Interventions to Improve Interactions between Drug Abusing Mothers and Their Drug-Exposed Infants: A Review of the Research Literature

Substance abuse during pregnancy continues to be a large public health problem throughout the United States. It has been established through several studies that healthy mother-infant interactions are essential for optimal infant development. This relationship can be severely compromised when a mother is using drugs during and after pregnancy. A review of the literature was performed to ascertain what are the most effective interventions for enhancing mother-infant interactions of drug-abusing mothers. Ten studies were identified as meeting the criteria of using an intervention to enhance the mother-infant interaction of drug-abusing mothers and their infants. A synthesis of the findings suggests that abstinence is an important factor in determining success of interventions, as well as enhancing the mother's self-esteem or self-efficacy through education or a counseling process. In order to determine the best intervention, or combination of interventions for this high-risk population, more research is needed.     

Assisting mother with preterm infant breastfeeding

It is necessary to gain nutrition for infants, especially premature. The digestive systems of premature infants are immature, so they find it hard to absorb nutrients. Mother's milk is easy for preterm infants to digest and absorb, so it is the best food for them. In reality, however, mothers always face many problems when breastfeeding preterm infants. They need support systems to establish their confidence in breastfeeding in order to improve their success rates and thus facilitate their continuation of the practice. Nurses can teach mothers how to breastfeed preterm infants. The purpose of this paper, therefore, is to describe the characteristics of the gastrointestinal systems of premature babies, the benefits of breastfeeding for premature babies, the factors influencing premature breastfeeding, the transition from gavage to oral feeding and how to assist the mothers of premature babies with breastfeeding. It also provides information on premature breastfeeding to enable nurses to provide early assistance to mothers in nursing their premature infants and in maintaining the practice of breastfeeding.     

Mothers' involvement in caring for their premature infants: an historical overview

BACKGROUND: Advances in technology have resulted in increasing survival rates even for extremely premature infants. While sophisticated medical management is vital to infant survival, research has found that social factors and care giving processes are important predictors of infants' later outcome. Consequently, evidence is accumulating to demonstrate the fundamental role of mothers and families to the optimal developmental outcome of premature infants. AIM: The aim of the work reported here was to undertake an historical overview of premature infant care practices to increase neonatal nurse's knowledge of the crucial role of mothers and families in the care of their premature infants. Understanding past practice and current trends can provide neonatal nurses with critical insight which will assist in formulating current and future care. METHOD: Research and historical articles focusing on maternal involvement in preterm infant care from the development of the incubator to the present time were examined. A search of the literature between 1960 and 2002 was conducted using the MEDLINE, CINAHL and PSYCLIT databases. The search terms were premature infant, neonatal intensive care, history, and maternal care. FINDINGS: Three major themes were identified which reflect the development of neonatal care. Firstly, over the last century advances in medical and public health practice saw a decline in mortality rates for mothers and infants. Secondly, the application of this new knowledge resulted in the institutionalization and professionalization of obstetric and neonatal care which, in turn, resulted in the isolation of infants from their mothers. Finally, concurrent advances in infant research emphasized the importance of mother-infant relationships to infants' developmental outcome, resulting in greater flexibility in hospital practices regarding parental contact with their infants. CONCLUSION: As biomedical advances in technology continue to help smaller, sicker premature infants to survive, neonatal nurses are strategically placed to promote positive outcomes for infants and their families through the integration of social science and behavioural research into nursing practice.     

Pain in Premature Infants: What Is Conclusive Evidence and What Is Not

Premature infants spend much of their early days of life in an environment that is stressful and in many situations painful. Short and long term consequences of pain are not well documented, yet postulated to have a negative impact on stress-response systems and on deployment. To date there is insufficient evidence for the best methods to assess or to effectively treat their pain. Though a variety of uni- and multidimensional assessment tools are available, many lack sufficient psychometric testing, do not incorporate essential developmental cues to premature infants, and do not distinguish between acute and chronic pain. This review paper will discuss the etiology, sources, and manifestations of pain as well as the short and long term consequences of pain. The available assessment tools for pain in premature infants along with reliability and validity will also be presented.     

