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Denge TT, Bam NE, Lubbe W, Rakhudu A. Essential components of an educational program for implementing skin-to-skin contact for preterm infants in intensive care units: an integrative literature review. BMC Pregnancy Childbirth 2024; 24:281. [PMID: 38627706 PMCID: PMC11022346 DOI: 10.1186/s12884-024-06447-6] [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: 09/09/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Globally, prematurity is the primary factor behind the mortality of children under the age of 5 years, resulting in approximately 1 million children dying annually. The World Health Organization (WHO) recommends Skin-to-Skin Contact (SSC) as part of routine care for preterm infants. Evidence shows that SSC reduces mortality, possibly by improving thermoregulation, facilitating the earlier initiation of breastfeeding and reducing the risk of nosocomial infection. An educational program for implementing SSC has been demonstrated to enhance the knowledge and practice of parents and nurses in intensive care units. This study, the first of its kind in the North West Province (NWP), aims to identify the essential components of an educational program for implementing SSC for premature infants in intensive care units. OBJECTIVE This paper presents an integrative literature review that critically synthesizes research-based literature on essential components of an educational program for implementing SSC for preterm infants in intensive care units. METHODS A comprehensive search of electronic databases, such as CINAHL, MEDLINE, PsycINFO, ProQuest and Health Source: Nursing/Academic Edition and Health Source-Consumer Edition, was conducted using different keywords and references lists from the bibliography. RESULTS Twelve articles relevant to this review were identified, read and synthesized to answer the research question. Three essential components emerged from the findings of this review, namely (1) the necessity of policy and role players for implementing SSC, (2) the availability of education and training, and (3) counseling and support for parents of preterm infants. CONCLUSIONS The outcomes of this study have the potential to facilitate the implementation and expansion of SSC in intensive care units. This could aid program implementers, policymakers, and researchers to implement and scale up this important tool in intensive care units.
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Affiliation(s)
- Takalani T Denge
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
| | - Nokwanda Edith Bam
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Mafikeng, South Africa
| | - Welma Lubbe
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Annah Rakhudu
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Mafikeng, South Africa
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Diaz-Ogallar MA, Hernandez-Martinez A, Linares-Abad M, Martinez-Galiano JM. Factors related to a disturbance in the mother-child bond and attachment. J Pediatr Nurs 2024; 76:114-123. [PMID: 38377918 DOI: 10.1016/j.pedn.2024.02.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Establishing an adequate bond and attachment between a mother and child is essential for preventing pathologies and developing this relationship in the future. PURPOSE To identify the factors related to a disturbance of the mother-child bond or attachment. METHODS A cross-sectional descriptive study was carried out with women with a biological child between 6 weeks and 18 months of age. The Mother-Child Bond-Attachment Questionnaire (VAMF, for its name in Spanish) was administered to measure the bond and postnatal attachment together with a questionnaire containing sociodemographic, psychosocial, and health variables referring to the mother and the newborn. RESULTS 1114 women participated. The multivariate analysis showed that skin-to-skin contact (aOR = 0.58; 95% CI: 0.37, 0.90) and breastfeeding (aOR = 0.55; 95% IC: 0.35, 0.86) reduce the probability of presenting a bond disturbance. Anxiety during pregnancy, childbirth, and the puerperium (aOR = 3.95; 95% CI: 2.57, 6.05) and postpartum complications (aOR = 1.60; 95% CI: 1.03, 2.48) increase the chance of having a bond disturbance. Skin-to-skin contact (aOR = 0.61; 95% CI: 0.38, 1.00), breastfeeding (aOR = 0.47; 95% CI: 0.27, 0.80,) and an older age of the infant (months) (aOR = 0.77: 95% CI: 0.72, 0.82) reduces the probability of presenting an attachment disturbance. CONCLUSIONS Skin-to-skin contact and breastfeeding are associated with a lower probability of impaired bonding and attachment. Anxiety states during pregnancy, childbirth, and the puerperium, and complications after childbirth increase the probability of developing a bond disorder. The older the age of the infant, the lower the frequency of having an impaired attachment. IMPLICATIONS TO PRACTICE Identifying the factors associated with the establishment of the mother-child bond and attachment is essential for the development of prevention strategies and early identification of cases that may present alterations and avoid their consequences on the health of the mother and child.
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Affiliation(s)
- Maria Antonia Diaz-Ogallar
- Unit of Clinical Management Jodar, Andalusian Health Service, 23500 Jodar, Spain; Nursing Department, University of Jaen, 23071 Jaen, Spain.
| | - Antonio Hernandez-Martinez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, 13071 Ciudad Real, Spain
| | | | - Juan Miguel Martinez-Galiano
- Nursing Department, University of Jaen, 23071 Jaen, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Prian-Gaudiano A, Horta-Carpinteyro D, Sarmiento-Aguilar A. Relationship between skin-to-skin contact during the first hour of life and duration of exclusive breastfeeding. Bol Med Hosp Infant Mex 2024; 81:10-15. [PMID: 38503328 DOI: 10.24875/bmhim.23000160] [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: 11/09/2023] [Accepted: 12/18/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Exclusive breastfeeding (BF) has the greatest potential impact on child mortality of any preventive intervention. Skin-to-skin contact (SSC) during the first hour of life is beneficial for initiating BF; however, routine separation of mother and infant is still common. This work aimed to demonstrate that SSC during the first hour of life is associated with a greater frequency and duration of exclusive BF. METHODS This is an observational case-control study. We reviewed the medical records of patients born between 2016 and 2022 classified as cases or controls based on the history of SSC in the first hour of life. Statistical analysis was performed using SPSS version 28. RESULTS We included 362 medical records, of which 200 (55.2%) had SSC and were considered cases; the 162 (44.8%) who did not have SSC were considered controls. Those who received SSC were more likely to receive exclusive BF at 3 (163 [81.5%] vs. 94 [58%], p < 0.001) and 6 months of age (147 [73.5%] vs. 83 [51.2%], p < 0.001). CONCLUSIONS Patients who received SSC in the first hour of life were more likely to receive exclusive BF at 3 and 6 months of age. Promoting and respecting this practice is essential to increase the possibility of a newborn to be exclusively breastfed for the first 6 months of life.
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Giang HTN, Hieu LTM, Duy DTT, Phuong MT, Trung TD. The effect of skin-to-skin contact on early initiation of breastfeeding among women in Vietnam. Pediatr Neonatol 2023:S1875-9572(23)00215-2. [PMID: 38057258 DOI: 10.1016/j.pedneo.2023.07.007] [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: 10/09/2022] [Revised: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 12/08/2023] Open
Abstract
AIM To describe prevalence of early initiation of breastfeeding and associated factors among Vietnamese mothers. METHODS A self-administered questionnaire was used to survey 1812 mothers whose infants were aged 0 to less than 30 months in multi-center Vietnam. Multivariate logistic regression was performed to identify factors associated independently with early initiation of breastfeeding. RESULTS Prevalence of early initiation of breastfeeding was 57.2 % and this prevalence was higher in female infants compared with male infants (p = 0.004). Factors associated with increased odds of early initiation of breastfeeding include female infants (aOR: 1.33; 95%CI: 1.06 to 1.68) living in urban areas (aOR: 1.34, 95%CI: 1.05 to 1.71), giving birth in private hospitals (aOR: 1.94, 95%CI: 1.25 to 3.03), vaginal birth (aOR: 1.70, 95%CI: 1.34 to 2.16). Factors associated with decreased odds of early initiation of breastfeeding include higher educational level, mother's weight gain during pregnancy, and infant complication at birth. Compared with mothers who had not experienced skin-to-skin contact with their babies, the prevalence of early initiation of breastfeeding was higher in mothers who experienced <15 min (aOR: 2.03, 95%CI: 1.32 to 3.14), 15-90 min (aOR: 6.33, 95%CI: 4.11 to 9.76), and >90 min (aOR: 10.98, 95%CI: 6.79 to 17.75). CONCLUSION Focusing on modifiable factors should be a key priority to help improve early initiation of breastfeeding practice.
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Affiliation(s)
- Hoang Thi Nam Giang
- School of Medicine and Pharmacy, The University of Danang, Danang, Viet Nam.
| | - Le Tho Minh Hieu
- School of Medicine and Pharmacy, The University of Danang, Danang, Viet Nam
| | - Do Thi Thuy Duy
- School of Medicine and Pharmacy, The University of Danang, Danang, Viet Nam
| | | | - Tran Dinh Trung
- Faculty of Public Health, Danang University of Medical Technology and Pharmacy, Danang, Viet Nam
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Oyedele OK. Correlates of non-institutional delivery to delayed initiation of breastfeeding in Nigeria: logit-decomposition and subnational analysis of population-based survey. J Health Popul Nutr 2023; 42:121. [PMID: 37932844 PMCID: PMC10629092 DOI: 10.1186/s41043-023-00466-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/28/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Studies have connected newborn delivery settings and modality to optimal breastfeeding, but how it influences untimely initiation, mostly prevalent in sub-Saharan Africa is unknown. Hence, the role of home delivery on delay initiation of breastfeeding (DIBF) in Nigeria was investigated to inform evidence-based strategy for improved breastfeeding practice. METHODOLOGY This is a secondary analysis of births (11,469 home and 7632 facility delivery) by 19,101 reproductive age women in the 2018 NDHS. DIBF is the outcome, home birth is the exposure, and explanatory variables were classified as: socio-demographics, obstetrics and economic factors. Descriptive statistics (frequencies and percentages) were reported, and bivariate (chi-square) analysis was carried out at 20% (p < 0.20) cutoff point. Multivariable logistic regression assessed the probability and significance of the outcome per place of birth. Multivariate decomposition further evaluated the endowment and coefficient effect contribution by independent factors to the outcome. Analysis was carried out at p < 0.05 (95% confidence level) on Stata. RESULTS 56.6% of mothers DIBF, with 37.1% and 19.5% from home and facility delivery, respectively. Home delivery (AOR = 1.34, 95% CI 1.17-1.52) increase the chance of DIBF by 34%, while DIBF probability reduces by 26% in facility delivery (AOR = 0.74, 95% CI 0.65-0.85). DIBF is 5 times more likely in caesarian section delivery (AOR = 5.10, 95% CI 4.08-6.38) compared to virginal birth in facility delivery. Skilled antenatal provider, parity and wealth are negatively associated with DIBF in home birth, while undesired pregnancy, rural residency, partial/no skin-to-skin contact and large child size positively influence DIBF in both home and facility delivery. Skilled antenatal provider (C = - 66.3%, p < 0.01) and skin-to-skin contact (C = - 60.6%, p < 0.001) contributed most to reducing the negative DIBF effect with 69% and 31% overall characteristics and coefficient effect component, respectively. DIBF is more likely in Bauchi and Sokoto but less likely in Bayelsa. CONCLUSIONS High DIBF prevalent in Nigeria was largely due to elevated rate of home birth, positively associated with DIBF. Caesarian section delivery though heightens the chance of DIBF in facility delivery. Strengthening utilization of skilled provider and skin-to-skin contact can eliminate two-third of the adverse DIBF effect and improve early initiation rate. Adopting this strategy will bridge home-facility delivery gap to achieve optimal breastfeeding practice.
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Affiliation(s)
- Oyewole K Oyedele
- International Research Centre of Excellence, Institute of Human Virology, Nigeria (IHVN), Abuja, FCT, Nigeria.
