The association between baby care books that promote strict care routines and infant feeding,night‐time care,and maternal–infant interactions

Baby care books that promote strict infant care routines are popular, but little research has considered their impact upon maternal infant care behaviours. We explored whether mothers who have read these books guide their infant care behaviours based on their concepts and how this is associated with infant feeding, night‐time care, and response to infant's needs. Three hundred and fifty‐four U.K. mothers with a baby aged 0–12 months completed an online questionnaire exploring use of baby care books, motivations for use, whether guidance was followed, and infant care behaviours. Mothers who read the books were drawn to them for information about how to settle their infant, infant sleep, and infant feeding behaviour. Those who read the books were less likely to breastfeed, feed responsively, have their infant sleep in the same room, cuddle their infant to sleep, or respond promptly to infant cries. Although the causality between reading these books and care cannot be determined through this study design, and is likely bidirectional with some reading the books to confirm existing preferences, around 25–40% of mothers noted the information determined their care decisions. Regardless of specific causal pathways, there is an association between these books and behaviours that go against infant feeding and responsive care recommendations. Understanding what drives mothers to follow these books and increasing support for new mothers in these areas is important. The findings will be important for those supporting mothers in the perinatal period in starting conversations around responsive infant care.     

Premature infant massage in the NICU

Infant massage therapy is an inexpensive tool that should be utilized as part of the developmental care of the preterm infant. Nurses have been hesitant to begin massage therapy for fear of overstimulating the infant and because there has been insufficient research to prove its safety. Recent research, however, has shown that the significant benefits of infant massage therapy far outweigh the minimal risks. When infant massage therapy is properly applied to preterm infants, they respond with increased weight gains, improved developmental scores, and earlier discharge from the hospital. Parents of the preterm infant also benefit because infant massage enhances bonding with their child and increases confidence in their parenting skills. This article discusses the benefits and risks of massage for preterm infants and their families and explains how to implement massage therapy in the neonatal intensive care setting.     

Neonatologische Versorgung – Fallzahlregelung

Germany’s infant mortality rate is high compared with Scandinavian countries, for instance, despite relatively high expenditure on health care. Since the infant mortality rate is influenced mainly by the neonatal mortality rate, which in turn is strongly determined by premature infant mortality, the national discussion has been focusing on the improvement of very low birthweight (VLBW) infant care in Germany. In 2005, the Joint Federal Committee (Gemeinsamer Bundesausschuss), the legislative organ of self-governance in the German statutory health care system, after drawing up a list of structural requirements, agreed upon a minimum number of 14 VLBW babies below 1250 g birthweight or between 1250 and 1500 g birthweight, as well as publishing outcome quality. The pros and cons of such regulations to reduce infant mortality and improve the care of VLBW are discussed.     

The mPINC survey: Impacting US maternity care practices

The Centers for Disease Control and Prevention administered the original Maternity Practices in Infant Nutrition and Care (mPINC) survey, a census of all US birth facilities, from 2007 to 2015 to monitor infant feeding‐related maternity care practices and policies. The purpose of this paper is to describe the many uses of mPINC data. Hospitals, organizations and governments (federal, state and local) have used the mPINC survey as a tool for improving care among the populations they serve. Nationally, the mPINC survey has been used to document marked improvements in infant feeding‐related maternity care. Researchers have used the mPINC data to examine a variety of questions related to maternity care practices and policies. The newly revised mPINC survey (2018) has been designed to capture changes that have occurred over the past decade in infant feeding‐related US maternity care. Hospitals, organizations, governments and researchers will be able to continue using this important tool in their efforts to ensure US maternity care practices and policies are fully supportive of breastfeeding.     

Infant care review committees. The response to federal guidelines

A 1986 survey of hospitals with neonatal intensive care units and/or 1500 or more births indicated (1) which hospitals had established infant care review committees and (2) what hospital and committee characteristics influenced the functioning of infant care review committees. Of the hospitals surveyed, 51.8% had established infant care review committees. This study provides baseline information on the development of infant care review committees.     

The changing role of parents in neonatal care: a historical review

Over the past century, improvements in technology and neonatal care techniques have dramatically reduced infant mortality rates. While this progress continues, a growing body of literature supports the significant role that parents play in the development of infants, particularly within the hospital setting. Throughout much of the twentieth century, various barriers prevented many parents from participating in thc care of their neonates, negatively influencing infant outcomes. Today parental involvement in neonatal carc has become a key part of a larger family-centered care model. This historical review describes how past neonatal care practices affected the roles of parents, from absence or indirect involvemcnt to the important involved roles of today. Understanding current trends in relation to these past experiences may encourage the formulation of family-centered care practices now and in the friture.     