Feeding and non-feeding interactions of mothers and prematures

The interactions between mothers and premature infants during feeding and nonfeeding periods were explored. Twenty-nine premature infants and their mothers were observed interacting for 1 hour in their homes at 6 months corrected for prematurity. Mothers were more likely to engage in the following behaviors involving close contact during feeding: looking at the infant, holding the infant, having body contact, and rocking their infants. They interacted with their infants 96% of feeding time. During nonfeeding periods, they were more likely to engage in more distal behaviors (e.g., gesturing, touching, and playing with the infant) and spent only 67% of the time interacting with the infant. Infants were more likely to be alert, vocalize, play with objects, express negative affect, and locomote during nonfeeding, and they were more likely to be drowsy or asleep during feeding. Therefore, a complete understanding of interactions between mothers and prematures can only come from examining both feeding and nonfeeding periods.     

Maternal perception of first-born infants: a controlled comparative study of mothers of premature and full-term infants.

Mothers of premature infants monitored at home for apnea and mothers of full-term infants had significantly more positive perceptions of their infants than mothers of premature infants not monitored. Using the Brief Symptom Inventory 2 weeks after the infants went home from the hospital, the mothers of infants not monitored reported significantly more psychological symptoms than the other two groups. Maternal perceptions of their infants had not changed when interviewed 6 months later. Implications for nursing practice are discussed.     

NICU早产儿父亲出院准备度的研究进展

NICU早产儿出院后需要接受持续的健康管理。父亲是早产儿的主要照护者之一,其出院准备度对早产儿生长发育的影响较大。该文对NICU早产儿父亲出院准备度的概念、现状、评价工具、影响因素及提高策略进行综述,旨在促进国内医护人员关注早产儿父亲的出院准备度,为制订针对性的健康教育方案提供参考依据。     

Emollient Therapy for Newborn Infants—A Global Perspective

Research on emollient therapy as a strategy to reduce mortality in newborn infants is a global priority. This paper discusses the use of emollients on newborn infants. Since the question is “Should emollients be applied to newborn infants, particularly premature infants?” the focus is on reports that discussed some measure of skin condition such as skin grades, skin effects, transepidermal water loss (TEWL), or impact on infection/mortality. The investigations on the use of emollients for premature infants are reviewed. Consideration is also given to the infant caregiver interactions during the applicaton as the process itself may be important for achieving benefits on skin barrier development and integrity. The remaining questions and subjects of future research are presented.     

Biochemical markers in the assessment of protein-calorie malnutrition in premature neonates

We studied 135 premature newborns of 26 to 36 weeks gestation, divided into three groups: the control group, 66 premature infants with uncomplicated course; 51 premature neonates with appropriate birth weight for gestational age (AGA), who suffered from clinical problems that delayed oral feeding; and 18 premature infants with small birth weight for gestational age (SGA). When neonates of the same postnatal age were compared, prealbumin concentrations were the lowest in the SGA group at the third and fourth postnatal week. Although the AGA group had the most infants with serious illnesses and the lowest protein-calorie intakes, their prealbumin concentrations did not differ significantly from those of the control group. But when the infants of each group were subdivided on the basis of intakes and weight gain regardless of postnatal age, those with greater intakes showed significantly higher prealbumin values; however, in all groups, the infants with higher intakes were also significantly older. Total proteins and albumin showed similar changes in all groups. Prealbumin concentrations showed great interindividual variability in infants of the same postnatal age. We conclude that prealbumin, albumin, and serum total proteins are not sufficiently sensitive biochemical markers to assess alterations of the nutritional status of premature infants.     

Management of an extremely premature infant in the out-of-hospital environment

The rate of premature infant mortality has decreased over the last several decades, with an accompanying decrease in the gestational age of premature infants who survive to hospital discharge. Emergency medical services (EMS) providers are sometimes called to provide prehospital care for infants born at the edge of viability. Such extremely premature infants (EPIs) present medical and ethical challenges. In this case report, we describe an infant born at 24 weeks into a toilet by a mother who thought she had miscarried. The EMS providers evaluated the infant as nonviable and placed him in a plastic bag for transport to a local emergency department (ED). The ED staff found the infant to have a bradycardic rhythm, initiated resuscitation, and admitted him to the neonatal intensive care unit. The infant died seven days later. We review the literature for recommendations in resuscitation of EPIs and discuss the ethics regarding their management in the prehospital setting.     

