Journal of Perinatal & Neonatal Nursing最新文献

Introduction: Maternal speech has been shown to benefit premature infants by improving feeding outcomes and potentiating the development of the auditory cortex. To our knowledge, limited studies have addressed the benefits of exposure to maternal speech on neural development in premature infants. The objective of this study was to investigate the effect of early controlled exposure to maternal recording a passage of speech on heart rate variability (obtained before, during, and after playback of a test stimulus of a female stranger speaking the same passage) in very low-birth-weight premature infants tracked weekly from 28 to 34 weeks.

Methods: Prospective, randomized controlled trial, longitudinal, and repeated-measures design were conducted on 49 subjects. Infants heard a recording of their mother's speech twice a day from either 28 to 34 weeks (group 1) or from 32 to 34 weeks (group 2). Spectral analysis was measured weekly for 45 seconds before, during, and after playback of maternal speech. A generalized linear mixed model was conducted to examine the 2-way interaction in the log high-frequency power between groups, genders, sessions, and conditions.

Results: It was found that there were no significant differences between groups before, during, and after playback of the stimulus. A significant difference, however, was noted between conditions (before vs during period).

Conclusion: It can be concluded cautiously that playing back of maternal speech recordings to the premature infant has a beneficial impact on neural development after 32 weeks gestational age.

Objective: Breastfeeding is the optimal source of nutrition for all infants, but there are limited data on feeding outcomes in infants with neonatal abstinence syndrome (NAS) who are admitted in the neonatal intensive care unit (NICU).

Methods: A retrospective cohort study was conducted at a level II/III NICU. Study sample consisted infants with a diagnosis of NAS and those diagnosed with respiratory distress syndrome. The primary outcome was attainment of independent oral feeds, defined as the number of days to transition from full-tube to full oral feeds. Secondary outcomes included length of hospital stay and method (breast or bottle) of oral feeds at the start, at attainment of independent oral feeds, and at hospital discharge.

Results: Infants with NAS took significantly longer to attain independent oral feeds than controls ( P = .021) and received significantly fewer breastfeeds at the start of oral feeds, at independent oral feeds, and at hospital discharge ( P = .000). There was no difference in length of hospital stay between groups.

Conclusion: These results suggest that infants with NAS can experience difficulties achieving independent oral feeds and are less likely to receive breastfeeds. Additional support is required to enhance oral feeds in infants with NAS in the NICU.

The aim was to describe the prevalence of exclusive breastfeeding among mothers of premature infants and investigate the extent to which breastfeeding self-efficacy is associated with early cessation of exclusive breastfeeding. The study population consisted of 136 mother-infant dyads with information on the outcome of exclusive breastfeeding and exposure of self-efficacy, recruited between September 2016 and February 2018. Data were collected via questionnaires with follow-up at 6 months. The statistical analysis included descriptive analysis with survival curves and logistic regression analysis. At 2 months, 101 (74%) premature infants were exclusively breastfed; at 4 and 6 months, 82 (60%) and 41 (30%), respectively. Higher levels of self-efficacy were significantly associated with breastfeeding exclusively for 2 months ( P = .03). In multivariate analysis, mothers who had a low level of early self-efficacy toward breastfeeding had 2½ times higher odds of breastfeeding cessation before 2 months (odds ratio = 2.63, 95% confidence interval: 1.16-5.96). The risk did not change when adjusted for potential confounders. Breastfeeding self-efficacy is an early predictor of exclusive breastfeeding for 2 months of the premature infant. Health professionals should use self-efficacy as a prognostic factor to identify mothers at risk of early cessation of breastfeeding and support those with low self-efficacy to increase duration of exclusive breastfeeding.

Purpose: To understand how barriers and facilitators interact over time to support or disrupt breastfeeding among women on opioid maintenance therapy for opioid use disorder.

Background: Breastfeeding has additional benefits for newborns with prenatal opioid exposure. Up to 80% of women on opioid maintenance therapy plan to breastfeed, but many do not beyond the first 7 to 10 days.

