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Hall M, Valencia CM, Soma-Pillay P, Luyt K, Jacobsson B, Shennan A. Effective and simple interventions to improve outcomes for preterm infants worldwide: The FIGO PremPrep-5 initiative. Int J Gynaecol Obstet 2024; 165:929-935. [PMID: 38264849 DOI: 10.1002/ijgo.15269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 01/25/2024]
Abstract
Preterm birth remains the leading cause of mortality among under-5's and is a major contributor to the reduction in quality-of-life adjusted years and reduction in human capital. Globally, there are many interventions and care bundles that aim to reduce the impact of preterm birth once preterm labor has ensued and into the neonatal period; not all of these are applicable in all settings. Here, we introduce the FIGO PremPrep-5 initiative, which aims to disseminate key information on the most simple and effective interventions with the aim of increasing implementation globally. Before delivery, we recommend a course of antenatal corticosteroids, and intrapartum magnesium sulfate. At delivery, we recommend delayed cord clamping. Postnatally, we recommend early feeding with breast milk and immediate kangaroo care. While there are many other interventions that may improve outcomes at the time of labor and after preterm birth, these are clinically effective and relatively inexpensive options that can be practiced in most settings and supplemented with more advanced care. We include examples of a training video and infographics that will be used for dissemination.
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Affiliation(s)
- Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Catalina M Valencia
- Department of Obstetrics and Gynecology, Universidad CES, Medellín, Colombia
- Maternal Fetal Medicine Unit, Clinica del Prado, Medellín, Colombia
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Steve Biko Academic Hospital, Pretoria, South Africa
| | - Karen Luyt
- Bristol Medical School, University of Bristol, Bristol, UK
- Neonatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
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Campanha PDPA, de Magalhães-Barbosa MC, Prata-Barbosa A, Rodrigues-Santos G, da Cunha AJLA. Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care. J Pediatr (Rio J) 2024:S0021-7557(24)00028-7. [PMID: 38522479 DOI: 10.1016/j.jped.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in preterm infants undergoing or not the Kangaroo-Mother Care Method (KMC). METHODS A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. RESULTS 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85-109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76-0.86) compared to the non-KMC group. CONCLUSIONS The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals.
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Affiliation(s)
- Patrícia de Padua Andrade Campanha
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, RJ, Brazil; Secretaria Municipal de Saúde do Rio de Janeiro - Maternidade Leila Diniz, Rio de Janeiro, RJ, Brazil.
| | - Maria Clara de Magalhães-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira, Rio de Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | | | - Antônio José Ledo Alves da Cunha
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
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Yangin Ergon E, Alkan Ozdemir S, Akbay Ak S, Yenilmez M, Soysal B, Kalkanlı OH, Çalkavur Ş, Gokmen Yıldırım T. The long-term neurodevelopmental outcomes of toddlers with SARS-CoV-2 infection in the neonatal period: a prospective observational study. Ital J Pediatr 2024; 50:34. [PMID: 38413995 PMCID: PMC10900707 DOI: 10.1186/s13052-024-01609-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The effect of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus in the neonatal period on developing brain is still unknown. This study aims to investigate the long-term neurodevelopmental outcomes of newborns exposed to SARS-CoV-2 & Delta variant. METHODS At a tertiary referral center, a prospective observational cohort research was carried out. All babies who were equal to or more than 34 gestational weeks gestation and were admitted to the NICU between January 2021 and January 2022 due to SARS-CoV-2 infection (Delta - or Delta +) were included in the study. Infants who were hospitalized for non-SARS-CoV-2 reasons at similar dates and who had no history of invasive mechanical ventilation were incorporated as a control group using a 2:1 gender and gestational age match. Thirty infants were assigned to the study group and sixty newborns to the control group based on the sample size calculation. These toddlers' neurodevelopment was evaluated between the ages of 18 and 24 months using the Bayley-II scale. RESULTS We enrolled 90 infants. SARS-CoV-2-positive infants had poorer psychomotor development index (PDI) scores and significantly greater mildly delayed performances (MDPs) at 18-24 months (PDI p = 0.05, MDPs p = 0.03, respectively). Delta variant showed statistically significant lower MDI and PDI scores (MDI p=0.03, PDI p=0.03, respectively). A smaller head circumference of SARS-CoV-2-positive toddlers was detected in the first year (p < 0.001), which improved at the second age. CONCLUSION SARS-CoV-2-positive neonates revealed lower PDI scores and greater MDPs at 18th-24th months. The effect is most noticeable in Delta variant. Longer-term examination of neurodevelopmental outcomes and reevaluation of these children between the ages of 5 and 12 are critical.
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Affiliation(s)
- Ezgi Yangin Ergon
- Clinic of Neonatology, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey.
| | - Senem Alkan Ozdemir
- Clinic of Neonatology, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey
| | - Sinem Akbay Ak
- Clinic of Neonatology, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey
| | - Meltem Yenilmez
- Clinic of Pediatrics, Developmental and Behavioral Pediatrics Unit, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey
| | - Buse Soysal
- Clinic of Neonatology, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey
| | - Oğuz Han Kalkanlı
- Clinic of Neonatology, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey
| | - Şebnem Çalkavur
- Clinic of Neonatology, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey
| | - Tülin Gokmen Yıldırım
- Clinic of Neonatology, T.C. Ministry of Health, Izmir Provincial Health Directorate, H.S.U. Dr. Behcet Uz Children's Education and Research Hospital, 35210, Izmir, Turkey
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Eckermann HA, Meijer J, Cooijmans K, Lahti L, de Weerth C. Daily skin-to-skin contact alters microbiota development in healthy full-term infants. Gut Microbes 2024; 16:2295403. [PMID: 38197254 DOI: 10.1080/19490976.2023.2295403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
The gut microbiota is vital for human body development and function. Its development in early life is influenced by various environmental factors. In this randomized controlled trial, the gut microbiota was obtained as a secondary outcome measure in a study on the effects of one hour of daily skin-to-skin contact (SSC) for five weeks in healthy full-term infants. Specifically, we studied the effects on alpha/beta diversity, volatility, microbiota maturation, and bacterial and gut-brain-axis-related functional abundances in microbiota assessed thrice in the first year. Pregnant Dutch women (n = 116) were randomly assigned to the SSC or care-as-usual groups. The SSC group participants engaged in one hour of daily SSC from birth to five weeks of age. Stool samples were collected at two, five, and 52 weeks and the V4 region was sequenced. We observed significant differences in the microbiota composition, bacterial abundances, and predicted functional pathways between the groups. The SSC group exhibited lower microbiota volatility during early infancy. Microbiota maturation was slower in the SSC group during the first year and our results suggested that breastfeeding duration may have partially mediated this relation. Our findings provide evidence that postpartum SSC may influence microbiota development. Replication is necessary to validate and generalize these results. Future studies should include direct stress measurements and extend microbiota sampling beyond the first year to investigate stress as a mechanism and research SSC's impact on long-term microbiota maturation trajectories.
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Affiliation(s)
- Henrik Andreas Eckermann
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
| | - Jennifer Meijer
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
| | - Kelly Cooijmans
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Leo Lahti
- Department of Computing, University of Turku, Turku, Finland
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
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Baud O, Knoop M. [Oxytocin as a neuroprotective strategy in neonates: concept and preclinical evidence]. Gynecol Obstet Fertil Senol 2023:S2468-7189(23)00257-X. [PMID: 38145743 DOI: 10.1016/j.gofs.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Prematurity and intra-uterine growth retardation are responsible for brain damage associated with various neurocognitive and behavioral disorders in more than 9 million children each year. Most pharmacological strategies aimed at preventing perinatal brain injury have not demonstrated substantial clinical benefits so far. In contrast, enrichment of the newborn's environment appears to have positive effects on brain structure and function, influences newborn hormonal responses, and has lasting neurobehavioral consequences during infancy and adulthood. Oxytocin (OT), a neuropeptide released by the hypothalamus, may represent the hormonal basis for these long-term effects. METHOD This review of the literature summarizes the knowledge concerning the effect of OT in the newborn and the preclinical data supporting its neuroprotective effect. RESULTS OT plays a role during the perinatal period, in parent-child attachment and in social behavior. Furthermore, preclinical studies strongly suggest that endogenous and synthetic OT is capable of regulating the inflammatory response of the central nervous system in response to situations of prematurity or more generally insults to the developing brain. The long-term effect of synthetic OT administration during labor is also discussed. CONCLUSION All the conceptual and experimental data converge to indicate that OT would be a promising candidate for neonatal neuroprotection, in particular through the regulation of neuroinflammation.
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Affiliation(s)
- Olivier Baud
- Laboratoire du développement, Université de Genève, Genève, Suisse; Inserm U1141, Université Paris Cité, Paris, France; Service de Soins Intensifs Pédiatriques et Néonatologie, Hôpitaux Universitaires de Genève, Genève, Suisse.
| | - Marit Knoop
- Laboratoire du développement, Université de Genève, Genève, Suisse
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Yildirim F, Büyükkayaci Duman N, Şahin E, Vural G. The Effect of Kangaroo Care on Paternal Attachment: A Randomized Controlled Study. Adv Neonatal Care 2023; 23:596-601. [PMID: 37884013 DOI: 10.1097/anc.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND During the first interaction between the father and the infant, touch can be very important especially father-infant skin-to-skin contact. Few studies have focused on the effect of kangaroo care (KC) on paternal attachment. PURPOSE This randomized controlled study was conducted to determine the effect of KC on paternal attachment. METHODS A total of 90 fathers of healthy newborns, including 45 in the intervention group and 45 in the control group who met the inclusion criteria, were included randomly in the study. Data were collected using the Introductory Information Form at study admission and the Father-Infant Attachment Scale (FIAS) at 3 months of age. T test, Mann-Whitney U test, and Kruskal-Wallis test were used for statistical analysis. RESULTS The mean FIAS scores for the intervention group (I) were higher than for the control group (C) (I: 80.57 ± 13.70; C: 56.76 ± 13.23) ( P < .05). Patience and tolerance (I: 13.70 ± 1.18; C: 11.57 ± 2.30), pleasure in interaction (I: 29.50 ± 2.86; C: 17.13 ± 5.93), and love and pride (I: 37.37 ± 2.85; C: 28.06 ± 5.82) mean scores for FIAS subdimensions in the intervention group were also higher than in the control group ( P < .05). IMPLICATIONS FOR PRACTICE AND RESEARCH Findings of this study demonstrate that KC has the potential to increase paternal attachment. Healthcare providers should provide discharge education for fathers on KC to increase father-infant attachment. There is a need for studies with larger samples in different cultures on the factors related to parents that affect father-infant attachment and evidence-based practices that increase attachment.
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Affiliation(s)
- Fatma Yildirim
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Hitit University, Çorum, Turkey (Drs Yildirim and Duman); Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey (Dr Şahin); and Yüksek I˙htisas University, Faculty of Health Sciences, Obstetrics and Gynecology Department, Ankara, Turkey (Dr Vural)
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Pallás-Alonso C, Montealegre A, Hernández-Aguilar MT, Muñoz-Amat B, Collados-Gómez L, Jiménez-Fernández L, García-Lara N, Cabrera-Lafuente M, Moral-Pumarega MT, López-Maestro M, Charpak N. XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support. Acta Paediatr 2023; 112:2478-2485. [PMID: 37667990 DOI: 10.1111/apa.16960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
AIM This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC). METHODS The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation. RESULTS Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability. CONCLUSION Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.