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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Durmaz A, Sezici E, Akkaya DD. The effect of kangaroo mother care or skin-to-skin contact on infant vital signs: A systematic review and meta-analysis. Midwifery 2023; 125:103771. [PMID: 37454580 DOI: 10.1016/j.midw.2023.103771] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND It has been reported that kangaroo mother care/skin-to-skin contact immediately after birth facilitates the newborn's physiological and psychological adaptation to extrauterine life. OBJECTIVE To examine the effect of kangaroo mother care/skin-to-skin contact on infants' body temperature, oxygen saturation, respiratory rate and heart rate. DESIGN Systematic review and meta-analysis. METHODS PubMed, ScienceDirect, SpringerLink, Wiley Online Library and Taylor & Francis Online were searched for the period 1 January 2015 to 30 November 2021 for studies published in the English language. The methodological quality of articles was assessed using the modified Jadad scale and the Newcastle-Ottawa scale. Effect size calculations were made using the fixed effects and random effects models. FINDINGS This meta-analysis included 13 studies, with a total of 891 infants. Kangaroo mother care/skin-to-skin contact was effective for maintaining infants' body temperature (p = 0.000). Infants' heart rate decreased (p = 0.015) and oxygen saturation was higher (p = 0.040) following kangaroo mother care/skin-to-skin contact. Kangaroo mother care/skin-to-skin contact did not affect infants' respiratory rate (p = 0.896), but infants' respiratory rate decreased after kangaroo mother care/skin-to-skin contact (p = 0.047). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Kangaroo mother care/skin-to-skin contact is effective for improving the vital signs of newborns. Kangaroo mother care/skin-to-skin contact is recommended for all neonates, and standardization of this approach would be beneficial.
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Affiliation(s)
- Aysegul Durmaz
- Department of Midwifery, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye.
| | - Emel Sezici
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye
| | - Deniz Done Akkaya
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye
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Giang HTN, Duy DTT, Vuong NL, Ngoc NTT, Pham TT, Duc NTM, Le TTD, Nga TTT, Hieu LTM, Vi NTT, Triet BM, Thach NT, Truc TTB, Huy NT. Prevalence of exclusive breastfeeding for the first six months of an infant's life and associated factors in a low-middle income country. Int Breastfeed J 2023; 18:47. [PMID: 37653448 PMCID: PMC10472614 DOI: 10.1186/s13006-023-00585-x] [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: 02/17/2022] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Although breastfeeding is practiced by 98% of mothers in Vietnam, infant breastfeeding behaviors remain far from World Health Organization recommendations and continues to decline. This study aims to explore the prevalence and factors associated with exclusive breastfeeding in the first six months of an infant's life. METHODS A cross-sectional study utilized a self-administered maternal questionnaire to collect data on 1072 Vietnamese mothers who brought infants aged between 6 and 30 months to a community health centre (CHC) for routine vaccination. Data collection was conducted from March to May 2021 in two cities in Central and North Vietnam. In order to measure exclusive breastfeeding, we asked mothers to recall (yes / no), if the child had received breast milk, formula, colostrum milk powder, water, vitamin / medicine, fruit juice / honey, and complementary foods aged under six months. RESULTS In the first six months, 14.2% of mothers exclusively breastfed their infants. Multivariable logistic regression analysis demonstrated a significant association between exclusive infant breastfeeding and the highest maternal education level (university or postgraduate) (adjusted odds ratio (aOR) 2.55; 95% confidence interval (CI) 1.10, 5.91); male infants (aOR 1.72; 95% CI 1.11, 2.68); duration of skin-to-skin contact greater than 90 min (aOR 7.69; 95% CI 1.95, 30.38); receiving first breastfeeding during skin-to-skin contact (aOR 2.31; 95% CI 1.30, 4.10); completely feeding infant directly at the breast (aOR 1.65; 95% CI 1.00, 2.71) and exclusive breastfeeding intention during pregnancy (aOR 2.48; 95% CI 1.53, 4.00). When compared with mothers who were prenatally exposed to infant formula advertising classified as "often", the prevalence of exclusive infant breastfeeding was higher in mothers who classified their prenatal exposure to infant formula advertising as "sometimes" (aOR 2.15; 95% CI 1.13, 4.10), and "seldom" (aOR 2.58; 95% CI 1.25, 5.36). CONCLUSION The prevalence of mothers who practiced exclusive infant breastfeeding during the first six months in Vietnam was low. Infants should receive early maternal-infant skin-to-skin contact greater than 90 min and complete first breastfeeding during skin-to-skin contact. Further, mothers should be protected against infant formula advertisements to maximise the likelihood of exclusive breastfeeding during the child's infancy.
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Affiliation(s)
| | - Do Thi Thuy Duy
- School of Medicine and Pharmacy, The University of Danang, Danang, Vietnam
| | - Nguyen Lam Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Thu Thi Pham
- School of Medicine and Pharmacy, The University of Danang, Danang, Vietnam
| | - Nguyen Tran Minh Duc
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Trinh Thi Diem Le
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thi Tuyet Nga
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Tho Minh Hieu
- School of Medicine and Pharmacy, The University of Danang, Danang, Vietnam
| | | | - Bui Minh Triet
- School of Medicine and Pharmacy, The University of Danang, Danang, Vietnam
| | - Nguyen Tan Thach
- School of Medicine and Pharmacy, The University of Danang, Danang, Vietnam
| | - Tran Thi Bach Truc
- School of Medicine and Pharmacy, The University of Danang, Danang, Vietnam
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Adongo EA, Ganle JK. Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana maternal health survey. BMC Pregnancy Childbirth 2023; 23:556. [PMID: 37533034 PMCID: PMC10394848 DOI: 10.1186/s12884-023-05877-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Neonatal mortality contributes about 47% of child mortality globally and over 50% of under-5 deaths in Ghana. There is limited population level analysis done in Ghana on predictors of neonatal mortality. OBJECTIVES The objective of the study was to examine the predictors of neonatal mortality in Ghana. METHOD This study utilizes secondary data from the 2017 Ghana Maternal Health Survey (GMHS). The GMHS survey focuses on population and household characteristics, health, nutrition, and lifestyle with particular emphasis on topics that affect the lives of newborns and women, including mortality levels, fertility preferences and family planning methods. A total of 10,624 respondents were included in the study after data cleaning. Descriptive statistical techniques were used to describe important background characteristics of the women and Pearson's Chi-squares (χ2) test used to assess association between the outcome (neonatal death) and independent variables. Multivariate logistic regression analysis was done to estimate odd ratios and potential confounders controlled. Confidence level was held at 95%, and a p < 0.05 was considered statistically significant. Data analysis was done using STATA 15. RESULTS The prevalence of neonatal mortality was 18 per 1000 live births. ANC attendance, sex of baby, and skin-to-skin contact immediately after birth were predictors of neonatal mortality. Women with at least one ANC visit were less likely to experience neonatal mortality as compared to women with no ANC visit prior to delivery (AOR = 0.11; CI = 0.02-0.56, p = 0.01). Girls were less likely (AOR = 0.68; CI = 0.47-0.98; p = 0.03) to die during the neonatal period as compared to boys. Neonates who were not put skin-to-skin contact immediately after birth were 2.6 times more likely to die within the neonatal period than those who were put skin-to-skin contact immediately after birth (AOR = 2.59; CI = 1.75-3.83, p = 0.00). CONCLUSION Neonatal mortality remains a public health concern in Ghana, with an estimated rate of 18 deaths per 1,000 live births. Maternal and neonatal factors such as the sex of the newborn, the number of antenatal care visits, and skin-to-skin contact between the newborn and mother immediately after birth are the predictors of neonatal mortality in Ghana.
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Affiliation(s)
- Emmanuel Ayire Adongo
- World Child Cancer, Moorfields House, Slater Avenue, Korle Bu, P. O. Box KB273, Accra, Ghana
- Ghana College of Nurses and Midwives, 214 Westlands Residential Area, Accra, Ghana
| | - John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra Ghana
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Singh K, Chawla D, Jain S, Khurana S, Takkar N. Immediate skin-to-skin contact versus care under radiant warmer at birth in moderate to late preterm neonates - A randomized controlled trial. Resuscitation 2023; 189:109840. [PMID: 37196802 DOI: 10.1016/j.resuscitation.2023.109840] [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: 03/08/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To compare the effect of immediate care at birth in skin-to-skin contact (SSC) or under a radiant warmer on cardiorespiratory stability at 60 minutes of age in moderate-to-late preterm neonates. METHODS In this open-label, parallel-group, randomized controlled trial, neonates born at 330/7 to 366/7 weeks of gestation by vaginal delivery and breathing or crying were randomized to receive care at birth in SSC (n = 50) or under a radiant warmer (n = 50). In the SSC group, immediate care at birth including drying and clearing of the airway was provided in SSC over the mother's abdomen. SSC was maintained for an observational period of 60 minutes after birth. In the radiant warmer group, care at birth and post-birth observation was performed under an overhead radiant warmer. The primary outcome of the study was the stability of the cardio-respiratory system in late preterm infants (SCRIP) score at 60 minutes of age. RESULTS Baseline variables were similar in the two study groups. The SCRIP score at 60 minutes of age was similar in the two study groups (median: 5.0, IQR: 5-6 vs. 5.0, 5-6). The mean axillary temperature at 60 minutes of age was significantly lower in the SSC group (°C; 36.4 ± 0.4 vs. 36.6 ± 0.4, P = 0.004). CONCLUSION It was feasible to provide immediate care at birth in moderate and late preterm neonates while being positioned in SSC with the mother. However, in comparison to care under a radiant warmer, this did not lead to better cardiorespiratory stability at 60 minutes of age. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/09/036730).
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Affiliation(s)
- Kuldeep Singh
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Suksham Jain
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Navneet Takkar
- Department of Obstetrics & Gynecology, Government Medical College Hospital, Chandigarh, India
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Ball MK, Seabrook RB, Corbitt R, Stiver C, Nardell K, Medoro AK, Beer L, Brown A, Mollica J, Bapat R, Cosgrove T, Texter KT. Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates. Pediatr Cardiol 2023; 44:1023-1031. [PMID: 36971793 PMCID: PMC10040310 DOI: 10.1007/s00246-023-03149-2] [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: 12/18/2022] [Accepted: 03/12/2023] [Indexed: 03/28/2023]
Abstract
Early skin-to-skin contact (SSC), beginning in the delivery room, provides myriad health benefits for mother and baby. Early SSC in the delivery room is the standard of care for healthy neonates following both vaginal and cesarean delivery. However, there is little published evidence on the safety of this practice in infants with congenital anomalies requiring immediate postnatal evaluation, including critical congenital heart disease (CCHD). Currently, the standard practice following delivery of infants with CCHD in many delivery centers has been immediate separation of mother and baby for neonatal stabilization and transfer to a different hospital unit or a different hospital altogether. However, most neonates with prenatally diagnosed congenital heart disease, even those with ductal-dependent lesions, are clinically stable in the immediate newborn period. Therefore, we sought to increase the percentage of newborns with prenatally diagnosed CCHD who are born in our regional level II-III delivery hospitals who receive mother-baby SSC in the delivery room. Using quality improvement methodology, through a series of Plan-Do-Study-Act cycles we successfully increased mother-baby skin-to-skin contact in the delivery room for eligible cardiac patients born across our city-wide delivery hospitals from a baseline 15% to greater than 50%.
