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Villavisanis DF, Wagner CS, Morales CZ, Smith TE, Blum JD, Cho DY, Bartlett SP, Taylor JA, Swanson JW. Geospatial and Socioeconomic Factors Interact to Predict Management and Outcomes in Cleft Lip and Palate Surgery: A Single Institution Study of 740 Patients. Cleft Palate Craniofac J 2024; 61:921-929. [PMID: 36802891 DOI: 10.1177/10556656221150291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Determine interactions between geospatial and socioeconomic factors influencing cleft lip and/or cleft palate (CL/P) management and outcomes. DESIGN Retrospective review and outcomes analysis (n = 740). SETTING Urban academic tertiary care center. PATIENTS 740 patients undergoing primary (CL/P) surgery from 2009 to 2019. MAIN OUTCOMES MEASURES Prenatal evaluation by plastic surgery, nasoalveolar molding, cleft lip adhesion, and age at CL/P surgery. RESULTS Prenatal evaluation by plastic surgery was predicted by the interaction between higher patient median block group income and shorter patient distance from the care center (OR = 1.07, p = 0.022). Nasoalveolar molding was also predicted by the interaction between higher patient median block group income and shorter distance from the care center (OR = 1.28, p = 0.016), whereas cleft lip adhesion was predicted by higher patient median block group income alone (OR = 0.41, p < 0.001). Lower patient median block group income predicted later age at cleft lip (β = -67.25, p = 0.011) and cleft palate (β = -46.35, p = 0.050) repair surgery. CONCLUSIONS Distance from the care center and lower median income by block group interacted to significantly predict prenatal evaluation by plastic surgery and nasoalveolar molding for patients with CL/P at a large, urban, tertiary care center. Patients living farthest from the care center who received prenatal evaluation by plastic surgery or who underwent nasoalveolar molding had higher median block group income. Future work will determine mechanisms perpetuating these barriers to care.
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Affiliation(s)
- Dillan F Villavisanis
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Connor S Wagner
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carrie Z Morales
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tony E Smith
- Department of Electrical & Systems Engineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica D Blum
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Y Cho
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Grant C, Gephart SM, Rattray N. Mothers' Internet Journeys Through Social, Health Care, and Virtual Systems When Congenital Anomalies Are Diagnosed In Utero. Nurs Womens Health 2024:S1751-4851(24)00089-8. [PMID: 38768646 DOI: 10.1016/j.nwh.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/14/2024] [Accepted: 04/11/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To examine mothers' internet usage, in conjunction with social, health care, and virtual peer support navigations, when congenital anomalies were diagnosed in utero. DESIGN Qualitative descriptive, consisting of semistructured interviews. SETTING Interview data were collected over Zoom; mothers participated from locations of their choosing. PARTICIPANTS Mothers of neonates discharged postoperatively from NICUs for uterine-diagnosed congenital anomalies. The sample was purposefully recruited from private Facebook groups for parents of children with congenital anomalies. INTERVENTION/MEASUREMENTS Analysis was done with deductive coding using concepts from the systems engineering initiative for patient safety theory. The a priori codes were health care, social, journey-benefit, journey-risk, task, and technology. RESULTS Twenty-two mothers signed up for an interview; 12 completed an interview, and 10 did not. The majority (n = 8, 66%) were White, had a bachelor's or graduate degree (n = 7, 58%) and were between 24 and 33 years of age (n = 8, 66%). Nine themes emerged: (a) Providers cautioned searching for diagnosis information but encouraged private Facebook groups for peer support, (b) Mothers' inquiries for their own care are lacking, (c) Search for information while recognizing parent-partner's coping differences, (d) Pace information from friends and family with patience and appreciation, (e) Manage inquiries from friends and family with group sharing, (f) Private Facebook groups provide a means of receiving and giving peer support, (g) Exposure to difficult stories on Facebook is a risk of stress, (h) Select a NICU, learn about their children's diagnoses, participate in virtual peer support, and (i) Device features frame search strategies. CONCLUSION Mothers reflected on the internet as a burden and a source of support in their health care journeys. The ubiquity of internet access calls for mothers to include in their health care journeys the complexities of managing time spent on the internet.
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Clelland AD, Lester R, Duncan Ó, Lam WL. Parental experience after diagnosis of a congenital upper limb difference: a national survey. J Hand Surg Eur Vol 2024:17531934241249014. [PMID: 38702055 DOI: 10.1177/17531934241249014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Congenital hand and upper limb differences may be detected during antenatal ultrasonography or visually at birth. We investigated the experience of parents when they first learned that their child had an upper limb difference. This national retrospective cross-sectional quantitative and qualitative survey within the UK and Ireland received 261 responses from parents of children. Differences were first suspected antenatally among 41% of respondents and in 57% postnatally, with 2% unsure. Of the children, 54% were seen in a clinic by a specialist congenital hand surgeon within 3 months and 88% within 12 months, with 73% of respondents feeling unsupported after a diagnosis that was unexpected. Qualitative analysis outlined a broad spectrum of parental concerns about the quality of information received, especially regarding the child's future biopsychosocial needs. This study showed the need for more support for parents from frontline healthcare professionals and the need for a streamlined referral pathway.Level of evidence: IV.
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Affiliation(s)
- Andrew D Clelland
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | | | - Órla Duncan
- Department of Plastic and Reconstructive Surgery, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Wee L Lam
- Department of Plastic and Reconstructive Surgery, Royal Hospital for Children and Young People, Edinburgh, UK
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Gramszlo C, Karpyn A, Christofferson J, McWhorter LG, Demianczyk AC, Neely T, Zyblewski S, Shillingford A, Kazak AE, Sood E. Meeting Parents' Needs for Education and Preparation following Congenital Heart Disease Diagnosis: Recommendations from a Crowdsourced Study. Am J Perinatol 2024; 41:e446-e455. [PMID: 35863373 PMCID: PMC10008463 DOI: 10.1055/a-1906-8786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This article characterizes the educational needs of parents following fetal or neonatal congenital heart disease (CHD) diagnosis and generates recommendations for meeting these needs. STUDY DESIGN Online crowdsourcing methods were used to collect qualitative data from 95 parents of children with CHD regarding their needs for education and preparation following fetal or neonatal diagnosis. Data were analyzed using qualitative methods and themes were organized around the substructure of met and unmet needs. RESULTS Two themes represented consistently met needs, whereas 10 themes represented needs that were either inconsistently met or consistently unmet. Parents reported needing more information about social, emotional, and financial supports, preparation for long-term care, and guidance toward reputable online resources. Parents also provided recommendations for meeting these needs. CONCLUSION Parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive. Addressing these may support parental coping and active participation in medical decision-making. KEY POINTS · CHD counseling after diagnosis may provide opportunities to promote parents' mental health.. · Guidelines recommend that this counseling should include emotional and decision-making support, however, it is unclear what parents actually receive.. · This study found that parents' needs for education and preparation following CHD diagnosis are much broader in scope than what they currently receive..
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Affiliation(s)
- Colette Gramszlo
- Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | | | - Linda G. McWhorter
- Division of Behavioral Health, Nemours Children’s Hospital, Delaware, Wilmington, DE
| | - Abigail C. Demianczyk
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Trent Neely
- Brothers by Heart/Sisters by Heart, El Segundo, CA
| | - Sinai Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Amanda Shillingford
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Erica Sood
- Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
- Division of Behavioral Health, Nemours Children’s Hospital, Delaware, Wilmington, DE
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Walker EYX, Winyard P, Marlais M. Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families. Pediatr Nephrol 2024; 39:1065-1075. [PMID: 37656310 PMCID: PMC10899401 DOI: 10.1007/s00467-023-06137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
Congenital anomalies of the kidney and urinary tract are collectively one of the most commonly diagnosed antenatal conditions. Clinicians have several tools available to diagnose anomalies, including imaging, biomarkers, family history and genetic studies. In certain cases, antenatal interventions such as vesico-amniotic shunting may be considered to improve postnatal outcomes.Congenital kidney anomalies detected antenatally can vary in clinical significance from almost no impact postnatally to significant morbidity and perinatal mortality. Prognosis broadly depends on kidney size, structure and amount of amniotic fluid, alongside genetics and family history, and progression on subsequent scans. It is important to counsel parents appropriately using a parent-focused and personalised approach. The use of a multidisciplinary team should always be considered.
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Affiliation(s)
- Emma Y X Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Paul Winyard
- UCL Great Ormond Street Institute for Child Health, London, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute for Child Health, London, UK.
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Sunal Akturk E, Seker ED, Capkın D, Kutuk MS. Evaluation of Anxiety in Turkish Parents of Newborns with Cleft Palate with or Without Cleft Lip. Cleft Palate Craniofac J 2024; 61:492-497. [PMID: 36594490 DOI: 10.1177/10556656221148903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE (1) To compare anxiety between parents of newborns with cleft lip and palate (CLP), isolated cleft palate (CP), and healthy newborns and (2) to evaluate anxiety between parental dyads within these groups. DESIGN A cross-sectional study. SETTING University Hospital. PARTICIPANTS Surveys were completed by 20 mothers and 20 fathers of newborns with CLP, 21 mothers and 21 fathers of newborns with CP, and 23 mothers and 23 fathers of healthy newborns (controls). MAIN OUTCOME MEASURE The State-Trait Anxiety Inventory (STAI) assessed parental anxiety. Mothers of newborns with a cleft reported on concerns regarding cleft-related issues and facial appearance. RESULTS State and trait anxiety were generally in the moderate range for parents of newborns with a cleft, while control parents had low state anxiety and moderate trait anxiety. Mothers of newborns with CP and CLP had significantly higher state and trait anxiety levels than control mothers (p < .05). Fathers of newborns with CLP had a higher state anxiety level than control fathers. When maternal and paternal anxiety was compared within the groups, only trait anxiety scores were significantly higher in mothers of newborns with CLP than that of fathers (p < .05). More than half of mothers of newborns with a cleft were concerned about their newborn's feeding, speech, and palate. CONCLUSIONS Parents of children with a cleft may need psychological support in the early postnatal period. It is important for neonatal cleft team providers to help reduce parental anxiety and educate families about cleft care, with a focus on feeding.
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Affiliation(s)
- Ezgi Sunal Akturk
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Elif Dilara Seker
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Duygu Capkın
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Mehmet Serdar Kutuk
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, 34093, Turkey
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Payer D, Krimmel M, Reinert S, Koos B, Weise H, Weise C. Oral health-related quality of life in patients with cleft lip and/or palate or Robin sequence. J Orofac Orthop 2024; 85:98-109. [PMID: 35852562 PMCID: PMC10879386 DOI: 10.1007/s00056-022-00414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the oral health-related quality of life (OHRQoL) in patients with cleft lip and/or palate or Robin sequence versus a healthy control group using the Child Oral Health Impact Profile (COHIP-G19). Factors such as age, gender, and cleft type were considered. METHODS Over an 8-month period, the OHRQoL was surveyed by using the COHIP-G19 questionnaire. Included were patients with a craniofacial disorder (n = 61; average age 11.24 years) and a healthy control group (n = 70, average age 12.63 years) for a total of 131 patients (average age 11.99 years) from the Department of Orthodontics University Hospital Tübingen, Germany. These were divided into two age groups (6-11 years; 12-18 years). RESULTS Statistically, patients with a craniofacial disorder presented a significantly lower OHRQoL than the control group (p = 0.0055). In the craniofacial disorder group, older patients revealed a significantly (p = 0.005) lower OHRQoL than the younger patients. Female patients showed in nearly all groups a better OHRQoL than male patients, but this difference was not statistically significant (p > 0.05). Males with a craniofacial disorder scored significantly lower than males without (p = 0.016); females showed no differences between the groups. Visibility, location, and severity of the craniofacial malformation did not have a significant influence on the OHRQoL. CONCLUSION The occurrence of a craniofacial malformation impacted the OHRQoL especially in older and male affected patients, unrelated to the expression level or localization. An early instruction about oral health, rehabilitation and functional training should be considered in therapy.