Physiologic Sequelae of Prematurity: The nurse practitioner''s role part VI. Feeding difficulties and growth Failure (prevention, intervention, parent teaching, and complications)

Feeding difficulties and growth failure are common problems of the premature infant who has been in a neonatal intensive care unit. This article, the sixth in a series, discusses the prevention, intervention, and parent teaching necessary to assist parents in coping and dealing with feeding problems in their premature infant.     

Care mapping: A common sense approach

Because of trends in the health care environment, hospitals are searching for ways to continuously improve the quality of care and to decrease the costs of care. One approach that is gaining widespread recognition throughout the United States is the use of case management and practice guidelines such as critical paths, CareMaps, and in the neonatal field, NeoMaps. The NeoMap is a clinical tool which delineates practice guidelines for each discipline that provide care to a specific infant population. It reduces variation in clinical process and thereby has been shown to improve the quality of infant care. When practice guidelines are linked to both health and economic outcomes, they have significant impact on health care costs. In this paper, case management and the development of the NeoMap will be described in relation to the Intensive Care Nursery (ICN) at Pennsylvania Hospital.     

Shared decision‐making for infant feeding and care during the coronavirus disease 2019 pandemic

Despite decades of research establishing the importance of breastfeeding, skin‐to‐skin contact and mother–infant closeness, the response to the coronavirus disease 2019 (COVID‐19) pandemic has underscored the hidden assumption that these practices can be dispensed with no consequences to mother or child. This article aims to support shared decision‐making process for infant feeding and care with parents and health care providers during the unprecedented times of the pandemic. It proposes a structure and rationale to guide the process that includes (1) discussing with parents evidence‐based information and the different options to feed and care for an infant and young child in the context of the pandemic as well as their potential benefits, risks and scientific uncertainties; (2) helping parents to recognize the sensitive nature of the decisions and to clarify the value they place on the different options to feed and care for their infant or young child; and (3) providing guidance and support needed to make and implement their decisions. A shared decision‐making process will help parents navigate complex feeding and care decisions for their child as we face the different stages of the COVID‐19 pandemic.     

The Apgar score

The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care.     

Family-centred and developmental care on the neonatal unit

Admission of a sick or preterm newborn to the neonatal unit can be an extremely stressful experience for both the infant and family. Parent-infant interaction may be considerably hampered. This interaction is, however recognized to be vital and confers a range of benefits to parents and babies and contributes to the physical, emotional and social well-being of both. Developmental care consists of a large range of medical and nursing interventions that help to reduce the stress of preterm infants in neonatal units and allow optimal neurobehavioral development of the infant. Family-Centred and Family Integrated Care practices promote parental participation in the care of their infant on NICU whilst recognizing them as integral members of the care team and primary decision-makers for their infant. Established historical practices and beliefs can present as challenges to the implementation and sustenance of family-centred and developmental care. We review these challenges in order to develop strategies to successfully implement this important aspect of neonatal care.     

Parents as practitioners in preterm care

The very preterm birth of an infant is physiologically traumatic for the infant and physiologically and psychologically traumatic for the parents. The manner of care delivery in the first few days and weeks of the infant's life plays a large role in determining the impact of that trauma. For optimal outcomes parents need to be integrated into the care process as the primary practitioners of their infant's care in the neonatal intensive care unit. Supporting and enabling parents to be central to the care process establishes a consistent care environment where parents are in control and able to support their infant's physiological and psychological needs, thereby improving infant outcomes and reducing parent stress and anxiety. This article reviews the role of parents in the optimal development of preterm neonates, and discusses the elements crucial to promoting parent involvement in the neonatal intensive care unit and supporting parents following discharge.     

A controlled trial of skin-to-skin contact in extremely preterm infants

BACKGROUND: Extremely preterm birth, even in the absence of significant neurological impairment, is associated with altered pain responses and impaired memory and behaviour. Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship, factors that in turn are also associated with impaired infant outcome. Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects. METHODS: We conducted a pragmatic, prospective, controlled, intention-to-treat trial in two neonatal intensive care units. Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks. We assessed infant behaviour at time of discharge from hospital, responses to immunisation at 4 and 12 months of age, and memory, behaviour and development at 1 year corrected (postmenstrual) age. Indices of maternal depression, stress, anxiety, lactation performance and infant interaction were assessed at time of infant discharge, 4 months and 1 year. RESULTS: No significant difference was identified in any infant or maternal measure at any time point. CONCLUSIONS: Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences. Although there is no reason to dissuade mothers who wish to provide STS contact, we are unable to recommend resource allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting.     

