Impacts of Integrating Family-Centered Care and Developmental Care Principles on Neonatal Neurodevelopmental Outcomes among High-Risk Neonates

Identifying outcomes and outcome measures in neonatal family-centered care trials: a systematic review

BACKGROUND

A wide range of outcomes for infants and parents has been reported in clinical trials testing FCC interventions. This systematic review aimed to identify outcomes, outcome measures, and time-points reported in experimental studies testing FCC interventions in neonatal care units.

METHODS

This review included experimental studies investigating FCC interventions in neonatal settings. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Cochrane, PsycINFO, Scopus, JBI, Lilacs, and SciELO, completed in December 2022 and updated in November 2023. Critical appraisal was performed using the JBI checklist for randomized controlled trials, and a narrative synthesis process was used. Outcomes were categorized into the Comet Taxonomy core areas.

RESULTS

The search identified 8787 papers; 42 studies were included in the analysis. Totally, 60 outcomes were identified: 42 infant and 18 parents' outcomes. Outcomes were clustered into 12 domains for infants and five domains for parents and measured by 97 outcome measures. The included studies reported 25 and 27 different time-points for infants and parents, respectively.

CONCLUSION

This review of studies testing FCC interventions identified heterogeneity and inconsistency of outcomes, outcome measures, and time-points measuring the outcomes. Developing a core outcome set for FCC studies is warranted to benchmark the evidence and identify best-practices.

IMPACT

This systematic review identified inconsistency of outcomes, outcome measures, and time-points reported in quantitative studies testing family-centered care interventions in neonatal care settings. The lack of standardized outcomes and outcome measures reported in clinical trials makes it difficult to synthesize data to provide conclusive recommendations. This systematic review will contribute to the development of a core outcome set for research testing family-centered care interventions in neonatal care settings.

Nursing practice of routine gastric aspiration in preterm infants and its link to necrotizing enterocolitis: is the practice still clinically relevant?

The practice of routine gastric residual aspiration in preterm infants remains controversial, with conflicting evidence regarding its impact on necrotizing enterocolitis (NEC). As front-line caregivers, nurses play a vital role in gastric aspiration procedures and must be informed by evidence. This quasi-experimental nursing study aimed to assess whether gastric aspiration is clinically relevant in reducing the risk of NEC in preterm infants.A total of 250 preterm infants from two NICUs in Egypt were allocated to the gastric aspiration (n = 125) and non-aspiration (n = 125) groups. Feeding practices, gastric residuals, and incidence/severity of NEC were compared between groups according to modified Bell's criteria. Risk factors were analyzed using multivariate regression. There were no significant baseline differences between the groups. The gastric residual attributes and feeding outcomes did not differ substantially from aspiration. The overall incidence of NEC was 14-15%, with no significant differences in the odds of onset or progression of NEC by stage between the groups. Lower gestational age and birth weight emerged as stronger predictors of NEC. Routine gastric aspiration does not appear to directly prevent or reduce the severity of NEC in this population. Although gastric residuals retain clinical importance, study findings question assumptions that aspiration protects against NEC and informs nursing practice. Evidence-based feeding protocols must continually evolve through ongoing research on modifiable risk factors for this devastating intestinal disease in preterm infants.

Improving parental mental health in the perinatal period: A review and analysis of quality improvement initiatives

Parental mental health is an essential sixth vital sign that, when taken into consideration, allows clinicians to improve clinical outcomes for both parents and infants. Although standards exist for screening, referral, and treatment for perinatal mood and anxiety disorders (PMADs), they are not reliably done in practice, and even when addressed, interventions are often minimal in scope. Quality improvement methodology can accelerate the implementation of interventions to address PMADs, but hurdles exist, and systems are not well designed, particularly in pediatric inpatient facilities. In this article, we review the effect of PMADs on parents and their infants and identify quality improvement interventions that can increase screening and referral to treatment of parents experiencing PMADs.

Knowledge, Attitudes, and Practice About Emergency Contraception Among Saudi Women of Childbearing Age of Eastern Region in Saudi Arabia

Background and aim Emergency contraception (EC) refers to methods of contraception that are used within 72 hours up to 120 hours after unprotected intercourse to prevent unintended pregnancy. It can postpone ovulation, stopping fertilization. Ella® (progestin receptor modulator), plan B, birth control tablets, and the copper intrauterine device (IUD) are examples of emergency contraception. The aim of the study is to evaluate knowledge, attitudes, and practices of emergency contraception among Saudi women of childbearing age in the eastern province of Saudi Arabia. Methods It is a descriptive cross-sectional study conducted in the eastern region of Saudi Arabia. Data was collected through a pretested online questionnaire after approval from an ethical committee and women's consent to participate in the study. Women between 18 and 49 years old were included in the study. Women aged under 18 and over 49 years were excluded from the study to make the sample population more homogenous. Participants were provided a link to a questionnaire form to be completed from their devices (phone or laptop). Results A total of 648 childbearing Saudi women completed the survey. The majority were between 18 and 25 years old. Approximately 263 (40.6%) had no children, and 348 (53.7%) earned less than 5,000 SAR monthly. Four hundred and sixty-seven (72%) of the participants had never used emergency contraception. Four hundred and seventy-eight (73.8%) did not know the maximum acceptable time for using EC. Three hundred and fourteen (48.5%) did not know the potential risks to the baby in case of failure of emergency contraception. Two hundred and twenty-three (34%) patricians wrongly believed that there would be a potential risk to the baby if the patient got pregnant after using emergency contraception. Three hundred and eight (47.5%) participants supported the idea of the availability of emergency contraception without a prescription, and a majority believed that they would not feel shy in asking for emergency contraception. Five hundred and seventy-one (88%) participants did not visit any family planning clinic last year. A significant source of EC information was a doctor or a family planner, 206 (31.8%). A considerable barrier to EC use was fear of side effects and health risks, as reported by 382 (59%) respondents. Conclusions The current study reveals that participants have positive attitudes towards emergency contraception, but use is deficient because of poor knowledge and lack of awareness. Our study urges the urgent need for awareness campaigns by health professionals to improve learning and remove wrong fears and beliefs about emergency contraception.

Scar Ectopic Pregnancy as an Uncommon Site of Ectopic Pregnancy: A Case Report and Literature Review

A cesarean scar pregnancy is a rare type of ectopic pregnancy that occurs when a fertilized egg implants in the scar from a previous cesarean section. It is a serious condition that can lead to significant morbidity and mortality if not managed promptly and appropriately. In this literature review and case report, we discuss the etiology, diagnosis, and management of cesarean scar pregnancy. We conducted a comprehensive search of relevant literature using electronic databases and included studies that reported on the diagnosis and management of cesarean scar pregnancy. We also present a case report of a patient with cesarean scar pregnancy who was managed surgically. The diagnosis of cesarean scar pregnancy is primarily done via transvaginal or transabdominal ultrasound, and medical or surgical management can be used depending on the gestational age, hemodynamic status, and patient preferences. The surgical approach, which involves hysteroscopy, laparoscopy, or laparotomy, is usually preferred, since it is associated with fast recovery and lower recurrence rates. However, it is crucial to consider the patient's plans for future fertility when selecting the management approach. In conclusion, cesarean scar pregnancy is a rare but potentially life-threatening condition that requires prompt and appropriate management. Early diagnosis and treatment can prevent significant morbidity and mortality, and surgical management is usually preferred due to its higher success rates and lower recurrence rates.