Journal of Perinatal & Neonatal Nursing最新文献

Objective: The purpose of this scoping review is to consolidate existing scholarly literature on the experiences of racism in maternal health by African American women.

Background: Maternal health disparities among African American women are linked to systemic racism and resulting in alarming rates of adverse maternal disparities.

Methods: Using the Joanna Briggs Institute (JBI) scoping review methodological approach, a literature search was conducted on PubMed, Scopus, and Google Scholar for empirical studies published between 2013 and 2023. The search was limited to the experience of racism among African American women during the perinatal period.

Results: Ten studies describing Black/African American women's experiences with systemic, institutional, interpersonal, and internalized racism in maternal healthcare settings were identified. All studies included in the final review were qualitative. Poor provider communication and listening were highlighted as the major contributors to maternal health disparities. While mental health support, social support, and community-based interventions such as doula and midwife services have demonstrated improved outcomes, their broader impact remains understudied and unavailable to many women.

Conclusion: This review revealed (1) a lack of longitudinal research focused on dismantling racism at the institutional leadership level, (2) the absence of long-term evaluations of systemic interventions, and (3) a limited focus on garnering a deeper understanding of mental health impacts. By aggregating the findings from diverse studies, this review aims to contribute to future research to influence research, policy changes, and clinical practices that eliminate maternal health disparities.

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: The study sought to identify differences in use of elective induction of labor (IOL) post-ARRIVE trial, by race and ethnicity, and contributions of multilevel contextual factors to induction use.

Background: Racial disparities in birth outcomes have been attributed to community and provider (ie, multilevel contextual) factors. The varied use of elective induction, a common obstetric procedure, can provide insights on how racial biases are evidenced in care delivery.

Methods: A retrospective cohort study, 2018 from 2020, utilized health record data from a multi-hospital regional health system to identify the sample of term, singleton gestations without maternal or fetal indications for induction. Multivariate logistic regression was used to test associations between race/ethnicity and odds of labor induction.

Results: Labor induction occurred in 26.8% of 10 473 births. Use varied by reported race or ethnicity; non-Hispanic-White (31.1%), -Asian (22.2%), -Black or African American (22.1%), and -all other races (24.1%) and Hispanic (19.3%). Hispanic women had significantly fewer labor inductions compared to non-Hispanic White women (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.55-0.70, P < .001). Physician care was associated with higher use compared to midwifery care (OR: 1.48, 95% CI: 1.33-1.65, P < .001); hospital geographic location and older maternal age were associated with higher induction use. Hispanic women had significantly higher rate of cesarean birth after IOL.

Conclusions: Provider type, hospital geographic location, and maternal age predicted differences in elective IOL use between racial and ethnic groups.

Implications for practice and research: Future research should focus on additional contextual factors affecting use of elective induction and resultant mode of birth, particularly between racial and ethnic groups.

Objective: This study aimed to explore the relationship between disaster anxiety and prenatal attachment in pregnant women.

Method: A descriptive, cross-sectional design was used with 443 pregnant women recruited between April and August 2023. Data were collected using the Demographic Data Form, Disaster Anxiety Scale, and Prenatal Attachment Inventory. Statistical analysis was conducted using SPSS 29.0.

Results: The mean Disaster Anxiety Scale score was 11.87 ± 7.49, and the mean Prenatal Attachment Inventory score was 64.93 ± 9.16. Disaster anxiety increased with maternal age, extended family living, and higher numbers of pregnancies and children, while prenatal attachment decreased in these groups. No significant correlation was found between disaster anxiety and prenatal attachment.

Conclusion: The findings suggest that maternal age, family structure, and parity influence disaster anxiety and prenatal attachment levels. Healthcare providers should develop targeted interventions to reduce disaster anxiety and enhance prenatal attachment, particularly for high-risk groups such as older mothers or those with larger families.

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.