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Affiliation(s)
- Molly K Ball
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA.
| | - R B Seabrook
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - R Corbitt
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - C Stiver
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - K Nardell
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - A K Medoro
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
| | - L Beer
- Pediatrix Medical Group, Columbus, OH, USA
| | - A Brown
- Phoenix Children's Medical Group, Neonatology, Phoenix, AZ, USA
| | - J Mollica
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - R Bapat
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
| | - T Cosgrove
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - K T Texter
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
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11
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Li L, Ji F, Wang Y, Wang L, Yu L, Wu X, Lyu T, Dou Y, Cao Y, Hu XJ. The clinical experience of early skin-to-skin contact combined with non-nutritive comfort sucking in mothers of preterm infants: a qualitative study. BMC Pregnancy Childbirth 2023; 23:281. [PMID: 37095429 PMCID: PMC10123578 DOI: 10.1186/s12884-023-05581-x] [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: 01/29/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND In most areas of China, mothers typically do not participate in early care of preterm infants in NICU. This study aims to examine the early experience of mothers of preterm infants participating in skin-to-skin contact combined with non-nutritive comfort sucking in China. METHODS This qualitative research study used one-on-one, face-to-face, semi-structured in-depth interviews. Eighteen mothers who participated in early skin-to-skin contact combined with non-nutritive comfort sucking were interviewed in the NICU of a tertiary children's hospital in Shanghai between July and December 2020. Their experiences were analyzed using the inductive topic analysis method. RESULTS Five themes about skin-to-skin contact combined with non-nutritive comfort sucking were identified, including alleviation of maternal anxiety and fear during mother infant separation, reshaping the maternal role, promotion of active breast pumping, enhances the mother's willingness to actively breast feed and building the maternal confidence in baby care. CONCLUSION Skin-to-skin contact combined with non-nutritive comfort sucking in the NICU can not only enhance the identity and responsibility of the mother's role, but also provide non-nutritive sucking experience for promoting the establishment of oral feeding in preterm infants.
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Affiliation(s)
- Liling Li
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Futing Ji
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Yuejue Wang
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Li Wang
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Ling Yu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Xi Wu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Tianchan Lyu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Yalan Dou
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Yun Cao
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Xiao-Jing Hu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China.
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases(2018RU002), Chinese Academy of Medical Sciences , Beijing, China.
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12
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Wan S, Jin B, Kpordoxah MR, Issah AN, Yeboah D, Aballo J, Boah M. A descriptive analysis of the coverage of newborn care services among women who delivered in health facilities in 17 sub-Saharan African countries. BMC Pregnancy Childbirth 2023; 23:256. [PMID: 37069513 PMCID: PMC10108479 DOI: 10.1186/s12884-023-05592-8] [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: 01/12/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has seen an increase in facility-based births over the years. However, the region has the world's highest newborn mortality rate (42% in 2019). Quality care around the time of birth can avert these deaths. This study examined the newborn care interventions given to women who gave birth in health facilities in 17 countries in SSA. METHODS A cross-sectional population-based study was conducted. We used data from the most recent Demographic and Health Surveys (DHS) conducted in 17 sub-Saharan African countries. We analysed a weighted sample of 226,706 women aged 15-49 years who gave birth in the five years preceding the surveys. We described the coverage of nine newborn care services, namely weighing at birth, breastfeeding initiation within 1 h after birth, skin-to-skin contact, temperature measurement, cord examination, counselling on newborn danger signs, counselling on breastfeeding, breastfeeding observation, and child health assessment before discharge. RESULTS Overall, 72.0% (95% CI: 71.1, 72.8) of births occurred in health facilities, ranging from 40.0% (95% CI: 38.0, 42.1) in Nigeria to 96.3% (95% CI: 95.4, 97.1) in South Africa. Weighing at birth was the most common intervention (91.4%), followed by health checks before discharge (81%). The other interventions, including those given immediately at birth (breastfeeding and skin-to-skin contact), had suboptimal coverage. For instance, 66% of newborns were breastfed within 1 h after birth, and 56% had immediate skin-to-skin contact. Service coverage varied considerably by country and healthcare provider type. CONCLUSIONS The majority of the examined services, namely early breastfeeding, skin-to-skin contact, cord examination, temperature measurement, counselling on newborn danger signs, breastfeeding observation, and counselling on breastfeeding, were found to have suboptimal coverage. Even though many pregnant women in SSA give birth in healthcare facilities, some newborns do not always get the care they need to be healthy and live. This is a missed chance to improve newborn health and survival around the time of birth.
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Affiliation(s)
- Siyuan Wan
- Department of Preventive Medicine, Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - Baiming Jin
- Department of Preventive Medicine, Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Abdul-Nasir Issah
- Department of Health Services, Planning, Management, and Economics, School of Public Health, University for Development Studies, Policy, Tamale, Ghana
| | - Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Jevaise Aballo
- United Nations Children Fund (UNICEF), Ghana Country Office, P.O. Box AN 5051, Accra, Ghana
| | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana.
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13
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Ruiz MT, Azevedo NF, Raponi MBG, Fonseca LMM, Wernet M, Silva MPC, Contim D. Skin-to-Skin Contact in the Third Stage of Labor and Postpartum Hemorrhage Prevention: A Scoping Review. Matern Child Health J 2023; 27:582-596. [PMID: 36867304 DOI: 10.1007/s10995-022-03582-4] [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] [Accepted: 12/23/2022] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Literature supports numerous benefits of skin-to-skin contact for neonatal adaptation to extrauterine life and bonding/attachment, but few studies explore the effects of skin-to-skin contact on maternal outcomes. This review aims to map the evidence on skin-to-skin contact in the third stage of labor for postpartum hemorrhage prevention. METHODS Scoping review, which covered stages recommended by the Institute Joanna Briggs, including studies from the PubMed, EMBASE, CINAHL, LILACS, Web of Science, and Scopus databases, using the descriptors "Postpartum hemorrhage", "Labor stages, third", "Prevention" and "Kangaroo care/Skin-to-skin". RESULTS 100 publications on the subject found, 13 articles met the inclusion criteria, with 10,169 dyads were assessed in all studies. Publications from 2008 to 2021 were mostly written in English and designed as a randomized controlled trial. Skin-to-skin contact was effective and significant in: reducing the duration of the third stage of labor; placenta delivery; uterine contractility and physiological involution; absence of atony, decreasing blood loss with lower rates of erythrocyte and hemoglobin drop; reducing the need for synthetic oxytocin and/or ergometrine to control bleeding; and reducing changing pads per period and length of stay. DISCUSSION Skin-to-skin contact was considered an effective, low-cost, and safe strategy, with positive effects already established in the literature for infants and extremely favorable results in postpartum hemorrhage prevention cases, being highly recommended in assistance for the dyad. Open Science Framework Registry ( https://osf.io/n3685 ).
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Affiliation(s)
- Mariana Torreglosa Ruiz
- Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Centro, Uberaba, MG, CEP 38025-015, Brazil.
| | - Nayara Freitas Azevedo
- Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Centro, Uberaba, MG, CEP 38025-015, Brazil
| | | | | | - Monika Wernet
- Federal University of Sāo Carlos, Sāo Carlos, Sāo Paulo, Brazil
| | - Maria Paula Custódio Silva
- Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Centro, Uberaba, MG, CEP 38025-015, Brazil
| | - Divanice Contim
- Federal University of Triângulo Mineiro, Praça Manoel Terra, 330, Centro, Uberaba, MG, CEP 38025-015, Brazil
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14
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Linnér A, Westrup B, Rettedal S, Kawaza K, Naburi H, Newton S, Morgan B, Chellani H, Arya S, Phiri VS, Adejuyigbe E, Brobby NA, Boakye-Yiadom AP, Gadama L, Assenga E, Ngarina M, Rao S, Bahl R, Bergman N. Immediate skin-to-skin contact for low birth weight infants is safe in terms of cardiorespiratory stability in limited-resource settings. Glob Pediatr 2023; 3:None. [PMID: 37063780 PMCID: PMC10091907 DOI: 10.1016/j.gpeds.2022.100034] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aim To investigate the safety of skin-to-skin contact initiated immediately after birth on cardiorespiratory parameters in unstable low birth weight infants. Methods A randomized clinical trial was conducted in tertiary newborn units in Ghana, India, Malawi, Nigeria and Tanzania in 2017-2020, in infants with birth weight 1.0-1.799 kg. The intervention was Kangaroo mother care initiated immediately after birth and continued until discharge compared to conventional care with Kangaroo mother care initiated after meeting stability criteria. The results of the primary study showed that immediate Kangaroo mother care reduced neonatal mortality by 25% and the results have been published previously. The post-hoc outcomes of this study were mean heart rate, respiratory rate, oxygen saturation during the first four days and the need of respiratory support. Results 1,602 infants were allocated to control and 1,609 to intervention. Mean birth weight was 1.5 kg (SD 0.2) and mean gestational age was 32.6 weeks (SD 2.9). Infants in the control group had a mean heart rate 1.4 beats per minute higher (95% CI -0.3-3.1, p = 0.097), a mean respiratory rate 0.4 breaths per minute higher (-0.7-1.5, p = 0.48) and a mean oxygen saturation 0.3% higher (95% CI -0.1-0.7, p = 0.14) than infants in the intervention group. Conclusion There were no significant differences in cardiorespiratory parameters during the first four postnatal days. Skin-to-skin contact starting immediately after birth is safe in low birth weight infants in limited-resource settings.
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Affiliation(s)
- Agnes Linnér
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden
- Neonatal Unit, Karolinska University Hospital, Sweden
| | - Björn Westrup
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Siren Rettedal
- Department of Pediatrics, Stavanger University Hospital, Norway
- Faculty of Health Sciences, University of Stavanger, Norway
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, Kamuzu University of Health Sciences, Malawi
| | - Helga Naburi
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana
| | - Barak Morgan
- Institute for Safety Governance and Criminology, University of Cape Town, South Africa
| | - Harish Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, India
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, India
| | | | - Ebunoluwa Adejuyigbe
- Department of Pediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Naana A.Wireko Brobby
- Department of Child Health, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Ghana
| | - Adwoa Pokua Boakye-Yiadom
- Department of Child Health, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Ghana
| | - Luis Gadama
- Department of Obstetrics and Gynecology, Kamuzu University of Health Sciences, Malawi
| | - Evelyne Assenga
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Matilda Ngarina
- Department of Obstetrics and Gynecology, Muhimbili National Hospital, Tanzania
| | - Suman Rao
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Switzerland
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Switzerland
| | - Nils Bergman
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
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15
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Christoph P, Aebi J, Sutter L, Schmitt KU, Surbek D, Oelhafen S. The extended gentle caesarean section protocol-expanding the scope and adding value for the family: a cross-sectional study. Arch Gynecol Obstet 2023; 307:1481-1488. [PMID: 36645503 PMCID: PMC10110671 DOI: 10.1007/s00404-023-06913-0] [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: 11/11/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE In Switzerland, about one in three children is born by caesarean section (CS). For many women, this means a restricted birth experience, limited observation of the birth process and a restricted involvement. We evaluated an extended gentle CS protocol, which offered early intraoperative skin-to-skin contact and the possibility of observing the delivery of the baby from the abdomen through a transparent drape. METHODS This is a cross-sectional study incorporating data from a purposely tailored questionnaire and clinical routine data. The extended gentle CS protocol was compared with the gentle CS, which does not allow the possibility of observing the delivery. Data were collected online and analysed by multivariable regression for quantitative data and content analysis for all text responses to open questions, respectively. RESULTS 193 women completed the questionnaire. Of these, 154 had a gentle CS and 39 had an extended gentle CS. Multivariable regression did not reveal a statistically significant difference for extended gentle CS with regard to satisfaction with childbirth, mother-to-child bonding, or breastfeeding duration. Nevertheless, early intraoperative skin-to-skin contact was associated with the fulfilment of birth expectations. Furthermore, most women who experienced an extended gentle CS would prefer the same procedure for any potential future CS. CONCLUSIONS Although our study showed no statistically significant difference in satisfaction from using a transparent drape, most women expressed a preference for this technique. We recommend that the option of an extended gentle CS should be offered to all women for whom CS is indicated.
