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Santoli CMA, Taylor-Cho IA, Darling AJ, Montoya MN, Gilner JB, Wheeler SM, Dotters-Katz SK. Predictors of Breastfeeding among Patients Admitted with Preterm Prelabor Rupture of Membranes. Am J Perinatol 2024; 41:e3196-e3201. [PMID: 37967869 DOI: 10.1055/a-2211-1787] [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: 11/17/2023]
Abstract
OBJECTIVE We sought to describe rates of breastmilk feeding (BF) at hospital discharge and 6 weeks postpartum and to identify risk factors for noninitiation or cessation among pregnancies complicated by preterm prelabor rupture of membranes (PPROM). STUDY DESIGN Retrospective cohort study of pregnant persons with PPROM admitted to a single tertiary center (2013-2019). Patients with deliveries complicated by intrauterine or neonatal demise or with incomplete BF data were excluded. Demographic, antepartum, and delivery characteristics were evaluated. Primary analysis identified rate of BF initiation at maternal discharge and factors associated with noninitiation. Secondary analysis evaluated BF continuation and factors associated with cessation at 6 weeks postpartum. Bivariate statistics were used to compare characteristics and logistic regression was used to estimate adjusted odds ratios (aOR). RESULTS Of 397 patients with PPROM, 342(86%) initiated BF prior to discharge. Those reporting tobacco use in pregnancy were less likely to initiate BF (aOR: 0.32; 95% confidence interval [CI]: 0.16, 0.64). In contrast, private insurance (aOR: 2.53; 95% CI: 1.19, 5.37) and pregnancy latency ≥ 14 days (aOR: 3.02; 95% CI: 1.09, 8.38) were associated with BF initiation at hospital discharge. Of the 293 patients with postpartum follow-up, only 214 (73%) had BF continuation at 6 weeks postpartum. Maternal age <20 years (aOR: 0.07; 95% CI: 0.01, 0.68) and multiparity (aOR: 0.54; 95% CI: 0.29, 0.99) were associated with BF cessation. Patients with private insurance were observed to have increased odds of BF continuation (aOR: 2.10; 95% CI: 1.07, 4.12). CONCLUSION Among patients with PPROM, tobacco use may be associated with noninitiation of BF prior to discharge, whereas age < 20 years and multiparity were associated with cessation by 6 weeks postpartum. Longer pregnancy latency ≥ 14 days was associated with BF initiation prior to discharge. Private insurance was associated with increased rates of BF initiation and continuation postpartum. BF education and support should be offered to all patients admitted for PPROM. KEY POINTS · Tobacco use may be associated with BF noninitiation.. · Young age and multiparity are linked with BF cessation.. · Private insurance resulted in BF initiation and continuation..
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Affiliation(s)
- Carmen M A Santoli
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Ian A Taylor-Cho
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Alice J Darling
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Melissa N Montoya
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Jennifer B Gilner
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Sarahn M Wheeler
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Sarah K Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Tomlinson C, Haiek LN. Breastfeeding and human milk in the NICU: From birth to discharge. Paediatr Child Health 2023; 28:510-526. [PMID: 38638537 PMCID: PMC11022875 DOI: 10.1093/pch/pxad034] [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: 09/27/2021] [Accepted: 04/20/2022] [Indexed: 04/20/2024] Open
Abstract
It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.
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Affiliation(s)
- Christopher Tomlinson
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
| | - Laura N Haiek
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
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A. Assaf E, Al Sabbah H, Al-Jawadleh A. Analysis of the nutritional status in the Palestinian territory: a review study. Front Nutr 2023; 10:1206090. [PMID: 37533576 PMCID: PMC10391640 DOI: 10.3389/fnut.2023.1206090] [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: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 08/04/2023] Open
Abstract
Background Food insecurity, occupation, and poverty contribute to the poor nutritional status of Palestine. This review study aimed to analyze the nutritional status in the Palestinian Territory by analyzing published data from 2011 to 2023. Method Searching for relevant publications yielded 67 studies. Based on reviewing these studies, five major themes were identified: low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Results Based on the review of these studies, five major themes were identified, namely, low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Based on the literature, the prevalence rate of exclusive breastfeeding was 24.4% in the Gaza Strip, compared to a national rate of 39.9% in 2020. Smoking, anemia in mothers, diet during pregnancy, and indoor pollution were associated with low birth weight. One-fifth of the boys and girls were stunted by 2 years of age in the Gaza Strip, and girls were more stunted than boys. The prevalence rates of underweight, overweight, and obesity among school children in the West Bank were 7.3%, 14.5%, and 15.7%, respectively. Age, gender, and living area were significant predictors of being overweight among school children. The prevalence rates of overweight and obesity among adults in Palestine were 57.8% and 26.8%, respectively. Obesity is associated with a family history, chronic diseases, and low physical activity among adults. Exclusive breastfeeding was below the WHO recommendations, while significant rates of obesity and overweight were found among children and adults. Iron-deficiency anemia (IDA) among pregnant women and children remains a challenging public health issue, while other micronutrient deficiencies are high among children. Conclusion This review emphasizes the need for multi-sectoral interventions to address malnutrition and nutritional shifts. It identifies gaps and addresses nutrition-related issues in the Palestinian Territory, which can serve as a basis for guiding United Nations agencies and governments in formulating evidence-based policies and strategies for prioritizing nutritional interventions to meet sustainable development goals.
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Affiliation(s)
- Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Haleama Al Sabbah
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Ayoub Al-Jawadleh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Sjömar J, Ottesen H, Banik G, Rahman AE, Thernström Blomqvist Y, Rahman SM, Målqvist M. Exploring caregivers' experiences of Kangaroo Mother Care in Bangladesh: A descriptive qualitative study. PLoS One 2023; 18:e0280254. [PMID: 36689433 PMCID: PMC9870098 DOI: 10.1371/journal.pone.0280254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) is an evidence-based intervention recommended by the World Health Organization (WHO) to reduce preterm mortality and morbidity. The aim of this study was to explore caregivers' experiences of providing KMC in hospital settings and after continuation at home in Bangladesh in order to assess enablers and barriers to optimal implementation. METHODS Interviews with fifteen caregivers were conducted using an interview guide with semi-structured questions in August 2019 and March 2020. Convenience sampling was used to select hospitals and participants for the study. The inclusion criteria were being a caregiver currently performing KMC in the hospital or having been discharged one week earlier from the KMC ward. The interviews were audio recorded, transcribed verbatim, and translated. The data were analyzed using thematic analysis with an inductive approach. RESULTS Three themes were identified as regards the caregivers' experiences of providing KMC: conducive conditions, an empowering process, and suboptimal implementation. The results showed that there are supporting circumstances for caregivers performing KMC in Bangladesh, including social support structures and positive attitudes to the method of care. It also appeared that the caregivers felt strengthened in their roles as caregivers by learning and performing KMC. However, the implementation of KMC was suboptimal due to late initiation of KMC, difficulties with keeping the baby skin-to-skin, and pain after cesarean section hampering skin-to-skin practice. CONCLUSIONS The social and cultural conditions for the caregivers to perform KMC as well as the empowerment the parents felt in their roles as caregivers when performing KMC are facilitating factors for this method of care. Initial separation and late initiation of KMC, as well as disregard for the mothers' needs for care and support, were barriers to optimal practice leading to missed opportunities. These facilitators and barriers need to be addressed in order to succeed in scaling up the national KMC program.