Methods: A qualitative, longitudinal design was used. Semi-structured interviews occurred during the third trimester of pregnancy and again between 1 and 6 weeks postpartum. Thematic analysis was conducted using the Breastfeeding in a Life Course Context model as a framework. The design and methods were informed by a post-positivist, critical realist perspective.

Results: Thirteen participants were enrolled, and 19 interviews were completed. Five themes were identified. It Will Work Out was the primary theme that describes participants' sense of self-efficacy, stemming from their experiences of managing addiction recovery. Women considered breastfeeding to support their own health and that of their newborn while in recovery, summarized by Being Healthy. Making the choice to breastfeed, represented by Weighing the Options, was influenced by their perinatal health care providers. During the Sensitive Period, challenges could overwhelm their self-efficacy. Of 9 women, 4 were still breastfeeding when interviewed postpartum, exemplified by Moving On.

Conclusions and implications for practice: Participants' self-efficacy and motivation to be healthy played a significant role in managing breastfeeding challenges over time. Nursing interventions must empower women's self-efficacy to help them achieve their breastfeeding goals.

Purpose: The purpose of this study among pregnant and postpartum Black women was twofold: (1) to compare levels of perceived stress, depressive symptoms, social support, and neighborhood disorder and crime before the pandemic vs during the pandemic; and (2) to examine the association of perceived stress, depressive symptoms, and social support with neighborhood disorder and crime at both time points.

Methods: This was a prospective study as part of the Biosocial Impact on Black Births, a longitudinal study that examined the role of maternal factors on preterm birth among Black women. A sample of 143 women were included who responded to survey questions during pregnancy prior to the pandemic and again after birth, during the pandemic. Women completed the COVID survey between May 21, 2020, and January 28, 2021.

Results: The levels of perceived stress (70.75 and 76.28, respectively, P < .01) and social support (17.01 and 18.78, respectively, P < .01) were lower during the pandemic than prior to the pandemic. Social support, perceived stress, and depressive symptoms were significantly correlated with the pre-pandemic measures of perceived neighborhood disorder and crime. Perceived stress and depressive symptoms were also significantly correlated with pandemic measures of perceived neighborhood.

Conclusion: Women reported lower levels of perceived stress during the pandemic than prior to the pandemic, but neighborhood characteristics were consistently associated with perceived stress and depressive symptoms both prior to and during the pandemic. Further exploration is warranted to better understand these relationships.

Purpose: This study aimed to longitudinally investigate the preterm infant feeding regimens, feeding behaviors, effect on infant growth, and caregiver perceptions and experiences with feeding in the first 4 weeks following hospital discharge.

Background: Preterm infants face high nutritional risk due to their underdeveloped gastrointestinal systems and feeding coordination.

Methods: Caregivers of preterm infants were recruited to participate in a weekly telephone survey for the first 4 weeks following the infant's hospital discharge. Responses for infant feeding behaviors and caregiver experiences were scored on a 3-point Likert scale. Growth and feeding data were collected from the infant's first neonatal intensive care unit (NICU) developmental follow-up visit.

Results: Twenty-four caregivers completed the study. Changes in feeding regimens were common (8/24 infants; 33%), with the percentage of infants receiving any human milk feedings decreasing from 70% at hospital discharge to 54% at 4 weeks post-discharge. Poor infant feeding skills were weakly associated with poor caregiver feeding experiences, and 46% of caregivers reported contacting their healthcare provider with feeding-related questions. Thirty-eight percent of infants required nutritional intervention at NICU developmental follow-up visit. Infants who received fortified feedings during the first 4 weeks after hospital discharge grew an average of 2.5 g/day faster than infants who did not receive fortified feedings.

Conclusion: The postdischarge period for preterm infants is characterized by feeding regimen changes, a decrease in human milk use, and caregiver questions about feeding.

Implications for practice and research: Future studies should further investigate the period after hospital discharge to enable better feeding support for preterm infants and their caregivers.