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Affiliation(s)
- D Payer
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - M Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - S Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - B Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - H Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - C Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany.
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Ronai C, Garcia Godoy L, Madriago E. Homogenous access to fetal cardiac care in a heterogeneous state. Cardiol Young 2024; 34:500-504. [PMID: 37485827 DOI: 10.1017/s1047951123002536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Timely prenatal diagnosis of CHD allows families to participate in complex decisions and plan for the care of their child. This study sought to investigate whether timing of initial fetal echocardiogram and the characteristics of fetal counselling were impacted by parental socio-economic factors. METHODS Retrospective chart review of fetal cardiac patients from 1 January, 2017 to 31 December, 2018. We reviewed gestational age at first fetal echo, maternal age and ethnicity, zip code, rurality index, and hospital distance. Counselling was evaluated based on documentation regarding use of interpreter, time billed for counselling, and treatment option chosen. RESULTS Total of 139 maternal-fetal dyads were included, and 29 dyads had single-ventricle heart disease. There was no difference in income, hospital distance or rurality index, and first fetal echo timing. There was no significant difference between maternal ethnicity and maternal age, gestational age at initial visit, or follow-up. Patients in rural areas had increased counselling time (p < .05). There was no difference between socio-economic factors and ultimate parental choices (termination, palliative delivery, or cardiac interventions). CONCLUSION Oregon comprises a heterogeneous population from a large geographical catchment. While prenatal counselling and family decision-making are multifaceted, we demonstrated that dyads were referred from across the state and received care in a uniformly timely manner, and once at our centre received consistent counselling despite differences in parental socio-economic factors.
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Affiliation(s)
- Christina Ronai
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health and Sciences University, Portland, OR, USA
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Laura Garcia Godoy
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health and Sciences University, Portland, OR, USA
| | - Erin Madriago
- Department of Pediatrics, Division of Pediatric Cardiology, Oregon Health and Sciences University, Portland, OR, USA
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Burgos CM, Irvine W, Vivanti A, Conner P, Machtejeviene E, Peters N, Sabria J, Torres AS, Tognon C, Sgró A, Kouvisalo A, Langeveld-Benders H, Sfeir R, Miserez M, Qvist N, Lokosiute-Urboniene A, Zahn K, Brendel J, Prat J, Eaton S, Benachi A. European reference network for rare inherited congenital anomalies (ERNICA) evidence based guideline on the management of gastroschisis. Orphanet J Rare Dis 2024; 19:60. [PMID: 38347519 PMCID: PMC10860293 DOI: 10.1186/s13023-024-03062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The European Reference Network for rare Inherited Congenital Anomalies, ERNICA, guidelines for gastroschisis cover perinatal period to help teams to improve care. METHOD A systematic literature search including 136 publications was conducted. Research findings were assessed following the GRADE methodology. The evidence to decision framework was used to determine the strength and direction of recommendations. RESULTS The mode or timing of delivery do not impact neonatal mortality, risk of NEC or time on parenteral nutrition (PN). Intra or extra abdominal bowel dilatation predict complex gastroschisis and longer length of hospital stay but not increased perinatal mortality. Outcomes after Bianchi procedure and primary fascia closure under anesthesia are similar. Sutureless closure decreases the rate of surgical site infections and duration of ventilation compared to surgical closure. Silo-staged closure with or without intubation results in similar outcomes. Outcomes of complex gastroschisis (CG) undergoing early or delayed surgical repair are similar. Early enteral feeds starting within 14 days is associated with lower risk of surgical site infection. RECOMMENDATIONS The panel suggests vaginal birth between 37 and 39 w in cases of uncomplicated gastroschisis. Bianchi's approach is an option in simple gastroschisis. Sutureless closure is suggested when general anesthesia can be avoided, sutured closure. If anesthesia is required. Silo treatment without ventilation and general anesthesia can be considered. In CG with atresia primary intestinal repair can be attempted if the condition of patient and intestine allows. Enteral feeds for simple gastroschisis should start within 14 days.
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Affiliation(s)
- Carmen Mesas Burgos
- Department of Pediatric Surgery, Karolinska University Hospital, Eugeniavägen 23, C11:33, 17176, Stockholm, Sweden.
| | - Willemijn Irvine
- Department of Evidence Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, The Netherlands
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
| | - Peter Conner
- Center for Maternal and Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Egle Machtejeviene
- Department of Gynecology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Nina Peters
- Department of Gynecology and Obstetrics, Erasmus MC, Rotterdam, The Netherlands
| | - Joan Sabria
- Center for Maternal and Fetal Medicine, Hospital St Joan de Dieu, Barcelona, Spain
| | | | - Costanza Tognon
- Department of Neonatology, University of Padua, Padua, Italy
| | - Alberto Sgró
- Department of Pediatric Surgery, University of Padua, Padua, Italy
| | - Antti Kouvisalo
- Department of Pediatric Surgery, Helsinki University Hospital, Helsinki, Finland
| | | | - Rony Sfeir
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Marc Miserez
- Department of Surgery, UZ Leuven, Louvain, Belgium
| | - Nils Qvist
- Department of Pediatric Surgery, Odense University Hospital, Odense, Denmark
| | - Ausra Lokosiute-Urboniene
- Department of Pediatric Surgery, Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania
| | - Katrin Zahn
- Department of Pediatric Surgery, Mannheim, Germany
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical University, Hanover, Denmark
| | - Jordi Prat
- Department of Pediatric Surgery, Hospital S Joan de Diu, Barcelona, Spain
| | - Simon Eaton
- Department of Pediatric Surgery, Erasmus MC, Rotterdam, The Netherlands
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University, Clamart, France
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Uveges MK, Hamilton JB, Pados BF, Thayer WM, Hinds PS, Nolan MT. Being a "Good Parent" to a NICU Infant With a Major Congenital Anomaly. Adv Neonatal Care 2024; 24:14-26. [PMID: 38232327 DOI: 10.1097/anc.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND In the United States, up to one-third of infants with a congenital anomaly require neonatal intensive care unit (NICU) hospitalization. Parents of these infants may have different decision-making priorities, which may be influenced by the timing of the infant's diagnosis. PURPOSE (1) To compare the ranked importance of decision-making beliefs for parents of infants who received a prenatal versus postnatal congenital diagnosis and (2) explore how parents describe their decision-making beliefs. METHODS A cross-sectional, sequential mixed-methods pilot design was applied to collect quantitative data using the Good Parent Ranking Exercise and further explore parents' decision-making beliefs through qualitative interviews. Maximum difference scaling/hierarchical Bayes estimation and content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS Forty mothers completed the Good Parent Ranking Exercise and 20 mothers completed qualitative interviews. Four of the top 5 ranked parenting beliefs were shared by mothers in the prenatal and postnatal groups. Mothers in the postnatal group ranked "focusing on my child's quality of life" higher. Qualitative interviews revealed that previously identified decision-making beliefs were consistent in this NICU parent population, with 1 additional belief identified. Mixed-methods analysis revealed high concordance between the prenatal and postnatal groups. IMPLICATIONS FOR PRACTICE NICU nurses need to know that decision-making beliefs for parents who receive a prenatal versus postnatal congenital diagnosis, while largely similar, may have differences. IMPLICATIONS FOR RESEARCH Future research should explore decision-making beliefs in demographically diverse parent groups (ie, fathers, partnered vs nonpartnered couples) and effective strategies for promoting NICU parents' decision-making beliefs.
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Affiliation(s)
- Melissa K Uveges
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Uveges); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Hamilton); Infant Feeding Care, Wellesley Hills, Massachusetts (Dr Pados); School of Nursing, Johns Hopkins University, Baltimore, Maryland (Mr Thayer); Children's National Health System, Washington, District of Columbia (Dr Hinds); Department of Pediatrics, The George Washington University, Washington, District of Columbia (Dr Hinds); and Conway School of Nursing, The Catholic University of America, Washington, District of Columbia (Dr Nolan)
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11
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Sholler GF, Selbie LA, Tallon M, Keating J, Ayer J, Burchill L, Cheung MMH, Cordina R, Culnane E, Donovan S, Eastaugh L, Elliott C, Fletcher J, Justo RN, Kasparian NA, Kelly A, Morsman D, Nicolae M, Orr Y, Pendrick E, Ramsay JM, Reményi B, Shipton S, Weintraub RG, Van Wijk E, Wheaton G, Venugopal P. Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards). 1st Edition. Heart Lung Circ 2024; 33:153-196. [PMID: 38453293 DOI: 10.1016/j.hlc.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/09/2024]
Abstract
These first Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards) have been developed to inform the healthcare requirements for CoHD services and enable all Australian patients, families and carers impacted by CoHD (paediatric CoHD and adult congenital heart disease [ACHD]) to live their best and healthiest lives. The CoHD Standards are designed to provide the clarity and certainty required for healthcare services to deliver excellent, comprehensive, inclusive, and equitable CoHD care across Australia for patients, families and carers, and offer an iterative roadmap to the future of these services. The CoHD Standards provide a framework for excellent CoHD care, encompassing key requirements and expectations for whole-of-life, holistic and connected healthcare service delivery. The CoHD Standards should be implemented in health services in conjunction with the National Safety and Quality Health Service Standards developed by the Australian Commission on Safety and Quality in Health Care. All healthcare services should comply with the CoHD Standards, as well as working to their organisation's or jurisdiction's agreed clinical governance framework, to guide the implementation of structures and processes that support safe care.