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Affiliation(s)
- Johanna Sjömar
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| | - Hedda Ottesen
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| | - Goutum Banik
- Maternal and Child Health Division, International Centre for Diarrhoeal Research, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Research, Bangladesh
| | | | | | - Mats Målqvist
- Department of Women’s and Children’s Health, Uppsala University, Sweden
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Al Sabbah H, Assaf EA, Al-Jawaldeh A, AlSammach AS, Madi H, Khamis Al Ali N, Al Dhaheri AS, Cheikh Ismail L. Nutrition Situation Analysis in the UAE: A Review Study. Nutrients 2023; 15:nu15020363. [PMID: 36678240 PMCID: PMC9861891 DOI: 10.3390/nu15020363] [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: 12/13/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/14/2023] Open
Abstract
This review study aimed to assess the nutrition situation in the UAE using published data from 2010 to 2022. It highlights the gaps and challenges that prevail in addressing the nutrition-related problems in the UAE and the opportunities that have been overlooked. The available literature indicates that the UAE is burdened with more than one form of nutrition-related problems, including being underweight, being overweight, obesity, micronutrient deficiencies, and nutrition-related chronic diseases. It is clear that data on micronutrient deficiencies, protein-energy malnutrition, obesity, diabetes, and other nutrition-related diseases among the UAE population are extremely scarce. The UAE has a high prevalence of obesity and diabetes; however, limited studies have been conducted to document this nutritional phenomenon. Few examples of published data are available assessing the burden of stunting, wasting, and being underweight among children under five years of age. Despite the importance of protein-energy malnutrition, no recent publications analyze its prevalence within the UAE population. Therefore, future studies must be conducted, focusing on malnutrition. Based on the literature, and bearing in mind the magnitude of the health issues due to the UAE population's nutrition negligence, there is an urgent need to assess the population's nutrient behaviors, to aid policy decision-makers in developing and implementing effective health policies and strategies.
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Affiliation(s)
- Haleama Al Sabbah
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Dubai P.O. Box 144534, United Arab Emirates
- Correspondence: ; Tel.: +971-56-950-1179
| | - Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman 11931, Jordan
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11516, Egypt
| | - Afra Salah AlSammach
- Health Promotion Department, Ministry of Health, Dubai 20224, United Arab Emirates
| | - Haifa Madi
- Health Promotion Department, Ministry of Health, Dubai 20224, United Arab Emirates
| | - Nouf Khamis Al Ali
- Health Promotion Department, Ministry of Health, Dubai 20224, United Arab Emirates
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
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Zhu Z, Wang X, Chen W, Pei S, Wang Q, Guan H, Zhu G. The efficacy of Kangaroo-Mother care to the clinical outcomes of LBW and premature infants in the first 28 days: A meta-analysis of randomized clinical trials. Front Pediatr 2023; 11:1067183. [PMID: 36923278 PMCID: PMC10008937 DOI: 10.3389/fped.2023.1067183] [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] [Received: 10/11/2022] [Accepted: 01/31/2023] [Indexed: 03/03/2023] Open
Abstract
Objective The objective of this study was to systematically determine the benefits of Kangaroo-Mother Care (KMC) on the clinical outcomes of low birthweight (LBW) and preterm infants. Methods For this study, the following databases were retrieved for articles published until November 2021: PubMed, Web of Science, EBSCO, and the Cochrane library. The primary clinical outcome was mortality between enrollment and 28 days. The secondary clinical outcomes were the mean duration of hospital stay, hypothermia, sepsis, exclusive breastfeeding at the end of the neonatal period, and exclusive breastfeeding at discharge. Results We conducted a meta-analysis, which included 17 RCTs, involving overall 17,668 participants. The results of this meta-analysis showed that KMC could reduce the primary clinical outcome of mortality between enrollment and 28 days (RR: 0.80, 95% Cl: 0.71-0.91, p < 0.01). For the secondary clinical outcomes, KMC had a varying degree of benefits on the mean duration of hospital stay (SMD: -0.96, 95% Cl: -1.02-0.90, p < 0.001), hypothermia (RR: 0.45, 95% Cl: 0.27-0.75, p < 0.01), and sepsis (RR: 0.79, 95% Cl: 0.70-0.89, p < 0.001). The exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge of KMC had benefits, which was not statistically different though (OR: 2.16, 95% Cl: 0.55-8.41, p = 0.27; OR: 1.16, 95% Cl: 0.82-1.64, p = 0.39, respectively). Conclusions KMC was decreased mortality in LBW and premature infants between enrollment and 28 days. In addition, KMC also had a favorable effectiveness on the secondary clinical outcomes, such as mean duration of hospital stay, hypothermia, sepsis. Moreover, KMC also had a slight effectiveness on exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge.