早产儿潮气肺功能检查的操作技巧及意义

目的 探讨早产儿潮气肺功能检查的操作技巧及意义.方法 选择本院2011年1月~2012年5月新生儿科收治的50例早产儿,于纠正胎龄40周时进行潮气肺功能检查;与同期产科分娩,胎龄39~40周健康患儿为足月组生后5~7 d时测定潮气肺功能检查相比较.结果 早产儿组的RR比足月组明显增快（P〈0.05）,TV/kg明显降低（P〈0.05）;TPEF、TPEF/TE、VPEF、VPEF/VE较足月组明显降低（P〈0.05）,PTEF较足月组明显增快（P〈0.05）.MV、TI/TE变化不明显（P〉0.05）.结论 早产儿气道发育比足月儿慢,注意操作技巧可以最大程度地消除对结果的影响,更能真实地反映肺功能结果;根据肺功能结果进行健康宣教,最大程度地使早产儿肺功能恢复到最佳状态.     

Resuscitation in the delivery room: lung protection from the first breath

Resuscitation of newborn infants occurs in approximately 10% of the more than 100 million infants born annually worldwide. The techniques used during resuscitation, such as positive-pressure ventilation and supplemental oxygen, may revive many infants, but have the potential to harm their lungs. In recent years increasing attention has been applied to providing lung protection from the first breath. This paper reviews the currently available medical evidence concerning modifying aspects of delivery room management that are thought to mitigate lung injury. These include: F(IO(2)) < 1.0; early use of continuous positive airway pressure (CPAP) and PEEP; optimizing pressure and/or volume during ventilation; sustained inflations; need for and timing of surfactant therapy; and airway management of meconium-stained amniotic fluid. Although the evidence against 100% oxygen use is of low quality, it has been enough to alter the recommendations for oxygen use in the delivery room. It is suggested (not mandated) to use room air initially when resuscitating a term-gestation infant, and to use F(IO(2)) < 1.0 in premature infants, with F(IO(2)) adjustments depending on oximetry values. Recent studies have not indicated better outcomes in premature infants in whom CPAP or PEEP is applied in the delivery room. Optimal peak ventilatory pressure and tidal volume have yet to be delineated. Although an intriguing therapy, sustained inflations have not been shown to markedly improve outcomes. Prophylactic use of surfactant in small, premature infants remains the accepted standard. Immediate placement on CPAP after surfactant instillation has yet to demonstrate clear-cut advantages. Finally, intrapartum oropharyngeal and nasopharyngeal suctioning of meconium-stained amniotic fluid does not improve outcomes in meconium-stained infants. Moreover, routine intubation and intratracheal suctioning of apparently vigorous meconium-stained infants do not improve outcomes. In summary, although multiple therapies are touted as protecting the lungs in the delivery room "from the first breath," to date there are scant supportive data.     

早产对新生儿肾脏的影响

近几十年来,全球早产率持续上升趋势,早产儿被定义为妊娠满28周至不足37周之间分娩出来的新生儿,随着步入成年早产儿数量的增多,越来越多的研究开始关注其成年后的长期健康问题,近年来,大量的研究证实了早产成年幸存者存在各种器官、系统慢性疾病的风险,特别是早产对以后肾脏功能及结局不利影响方面的研究进一步增多。故本文对早产儿肾脏功能的长期改变的相关研究进展做一综述。     

Management of an Extremely Premature Infant in the Out-of-Hospital Environment

Abstract

The rate of premature infant mortality has decreased over the last several decades, with an accompanying decrease in the gestational age of premature infants who survive to hospital discharge. Emergency medical services (EMS) providers are sometimes called to provide prehospital care for infants born at the edge of viability. Such extremely premature infants (EPIs) present medical and ethical challenges. In this case report, we describe an infant born at 24 weeks into a toilet by a mother who thought she had miscarried. The EMS providers evaluated the infant as nonviable and placed him in a plastic bag for transport to a local emergency department (ED). The ED staff found the infant to have a bradycardic rhythm, initiated resuscitation, and admitted him to the neonatal intensive care unit. The infant died seven days later. We review the literature for recommendations in resuscitation of EPIs and discuss the ethics regarding their management in the prehospital setting.     