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Affiliation(s)
- Patricia Christoph
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Julia Aebi
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Lena Sutter
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Kai-Uwe Schmitt
- School of Health Professions, Bern University of Applied Sciences, 3008, Bern, Switzerland. .,Department of Nursing, Insel Gruppe, Bern University Hospital, 3010, Bern, Switzerland.
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Stephan Oelhafen
- School of Health Professions, Bern University of Applied Sciences, 3008, Bern, Switzerland
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16
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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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17
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Rashidi M, Maier E, Dekel S, Sütterlin M, Wolf RC, Ditzen B, Grinevich V, Herpertz SC. Peripartum effects of synthetic oxytocin: The good, the bad, and the unknown. Neurosci Biobehav Rev 2022; 141:104859. [PMID: 36087759 DOI: 10.1016/j.neubiorev.2022.104859] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
The first clinical applications of oxytocin (OT) were in obstetrics as a hormone to start and speed up labor and to control postpartum hemorrhage. Discoveries in the 1960s and 1970s revealed that the effects of OT are not limited to its peripheral actions around birth and milk ejection. Indeed, OT also acts as a neuromodulator in the brain affecting fear memory, social attachment, and other forms of social behaviors. The peripheral and central effects of OT have been separately subject to extensive scrutiny. However, the effects of peripheral OT-particularly in the form of administration of synthetic OT (synOT) around birth-on the central nervous system are surprisingly understudied. Here, we provide a narrative review of the current evidence, suggest putative mechanisms of synOT action, and provide new directions and hypotheses for future studies to bridge the gaps between neuroscience, obstetrics, and psychiatry.
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Affiliation(s)
- Mahmoud Rashidi
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.
| | - Eduard Maier
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Robert C Wolf
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Valery Grinevich
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
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18
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Lebel V, Campbell-Yeo M, Feeley N, Axelin A. Understanding factors associated with emotional closeness in parents with a preterm infant in the neonatal intensive care unit. Early Hum Dev 2022; 173:105664. [PMID: 36075153 DOI: 10.1016/j.earlhumdev.2022.105664] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is a dearth of knowledge regarding the specific factors associated with emotional closeness in parents with an infant in the NICU. AIM To determine if parental presence, involvement in infant care, holding, skin-to-skin contact (SSC), perceived family-centered care, depression symptoms, and sociodemographic characteristics are associated with the emotional closeness of parents with an infant hospitalized at the NICU. STUDY DESIGN This longitudinal descriptive study was conducted in two Canadian level-three NICUs. A sociodemographic questionnaire was completed by parents at enrolment. A closeness diary was completed by each parent for 14 days to measure parental presence, involvement in infant care, holding, SSC, and emotional closeness. One question from the DigiFCC tool was sent daily via text message to the parents' cellphones to measure their perception of the quality of family-centered care they experienced. Parent depression symptoms were measured using the Edinburgh Postnatal Depression Scale at discharge. RESULTS A total of 60 families were involved in the study. Increased parental presence (B = 0.21, p < 0.001), increased time involved in infant care (B = 0.14, p < 0.001), increased holding time (B = 0.53, p < 0.001), and greater time in SSC (B = 0.27, p = 0.01) were associated with greater parental emotional closeness. CONCLUSION Several factors may enhance parents' emotional closeness when their infant is in the NICU. Care providers need to be aware and adapt their clinical practices accordingly to promote emotional closeness by encouraging parental presence, involvement in infant care, holding, and skin-to-skin contact.
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Affiliation(s)
- Valérie Lebel
- Nursing department, Université du Québec en Outaouais, 5 St-Joseph, St-Jérôme, Québec J7Z 0B7, Canada.
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, 5869 University Avenue PO BOX 15000, Halifax, Nova Scotia B3H 4R2, Canada; Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada; Izaak Walton Killam Health Centre, 5980 University Ave #5850, Halifax, Nova Scotia B3K 6R8, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, 680 Sherbrooke St W, Bureau 1800, Montreal, Québec H3A 2M7, Canada; Jewish General Hospital Centre for Nursing Research & Lady Davis Institute, 3755 Côte-Sainte-Catherine Street, Montréal, Québec H3T 1E2, Canada
| | - Anna Axelin
- Department of Nursing Science, University of Turku, 20014, Finland
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19
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Sampieri CL, Fragoso KG, Córdoba-Suárez D, Zenteno-Cuevas R, Montero H. Influence of skin-to-skin contact on breastfeeding: results of the Mexican National Survey of Demographic Dynamics, 2018. Int Breastfeed J 2022; 17:49. [PMID: 35799253 PMCID: PMC9261042 DOI: 10.1186/s13006-022-00489-2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Skin-to-skin contact and breastfeeding initiation within the first hour after birth are key recommendations to promote breastfeeding. In Mexico, the National Survey of Demographic Dynamics 2018, known by its Spanish acronym ENADID, collected information about breastfeeding practices. The ENADID survey is probabilistic and allows results to be generalized to the entire population in Mexico. Methods Information from a public database featuring 26,587 mother-baby pairs was analyzed by proportions, means and associations, as well as machine learning methods, to conduct a comparison among the pairs according to immediate skin-to-skin contact after delivery status. Results Skin-to-skin contact was described by 78.7% of the mothers and was associated with receiving an explanation regarding how to give breastmilk or the breast to the baby immediately following birth [Odds ratio (OR) 6.46; 95% Confidence Interval (CI) 6.02, 6.97], initiating breastfeeding in the first hour of life (OR 2.01; 95% CI (1.84, 2.18) and a breastfeeding duration of ≥ 6 months (OR 1.16; 95% CI 1.08, 1.25). The breastfeeding duration, in days, was greater in the group with skin-to-skin contact than in the group without skin contact. Conclusions In Mexico, immediate and uninterrupted skin-to-skin contact between newborns and their mothers should be facilitated. Support should be provided to mothers to favor skin-to-skin contact and breasting initiation during the first hour of life, ideally through an empathic explanation by trained health personnel. Future research should focus on the evaluation of strategies to modify maternity services to facilitate immediate skin-to-skin contact after delivery and develop training programs for health personnel to support the initiation of breastfeeding during the first hour of life. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00489-2.
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Affiliation(s)
- Clara Luz Sampieri
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala S/N, Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México.
| | - Karina Gutiérrez Fragoso
- Instituto Tecnológico Superior del Oriente del Estado de Hidalgo, ITESA. Carretera Apan-Tepeapulco km 3.5, Las Peñitas, 43900, Apan, Hidalgo, México
| | - Daniel Córdoba-Suárez
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala S/N, Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México
| | - Roberto Zenteno-Cuevas
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala S/N, Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México
| | - Hilda Montero
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala S/N, Col. Industrial Ánimas, 91190, Xalapa, Veracruz, México
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Campbell-Yeo M, Benoit B, Newman A, Johnston C, Bardouille T, Stevens B, Jiang A. The influence of skin-to-skin contact on Cortical Activity during Painful procedures in preterm infants in the neonatal intensive care unit (iCAP mini): study protocol for a randomized control trial. Trials 2022; 23:512. [PMID: 35725632 PMCID: PMC9208173 DOI: 10.1186/s13063-022-06424-4] [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: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background
Strong evidence suggests that maternal-infant skin-to-skin contact (SSC) is effective in reducing behavioural responses to pain. Given the multi-sensory benefits of SSC, it is highly likely that SSC provided during pain in early life may reduce pain-induced brain activity. The aim of this study is to examine the effect of SSC compared to 24% sucrose on pain-induced activity in the preterm infant brain during a medically required heel lance. Secondary objectives include determining (a) differences between behavioural pain response and noxious-related brain activity during heel lance and (b) rate of adverse events across groups. Methods We will randomly assign 126 babies (32 to 36 completed weeks gestational age) admitted to the neonatal intensive care unit, and their mothers within the first seven days of age to receive (i) SSC plus sterile water and (ii) 24% oral sucrose. Each baby will receive a medically indicated heel lance, following a no treatment baseline period. The primary outcome is noxious-related brain activity measured using an electroencephalogram (EEG) pain-specific event-related potential. Secondary outcomes include pain intensity measured using a bio-behavioural infant pain assessment tool (Premature Infant Pain Profile-Revised) and rate of adverse events. Discussion This will be the first clinical trial to compare the effect of SSC and 24% sucrose on pain-induced brain activity in the preterm infant brain during a clinical noxious stimulus, measured using EEG. Given the negative neurodevelopmental outcomes associated with unmanaged pain, it is imperative that preterm babies receive the most effective pain-reducing treatments to improve their health outcomes. Our findings will have important implications in informing optimal pain assessment and management in preterm infants. Trial registration ClinicalTrials.gov NCT03745963. Registered on November 19, 2018.
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Affiliation(s)
- Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University and IWK Health, Halifax, NS, Canada.
| | - Britney Benoit
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Aaron Newman
- Faculty of Science, Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | | | - Tim Bardouille
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Bonnie Stevens
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto and Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
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21
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Koliouli F, Gaudron CZ, Bourque CJ, Raynaud JP. Parental sense of competence, paternal stress and perceived construction of the relationship with the premature newborn: A mixed method study. Early Hum Dev 2022; 168:105576. [PMID: 35483108 DOI: 10.1016/j.earlhumdev.2022.105576] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the parental sense of competence, the paternal stress and the perceived construction of the relationship with the infant of during the hospitalization in a neonatal intensive care unit. METHODS Forty-eight French fathers of premature infants participated in this study, which took place in the Toulouse University Hospital in France. Mixed methods are used, a semi-structured interview and two self-reported questionnaires. RESULTS Main results show that fathers perceive the construction of the first relationship with their infant through the skin-to-skin and eye contact, along with their immediate presence by their child. The physical contact, although it may induce more stress, it motivates the father to be more involved in the caregiving process. Child's fragile appearance generates more stress to fathers. Finally, the stress linked to the construction of their relationship with the infant will affect their parental sense of competence. CONCLUSION Results are discussed with respect to recent literature and ways to improve professional practice are proposed.
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Affiliation(s)
- Flora Koliouli
- Developmental Psychology, Center of Qualitative Research in Psychology and Mental Health, Department of Psychology, National and Kapodistrian University of Athens, Greece.