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Affiliation(s)
- Zhen Zhu
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xinchen Wang
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Wenzeng Chen
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Shuping Pei
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Qingmin Wang
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Hailian Guan
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Guang Zhu
- Department of Gynaecology, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Brødsgaard A, Andersen BL, Skaaning D, Petersen M. From Expressing Human Milk to Breastfeeding-An Essential Element in the Journey to Motherhood of Mothers of Prematurely Born Infants. Adv Neonatal Care 2022; 22:560-570. [PMID: 34923499 PMCID: PMC10519291 DOI: 10.1097/anc.0000000000000962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lactation and breastfeeding present an extraordinary challenge for mothers of prematurely born infants. PURPOSE To explore the significance of and the circumstances that affect lactation for mothers of premature infants. METHODS A qualitative exploratory study based on single, in-depth, semistructured interviews with 16 purposefully sampled mothers of premature infants admitted to the neonatal intensive care unit (NICU). Data were analyzed using content analysis. The study was reported according to Standards for Reporting Qualitative Research. FINDINGS The overall theme was "From expressing human milk to breastfeeding-an essential element in the journey to motherhood." The theme emerged from 3 categories: the birth preparation time has been interrupted; expressing human milk is essential for lactation; and the motherhood journey encompasses breastfeeding. The analysis also revealed that the categories were impacted by initiating, performing, and maintaining lactation and further influenced by inhibitors and promoters. IMPLICATIONS FOR PRACTICE The promoters for performing milk expression and breastfeeding should be stimulated and the inhibitors should be eliminated. The achievement of "zero separation" and mother-infant couplet care in the NICU would be beneficial. In order for mothers to maintain successful lactation, it is essential that they receive supportive around-the-clock access to health professionals with expertise in lactation and breastfeeding until exclusive breastfeeding is well established. IMPLICATIONS FOR RESEARCH The study highlights the need to investigate mother-infant as one entity rather than separately as mother and infant.
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Affiliation(s)
- Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
| | - Bente Lund Andersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
| | - Diana Skaaning
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
| | - Mette Petersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
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Encourage, Assess, Transition (EAT): A Quality Improvement Project Implementing a Direct Breastfeeding Protocol for Preterm Hospitalized Infants. Adv Neonatal Care 2022; 23:107-119. [PMID: 36037212 DOI: 10.1097/anc.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals. PURPOSE To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants. METHODS Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit. RESULTS Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%. IMPLICATIONS FOR PRACTICE AND RESEARCH Standardizing DBF practices with the EAT protocol increased DBF during hospitalization-a known driver of patient experience-and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change.Video abstract available at: https://journals.na.lww.com/advancesinneonatalcare/pages/videogallery.aspx?autoPlay=false&videoId=61.
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Cabrera-Lafuente M, Alonso-Díaz C, Pumarega MTM, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey. An Pediatr (Barc) 2022; 96:300-308. [PMID: 35523686 DOI: 10.1016/j.anpede.2021.04.010] [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] [Received: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Laura N Haiek
- Ministère de la santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Denmark
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Sankar MN, Weiner Y, Chopra N, Kan P, Williams Z, Lee HC. Barriers to optimal breast milk provision in the neonatal intensive care unit. J Perinatol 2022; 42:1076-1082. [PMID: 34815522 PMCID: PMC8610106 DOI: 10.1038/s41372-021-01275-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/19/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examines comprehensive patient and process factors that influence breast milk use in the NICU setting. STUDY DESIGN We examined the association of maternal, neonatal, and family factors and lactation support systems to identify gaps in breast milk use in a retrospective study of 865 infants born in 23-41 weeks gestation admitted to the NICU. RESULTS Breast milk at discharge for all infants was 89.3%, for extremely preterm 82.3%, moderately preterm 91.4%, late preterm 86.5%, and term 92.7%. Prematurity (OR 0.31 [0.17-0.56]), low birth weight, morbidities, Black maternal race (OR 0.20 [0.07-0.57]) and public insurance (OR 0.54 [0.34-0.85]) were associated with decreased breast milk use. Early initiation of feeds was associated with increased breast milk use. CONCLUSIONS There is a need to increase social as well as hospital support systems to address gaps in breast milk use in the NICU.
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Affiliation(s)
- Meera N. Sankar
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA
| | - Ya’el Weiner
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Neha Chopra
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Peiyi Kan
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Zakiyah Williams
- grid.414123.10000 0004 0450 875XLactation services, Lucile Packard Children’s Hospital, Stanford, CA USA
| | - Henry C. Lee
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
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Aita M, De Clifford Faugère G, Laporte G, Colson S, Feeley N. French translation and preliminary psychometric validation of a skin-to-skin contact instrument for nurses (SSC-F). J SPEC PEDIATR NURS 2022; 27:e12359. [PMID: 34581004 DOI: 10.1111/jspn.12359] [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: 02/18/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To translate and conduct the preliminary psychometric validation of a skin-to-skin contact instrument in French (SSC-F) with a sample of nurses from Quebec and France working in neonatal intensive care units. METHODS The 20 items of the SSC instrument containing four subscales (knowledge, attitudes and beliefs, training and education and implementation), developed by Vittner et al. (2017), was translated into French. The methodological steps used for psychometric validation included assessment of the item and subscale normality distributions, assessment of reliability using internal consistency, and assessment of validity using inter-item and inter-scale correlations and principal component analysis. RESULTS The preliminary psychometric validation showed that all four subscales of the French version had adequate internal consistency (0.61-0.77), supporting the calculation of a total score for each subscale based on the English version of the instrument. The structural validity was supported by principal component analysis findings. PRACTICE IMPLICATIONS Based on the findings of the preliminary psychometric validation of our study, the SSC-F instrument could be used in research with French-speaking neonatal nurses in Western countries, but gathering more evidence about its reliability and validity is warranted for clinical practice.
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Affiliation(s)
- Marilyn Aita
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada.,CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montreal, Quebec, Canada
| | - Gwenaëlle De Clifford Faugère
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada.,CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada.,School of Nursing, Faculty of Medical and Paramedical Sciences, CEReSS, Aix-Marseille Université, Marseille, France
| | - Geneviève Laporte
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada.,CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Sébastien Colson
- Quebec Network on Nursing Intervention Research (RRISIQ), Montreal, Quebec, Canada.,School of Nursing, Faculty of Medical and Paramedical Sciences, CEReSS, Aix-Marseille Université, Marseille, France
| | - Nancy Feeley
- Quebec Network on Nursing Intervention Research (RRISIQ), Montreal, Quebec, Canada.,Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
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Namchaitaharn S, Pimpiwan N, Saengnipanthkul S. Breastfeeding Promotion and Nursing Care for Infants with Cleft Palate and/or Cleft Lip in Northeastern Craniofacial Center, Thailand. Open Nurs J 2021. [DOI: 10.2174/1874434602115010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process.
Objective:
To evaluate the treatment and breastfeeding rate in infants with CP and CLP.
Methods:
A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected.
Results:
A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively.
Conclusion:
Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.
