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: Noninvasive mechanical ventilation (NIMV), when in synchronized intermittent mandatory ventilation, continuous positive airway pressure, or patient-triggered ventilation modes, is known to be a cause of facial, nasal, head, and skin pressure injuries in preterm infants.

Objective: The objective of this study is to examine the efficacy of using a checklist with preterm infants under nasal NIMV in preventing facial, nasal, and head pressure injuries.

Method: The study was conducted quasi-experimentally on preterm infants under NIMV. The sampling comprised a total of 104 infants, an intervention group of n = 52 and a control group of n = 52. All procedural steps of NIMV of the infants in the intervention group were performed in accordance with a checklist. The checklist covered: (1) preparation of the ventilation device and cannula placement; (2) care; and (3) monitoring and assessment.

Result: There was a statistically significant difference in nasal tip, septal, intranasal, upper lip, and right-left cheek pressure injury scores between the intervention and control groups ( P < .05).

Conclusion: Performing all procedural steps of nasal NIMV in accordance with a checklist is effective in preventing pressure injuries on the face, nose, and head of preterm infants, reducing the severity of pressure injuries.

Implications for practice: It is recommended to use a checklist covering the ventilation device preparation, cannula placement, care, observation, and assessment steps to prevent any pressure injuries in the face, nose, and head, as well as to reduce the severity of pressure injuries and improve the skin condition of preterm infants under nasal NIMV support.

Purpose: This study aims to evaluate the content and quality of patient educational materials on gestational diabetes mellitus (GDM) generated by ChatGPT and Gemini.

Background: The sources of knowledge are crucial in the effective management of disease. Artificial intelligence (AI) platforms could become a primary source of patient education materials in the near future.

Methods: A descriptive research design was employed. Frequently asked questions related to GDM were extracted from patient education sections of existing guidelines. These questions were then submitted to both ChatGPT and Gemini. The responses provided by these platforms were used to create educational material aimed at pregnant women diagnosed with GDM. The content was reviewed by a panel of 11 experts. The Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P) was employed to evaluate the content's effectiveness and clarity, and the readability was assessed through the Ateşman Readability Formula and the Gunning Fog Index.

Results: A total of 32 questions regarding GDM were directed to the AI platforms. The resulting educational materials had a readability score of 77.8 based on the Ateşman scale and 16.25 according to the Gunning Fog Index. The experts rated the material as highly comprehensible, with an average PEMAT-P understandability score of 91.36% (range: 86.66%-93.75%) and an actionability score of 89.67% (range: 80%-100%).

Conclusion: The GDM educational materials generated by ChatGPT and Gemini exhibit a high level of readability, making them easy to understand. Moreover, the material was deemed comprehensible and actionable for pregnant women with GDM.

Implications for practice and research: Although AI-generated patient educational materials show great potential, further experimental research is necessary to assess their long-term effectiveness.

Purpose: This study aims to assess the applicability of ultralow-field (ULF) magnetic resonance imaging (MRI) in the neonatal intensive care unit (NICU), its impact on both the neonate being scanned and neighboring patients, and its effects on medical procedures and early parent-child interaction.

Background: Neonatal MRI is crucial for diagnosis and treatment in the NICU, but access is limited, both in high-income countries and low- and middle-income countries. Portable ULF MRI presents an opportunity to expand access, but its applicability and potential impacts on neonates and nearby patients have not been studied, including its effects on medical care and early parent-child interaction.

Methods: We assessed applicability, safety and stress levels of neonates during ULF MRI at a NICU by measuring heart rate, oxygen saturation and blood pressure of the neonate scanned and neighboring patients and by measuring subjective stress levels assessed by attending physicians, nurses and parents. Using questionnaires, we assessed whether medical care and early parent-child interaction was affected.

Results: No significant differences were found in the physiological measures of the scanned and neighboring neonates. Medical care and parent-child interaction were not affected by ULF MRI.