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22
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Kahalon R, Preis H, Benyamini Y. Mother-infant contact after birth can reduce postpartum post-traumatic stress symptoms through a reduction in birth-related fear and guilt. J Psychosom Res 2022; 154:110716. [PMID: 35063800 DOI: 10.1016/j.jpsychores.2022.110716] [Citation(s) in RCA: 6] [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: 11/17/2020] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite the well-documented negative effects of posttraumatic stress symptoms following childbirth (PTSS-FC), research on protective factors for PTSS-FC is still missing. Aiming to fill this gap, we proposed and examined a process model through which maternal-infant skin-to-skin contact after birth reduces PTSS-FC by decreasing negative emotions, especially for women who had operative births. METHOD In this longitudinal study, pregnant women (N = 1833) were recruited at community and hospital medical centres in the center of Israel and through internet forums. At Time 1, during pregnancy, they rated their prenatal depressive symptoms which served as an indicator for prenatal vulnerabilities. At Time 2, two-months postpartum (N = 1371, 75% of the sample), they reported their mode of birth, whether they had skin-to-skin contact with their newborn after birth, their emotions during birth, and rated their current PTSS-FC. A moderated mediation analysis was used to examine the proposed model. RESULTS Guilt and fear during birth mediated the association between mode of birth (instrumental or cesarean versus vaginal) and PTSS-FC. Skin-to-skin contact was related to reduced feelings of guilt and fear during birth, especially for women who had a cesarean section. CONCLUSIONS Our results recognize the specific emotions that contribute to the development of PTSS-FC following operative births and show how skin-to-skin contact can possibly reduce them. As such they emphasize the importance of the implementation of skin-to-skin contact following childbirth, and especially following a cesarean section as recommended by the Baby Friendly Health Initiative (World Health Organization & UNICEF, 2009).
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Affiliation(s)
- Rotem Kahalon
- Bob Shapell School of Social Work Tel Aviv University, Israel; Department of Psychology, Simon Fraser University, Canada.
| | - Heidi Preis
- Bob Shapell School of Social Work Tel Aviv University, Israel; Department of Psychology, Stony Brook University, USA.
| | - Yael Benyamini
- Bob Shapell School of Social Work Tel Aviv University, Israel.
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23
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Abstract
Nurturing extremely premature infants is a complicated task that not only necessitates a systematic approach to the immature physiology and its medical management, but also to the needs of the family. Infants born at 22-24 weeks require many weeks of intensive care including a long duration of mechanical ventilation, numerous stressful medical interventions, and for the parents to spend a lot of time in the Neonatal Intensive Care unit (NICU). This paper aims to outline the Swedish nursing approach to nurturing these infants and their families. The nursing care is structured so the parents are the primary caregivers supported by the staff and is based on: timely expression and provision of mother's own breast milk, early and prolonged skin-to-skin contact and close collaboration with the family. While this presentation is based on a single-center's experience, it well represents the general features of nursing provided to extremely preterm infants in Swedish NICUs.
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Affiliation(s)
- Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Johan Ågren
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Victoria Karlsson
- Neonatal Intensive Care Unit, University Children's Hospital, Uppsala, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
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24
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Artese C, Ferrari F, Perugi S, Cavicchioli P, Paterlini G, Mosca F. Surveying family access: kangaroo mother care and breastfeeding policies across NICUs in Italy. Ital J Pediatr 2021; 47:231. [PMID: 34857018 PMCID: PMC8638249 DOI: 10.1186/s13052-021-01164-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies on the application of developmental care initiatives in Italian NICUs are rather scarce. We aimed to assess parental access to the NICUs and facilities offered to the family members and to test "the state of art" regarding kangaroo mother care (KMC) and breastfeeding policies in level III Italian NICUs. METHODS A questionnaire both in paper and in electronic format was sent to all 106 Italian level III NICUs; 86 NICUs (i.e., 80% of NICUs) were completed and returned. The collected data were analysed. In addition, a comparison between the 2017 survey results and those of two previous surveys conducted from 2001 to 2006 was performed. RESULTS In total, 53 NICUs (62%) reported 24-h open access for both parents (vs. 35% in 2001 and 32% in 2006). Parents were requested to temporarily leave the unit during shift changes, emergencies and medical rounds in 55 NICUs (64%). Some parental amenities, such as an armchair next to the crib (81 units (94%)), a room for pumping milk and a waiting room, were common, but others, such as family rooms (19 units (22%)) and adjoining accommodation (30 units (35%)), were not. KMC was practised in 81 (94%) units, but in 72 (62%), i.e., the majority of units, KMC was limited to specific times. In 11 (13%) NICUs, KMC was not offered to the father. The average duration of a KMC session, based on unit staff estimation, was longer in 24-h access NICUs than in limited-access NICUs. KMC documentation in medical records was reported in only 59% of questionnaires. Breastfeeding was successful in a small proportion of preterm infants staying in the NICU. CONCLUSION The number of 24-h access NICUs doubled over a period of 13 years. Some basic family facilities, such as a dedicated kitchen, rooms with dedicated beds and showers for the parents, remain uncommon. KMC and breastfeeding have become routine practices; however, the frequency and duration of KMC sessions reported by NICU professionals still do not meet the WHO recommendations.
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Affiliation(s)
- Claudia Artese
- Neonatology and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Fabrizio Ferrari
- Neonatology and Neonatal Intensive Care Unit, University of Modena and Reggio Emilia Hospital, Via del Pozzo 71, 41125, Modena, Italy.
| | - Silvia Perugi
- Neonatology and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Paola Cavicchioli
- Neonatal Intensive Care Unit, Hospital "Dell'Angelo" Venezia Mestre, Venice, Italy
| | - Giuseppe Paterlini
- Department of Mother's and Child' Health, Neonatology and Neonatal Intensive Care Unit, Poliambulanza Foundation Hospital Institute, Brescia, Italy
| | - Fabio Mosca
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Foundation, University Hospital, Milan, Italy
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25
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Saarinen A, Harjunen V, Jasinskaja-Lahti I, Jääskeläinen IP, Ravaja N. Social touch experience in different contexts: A review. Neurosci Biobehav Rev 2021; 131:360-372. [PMID: 34537266 DOI: 10.1016/j.neubiorev.2021.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/30/2021] [Revised: 08/05/2021] [Accepted: 09/13/2021] [Indexed: 01/27/2023]
Abstract
Social touch is increasingly utilized in a variety of psychological interventions, ranging from parent-child interventions to psychotherapeutic treatments. Less attention has been paid, however, to findings that exposure to social touch may not necessarily evoke positive or pleasant responses. Social touch can convey different emotions from love and gratitude to harassment and envy, and persons' preferences to touch and be touched do not necessarily match with each other. This review of altogether 99 original studies focuses on how contextual factors modify target person's behavioral and brain responses to social touch. The review shows that experience of social touch is strongly modified by a variety of toucher-related and situational factors: for example, toucher's facial expressions, physical attractiveness, relationship status, group membership, and touched person's psychological distress. At the neural level, contextual factors modify processing of social touch from early perceptual processing to reflective cognitive evaluation. Based on the review, we present implications for using social touch in behavioral and neuroscientific research designs.
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Affiliation(s)
- Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | - Ville Harjunen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Inga Jasinskaja-Lahti
- Department of Social Psychology, Faculty of Social Sciences, University of Helsinki, Finland
| | - Iiro P Jääskeläinen
- Brain and Mind Laboratory, Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; International Laboratory of Social Neurobiology, Institute of Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russian Federation
| | - Niklas Ravaja
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
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26
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Brotherton H, Gai A, Kebbeh B, Njie Y, Walker G, Muhammad AK, Darboe S, Jallow M, Ceesay B, Samateh AL, Tann CJ, Cousens S, Roca A, Lawn JE. Impact of early kangaroo mother care versus standard care on survival of mild-moderately unstable neonates <2000 grams: A randomised controlled trial. EClinicalMedicine 2021; 39:101050. [PMID: 34401686 PMCID: PMC8358420 DOI: 10.1016/j.eclinm.2021.101050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Understanding the effect of early kangaroo mother care on survival of mild-moderately unstable neonates <2000 g is a high-priority evidence gap for small and sick newborn care. METHODS This non-blinded pragmatic randomised clinical trial was conducted at the only teaching hospital in The Gambia. Eligibility criteria included weight <2000g and age 1-24 h with exclusion if stable or severely unstable. Neonates were randomly assigned to receive either standard care, including KMC once stable at >24 h after admission (control) versus KMC initiated <24 h after admission (intervention). Randomisation was stratified by weight with twins in the same arm. The primary outcome was all-cause mortality at 28 postnatal days, assessed by intention to treat analysis. Secondary outcomes included: time to death; hypothermia and stability at 24 h; breastfeeding at discharge; infections; weight gain at 28d and admission duration. The trial was prospectively registered at www.clinicaltrials.gov (NCT03555981). FINDINGS Recruitment occurred from 23rd May 2018 to 19th March 2020. Among 1,107 neonates screened for participation 279 were randomly assigned, 139 (42% male [n = 59]) to standard care and 138 (43% male [n = 59]) to the intervention with two participants lost to follow up and no withdrawals. The proportion dying within 28d was 24% (34/139, control) vs. 21% (29/138, intervention) (risk ratio 0·84, 95% CI 0·55 - 1·29, p = 0·423). There were no between-arm differences for secondary outcomes or serious adverse events (28/139 (20%) for control and 30/139 (22%) for intervention, none related). One-third of intervention neonates reverted to standard care for clinical reasons. INTERPRETATION The trial had low power due to halving of baseline neonatal mortality, highlighting the importance of implementing existing small and sick newborn care interventions. Further mortality effect and safety data are needed from varying low and middle-income neonatal unit contexts before changing global guidelines.