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13
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Minot KL, Kramer KP, Butler C, Foster M, Gregory C, Haynes K, Lagon C, Mason A, Wynn S, Rogers EE, Liebowitz MC. Increasing Early Skin-to-Skin in Extremely Low Birth Weight Infants. Neonatal Netw 2021; 40:242-250. [PMID: 34330874 DOI: 10.1891/11-t-749] [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] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early skin-to-skin care (SSC) has been shown to improve outcomes after preterm birth, including improved clinical stability and establishment of breastfeeding. Recent evidence suggests the most unstable infants get the most benefit, yet these infants are not consistently offered opportunities for SSC because of safety concerns and discomfort of the care team. PURPOSE To identify barriers and implement a multidimensional approach to increase SSC within the first 72 hours of life among infants born less than 28 weeks' gestation and less than 1,000 g in a Level IV university-based regional intensive care nursery. METHODS Using Institute of Healthcare Improvement quality improvement methodology, a multidisciplinary team identified barriers to SSC and developed targeted interventions, including a unit-specific protocol; widespread parent, staff, and provider education; and an infant readiness checklist. The primary outcome was the rate of SSC within 72 hours. The balancing measure was the rate of severe intraventricular hemorrhage (IVH). Data were collected from monthly chart review and analyzed with statistical process control charts. The aim was to increase SSC within 72 hours of birth from 7 percent to greater than 80 percent within 12 months for infants born less than 28 weeks' gestation or less than 1,000 g. RESULTS Between June 2017 and December 2019, there were 52 extremely preterm infants included in the project (15 preintervention and 37 postintervention). The rate of SSC within the first 72 hours increased from 7 to 84 percent. There has been no increase in any or severe IVH during the project period despite the increased rate of SSC. IMPLICATIONS FOR PRACTICE Implementation of multidimensional, multidisciplinary interventions for reducing barriers to early SSC in extremely preterm infants resulted in rapid adoption of SSC in the first 72 hours of life without increasing severe IVH in this high-risk population.
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Cabrera-Lafuente M, Alonso-Díaz C, Moral Pumarega MT, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. [Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00178-8. [PMID: 34045162 DOI: 10.1016/j.anpedi.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Mariana Díaz-Almirón
- Sección de Bioestadística, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canadá; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Dinamarca
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15
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Mother's Own Milk Feeding in Preterm Newborns Admitted to the Neonatal Intensive Care Unit or Special-Care Nursery: Obstacles, Interventions, Risk Calculation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084140. [PMID: 33919856 PMCID: PMC8070824 DOI: 10.3390/ijerph18084140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/24/2023]
Abstract
Early nutrition of newborns significantly influences their long-term health. Mother's own milk (MOM) feeding lowers the incidence of complications in preterm infants and improves long-term health. Unfortunately, prematurity raises barriers for the initiation of MOM feeding and its continuation. Mother and child are separated in most institutions, sucking and swallowing is immature, and respiratory support hinders breastfeeding. As part of a quality-improvement project, we review the published evidence on risk factors of sustained MOM feeding in preterm neonates. Modifiable factors such as timing of skin-to-skin contact, strategies of milk expression, and infant feeding or mode of delivery have been described. Other factors such as gestational age or neonatal complications are unmodifiable, but their recognition allows targeted interventions to improve MOM feeding. All preterm newborns below 34 weeks gestational age discharged over a two-year period from our large German level III neonatal center were reviewed to compare institutional data with the published evidence regarding MOM feeding at discharge from hospital. Based on local data, a risk score for non-MOM feeding can be calculated that helps to identify mother-baby dyads at risk of non-MOM feeding.
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16
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Rocha HAL, Sudfeld CR, Leite ÁJM, Machado MMT, Rocha SGMO, Campos JS, Silva ACE, Correia LL. Maternal and neonatal factors associated with child development in Ceará, Brazil: a population-based study. BMC Pediatr 2021; 21:163. [PMID: 33827507 PMCID: PMC8025508 DOI: 10.1186/s12887-021-02623-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/23/2021] [Indexed: 01/28/2023] Open
Abstract
Background The first 1000 days of life are a critical period when the foundations of child development and growth are established. Few studies in Latin America have examined the relationship of birth outcomes and neonatal care factors with development outcomes in young children. We aimed to assess the association between pregnancy and neonatal factors with children’s developmental scores in a cross-sectional, population-based study of children in Ceará, Brazil. Methods Population-based, cross-sectional study of children aged 0–66 months (0–5.5 years) living in Ceará, Brazil. We examined the relationship of pregnancy (iron and folic acid supplementation, smoking and alcohol consumption) and neonatal (low birth weight (LBW) gestational age, neonatal care interventions, and breastfeeding in the first hour) factors with child development. Children’s development was assessed with the Ages and Stages Questionnaire (ASQ-BR). We used multivariate generalized linear models that accounted for clustering sampling to evaluate the relationship of pregnancy and neonatal factors with development domain scores. Findings A total of 3566 children were enrolled. Among pregnancy factors, children whose mothers did not receive folic acid supplementation during pregnancy had lower fine motor and problem-solving scores (p-values< 0.05). As for neonatal factors, LBW was associated with 0.14 standard deviations (SD) lower (CI 95% -0.26, − 0.02) communication, 0.24 SD lower (95% CI: − 0.44, − 0.04) fine motor and 0.31 SD lower (CI 95% -0.45, − 0.16) problem-solving domain scores as compared to non-LBW children (p values < 0.05). In terms of care, newborns that required resuscitation, antibiotics for infection, or extended in-patient stay after birth had lower development scores in selected domains. Further, not initiating breastfeeding within the first hour after birth was associated with lower gross motor and person-social development scores (p-values < 0.05). Conclusion Pregnancy and neonatal care factors were associated with later child development outcomes. Infants at increased risk of suboptimal development, like LBW or newborns requiring extended in-patient care, may represent groups to target for supplemental intervention. Further, early integrated interventions to prevent adverse pregnancy and newborn outcomes may improve child development outcomes.