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Affiliation(s)
- Carmen Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Adriana Montealegre
- Fundación Canguro Bogotá, Bogotá, Colombia
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Bárbara Muñoz-Amat
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Laura Collados-Gómez
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
- Nursing and Nutrition Department, Faculty of Biomedicine, Universidad Europea, Madrid, Spain
| | | | - Nadia García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Marta Cabrera-Lafuente
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
- Spanish Neonatal BFHI Coordinator, Madrid, Spain
| | - María Teresa Moral-Pumarega
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - María López-Maestro
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
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Klemming S, Lilliesköld S, Arwehed S, Jonas W, Lehtonen L, Westrup B. Mother-newborn couplet care: Nordic country experiences of organization, models and practice. J Perinatol 2023; 43:17-25. [PMID: 38086962 PMCID: PMC10716037 DOI: 10.1038/s41372-023-01812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023]
Abstract
Mother-Newborn Couplet Care is a concept and is defined as the provision of care for a sick or preterm newborn in close proximity to and coupled with the care for the mother from the birth of the infant and for as long as the mother needs hospital care. This concept of care requires system change in both obstetrics and pediatrics in terms of the planning and organization of care, equipment and design of units. Accordingly, strong leadership setting clear goals and emphasizing a culture of cohesive care, supported by targeted education and training is crucial to ensure high-quality care of all mother-newborn dyads without separation. We describe various organizational models of Mother-Newborn Couplet Care used in Sweden and Finland and implementation processes. We envision a future where newborns and mothers are always together, irrespective of medical needs, and form an inseparable center around which healthcare services and providers are organized.
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Affiliation(s)
- Stina Klemming
- Lund-Malmö NIDCAP Training and Research Center, Department of Neonatology, Skåne University Hospital, Lund, Sweden.
| | - Siri Lilliesköld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Arwehed
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neonatology, Uppsala University Hospital, Uppsala, Sweden
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Liisa Lehtonen
- Faculty of Medicine, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescence Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Björn Westrup
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Brown C, Bhatti Y, Harris M. Environmental sustainability in healthcare systems: role of frugal innovation. BMJ 2023; 383:e076381. [PMID: 37783474 DOI: 10.1136/bmj-2023-076381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Cyan Brown
- Department of Bioengineering, Biodesign, Stanford University, USA
| | - Yasser Bhatti
- MBS College of Business and Entrepreneurship, Saudi Arabia
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, UK
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Murthy R, Kallesh A, Somasekhara Aradhya A, Bharadwaj SK, Venkatagiri P, Jagadish M, Rao P, Chandramouli D, Hema D, Chaithra SN, Glory H, Purkayastha J. Sustaining extended Kangaroo mother care in stable low birthweight babies in NICU: a quality improvement collaborative of six centres of Karnataka. BMJ Open Qual 2023; 12:e002307. [PMID: 37863504 PMCID: PMC10603408 DOI: 10.1136/bmjoq-2023-002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/21/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Kangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies from a baseline of 1.5 hours/baby/day to above 4 hours/baby/day through a series of plan-do-study-act (PDSA) cycles over a period of 53 weeks. METHODS All babies with birth weight <2000 g not on any respiratory support or phototherapy and or umbilical lines were eligible. The key quantitative outcome was KMC hours/baby/day. A QI collaborative was formed between six centres of Karnataka mentored by a team with a previous QI experience on KMC. The potential barriers for extended KMC were evaluated using fishbone analysis. Baseline data were collected over 3 weeks. A bundled approach consisting of a variety of parent centric measures (such as staff awareness, making KMC an integral part of treatment order, foster KMC, awareness sessions to parents weekly, recognising KMC champions) was employed in multiple PDSA cycles. The data were aggregated biweekly and the teams shared their implementation experiences monthly. RESULTS A total of 1443 parent-baby dyads were enrolled. The majority barriers were similar across the centres. Bundled approach incorporating foster KMC helped in the quick implementation of KMC even in outborns. Parental involvement and empowering nurses helped in sustaining KMC. Two centres had KMC rates above 10 hours/baby/day, while remaining four centres had KMC rates sustained above 6 hours/baby/day. Cross-learnings from team meetings helped to sustain efforts. Extended KMC could be implemented and sustained by low intensity training and QI collaboration. CONCLUSIONS Formation of a QI collaborative with mentoring helped in scaling implementation of extended KMC. Extended KMC could be implemented by parent centric best practices in all the centres without any additional need of resources.
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Affiliation(s)
| | - Anil Kallesh
- Pediatrics, Sarji Hospital, Shimoga, Karnataka, India
| | | | | | | | | | | | - Divya Chandramouli
- Pediatrics, Ovum Woman & Child Speciality Hospital Banaswadi, Bangalore, Karnataka, India
| | | | - S N Chaithra
- Pediatrics, Sarji Hospital, Shimoga, Karnataka, India
| | - Hellan Glory
- Pediatrics, Ovum Woman & Child Speciality Hospital Banaswadi, Bangalore, Karnataka, India
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Bourque SL, Williams VN, Scott J, Hwang SS. The Role of Distance from Home to Hospital on Parental Experience in the NICU: A Qualitative Study. Children (Basel) 2023; 10:1576. [PMID: 37761537 PMCID: PMC10529472 DOI: 10.3390/children10091576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
Prolonged admission to the neonatal intensive care unit presents challenges for families, especially those displaced far from home. Understanding specific barriers to parental engagement in the NICU is key to addressing these challenges with hospital-based interventions. The objective of this qualitative study was to explore the impact of distance from home to hospital on the engagement of parents of very preterm infants (VPT) in the neonatal intensive care unit (NICU). We used a grounded theory approach and conducted 13 qualitative interviews with parents of VPT who were admitted ≥14 days and resided ≥50 miles away using a semi-structured interview guide informed by the socio-ecological framework. We used constant comparative method with double coders for theme emergence. Our results highlight a multitude of facilitators and barriers to engagement. Facilitators included: (1) individual-delivery preparedness and social support; (2) environmental-medical team relationships; and (3) societal-access to perinatal care. Barriers included: (1) individual-transfer stressors, medical needs, mental health, and dependents; (2) environmental-NICU space, communication, and lack of technology; and (3) societal-lack of paid leave. NICU parents with geographic separation from home experienced a multitude of barriers to engagement, many of which could be addressed by hospital-based interventions.
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Affiliation(s)
- Stephanie L. Bourque
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (S.S.H.)
| | - Venice N. Williams
- Department of Pediatrics, Prevention Research Center for Family & Child Health, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Jessica Scott
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (S.S.H.)
| | - Sunah S. Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (S.S.H.)
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Webbe J, Baba A, Butcher NJ, Rodrigues C, Stallwood E, Goren K, Monsour A, Chang ASM, Trivedi A, Manley BJ, McCall E, Bogossian F, Namba F, Schmölzer GM, Popat H, Nguyen KA, Doyle LW, Jardine L, Rysavy MA, Konstantinidis M, Muhd Helmi MA, Lai NM, Hay S, Onland W, Choo YM, Gale C, Soll RF, Offringa M. Strengthening Reporting of Neonatal Trials. Pediatrics 2023; 152:e2022060765. [PMID: 37641894 DOI: 10.1542/peds.2022-060765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is variability in the selection and reporting of outcomes in neonatal trials with key information frequently omitted. This can impact applicability of trial findings to clinicians, families, and caregivers, and impair evidence synthesis. The Neonatal Core Outcomes Set describes outcomes agreed as clinically important that should be assessed in all neonatal trials, and Consolidated Standards of Reporting Trials (CONSORT)-Outcomes 2022 is a new, harmonized, evidence-based reporting guideline for trial outcomes. We reviewed published trials using CONSORT-Outcomes 2022 guidance to identify exemplars of neonatal core outcome reporting to strengthen description of outcomes in future trial publications. METHODS Neonatal trials including >100 participants per arm published between 2015 to 2020 with a primary outcome included in the Neonatal Core Outcome Set were identified. Primary outcome reporting was reviewed using CONSORT 2010 and CONSORT-Outcomes 2022 guidelines by assessors recruited from Cochrane Neonatal. Examples of clear and complete outcome reporting were identified with verbatim text extracted from trial reports. RESULTS Thirty-six trials were reviewed by 39 assessors. Examples of good reporting for CONSORT 2010 and CONSORT-Outcomes 2022 criteria were identified and subdivided into 3 outcome categories: "survival," "short-term neonatal complications," and "long-term developmental outcomes" depending on the core outcomes to which they relate. These examples are presented to strengthen future research reporting. CONCLUSIONS We have identified examples of good trial outcome reporting. These illustrate how important neonatal outcomes should be reported to meet the CONSORT 2010 and CONSORT-Outcomes 2022 guidelines. Emulating these examples will improve the transmission of information relating to outcomes and reduce associated research waste.
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Affiliation(s)
- James Webbe
- Neonatal Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Craig Rodrigues
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emma Stallwood
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Katherine Goren
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Alvin S M Chang
- Quality, Safety and Risk Management (QSRM) and Department of Neonatology, KK Women's and Children's Hospital, Singapore
- DUKE-NUS Medical School, Singapore
| | - Amit Trivedi
- The Children's Hospital at Westmead, New South Wales, Australia
| | | | - Emma McCall
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | | | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | | | - Himanshu Popat
- The Children's Hospital at Westmead, New South Wales, Australia
| | | | - Lex W Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Luke Jardine
- Department of Neonatology, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Australia
| | - Matthew A Rysavy
- University of Texas Health Science Centre at Houston, Houston, Texas
| | - Menelaos Konstantinidis
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Muhd Alwi Muhd Helmi
- Department of Paediatrics, International Islamic University, Kuala Lumpur, Malaysia
| | - Nai Ming Lai
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Susanne Hay
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Yao Mun Choo
- Neonatal Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Roger F Soll
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Gobezayehu AG, Lijalem M, Endalamaw LA, Mohammad H, Beyene T, Mekonnen TB, Abay GG, Sibley LM, Cranmer JN. Creation of a globally informed and locally relevant KMC implementation model for population-impact in Amhara, Ethiopia. Acta Paediatr 2023; 112 Suppl 473:42-55. [PMID: 36544262 DOI: 10.1111/apa.16587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
AIM As part of a multi-country implementation trial, we tested a regionally specific model of kangaroo mother care (KMC). Effective KMC was defined as ≥8 h of newborn-caregiver skin-to-skin contact daily plus exclusive breast feeding. The study was designed to achieve ≥80+% effective KMC coverage at the population level. METHODS The Amhara KMC model was designed using global evidence, formative research in the region and input from government officials, clinicians, newborn families and global scientists. We optimised the initial model using continuous quality improvement with process feedback, outcome measurement and collaborative re-design. Outcomes from the evaluation period are reported. RESULTS At discharge, the final model resulted in a median of 16 h per day of skin-to-skin contact with 63% effective KMC coverage. Fifty-three percent sustained effective KMC to 7 days post-discharge. CONCLUSIONS It is possible to achieve high coverage (63%), high-quality KMC at public hospitals without prior KMC services using government-owned, multisectoral collaborative design. Targeted co-design, real-time data and customisation of KMC interventions with input from impacted stakeholders was critical in achieving high coverage and sustained quality.