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Key Words
- CFR, (Case-fatality rate)
- CI, (confidence interval)
- CLSI, (Clinical & Laboratory Standards Institute)
- CONSORT, (Consolidated Standards of Reporting Trials)
- CSF, (Cerebral-Spinal Fluid)
- DSMB, (Data Safety Monitoring Board)
- EFSTH, (Edward Francis Small Teaching Hospital)
- GEE, (Generalized Estimating Equation)
- HR, (Hazard Ratio)
- ICH-GCP, (International Conference on Harmonisation – Good Clinical Practice)
- IQR, (Inter Quartile Range)
- ISO, (International organisation for standardisation)
- IV, (intravenous)
- KMC, (Kangaroo mother care)
- Kangaroo Mother Care
- Kangaroo method
- LMIC, (Low and middle-income countries)
- LSHTM, (London School of Hygiene & Tropical Medicine)
- MDR, (Multi-drug resistant)
- MRCG, (Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine)
- Mortality
- NA, (not applicable)
- NNU, (Neonatal Unit)
- Neonate
- Newborn
- Premature
- RCT, (Randomised controlled trial)
- RD, (Risk difference)
- RDS, (Respiratory Distress Syndrome)
- RR, (Risk Ratio)
- SAE, (Serious Adverse Event)
- SD, (Standard Deviation)
- SDG, (Sustainable Development Goal)
- SSA, (Sub-Saharan Africa)
- Skin-to-skin contact
- Survival
- WHO, (World Health Organisation)
- aPSBI, (adapted Possible Severe Bacterial Infection)
- aSCRIP, (adapted Stability of Cardio-respiratory in Preterm infants)
- bCPAP, (bubble Continuous Positive Airway Pressure)
- eKMC trial, (early Kangaroo Mother Care before Stabilisation trial)
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Affiliation(s)
- Helen Brotherton
- Department of Infectious Disease Epidemiology and MARCH Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, UK
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, Gambia
| | - Abdou Gai
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, Gambia
| | - Bunja Kebbeh
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, Gambia
| | - Yusupha Njie
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, Gambia
| | - Georgia Walker
- Department of Infectious Disease Epidemiology and MARCH Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, UK
| | | | | | - Mamadou Jallow
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, Gambia
| | - Buntung Ceesay
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, Gambia
| | | | - Cally J Tann
- Department of Infectious Disease Epidemiology and MARCH Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Nakiwogo Road, Entebbe, Uganda
- Neonatal Medicine, University College London Hospitals NHS Trust, Euston Rd, London, UK
| | - Simon Cousens
- Department of Infectious Disease Epidemiology and MARCH Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, UK
| | - Anna Roca
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, Gambia
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology and MARCH Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, UK
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Nunes CRN, Azevedo VMGO, Freitas NF, Rodrigues TM, Costa PR, Alves FL, Rabello MO, Salgado IBVB, Bouzada MCF. Factors associated with the socioemotional development of preterm infants. Infant Behav Dev 2021; 64:101602. [PMID: 34246181 DOI: 10.1016/j.infbeh.2021.101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/03/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022]
Abstract
Preterm birth is a risk factor for problems in interactions with others. We compared the difference in socioemotional development between hospital discharge and at six months of corrected age of infants born ≤32 weeks and assessed the impact of maternal and infantile factors on socioemotional development rate within a 6 month's period. Mother-child dyads (n = 144) were assessed by the Mother-Baby Observation Protocol 0-6 months through a video microanalysis. Multivariate model was built. Neonatal, maternal and child factors were associated with interactive gaze, initiate contact, responsiveness, infantile vocalization, and thus contributed to the socioemocional development of preterm infants with their mothers.
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Kato Y, Takemoto A, Oumi C, Hisaichi T, Shimaji Y, Takaoka M, Moriyama H, Hirata K, Wada K. Effects of skin-to-skin care on electrical activity of the diaphragm in preterm infants during neurally adjusted ventilatory assist. Early Hum Dev 2021; 157:105379. [PMID: 33962362 DOI: 10.1016/j.earlhumdev.2021.105379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/17/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Skin-to-skin care (SSC) reduces neonatal mortality and morbidity and is widely implemented in the neonatal intensive care unit. However, changes in respiratory effort during SSC in ventilated preterm infants remain unclear. AIMS To evaluate the effect of SSC on electrical activity of the diaphragm (Edi) and vital signs in premature infants who are intubated and under neurally adjusted ventilatory assist ventilation. STUDY DESIGN We performed an observational cross-over study. Data were measured in three periods: before (pre-SSC period), during (SSC period), and after (post-SSC period) SSC. Stable 30-min data in each period were extracted. SUBJECTS Thirty-four SSC procedures were performed in 14 preterm infants with a median gestational age of 25.3 weeks (interquartile range, 24, 26.4) and a birth weight of 659 g (566, 694). The median postnatal age was 41 days (31, 53) at the study with a median postmenstrual age of 31.3 weeks (30.4, 32.5). OUTCOME MEASURES Median values of Edi peak, Edi minimum, respiratory rate, SpO2, and heart rate were measured in each condition. The Kruskal-Wallis test with Bonferroni multiple comparisons was used to compare each parameter in each period. RESULTS Median Edi peak and Edi minimum values were significantly lower during SSC compared with pre- and post-SSC, without any change in respiratory rate, SpO2, or heart rate. CONCLUSIONS Respiratory efforts as evaluated by Edi are significantly reduced during SSC in ventilated preterm infants.
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Affiliation(s)
- Yuta Kato
- Department of Nursing, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Ayumi Takemoto
- Department of Nursing, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Chiyo Oumi
- Department of Nursing, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Tomomi Hisaichi
- Department of Nursing, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Yuki Shimaji
- Department of Nursing, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Misa Takaoka
- Department of Nursing, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Hiroko Moriyama
- Department of Nursing, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
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Epstein S, Bauer S, Levkovitz Stern O, Litmanovitz I, Elefant C, Yakobson D, Arnon S. Preterm infants with severe brain injury demonstrate unstable physiological responses during maternal singing with music therapy: a randomized controlled study. Eur J Pediatr 2021; 180:1403-1412. [PMID: 33244709 DOI: 10.1007/s00431-020-03890-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/27/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/16/2022]
Abstract
Preterm infants with severe brain injury are at high risk for poor outcomes and, therefore, may benefit from developmental care modalities such as music therapy (MT). In this prospective, randomized intervention, preterm infants with severe brain injury (grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia) who underwent skin-to-skin contact (SSC) with or without maternal singing during MT were evaluated for physiological responses, including autonomic nervous system stability (low frequency (LF)/high frequency (HF) power), heart rate, respiratory rate, oxygen saturation, and behavioral state. Maternal anxiety state and physiological data were also evaluated. A total of 35 preterm infants with severe brain injuries were included in the study analysis. Higher mean ± standard deviation (SD) LF/HF ratio (1.8 ± 0.7 vs. 1.1 ± 0.25, p = 0.01), higher mean ± SD heart rate (145 ± 15 vs. 132 ± 12 beats per minute, p = 0.04), higher median (interquartile range) infant behavioral state (NIDCAP manual for naturalistic observation and the Brazelton Neonatal Behavioral Assessment) score (3 (2-5) vs. 1 (1-3), p = 0.03), and higher mean ± SD maternal anxiety (state-trait anxiety inventory) score (39.1 ± 10.4 vs. 31.5 ± 7.3, p = 0.04) were documented in SSC combined with maternal singing during MT, as compared to SSC alone.Conclusion: Maternal singing during MT for preterm infants with severe brain injury induces physiological and behavioral instability and increases maternal anxiety during NICU hospitalization. A unique MT intervention should be designed for preterm infants with severe brain injury and their mothers. What is Known: • Preterm infants with severe brain injury are at high risk for poor outcomes. • Music therapy benefits brain development of preterm infants without severe brain injury, however it is unknown whether maternal singing during music therapy for preterm infants with severe brain injury is beneficial. What is New: • Maternal singing during music therapy for preterm infants with severe brain injury induces physiological and behavioral instability and increases maternal anxiety during NICU hospitalization. • A unique music therapy intervention should be designed for preterm infants with severe brain injury and their mothers.
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Affiliation(s)
- Shulamit Epstein
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Sofia Bauer
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Levkovitz Stern
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cochavit Elefant
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Dana Yakobson
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Doctoral program in Music Therapy, Aalborg University, Aalborg, Denmark
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Agudelo SI, Gamboa OA, Acuña E, Aguirre L, Bastidas S, Guijarro J, Jaller M, Valderrama M, Padrón ML, Gualdrón N, Obando E, Rodríguez F, Buitrago L. Randomized clinical trial of the effect of the onset time of skin-to-skin contact at birth, immediate compared to early, on the duration of breastfeeding in full term newborns. Int Breastfeed J 2021; 16:33. [PMID: 33849584 DOI: 10.1186/s13006-021-00379-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Skin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. However, separation at birth is common with negative impact on breastfeeding. The aim was to determine the effect of immediate SSC compared to early SSC on the duration of exclusive breastfeeding. Methods A randomized multicentre parallel clinical trial was conducted in two hospitals in Cundinamarca (Colombia) between November 2018 and January 2020. Low-risk full term newborns at birth were included. Neonates were assigned to immediate (in the first minute after birth) or early onset (start exactly at 60 min of life) skin to skin contact. Monthly follow-up was performed until 6 months of age. The primary outcome was the percentage of exclusively breastfed infants at 6 months (time in months with human milk as the only source of food). Secondary outcomes were the percentage of infants with exclusive breastfeeding at 3 months, duration in months of exclusive breastfeeding, neonate’s breastfeeding ability, percentage of weight change between birth and the first week of life and hospitalization in the neonatal unit in the first week. A bivariate analysis was performed to determine the variables associated with exclusive breastfeeding at 6 months. A survival analysis was performed to evaluate the effect of the onset of SSC on exclusive breastfeeding duration. Results A total of 297 newborns were included: 49.8% (n = 148) in the immediate SSC group, and 50.2% (n = 149) in the early SSC group. The mean duration of exclusive breastfeeding in both groups was 5 months. There were no differences between the groups in the percentage of exclusive breastfeeding at 6 months (relative risk [RR] 1.06, 95% CI 0.72, 1.58) or in the duration of exclusive breastfeeding (hazard ratio [HR] 0.98, 95% CI 0.74, 1.28). Conclusions The percentage of infants and the duration of exclusive breastfeeding in the first 6 months of age were the same between the two groups of SSC interventions. Given the current barriers to its implementation, the results of this study could positively impact the use of SSC at birth and standardize the intervention and improve breastfeeding indicators. Trial registration ClinicalTrials.gov NCT02687685.
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Abdulghani N, Cooklin A, Edvardsson K, Amir LH. Mothers' perceptions and experiences of skin-to-skin contact after vaginal birth in Saudi Arabia: A cross-sectional study. Women Birth 2021; 35:e60-e67. [PMID: 33608236 DOI: 10.1016/j.wombi.2021.02.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/22/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
PROBLEM The World Health Organization recommends immediate skin-to-skin contact after birth, however, worldwide, separation of mothers and infant is common. BACKGROUND In Saudi Arabia, there is a lack of research exploring mothers' experiences of skin-to-skin contact after birth. AIM To estimate the rate of skin-to-skin contact and describe mothers' perceptions and experiences of immediate skin-to-skin contact after vaginal birth in two largest hospitals in Jeddah, Saudi Arabia. METHODS A cross-sectional study conducted in 2017. A total of 254 mothers completed the survey on the postnatal ward (92 % response rate). The survey consisted of 36 closed and open-ended items. Data were described using summary statistics and free text comments were analysed using content analysis. RESULTS The rate of direct skin-to-skin contact was 15%. A further 54% of mothers had the baby placed on their chest/abdomen but with a sheet/gown between them. Mothers reported favourable perceptions towards skin-to-skin contact and reported the practice as acceptable (67%). Most mothers did not express concerns about feeling exposed (85%) or that skin-to-skin contact was inconsistent with norms of modesty or culture (87%). The free text comments indicated that most mothers felt positive about their experience of skin-to-skin contact, while some mothers felt overwhelmed and unprepared. DISCUSSION AND CONCLUSIONS Skin-to-skin contact was not routinely implemented after birth and the rate was low. Mothers held positive perceptions and wanted to practice skin-to-skin contact. Policy makers and clinicians should acknowledge mothers' needs and feelings by facilitating skin-to-skin contact to achieve optimal outcomes for mothers and infants.