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Affiliation(s)
- Hermano A L Rocha
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. .,Department of Maternal and Child Health, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Álvaro J M Leite
- Department of Maternal and Child Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Márcia M T Machado
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Sabrina G M O Rocha
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil.,ISEC, Unichristus University Center, Fortaleza, CE, Brazil
| | | | | | - Luciano L Correia
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
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17
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Aita M, Héon M, Lavallée A, De Clifford Faugère G, Altit G, Le May S, Dorval V, Lippé S, Larone Juneau A, Remmer E, Rennick JE. Nurturing and quiet intervention (NeuroN-QI) on preterm infants' neurodevelopment and maternal stress and anxiety: A pilot randomized clinical trial protocol. J Adv Nurs 2021; 77:3192-3203. [PMID: 33719093 DOI: 10.1111/jan.14819] [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: 11/11/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Primary objective of this pilot study is to evaluate the feasibility and acceptability of the NeuroN-QI and the study procedures. Secondary objectives are to assess the feasibility and acceptability of the NeuroN-QI by the nurses, assess the nurses' training needs about the components of the NeuroN-QI, and estimate the preliminary effects of the NeuroN-QI on infants' neurodevelopment as well as maternal stress and anxiety at infants' 36 weeks of gestational age. DESIGN A two-group pilot parallel randomized clinical trial stratified by center. METHODS The pilot study will be conducted in two neonatal intensive care units (NICUs). A sample of 24 mother-infant dyads born between 26 and 316/7 gestational age will be randomized into an experimental or control group. Fifty nurses will be recruited. The NeuroN-QI consists of four 2-hour skin-to-skin contact sessions/week with a 15-minute auditory stimulation by mothers with controlled ambient levels of light and noise. A 1-hour quiet period will follow where infants will rest in their incubator/crib with their mother's milk for olfactory stimulation and where the light and noise control will be continued. In the control group, mother-infant dyads will do four skin-to-skin contacts per week and receive standard care. Acceptability and feasibility of the NeuroN-QI in addition to maternal stress and anxiety will be measured through questionnaires, while infants' neurodevelopment will be assessed with Assessment of Preterm Infant Behaviour and General Movement Assessment. CONCLUSIONS This pilot trial will address knowledge gaps and generate evidence in neonatal care by evaluating the feasibility and acceptability of a multi-component developmental care intervention. IMPACT This project is an innovative step towards optimizing the neurodevelopmental trajectory of infants in NICUs and consequently promoting their long-term health outcomes. TRIAL REGISTRATION NCT04593095.
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Affiliation(s)
- Marilyn Aita
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | - Marjolaine Héon
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | | | - Gabriel Altit
- Department of Pediatrics, Division of Neonatology, Montreal Children's Hospital - McGill University Health Center (MUHC), Montréal, Canada.,Research Institute MUHC, Montréal, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Sylvie Le May
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | | | - Sarah Lippé
- CHU Sainte-Justine Research Centre, Montréal, Canada.,Faculty of Arts and Science, Department of Psychology, Université de Montréal, Montréal, Canada
| | | | - Elissa Remmer
- NICU, Montreal Children's Hospital (MCH, MUHC), Montréal, Canada
| | - Janet E Rennick
- Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada.,Research Institute MUHC, Montréal, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.,Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.,Department of Nursing, MCH, MUHC, Montréal, Canada
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18
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Maastrup R, Rom AL, Walloee S, Sandfeld HB, Kronborg H. Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices. PLoS One 2021; 16:e0245273. [PMID: 33534831 PMCID: PMC7857627 DOI: 10.1371/journal.pone.0245273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early breast milk expression, prolonged skin-to-skin contact, rooming-in, use of test-weighing and minimizing use of pacifiers are positively associated with exclusive breastfeeding of preterm infants, whereas use of nipple shields is negatively associated. AIM To test whether a training program for neonatal nurses with a focus on these six breastfeeding-supportive clinical practices affects the rate of preterm infants exclusively breastfed at discharge to home, the postmenstrual age at establishment of exclusive breastfeeding, and maternal self-reported use of the practice in the neonatal intensive care unit, the. METHODS A quasi-experimental multi-centre intervention study from 2016-2019 including a control group of 420 preterm mother-infant dyads, an intervention with a training program for neonatal nurses and implementation of weekly breastfeeding meetings for neonatal nurses, and an intervention group of 494 preterm mother-infant dyads. RESULTS Significantly more preterm infants in the intervention group were exclusively breastfed at discharge to home (66.6%) than in the control group (58.1%) p = 0.008. There was no significant difference in postmenstrual age at establishment of exclusive breastfeeding between control and intervention group (37.5 vs.37.8 weeks, p = 0.073). Compared to the control group the number of infants continuing daily skin-to-skin contact after incubator care increased (83.2% vs. 88.3%, p = 0.035), infants using a nipple shield decreased (61.8% vs. 54.2%, p = 0.029), and the number of mothers initiating breast milk expression before six hours post-partum increased (32.6% vs. 42.4%, p = 0.007). There was a significant correlation between percentage of neonatal nurses participating in the breastfeeding training program and changes in exclusive breastfeeding rates (Pearson Correlation 0.638, p = 0.047). CONCLUSION Exclusive breastfeeding rates in preterm infants and maternal self-reported use of breastfeeding-supportive practices increased by training neonatal nurses in the six clinical practices. It is important to include all nurses in the breastfeeding training program to ensure positive effect on exclusive breastfeeding rates.
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Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology, Knowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ane L Rom
- Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Walloee
- Dept of Clinical Research, OPEN-Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | | | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
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Gerhardsson E, Oras P, Mattsson E, Blomqvist YT, Funkquist EL, Rosenblad A. Developing the Preterm Breastfeeding Attitudes Instrument: A tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive care. Midwifery 2020; 94:102919. [PMID: 33422884 DOI: 10.1016/j.midw.2020.102919] [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: 03/11/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care. DESIGN The study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme. SETTING AND PARTICIPANTS A total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis. MEASUREMENTS AND FINDINGS Higher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the pre- and the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeeding- and skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (rs = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Neonatal intensive care units need to increase their efforts to support breastfeeding. An important factor for mothers when establishing breastfeeding is support from well-trained professionals with a positive attitude to breastfeeding. The PreBAI could be a useful tool for identifying attitudes among HCPs before and after attending a breastfeeding training programme.
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Affiliation(s)
- Emma Gerhardsson
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden.
| | - Paola Oras
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
| | - Elisabet Mattsson
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
| | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
| | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14 B, 752 37 Uppsala, Sweden
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20
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Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy. Adv Neonatal Care 2020; 20:495-498. [PMID: 32384330 DOI: 10.1097/anc.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin-to-skin contact (SSC) has been demonstrated to allow adequate thermal stability in high-technology settings with extremely preterm infants, while other aspects on how SSC influences basic physiological parameters have been less extensively investigated. PURPOSE To evaluate physiological stability during SSC and incubator care in a group of preterm infants born at a gestational age (GA) of 32 weeks or less and receiving respiratory support. METHODS Descriptive, observational study including 10 preterm infants (GA 22-32 weeks, postnatal age 2-48 days) were evaluated during SSC compared with flanking time periods in the incubator. Cerebral and systemic regional oxygen saturation (rSaO2), pulse oximetry (SpO2), heart rate (HR), and body temperature were recorded, and the fractional tissue oxygen extraction (fTOE) was calculated. RESULTS A total of 16 periods of SSC (mean duration 3 hours 30 minutes) were evaluated, 9 during nasal continuous positive airway pressure and 7 during mechanical ventilation. Cerebral rSaO2 was 68% ± 4% (SE) and 69% ± 4% during incubator care and SSC, respectively (P = .56). Somatic rSao2 was 64% ± 4% during incubator care and 66% ± 4% during SSC (P = .54). Also, fTOE, HR, and SpO2 was similar during the 2 modes of care. Body temperature increased during SSC (P < .01). IMPLICATIONS FOR PRACTICE The present study reveals no differences in cerebral and somatic tissue oxygenation between periods of SSC and care in the incubator. The findings indicate that SSC supports physiological stability also during management of very preterm infants receiving respiratory support. IMPLICATIONS FOR RESEARCH Further studies directed to further optimize SSC performance should enable its safe implementation at gradually lower gestational and postnatal ages.