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Affiliation(s)
- Gary F Sholler
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Lisa A Selbie
- HeartKids Ltd, Parramatta, NSW, Australia; School of Biotechnology & Biomolecular Sciences University of NSW, Sydney, NSW, Australia and Johns Hopkins University, Baltimore, MD, USA
| | - Mary Tallon
- HeartKids Ltd, Parramatta, NSW, Australia; Perth Children's Hospital, Perth, WA, Australia; School of Nursing, Curtin University, Perth, WA, Australia
| | | | - Julian Ayer
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Luke Burchill
- The Royal Melbourne Hospital, Melbourne, Vic, Australia and Mayo Clinic, Rochester, New York, NY, USA
| | - Michael M H Cheung
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Evelyn Culnane
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Lucas Eastaugh
- The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Jeffery Fletcher
- Queensland Paediatric Specialists, Southport, Qld, Australia; Department of Paediatrics, The Tweed Hospital, Tweed Heads, NSW, Australia and Griffith University, Brisbane, Qld, Australia
| | - Robert N Justo
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia; Queensland Paediatric Cardiac Research, Children's Health Queensland, South Brisbane, Qld, Australia
| | - Nadine A Kasparian
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Ohio, OH, USA
| | - Andrew Kelly
- Women's and Children's Hospital, North Adelaide, SA, Australia
| | | | - Mugur Nicolae
- The University of Queensland, Herston, Qld, Australia; Mater Hospital Services, Brisbane, Qld, Australia
| | - Yishay Orr
- Sydney Children's Hospitals Network, NSW, Australia; Heart Centre for Children, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | | | | | - Bo Reményi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT and Royal Darwin Hospital, Darwin, NT, Australia
| | | | - Robert G Weintraub
- The University of Melbourne, Melbourne, Vic, Australia; The Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Elsa Van Wijk
- HeartKids Ltd, Parramatta, NSW, Australia; Australian Institute of Company Directors, NSW, Australia
| | - Gavin Wheaton
- Women's and Children's Hospital, North Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Prem Venugopal
- Queensland Children's Hospital, South Brisbane, Qld, Australia; The University of Queensland, Herston, Qld, Australia
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12
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Hoselton AS, Finup J, Roedel M, Davidson E, Farhat W. A Case of Urethral Atresia: Emphasizing the Role of Parental Engagement. Urology 2024; 184:e243-e245. [PMID: 37956764 DOI: 10.1016/j.urology.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
Congenital urethral atresia is generally considered to be incompatible with life unless there is either a patent urachus or vesicoamniotic shunt. Here we present the case of a male neonate with anhydramnios detected at 28weeks gestation due to urethral atresia, who was born without evidence of either a patent urachus or vesicoamniotic shunt, who has survived and is not requiring respiratory support at age 5months. While this is a thought-provoking clinical case, it also highlights the importance of early and effective parental engagement in cases of complex congenital anomalies of the urinary tract.
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Affiliation(s)
| | - Jennika Finup
- University of Wisconsin - Madison, Department of Urology, Madison, WI
| | - Megan Roedel
- University of Wisconsin - Madison, Department of Urology, Madison, WI
| | - Emily Davidson
- University of Wisconsin - Madison, Department of Urology, Madison, WI
| | - Walid Farhat
- University of Wisconsin - Madison, Department of Urology, Madison, WI
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13
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De Groot CRS, Konings EJC, de Boode WP, Oerlemans AJM, Sikkel E, Botden SMBI, Merkus PJ, van der Lee R, Geurtzen R. Exploring professionals' views regarding prenatal counselling in congenital diaphragmatic hernia. J Perinat Med 2023; 51:1229-1238. [PMID: 37561765 DOI: 10.1515/jpm-2023-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Congenital diaphragmatic hernia (CDH) is a congenital malformation in which the diaphragm and lungs are underdeveloped, leading to cardiorespiratory and other problems. This study aimed to explore professionals' views regarding prenatal counselling in CDH. METHODS A qualitative study was performed among healthcare professionals involved in the care of CDH patients in Radboud university medical center Amalia Children's Hospital. Semi-structured interviews were conducted until saturation was achieved. Transcripts were qualitatively analysed to gain insight into professionals' views regarding counselling. RESULTS Eighteen professionals with various backgrounds were included. The professionals agreed that the first counselling session should be soon after diagnosis and additional sessions should be offered. Concerning counselling content, participants considered explanation of the diagnosis, prognosis, short- and long-term consequences, treatment options and practical aspects important. As for decision-making about possible termination of pregnancy, all professionals emphasised the importance of the parental role, but the preferred parental involvement varied. Regarding practical aspects, preferred counsellors were a neonatologist, obstetrician, paediatric surgeon and/or medical social worker. Participants emphasised that the counselling should be adjusted to parents' needs. CONCLUSIONS This study gained insight into professionals' views regarding the timeline, content, decision-making process, and practical aspects of prenatal counselling in CDH.
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Affiliation(s)
- Celeste R S De Groot
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Esther J C Konings
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Anke J M Oerlemans
- Department IQ healthcare, Section Healthcare Ethics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sanne M B I Botden
- Department of Paediatric Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Peter J Merkus
- Department of Paediatric Pulmonology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Robin van der Lee
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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14
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Psaila KM, Schmied V, Heath S. Exploring continuity of care for women with prenatal diagnosis of congenital anomaly: A mixed method study. J Clin Nurs 2023; 32:7147-7161. [PMID: 37409420 DOI: 10.1111/jocn.16777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/04/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023]
Abstract
AIMS To map the pathway and service provision for pregnant women whose newborns require admission into the surgical neonatal intensive care unit at or soon after birth, and to examine the nature of continuity of care (COC) provided and the facilitators and barriers to woman- and family-centred care from the perspective of women/parents and health professionals. BACKGROUND Limited research exists on current service and care pathways for families whose babies are diagnosed with congenital abnormality requiring surgery. DESIGN A mixed method sequential design adhering to EQUATOR guidelines for Good Reporting of a Mixed Methods Study. METHODS Data collection methods included: (1) a workshop with health professionals (n = 15), (2) retrospective maternal record review (n = 20), prospective maternal record review (17), (3) interviews with pregnant women given a prenatal diagnosis of congenital anomaly (n = 17) and (4) interviews with key health professionals (n = 7). RESULTS/FINDINGS Participants perceived care delivered by state-based services as problematic prior to admission into the high-risk midwifery COC model. Once admitted to the high-risk maternity team women described care 'like a breath of fresh air' with a 'contrast in support', where they felt supported in their decisions. CONCLUSION This study highlights provision of COC, in particular relational continuity between health providers and women as essential to achieve optimal outcomes. RELEVANCE TO CLINICAL PRACTICE Provision of individualised COC offers an opportunity for perinatal services to reduce the negative consequences of pregnancy-related stress associated with diagnosis of foetal anomaly. PATIENT OR PUBLIC CONTRIBUTION No patient or public was involved in the design, analysis, preparation or writing of this review.
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Affiliation(s)
- Kim M Psaila
- School of Nursing and Midwifery, University of Western, Sydney, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, University of Western, Sydney, New South Wales, Australia
| | - Susan Heath
- PEARLS Team, Westmead Hospital, Sydney, New South Wales, Australia
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15
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Karapanos I, Bolou A, Nazer M, Iliodromiti S, Greco E. Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals. Curr Opin Obstet Gynecol 2023; 35:411-419. [PMID: 37560805 DOI: 10.1097/gco.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE/METHODS This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included. RECENT FINDINGS Forty-three studies were included and grouped according to the gestational age of the pregnancy complication - miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation - Referral - Individualized care - Clarity - Empowerment - Sensitivity). SUMMARY Given the negative impact of failed communications both in pregnancy outcomes and patients' experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.
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Affiliation(s)
- Ioannis Karapanos
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Angeliki Bolou
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
- School of Health Sciences, Institute for Lifecourse Development: Centre for Chronic Illness and Ageing, Faculty of Education, Health & Human Sciences, University of Greenwich
| | - Maya Nazer
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Elena Greco
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
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16
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Schneider K, Bousi D, Stressig R. Impact of interdisciplinary counselling for parental decision-making in cases of pregnancies with prenatally diagnosed CHD. Cardiol Young 2023; 33:1172-1176. [PMID: 35915979 DOI: 10.1017/s104795112200213x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Parental counselling after antenatal diagnosis of a congenital heart defect requires a high degree of professional and emotional competence and ultimately a sense of responsibility on the part of the consulting physicians. However, little is known about parents` perceptions and evaluation of these consultations. MATERIAL/METHODS Survey on 425 women who received interdisciplinary counselling after antenatal diagnosis of a complex fetal congenital heart defect in a specialized prenatal outpatient clinic with an affiliated paediatric heart centre. Two questionnaires were used to retrospectively evaluate the parental perception and impact on counselling, particularly on decision-making. Questionnaires differed between women conceiving the child and women who terminated the pregnancy. RESULTS 400 women continued, 25 women terminated the pregnancy after diagnosis and counselling. Good quality of life was reported for 68% of the children, 15% died postnatally in the further course. 95% rated the counselling as good or very good regardless of the child´s outcome. 73% described the counselling as highly important for their subsequent decision. The possibility of termination of pregnancy was discussed with 37% of the respondents, 22% of them found it outrageous or very distressing. Of all respondents, one woman would have made a different decision regarding continuation of the pregnancy in retrospect. CONCLUSION Retrospectively, parents rate prenatal counselling extremely positively, irrespective of the severity of the child´s heart defect. It can be assumed that the consistent joint interdisciplinary consultation and the high reputation of the cooperating heart centre have had an influence on the below-average rate of termination of pregnancy.
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Affiliation(s)
| | - Dafni Bousi
- Department of Gynaecology and Obstetrics, Städtische Kliniken, Cologne, Germany
| | - Rüdiger Stressig
- Department of Fetal Diagnostics, Pränatal Plus, Cologne, Germany
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17
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Mamun GMS, Sarmin M, Shahid ASMSB, Nuzhat S, Shahrin L, Afroze F, Saha H, Shaima SN, Sultana MS, Ahmed T, Chisti MJ. Burden, predictors, and outcome of unconsciousness among under-five children hospitalized for community-acquired pneumonia: A retrospective study from a developing country. PLoS One 2023; 18:e0287054. [PMID: 37343025 DOI: 10.1371/journal.pone.0287054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023] Open
Abstract
Despite the reduction of death from pneumonia over recent years, pneumonia has still been the leading infectious cause of death in under-five children for the last several decades. Unconsciousness is a critical condition in any child resulting from any illness. Once it occurs during a pneumonia episode, the outcome is perceived to be fatal. However, data on children under five with pneumonia having unconsciousness are scarce. We've retrospectively analyzed the data of under-five children admitted at the in-patient ward of Dhaka Hospital of icddr,b during 1 January 2014 and 31 December 2017 with World Health Organization classified pneumonia or severe pneumonia. Children presented with or without unconsciousness were considered as cases and controls respectively. Among a total of 3,876 children fulfilling the inclusion criteria, 325 and 3,551 were the cases and the controls respectively. A multivariable logistic regression analysis revealed older children (8 months vs. 7.9 months) (adjusted odds ratio, aOR 1.02, 95% CI: 1.004-1.04, p = 0.015), hypoxemia (aOR 3.22, 95% CI: 2.39-4.34, p<0.001), severe sepsis (aOR 4.46, 95% CI: 3.28-6.06, p<0.001), convulsion (aOR 8.90, 95% CI: 6.72-11.79, p<0.001), and dehydration (aOR 2.08, 95% CI: 1.56-2.76, p<0.001) were found to be independently associated with the cases. The cases more often had a fatal outcome than the controls (23% vs. 3%, OR 9.56, 95% CI: 6.95-13.19, p<0.001). If the simple predicting factors of unconsciousness in children under five hospitalized for pneumonia with different severity can be initially identified and adequately treated with prompt response, pneumonia-related deaths can be reduced more effectively, especially in resource-limited settings.