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Affiliation(s)
- Nawal Abdulghani
- Faculty of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia; Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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He FB, Axelin A, Ahlqvist-Björkroth S, Raiskila S, Löyttyniemi E, Lehtonen L. Effectiveness of the Close Collaboration with Parents intervention on parent-infant closeness in NICU. BMC Pediatr 2021; 21:28. [PMID: 33430816 PMCID: PMC7798198 DOI: 10.1186/s12887-020-02474-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parent-infant closeness during hospital care of newborns has many benefits for both infants and parents. We developed an educational intervention for neonatal staff, Close Collaboration with Parents, to increase parent-infant closeness during hospital care. The aim of this study was to evaluate the effectiveness of the intervention on parent-infant closeness in nine hospitals in Finland. METHODS Parents of hospitalized infants were recruited in the hospitals during 3-month periods before and after the Close Collaboration with Parents intervention. The data were collected using daily Closeness diaries. Mothers and fathers separately filled in the time they spent in the hospital and the time of skin-to-skin contact with their infant during each hospital care day until discharge. Statistical analyses were done using a linear model with covariates. RESULTS Diaries were kept before and after the intervention by a total of 170 and 129 mothers and 126 and 84 fathers, respectively. Either parent was present on average 453 min per day before the intervention and 620 min after the intervention in the neonatal unit. In the adjusted model, the increase was 99 min per day (p = 0.0007). The infants were in skin-to-skin contact on average 76 min per day before the intervention and 114 min after the intervention. In the adjusted model, skin-to-skin contact increased by 24 min per day (p = 0.0405). CONCLUSION The Close Collaboration with Parents intervention increased parents' presence and skin-to-skin contact in nine hospitals. This study suggests that parent-infant closeness may be one mediating factor explaining benefits of parenting interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT04635150 . Retrospectively registered.
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Affiliation(s)
- Felix B He
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Simo Raiskila
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | | | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
- University of Turku, Turku, Finland.
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Quiñoz-Gallardo MD, Rodríguez-Soberado P, González-María E, Albornos-Muñoz L, Gutiérrez-Martínez MM, Harillo-Acevedo D, Cutanda-Carrión B, Del Rio-Martínez P, Lozano-Díaz D, Maestre-García MÁ, Cabrera-Cabrera MÁ, Gómez-Martín I, Pino-Morales E. [Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study.]. Rev Esp Salud Publica 2020; 94:e202012152. [PMID: 33226012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). METHODS Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. RESULTS The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05). CONCLUSIONS According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.
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Affiliation(s)
| | | | - Esther González-María
- Unidad de Investigación en Cuidados de Salud (Investen-isciii). Instituto de Salud Carlos III. Madrid. España
| | - Laura Albornos-Muñoz
- Unidad de Investigación en Cuidados de Salud (Investen-isciii). Instituto de Salud Carlos III. Madrid. España
| | | | | | | | | | - David Lozano-Díaz
- Servicio de Pediatría. Hospital General La Mancha Centro. Alcázar de San Juan. Ciudad Real. España
| | | | | | - Inmaculada Gómez-Martín
- Departamento de Osbtetricia/Puerperio. Hospital Universitario Vall d'Hebron. Barcelona. España
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Hucklenbruch-Rother E, Vohlen C, Mehdiani N, Keller T, Roth B, Kribs A, Mehler K. Delivery room skin-to-skin contact in preterm infants affects long-term expression of stress response genes. Psychoneuroendocrinology 2020; 122:104883. [PMID: 33027708 DOI: 10.1016/j.psyneuen.2020.104883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Received: 08/27/2019] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/27/2022]
Abstract
Premature birth is a traumatic event that puts mother and child at risk for subsequent psychopathology. Skin-to-skin contact in the form of intermittent kangaroo mother care has been shown to positively affect the infant's stress response and cognitive development, but underlying mechanisms remain unclear. Moreover, first skin-to-skin contact is usually delayed for days after birth. In the delivery room skin-to-skin study (DR-SSC), a prospective randomized controlled trial conducted from 2/2012 to 7/2015, we set out to assess the effect of delivery room skin-to-skin contact on the infant's mRNA expression of six key molecules involved in stress response and neurobehavioral development at hospital discharge. 88 firstborn, singleton preterm infants (born at 25-32 weeks of gestational age) were included. In the delivery room after initial stabilization, infants were randomized to either 60 min of skin-to-skin or 5 min of visual contact with their mother. In this explorative add-on study on the original DR-SSC study, we determined the expression of six important stress response genes (CRHR1 and CRHR2, AVP, NR3C1, HTR2A, and SLC6A4) in peripheral white blood cells of infants during routine blood sampling upon hospital discharge (corrected gestational age of 40 weeks). Infants were followed up to six months corrected age. Relative mRNA expression of the corticotropin releasing hormone receptor 2 (CRH R2), the glucocorticoid receptor gene (NR3C1), and the serotonin transporter gene (SLC6A4) was significantly reduced in the delivery room SSC infants. Additionally, gene expression of CRH R2 showed a correlation with HPA axis reactivity and parameters of mother-child interaction at six months corrected age. Our results highlight the importance of delivery room mother-child skin-to-skin contact and underline the urgent need for in-depth studies on the underlying molecular mechanisms.
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Affiliation(s)
- Eva Hucklenbruch-Rother
- Metabolism and Perinatal Programming, Children's Hospital, University of Cologne, Cologne, Germany.
| | - Christina Vohlen
- Metabolism and Perinatal Programming, Children's Hospital, University of Cologne, Cologne, Germany
| | - Nava Mehdiani
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Titus Keller
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Bernhard Roth
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Angela Kribs
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Katrin Mehler
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
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Selman SB, Dilworth-Bart J, Selman HS, Cook JG, Duncan LG. Skin-to-skin contact and infant emotional and cognitive development in chronic perinatal distress. Early Hum Dev 2020; 151:105182. [PMID: 32977205 PMCID: PMC8536803 DOI: 10.1016/j.earlhumdev.2020.105182] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined whether the timing of maternal-neonate skin-to-skin contact (SSC) predicts infant emotional and cognitive development in the context of chronic maternal perinatal stress and depressive symptoms. STUDY DESIGN This secondary analysis included data from a group-based prenatal care clinical trial for 37 pregnant women with low household income. Mothers completed the Perceived Stress Scale (PSS), and the Center for Epidemiologic Studies Depression Scale (CES-D) during the third trimester and postpartum. After birth, they reported timing of SSC, and completed the Infant Behavior Questionnaire-Revised Very Short Form (IBQ-R VSF) (M = 51.7 weeks, SD = 4.2). Increased PSS or CES-D score from the third trimester to post-birth indicates chronic maternal perinatal stress or depressive symptoms compared to a decrease or no change. Using hierarchical regression models, we examined if the timing of SSC makes a unique contribution in predicting infant outcomes in the context of chronic maternal perinatal stress and depressive symptoms. RESULTS Stress-exposed infants had less negative emotionality if SSC is provided immediately after delivery, less than 10 min after birth. The effect of SSC on effortful control in relation to chronic perinatal stress was not statistically significant. The impact of timing of SSC on negative emotionality or effortful control in relation to chronic perinatal depressive symptoms was not statistically significant. CONCLUSION This work implies that very early SSC may play a role in later infant emotion regulation process and could act as a protective factor in chronically stressed pregnant women.
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Affiliation(s)
- Saliha B. Selman
- Department of Human Development & Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Janean Dilworth-Bart
- Department of Human Development & Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - H. Sule Selman
- Department of Midwifery, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Joseph G. Cook
- Osher Center for Integrative Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Larissa G. Duncan
- Department of Human Development & Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Şolt Kırca A, Kanza Gül D. The effect of music and skin contact with the newborn on pain and anxiety during episiotomy repair in primiparous women: A double-blind randomized controlled study. Explore (NY) 2020; 18:210-216. [PMID: 33277203 DOI: 10.1016/j.explore.2020.11.007] [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: 08/17/2020] [Revised: 10/21/2020] [Accepted: 11/21/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To show that music medicine and skin contact with the newborns can reduce pain and anxiety during episiotomy repair. DESIGN Double-blind randomized controlled trial SETTING: The study was conducted between April and July 2020 at the private Medipol Nisa Hospital. PARTICIPANTS A total of 150 primiparous pregnant women over 20 years of age who underwent vaginal delivery with episiotomy INTERVENTIONS: Participants were randomized into the music medicine, skin contact with the newborn, and control groups (with no treatment). After episiotomy repair (with the designated treatment or no treatment), the State Trait Anxiety Inventory and Visual Analog Scale were used to assess anxiety and pain, respectively. MAIN OUTCOME MEASURES Pain and anxiety experienced after episiotomy repair in the treatment and control groups. RESULTS Women in both treatment groups (music medicine and skin-to-skin contact) had significantly lower anxiety and pain levels than those in the control group. In particular, music medicine significantly reduced pain in comparison to skin contact with the newborn (VAS 2 3.92 ± 1.46 vs. 5.42 ± 1.73, respectively, VAS 3 2.64 ± 1.63 vs. 5.14 ± 1.77, respectively, VAS 4 1.38 ± 1.46 vs. 4.14 ± 2.04, respectively, p < 0.05). Thus, music medicine is more effective than skin-to-skin contact in reducing the pain experienced during episiotomy repair, but both treatments were equally effective in reducing anxiety (35.30 ± 6.47 vs. 36.82 ± 9.71 vs. 49.22 ± 16.95, respectively, p < 0.05). CONCLUSION Both of these nonpharmacological treatments can be used along with analgesics and anxiolytics for the treatment of pain and anxiety during episiotomy repair.
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Affiliation(s)
- Ayça Şolt Kırca
- Kirklareli University School of Health, Midwifery Depertmant Kirklareli, Turkey.
| | - Derya Kanza Gül
- Medipol University School of Medicine Health, Istanbul, Turkey
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Olsson E, Carlsen Misic M, Dovland Andersen R, Ericson J, Eriksson M, Thernström Blomqvist Y, Ullsten A. Study protocol: parents as pain management in Swedish neonatal care - SWEpap, a multi-center randomized controlled trial. BMC Pediatr 2020; 20:474. [PMID: 33046026 PMCID: PMC7549219 DOI: 10.1186/s12887-020-02356-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND During the first period of life, critically ill as well as healthy newborn infants experience recurrent painful procedures. Parents are a valuable but often overlooked resource in procedural pain management in newborns. Interventions to improve parents' knowledge and involvement in infants' pain management are essential to implement in the care of the newborn infant. Neonatal pain research has studied a range of non-pharmacological pain alleviating strategies during painful procedures, yet, regarding combined multisensorial parent-driven non-pharmacological pain management, research is still lacking. METHODS/DESIGN A multi-center randomized controlled trial (RCT) with three parallel groups with the allocation ratio 1:1:1 is planned. The RCT "Parents as pain management in Swedish neonatal care - SWEpap", will investigate the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, during routine metabolic screening of newborn infants (PKU-test). DISCUSSION Parental involvement in neonatal pain management enables a range of comforting parental interventions such as skin-to-skin contact, breastfeeding, rocking and soothing vocalizations. To date, few studies have been published examining the efficacy of combined multisensorial parent-driven interventions. So far, research shows that the use of combined parent-driven pain management such as skin-to-skin contact and breastfeeding, is more effective in reducing behavioral responses to pain in infants, than using the pain-relieving interventions alone. Combined parental soothing behaviors that provide rhythmic (holding/rocking/vocalizing) or orogustatory/orotactile (feeding/pacifying) stimulation that keep the parent close to the infant, are more effective in a painful context. In the SWEpap study we also include parental live lullaby singing, which is an unexplored but promising biopsychosocial, multimodal and multisensory pain alleviating adjuvant, especially in combination with skin-to-skin contact and breastfeeding. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04341194 ) 10 April 2020.