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21
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Cirrito BL, Gordon JM, Basden FL, Canals-Alonso J, Green NR, Slezak A, Sosteri R, Eldridge W. An EBP to Promote Early Skin-to-Skin Care Intervention and Mother's Own Milk Feedings in the Extremely Low Birth Weight Population. Neonatal Netw 2020; 39:330-338. [PMID: 33318229 DOI: 10.1891/0730-0832/11-t-650] [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] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Describe an evidence-based process (EBP) to promote early skin-to-skin care (SSC) intervention and increase mother's-own-milk (MOM) feedings at discharge among extremely low birth weight (ELBW) infants. DESIGN This EBP aimed to address the following clinical question: Among ELBW infants, does early SSC &#ξ2264;16 days of life (DOL), compared to SSC >16 DOL, result in more infants receiving MOM feedings at discharge? SAMPLE A retrospective chart review of 199 ELBW infants. MAIN OUTCOME VARIABLE Early SSC intervention among ELBW infants and MOM at discharge. RESULTS Early SSC intervention increased from 46 to 73 percent among ELBW infants over the EBP period. Frequency of SSC intervention was associated with year of EBP and MOM at discharge (p = <.05). ELBW infants in the early SSC intervention group received more MOM at discharge.
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22
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Vetcho S, Cooke M, Ullman AJ. Family-Centred Care in Dedicated Neonatal Units: An Integrative Review of International Perspectives. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jnn.2019.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Linnér A, Klemming S, Sundberg B, Lilliesköld S, Westrup B, Jonas W, Skiöld B. Immediate skin-to-skin contact is feasible for very preterm infants but thermal control remains a challenge. Acta Paediatr 2020; 109:697-704. [PMID: 31618466 DOI: 10.1111/apa.15062] [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: 06/27/2019] [Revised: 09/15/2019] [Accepted: 10/15/2019] [Indexed: 01/07/2023]
Abstract
AIM Current care of very preterm infants in an incubator implies separation of the mother-infant dyad. The aim of this study was to determine whether skin-to-skin contact (SSC) between parent and very preterm infant from birth and during the first postnatal hour is feasible. METHODS Infants born in 2014-16 in Stockholm at gestational age 28 + 0-33 + 6 weeks were randomised to care provided in SSC with a parent or on a resuscitaire and later in an incubator or bed during the first postnatal hour. Infant body temperature was measured on admission to the neonatal unit and at one postnatal hour. Data on respiratory support and breastfeeding were prospectively collected. RESULTS We studied 55 infants at 32 + 0 ± 1.4 weeks (range 28 + 2-33 + 6), with birthweight 1760 g ± 449 g (range 885-2822). 60% were boys. Mean body temperature in the SSC group was 0.3°C lower 1 hour after birth, 36.3°C ± 0.52 (range 34.4-37.2) vs 36.6°C ± 0.42 (range 36.0-37.4, P = .03). No differences between groups were seen in respiratory support or breastfeeding. CONCLUSION Stabilisation of very preterm infants can be performed while in SSC with a parent, but caution needs to be paid to maintain normothermia.
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Affiliation(s)
- Agnes Linnér
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
| | - Stina Klemming
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
| | - Bo Sundberg
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Siri Lilliesköld
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
| | - Björn Westrup
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
| | - Wibke Jonas
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Béatrice Skiöld
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
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24
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Systematic Review of the Effects of Skin-to-Skin Care on Short-Term Physiologic Stress Outcomes in Preterm Infants in the Neonatal Intensive Care Unit. Adv Neonatal Care 2020; 20:48-58. [PMID: 30893092 DOI: 10.1097/anc.0000000000000596] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are exposed to many stressors. There is growing evidence that chronic stress early in life has long-term neurodevelopmental implications. Skin-to-skin care (SSC) is an intervention used to reduce stress in the NICU. CLINICAL QUESTION In premature infants in the NICU, what is the available evidence that SSC improves short-term physiologic stress outcomes compared with incubator care? SEARCH STRATEGY PubMed and CINAHL were searched for terms related to SSC, stress, physiology, and premature infants. Of 1280 unique articles, 19 were identified that reported on research studies comparing SSC with incubator care in the NICU and reported stress-related physiologic outcome measures. RESULTS Although there have been some mixed findings, the research supports that SSC improves short-term cardiorespiratory stress outcomes compared with incubator care. The evidence is clearer for studies reporting stress hormone outcomes, with strong evidence that SSC reduces cortisol and increases oxytocin levels in preterm infants. IMPLICATIONS FOR PRACTICE AND RESEARCH SSC is safe and has stress-reducing benefits. SSC should be considered an essential component to providing optimal care in the NICU. More research is needed to determine the timing of initiation, duration, and frequency of SSC to optimize the stress-reducing benefits. Future research should include the most fragile infants, who are most likely to benefit from SSC, utilize power analyses to ensure adequate sample sizes, and use sophisticated data collection and analysis techniques to more accurately evaluate the effect of SSC on infants in the NICU.
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Mitha A, Piedvache A, Khoshnood B, Fresson J, Glorieux I, Roué JM, Blondel B, Durox M, Burguet A, Ancel PY, Kaminski M, Pierrat V. The impact of neonatal unit policies on breast milk feeding at discharge of moderate preterm infants: The EPIPAGE-2 cohort study. MATERNAL AND CHILD NUTRITION 2019; 15:e12875. [PMID: 31310706 DOI: 10.1111/mcn.12875] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/30/2023]
Abstract
Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE-2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Babak Khoshnood
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Jeanne Fresson
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Clinical Epidemiology and Biostatistics, CHRU Nancy, Nancy, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
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Eliades C. Mitigating Infant Medical Trauma in the NICU: Skin-to-Skin Contact as a Trauma-Informed, Age-Appropriate Best Practice. Neonatal Netw 2019; 37:343-350. [PMID: 30567883 DOI: 10.1891/0730-0832.37.6.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant's traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant's traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes.
