Mothers' experiences of having their newborn child in a neonatal intensive care unit

BACKGROUND: From birth the child has an ability to respond to the environment, which influences the interaction between mother and child. If this attachment is interrupted, the child's emotional development is negatively influenced. When the child needs care in a neonatal intensive care unit (NICU) it is difficult to establish contacts between mother and child. Separation from the child is found to be the most difficult aspect for mothers when their newborn child is hospitalized in a NICU. AIM: The aim of this study was to describe mothers' experiences when their full-term newborn child was cared for in a NICU during the postpartum maternity care period. METHOD: A phenomenological hermeneutic interview study was performed. Ten mothers were interviewed once, 6 months to 6 years after the experience. RESULTS: The essence of the experience is understood as an alternation between two opposite concepts, exclusion and participation, with emphasis on exclusion. A feeling of exclusion dominates when the new mother feels a lack of interaction and a sense of not belonging to either the maternity care unit or the NICU. This has a negative effect on her maternal feelings. On the contrary, when a feeling of participation dominates, a continuous dialogue exists and the mother is cared for as a unique person with unique needs. This supports her maternal feelings in a positive direction. The implication of the result for nurses is that it is important to decrease mothers' experience of exclusion and to increase their feeling of participation when their child is cared for in a NICU. A return visit to the responsible nurse to go through the treatment and experiences should be offered to all parents whose child has been cared for in a NICU.     

The influence of adult behaviors on child coping during venipuncture: a sequential analysis

The aim of this exploratory study was to investigate the influences of adult behaviors on child coping behaviors during venipunctures (VPs) in an emergency department. Observations of children and adults from 66 VPs were coded using a modified version of the Child-Adult Medical Procedure Interaction Scale and analyzed using sequential analysis. Results showed adult reassurance behavior promoted child distress behaviors, such as crying, as well as nondistress behaviors, such as information seeking; adult distraction behaviors promoted children's distraction, control, and coping behaviors; and children frequently ignored adult behaviors. Findings suggest further exploration of children's internal strategies for coping, such as appraisal, and clarifying the role of adult reassurance in child coping behaviors.     

Book review

Hyman, Larry M. and Li, Charles N. (1988) Language, Speech and Mind: Studies in Honour of Victoria A. Fromkin. Routledge, London and New York. ISBN 0 415 00311 3. Pp. xvii + 352. Hdbk £35·00.     

Migraine and asthma in childhood: evidence for specific asymmetric parent-child interactions in migraine and asthma families

In spite of the fact that migraine often manifests as a familial disorder, the role of the family in migraine has not been adequately explored. In this study parent-child interactions in 20 families with a child suffering from migraine were analysed and compared with 20 healthy families and 20 families with an asthma child. The families had to solve a puzzle within a limited time. Parent-child interactions within migraine and asthma families were asymmetric, revealing a disease-specific interpersonal context in the family. Communication with the affected child in migraine families was significantly more directive, with more specific instructions and less help, towards migraineurs than with the healthy siblings. Dominance of parents and submissive behaviour of children were the main features of interactions. In asthma families interactions were more conflicting and less cooperative. This study demonstrated a specific, asymmetric, pattern of family interactions predisposing children either to migraine or asthma.     

Programmatic adaptations to acute malnutrition screening and treatment during the COVID‐19 pandemic

The COVID‐19 pandemic presented numerous challenges to acute malnutrition screening and treatment. To enable continued case identification and service delivery while minimising transmission risks, many organisations and governments implemented adaptations to community‐based management of acute malnutrition (CMAM) programmes for children under 5. These included: Family mid‐upper arm circumference (MUAC); modified admission and discharge criteria; modified dosage of therapeutic foods; and reduced frequency of follow‐up visits. This paper presents qualitative findings from a larger mixed methods study to document practitioners'' operational experiences and lessons learned from these adaptations. Findings reflect insights from 37 interviews representing 15 organisations in 17 countries, conducted between July 2020 and January 2021. Overall, interviewees indicated that adaptations were mostly well‐accepted by staff, caregivers and communities. Family MUAC filled screening gaps linked to COVID‐19 disruptions; however, challenges included long‐term accuracy of caregiver measurements; implementing an intervention that could increase demand for inconsistent services; and limited guidance to monitor programme quality and impact. Modified admission and discharge criteria and modified dosage streamlined logistics and implementation with positive impacts on staff workload and caregiver understanding of the programme. Reduced frequency of visits enabled social distancing by minimising crowding at facilities and lessened caregivers'' need to travel. Concerns remained about how adaptations impacted children''s identification for and progress through treatment and programme outcomes. Most respondents anticipated reverting to standard protocols once transmission risks were mitigated. Further evidence, including multi‐year programmatic data analysis and rigorous research, is needed in diverse contexts to understand adaptations'' impacts, including how to ensure equity and mitigate unintended consequences.     