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Campanha PDPA, Magalhães-Barbosa MCD, Rodrigues-Santos G, Prata-Barbosa A, Cunha AJLAD. Maternal-fetal and neonatal characteristics associated with Kangaroo-Mother Care Method adherence. J Pediatr (Rio J) 2023; 99:355-361. [PMID: 36716789 PMCID: PMC10373141 DOI: 10.1016/j.jped.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To describe the association of maternal and neonatal characteristics with the adherence status to the in-hospital stages of the Kangaroo-Mother Care Method - KMC (full, partial, and no-adherence). METHODS Retrospective cohort study including infants < 2500 g admitted to a reference maternity hospital for the KMC in Rio de Janeiro from January to December 2018. Maternal and neonatal characteristics were distributed according to the adherence status to the KMC in-hospital stages. In the first stage, KMC is performed in Neonatal Intensive Care Unit and Conventional Neonatal Intermediate Care Unit. The second stage is completed in Kangaroo Neonatal Intermediate Care Unit. Multinomial multiple regression was performed with KMC adherence as a three-category dependent variable and maternal and neonatal characteristics as independent variables. RESULTS Of 166 dyads, 102 (61.5%) participated in two stages. Those who did not participate in any stage (n = 52; 31.3%) had a lower level of education, a higher frequency of adverse conditions, and were more often single mothers; mothers who participated only in the first stage (n = 12; 7,2%) had more premature and sick infants. Conditions associated with adherence to the two stages compared to no adherence were: high school education (OR = 2.34; 95% CI = 1.08-5.07), presence of a partner (OR = 3.82; 95% CI = 1.7-8.61), no adverse conditions (OR = 3.54; 95% CI = 1.59-7.89) and no neonatal resuscitation (OR = 2.73; 95% CI = 1.22-6.1). CONCLUSIONS The study identified maternal and neonatal conditions associated with adherence status to the KMC. The results suggest opportunities to improve adherence.
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Affiliation(s)
- Patrícia de Padua Andrade Campanha
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Secretaria Municipal de Saúde do Rio de Janeiro - Maternidade Leila Diniz, Rio de Janeiro, RJ, Brazil.
| | - Maria Clara de Magalhães-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil; Instituto de Puericultura e Pediatria Martagão Gesteira da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Arnaldo Prata-Barbosa
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | - Antônio José Ledo Alves da Cunha
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
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15
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Medvedev MM, Tumukunde V, Kirabo-Nagemi C, Greco G, Mambule I, Katumba K, Waiswa P, Tann CJ, Elbourne D, Allen E, Ekirapa-Kiracho E, Pitt C, Lawn JE. Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda. BMC Health Serv Res 2023; 23:613. [PMID: 37301974 DOI: 10.1186/s12913-023-09624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Preterm birth complications result in > 1 million child deaths annually, mostly in low- and middle-income countries. A World Health Organisation (WHO)-led trial in hospitals with intensive care reported reduced mortality within 28 days among newborns weighing 1000-1799 g who received immediate kangaroo mother care (iKMC) compared to those who received standard care. Evidence is needed regarding the process and costs of implementing iKMC, particularly in non-intensive care settings. METHODS We describe actions undertaken to implement iKMC, estimate financial and economic costs of essential resources and infrastructure improvements, and assess readiness for newborn care after these improvements at five Ugandan hospitals participating in the OMWaNA trial. We estimated costs from a health service provider perspective and explored cost drivers and cost variation across hospitals. We assessed readiness to deliver small and sick newborn care (WHO level-2) using a tool developed by Newborn Essential Solutions and Technologies and the United Nations Children's Fund. RESULTS Following the addition of space to accommodate beds for iKMC, floor space in the neonatal units ranged from 58 m2 to 212 m2. Costs of improvements were lowest at the national referral hospital (financial: $31,354; economic: $45,051; 2020 USD) and varied across the four smaller hospitals (financial: $68,330-$95,796; economic: $99,430-$113,881). In a standardised 20-bed neonatal unit offering a level of care comparable to the four smaller hospitals, the total financial cost could be in the range of $70,000 to $80,000 if an existing space could be repurposed or remodelled, or $95,000 if a new unit needed to be constructed. Even after improvements, the facility assessments demonstrated broad variability in laboratory and pharmacy capacity as well as the availability of essential equipment and supplies. CONCLUSIONS These five Ugandan hospitals required substantial resource inputs to allow safe implementation of iKMC. Before widespread scale-up of iKMC, the affordability and efficiency of this investment must be assessed, considering variation in costs across hospitals and levels of care. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in settings where space, devices, and specialised staff for newborn care are unavailable. TRIAL REGISTRATION ClinicalTrials.gov, NCT02811432 . Registered: 23 June 2016.
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Affiliation(s)
- Melissa M Medvedev
- Department of Pediatrics, University of California San Francisco, 550 16th St., Box 1224, San Francisco, CA, 94158, USA.
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK.
| | - Victor Tumukunde
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Charity Kirabo-Nagemi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Giulia Greco
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl., London, WC1H 9SH, UK
| | - Ivan Mambule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Kenneth Katumba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl., London, WC1H 9SH, UK
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, New Mulago Hill Rd., Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Cally J Tann
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Neonatal Medicine, University College London Hospital, 235 Euston Rd, London, NW1 2BU, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, New Mulago Hill Rd., Kampala, Uganda
| | - Catherine Pitt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Pl., London, WC1H 9SH, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK
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Darmstadt GL, Kirkwood B, Gupta S. WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal-infant care. Lancet 2023; 401:1751-1753. [PMID: 37207686 DOI: 10.1016/s0140-6736(23)01000-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Charpak N, Montealegre-Pomar A. Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia. BMJ Glob Health 2023; 8:bmjgh-2022-011192. [PMID: 37208122 DOI: 10.1136/bmjgh-2022-011192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of these high-risk newborns.Here, we describe an overview analysis performed in an unprecedented data set comprising Colombian infants and spanning 28 years. METHODS Cohort study of 57 154 infants discharged home in kangaroo position (KP) for follow-up in four KMCPs between 1993 and 2021. RESULTS At birth and at hospital discharge to a KMCP, median gestational age and weight were 34.5 and 36 weeks, 2000 g and 2200 g, respectively. Chronological age at admission was 8 days. Over time, anthropometric measures at birth and somatic growth during follow-up improved; on the other hand, percentages of mechanical ventilation, intraventricular haemorrhage and need for intensive care decreased as neuropsychomotor, sensory disorders and bronchopulmonary dysplasia incidence at 40 weeks. Risk of cerebral palsy and teenage mothers' frequency was higher in the poorest population. Early home discharge in KP in less than 72 hours was possible in 19% of the cohort. During the COVID-19 pandemic, we observed a more than twofold increase in exclusive breast feeding at 6 months and a reduction in readmission rates. CONCLUSION This study provides a general overview of KMCPs follow-up during the last 28 years within the Colombian healthcare system. These descriptive analyses have allowed us to structure KMC as an evidence-based method. KMCPs allow close monitoring with regular feedback about preterm or LBW infants' perinatal care, quality of care over time and health status during their first year of life. Monitoring these outcomes is challenging but guarantees access to high-risk infants' care with equity.
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Affiliation(s)
| | - Adriana Montealegre-Pomar
- Research Group, Kangaroo Foundation, Bogota DC, Colombia
- Facultad de Medicina, Departamento de Pediatría, Pontificia Universidad Javeriana, Bogota, Colombia
- Neonatal Unit, Hospital Universitario San Ignacio, Bogota, Colombia
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Adejuyigbe EA, Agyeman I, Anand P, Anyabolu HC, Arya S, Assenga EN, Badhal S, Brobby NW, Chellani HK, Chopra N, Debata PK, Dube Q, Dua T, Gadama L, Gera R, Hammond CK, Jain S, Kantumbiza F, Kawaza K, Kija EN, Lal P, Mallewa M, Manu MK, Mehta A, Mhango T, Naburi HE, Newton S, Nyanor I, Nyako PA, Oke OJ, Patel A, Phlange-Rhule G, Sehgal R, Singhal R, Wadhwa N, Yiadom AB. Evaluation of the impact of continuous Kangaroo Mother Care (KMC) initiated immediately after birth compared to KMC initiated after stabilization in newborns with birth weight 1.0 to < 1.8 kg on neurodevelopmental outcomes: Protocol for a follow-up study. Trials 2023; 24:265. [PMID: 37038239 PMCID: PMC10088121 DOI: 10.1186/s13063-023-07192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/20/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Preterm birth or low birth weight is the single largest cause of death in newborns, however this mortality can be reduced through newborn care interventions, including Kangaroo Mother Care (KMC). Previously, a multi-country randomized controlled trial, coordinated by the World Health Organization (WHO), reported a significant survival advantage with initiation of continuous KMC immediately after birth compared with initiation of continuous KMC a few days after birth when the baby is considered clinically stable. Whether the survival advantage would lead to higher rates of neurodevelopmental morbidities, or the immediate KMC will also have a beneficial effect on cognitive development also, has not been investigated. We therefore propose to test the hypothesis that low-birth-weight infants exposed to immediate KMC will have lower rates of neurodevelopmental impairment in comparison to traditional KMC-treated infants, by prospectively following up infants already enrolled in the immediate KMC trial for the first 2 years of life, and assessing their growth and neurodevelopment. METHODS This prospective cohort study will enroll surviving neonates from the main WHO immediate KMC trial. The main trial as well as this follow-up study are being conducted in five low- and middle-income countries in South Asia and sub-Saharan Africa. The estimated sample size for comparison of the risk of neurodevelopmental impairment is a total of 2200 children. The primary outcome will include rates of cerebral palsy, hearing impairment, vision impairment, mental and motor development, and epilepsy and will be assessed by the age of 3 years. The analysis will be by intention to treat. DISCUSSION Immediate KMC can potentially reduce low-birth-weight-associated complications such as respiratory disease, hypothermia, hypoglycemia, and infection that can result in impaired neurocognitive development. Neuroprotection may also be mediated by improved physiological stabilization that may lead to better maturation of neural pathways, reduced risk of hypoxia, positive parental impact, improved sleep cycles, and improved stress responses. The present study will help in evaluating the overall impact of KMC by investigating the long-term effect on neurodevelopmental impairment in the survivors. TRIAL REGISTRATION Clinical Trials Registry-India CTRI/2019/11/021899. Registered on 06 November 2019. Trials registration of parent trial: ACTRN12618001880235; Clinical Trials Registry-India: CTRI/2018/08/015369.