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Affiliation(s)
- Gazi Md Salahuddin Mamun
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Sharika Nuzhat
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Haimanti Saha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shamsun Nahar Shaima
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mst Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Oftedal A, Bekkhus M, Haugen G, Hjemdal O, Czajkowski NO, Kaasen A. Long-Term Impact of Diagnosed Fetal Anomaly on Parental Traumatic Stress, Resilience, and Relationship Satisfaction. J Pediatr Psychol 2022; 48:181-192. [PMID: 36399086 PMCID: PMC9941832 DOI: 10.1093/jpepsy/jsac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Knowledge regarding the long-term psychological adjustment of parents to children with prenatal diagnosis of congenital malformation is scarce. The aim of this study is to examine traumatic stress trajectories, resilience, and relationship satisfaction among parents to children with prenatal diagnosis of a congenital malformation, and to compare this to a sample of non-affected parents. METHODS A prospective longitudinal cohort study was conducted at a tertiary perinatal referral center. Ninety-three mothers and 80 fathers who received a diagnosis of fetal anomaly during obstetric ultrasound examination (study group), and 110 mothers and 98 fathers with normal ultrasound findings (comparison group), reported their traumatic stress at four timepoints during pregnancy (T1-T4), 6 weeks after birth (T5), and 10-12 years after birth (T6). Resilience and relationship satisfaction was reported at 10-12 years after birth. RESULTS Parents to children with a congenital malformation experienced significantly elevated traumatic stress levels over time, compared with parents of children without congenital malformation. The difference between groups was largest acutely after diagnosis and remained significant 10-12 years after the birth of the child. Resilience and relationship satisfaction levels were similar in both groups. CONCLUSIONS Despite experiencing high levels of traumatic stress over time, parents to children with a congenital malformation reported resilience and relationship satisfaction at similar levels to non-affected parents. This suggests that despite ongoing long-term distress, parents are still able to maintain positive psychological coping resources.
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Affiliation(s)
- Aurora Oftedal
- All correspondence concerning this article should be addressed to Aurora Oftedal, Faculty of Health Science, Oslo Metropolitan University, Pilestredet 32, 0166 Oslo, Norway. E-mail:
| | - Mona Bekkhus
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Guttorm Haugen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nikolai Olavi Czajkowski
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway,Department of Mental Disorders, Norwegian Institute of Public Health, Norway
| | - Anne Kaasen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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19
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So PL, Hui ASY, Ma TWL, Shu W, Hui APW, Kong CW, Lo TK, Kan ANC, Kan EYL, Chong SC, Chung BHY, Luk HM, Choy KW, Kan ASY, Leung WC. Implementation of Public Funded Genome Sequencing in Evaluation of Fetal Structural Anomalies. Genes (Basel) 2022; 13:2088. [PMID: 36360323 PMCID: PMC9690018 DOI: 10.3390/genes13112088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 08/20/2023] Open
Abstract
With the advancements in prenatal diagnostics, genome sequencing is now incorporated into clinical use to maximize the diagnostic yield following uninformative conventional tests (karyotype and chromosomal microarray analysis). Hong Kong started publicly funded prenatal genomic sequencing as a sequential test in the investigation of fetal structural anomalies in April 2021. The objective of the study was to evaluate the clinical performance and usefulness of this new service over one year. We established a web-based multidisciplinary team to facilitate case selection among the expert members. We retrospectively analyzed the fetal phenotypes, test results, turnaround time and clinical impact in the first 15 whole exome sequencing and 14 whole genome sequencing. Overall, the molecular diagnostic rate was 37.9% (11/29). De novo autosomal dominant disorders accounted for 72.7% (8/11), inherited autosomal recessive disorders for 18.2% (2/11), and inherited X-linked disorders for 9.1% (1/11). The median turnaround time for ongoing pregnancy was 19.5 days (range, 13-31 days). Our study showed an overall clinical impact of 55.2% (16/29), which influenced reproductive decision-making in four cases, guided perinatal management in two cases and helped future family planning in ten cases. In conclusion, our findings support the important role of genome sequencing services in the prenatal diagnosis of fetal structural anomalies in a population setting. It is important to adopt a multidisciplinary team approach to support the comprehensive genetic service.
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Affiliation(s)
- Po Lam So
- Department of Obstetrics and Gynecology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Annie Shuk Yi Hui
- Department of Obstetrics & Gynaecology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Teresa Wei Ling Ma
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Wendy Shu
- Department of Obstetrics & Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Amelia Pui Wah Hui
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong SAR, China
| | - Choi Wah Kong
- Department of Obstetrics & Gynaecology, United Christian Hospital, Hong Kong SAR, China
| | - Tsz Kin Lo
- Department of Obstetrics & Gynaecology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Amanda Nim Chi Kan
- Department of Pathology, Hong Kong Children’s Hospital, Hong Kong SAR, China
| | - Elaine Yee Ling Kan
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong SAR, China
| | - Shuk Ching Chong
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong SAR, China
| | - Brian Hon Yin Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ho Ming Luk
- Clinical Genetics Service Unit, Hong Kong Children’s Hospital, Hong Kong SAR, China
| | - Kwong Wai Choy
- Prenatal Genetic Diagnosis Centre, Department of Obstetrics & Gynaecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anita Sik Yau Kan
- Prenatal Diagnostic Laboratory, Tsan Yuk Hospital, Hong Kong SAR, China
| | - Wing Cheong Leung
- Department of Obstetrics & Gynaecology, Kwong Wah Hospital, Hong Kong SAR, China
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20
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Özdemir MA, Topak D, Turgut C, Telek M, Doğar F. Evaluation of depression, anxiety, and stress status in parents of patient with congenital clubfoot treated with Ponseti method: A prospective study. Medicine (Baltimore) 2022; 101:e31654. [PMID: 36343081 PMCID: PMC9646646 DOI: 10.1097/md.0000000000031654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Congenital diseases have been reported to increase the incidence of depression, anxiety, and stress among parents. In this study, we aimed to investigate the depression, anxiety, and stress status in parents of patients with congenital clubfoot before and after treatment with the Ponseti method. A total of 20 patients diagnosed with congenital clubfoot at our clinic and treated with the Ponseti method were included in this study. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate the depression, anxiety, and stress status of the parents before and after treatment. We considered the following parameters to investigate the effects of these on the parents: the educational level of the parents; economic status of the family; gender; birth order of the child in the family; time of diagnosis (prenatal or postnatal). The mean DASS and subdomain scores after treatment were significantly lower than those before treatment (P < .05). Moreover, there was a significant difference in the pre- and posttreatment mean DASS and depression scores of the participants in terms of the education level (P < .05). The pre- and posttreatment DASS and depression scores of the participants with an education level of primary school and below were lower than those of the participants with an education level of secondary and high school. Parents may be less concerned during this process if they are fully informed by the orthopedic surgeons about the treatment protocol and the near-perfect results of the Ponseti method as well as are counseled by healthcare professionals.
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Affiliation(s)
- Mustafa Abdullah Özdemir
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
- *Correspondence: Mustafa Abdullah Özdemir, Kahramanmaraş Sütçü İmam Üniversitesi Tip Fakültesi Avşar Mahallesi Bati Çevreyolu Blv. No:251\A, 46040-Onikişubat\Kahramanmaraş, Türkiye (e-mail: )
| | - Duran Topak
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
| | - Celaleddin Turgut
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Psychiatry, 46040, Kahramanmaras, Turkey
| | - Mikail Telek
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
| | - Fatih Doğar
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopaedic and Traumatology, 46040, Kahramanmaras, Turkey
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21
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Current State of Fetal Heart Disease Counseling and Training: Room for Improvement? : Endorsed by the Fetal Heart Society. Pediatr Cardiol 2022; 43:1548-1558. [PMID: 35380215 DOI: 10.1007/s00246-022-02882-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
We sought to describe the fellowship experiences and current practice habits of pediatric cardiologists who counsel patients with fetal heart disease (FHD) and to identify fellowship experiences related to FHD counseling perceived as valuable by respondents as well as opportunities for improvement. A cross-sectional survey of attending pediatric cardiologists who care for patients with FHD was performed. The respondents' demographics, fellowship experiences related to FHD counseling, reflections on fellowship training, and current practice habits were collected. The Fetal Heart Society endorsed this survey. There were 164 survey responses. 56% of respondents did not have 4th-year subspecialty training in fetal cardiology. Observing and performing FHD counseling were the most commonly used methods of training, with the highest perceived effectiveness. The number of counseling sessions observed and performed correlated moderately with confidence in FHD counseling skills at fellowship graduation. Extracardiac pathology and neurodevelopment were the least frequently addressed topics in fellowship training and in current practice. Fewer than 50% of respondents received formal education and feedback in counseling techniques during fellowship training. A significant proportion of practicing pediatric cardiologists provide FHD counseling with only standard categorical training. This highlights the potential importance of expanding FHD counseling education into categorical fellowship curricula. We suggest increasing opportunities for fellows to perform FHD counseling and receive feedback as this is a valued and beneficial experience during training. A formalized curriculum including extracardiac pathology and neurodevelopment and the use of evidence-based workshops in counseling techniques may address identified gaps in fellowship education.
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"The Mental Health Piece is Huge": perspectives on developing a prenatal maternal psychological intervention for congenital heart disease. Cardiol Young 2022; 32:1268-1275. [PMID: 34588092 DOI: 10.1017/s1047951121004030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Women carrying a fetus diagnosed with congenital heart disease often experience significant distress because of their medical diagnosis. Given the well-documented impact associated with elevated prenatal stress and critical importance of developing targeted interventions, this study aims to examine stressors, coping and resilience resources, and mental health treatment preferences in pregnant women receiving a congenital heart disease diagnosis to inform the development of a psychological intervention to reduce maternal distress prenatally. METHODS Three groups of participants were included consisting of two pregnant women carrying a fetus with congenital heart disease, five women of children (4-16 months) with congenital heart disease, and five paediatric cardiology medical providers. Responses were gathered via semi-structured interviews and analysed using qualitative thematic analysis. RESULTS Information regarding four broad areas were analysed of emotional distress during pregnancy; experience of initial diagnosis; coping and resilience; and perspectives on a mental health intervention in pregnancy. Anxiety regarding baby's future, guilt following diagnosis, and various coping strategies emerged as primary themes among the participant sample. Medical staff corroborated mothers' heightened anxiety and viewed a psychotherapeutic intervention during the prenatal period as essential and complimentary to standard of care. CONCLUSION We identified salient themes and preferred components for a future psychological intervention delivered prenatally. PRACTICE IMPLICATIONS Patients' and providers' perspectives regarding the nature of maternal distress, resilience and treatment preferences can inform the development of interventions to support the emotional well-being of pregnant women carrying a fetus with congenital heart disease to optimise care and potentially improve outcomes for fetal brain development.
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Evaluation and Nonsurgical Treatment of Neonatal Ear Anomalies: A Case Report. Adv Neonatal Care 2022; 22:317-324. [PMID: 35816427 DOI: 10.1097/anc.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inspection and evaluation of the neonate's ears are important parts of the neonatal examination. Neonates display a wide variety of ear size and configuration. In many cases, ear molding techniques obviate the need for future surgical correction. This article provides a review of the fetal ear development and describes common physical examination findings of the newborn's external ear. A case report reviews a successful nonsurgical treatment of a minor ear deformity. CLINICAL FINDINGS Newborn infant with near absent to very thin bilateral helical rims and otherwise normal bilateral ear shape and structures. PRIMARY DIAGNOSIS Bilateral Stahl's ear deformity. INTERVENTIONS The EarBuddies product was applied to bilateral ears in an outpatient pediatric plastic surgery clinic. This product remained in place for 8 weeks. OUTCOMES The family was pleased with the overall progress and shape of their child's ears. At 18 months of age, the family has no desire to pursue surgical correction of their child's ears. PRACTICE RECOMMENDATIONS Assessment of the newborn's external ear is part of a routine admission examination. Careful attention to abnormal or unusual findings allows for prompt evaluation and nonsurgical intervention.
