Systematic Review of the Effects of Positioning on Nonautonomic Outcomes in Preterm Infants

ObjectiveTo identify and synthesize the available evidence on the effect of different positions (prone, supine, and right and left lateral) on nonautonomic outcomes for preterm infants admitted to the NICU.Data SourcesWe searched the CINAHL, MEDLINE, Scopus, and Cochrane databases for reports of primary research studies using a three-step strategy. We also searched for gray literature and reviewed the reference lists of retrieved articles.Study SelectionWe included reports of quantitative studies published in English from database inception through February 2022 that focused on positioning and nonautonomic outcomes (pain, comfort, skin integrity, behavioral state, and sleep quality and duration) for preterm infants in the NICU. Two authors independently screened titles and abstracts and assessed articles in full text against the inclusion criteria.Data ExtractionTwo authors independently extracted the data from the full-text articles using a standardized data extraction tool. We synthesized the data narratively because of the different designs and outcome measures among the included studies.Data SynthesisFrom a total of 550 records initially screened, we included 17 articles in our review. In the included articles, prone positioning improved sleep quality and duration, whereas supine positioning was associated with increased awakenings and activity. Infants demonstrated fewer self-regulatory behaviors in the prone position compared to supine or side-lying and were less stressed in the prone position. We found minimal evidence on the effect of positioning on skin integrity or pain.ConclusionThere is limited good-quality evidence on the effect of positioning on nonautonomic outcomes in preterm infants. To inform clinical practice, high-quality randomized controlled trials focused on the positioning of premature infants are warranted.     

Effectiveness and Accuracy of Tests for Preterm Delivery in Symptomatic Women: A Systematic Review

This study systematically reviewed evidence on the effectiveness and accuracy of predictive tests for preterm delivery among symptomatic women. The study included English-language systematic reviews (SRs) on any predictive test for preterm delivery among symptomatic women and primary studies for placental alpha-microglobulin-1. PubMed, Wiley Cochrane Library, the Centre for Reviews and Dissemination Database, the National Guidelines Clearinghouse, and the TRIP database were searched for SRs, PubMed and PubMed Central via the Wiley Cochrane Library were searched for primary studies. One reviewer performed study selection, with input from a second reviewer when needed. One reviewer appraised study quality and extracted: study characteristics (i.e., country, funding source, study design [primary studies] or synthesis method [SRs], study appraisal method [SRs]), population characteristics, index test(s) and cut-off points used, comparator(s) or reference standard(s), and outcomes. A second reviewed a random 10% sample. The authors synthesized the findings narratively. Of 451 unique records, the review included 22 (17 SRs, five primary studies). For effectiveness, there was evidence for use of transvaginal sonographic cervical length assessment (15–25 mm cut point) in reducing incidence of preterm delivery at <37 weeks (relative risk 0.64; 95% CI 0.44–0.94, one SR of three trials; n?=?287) but lack of support for cervicovaginal fetal fibronectin. In terms of accuracy, one high-quality study within a best-evidence SR showed that cervical length measurement was useful to predict delivery within 48 hours (LR+ 6.43, 95% CI 5.17–8.00; LR? 0.03, 95% CI 0.00–0.42; n?=?510) and 7 days (LR+ 8.61, 95% CI 6.65–11.14; LR? 0.03, 95% CI 0.00–0.18; n?=?510). Accuracy of placental alpha-microglobulin-1 testing was not supported for most end points. In conclusion, some evidence supports the effectiveness of cervical length as a predictor of preterm delivery in symptomatic women. Evidence for most tests is limited in quality and quantity.     

Systematic Review of the Effect of Enteral Feeding on Gut Microbiota in Preterm Infants

Objective

To examine the effect of feeding type on microbial patterns among preterm infants and to identify feeding factors that promote the colonization of beneficial bacteria.

Integrative Review of Mental Health and Feeding Styles in Parents of Bottle-Fed Infants

ObjectiveTo review the literature regarding the relationship between symptoms of anxiety and depression and feeding styles in parents of bottle-fed infants.Data SourcesWe conducted literature searches in PubMed, CINAHL, Scopus, and PsycINFO.Study SelectionWe used Covidence systematic review management software during the selection process to allow for full blinding of decisions by team members. Articles were eligible for inclusion if they were reports of primary research, written in English, and focused on the relationship between symptoms of anxiety or depression and feeding styles in parents of term, bottle-fed infants younger than 12 months of age. We placed no restriction on date of publication because of the sparse amount of published literature on this topic. We identified a total of 1,882 articles. After removing duplicates, we screened 988 articles and retained six articles that met criteria for our review.Data ExtractionWe used Whittemore and Knafl’s integrative review methodology to guide data extraction and reporting. We extracted relevant data from all primary data sources and compiled the data into a matrix. We used the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies to assess the quality of the studies.Data SynthesisUsing an a priori coding scheme, we summarized the data using categorization of established parental feeding styles in infancy applicable to bottle-feeding. We synthesized the data into two broad categories: responsive and nonresponsive feeding styles.ConclusionAlthough research on the topic is limited, our findings suggest that symptoms of postpartum depression may be associated with nonresponsive feeding styles in parents of bottle-fed infants. We suggest several areas for future research and recommend increased emotional and feeding support in practice for parents of bottle-feeding infants.     