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Nonnutritive Sucking at the Mother's Breast Facilitates Oral Feeding Skills in Premature Infants: A Pilot Study. Adv Neonatal Care 2019; 19:110-117. [PMID: 30102620 DOI: 10.1097/anc.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Premature infants have difficulties in transitioning from gavage to breastfeeding. Targeted interventions to support breastfeeding in premature infants in the neonatal intensive care unit are scarce. PURPOSE This pilot study evaluates the effectiveness of nonnutritive sucking at the mother's breast in premature infants to facilitate breastfeeding performance and exclusive breastfeeding. METHODS The study design constituted a single-blinded randomized control trial, with 9 participants randomly allocated into experimental (n = 4) and control (n = 5) groups. The intervention, nonnutritive sucking at the mother's breast thrice a day for 5 minutes, till nutritive breastfeeding was started, was done in addition to standard care, which was nonnutritive sucking on a finger during gavage feeds. The control group received only standard care. Nonnutritive sucking was assessed using "Stages of Nonnutritive Sucking Scale," and breastfeeding performance was assessed using the "Preterm Infant Breastfeeding Behavior Scale" by a blinded assessor unaware of the infants' allocation. RESULTS Five infants in the control arm and 4 in the intervention arm completed the study. The infants in the intervention group showed faster transition to mature stages of nonnutritive sucking (P = .05) and had longer sucking bursts during breastfeeding (P = .06) than those in the control group. There was no difference in the rates of exclusive breastfeeding at 6 months in the intervention and control groups. IMPLICATIONS FOR PRACTICE Early initiation of nonnutritive sucking at the mother's breast in very preterm infants is a safe and effective intervention to facilitate maturation of oral feeding and breastfeeding behavior. IMPLICATIONS FOR RESEARCH Nonnutritive sucking at the mother's breast can be explored as an intervention, with a larger sample, to facilitate exclusive breastfeeding and to establish intervention fidelity.
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Pados BF. Physiology of Stress and Use of Skin-to-Skin Care as a Stress-Reducing Intervention in the NICU. Nurs Womens Health 2019; 23:59-70. [PMID: 30590016 DOI: 10.1016/j.nwh.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/18/2018] [Accepted: 11/01/2018] [Indexed: 06/09/2023]
Abstract
Advances in neonatal care have allowed for the increasing survival of critically ill infants. These infants experience significant stress related to painful procedures and physical separation from their parents. The purpose of this article is to describe the physiologic stress mechanisms that contribute to mortality and morbidity in infants in the NICU and the physiologic mechanisms by which skin-to-skin care (SSC) acts on the stress response system. Findings from current literature supporting the use of SSC and barriers and facilitators to implementation are reviewed. SSC is a safe and effective intervention to reduce stress for infants and their parents. Nurses play a key role in facilitating SSC to optimize outcomes of care in the NICU.
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Mitha A, Piedvache A, Glorieux I, Zeitlin J, Roué JM, Blondel B, Durox M, Burguet A, Kaminski M, Ancel PY, Pierrat V. Unit policies and breast milk feeding at discharge of very preterm infants: The EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2019; 33:59-69. [PMID: 30698887 DOI: 10.1111/ppe.12536] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 12/10/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Facilitating factors and barriers to breast milk feeding (BMF) very preterm (VP) infants have been widely studied at the individual level. We aimed to describe and analyse factors associated with BMF at discharge for VP infants, with a special focus on unit policies aiming to support BMF. METHODS We described BMF at discharge in 3108 VP infants enrolled in EPIPAGE-2, a French national cohort. Variables of interest were kangaroo care during the 1st week of life (KC); unit's policies supporting BMF initiation (BMF information systematically given to mothers hospitalised for threatened preterm delivery and breast milk expression proposed within 6 hours after birth) and BMF maintenance (availability of protocols for BMF and a special room for mothers to pump milk); the presence in units of a professional trained in human lactation and regional BMF initiation rates in the general population. Associations were investigated by multilevel logistic regression analysis, with adjustment on individual factors. RESULTS In total, 47.2% of VP infants received BMF at discharge (range among units 21.1%-84.0%). Unit policies partly explained this variation, regardless of individual factors. BMF at discharge was associated with KC (adjusted odds ratio (aOR) 2.26 (95% confidence interval (CI) 1.40, 3.65)), with policies supporting BMF initiation (aOR 2.19 (95% CI 1.27, 3.77)) and maintenance (aOR 2.03 (95% CI 1.17, 3.55)), but not with BMF initiation rates in the general population. CONCLUSION Adopting policies of higher performing units could be an effective strategy for increasing BMF rates at discharge among VP infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,Paris Descartes University, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jennifer Zeitlin
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital Dijon, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Paris, France.,CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
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Deng Q, Li Q, Wang H, Sun H, Xu X. Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial. Trials 2018; 19:701. [PMID: 30577818 PMCID: PMC6303962 DOI: 10.1186/s13063-018-3060-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin-to-skin contact (SSC) is an evidence-based intervention that benefits low birth weight /preterm infants. However, China's health institutional policy inhibits parents from visiting their baby in the neonatal intensive care unit (NICU). In addition, the Chinese traditional postpartum behavioral practice of confining women to home raises barriers to mother-infant contact. Thus, to shorten the duration of parent-infant separation, father-infant SSC is considered a possible alternative. This study determines whether it is safe to perform father-infant SSC in the NICU and investigates how paternal SSC affects outcomes compared with traditional care (TC) for moderately preterm infants. METHODS/DESIGN A randomized controlled trial will be used to investigate the effects of paternal-infant SSC in NICU wards in China. Preterm infants born at a gestational age in the range of 320-346 weeks with a birth weight > 1500 g will be eligible. A simple random sampling method will be used to allocate infants to the SSC group (n = 25) or the TC group (n = 25). After medical stability, infants in the SSC group will be provided SSC by fathers for one hour every day until discharged from hospital. The primary outcome is neurodevelopmental measures, specifically salivary cortisol and Premature Infant Pain Profile (PIPP) during hospitalization. At 40 weeks of corrected age, infants will be assessed using the Infant Neurological International Battery (INFANIB) and neuroimaging. Secondary outcomes include infants' physiological stability during SSC and throughout hospitalization and state observation at discharge. The fathers' mental health will be assessed with the State-Trait Anxiety Inventory (STAI) 1 day to 3 days after the infant's admission to the NICU and at discharge. Father-infant attachment will be evaluated at 4 and 6 months after the infants' discharge, measured by the Paternal Postnatal Attachment Scale (PPAS). Statistical analyses will be conducted using a two-sided significance level of 0.05. DISCUSSION The effects of paternal-infant SSC on moderately preterm infants will be assessed. The data gathered in this study may have important implications for medical practice and policy in the NICU regarding the care methods of premature infants in China. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IOR-1701274 . Registered on 20 September 2017. Retrospectively registered.