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Affiliation(s)
- E A Adejuyigbe
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - I Agyeman
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P Anand
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - H C Anyabolu
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - S Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - E N Assenga
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Badhal
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - N W Brobby
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - H K Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India.
| | - N Chopra
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - P K Debata
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Q Dube
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - T Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - L Gadama
- Department of Obstetrics and Gynaecology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - R Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - C K Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Jain
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - F Kantumbiza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - K Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - E N Kija
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - P Lal
- Atal Bihari Vajpayee Institute of Medical Sciences &, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - M Mallewa
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - M K Manu
- Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - A Mehta
- Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - T Mhango
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - H E Naburi
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, 255, Tanzania
| | - S Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - I Nyanor
- Research and Development, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - P A Nyako
- Department of Psychiatry, Child And Adolescent Mental Health, Komfo Anokye Teaching Hospital, P.O. Box 1934, Adum, Kumasi, Ghana
| | - O J Oke
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, 220005, Nigeria
| | - A Patel
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- Division of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - G Phlange-Rhule
- Clinical Development Services Agency (CDSA), Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, Faridabad, 121001, India
| | - R Sehgal
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - R Singhal
- Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, PO Box #04, 121001, Faridabad, India
| | - N Wadhwa
- Faridabad-Gurgaon Expressway, Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3Rd MilestonePost Box #04, Faridabad, Haryana, 121001, India.
| | - A B Yiadom
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Sahoo M, Dubey B, Vani K, Maria A. Changes in cerebral blood flow parameters among preterm 30-34 week neonates who are initiated on kangaroo mother care - A prospective analytical observational study. Early Hum Dev 2023; 180:105764. [PMID: 37031613 DOI: 10.1016/j.earlhumdev.2023.105764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/30/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Kangaroo mother care (KMC) is recommended standard of care for preterm neonates. They are vulnerable for cerebral blood flow (CBF) fluctuations linked to intraventricular hemorrhage and periventricular leukomalacia, which have implications on neurodevelopment. This study was designed to document any change in CBF in middle cerebral artery (MCA) of stabilized preterm 30-34 weeks neonates who are initiated on KMC. METHODS We designed a prospective analytical observational study in a tertiary care neonatal unit. We enrolled 30-34 weeks preterm neonates eligible for KMC after their stabilization (n = 40). CBF was measured in supine position via right MCA Doppler through the temporal window before any KMC, after 2 h of 1st KMC session and following 24 h of 1st session. CBF was quantified in terms of pulsatility index (PI), Resistive Index (RI), peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV) and values were compared against the existing normative values. RESULTS Mean gestation of study population was 31.91 weeks with a mean birth weight of 1432.75 g. Median day of initiation of KMC was 7 days with mean duration of KMC on day 1 was 4.56 h. We could find statistically significant decrease in the values of PI and RI from 90th centile towards 50th centile of normative values with a mean difference of 0.22 (99 % CI 0.02-0.43, p 0.005) for PI and 0.05 (99 % CI 0.02-0.07, p = 0.000) for RI post the first session of KMC. Following 24 h of 1st KMC session, we could find a significant increase in values of PSV, EDV and MV comparing values of pre-initiation with day 2 pre-KMC but values of PI and RI were not significantly different. CONCLUSION CBF among 30-34 week preterm neonates tend to optimize after initiation of KMC.
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Affiliation(s)
- Manaswinee Sahoo
- Department of neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India.
| | - Bhawna Dubey
- Department of neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India
| | - Kavita Vani
- Department of Radio diagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India
| | - Arti Maria
- Department of neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Institute of Medical Sciences, New Delhi, India
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Bedetti L, Lugli L, Bertoncelli N, Spaggiari E, Garetti E, Lucaccioni L, Cipolli F, Berardi A. Early Skin-to-Skin Contact in Preterm Infants: Is It Safe? An Italian Experience. Children 2023; 10:children10030570. [PMID: 36980127 PMCID: PMC10047376 DOI: 10.3390/children10030570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
Background: Skin-to-skin contact (SSC) is one of the four components of kangaroo care (KC) and is also a valued alternative to incubators in low-income countries. SSC has also become a standard of care in high-income countries because of its short- and long-term benefits and its positive effect on infant growth and neurodevelopmental outcome. However, barriers in the implementation of SSC, especially with preterm infants, are common in NICUs because parents and health care professionals can perceive it as potentially risky for the clinical stability of preterm infants. Previous studies have assessed safety before and during SSC by monitoring vital parameters during short-time intervals. Aims: To demonstrate the safety of early SSC in preterm infants during at least 90 min intervals. Design: Prospective observational monocentric study. Methods: Preterm infants born between June 2018 and June 2020 with a gestational age of ≤33 weeks and a birth weight of <2000 g were monitored while performing an SSC session during the first three weeks of life. Infants with necrotizing enterocolitis, sepsis, and congenital malformations on mechanical ventilation or with more than five apneas in the hour before SSC were excluded. Continuous oxygen saturation (SaO2), heart rate (HR), and respiratory rate (RR) were registered during an SSC session and in the hour before. The minimum duration of an SSC session was 90 min. Information regarding postmenstrual age (PMA), body weight, respiratory support, presence of a central venous catheter and the onset of sepsis within 72 h after a session was collected. Two physicians, blinded to infant conditions and the period of analysis (before or during SSC), evaluated desaturation episodes (SaO2 < 85%, >15 s), bradycardia (HR < 100, >15 s) and apneas (pause in breathing > 20 s associated with desaturation and/or bradycardia). A Wilcoxon rank sum test was used for the statistical analysis. Results: In total, 83 episodes of SSC were analyzed for a total of 38 infants. The mean gestational age at birth was 29 weeks (range 23–33 weeks). Median PMA, days of life, and body weight at SSC were 31 weeks (range 25–34 weeks), 10 days (range 1–20 days), and 1131 g (range 631–2206 g), respectively. We found that 77% of infants were on respiratory support and 47% of them had a central venous catheter (umbilical or peripherally inserted central catheter) during SSC. The total duration of desaturation, bradycardia, and the number of apneas were not statistically different during the SSC session and the hour before. No catheter dislocation or ruptures were reported. Conclusions: These findings highlighted the safety of early SSC in preterm infants and the possibility of performing it in an intensive care setting in the first weeks of life. In addition, these findings should reassure health care professionals offering this practice as a standard of care. SSC plays a key role in the care of preterm infants due to its short- and long-term positive benefits, and it deserves to be increasingly offered to infants and their parents.
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Affiliation(s)
- Luca Bedetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Eugenio Spaggiari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Elisabetta Garetti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Federica Cipolli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
- Correspondence: ; Tel.: +39-594-222-522; Fax: +39-594-223-770
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Alexander SL, Frederico M, Long M, Vicendese D. Attachment security in children with disability or developmental delay: Systematic review of quality and interventions. Journal of Occupational Therapy, Schools, & Early Intervention 2023. [DOI: 10.1080/19411243.2023.2177237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Stacey L. Alexander
- Department of Occupational Therapy, Social Work, and Social Policy, La Trobe University, Melbourne, Victoria, Australia
| | - Margarita Frederico
- Department of Occupational Therapy, Social Work, and Social Policy, La Trobe University, Melbourne, Victoria, Australia
| | - Maureen Long
- Department of Occupational Therapy, Social Work, and Social Policy, La Trobe University, Melbourne, Victoria, Australia
| | - Don Vicendese
- Department of Occupational Therapy, Social Work, and Social Policy, La Trobe University, Melbourne, Victoria, Australia
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George S, Showalter D, Graham K. Implementing the Role of Neonatal Assessment Nurse to Improve Skin-to-Skin Care and Breastfeeding Exclusivity. Nurs Womens Health 2023; 27:79-89. [PMID: 36773627 DOI: 10.1016/j.nwh.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/01/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To improve rates of exclusive breastfeeding during the postpartum hospital stay by implementing a new role of dedicated neonatal assessment nurse (NAN), whose primary function was neonatal care beginning immediately after birth. DESIGN Quality improvement project with plan-do-study-act using evidence-based guidelines for implementing the NAN role. SETTING/LOCAL PROBLEM Labor and delivery department of a tertiary care teaching hospital in the southeastern United States; breastfeeding exclusivity rates at this hospital were in the range of 50%. PARTICIPANTS Registered nurses employed in the labor-delivery-recovery unit, mother-baby unit, and NICU. INTERVENTION/MEASUREMENTS The NAN role was implemented to promote immediate skin-to-skin care (SSC) for stable newborns after vaginal and cesarean birth. Each NAN's competency was evaluated at the beginning and end of the education session through a pretest/posttest, and a skills validation was used to affirm their readiness for the new role. The outcome measure was breastfeeding exclusivity at the time of discharge from the hospital. SSC initiation and duration immediately after birth were the process measures. RESULTS Twenty-five bedside registered nurses participated in this quality improvement project. There was a statistically significant difference between the pretest and posttest scores (p < .001), indicating a knowledge increase. All nurses met the skills validation criteria. The rate of SSC immediately after vaginal birth increased from 49% to 82% and after cesarean birth from 33% to 63%. Breastfeeding exclusivity rate at the time of discharge from the hospital increased from 50% to 86%. CONCLUSION The NAN role provided transitional care at the bedside without the separation of mothers and newborns. This was an innovative role, without the need to hire new staff, that provided evidence-based care, resulting in improved SSC and exclusivity of breastfeeding before discharge.
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23
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Baud O, Knoop M, Jacquens A, Possovre ML. [Oxytocin: a new target for neuroprotection?]. Biol Aujourdhui 2023; 216:145-153. [PMID: 36744980 DOI: 10.1051/jbio/2022012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 02/07/2023]
Abstract
Every year, 30 million infants worldwide are delivered after intra-uterine growth restriction (IUGR) and 15 million are born preterm. These two conditions are the leading causes of ante-/perinatal stress and brain injury responsible for neurocognitive and behavioral disorders affecting more than 9 million children each year. Most pharmacological candidates to prevent perinatal brain damage have failed to demonstrate substantial benefits. In contrast, environment enrichment based on developmental care, skin-to-skin contact and vocal/music exposure appear to exert positive effects on brain structure and function. However, mechanisms underlying these effects remain unknown. There is strong evidence that an adverse environment during pregnancy and the neonatal period can influence hormonal responses of the newborn with long-lasting neurobehavioral consequences in infancy and adulthood. In particular, excessive cortisol release in response to perinatal stress associated with prematurity or IUGR is recognized to induce brain-programming effects and neuroinflammation, a key predictor of subsequent neurological impairments. These deleterious effects are known to be balanced by oxytocin (OT), a neuropeptide released by the hypothalamus, which plays a role during the perinatal period and in social behavior. In addition, preclinical studies suggest that OT is able to regulate the central inflammatory response to injury in the adult brain. Using a rodent model of IUGR associated with developing white matter damage, we recently reported that carbetocin, a brain permeable OT receptor (OTR) agonist, induced a significant reduction of activated microglia, the primary immune cells of the brain. Moreover, this reduced microglia reactivity was associated with long-term neuroprotection. These findings make OT a promising candidate for neonatal neuroprotection through neuroinflammation regulation. However, the mechanisms linking endogenous OT and central inflammation response to injury have not yet been established. Further studies are needed to assess the protective role of OT in the developing brain through modulation of microglial activation, a key feature of brain injury observed in infants born preterm or growth-restricted. They are expected to have several impacts in the near future not only for improving knowledge of microglial cell physiology and reactivity during brain development, but also to design clinical trials testing interventions associated with endogenous OT release as a relevant strategy to alleviate neuroinflammation in neonates.