羊膜腔穿刺对母婴HBV垂直传播的meta分析

目的母婴乙肝病毒垂直传播已成为我国乙肝病毒感染的主要途径,本研究分析乙肝病毒感染的孕妇进行羊膜腔穿刺是否增加母婴垂直传播的风险。方法搜索1990年1月1日~2016年3月15日之间在Pubmed、Embase、谷歌学术和万方数据库等数据库中所有关于乙肝孕妇行羊膜腔穿刺对母婴垂直传播影响的相关英文或中文文章,根据纳入剔除标准对文章进行筛选,然后对文章治疗评分,最后有4篇文章纳入,共有3997孕妇,其中实验组167名、对照组3830名,使用Review Manager Version 5.0进行数据分析。结果荟萃分析结果显示,进行羊膜腔穿刺术与不行羊膜腔穿刺术两组婴儿HBsAg阳性率无明显差异（R²=1.37,95% CI: 0.70~2.69,P=0.36）。当孕妇是HBV-DNA≥10⁷ copies/mL、HBeAg阳性时,进行羊膜腔穿刺术后胎儿宫内感染风险增加（R²=9.54,95% CI: 3.52~25.85,P<0.0004;R²=3.41,95% CI: 1.05~11.13,P=0.04）。结论孕妇HBV-DNA≥10⁷ copy/mL和（或）HBeAg阳性时将增加母婴垂直传播的风险。     

An Examination of the Glucose Management Indicator in Young Children with Type 1 Diabetes

Background:Previous studies utilizing glucose data from continuous glucose monitors (CGM) to estimate the Glucose Management Indicator (GMI) have not included young children or determined appropriate GMI formulas for young children with type 1 diabetes (T1D).Methods:We extracted CGM data for 215 children with T1D (0-6 years) from a repository. We defined sampling periods ranging from the 3-27 days prior to an HbA1c measurement and compared a previously established GMI formula to a young child-specific GMI equation based on the sample’s CGM data. We examined associations between HbA1c, GMI values, and other CGM metrics for each sampling period.Results:The young child-specific GMI formula and the published GMI formula did not evidence significant differences when using 21-27 days of CGM data. The young child-specific GMI formula demonstrated higher correlations to laboratory HbA1c when using 18 or fewer days of CGM data. Overall, the GMI estimate and HbA1c values demonstrate a strong relationship in young children with T1D.Conclusions:Future research studies may consider utilizing the young child-specific GMI formula if the data collection period for CGM values is under 18 days. Further, researchers and clinicians may consider changing the default number of days of data used to calculate glycemic metrics in order to maximize validity of CGM-derived metrics.     

The Nutritional Adequacy and Diet Quality of Vegetarian Menu Substitutions in Urban Kansas Childcare Centers