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Uphoff EP, Zamperoni V, Yap J, Simmonds R, Rodgers M, Dawson S, Seymour C, Kousoulis A, Churchill R. Mental health promotion and protection relating to key life events and transitions in adulthood: a rapid systematic review of systematic reviews. J Ment Health 2022:1-14. [PMID: 35658814 DOI: 10.1080/09638237.2022.2069724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND During the decades representing working-age adulthood, most people will experience one or several significant life events or transitions. These may present a challenge to mental health. AIM The primary aim of this rapid systematic review of systematic reviews was to summarise available evidence on the effectiveness of interventions to promote and protect mental health relating to four key life events and transitions: pregnancy and early parenthood, bereavement, unemployment, and housing problems. This review was conducted to inform UK national policy on mental health support. METHODS We searched key databases for systematic reviews of interventions for working-age adults (19 to 64 years old) who had experienced or were at risk of experiencing one of four key life events. Titles and abstracts were screened by two reviewers in duplicate, as were full-text manuscripts of relevant records. We assessed the quality of included reviews and extracted data on the characteristics of each literature review. We prioritised high quality, recent systematic reviews for more detailed data extraction and synthesis. RESULTS The search and screening of 3997 titles/abstracts and 239 full-text papers resulted in 134 relevant studies, 68 of which were included in a narrative synthesis. Evidence was strongest and of the highest quality for interventions to support women during pregnancy and after childbirth. For example, we found benefits of physical activity and psychological therapy for outcomes relating to mental health after birth. There was high quality evidence of positive effects of online bereavement interventions and psychological interventions on symptoms of grief, post-traumatic stress, and depression. Evidence was inconclusive and of lower quality for a range of other bereavement interventions, unemployment support interventions, and housing interventions. CONCLUSIONS Whilst evidence based mental health prevention and promotion is available during pregnancy and early parenthood and for bereavement, it is unclear how best to support adults experiencing job loss, unemployment, and housing problems.
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Affiliation(s)
| | | | - Jade Yap
- Mental Health Foundation, London, UK
| | | | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
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Froeliger A, Harper L, Tunon de Lara S, Lavrand F, Loot M, Lefevre Y, Sentilhes L, Coatleven F, Dobremez É. Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital. J Perinat Med 2022; 50:419-426. [PMID: 35026885 DOI: 10.1515/jpm-2021-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe our experience with prenatal counselling for surgical anomalies in a large volume center. The secondary aim is to suggest a list of prenatal abnormalities warranting counselling by a pediatric surgeon. METHODS We reviewed all prenatal counselling consultations performed by the pediatric surgery team between January 1st, 2015 and December 31st, 2016. RESULTS A total of 169 patients or couples had a prenatal consultation with a pediatric surgeon. Prenatal work-up included a fetal MRI in 26% of cases, mainly for digestive and thoracic pathologies (56.1% of cases). Consultation with the pediatric surgeon led mainly to recommendations concerning the place of delivery. Induction for reasons related to the fetal anomaly occurred in 22.2% of cases. Most children were surgically treated within the first year of life (63.5%). Correlation between predicted prognosis and actual status at four years of life was 96.9%. Correlation between prenatal and postnatal diagnosis was 87.4%. CONCLUSIONS Prenatal counselling by a pediatric surgeon allows couples to obtain clear information on the pathology of their unborn child, giving them greater autonomy in their decision to continue the pregnancy.
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Affiliation(s)
- Alizée Froeliger
- Department of Gynecology and Obstetrics, Bordeaux University Hospital, Bordeaux, France
| | - Luke Harper
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Sara Tunon de Lara
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Lavrand
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Maya Loot
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Yan Lefevre
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Gynecology and Obstetrics, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Coatleven
- Department of Gynecology and Obstetrics, Bordeaux University Hospital, Bordeaux, France
| | - Éric Dobremez
- Department of Pediatric Surgery, Bordeaux University Hospital, Bordeaux, France
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Tan AG, Sethi N, Sulaiman S. Evaluation of prenatal central nervous system anomalies: obstetric management, fetal outcomes and chromosome abnormalities. BMC Pregnancy Childbirth 2022; 22:210. [PMID: 35291955 PMCID: PMC8925063 DOI: 10.1186/s12884-022-04555-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To study the outcomes of fetuses who were diagnosed with central nervous system (CNS) anomalies during prenatal period and to describe the obstetric management of those pregnancies. Methods In this retrospective study, fetuses who were detected to have central nervous system anomalies by prenatal ultrasound from January 2010 to December 2019 were recruited. Data regarding prenatal diagnosis and obstetric outcomes were retrieved from maternal and paediatric records. The prognosis of fetuses who were born alive was classified based on their neurodevelopmental outcome within two years of life. Results There were a total of 365 fetuses with CNS anomalies within the 10-year study period, with a mean gestational age of 24.65±7.37 weeks at diagnosis. Ventriculomegaly (23.36%) was the commonest CNS anomalies seen. 198 (54.20%) of these fetuses had associated extra-CNS anomalies, with cardiovascular being the most common system involved. Fetal karyotyping was performed in 111 pregnancies, with chromosomal aberrations detected in 53 (49.07%) cases and culture failure in 3 cases. Majority of the chromosomal abnormalities were Edward syndrome (trisomy 18) and Patau syndrome (trisomy 13). Fetuses with congenital CNS anomalies and abnormal chromosomal karyotyping were more likely to be diagnosed earlier by prenatal ultrasound and tend to have poorer obstetric and neurocognitive prognosis. Prenatally, 86 (23.56%) of the cases were lost to follow up and likely to deliver elsewhere. Among the 279 cases whom their pregnancy outcomes were available, 139 (49.82%) pregnancies resulted in live births, 105 (37.63%) pregnancies were electively terminated, while the remaining 35 (12.54%) pregnancies ended in spontaneous loss. The decision of termination of pregnancy largely depends on mean diagnostic gestational age, presence of chromosomal aberrations and abnormal amniotic fluid volume in those fetuses. Two years after delivery, only 75 (53.96%) children out of 139 live births were still alive, 43 (30.93%) died and 21 (15.11%) cases were lost to follow-up. 32 (23.02%) children with prenatally diagnosed CNS anomalies had normal neurodevelopmental outcome. The presence of multiple CNS anomalies and involvement of extra-CNS anomalies indicated a poorer neurodevelopmental prognosis. Conclusion Less than 50% of fetuses with prenatally diagnosed CNS anomalies resulted in live births. Even if they survive till delivery, 36.45% of them passed away within 2 years and 62.79% of children who survived till 2 years old had neurodevelopmental disability.
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Affiliation(s)
- Ann Gee Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Neha Sethi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sofiah Sulaiman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Crombag N, Ceulemans V, Debeer A, Russo F, Bollen B, Power B, Meijer F, Henrotte N, Depré K, Laurent J, Deprest J. Prenatal diagnosis of congenital diaphragmatic hernia: parental counselling and support needs. Prenat Diagn 2022; 42:387-397. [DOI: 10.1002/pd.6118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Neeltje Crombag
- Department of Development and Regeneration cluster Woman and Child Biomedical Sciences Leuven Belgium
- Elizabeth Garrett Anderson Institute of Women's Health University College London London United Kingdom
| | - Vanessa Ceulemans
- Department of Development and Regeneration cluster Woman and Child Biomedical Sciences Leuven Belgium
| | - Anne Debeer
- Department of Development and Regeneration cluster Woman and Child Biomedical Sciences Leuven Belgium
- Neonatal Intensive Care Unit University Hospitals Leuven Leuven Belgium
| | - Francesca Russo
- Department of Development and Regeneration cluster Woman and Child Biomedical Sciences Leuven Belgium
- Elizabeth Garrett Anderson Institute of Women's Health University College London London United Kingdom
| | - Bieke Bollen
- Department of Development and Regeneration cluster Woman and Child Biomedical Sciences Leuven Belgium
- Neonatal Intensive Care Unit University Hospitals Leuven Leuven Belgium
| | | | | | - Nancy Henrotte
- Department of Obstetrics and Gynaecology Division Woman and Child University Hospitals Leuven Leuven Belgium
| | - Kathleen Depré
- Department of Obstetrics and Gynaecology Division Woman and Child University Hospitals Leuven Leuven Belgium
| | - Josefien Laurent
- Department of Obstetrics and Gynaecology Division Woman and Child University Hospitals Leuven Leuven Belgium
| | - Jan Deprest
- Department of Development and Regeneration cluster Woman and Child Biomedical Sciences Leuven Belgium
- Elizabeth Garrett Anderson Institute of Women's Health University College London London United Kingdom
- Department of Obstetrics and Gynaecology Division Woman and Child University Hospitals Leuven Leuven Belgium
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Early Renal Ultrasound in Patients with Congenital Solitary Kidney Can Guide Follow-Up Strategy Reducing Costs While Keeping Long-Term Prognostic Information. J Clin Med 2022; 11:jcm11041052. [PMID: 35207325 PMCID: PMC8876569 DOI: 10.3390/jcm11041052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to evaluate the prognostic value of renal length (RL) > 2 standard deviation scores (SDS) measured by renal ultrasound (RUS), across infancy, childhood and adolescence, in identifying which patients with congenital solitary functioning kidney (CSFK) are at lower risk of developing kidney injury (KI). We also estimated the cost saving of integrating the current follow-up protocols with an early RUS algorithm (ERUSA). Fifty-six CSFK adult patients who were 1–3 months old at first observation of undergoing RUS were enrolled. KI was defined by hypertension and/or proteinuria and/or declined renal function. ERUSA was assessed by early (at 1–3 months of life) RUS and was retrospectively tested in our patients. ERUSA establishes that patients with RL > 2SDS at early RUS do not undergo further follow-ups. The others undergo another RUS at 1 year of age along with follow-ups according with current protocols, with the exception of RUS which could be no longer performed. Direct and indirect costs were calculated for each analysed protocol and the cost saving of applying ERUSA was calculated. None of the patients with early RL > 2SDS presented KI in adulthood. A RL > 2SDS was predictive of absence of KI only at 1–3 months (OR = infinity) and 1 year of age (OR = 0.13; 95%CI: 0.03–0.66; p = 0.01). ERUSA provided a total cost-sparing ranging from 38.6% to 55.3% among the analysed follow-up protocols. With ERUSA, no patients developing KI in adulthood were missed. In conclusion, only a RL > 2SDS at 1–3 months and 1 year of age predicted good prognosis in young adulthood. ERUSA can guide a cost-sparing follow-up strategy in CSFK patients while maintaining important long-term information.
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Prenatal neurosurgical counseling for conditions affecting the fetal nervous system. Neurochirurgie 2021; 68:293-299. [PMID: 34906555 DOI: 10.1016/j.neuchi.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/31/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to share a single center's experience of prenatal neurosurgical counseling and explore pregnant women's experiences with counseling. MATERIAL AND METHODS This retrospective study analyzed data for 81 women who received prenatal counseling in a single institution (same senior pediatric neurosurgeon) over a 6-year period. Additionally, a retrospective questionnaire study was conducted with 33 women who chose to continue their pregnancy, to assess the strengths and weaknesses of counseling and analyze the reasons for their decision. RESULTS Spinal dysraphism was the most frequent condition leading to prenatal counseling, followed by conditions affecting the cerebrospinal fluid. 57.6% of the women did not follow the French national recommendations on folic acid supplementation in the periconceptional period, and 38.3% underwent termination of pregnancy (TOP). One-third of the 33 women who answered our questionnaire changed their mind about TOP after counseling, and 50% reported that the information provided influenced their decision. CONCLUSION Prenatal neurosurgical counseling is nowadays an important part of a pediatric neurosurgeon's practice. It provides specific information to the woman to decide whether to continue the pregnancy. Urological concerns are frequent among the malformations encountered. Hence, we conclude that these women should be offered the possibility of seeing a urologist. Areas for improvement include greater awareness regarding folic acid supplementation and improved psychological care. The advantage for a woman of consulting a neurosurgeon consists in receiving information that is as accurate as possible about the level of disability of the future child and about surgery and follow-up.