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Affiliation(s)
- Olivier Baud
- Laboratoire du développement, Université de Genève, Genève, Suisse - Inserm U1141, Université Paris Cité, 75019 Paris, France - Service de Soins Intensifs Pédiatriques et Néonatologie, Hôpitaux Universitaires de Genève, 30 boulevard de Cluse, 1205 Genève, Suisse
| | - Marit Knoop
- Laboratoire du développement, Université de Genève, Genève, Suisse
| | - Alice Jacquens
- Laboratoire du développement, Université de Genève, Genève, Suisse - Inserm U1141, Université Paris Cité, 75019 Paris, France
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Bembich S, Castelpietra E, Cont G, Travan L, Cavasin J, Dolliani M, Traino R, Demarini S. Cortical activation and oxygen perfusion in preterm newborns during kangaroo mother care: A pilot study. Acta Paediatr 2023; 112:942-950. [PMID: 36722000 DOI: 10.1111/apa.16695] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
AIM This study aimed to assess the functional activation of preterm newborns' cerebral cortex during kangaroo mother care. Possible effects of gestational age and previous kangaroo mother care experience were also considered. METHODS Fifteen preterm newborns were recruited (gestational age: 24-32 weeks). Cortical activation was assessed in frontal, motor and primary somatosensory cortices after 15 and 30 min of kangaroo mother care by multichannel near-infrared spectroscopy (gestational age at assessment: 30-36 weeks). Both oxy- and deoxy-haemoglobin variations were analysed by t-test. Possible effects of gestational age and previous kangaroo mother care experience on cortical activation were studied by regression analysis. RESULTS After 15 min, bilateral activations (oxy-haemoglobin increase) were observed in frontal, somatosensory and motor cortices. After 30 min, the right motor and primary somatosensory cortices were found activated. Deoxy-haemoglobin increased after 15 min, returning to baseline at 30 min. After 15 min, there was a positive effect of gestational age at the assessment on both haemoglobin concentrations and a negative effect of previous kangaroo mother care on deoxy-haemoglobin increase. CONCLUSION Motor and somatosensory cortices, particularly on the right side, showed significant activation during kangaroo mother care. Kangaroo mother care seems to benefit activated cortical areas by improving oxygen supply.
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Affiliation(s)
- Stefano Bembich
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elena Castelpietra
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Gabriele Cont
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Laura Travan
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Julia Cavasin
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Matteo Dolliani
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Rosaria Traino
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Sergio Demarini
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Sakonidou S, Kotzamanis S, Tallett A, Poots AJ, Modi N, Bell D, Gale C. Parents' Experiences of Communication in Neonatal Care (PEC): a neonatal survey refined for real-time parent feedback. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324548. [PMID: 36717224 DOI: 10.1136/archdischild-2022-324548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Assessing parent experiences of neonatal services can help improve quality of care; however, there is no formally evaluated UK instrument available to assess this prospectively. Our objective was to refine an existing retrospective survey for 'real-time' feedback. METHODS Co-led by a parent representative, we recruited a convenience sample of parents of infants in a London tertiary neonatal unit. Our steering group selected questions from the existing retrospective 61-question Picker survey (2014), added and revised questions assessing communication and parent involvement. We established face validity, ensuring questions adequately captured the topic, conducted parent cognitive interviews to evaluate parental understanding of questions,and adapted the survey in three revision cycles. We evaluated survey performance. RESULTS The revised Parents' Experiences of Communication in Neonatal Care (PEC) survey contains 28 questions (10 new) focusing on communication and parent involvement. We cognitively interviewed six parents, and 67 parents completed 197 PEC surveys in the survey performance evaluation. Missing entries exceeded 5% for nine questions; we removed one and format-adjusted the rest as they had performed well during cognitive testing. There was strong inter-item correlation between two question pairs; however, all were retained as they individually assessed important concepts. CONCLUSION Revised from the original 61-question Picker survey, the 28-question PEC survey is the first UK instrument formally evaluated to assess parent experience while infants are still receiving neonatal care. Developed with parents, it focuses on communication and parent involvement, enabling continuous assessment and iterative improvement of family-centred interventions in neonatal care.
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Affiliation(s)
- Susanna Sakonidou
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Sophia Kotzamanis
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | | | | | - Neena Modi
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Derek Bell
- NIHR CLAHRC for Northwest London, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
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Guittard C, Novo A, Eutrope J, Gower C, Barbe C, Bednarek N, Rolland AC, Caillies S, Loron G. Protocol for a prospective multicenter longitudinal randomized controlled trial (CALIN) of sensory-tonic stimulation to foster parent child interactions and social cognition in very premature infants. Front Pediatr 2023; 10:913396. [PMID: 36727004 PMCID: PMC9885178 DOI: 10.3389/fped.2022.913396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/15/2022] [Indexed: 01/17/2023] Open
Abstract
Introduction Premature birth is associated with long-term somatic and neurological disorders, including cognitive, social and behavioral impairments. Moreover, the mothers of infants born preterm exhibit a higher prevalence of anxiety and depressive symptoms after birth. Early rehabilitation, developmental care, and parenting support have already been shown to have a positive impact on neurological outcome. However, no randomized controlled study has so far assessed the effects on parenting and long-term neurological outcomes of proprioceptive stimulation to trigger positive brain plasticity in very preterm babies. The CALIN project will therefore investigate the impact of sensory-tonic stimulation (STS) of extremely preterm infants by their parents on child parent interactions, infants' morphological and functional brain development and subsequent cognition (including social cognition), and parents' anxiety and depressive symptoms in the postpartum period. Methods and analysis Infants born between 25 and 32 weeks of gestation will be randomly assigned to the "STS + Kangaroo care" or "Kangaroo care" group. The primary endpoint, child and parent interactions, will be rated at 12 months corrected age using the Coding Interactive Behavior system. Secondary endpoints include: 1/functional and anatomical brain maturation sequentially assessed during neonatal hospitalization using electroencephalogram (EEG), amplitude-integrated EEG (aEEG), cranial ultrasound and MRI performed at term-corrected age, 2/social and cognitive outcomes assessed at 15 months, 2, 4 and 6 years, and 3/parents' anxiety and depressive symptoms assessed at 7 ± 1 weeks after birth, using dedicated questionnaires. Ethics and dissemination This study was approved by the French Ethics Committee for the Protection of Persons on 18 October 2021. It is registered with the French National Agency for the Safety of Medicines and Health Products (ANSM; no. 2020-A00382-37). The registry number on ClinicalTrials.gov is NCT04380051.
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Affiliation(s)
| | - Alexandre Novo
- CHU Nantes, Département de Psychiatrie, Les Apsyades, Nantes, France
| | - Julien Eutrope
- Université de Reims Champagne-Ardenne, C2S, CHU Reims, Service de Pédopsychiatrie, Reims, France
| | - Corinne Gower
- CHU Reims, Unité d’Aide Méthodologique, Reims, France
| | - Coralie Barbe
- Université de Reims Champagne-Ardenne, Research on Health University Department, C2S, Reims, France
| | - Nathalie Bednarek
- Université de Reims Champagne-Ardenne, CReSTIC, CHU Reims, Service de Médecine Néonatale et de Réanimation Pédiatrique, Reims, France
| | - Anne-Catherine Rolland
- Université de Reims Champagne-Ardenne, C2S, CHU Reims, Service de Pédopsychiatrie, Reims, France
| | | | - Gauthier Loron
- Université de Reims Champagne-Ardenne, CReSTIC, CHU Reims, Service de Médecine Néonatale et de Réanimation Pédiatrique, Reims, France
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27
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Chaudhari AJ, Nimbalkar SM, Patel DV, Phatak AG. Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Neonates Assessed by Transcranial Doppler Sonography in Middle Cerebral Artery. Indian Pediatr 2023; 60. [PMID: 36333897 PMCID: PMC9885412 DOI: 10.1007/s13312-023-2690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective To study the effect of KMC in premature newborns on cerebral hemodynamics in the middle cerebral artery (MCA) using transcranial doppler sonography. Methods In this descriptive study, 40 clinically stable preterm neonates admitted to the neonatal intensive care unit of our institute and undergoing Kangaroo mother care (KMC) were enrolled. Physiological and cerebral blood flow parameters of MCA were obtained by using transcranial doppler sonography at baseline, at 60 minutes of KMC, and after 60 minutes of stopping KMC. Results Of the 40 enrolled neonates (24 males), the mean (SD) birth weight, gestation age, and postnatal age were 1698.25 (495.44) g, 33.00 (1.67) wk, and 6.80 (4.51) days, respectively. The mean (SD) cerebral blood flow velocities increased (peak systolic velocity (PSV), P=0.03; end diastolic velocity, P<0.001; mean velocity, P<0.001) and doppler indices decreased (resistive index, P=0.001; pulsatility index, P<0.001) significantly; whereas, heart rate (P<0.001) decreased but SpO2 (P=0.001) and mean blood pressure (P=0.003) increased significantly at 60 minutes of KMC as compared to baseline. Sixty minutes after stopping KMC, all parameters (except PSV) were higher than baseline, indicating post KMC effect. Conclusion KMC improves cerebral hemodynamics in clinically stable preterm neonates.
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Affiliation(s)
- Anal J. Chaudhari
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
| | - Somashekhar M. Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
- Central Research Services, Charutar Arogya Mandal, Bhaikaka University, Karamsad, Gujarat India
| | - Dipen V. Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
| | - Ajay G. Phatak
- Central Research Services, Charutar Arogya Mandal, Bhaikaka University, Karamsad, Gujarat India
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Rheinheimer N, Beijers R, Bruinhof N, Cooijmans KHM, de Weerth C. Effects of daily full-term infant skin-to-skin contact on behavior and cognition at age three - secondary outcomes of a randomized controlled trial. J Child Psychol Psychiatry 2023; 64:136-144. [PMID: 35942886 PMCID: PMC10087794 DOI: 10.1111/jcpp.13679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Daily skin-to-skin contact (SSC) during early infancy fosters the long-term development of children born preterm. This is the first randomized controlled trial assessing the potential beneficial effects of daily SSC on executive functioning and socio-emotional behavior of children born full-term. Whether children of mothers who experienced prenatal stress and anxiety benefitted more from SSC was also explored. METHODS Pregnant women (N = 116) were randomly assigned to a SSC or care-as-usual (CAU) condition. Women in the SSC condition were instructed to perform one hour of SSC daily from birth until postnatal week five. Prenatal stress was measured with questionnaires on general and pregnancy-specific stress and anxiety completed by the mothers in gestational week 37. At child age three, mothers filled in questionnaires on children's executive functioning, and externalizing and internalizing behavior. Analyses were performed in an intention-to-treat (ITT), per-protocol, and dose-response approach. Netherlands Trial Register: NL5591. RESULTS In the ITT approach, fewer internalizing (95% CI = 0.11-1.00, U = 2148.50, r = .24, p = .001) and externalizing (95% CI = 0.04-2.62, t = 2.04, d = 0.38, p = .04) problems were reported in the SSC condition compared to the CAU condition. Multivariate analyses of variance did not show group differences on executive functioning. Additional analyses of covariance showed no moderations by maternal prenatal stress. CONCLUSIONS Current findings indicate that early daily SSC in full-term infants may foster children's behavioral development. Future replications, including behavioral observations of child behavior to complement maternal reports, are warranted.
