imam Reza and Qaem hospitals in Mashhad, Iran. The control group received routine pain-reducing measures during the placement of the intravenous catheter, whereas the intervention group received the usual measures along with the nurse's voice before, during and after catheter insertion. The intensity of pain in the infants was measured via the Premature Infant Pain Profile at 4 time points. Data analysis was performed via SPSS version 26.

Results: The results of the Generalized Estimating Equations (GEE) test revealed that infants in the intervention group experienced 2.826 units less pain than those in the control group over time (P < .001).

Conclusion: The findings indicate that the presence of a nurse's voice positively influences pain reduction in infants undergoing painful procedures. It is advisable to implement this cost-effective approach, particularly in situations where the mother is not present.

Background and objectives: In vitro studies suggest that oral zinc supplementation reduces enterohepatic circulation of unconjugated bilirubin and serum bilirubin levels. Multiple randomized controlled trials (RCTs) have assessed the efficacy of oral zinc supplementation in reducing bilirubin levels and the need for phototherapy. However, the evidence remains conflicting. Therefore, we aimed to evaluate the effects of oral zinc supplementation in neonatal hyperbilirubinemia.

Methods: We searched PubMed, Embase, Web of Science, and various clinical registries for RCTs published until May 25, 2025, and compared zinc with placebo/routine care in neonates with or at risk of hyperbilirubinemia. A random-effects meta-analysis was conducted. The Risk of Bias Version 2 tool was used.

Results: Seventeen studies (1565 participants) were included in this systematic review. Only 1 study provided data on the need for exchange transfusion for extreme hyperbilirubinemia, in which no events were reported in either group. There was no significant difference in the incidence of significant hyperbilirubinemia (4 studies, 577 neonates, risk ratio [RR]: 0.96, 95% confidence interval [CI]: 0.41-2.27) or the need for phototherapy (5 studies, 619 neonates, RR: 0.72, 95% CI: 0.32-1.60) (very low certainty). Oral zinc supplementation also led to a statistically significant reduction in the duration of phototherapy (12 studies, 1528 neonates, mean difference: 8.6 hours, 95% CI: 3.7-13.6 hours, low certainty). No differences were observed in adverse events or the duration of hospital stay.

Conclusions: Oral Zn supplementation may reduce the duration of phototherapy but does not affect other outcomes.

Purpose: To evaluate the effect of lactation simulation model-based (LSM-based) training on laid-back breastfeeding (semi-sitting or semi-lying) and upright position (sitting upright) breastfeeding given in the antenatal period on breast problems and breastfeeding.

Methods: The study was a randomized controlled experimental and prospective one. A total of 108 primiparous pregnant women, 36 in the laid-back breastfeeding group (LBBG), 36 in the upright position breastfeeding group (UPBG), and 36 in the control group (CG) were included in this study.

Results: The mothers in the LBBG and UPBG had higher breastfeeding self-efficacy at postpartum 10th day and 6th month compared to the mothers in the CG; the mothers in the CG had significantly more breastfeeding problems at postpartum 24th hour and 10th day compared to the mothers in the LBBG (P<0.05); the duration of exclusive breastfeeding was significantly higher among the mothers in the LBBG and UPBG compared to the mothers in the CG (p<0.001).

Conclusion: It was determined that the LSM-based training on the breastfeeding position was effective in increasing mothers' breastfeeding self-efficacy and breastfeeding duration and that the LSM-based training on the laid-back breastfeeding position was an effective method in reducing breast problems.

Background: Surfactant therapy is traditionally delivered via endotracheal tube during mechanical ventilation. Newer methods, such as aerosol, thin catheter, and laryngeal mask airway administration, show potential for reducing bronchopulmonary dysplasia (BPD) compared to standard approaches like intubate-surfactant-extubate (INSURE). This review evaluates whether less-invasive surfactant administration is as effective as endotracheal intubation in reducing BPD incidence in preterm infants.

Methods: A systematic review was conducted in September of 2024 using MEDLINE, Embase, and Web of Science. Studies comparing LISA with INSURE, mechanical ventilation, or both regarding BPD outcomes were included. Risk of bias was assessed using the Johanna Briggs Institute critical appraisal tools. Data were synthesized using a study characteristic table.

Results: Fifty-eight studies were reviewed involving 26 to 7533 infants (gestational ages 22 to 41 weeks). Of these, 43 found no significant difference in BPD rates between the compared methods, while 15 reported lower BPD rates with LISA.

Discussion: Although BPD reduction with LISA was not statistically significant, LISA offered benefits such as fewer ventilation days, lower intubation rates, reduced intubation-associated risks, and less need for premedication. Limitations included the predominance of retrospective studies, making exclusion of confounding variables difficult, and small sample sizes in both supportive and non-supportive studies, which may have hindered statistical significance.