Infant mortality increase despite high access to tertiary care: an evolving relationship among infant mortality, health care, and socioeconomic change

In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.     

Extrasystoles: side effect of kangaroo care?

OBJECTIVE: To present an unpublished reason for an arrhythmic electrocardiogram (ECG) recording during kangaroo care in a preterm infant. DESIGN: Case report. PATIENT: Preterm infant. MEASUREMENTS AND MAIN RESULTS: A preterm infant exhibited cardiac arrhythmia on the ECG monitor during kangaroo care, leading to interruption of kangarooing. Arrhythmia disappeared after placing the baby back into the incubator. The most likely reasons for arrhythmia were excluded. However, arrhythmia reappeared upon continuation of kangaroo care. ECG monitoring revealed the reason for the monitoring error. CONCLUSIONS: ECG monitoring during kangaroo care should cause error because of superimposed electric activity from the parent. Oxygen saturation represents a more reliable method of monitoring during kangaroo care.     

The Medically Complex Premature Infant in Primary Care

The survival rate of the smallest and youngest of premature infants has continued to improve as medical technology has progressed. The current edge of viability is represented by infants born at 23 to 25 weeks' gestation. Neonatal survival of infants at 23 weeks' gestation ranges from 11% to 30%. Survival to hospital discharge for infants ranging from 23 to 26 weeks' gestation is about 70%; 30% to 50% of these infants have moderate to severe disability. Nurse practitioners and physicians will be meeting these young infants in primary care offices after they have been discharged from the neonatal intensive care unit. This article is Part III in a series addressing issues related to the premature infant. This installment focuses on medically complex premature infants and their health issues after discharge. Part I addressed issues common to all premature infants. Part II looked at the healthy premature infant and their management in primary care.     

Heart for bonding: a new protocol of care for hypoplastic left heart syndrome

There are significant challenges involved in the perinatal and postnatal care of an infant with hypoplastic left heart syndrome (HLHS) and the infant's family. In the blink of an eye, the perfect child is lost, and a fragile infant is about to join the family. This case study and discussion is an overview of HLHS , a family's desire to make the birth of their infant normal, and how that desire initiated a change in philosophy and practice in our neonatal intensive care unit.     

Prolonged Sinoatrial Block in an Infant With Respiratory Syncytial Viral Bronchiolitis

Complete heart block in children admitted to the pediatric intensive care unit with respiratory syncytial viral (RSV) infections has been described. This report describes a prolonged sinoatrial block exceeding 4?s in an infant with RSV, which, to the authors' knowledge, is the longest such event described in the published literature. This block was followed by shorter episodes within the next 24?h. An extensive workup showed no other known cause of bradycardia or sinoatrial block. The infant was discharged home with 48?h Holter monitoring, which was normal. At this writing, the infant has remained asymptomatic since discharge. Respiratory syncytial viral infections may cause prolonged sinoatrial block in an otherwise healthy child.     

A focused ethnographic assessment of Middle Eastern mothers' infant feeding practices in Canada

The aim of this study was to examine the barriers to following complementary feeding guidelines among Middle Eastern mothers and the cultural considerations of practitioners from an emic perspective. This is a two‐phase focused ethnographic assessment of infant feeding among 22 Middle Eastern mothers in Western Canada who had healthy infants aged <1 year. Data were collected through four focus groups conducted in Arabic/Farsi, and were further complemented by comprehensive survey data collected in the second phase of study. Mothers' main criterion for choosing infant foods was whether or not foods were Halal, while food allergens were not causes for concern. Vitamin D supplements were not fed to 18/22 of infants, and mashed dates (Halawi), rice pudding (Muhallabia/Ferni) and sugared water/tea were the first complementary foods commonly consumed. Through constant comparison of qualitative data, three layers of influence emerged, which described mothers' process of infant feeding: socio‐cultural, health care system and personal factors. Culture was an umbrella theme influencing all aspects of infant feeding decisions. Mothers cited health care professionals' lack of cultural considerations and lack of relevance and practicality of infant feeding guidelines as the main reasons for ignoring infant feeding recommendations. Early introduction of pre‐lacteal feeds and inappropriate types of foods fed to infants among immigrant/refugee Middle Eastern mothers in Canada is cause of concern. Involving trained language interpreters in health teams and educating health care staff on cultural competency may potentially increase maternal trust in the health care system and eventually lead to increased awareness of and adherence to best practices with infant feeding recommendations.