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Affiliation(s)
- Nicole Rheinheimer
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Nina Bruinhof
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Kelly H M Cooijmans
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lyne H, Burgoine K, Ogara C, Ditai J, Gladstone M. ‘They said, let’s teach you how you are going to care for the child at home…’: caregivers’ and healthcare worker’s perceptions and experiences of post-discharge preterm care in eastern Uganda. BMC Health Serv Res 2022; 22:1521. [DOI: 10.1186/s12913-022-08894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Complications of prematurity are the leading cause of neonatal mortality, and the majority of these deaths occur in low and middle-income countries. Research in these settings has focused on improved outcomes for preterm infants in hospital settings, however, research into the continuation of preterm care in the home after discharge from a neonatal unit is limited. This study examines the experiences and perceptions of caregivers of preterm infants during the initial weeks following discharge from a neonatal unit in Uganda, and the views of healthcare workers (HCWs) on the ability of caregivers to cope.
Methods
This qualitative study used multiple data collection approaches, namely focus group discussions (FGDs), in-depth interviews (IDIs), field observations, and case studies to explore the perceptions and experiences of providing care to preterm infants post-discharge from a neonatal unit in eastern Uganda from the perspectives of caregivers and HCWs.
Results
We recruited 39 participants with a total of 35 separate sessions including 18 IDIs (12 caregivers and 6 HCWs), 3 FGDs (17 caregivers), and 4 case studies (14 separate IDIs over 5 weeks after discharge, three mothers, and one grandmother). IDIs and FGDs took place at the Mbale Regional Referral Hospital or in participants’ homes.
Key themes emerged; preparation for continuing care in the home, psychosocial challenges to providing preterm care in the home, barriers to continuing preterm care in the home, and suggestions for improvement of preterm care in the home. Caregivers had good knowledge and awareness about different aspects of preterm care. Following discharge, caregivers struggled to maintain quality care due to loss of continuous support from the neonatal team, feelings of anxiety and isolation, financial issues, and home responsibilities.
Conclusion
This study highlights multiple challenges to continuing preterm care in this Ugandan setting. Improved training and education for caregivers, especially in neonatal resuscitation, enhanced and continued support of the caregiver and infant in the home, and increased community involvement following discharge may all be key solutions. These findings are fundamental to improving care in the home for preterm infants in eastern Uganda and similar settings.
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Cortés D, Maldonado D, Gallego J, Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Pico J. Comparing long-term educational effects of two early childhood health interventions. J Health Econ 2022; 86:102693. [PMID: 36323186 DOI: 10.1016/j.jhealeco.2022.102693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/20/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
We compare the educational effects of two medical protocols that mitigate long-term consequences of prematurity or low birth weight. The two protocols are Traditional Care (TC), which uses incubators, and Kangaroo Mother Care (KMC) which replaces incubators for 24-hour skin-to-skin contact between newborns and caregivers. We concentrate on educational outcomes addressing contradictory results in previous contributions. We use a randomized controlled trial implemented in 1993 that randomly assigned children to either TC or KMC. OLS results suggest that KMC children spent more time in preschool, had fewer temporary school absences, and showed lower math test scores. Both groups observed similar effects on high-school graduation and language test scores. We correct for attrition, small sample, and multiple outcomes. Effects on preschool attendance and school absenteeism are robust, particularly for more vulnerable infants (birth weight ≤ 1,800 g). The other effects lose statistical significance due to multiple outcome testing or attrition corrections.
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Affiliation(s)
- Darwin Cortés
- School of Economics, Universidad del Rosario, Colombia.
| | | | - Juan Gallego
- School of Economics, Universidad del Rosario, Colombia
| | | | | | - Juan Gabriel Ruiz
- Department of Medical and Population Health Sciences Research, Herber Wertheim, Florida International University, United States of America
| | | | - Felipe Uriza
- Hospital San Ignacio, Universidad Javeriana, Colombia
| | - Julieth Pico
- School of Economics, Universidad del Rosario, Colombia
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Le Ray I, Kuhn P, Letouzey M, Roué JM, Mitha A, Glorieux I, Foix-L'Hélias L, Marchand-Martin L, Ancel PY, Kaminski M, Pierrat V; Epipage 2 Neurodevelopmental care writing Group, EPIPAGE-2 Infectious diseases writing group. Early skin-to-skin contact and risk of late-onset-sepsis in very and extremely preterm infants. Pediatr Res 2022. [PMID: 36376509 DOI: 10.1038/s41390-022-02383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate the association between exposure to early skin-to-skin contact (SSC) and incidence of late-onset sepsis (LOS) in extremely and very preterm infants. METHODS Observational study using the national population-based EPIPAGE-2 cohort in 2011. A propensity score for SSC exposure was used to match infants with and without exposure to SSC before day 4 of life and binomial log regression used to estimate risk ratios and CIs in the matched cohort. The primary outcome was at least one episode of LOS during hospitalization. Secondary outcomes were the occurrence of any late-onset neonatal infection (LONI), LOS with Staphylococcus or Staphylococcus aureus, incidence of LOS and LONI per 1000 central venous catheter days. RESULTS Among the 3422 included infants, 919 were exposed to early SSC. The risk ratio (RR) for LOS was 0.86 (95% CI, 0.67-1.10), for LONI was 1.00 (95% CI, 0.83-1.21), and for LOS with Coagulase-negative Staphylococcus or Staphylococcus aureus infection was 0.91 (95% CI, 0.68-1.21) and 0.77 (95% CI, 0.31-1.87). The incidence RR for LOS per-catheter day was 0.87 (95% CI, 0.64-1.18). CONCLUSION Early SSC exposure was not associated with LOS or LONI risk. Thus, their prevention should not be a barrier to a wider use of SSC. IMPACT Kangaroo Mother Care decreased neonatal infection rates in middle-income countries. Skin-to-skin contact is beneficial for vulnerable preterm infants but barriers exist to its implementation. In a large population-based study using a propensity score methods, we found that skin-to-skin contact before day 4 of life was not associated with a decreased risk of late-onset-sepsis in very and extremely preterm infants. Early skin-to-skin contact was not associated with an increased risk of any late-onset-neonatal-infection, in particular with staphylococcus. The fear of neonatal infection should not be a barrier to a wider use of early skin-to-skin contact in this population.
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Cristo Borrero M, Goretty Trujillo T, Sanchez C, Salazar A, Cárdenas MP, Charpak N. Bayley-III and Griffiths-II scales performance in a cohort of premature infants followed in Colombia. Early Hum Dev 2022; 173:105660. [PMID: 36058138 DOI: 10.1016/j.earlhumdev.2022.105660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
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Souza RCD, Wolkers PCB, Pereira LA, Romão RS, Medeiros ES, Ferreira DMDLM, Rinaldi AEM, Azevedo VMGDO. The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding. J Pediatr (Rio J) 2022; 98:540-544. [PMID: 35257670 PMCID: PMC9510796 DOI: 10.1016/j.jped.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. METHOD Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. RESULTS The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. CONCLUSION The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.
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Affiliation(s)
- Rayany Cristina de Souza
- Pós-graduação em Ciências da Saúde/FAMED, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Rejane Sousa Romão
- Pós-graduação em Ciências da Saúde/FAMED, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Eliziane Santos Medeiros
- Pós-graduação em Ciências da Saúde/FAMED, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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Araújo CRV, Mota BEF, Campagnoli RR, Rocha-Rego V, Volchan E, Souza GGL. Decreased self-reported receiving of social touch and social support predict loneliness in healthy adults. Psicol Reflex Crit 2022; 35:25. [PMID: 35913547 PMCID: PMC9340735 DOI: 10.1186/s41155-022-00228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
Loneliness has emerged as a public health concern. Previous research has reported its deleterious effects on physical and mental health; however, some specific psychophysiological mechanisms in healthy adults remain to be elucidated. The aim of the current study is to investigate whether self-reported social support and social touch (giving and receiving social touch), as well as resting heart rate variability (HRV), are significant negative predictors of loneliness in healthy adults. The study sample consists of 120 healthy students (50% female) with a mean age of 21.85 years old (DP= 2.21). The students were asked to complete a psychiatric screening questionnaire utilizing loneliness, social support, and social touch scales. HRV was derived from an electrocardiographic signal recorded for 15 min, with the participant relaxed in a supine position. Linear regression analyses were conducted to evaluate loneliness as a function of social support, social touch (giving or receiving touch), and resting HRV. The results show that social support (p< 0.001) and social touch, specifically receiving touch (p< 0.002), accounted for a significant proportion of the variance in loneliness. However, neither giving touch nor resting HRV was a significant predictor of loneliness. The current study highlights specific psychosocial factors in healthy adults that should be considered as promising pathways in order to reduce or work toward preventing loneliness, thus promoting better health and well-being.
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Affiliation(s)
- Cássia Regina Vieira Araújo
- Laboratory of Psychophysiology, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Bruna Eugênia Ferreira Mota
- Laboratory of Psychophysiology, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.,School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Rafaela Ramos Campagnoli
- Biomedical Institute, Fluminense Federal University, Niterói, Brazil.,Department of Neurobiology, Institute of Biology, Fluminense Federal University, Niterói, Brazil
| | - Vanessa Rocha-Rego
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriela Guerra Leal Souza
- Laboratory of Psychophysiology, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.
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Goudard MJF, Lamy ZC, Marba STM, Cavalcante MCV, Dos Santos AM, Azevedo VMGDO, Costa R, Guimarães CNM, Lamy-Filho F. Skin-to-skin contact and deaths in newborns weighing up to 1800 grams: a cohort study. J Pediatr (Rio J) 2022; 98:376-382. [PMID: 34670115 PMCID: PMC9432175 DOI: 10.1016/j.jped.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g. METHOD Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis. RESULTS The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC. CONCLUSIONS The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection.
