Practice developments supporting change implementation in Wellington,New Zealand (NZ) for ‘continuity of care when transitioning complex preterm infants from NICU to home’

The discussion paper will focus on continuity of care relating to previous NZ research, specifically to transitioning complex preterm infants from NICU to home based on parent experiences, and on the practice developments that have occurred, to ensure optimal health outcomes. Previous NZ research discovered parent desire a consistent service delivery for the entire transition journey from NICU and at home.An informative and comprehensive opportunity has occurred for reflective professional practice, evaluation, development and implementation which have transpired in positive change through innovative practice developments and support change implementation in Wellington, NZ. This has resulted in the articulation of a model of care that has both embraced and integrated parental desires for a continuity of care process for complex preterm infants. This has been achieved by having the same Discharge Facilitator/Key Case Manager present within the NICU and external to the NICU for Home-based infants for the entire transition journey.The paper will focus and emphasis additional practice development changes and furthermore, will present a real purpose, for other countries to learn of such practice developments that have exemplified a celebratory success for families of Wellington, NZ.     

Center of pressure characteristics differ during single leg stance throughout pregnancy and compared to nulligravida individuals

BackgroundFalls are common during pregnancy and present potential for injury to the pregnant individual and the baby.Research questionDo center of pressure characteristics during single leg stance differ between participants during and after pregnancy and nulligravida participants in the presence and absence of visual input?MethodsNineteen pregnant participants completed testing during the second trimester, the third trimester, and 4–6 months post-partum. Matched, nulligravida females completed testing once. All participants performed single leg stance on a force platform on each limb for up to 20 s with eyes open and with eyes closed. Center of pressure characteristics were compared between pregnant and nulligravida females using three separate 2 × 2 mixed way ANOVAs, one for each pregnancy time point (second trimester, third trimester, and post-partum) with Bonferroni correction.ResultsPregnant females demonstrated smaller single leg stance time with eyes closed during the third trimester. During the second and third trimester, pregnant participants demonstrated smaller sway and sway velocity across eyes open and eyes closed conditions. During the third trimester and post-partum, pregnant participants demonstrated greater median frequency of the center of pressure data. Pregnant participants also demonstrated smaller sample entropy in the anteroposterior direction during the second and third trimesters and in the mediolateral direction during the second trimester.SignificanceThe decreased total sway and sway velocity observed during pregnancy may reflect rigidity or a protective strategy during single limb stance. Additionally, center of pressure data were less smooth and more repetitive during pregnancy indicating robust differences in postural control strategies and potentially increased fall risk. Because single limb stance is a component of many activities of daily living, the single limb stance task may have clinical utility for testing or training balance in this population with a goal of decreasing falls.     

Differences in means-end exploration between infants at risk for autism and typically developing infants in the first 15 months of life

Our study compared means-end exploration in infants at risk (AR) for autism and typically developing (TD) infants using a nested box paradigm. Sixteen AR and 16 TD infants were observed at 9, 12, and 15 months with follow-up at 18 and 24 months. We collected video data on three tasks involving retrieval of a small toy by opening (a) an opaque box, (b) a transparent box, and (c) two nested boxes. Dependent variables included hand bias, time to completion, bilateral hand use, problem-solving strategies used, and tester assistance required. There were no group differences in terms of hand biases. Compared to TD infants, AR infants had lower bilateral hand use, poor problem solving skills, and required greater assistance. Both groups demonstrated age-related improvements in motor and cognitive skills. Means-end exploration provides a window into the bilateral coordination and motor planning/problem-solving abilities of young infants at risk for autism. Lastly, object retrieval tasks could serve as important learning contexts for at-risk infants.     

Approaches to understanding and interpreting the risks of red blood cell transfusion in neonates

In this review, we explore how to assess potential harm related to neonatal transfusion practice. We consider different sources of information, including passive or active surveillance systems such as registries, observational studies, randomised trials and systematic reviews. Future research directions are discussed.     

Facilitators and barriers to developmentally supportive care for preterm infants in low and middle-income countries: A scoping review

BackgroundPreterm birth and its associated complications are a major cause of neonatal mortality worldwide. Approximately 15 million preterm infants are born annually, most births occurring in Sub-Saharan Africa and South Asia. However, Developmentally Supportive Care—an evidence-based intervention reported to improve the survival of preterm infants, is under utilized in Low and Middle-Income Countries. This review focuses on examining the barriers to, and facilitators of, Kangaroo Mother Care, positioning (nesting and swaddling), and control of the external neonatal intensive care environment in low- and middle-income countries.MethodsSix databases were systematically searched between January 2000 to April 2020. A search of the grey literature was also conducted. Two independent reviewers screened the citations of the retrieved papers and abstracted data for included studies based on predetermined inclusion/exclusion criteria.ResultsA total of 15853 articles were retrieved from the search. A full-text review was conducted on 155 articles. Thirty-two papers were identified and included in the review. Thirty papers focussed on KMC, two papers focused on noise control. No studies were identified on positioning and light control in the NICU. Barriers identified included lack of knowledge of DSC practices in both health care workers and family caregivers, existing cultural norms, and the absence of protocols and guidelines for practice. Facilitators included; healthcare worker training, leadership and support from health care facility managers to family caregivers, and available infrastructure.ConclusionFurther studies that comprehensively examine DSC implementation in Low-Middle-Income countries are required in order to improve sustained DSC practices.     

Souviens-toi. Processus de deuil,processus de création

ObjectivesThe authors set out to cast light on certain psychic mechanisms that help to give meaning to death, in particular via objects of great symbolic value, as links between the dead and the survivors.MethodsIn this clinical article using a heuristic methodology, we combine the analysis of a clinical situation of antenatal death, a paradigm of loss with a pathological risk, and that of the artistic creation of Michel Nadjar, linked to the genocide of the Jews.ResultsThe psychic processing of the loss of a loved one is accompanied by considerable psychopathological risk. While funeral rites, whether religious or lay, and the support of the family and the community often provide mourners with a framework that favours the achievement of the period of mourning, so as to continue living with the loss (rather than living with the deceased person), there are certain traumatic situations that make access to a non-pathological mourning process impossible.DiscussionThe authors reappraise the exclusiveness of Freud's mourning and melancholia model, and consider Winnicott's theoretical model of transitional phenomena to cast light on the psychic processes at work.ConclusionsThe creativity operating in the two situations maintains a certain distinction: sublimation for the artist, resurgence of transitional phenomena for the bereaved individual.