Conclusions: ULF MRI can be safely performed in the NICU without causing stress to neonates or affecting medical care or parent-child interaction. It can be performed at the bedside during natural sleep, requiring fewer resources compared to high-field MRI, making it a viable point-of-care option in both the NICU and low-resource settings. This could significantly increase MRI accessibility.

Purpose: To examine relationships between the subdomains of professional quality of life and intention to stay in the job and the profession among perinatal registered nurses in the United States during the COVID-19 pandemic.

Background: There is limited knowledge about professional quality of life, encompassing burnout, secondary traumatic stress, and compassion satisfaction, and its impact on turnover intention among U.S. perinatal registered nurses.

Methods: We conducted a repeated, cross-sectional survey. Surveys were distributed online in May 2021 and May 2022 to a convenience sample of perinatal registered nurses (N = 113). We conducted descriptive statistics, Mann-Whitney U, Kruskal-Wallis, Spearman's rank correlation, and multiple linear regression.

Results: There was an increase in burnout (P = .004) and secondary traumatic stress (P < .001) and a decrease in compassion satisfaction (P < .001), and intention to stay in the job (P < .0001) and the profession (P < .001). Higher compassion satisfaction was associated with higher intention to stay in the job (P < .0001) and the profession (P < .0001). Higher burnout was associated with lower intention to stay in the job (P < .0001) and the profession (P < .0001). Higher secondary traumatic stress was associated with lower intention to stay in the job (P < .0001) and the profession (P < .0001).

Conclusion: We observed deteriorating professional quality of life and decreased intention to stay in the job and in the profession among U.S. perinatal registered nurses.

Implications for practice and research: Strategies are needed to foster a health care environment in which compassion satisfaction is maximized among perinatal registered nurses.

Background: Conventional surfactant administration via tracheal tube involves short periods of positive pressure ventilation, which carries the risk of lung injury. The aim of this study was to investigate the feasibility and potential benefits of the less invasive surfactant administration (LISA) method in premature infants compared to the usual intubation-surfactant-extubation (INSURE).

Methods: This randomized clinical trial was performed in Yazd between 2021 and 2023. One hundred twenty neonates with RDS were included in the study. The INSURE group (n = 60) was injected with surfactant in the usual way inside the tracheal tube, and the LISA group was injected using nasal continuous positive airway pressure (CPAP) with a thin surfactant catheter.

Results: Duration of need for respiratory support by nasal CPAP (nCPAP) and high-flow nasal cannula was significantly more in the LISA group (P value = .00). Primary and secondary outcomes during surfactant injection in 2 groups were not statistically significant.

Conclusion: In our study, there was no significant difference between the primary and secondary outcomes between LISA and INSURE groups. Therefore, more studies are needed in this field.

Purpose: The purpose of this scoping review is to provide an overview of postpartum depression (PPD) screening practices for mothers with infants in the neonatal intensive care unit (NICU), identify gaps in PPD screening, and provide potential solutions for improved screening.

Background: The American Academy of Pediatrics (AAP) recommends routine screening for PPD at the first, second, 4th, and 6th months of well-child visits. However, mothers of premature or critically ill infants in the NICU often miss this screening. NICU mothers and parents are at high risk of developing PPD due to the many stressors and traumas experienced during the NICU stay. Missed screening for PPD and delayed diagnosis and treatment lead to poor long-term parental mental health and a defragmented family system.

Methods: Using the PRISMA model, the authors identified 30 articles that support the need for PPD screenings in the NICU, for all at-risk families. Barriers to implementing PPD screening in the NICU were identified and discussed.

Findings: Several gaps were revealed regarding PPD screening in the NICU, such as cultural barriers, diverse populations, and a need for staff education regarding PPD identification, treatment, and referral. Furthermore, encouraging mothers and non-birthing partners to engage in transparent communication was also identified to improve care.

Conclusion: It is crucial for the NICU team to actively involve the mother, father, or non-birthing partners in the process of education, training, and assessment. By doing so, they can empower families with the knowledge and skills necessary to support their infants, aiding in confidence and inclusion and decreasing the risk for PPD during this critical time.

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.