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Alshammari DM, Dobremez E, Froeliger A, Coatleven F, Harper L. Mothers' perception of prenatal counseling following diagnosis of congenital anomalies of the urinary tract. Arch Pediatr 2021; 28:533-536. [PMID: 34507863 DOI: 10.1016/j.arcped.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/08/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
Congenital abnormalities of the genitourinary tract are the most common sonographically identified malformations. Although prenatal diagnosis seldom modifies perinatal management, it can cause significant anxiety in parents. We aimed to assess how parents perceived the prenatal counseling they had received in our institution. Using a questionnaire, we evaluated by phone the mothers of 78 children diagnosed prenatally with urological tract anomalies between January 2018 and May 2019. Overall, mothers were satisfied and reassured by the prenatal counseling they received, although 19% of the mothers found the time from diagnosis to specialist consultation to be too long. Forty percent of the responders stated that the most important information they needed to hear during the specialist consultation was management and not diagnosis. Specialist counseling should focus on explaining postnatal management, should be offered as soon as possible, and should include practical aspects, especially concerning outpatient care.
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Affiliation(s)
- Dheidan M Alshammari
- Department of Pediatric Surgery, Hôpital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France
| | - Eric Dobremez
- Department of Pediatric Surgery, Hôpital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France
| | - Alizée Froeliger
- Department of Prenatal Diagnosis, Maternité Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Frédéric Coatleven
- Department of Prenatal Diagnosis, Maternité Pellegrin, CHU Bordeaux, Bordeaux, France
| | - Luke Harper
- Department of Pediatric Surgery, Hôpital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France.
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De Lima S, Kugelberg M, Jirwe M. Swedish Parents' Experiences and Their Need for Support When Having a Child with Congenital Cataract: A Qualitative Study. J Pediatr Nurs 2021; 60:109-115. [PMID: 33930621 DOI: 10.1016/j.pedn.2021.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/26/2021] [Accepted: 04/21/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To explore parents' experiences of living with a child with congenital cataract, with the intention of identifying how to improve the parental support. DESIGN AND METHOD A qualitative descriptive design using semi-structured interviews. The parents were interviewed when the children were aged 12-24 months. All children were operated on for congenital cataract before three months of age. The interviews were transcribed and analysed using qualitative content analysis with an inductive approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. RESULTS Three categories emerged from the data: trying to survive during a chaotic time; adapting to a different normal; being in need of support. When receiving the preliminary diagnosis, most of the parents were upset but managed well once the initial shock had subsided. However, some described feelings of despair, difficulties in accepting the situation and in connecting with the child. All parents stated that, to be valuable, a counsellor needed to have insights in how the eye works and the function of visual development. CONCLUSION The parents' need for psychosocial support in the early post-diagnostic stage varied greatly. Early identification of those in need of specialized counselling is therefore of importance, preferably at the maternity ward or by the regional ophthalmologist when the referral is made. CLINICAL IMPLICATIONS The study provides understanding of the importance to take the parents' well-being beyond the medical issues into consideration. This knowledge can be used to provide support at an earlier stage in the treatment programme than is currently the case.
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Affiliation(s)
- Sara De Lima
- St. Erik Eye Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
| | - Maria Kugelberg
- St. Erik Eye Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
| | - Maria Jirwe
- Department of Health Sciences, Red Cross University College, Sweden.
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Borg AF, Falzon R, Muscat A. Psychological implications and rehabilitation programmes due to football‐related injuries. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ruth Falzon
- Department of Counselling University of Malta Msida Malta
| | - Adele Muscat
- Institute for Physical Education and Sport University of Malta Msida Malta
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Sénéchal M, Taillefer C, Payot A. The Medical Process in Pregnancy Terminations for Fetal Anomaly: An Analysis of Counselling and Bereavement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:54-59. [PMID: 34339879 DOI: 10.1016/j.jogc.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022]
Abstract
Pregnancy termination for fetal anomaly (TOPFA) is a possible outcome of a pregnancy complicated by a fetal anomaly detected during routine prenatal care. Limited research is available on the quality of the counselling offered to women, in terms of enabling them to make an informed decision. The goal of this descriptive cohort study was to examine the medical process offered to a cohort of 151 women who underwent TOPFA in 2018 in a single tertiary mother and child hospital to identify areas for potential quality improvement (QI). Statistical analysis comprised basic statistical tests, Pearson's χ2 test, and logistic regression. Counselling was evaluated by two fetal health specialists who found that the counselling process was minimal in 42% of cases. Counselling referrals to pediatric specialists were made in 26% of cases, with many potential explanations for this finding. Complicated bereavement was present in 39% of cases. Risk factors for complicated bereavement were explored and were found to be insufficient social support (odds ratio [OR] 6.5; 95% CI 2.0-21.0, P < 0.001), history of a mood disorder (OR 3.4; 95% CI 1.3-8.8, P < 0.01), and history of another TOPFA (OR 6.2; 95% CI 1.2-31.0, P = 0.01). Viewing the fetus after termination was not correlated with a significant reduction in complicated bereavement. The evaluation of the counselling as minimal in 42% of cases and the high prevalence of complicated bereavement call for quality improvement (QI) in the process for women who undergo TOPFA. Clinicians should be able to screen women most at risk for complicated bereavement to best orient preventive care.
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Affiliation(s)
| | - Catherine Taillefer
- Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montréal, QC; Clinical Ethics Unit, CHU Sainte-Justine, Université de Montréal, Montréal, QC.
| | - Antoine Payot
- Sainte-Justine Hospital Pediatric Research Center, Montréal, QC; Clinical Ethics Unit, CHU Sainte-Justine, Université de Montréal, Montréal, QC; Centre of Excellence for Partnership with Patients and the Public, Montréal, QC; Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC
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What is the Impact of Prenatal Counseling on Postnatal Cleft Treatment? Multidisciplinary Pathway for Prenatal Orofacial Cleft Care. J Craniofac Surg 2021; 32:947-951. [PMID: 33654048 DOI: 10.1097/scs.0000000000007353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT In the pediatric general surgery literature, it has been shown that prenatal diagnosis of a congenital anomaly is an independent predictor of parental psychological distress. Surgical prenatal counseling can decrease parental anxiety by helping families understand the surgical needs and potential outcomes of their infant. In this retrospective analysis (n = 440), the authors sought to present our care pathway for prenatally diagnosed cleft lip and palate (CL/P) and explore the impact of cleft lip and palate-specific prenatal counseling on patient care by comparing the timing of clinical and surgical care between a cohort of patients who received prenatal CL/P consultation and a cohort of patients only seen postnatally. The authors hypothesize that our multidisciplinary prenatal care intervention is associated with earlier postnatal clinic visits and surgical repair. The care of all patients whose mother's presented for prenatal CL/P consultation (prenatal cohort, n = 118) was compared to all new CL/P patients without prenatal consultation at our institution (postnatal cohort, n = 322) from January 2015 through August 2019. 81.4% (n = 96) of the prenatal cohort returned for care postnatally while 2 pregnancies were interrupted, four neonates died, and 15 patients did not return for care. Prenatal consultation was associated with earlier postnatal clinic appointments (P < 0.001) as well as a shorter time to CL repair in patients with CL only (P = 0.002) and CLP (P = 0.047). Our described pre- and postnatal CL/P pathway is a multidisciplinary model associated with high retention rates from the prenatal period through complete surgical repair.
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35
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Russo FM, Debeer A, De Coppi P, Devriendt K, Crombag N, Hubble T, Power B, Benachi A, Deprest J. What should we tell parents? Congenital diaphragmatic hernia. Prenat Diagn 2020; 42:398-407. [PMID: 33599313 DOI: 10.1002/pd.5880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is characterized by a defect in the muscle dividing the thoracic and abdominal cavities. This leads to herniation of the abdominal organs into the thorax and a disturbance of lung development. Two-thirds of cases are identified by prenatal ultrasound in the second trimester, which should prompt referral to a tertiary center for prognosis assessment and counseling by a multidisciplinary team familiar with this condition. In this review, we summarize evidence on prenatal diagnosis and postnatal management of CDH. There is a focus on information that should be provided to expecting parents during prenatal counseling.
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Affiliation(s)
- Francesca M Russo
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Anne Debeer
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.,Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Paolo De Coppi
- Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, UK.,Stem Cells & Regenerative Medicine Section, NIHR Biomedical Research Center, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Neeltje Crombag
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Talia Hubble
- Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.,Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France.,Centre Référence Maladie Rare: Hernie de Coupole Diaphragmatique, Clamart, France
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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Mendoza M, Hurtado I, Bonacina E, Garcia-Manau P, Serrano B, Tur H, Rodo C, Maiz N, Carreras E. Individual risk assessment for prenatal counseling in early-onset growth-restricted and small-for-gestational-age fetuses. Acta Obstet Gynecol Scand 2020; 100:504-512. [PMID: 33098097 DOI: 10.1111/aogs.14032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/01/2020] [Accepted: 10/16/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Early-onset fetal growth restriction and small-for-gestational age of fetuses lead to an increased risk of adverse pregnancy outcomes. Doppler abnormalities can predict the occurrence of complications in the short term, but normal fetal Doppler values at the time of diagnosis do not exclude their occurrence in the long term. The objective of this study was to investigate the capacity of a predictive model to assess individual risks for prenatal counseling at the time of diagnosis. MATERIAL AND METHODS This was a prospective observational study of singleton pregnancies with estimated fetal weight below the 10th centile between 20+0 and 31+6 weeks of gestational age. Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) levels, estimated fetal weight centile, uterine artery pulsatility index, fetal Doppler and maternal risk factors for placental disease were assessed at the time of enrollment. The occurrence of adverse perinatal outcomes or the need for elective delivery at <30, <34 or <37 weeks was considered an adverse pregnancy outcomes. Univariable logistic regression analysis was used to examine the association between each predictive variable and the adverse outcomes. A multivariable logistic regression-based model was constructed with the combination of all variables. An additional model without sFlt-1/PlGF was also created. Both models, and the sFlt-1/PlGF alone, were used to develop the different formulas to assess individual risks. Receiver operating characteristic curves were constructed to assess and compare their performance of screening. RESULTS Forty-nine small-for-gestational-age fetuses and 124 with fetal growth restriction were enrolled at a median gestational age of 23.6 weeks. Elective delivery was needed in 77 (44.5%) women at <37 weeks, 53 (30.6%) women at <34 weeks and 30 (17.3%) at <30 weeks. Adverse perinatal outcomes occurred in 81 (55.9%) pregnancies. When areas under the curve were compared among models, no statistically significant differences were observed between the model with sFlt-1/PlGF and sFlt-1/PlGF alone; however, the model without sFlt-1/PlGF yielded an overall poorer performance. CONCLUSIONS Individual risk assessment can be made at the time of early-onset fetal growth restriction/small-for-gestational-age diagnosis, which permits accurate counseling of parents with an affected fetus. Two formulas could be used: one combining maternal characteristics and ultrasound findings and the other with a single sFlt-1/PlGF measurement.