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Affiliation(s)
- Qingqi Deng
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiufang Li
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Wang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilian Sun
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinfen Xu
- Haining Maternal and Child Health Hospital, Branch of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Fontana C, Menis C, Pesenti N, Passera S, Liotto N, Mosca F, Roggero P, Fumagalli M. Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial. Early Hum Dev 2018; 121:15-20. [PMID: 29730130 DOI: 10.1016/j.earlhumdev.2018.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although highly beneficial, human milk feeding is challenging in preterm infants due to adverse NICU factors for the infant and mother. AIM To investigate the effects of an early intervention in promoting infant's human milk feeding and acquisition of full oral feeding. METHODS This study is part of a RCT. We included preterm infants born between 25+0 and 29+6 weeks of gestational age (GA) without severe morbidities, and their parents. Infants were randomized to either receive early intervention (EI) or standard care (SC). EI included PremieStart and parental training to promote infant massage and visual attention according to a detailed protocol. SC, in line with NICU protocols, included Kangaroo Mother Care. The time of acquisition of full oral feeding and human milk consumption at discharge were recorded. RESULTS Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to the protocol. Fifty-seven (EI n = 29, SC n = 28) infants were evaluated at discharge. The two groups were comparable for parent and infant characteristics. A significantly higher rate of infants fed with any human milk was observed in the EI group (75.9%) compared with the SC group (32.1%) (p = 0.001), and EI infants were four times more likely to be fed exclusively with human milk. Full oral feeding was achieved almost one week earlier in EI infants (mean postmenstrual age 36.8 ± 1.6 vs 37.9 ± 2.4 weeks in EI vs SC, p = 0.04). CONCLUSIONS Early interventions promoting mother self-efficacy and involvement in multisensory stimulation have beneficial effects on human milk feeding in preterm infants.
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Affiliation(s)
- Camilla Fontana
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy.
| | - Camilla Menis
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy
| | - Nicola Pesenti
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy
| | - Sofia Passera
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy
| | - Nadia Liotto
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy.
| | - Paola Roggero
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy.
| | - Monica Fumagalli
- NICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 12, 20122 Milano, Italy.
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Parent-Infant Closeness, Parents' Participation, and Nursing Support in Single-Family Room and Open Bay NICUs. J Perinat Neonatal Nurs 2018; 32:E22-E32. [PMID: 30358674 DOI: 10.1097/jpn.0000000000000359] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.
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Infant and young child feeding patterns in Kuwait: results of a cross-sectional survey. Public Health Nutr 2017; 20:2201-2207. [PMID: 28676134 DOI: 10.1017/s1368980017001094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The beneficial role of breast-feeding for maternal and child health is now well established. Its possible role in helping to prevent diabetes and obesity in children in later life means that more attention must be given to understanding how patterns of infant feeding are changing. The present study describes breast-feeding profiles and associated factors in Kuwait. Design/Setting/Subjects Interviews with 1484 recent mothers were undertaken at immunisation clinics across Kuwait. Descriptive analysis and binary logistic regression of results were performed. RESULTS Rates of breast-feeding initiation in Kuwait were high (98·1 %) but by the time of discharge from hospital, only 36·5 % of mothers were fully breast-feeding, 37·0 % were partially breast-feeding and 26·5 % were already fully formula-feeding. Multiple social and health reasons were given for weaning the child, with 87·6 % of mothers who had stopped breast-feeding completely doing so within 3 months postpartum. Nationality (P<0·001), employment status 6 months prior to delivery (P<0·001), mode of delivery (P=0·01), sex of the child (P=0·026) and breast-feeding information given by nurses (P=0·026) were all found to be significantly associated with breast-feeding. Few women (5·6 %) got information on infant nutrition and feeding from nursing staff, but those who did were 2·54 times more likely to be still breast-feeding at discharge from hospital. Over 70 % of mothers had enjoyed breast-feeding and 74 % said they would be very likely to breast-feed again. CONCLUSIONS In Kuwait where the prevalence of both obesity and type 2 diabetes is growing rapidly, the public health role of breast-feeding must be recognised and acted upon more than it has in the past.
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Giannì ML, Sannino P, Bezze E, Comito C, Plevani L, Roggero P, Agosti M, Mosca F. Does parental involvement affect the development of feeding skills in preterm infants? A prospective study. Early Hum Dev 2016; 103:123-128. [PMID: 27591506 DOI: 10.1016/j.earlhumdev.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/05/2016] [Accepted: 08/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Feeding difficulties frequently occur in preterm infants, thus contributing to delayed growth and hospital discharge. AIMS To evaluate the effect of Kangaroo mother care implementation and parental involvement in infants' feeding on the timing of achievement of full oral feeding in preterm infants. STUDY DESIGN Prospective, observational, single-centre study. SUBJECTS A total of 81 infants born at a gestational age ≤32weeks, consecutively admitted to a tertiary neonatal unit between June 2014 and May 2015. OUTCOME MEASURES The timing of the achievement of full oral feeding of preterm infants. RESULTS Full oral feeding was achieved at a mean postmenstrual age of 35.5±2.1weeks. A multiple linear regression analysis showed that a low birth weight, the occurrence of bronchopulmonary dysplasia, and the need for gastrointestinal surgical procedures were associated with a higher postmenstrual age at achievement of full oral feedings. By contrast, the earlier that parents fed their infants and the earlier that Kangaroo mother care was started, the lower the postmenstrual age at the achievement of full oral feeding. CONCLUSIONS These findings indicate that an early start of Kangaroo mother care and early parental involvement in infants' feeding positively affect the achievement of independent oral feeding.
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Affiliation(s)
- Maria Lorella Giannì
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Patrizio Sannino
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122 Milano, Italy.
| | - Elena Bezze
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122 Milano, Italy.
| | - Carmela Comito
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Laura Plevani
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Paola Roggero
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Massimo Agosti
- Neonatologia e Terapia Intensiva Neonatale, Polo Universitario F. Del Ponte, Viale Borri 54, 21100, Varese, Italy.
| | - Fabio Mosca
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
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