Interventions to Try to Prevent Preterm Birth in Women With a History of Conization: A Systematic Review and Meta-analyses

Objectives

The most effective preterm birth (PTB) intervention is unknown for women who are at risk of PTB due to a history of conization. The objective of this systematic review was to determine whether PTB interventions, progesterone, cerclage, and pessary decrease the risk of PTB compared to no treatment in singleton—and separately in twin—pregnancies of women with history of conization.

Preterm Birth Prevention: Effectiveness of Current Strategies

Objective: to describe the current state of preterm birth in Canada and to ascertain the effectiveness of published preventive strategies.Data sources: a literature review including Statistics Canada 1991 and peer reviewed articles using preterm birth as the primary medical subject heading. The Cochrane Database of Systematic Reviews also was studied.Study selection: randomized controlled trials, quasi-experimental trials, and analytic studies (including retrospective and prospective cohort studies).Data extraction: the following information was recorded about each preventive intervention: population type, sample size, study design, type of intervention, and whether interventions or programmes were carried out in high risk pregnant women or using a population-oriented approach.Data synthesis: high risk strategy tested nine various single interventions and three programmes of multiple interventions in almost 35,000 pregnancies, all in randomized controlled trials. The population-oriented strategy was applied in almost 500,000 pregnancies, although only three interventions in less than 6,000 pregnancies were tested by randomized clinical trials.Conclusion: preterm birth rates have not decreased in Canada for at least thirty years. High risk screening and interventions are not effective in reducing preterm birth rates. There is promising potential for effectiveness with population-oriented strategies but these have to be tested in appropriately designed randomized controlled trials.     

Systematic Review of Interventions for Reproductive Life Planning

Objective

To systematically review the literature on interventions for reproductive life planning (RLP).

Factors Influencing Feeding Decisions of Black and White Mothers of Preterm Infants

Objective: To examine the factors involved in mothers' decisions to provide breast milk for their premature infants and to determine if these factors differ between Black and White mothers.
Design: Secondary analysis of data from 2 primary studies at 2 time points within 2 days of hospital admission (T1) and just before discharge (T2).
Setting: Urban level III Neonatal Intensive Care Unit in the eastern United States.
Participants: Convenience sample of 80 mothers, 34 White and 46 Black, who delivered a singleton infant less than 30 weeks' gestation.
Outcome Measures: Mother-focused and infant-focused factors involved in the decision to breastfeed or formula feed as measured by the Preterm Infant Feeding Survey.
Results: Infant-focused scores ranked higher than mother-focused scores at T1. Mother-focused scores ranked higher than infant-focused scores at T2. Between T1 and T2, the increase in mother-focused scores and the decrease in infant-focused scores were significant. There were no significant differences between the Black and White mothers' scores at either time point.
Conclusion: Mothers' focus on factors that impact their feeding decisions change over time from their infant to themselves. Additionally, no differences were noted between the Black and White mothers.     

Experiences of Fathers Shortly After the Birth of Their Preterm Infants

ObjectiveTo explore the experiences of fathers shortly after the birth of their preterm infants.Design/MethodA focused ethnography conducted over 33 months (2003–2006) in the neonatal intensive care unit (NICU) of a large U.K. National Health Trust (NHS) teaching hospital. Data were collected through participant observation, in‐depth interviews with fathers (n = 10), and an ethnographic survey distributed to NICU staff (n = 87). Practices and relationships with fathers were concurrently analyzed thematically through the conceptual perspective of emotion work.FindingsFathers’ emotional reactions to their experiences were described in three themes: emotional withdrawal and control, stereotyping, and mixed feelings. Fathers’ emotional behaviors were governed by complex, culturally determined conventions and expectations.ConclusionsFathers engaged in considerable effort to manage their emotions as they attempted to reconcile the tension between what they wanted to feel and what they thought others expected them to feel. The results of this study support the view that focusing on emotional externalities alone tends to underplay the amount of emotion work carried out by less expressive individuals; this “silent emotion work” was characteristic of the fathers in this study.     

早产预测指标及其检查时机的研究

早产是围生儿并发症及死亡的主要原因之一。早产的预测是研究热点,大量文献分别从超声测量学角度,包括宫颈长度,胎儿某内脏的测量;宫颈阴道分泌物中多项指标,如胎儿纤维结合蛋白、磷酸化及脱磷酸化胰岛素样生长因子连接蛋白-1、白细胞介素的测定;血生化分析,如血清松弛肽、C反应蛋白、糖化血红蛋白含量的变化及羊水化验与感染有关的一些因子,如快速基质金属蛋白酶8、单核细胞趋化蛋白-1、γ干扰素诱导T细胞α趋化因子等,阐述各指标对早产的预测价值。以期找到更加稳定可靠的预测早产指标,提高围生质量。     

早产预测指标及其检查时机的研究

早产是围生儿并发症及死亡的主要原因之一。早产的预测是研究热点,大量文献分别从超声测量学角度,包括宫颈长度,胎儿 某内脏的测量;宫颈阴道分泌物中多项指标,如胎儿纤维结合蛋白、磷酸化及脱磷酸化胰岛素样生长因子连接蛋白-1、白细胞介素的测定;血生 化分析,如血清松弛肽、C反应蛋白、糖化血红蛋白含量的变化及羊水化验与感染有关的一些因子,如快速基质金属蛋白酶8、单核细胞趋化蛋白 -1、γ干扰素诱导T细胞α趋化因子等,阐述各指标对早产的预测价值。以期找到更加稳定可靠的预测早产指标,提高围生质量。