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Affiliation(s)
- Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ivan Hurtado
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Serrano
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Helena Tur
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlota Rodo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nerea Maiz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Froh EB, Schwarz J, Spatz DL. Lactation Outcomes Among Dyads Following Participation in a Model of Group Prenatal Care for Patients with Prenatally Diagnosed Fetal Anomalies. Breastfeed Med 2020; 15:698-702. [PMID: 32589454 DOI: 10.1089/bfm.2020.0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: MamaCare is an adaptation of the CenteringPregnancy group prenatal care model designed to support women when the pregnancy has been complicated by the presence of known congenital anomalies. The lactation-related outcomes of participants were unknown. Materials and Methods: This is a retrospective descriptive cohort study describing the lactation-related outcomes of participants of MamaCare over 43 months. Data collection included abstraction of maternal demographic data, maternal group prenatal care session participation data, maternal pregnancy and delivery data, as well as documented lactation and breastfeeding data. Results: The total cohort consisted of 92 dyads. Of the 81 women who received an individualized prenatal nutrition consultation, 65 (80.2%) voiced a prenatal feeding goal of human milk and breastfeeding only, while the remaining 16 (19.8%) expressed goals of combination feeding (human milk and infant formula). For the surviving 85 infants, 91.8% of the mothers initiated lactation on the delivery day and the remaining 7 women initiated lactation on postpartum day 1. Also at the time of discharge from the initial intensive care unit stay, 87.1% of infants were receiving maternal human milk. Discussion: For families who participate in MamaCare, not only do they form a sense of community and learn about human milk and breastfeeding before delivery, the MamaCare facilitators and presenters normalize their experience to help MamaCare participants best meet their personal breastfeeding goals as well.
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Affiliation(s)
- Elizabeth B Froh
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Schwarz
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Pritam A, Kumar M, Choudhary SR. Patient Satisfaction after Antenatal Joint Fetal Medicine and Pediatric Surgery Counseling. J Indian Assoc Pediatr Surg 2020; 25:357-362. [PMID: 33487937 PMCID: PMC7815028 DOI: 10.4103/jiaps.jiaps_154_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/07/2019] [Accepted: 12/28/2019] [Indexed: 11/05/2022] Open
Abstract
Aims and Objectives: The aim of this study was to find out the level of satisfaction among couples receiving antenatal counseling provided jointly by fetal medicine specialists and pediatric surgeons. Materials and Methods: This was a questionnaire-based observational study. A total of 110 consecutive couples who were antenatally diagnosed with fetal structural anomaly and received counseling by fetal medicine specialist and pediatric surgeon together, were given a validated patient satisfaction questionnaire (PSQ-18) after delivery to assess their level of satisfaction regarding the antenatal care they received. Results: A total of 120 couple responded to the questionnaire, mean gestational age at delivery was 33.8 ± 7.14 weeks. In PSQ, 75.8% gave high scores for general satisfaction, maximum subjects provided high scores for interpersonal manner (IM) (77.5%) and communication (77.5%), and the least number gave high scores for time spent with the doctor (50.8%) and accessibility (42.5%). The technical quality (TQ) subscale was significantly high for the stillbirth/abortion group compared to live birth (P = 0.020). Significantly high scores for TQ (P = 0.037) and IM (P = 0.023) were obtained in the <20 weeks group. Conclusion: The joint counseling provided good interaction opportunity to the couple but still fell short of their expectations regarding time spent with the doctor and their accessibility.
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Affiliation(s)
- Anuja Pritam
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Manisha Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
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The effect of supportive program on maternal self-confidence in caring of infants with gastrointestinal anomalies: A randomized clinical trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jnn.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sato Y, Yoshioka E, Saijo Y, Miyamoto T, Sengoku K, Azuma H, Tanahashi Y, Ito Y, Kobayashi S, Minatoya M, Bamai YA, Yamazaki K, Ito S, Miyashita C, Araki A, Kishi R. Trajectories of the Psychological Status of Mothers of Infants With Nonsyndromic Orofacial Clefts: A Prospective Cohort Study From the Japan Environment and Children's Study. Cleft Palate Craniofac J 2020; 58:369-377. [PMID: 32844663 DOI: 10.1177/1055665620951399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study examined psychological status trajectories of mothers of infants with nonsyndromic orofacial clefts in Japan. DESIGN Prospective cohort study. SETTING Data from the Japan Environment and Children's Study. PARTICIPANTS Infants with a nonsyndromic cleft (N = 148) including cleft lip and palate (CLP; n = 72), cleft lip (CL; n = 46), and cleft palate (CP; n = 30). The control group included unaffected infants (N = 84 454). MAIN OUTCOME MEASURES At 15 weeks and 27 weeks of pregnancy and 12 months after birth, the Kessler Psychological Distress Scale (clinical cutoff ≥5) was used. At 1 month and 6 months after birth, the Edinburgh Postnatal Depression Scale (clinical cutoff ≥9) was used. RESULTS Prenatal diagnosis rates were unavailable. Mothers of infants with CLP had higher psychological distress than controls at 27 weeks of pregnancy (prevalence ratio [PR] = 1.36, 95% CI: 1.06-1.74) and postnatal depression at 1 month after birth (PR = 2.21, 95% CI: 1.53-3.19). Mothers of infants with CP showed heightened psychological distress at 27 weeks of pregnancy (PR = 1.62, 95% CI: 1.21-2.17) and postnatal depression 6 months after birth (PR = 1.86, 95% CI: 1.01-3.43). There was no significant association between CL and maternal psychological status. At 12 months after birth, no differences in distress were found between mothers of infants with a cleft and controls. CONCLUSIONS Mothers of infants with orofacial clefts may need psychosocial support, particularly during pregnancy and the first year after birth.
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Affiliation(s)
- Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Toshinobu Miyamoto
- Department of Obstetrics and Gynecology, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Kazuo Sengoku
- Department of Obstetrics and Gynecology, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Tanahashi
- Department of Pediatrics, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiya Ito
- Faculty of Nursing, 38325Japanese Red Cross Hokkaido College of Nursing, Hokkaido, Japan
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Machiko Minatoya
- Faculty of Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Yu Ait Bamai
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Keiko Yamazaki
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Sachiko Ito
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Atsuko Araki
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
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Schlund M, Levaillant JM, Nicot R. Three-Dimensional Printing of Prenatal Ultrasonographic Diagnosis of Cleft Lip and Palate: Presenting the Needed "Know-How" and Discussing Its Use in Parental Education. Cleft Palate Craniofac J 2020; 57:1041-1044. [PMID: 32462933 DOI: 10.1177/1055665620926348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Parental prenatal counseling is of paramount significance since parents often experience an emotional crisis with feelings of disappointment and helplessness. Three-dimensional (3D) printed model of the unborn child's face presenting with cleft lip and palate, based on ultrasonographic information, could be used to provide visual 3D information, further enhancing the prospective parent's comprehension of their unborn child's pathology and morphology, helping them to be psychologically prepared and improving the communication with the caretaking team. Prospective parents appreciate if prenatal counseling is available with the most detailed information as well as additional resources. The technique necessary to create 3D models after ultrasonographic information is explained, and the related costs are evaluated. The use of such models in parental education is then discussed.
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Affiliation(s)
- Matthias Schlund
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillofacial Surgery Department, U1008-Controlled Drug Delivery Systems and Biomaterial, Lille, France
| | - Jean-Marc Levaillant
- Center for Woman and Fetal Imaging, Lille, France.,Hôpital Privé Armand Brillard, Groupe Ramsay Générale de Santé, Nogent-sur-Marne, France
| | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Oral and Maxillofacial Surgery Department, U1008-Controlled Drug Delivery Systems and Biomaterial, Lille, France.,Center for Woman and Fetal Imaging, Lille, France
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Schwarz JG, Froh E, Farmer MC, Oser M, Howell LJ, Moldenhauer JS. A Model of Group Prenatal Care for Patients with Prenatally Diagnosed Fetal Anomalies. J Midwifery Womens Health 2020; 65:265-270. [PMID: 32037680 DOI: 10.1111/jmwh.13082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 12/19/2022]
Abstract
The model of group prenatal care was initially developed to include peer support and to improve education and health-promoting behaviors during pregnancy. This model has since been adapted for populations with unique educational needs. Mama Care is an adaptation of the CenteringPregnancy Model of prenatal care. Mama Care is situated within a national and international referral center for families with prenatally diagnosed fetal anomalies. In December 2013, the Center for Fetal Diagnosis and Treatment at Children's Hospital of Philadelphia began offering a model of group prenatal care to women whose pregnancies are affected by a prenatal diagnosis of a fetal anomaly. The model incorporates significant adaptations of CenteringPregnancy in order to accommodate these women, who typically transition their care from community-based settings to the Center for Fetal Diagnosis and Treatment in the late second or early third trimester. Unique challenges associated with caring for families within a referral center include a condensed visit schedule, complex social needs such as housing and psychosocial support, as well as an increased need for antenatal surveillance and frequent preterm birth. Outcomes of the program are favorable and suggest group prenatal care models can be developed to support the needs of patients with prenatally diagnosed fetal anomalies.
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Affiliation(s)
- Jessica G Schwarz
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Froh
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Maren Oser
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie S Moldenhauer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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43
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Power S, Meaney S, O'Donoghue K. The incidence of fatal fetal anomalies associated with perinatal mortality in Ireland. Prenat Diagn 2020; 40:549-556. [PMID: 31913532 DOI: 10.1002/pd.5642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The term fatal fetal anomaly (FFA) describes a condition likely to lead to death of the fetus in utero or within 28 days of birth. This study aimed to identify what congenital anomalies are responsible for perinatal death and whether they are classified as an FFA in accordance with criteria outlined in Irish legislation. METHODS Anonymised data pertaining to perinatal deaths from 2011 to 2016 in Ireland were obtained from the National Perinatal Epidemiology Centre. Secondary data analysis was conducted using SPSS. RESULTS Of the 2638 perinatal deaths, 939 (36%) had a congenital anomaly. Nearly half was chromosomal (43%, n = 406 of 939) with 36% of the cases (n = 333 of 938) having more than one anomaly. Additional information was available for 777 of these congenital anomaly, of which 42% (n = 328) could be classified an FFA. CONCLUSION This study identified that less than half of the congenital anomalies could be classified as an FFA; however, all were fatal. This acknowledges the complexity of these cases. In isolation, the congenital anomaly may not be fatal, but combined as multiorgan system anomalies, it is. Knowledge is required to inform clinical practice and counselling of parents who receive such a diagnosis.