While plant-based eating has become increasingly popular, little is known of how this trend has impacted childcare center meals. The purpose of this study was to measure the nutrient content and diet quality of vegetarian alternative lunches and compare these measures to those of standard childcare lunches and nutrient benchmarks representing one-third of the Dietary Reference Intake for 3-year-olds and 4–5-year-olds. Menu data were obtained from seven urban Kansas childcare centers participating in the Child and Adult Care Food Program and regularly providing a vegetarian alternative lunch. The centers provided detailed menu information for 27 days’ worth of meals. The most common vegetarian substitution was cheese, which was used to fulfill all or part of the meat/meat alternative requirement in over three-quarters of the vegetarian alternative meals (n = 22). Compared to the standard meals, the vegetarian alternative meals were higher in calories, fat, saturated fat, calcium, and sodium and lower in protein, choline, and diet quality (p = 0.05). Both lunch options met the benchmarks for vitamin A, vitamin D, vitamin B12, calcium, and protein. Iron content for both (95% CI: standard 1.61–2.17 mg; vegetarian 1.37–2.7 mg) was below the benchmark. Although additional research is needed to better understand how vegetarianism has impacted childcare meals in the U.S., important differences in the nutrient contents were observed between the standard and vegetarian alternative meals. In addition, the results suggest vegetarian alternative meals that rely heavily on cheese may be of lower diet quality.     

Predictors of Minimum Acceptable Diet among Children Aged 6–23 Months in Nepal: A Multilevel Analysis of Nepal Multiple Indicator Cluster Survey 2019

Background: Minimum Acceptable Diet (MAD), developed by the WHO and UNICEF, is a binary indicator of infant and young child feeding practice that assesses the quality and sufficiency of a child’s diet between the ages of 6 and 23 months. Identifying factors associated with MAD among children can inform policymakers to improve children’s nutritional status. Methods: We extracted data of 1930 children aged 6–23 months from the Nepal Multiple Indicator Cluster Survey 2019. Multilevel analysis was performed to identify factors associated with MAD. Results: Only 30.1% of the children received MAD. Children aged 13–18 months [aOR (Adjusted odds ratio): 2.37, 95% CI (95% Confidence Interval): 1.77, 3.17] and 19–23 months (aOR: 2.6, 95% CI: 1.95, 3.47) were more likely to receive MAD than children aged 6–12 months. Early breastfed children (aOR: 1.34, 95% CI: 1.05, 1.72), those currently breastfeeding (aOR: 4.13, 95% CI: 2.21, 7.69) and children without siblings aged under five (aOR: 1.33, 95% CI: 1.03, 1.73) were more likely to receive MAD. Younger maternal age (aOR: 0.97, 95% CI: 0.95–1.0), higher level of mother’s education (aOR: 1.04, 95% CI: 1.0–1.08) and more media exposure among mothers (aOR: 1.66, 95% CI: 1.24, 2.21) were positive predictors of MAD. Relatively disadvantaged ethnicity/caste (aOR: 0.71, 95% CI: 0.53, 0.94), rural residence (aOR: 1.45, 95% CI: 1.06, 2.00) and residing in Madhesh province (aOR: 0.61, 95% CI: 0.37, 1.0) were also significant predictors of MAD. Conclusions: Children aged 6–12 months, without appropriate breastfeeding, having under-five years siblings, with older mother or mother without media exposure or low education, from relatively disadvantaged ethnicity/caste, from urban areas and residing in Madhesh Province were less likely to receive MAD. Our findings can inform infant and young child feeding policies and practices in Nepal.     

Updated Meal Patterns in the Child and Adult Care Food Program and Changes in Quality of Food and Beverages Served: A Natural Experimental Study

With diet-related chronic diseases being the largest contributors to U.S. morbidity and mortality, identifying population-level strategies to promote healthier diets is essential. Intervention during early childhood may be particularly important. The Child and Adult Care Food Program (CACFP), a federal nutrition assistance program in the U.S. that supports serving meals and snacks in child care settings, reaches millions of U.S. children. Recent 2017 updates to CACFP’s meal patterns were meant to improve the nutritional quality of food served through CACFP by providing more whole grains, fruit, and vegetables. In this study, we used a natural experimental, longitudinal study of child care centers participating in CACFP compared to nonparticipating centers to assess whether the quality of food and beverages served (per menu analysis) improved following the CACFP meal pattern changes. While we found that CACFP centers were more likely to meet several key nutrition standards in comparison to non-CACFP centers overall, there were no differences in menu quality from before to after the 2017 standards change between CACFP and non-CACFP centers. Nutrition standards for CACFP may need to be further strengthened with adequate financial and technical support given to child care programs for effective implementation.