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Affiliation(s)
- Marivanda J F Goudard
- Universidade Federal do Maranhão, Departamento de Saúde Pública, São Luís, MA, Brazil
| | - Zeni C Lamy
- Universidade Federal do Maranhão, Departamento de Saúde Pública, São Luís, MA, Brazil
| | - Sérgio T M Marba
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Milady C V Cavalcante
- Universidade Federal do Maranhão, Departamento de Saúde Pública, São Luís, MA, Brazil.
| | - Alcione M Dos Santos
- Universidade Federal do Maranhão, Departamento de Saúde Pública, São Luís, MA, Brazil
| | - Vivian M G de O Azevedo
- Universidade Federal de Uberlândia, Faculdade de Educação Física e Fisioterapia, Pós-graduação em Ciências da Saúde, Uberlândia, MG, Brazil
| | - Roberta Costa
- Universidade Federal de Santa Catarina, Departamento de Enfermagem, Campus Universitário, Florianópolis, SC, Brazil
| | | | - Fernando Lamy-Filho
- Universidade Federal do Maranhão, Departamento de Medicina III, São Luís, MA, Brazil
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Yang J, Guo Y, Dai Y. Impact of Kangaroo Mother Care Intervention on Immunological and Pulmonary Functions of Preterm Infants during Breastfeeding. Evid Based Complement Alternat Med 2022; 2022:3180871. [PMID: 35646134 DOI: 10.1155/2022/3180871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Objective Preterm infants (PTIs) are prone to respiratory failure or other diseases due to immature organ development and poor immunological function. Herein, the effects of Kangaroo Mother Care (KMC) on the immunological and pulmonary functions of PTIs during breastfeeding were investigated in this study. Methods The study recruited 86 delivery women and their PTIs with preterm pregnancy outcomes, consisting of 46 cases receiving breastfeeding plus KMC intervention (KMC group) and 40 cases receiving breastfeeding plus routine care (control group). The time of first lactation, time of first breastfeeding, and duration of first breastfeeding were observed in both cohorts. The breastfeeding status was assessed using the LATCH system. Maternal psychological status was evaluated by the breastfeeding self-efficacy scale (BSES) and self-rating anxiety/depression scale (SAS/SDS). The growth and development of PTIs were recorded, and the levels of postalbumin (PA), transferrin (TRF), plasma albumin (ALB), immunoglobulin (Ig) A, IgG, IgM, and complement C3 and C4 were measured. The tidal volume (VT), tidal volume per kilogram (VT/kg), minute volume (MV), and minute volume per kilogram (MV/kg) were detected using a pulmonary function tester. Results The KMC group presented shorter time of first lactation and first breastfeeding than the control group, with longer duration of first breastfeeding (P < 0.05). After intervention, the BSES scores of delivery women were increased, while the SAS and SDS scores were decreased, with more notable improvements in the KMC group (P < 0.05). The levels of PA, TRF, ALB, IgA, IgG, VT, and MV were elevated in PTIs in both groups, with more evident increase in the KMC group than in the control group (P < 0.05). A better growth of PTIs was found in the KMC group than the control group (P < 0.05). Conclusions The study demonstrated that KMC intervention during breastfeeding could benefit PTIs specifically regarding their immunological and pulmonary functions.
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Saltzmann AM, Sigurdson K, Scala M. Barriers to Kangaroo Care in the NICU: A Qualitative Study Analyzing Parent Survey Responses. Adv Neonatal Care 2022; 22:261-9. [PMID: 34054009 DOI: 10.1097/ANC.0000000000000907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored. PURPOSE To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC. METHODS This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services. RESULTS Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance. IMPLICATIONS FOR PRACTICE AND RESEARCH The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.
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Ramachandrappa G, Somasekhara Aradhya A, Mercy L, Kumar A, Venkatagiri P. Sustaining prolonged kangaroo mother care in stable low birthweight babies over 2 years in a predominant outborn unit: a quality improvement approach. BMJ Open Qual 2022; 11:bmjoq-2021-001771. [PMID: 35545269 PMCID: PMC9092162 DOI: 10.1136/bmjoq-2021-001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Kangaroo mother care (KMC) is a proven intervention for improving intact survival in low birthweight babies. Despite the evidence, its adoption and implementation have been low. Availability of mothers for the first few days of life is a specific challenge at outborn units. We used a quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies (<2000 g) from a baseline of 2.7 hours/baby/day to 6 hours/baby/day (prolonged KMC) over a period of 2 years in our unit through a series of Plan-Do-Study-Act (PDSA) cycles. Methods All babies with birth weight <2000 g not on any respiratory support or jaundice were eligible. The key quantitative outcome was KMC hours/baby/day. A QI team consisting of nurses, nursing in charge and consultants of the unit was formed. The potential barriers for prolonged KMC were evaluated using fishbone analysis. A variety of parent-centric measures (provision of bed to mothers apart from KMC chairs, foster KMC, structured KMC counselling through a video, making KMC an integral part of treatment order) were introduced and subsequently tested by multiple PDSA cycles. Data on the duration of KMC per day were measured by bedside nurses on a daily basis. Results A total of 134 mother–baby dyads were enrolled over 2 years. The mean gestation (SD) and mean birth weight (SD) were 33 (2) weeks and 1557 (295) g, respectively. 78 (58%) babies were outborns. We implemented prolonged KMC over 9 months and sustained it over the next 18 months. KMC duration increased from a median of 2.7 hours/baby/day from baseline to a median of 7.4 hours/baby/day after implementation. Conclusions Prolonged KMC could be implemented and sustained over 2 years by implementing parent-centric best practices even in a predominant outborn unit.
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Affiliation(s)
| | | | - Latha Mercy
- Pediatrics, Ovum Hospitals, Bangalore, India
| | - Anil Kumar
- Pediatrics, Ovum Hospitals, Bangalore, India
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Soni R, Tscherning Wel-Wel C, Robertson NJ. Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle. Arch Dis Child Fetal Neonatal Ed 2022; 107:242-249. [PMID: 33972264 DOI: 10.1136/archdischild-2020-319450] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
Advances in neonatal-perinatal medicine have resulted in increased survival at lower gestations. Although the incidence of germinal matrix haemorrhage-intraventricular haemorrhage and cystic periventricular leucomalacia is reducing, a new phenotype of preterm brain injury has emerged consisting of a combination of destructive and dysmaturational effects. Consequently, severe neurological disability is reported at a lower rate than previously, but the overall morbidity associated with premature birth continues to present a large global burden and contributes significantly to increased financial costs to health systems and families. In this review, we examine the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. We review common morbidities associated with premature birth today. Although drug-based and cell-based neuroprotective therapies for the preterm brain are under intense study, we outline basic, sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes for this population and need to be considered part of the future neuroprotection care bundle.
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Affiliation(s)
- Roopali Soni
- Neonatology, Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar .,Department of Neonatology, Mediclinic Parkview Hospital, Dubai, UAE
| | - Charlotte Tscherning Wel-Wel
- Neonatology, Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar.,Center of Physiopathology Toulouse-Purpan(CPTP), University of Toulouse, Toulouse, France
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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41
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Charpak N, Tessier R, Ruiz JG, Uriza F, Hernandez JT, Cortes D, Montealegre‐Pomar A. Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm. Acta Paediatr 2022; 111:1004-1014. [PMID: 35067976 PMCID: PMC9303677 DOI: 10.1111/apa.16265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Aim The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. Method Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20‐year‐old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. Results The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders. Conclusion Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.
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Affiliation(s)
| | | | - Juan Gabriel Ruiz
- Department of Medical and Population Health Sciences Research Herber Wertheim Florida International University Miami Florida USA
| | - Felipe Uriza
- Hospital San Ignacio Universidad Javeriana Bogota Colombia
| | | | - Darwin Cortes
- Economics Department Universidad del Rosario Bogota Colombia
| | - Adriana Montealegre‐Pomar
- Fundación Canguro/Kangaroo Foundation Bogota Colombia
- Hospital San Ignacio Universidad Javeriana Bogota Colombia
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42
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Weber AM, Jackson YC, Elder MR, Remer SL, Parikh NA, Hofherr JJ, Voos KC, Kaplan HC. Application of a Risk Management Framework to Parent Sleep During Skin-to-Skin Care in the NICU. J Obstet Gynecol Neonatal Nurs 2022; 51:336-348. [PMID: 35288109 PMCID: PMC9086109 DOI: 10.1016/j.jogn.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
As NICU staff work to increase the frequency, duration, and comfort of skin-to-skin care (SSC) sessions, barriers to implementation are frequently encountered. Safety concerns are often raised when parents fall asleep during SSC intentionally or unintentionally. We present a risk management framework that we use in clinical practice to address risk related to parent sleep during SSC. Our approach is based on the steps of the Risk Management Life Cycle, which include the following: establish context, identify risk, analyze risk, respond to risk, and monitor and adapt response to risk. Clinicians may use this framework in clinical practice to manage risks related to prolonged SSC, specifically when parents relax and fall asleep during SSC.
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43
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Grichtchouk O, Oliveira JM, Campagnoli RR, Franklin C, Correa MF, Pereira MG, Vargas CD, David IA, Souza GGL, Gleiser S, Keil A, Rocha-Rego V, Volchan E. Visuo-Motor Affective Interplay: Bonding Scenes Promote Implicit Motor Pre-dispositions Associated With Social Grooming-A Pilot Study. Front Psychol 2022; 13:817699. [PMID: 35465505 PMCID: PMC9022038 DOI: 10.3389/fpsyg.2022.817699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Proximity and interpersonal contact are prominent components of social connection. Giving affective touch to others is fundamental for human bonding. This brief report presents preliminary results from a pilot study. It explores if exposure to bonding scenes impacts the activity of specific muscles related to physical interaction. Fingers flexion is a very important component when performing most actions of affectionate contact. We explored the visuo-motor affective interplay by priming participants with bonding scenes and assessing the electromyographic activity of the fingers flexor muscle, in the absence of any overt movements. Photographs of dyads in social interaction and of the same dyads not interacting were employed. We examined the effects upon the electromyographical activity: (i) during the passive exposure to pictures, and (ii) during picture offset and when expecting the signal to perform a fingers flexion task. Interacting dyads compared to matched non-interacting dyads increased electromyographic activity of the fingers flexor muscle in both contexts. Specific capture of visual bonding cues at the level of visual cortex had been described in the literature. Here we showed that the neural processing of visual bonding cues reaches the fingers flexor muscle. Besides, previous visualization of bonding cues enhanced background electromyographic activity during motor preparation to perform the fingers flexion task, which might reflect a sustained leakage of central motor activity downstream leading to increase in firing of the respective motor neurons. These data suggest, at the effector level, an implicit visuo-motor connection in which social interaction cues evoke intrinsic dispositions toward affectionate social behavior.
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Affiliation(s)
- Olga Grichtchouk
- Instituto de Biofísica Carlos Chagas Filho, Avenida Carlos Chagas Filho, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose M Oliveira
- Instituto de Biofísica Carlos Chagas Filho, Avenida Carlos Chagas Filho, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafaela R Campagnoli
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil.,Instituto de Biologia, Universidade Federal Fluminense, Niterói, Brazil
| | - Camila Franklin
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica F Correa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mirtes G Pereira
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | - Claudia D Vargas
- Instituto de Biofísica Carlos Chagas Filho, Avenida Carlos Chagas Filho, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabel A David
- Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil.,Instituto de Biologia, Universidade Federal Fluminense, Niterói, Brazil
| | - Gabriela G L Souza
- Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Sonia Gleiser
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andreas Keil
- Department of Psychology, Center for the Study of Emotion and Attention, University of Florida, Gainesville, FL, United States
| | - Vanessa Rocha-Rego
- Instituto de Biofísica Carlos Chagas Filho, Avenida Carlos Chagas Filho, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliane Volchan
- Instituto de Biofísica Carlos Chagas Filho, Avenida Carlos Chagas Filho, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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44
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Daae E, Feragen KB, Sitek JC, von der Lippe C. It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis. Health Psychol Behav Med 2022; 10:335-356. [PMID: 35402085 PMCID: PMC8986293 DOI: 10.1080/21642850.2022.2053685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents. Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis. Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships. Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.