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Affiliation(s)
- Stacey Power
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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Atienza-Carrasco J, Linares-Abad M, Padilla-Ruiz M, Morales-Gil IM. Experiences and outcomes following diagnosis of congenital foetal anomaly and medical termination of pregnancy: A phenomenological study. J Clin Nurs 2020; 29:1220-1237. [PMID: 31887230 DOI: 10.1111/jocn.15162] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/21/2019] [Accepted: 12/20/2019] [Indexed: 12/01/2022]
Abstract
AIM To determine and describe the experiences of pregnant women who receive a diagnosis of chromosomopathy and/or foetal malformation during a prenatal check-up and who decide to legally terminate the pregnancy. BACKGROUND When a pregnancy is terminated, the woman must cope with frustrated motherhood. The psychological consequences of this will largely depend on the care and support provided by health professionals. When a congenital anomaly is diagnosed, a patient-centred communication helps understanding, influences adaptation to the new situation and ensures the person concerned has sufficient (autonomy or independence or ability) to make appropriate decisions. METHODS A qualitative study, based on a phenomenological approach, was carried out through nonparticipant observation and semi-structured interviews with 27 obstetric patients. NVivo 11 software was used, and content analysis was performed. The manuscript was developed using the COREQ guidelines to inform qualitative studies. RESULTS The clinical relationship may be affected by communication problems such as patients' perceptions of scarce emotional involvement by obstetricians, by poor psychosocial support during the termination of the pregnancy and by insufficient follow-up after discharge. CONCLUSION Nurses are in a privileged position to promote the empowerment of affected women. It is necessary to improve aspects related to the privacy of patients and the awareness and training of the interdisciplinary team in interpersonal communication. Post-loss follow-up is recommended to assess individual needs, thus facilitating an optimal approach to ease the grieving process. RELEVANCE TO CLINICAL PRACTICE During the prenatal diagnosis, the existence of a fetal anomaly is emphasized, but support and follow up of the mother may be neglected; therefore, exhaustive knowledge about the obstetric history, the state of health and the expectations of patients is as important as a multidisciplinary team trained in counseling strategies and with a comprehensive care plan that covers all areas, especially those that control maternal emotions.
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Affiliation(s)
| | | | - María Padilla-Ruiz
- Research Unit, Costa del Sol Health Care Agency, Marbella, Spain.,Health Services Network for Research into Chronic Diseases (REDISSEC), Madrid, Spain
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Gramszlo C, Karpyn A, Demianczyk AC, Shillingford A, Riegel E, Kazak AE, Sood E. Parent Perspectives on Family-Based Psychosocial Interventions for Congenital Heart Disease. J Pediatr 2020; 216:51-57.e2. [PMID: 31735417 PMCID: PMC6917908 DOI: 10.1016/j.jpeds.2019.09.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/21/2019] [Accepted: 09/18/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify parents' preferences for goals and structure of intervention programs to support the psychosocial needs of families impacted by congenital heart disease (CHD). STUDY DESIGN Information about parent priorities for psychosocial programs was obtained in this mixed-methods study conducted at a pediatric hospital in the Mid-Atlantic region of the US. Participants were parents (N = 34; 20 mothers, 14 fathers) of children with CHD between the ages of 1 and 3 years who had cardiac surgery at less than 6 months of age. Qualitative data were excerpts from semistructured interviews. Quantitative data were participant choices regarding their ideal psychosocial program resulting from a card sort. RESULTS Parents reported that psychosocial interventions should support partnership in their child's care, promote self-care, facilitate communication with providers, prepare parents for challenges after hospitalization, provide education about child neurodevelopment, and help parents engage social support. Parents reported needing formalized support across care, brief intervention models, in-person individualized or small group support, and involvement of multidisciplinary providers and peer mentors in the delivery of interventions. CONCLUSIONS Parents of children with CHD need psychosocial interventions that empower them to act as primary caregivers and effective advocates for their child. Individualized, formalized, and multidisciplinary approaches to psychosocial care are necessary to best accommodate the dynamic stressors related to parenting a child with CHD and may mitigate the impact of parent mental health problems on child outcomes.
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Affiliation(s)
- Colette Gramszlo
- Division of Behavioral Health, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Allison Karpyn
- Center for Research in Education and Social Policy, Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | - Abigail C. Demianczyk
- Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Amanda Shillingford
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Erin Riegel
- Mended Little Hearts of Delaware, Wilmington, DE
| | - Anne E. Kazak
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA,Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
| | - Erica Sood
- Division of Behavioral Health, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.,Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA,Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE
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Abstract
PURPOSE The presence of a clubfoot is often found prenatally and some families seek counselling with a specialist. The purpose of this study was to compare the parental anxiety levels in families that: a) knew prenatally and had prenatal counselling; b) knew prenatally but did not seek prenatal counselling; and c) did not know until after delivery. METHODS This prospective cohort study evaluated the anxiety of parents as they presented to the paediatric orthopaedic clinic with their newborn with a foot disorder (prior to the diagnostic confirmation of clubfoot). Each family filled out the 'Pre-visit orthopaedic surgeon questionnaire' and then after the initial visit with the orthopaedic surgeon (confirming the clubfoot diagnosis) the family filled out the 'Immediately post-visit orthopaedic surgeon questionnaire'. Through these questionnaires, anxiety level was assessed prior to meeting postnatally with the paediatric orthopaedic specialist, as well as after the meeting and compared across groups. RESULTS A total of 121 parents completed questionnaires: 71% (86/121) confirmed clubfoot; 69% of families (59/86) received prenatal counselling (Group A); 16% (14/86) knew prenatally but had no counselling (Group B); and 15% (13/86) found out at birth (Group C). There was no difference in anxiety levels across groups before (p = 0.78) or after (p = 0.57) meeting with the paediatric orthopaedic surgeon; however, overall anxiety reduced significantly (p < 0.001). CONCLUSION We found no difference in the anxiety levels of across the three groups. Prenatal counselling for parents of children with likely clubfoot may not decrease parental anxiety, but nonetheless is very appreciated by the families who receive it. LEVEL OF EVIDENCE Prognostic Level II.
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Affiliation(s)
- S. T. Mahan
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA,Harvard Medical School Boston Massachusetts, USA,Correspondence should be sent to S. T. Mahan, Department of Orthopaedics, Boston Children’s Hospital, 300 Longwood Ave, Boston MA 02115, USA.
| | - P. E. Miller
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA
| | - C. J. May
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA,Harvard Medical School Boston Massachusetts, USA
| | - J. R. Kasser
- Department of Orthopaedics Boston Children’s Hospital Boston Massachusetts, USA,Harvard Medical School Boston Massachusetts, USA
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Abstract
The aim of this study was to evaluate the psychologic burden in terms of depression, anxiety, and stress among the parents of children with congenital craniofacial deformity, nonsyndromic cleft lip and/or palate (CL/P) with early and late diagnosis and/or treatment. In this study, total 240 patients were enrolled, out of which 72 were parents (either mother/father) of CL/P children, below 10 years (group A: before adolescence), 70 were parents of CL/P children, above 10 years of age (group B: after adolescence), and 98 were parents of children with no CL/P or any other genetic disorder (group C). Depression, anxiety, and stress scale-21 was administered in all groups after obtaining the informed consent. Mean ranks of group B revealed a higher score for all the 3 psychologic domains. The CL/P was further divided into only cleft lip, only cleft palate, and both cleft lip and palate groups. A statistically significant difference was observed in group B for all the psychologic domains. Analysis of variance was applied between the groups and a P-value <0.05 was considered as statistically significant. Analysis revealed severe to extremely severe depressed state of mind and moderate to severe levels of stress in maximum parents (above 20%) of group B. However, approximately 50% parents of group B showed extremely severe anxiety. Therefore, psychologic assessment helps in providing a psychiatric or psychologic counseling and treatment to the parents of CL/P children.
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de Leeuw RA, van der Horst SFB, de Soet AM, van Hensbergen JP, Bakker PCAM, Westerman M, de Groot CJM, Scheele F. Digital vs face-to-face information provision in patient counselling for prenatal screening: A noninferiority randomized controlled trial. Prenat Diagn 2019; 39:456-463. [PMID: 30995693 PMCID: PMC6593435 DOI: 10.1002/pd.5463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 11/25/2022]
Abstract
Objective To evaluate face‐to‐face information provision in patient counselling for prenatal screening compared with two forms of digital information provision, namely, noninteractive instructional video or interactive video. Method We performed a prospective, noninferiority, cluster‐randomized controlled trial comparing face‐to‐face (usual care) with two forms of digital information provision (intervention) in counselling for prenatal screening. This study was performed in the Amsterdam UMC, the Netherlands, in 2017, and included women in the first trimester of pregnancy. Main outcomes were knowledge gained by the patient and counselling duration. We performed a noninferiority analysis. Results One hundred forty‐one women were included, randomized, and analysed. The baseline characteristics were comparable. The intervention group was noninferior compared with the control group regarding the level of satisfaction. The knowledge grade difference was higher after using intervention, and the duration was significantly longer in the face‐to‐face group at 23 minutes versus 16 minutes. The addition of interaction with the video made no difference in any of the outcomes. Conclusion Adding an instructional video to patient counselling is of added value to improve patient's knowledge and shorten time consumption of the counsellor, therefore possibly saving costs. But this form of counselling maintains the same level of satisfaction. What is already known about this topic?
Counselling for prenatal screening is a complex process containing education, information, and evaluation in order to make a well‐considered decision. Counselling for prenatal screening has an increase in interdoctor variation and unpredictable time consumption.
What does this study add?
Digital information provision added to face‐to‐face counselling shortens the counsellors' time significantly without decreasing satisfaction and even improving knowledge. Shortening the counsellors' time consumption can be a very cost‐effective way of saving time or increasing atient care. Adding interactivity to patient information provision does not improve knowledge or satisfaction.
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Affiliation(s)
- Robert Adrianus de Leeuw
- Athena Institute for Trans-Disciplinary Research, VU University Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | - Michiel Westerman
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | | | - Fedde Scheele
- Athena Institute for Trans-Disciplinary Research, VU University Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Oehmke F, Lauer T, Baecker J, Mader S, Soydan N, Born T, Brumhard M, Dettmeyer R, Staszewski S, Heinemann T, Kilian U, Sarikaya Y, Kress H, Tinneberg HR, Bilgin Y, Zimmer KP, Ehrhardt H. Ethical, Legal, and Religious Aspects at the Border of Viability. Front Pediatr 2019; 7:175. [PMID: 31139602 PMCID: PMC6518665 DOI: 10.3389/fped.2019.00175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank Oehmke
- Department of Obstetrics and Gynecology, Justus-Liebig-University, Giessen, Germany
| | - Tina Lauer
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Johanna Baecker
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Nedim Soydan
- Türkisch-Deutsche Gesundheitsstiftung e.V., Giessen, Germany
| | - Thomas Born
- Clinical Pastoral Care, University Hospital of Gießen, Giessen, Germany
| | - Matthias Brumhard
- Ethics Delegate, Medical Management, University Hospital of Gießen, Giessen, Germany
| | | | | | - Thomas Heinemann
- Chair of Ethics, Theory and History of Medicine, Philosophical-Theological University of Vallendar, Vallendar, Germany
| | - Ulrika Kilian
- Department of History and Cultural Studies, Giessen, Germany
| | - Yasar Sarikaya
- Department of History and Cultural Studies, Giessen, Germany
| | - Hartmut Kress
- Department of Social Ethics, Faculty of Protestant Theology, Bonn University, Bonn, Germany
| | | | - Yasar Bilgin
- Türkisch-Deutsche Gesundheitsstiftung e.V., Giessen, Germany.,Department of Internal Medicine III, Giessen University Hospital, Giessen, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
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50
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Guo W, Zhu X, Yan L, Qiao J. The present and future of whole-exome sequencing in studying and treating human reproductive disorders. J Genet Genomics 2018; 45:517-525. [DOI: 10.1016/j.jgg.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 12/16/2022]
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