早产儿实施由NICU至家庭过渡期护理干预效果的Meta分析

目的对早产儿实施由NICU至家庭过渡期护理的干预效果进行Meta分析,以期为临床实践提供指导与借鉴。方法计算机检索中国知网、万方数据、中国生物医学文献、PubMed、Cochrane Library、EBSCO、Web of science等中英文数据库对早产儿实施NICU至家庭过渡期护理的随机对照试验。采用Cochrane手册(5.1.0)进行文献质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入13篇文献。结果显示,过渡期护理可增加早产儿母乳喂养率、体质量及1、3和6个月时身长,缩短住院天数,不会增加医院感染,提高其主要照顾者育儿技能、缓解焦虑情绪(P<0.01或P<0.05)。结论 NICU作为早产儿过渡期护理阶段的干预场所,实施后有助于提高早产儿的母乳喂养率、促进其生长发育,提升其主要照顾者育儿技能、缓解焦虑情绪,缩短早产儿住院天数且不会增加医院内感染的风险。     

Renal excretion of cystathionine and creatinine in humans at different ages

The renal excretion of cystathionine is not age-dependent when related to body surface. Regarding the urinary creatinine concentration as reference, the excretion of cystathionine in adults is lower than in infants and children. However, this is probably due to a higher urinary concentration of creatinine in adults compared to that in children. Premature infants excrete more cystathionine in their urine than mature infants. The same is true for premature infants on a methionine-enriched formula compared to premature infants on a low methionine formula.     

重症监护室早产儿出院后父母需求的质性研究

目的 了解重症监护室早产儿出院后父母的需求,旨在为重症监护室早产儿出院后延续性护理服务提供理论依据.方法 采用目的抽样法,选取2018年12月—2019年4月深圳市某妇幼保健院新生儿重症监护室(neonatal intensive care unit,NICU)15名已出院1周的早产儿的父母,对其进行半结构式深度访谈,...     

Tactile stimulation and preterm infants

A critical challenge for care providers is improving the outcomes for premature infants. The issues of how to control various kinds of stimulation, provide appropriate sensory stimulation, and maintain the quality of life of premature infants becomes the central focus of care given in neonatal intensive care units. Therefore, intervention research studies that improve the development and quality of life for premature infants are vitally important. This article comparatively analyzes and critiques five intervention studies of premature infants using tactile stimulation and provides future research directions in this area. By examining the effectiveness of the tactile stimulation studies, some evidence and guidance can be provided for researchers generating knowledge in this area as well as nurses involved in clinical care.     

The relationship between oral feeding and cardiorespiratory regulation of premature infants

Levels of maturity and diseases of premature infants are factors that produce individual differences in cardiorespiratory responses to oral feeding and feeding performances. Recognition of mechanisms and cardiorespiratory regulation of oral feeding may increase sensitivity of clinical observation of nurses and facilitate safe and comfort feeding experiences for premature infants. Four major concepts of this integrated literature review are: (a) The maturation of sucking skills and coordination of sucking, swallowing, and breathing play an important role in successful oral feeding. (b) There are significant relationships between the feeding performances and cardiorespiratory stability of premature infants in the early period of oral feeding. (c) During the oral feeding period, the reduction of vagal tone will increase the heart rate of premature infants in order to balance physiological metastasis. (d) During the early period of oral feeding, the SaO2 of premature infants might decrease continually. This condition can be improved gradually with experience of oral feeding. These concepts provide knowledge for assessing feeding readiness and facilitate protocols for safe feeding by reducing the cardiorespiratory workload of premature infants.     

324例早产儿败血症临床分析

目的探讨早产儿败血症患者的临床特征,为其早期诊断、治疗提供指导依据和协助判断预后。方法对2012年6月至2014年6月本院新生儿病房确诊的早产儿败血症324例临床资料进行回顾性分析。结果早产儿败血症以晚发型败血症（≥7 d）和院内感染败血症为主;临床表现无特异性,并发症以肺炎、弥散性血管内凝血、化脓性脑膜炎为主;血小板和高敏 C反应蛋白（hs-CRP）异常发生率高;病原菌以革兰阴性菌为主,其次为革兰阳性菌和真菌;药敏显示革兰阴性菌对喹诺酮类抗生素、氨基糖苷类抗生素和碳青酶烯类抗生素较敏感;死亡16例,以出生胎龄＜ 32周、出生体质量＜ 1500 g 者病死率高;5例诊断神经发育损害。结论早产儿败血症早期症状不典型,院感和合并症发生率高,监测血小板和 hs-CRP 有助于早产儿败血症的早期诊治。