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Affiliation(s)
- Elisabeth Daae
- Center for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
| | | | - Jan C Sitek
- Department of Dermatology, Oslo University Hospital HF, Oslo, Norway
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45
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Tomlinson M, Skeen S, Melendez-Torres GJ, Hunt X, Desmond C, Morgan B, Murray L, Cooper PJ, Rathod SD, Marlow M, Fearon P. First 1,000 days: enough for mothers but not for children? Long-term outcomes of an early intervention on maternal depressed mood and child cognitive development: follow-up of a randomised controlled trial. J Child Psychol Psychiatry 2022; 63:261-272. [PMID: 34227113 DOI: 10.1111/jcpp.13482] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Child cognitive development is often compromised in contexts of poverty and adversity, and these deficits tend to endure and affect the child across the life course. In the conditions of poverty and violence that characterise many low- and middle-income countries (LMIC), the capacity of parents to provide the kind of care that promotes good child development may be severely compromised, especially where caregivers suffer from depression. One avenue of early intervention focuses on the quality of the early mother-infant relationship. The aim of this study was to examine the long-term impact of an early intervention to improve the mother-infant relationship quality on child cognitive outcomes at 13 years of age. We also estimated the current costs to replicate the intervention. METHOD We re-recruited 333 children from an early childhood maternal-infant attachment intervention, 'Thula Sana', when the children were 13 years old, to assess whether there were impacts of the intervention on child cognitive outcomes, and maternal mood. We used the Kaufman Assessment Battery to assess the child cognitive development and the Patient Health Questionnaire (PHQ-9) and the Self-Reporting Questionnaire (SRQ-20) to assess maternal mental health. RESULTS Effect estimates indicated a pattern of null findings for the impact of the intervention on child cognitive development. However, the intervention had an effect on caregiver psychological distress (PHQ-9, ES = -0.17 [CI: -1.95, 0.05] and SRQ-20, ES = -0.30 [CI: -2.41, -0.19]), but not anxiety. The annual cost per mother-child pair to replicate the Thula Sana intervention in 2019 was estimated at ZAR13,365 ($780). CONCLUSION In a socio-economically deprived peri-urban settlement in South Africa, a home visiting intervention, delivered by community workers to mothers in pregnancy and the first six postpartum months, had no overall effect on child cognitive development at 13 years of age. However, those caregivers who were part of the original intervention showed lasting improvements in depressed mood. Despite the fact that there was no intervention effect on long-term child outcomes, the improvements in maternal mood are important.
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Affiliation(s)
- Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Sarah Skeen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group, University of Exeter Medical School, Exeter, UK
| | - Xanthe Hunt
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Chris Desmond
- Priceless, School of Public Health, Wits University, Johannesburg, South Africa
| | - Barak Morgan
- Global Risk Governance Programme, Institute for Safety Governance and Criminology, Law Faculty, University of Cape Town, Cape Town, South Africa
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Sujit D Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marguerite Marlow
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Pasco Fearon
- Developmental Neuroscience Unit, University College London, London, UK
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46
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Gire C, Garbi A, Zahed M, Beltran Anzola A, Tosello B, Datin-Dorrière V. Neurobehavioral Phenotype and Dysexecutive Syndrome of Preterm Children: Comorbidity or Trigger? An Update. Children (Basel) 2022; 9:239. [PMID: 35204960 PMCID: PMC8870742 DOI: 10.3390/children9020239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Premature birth is a worldwide public health priority. One in ten children is born before 37 weeks of gestational age and, in developed countries, survival rates without major neonatal morbidity are increasing. Although severe sequelae associated with these births have decreased, their neurobehavioral difficulties, often associated in multiple fields, remain stable but still widespread. These neurobehavioral difficulties hamper the normal development of academic achievements and societal integration and intensify the children's needs for rehabilitation during their preschool and academic years. Severe sequelae increase when gestational age decreases. This is even truer if the socio-cultural background is impeded by low income, education and language skills as compared with defined averages. However, moderate and/or minor neurocognitive and/or behavioral difficulties are almost identical for a moderate or a late preterm birth. Obtaining a better clinical description of neurobehavioral characteristics of those pretermly born, once they reach preschool age, is essential to detect behavioral issues as well as early specific cognitive difficulties (working memory, planning, inhibition, language expression and reception, attention and fine motor skills, etc.). Such information would provide a better understanding of the executive functions' role in brain connectivity, neurodevelopment and neuroanatomical correlation with premature encephalopathy.
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Affiliation(s)
- Catherine Gire
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Aurélie Garbi
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Meriem Zahed
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Any Beltran Anzola
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CNRS, EFS, ADES, Aix Marseille Universite, 13915 Marseille, France
| | - Valérie Datin-Dorrière
- Department of Neonatal Medicine, Caen University Hospital, Avenue Cote De Nacre, 14000 Caen, France;
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Montealegre‐Pomar A, Charpak N. Individual factors determine how long infants born preterm or with a low birth weight need to be kept in the Kangaroo position. Acta Paediatr 2022; 111:305-306. [PMID: 34713499 DOI: 10.1111/apa.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Adriana Montealegre‐Pomar
- Newborn Unit Kangaroo Foundation Hospital Universitario San Ignacio Pontificia Universidad Javeriana Bogotá Colombia
| | - Nathalie Charpak
- Kangaroo Foundation Scientific Coordination of the Kangaroo Mother Care Program Hospital Universitario San Ignacio Bogotá Colombia
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48
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Cristóbal Cañadas D, Bonillo Perales A, Galera Martínez R, Casado-Belmonte MDP, Parrón Carreño T. Effects of Kangaroo Mother Care in the NICU on the Physiological Stress Parameters of Premature Infants: A Meta-Analysis of RCTs. Int J Environ Res Public Health 2022; 19:583. [PMID: 35010848 PMCID: PMC8744895 DOI: 10.3390/ijerph19010583] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the randomised controlled trials that explored the effect of kangaroo mother care on physiological stress parameters of premature infants. METHODS Two independent researchers performed a systematic review of indexed studies in PubMed, Embase, CINAHL, Cochrane and Scopus. We included data from randomized controlled trials measuring the effects of kangaroo care compared to standard incubator care on physiological stress outcomes, defined as oxygen saturation, body temperature, heart rate and respiratory rate. The PRISMA model was used to conduct data extraction. We performed a narrative synthesis of all studies and a meta-analysis when data were available from multiple studies that compared the same physiological parameters with the kangaroo method as an intervention and controls and used the same outcome measures. RESULTS Twelve studies were eligible for inclusion in this meta-analysis. According to statistical analysis, the mean respiratory rate of preterm infants receiving KMC was lower than that of infants receiving standard incubator care (MD, -3.50; 95% CI, -5.17 to -1.83; p < 0.00001). Infants who received kangaroo mother care had a higher mean heart rate, oxygen saturation and temperature, although these results were not statistically significant. CONCLUSIONS Current evidence suggests that kangaroo care in the neonatal intensive care unit setting is a safe method that may have a significant effect on some of the physiological parameters of stress in preterm infants. However, due to clinical heterogeneity, further studies are needed to assess the effects of physiological stress in the neonatal intensive care unit on the development of preterm infants.
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Affiliation(s)
- Delia Cristóbal Cañadas
- Neonatal and Paediatric Intensive Care Unit, Torrecárdenas University Hospital, 04009 Almería, Spain;
| | - Antonio Bonillo Perales
- Pediatrics Department, Torrecárdenas University Hospital, 04005 Almería, Spain; (A.B.P.); (R.G.M.)
| | - Rafael Galera Martínez
- Pediatrics Department, Torrecárdenas University Hospital, 04005 Almería, Spain; (A.B.P.); (R.G.M.)
| | | | - Tesifón Parrón Carreño
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain;
- Andalusian Council of Health at Almería Province, 04005 Almería, Spain
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Mohammadi M, Sattarzadeh N, Heidarzadeh M, Hosseini MB, Hakimi S. Implementation Barriers for Practicing Continuous Kangaroo Mother Care from the Perspective of Neonatologists and Nurses. J Caring Sci 2021; 10:137-144. [PMID: 34849357 PMCID: PMC8609115 DOI: 10.34172/jcs.2021.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized.
Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software.
Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers.
Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.
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Affiliation(s)
- Marzieh Mohammadi
- Student's Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Niloufar Sattarzadeh
- Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Heidarzadeh
- Pediatric Health Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Bagher Hosseini
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Sevil Hakimi
- School of Nursing and Midwifery, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
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Ramdin T, Radomsky M, Raxendis C, Devchand T, Morris C, Sekgota C, Stols L, Mokhachane M. A Review of Very-Low-Birth-Weight Infants Admitted to the Kangaroo Mother Care Unit in Johannesburg, South Africa. Cureus 2021; 13:e20428. [PMID: 35047265 PMCID: PMC8759983 DOI: 10.7759/cureus.20428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background Kangaroo Mother Care (KMC) is a widely implemented intervention developed as an alternative form of care in low- and middle-income countries (LMICs) for neonates. The implementation of KMC has significantly reduced morbidity and mortality in very-low-birth-weight infants (VLBWIs). Aim To describe the maternal and neonatal characteristics and clinical outcomes in VLBWIs who received KMC at a tertiary hospital. Methods This is a retrospective descriptive study of 981 VLBWIs admitted at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over a six-year period (January 1, 2014, to December 31, 2019). Results The mean gestational age of infants admitted to the unit was 29.6 weeks (standard deviation (SD): 2.4), with a mean birth weight of 1185 g (SD: 205.6). The average duration of admission in the neonatal unit was 37 days. The mean rate of weight gain was 37.6 g/kg/day (SD: 57.6). The majority of infants were breastfed (61.4%). In our study, the prevalences of the complications of prematurity were as follows: respiratory distress syndrome (RDS), 84.2%; late-onset sepsis (LOS), 26.1%; and retinopathy of prematurity (ROP), 10.6%. The mortality rate was 3.1%. Maternal comorbidities include human immunodeficiency virus (HIV) (26.4%), syphilis (2.9%) and gestational hypertension (33.7%). The antenatal clinic attendance rate was good (84.7%). Conclusion KMC is a cost-effective alternative to conventional care for VLBWIs in limited-resource countries, with evidence of increased weight gain, less rates of complications of prematurity and low overall mortality. The provision of KMC facilities is urgently required in LMICs.
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Affiliation(s)
- Tanusha Ramdin
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Michael Radomsky
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Christina Raxendis
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Tejis Devchand
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Cassady Morris
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Charmaine Sekgota
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Lorenzo Stols
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Mantoa Mokhachane
- Unit for Undergraduate Medical Education, University of the Witwatersrand, Johannesburg, ZAF
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