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Affiliation(s)
- Emma Olsson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden.
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Martina Carlsen Misic
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jenny Ericson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Department of Pediatrics, Falun Hospital, Falun, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alexandra Ullsten
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 82, Örebro, Sweden
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden
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Abstract
BACKGROUND The COVID-19 pandemic is disrupting normal life globally, every area of life is touched. The pandemic demands quick action and as new information emerges, reliable synthesises and guidelines for care are urgently needed. Breastfeeding protects mother and child; its health benefits are undisputed and based on evidence. To plan and support breastfeeding within the current pandemic, two areas need to be understood: 1) the clinical characteristics of COVID-19 as it applies to breastfeeding and 2) the protective properties of breastfeeding, including the practice of skin-to-skin care. This review aims to summarise how to manage breastfeeding during COVID-19. The summary was used to create guidelines for healthcare professionals and mothers. METHODS Current publications on breastfeeding during the COVID-19 pandemic were reviewed to inform guidelines for clinical practice. RESULTS Current evidence states that the Coronavirus is not transmitted via breastmilk. Breastfeeding benefits outweigh possible risks during the COVID-19 pandemic and may even protect the infant and mother. General infection control measures should be in place and adhered to very strictly. CONCLUSIONS Breastfeeding should be encouraged, mothers and infant dyads should be cared for together, and skin-to-skin contact ensured throughout the COVID-19 pandemic. If mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. Guidelines, based on this current evidence, were produced and can be distributed to health care facilities where accessible information is needed.
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Affiliation(s)
- Welma Lubbe
- NuMIQ - Quality in Nursing and Midwifery, North-West University, 11 Hoffman St, Potchefstroom, South Africa.
| | - Elina Botha
- School of Health, Midwifery, Tampere University of Applied Sciences, Tampere, Finland
| | | | - Penny Reimers
- Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
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Zhang B, Duan Z, Zhao Y, Williams S, Wall S, Huang L, Zhang X, Wu W, Yue J, Zhang L, Liu J, Zhao G. Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China. Int Breastfeed J 2020; 15:64. [PMID: 32680538 PMCID: PMC7367356 DOI: 10.1186/s13006-020-00309-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/06/2019] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. METHODS Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the "KMC group", those who did not were enrolled in the "No KMC group". Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. RESULTS Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)). CONCLUSIONS Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.
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Affiliation(s)
- Bo Zhang
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | - Zhiying Duan
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | - Yingxi Zhao
- University of Oxford Nuffield Department of Medicine, Oxford, UK
| | | | - Stephen Wall
- Save the Children Saving Newborn Lives, Washington, DC, USA
| | - Limin Huang
- Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Xiaoqin Zhang
- Northwest Women & Children Hospital Department of Obstetrics, Xi'an, Shaanxi, China
| | - Wenli Wu
- Linyi Maternity and Child Health Hospital, Linyi, Shandong, China
| | - Jieya Yue
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | | | - Jun Liu
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.
| | - Gengli Zhao
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.
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Mukherjee D, Chandra Shaw S, Venkatnarayan K, Dudeja P. Skin-to-skin contact at birth for vaginally delivered neonates in a tertiary care hospital: A cross-sectional study. Med J Armed Forces India 2020; 76:180-184. [PMID: 32476716 DOI: 10.1016/j.mjafi.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/23/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background Neonates undergoing skin-to-skin contact (SSC) have shown to have better cardiovascular stability, improved duration of breastfeeding, temperature maintenance and bonding. The primary objective was to estimate the existing prevalence of SSC among mother-infant dyads in the first hour after vaginal delivery, and the secondary objective was to ascertain the factors affecting adherence of SSC after vaginal delivery. Methods This cross-sectional study was carried out in a tertiary care teaching hospital between September 2017 and December 2017. All mother-newborn dyads in the labour room were eligible for the study. Mothers with their newborns, who gave multiple births, or with major congenital malformations or those requiring any form of resuscitation or having respiratory distress or requiring observation in neonatal intensive care unit (NICU) were excluded. All included mother-newborn dyads, after exclusion, were observed for SSC, and the duration in each dyad was recorded. All enrolled mothers, the attending doctors and nurses were asked questions based on a prevalidated questionnaire for the possible barriers of implementation. Results Of a total of 164 mother-infant dyads studied, only 34 (20.7%) carried out SSC for more than 30 min. Sixty-two (37.8%) mother-infant dyads did not participate in any SSC. The commonest reason for non-adherence to SSC was unawareness about the practice in 82.25%, followed by pain and exhaustion after the labour process in 8%. Conclusion The rate of SSC at birth is suboptimal, and the commonest reason is lack of awareness about this important step of essential newborn care.
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Affiliation(s)
| | - Subhash Chandra Shaw
- Associate Professor, Department of Pediatrics, Armed Forces Medical College, Pune 411040, India
| | - K Venkatnarayan
- Senior Advisor & HOD (Pediatrics), Command Hospital (Southern Command), Pune 411040, India
| | - Puja Dudeja
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
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Impact of continuous Kangaroo Mother Care initiated immediately after birth (iKMC) on survival of newborns with birth weight between 1.0 to < 1.8 kg: study protocol for a randomized controlled trial. Trials 2020; 21:280. [PMID: 32188485 PMCID: PMC7081677 DOI: 10.1186/s13063-020-4101-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, about 15% of newborns are born with a low birth weight (LBW) as a result of preterm birth or intrauterine growth restriction or both. Up to 70% of neonatal deaths occur in this group within the first 3 days after birth. Kangaroo Mother Care (KMC) applied after stabilization of the infant has been shown to reduce mortality by 40% among hospitalized infants with a birth weight of less than 2.0 kg. In these studies, infants were randomly assigned and KMC was initiated after about 3 days of age, when the majority of neonatal deaths would have already occurred. The aim of this trial is to evaluate the safety and efficacy of continuous KMC initiated as soon as possible after birth compared with the current recommendation of initiating continuous KMC after stabilization in neonates with a birth weight between 1.0 and less than 1.8 kg. METHODS This randomized controlled trial is being conducted in tertiary-care hospitals in five low- to middle-income countries (LMICs) in South Asia and sub-Saharan Africa. All pregnant women admitted to these hospitals for childbirth are pre-screened. After delivery, all neonates with a birth weight between 1.0 and less than 1.8 kg are screened for enrollment. Eligible infants are randomly assigned to intervention and control groups. The intervention consists of continuous skin-to-skin contact initiated as soon as possible after birth, promotion and support for early exclusive breastfeeding, and provision of health care for mother and baby with as little separation as possible. This efficacy trial will primarily evaluate the impact of KMC started immediately after birth on neonatal death (between enrollment and 72 h of age and deaths between enrollment and 28 days of age) and other key outcomes. DISCUSSION This is the first large multi-country trial studying immediate KMC in LMICs. Implementation of this intervention has already resulted in an important enhancement of the paradigm shift in LMIC settings in which mothers are not separated from their baby in neonatal intensive care units (NICUs). The findings of this trial will have future global implications not only on how the LBW newborns are cared for immediately after birth but also for the dissemination of designing NICUs in accordance with the mother-neonatal intensive care unit (M-NICU) model. TRIAL REGISTRATION Clinical Trials Registry - India (CTRI): CTRI/2018/08/01536 (retrospectively registered); Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001880235 (retrospectively registered).
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Brotherton H, Gai A, Tann CJ, Samateh AL, Seale AC, Zaman SMA, Cousens S, Roca A, Lawn JE. Protocol for a randomised trial of early kangaroo mother care compared to standard care on survival of pre-stabilised preterm neonates in The Gambia (eKMC). Trials 2020; 21:247. [PMID: 32143737 PMCID: PMC7059319 DOI: 10.1186/s13063-020-4149-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Complications of preterm birth cause more than 1 million deaths each year, mostly within the first day after birth (47%) and before full post-natal stabilisation. Kangaroo mother care (KMC), provided as continuous skin-to-skin contact for 18 h per day to fully stabilised neonates ≤ 2000 g, reduces mortality by 36-51% at discharge or term-corrected age compared with incubator care. The mortality effect of starting continuous KMC before stabilisation is a priority evidence gap, which we aim to investigate in the eKMC trial, with a secondary aim of understanding mechanisms, particularly for infection prevention. METHODS We will conduct a single-site, non-blinded, individually randomised, controlled trial comparing two parallel groups to either early (within 24 h of admission) continuous KMC or standard care on incubator or radiant heater with KMC when clinically stable at > 24 h of admission. Eligible neonates (n = 392) are hospitalised singletons or twins < 2000 g and 1-24 h old at screening who are mild to moderately unstable as per a trial definition using cardio-respiratory parameters. Randomisation is stratified by weight category (< 1200 g; ≥ 1200 g) and in random permuted blocks of varying sizes with allocation of twins to the same arm. Participants are followed up to 28 ± 5 days of age with regular inpatient assessments plus criteria-led review in the event of clinical deterioration. The primary outcome is all-cause neonatal mortality by age 28 days. Secondary outcomes include the time to death, cardio-respiratory stability, hypothermia, exclusive breastfeeding at discharge, weight gain at age 28 days, clinically suspected infection (age 3 to 28 days), intestinal carriage of extended-spectrum beta-lactamase producing (ESBL) Klebsiella pneumoniae (age 28 days), and duration of the hospital stay. Intention-to-treat analysis will be applied for all outcomes, adjusting for twin gestation. DISCUSSION This is one of the first clinical trials to examine the KMC mortality effect in a pre-stabilised preterm population. Our findings will contribute to the global evidence base in addition to providing insights into the infection prevention mechanisms and safety of using this established intervention for the most vulnerable neonatal population. TRIAL REGISTRATION ClinicalTrials.gov NCT03555981. Submitted 8 May 2018 and registered 14 June 2018. Prospectively registered.
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Affiliation(s)
- Helen Brotherton
- Faculty of Epidemiology and Population Health, and MARCH Centre, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, UK.
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia.
- Department of Medical Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK.
| | - Abdou Gai
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Cally J Tann
- Faculty of Epidemiology and Population Health, and MARCH Centre, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, Entebbe, Uganda
- Neonatal Medicine, University College London Hospitals NHS Trust, 235 Euston Rd, London, UK
| | | | - Anna C Seale
- Faculty of Epidemiology and Population Health, and MARCH Centre, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, UK
| | - Syed M A Zaman
- Education Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Simon Cousens
- Faculty of Epidemiology and Population Health, and MARCH Centre, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, UK
| | - Anna Roca
- MRC Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Joy E Lawn
- Faculty of Epidemiology and Population Health, and MARCH Centre, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, UK
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Medvedev MM, Tumukunde V, Mambule I, Tann CJ, Waiswa P, Canter RR, Hansen CH, Ekirapa-Kiracho E, Katumba K, Pitt C, Greco G, Brotherton H, Elbourne D, Seeley J, Nyirenda M, Allen E, Lawn JE. Operationalising kangaroo Mother care before stabilisation amongst low birth Weight Neonates in Africa (OMWaNA): protocol for a randomised controlled trial to examine mortality impact in Uganda. Trials 2020; 21:126. [PMID: 32005286 PMCID: PMC6995072 DOI: 10.1186/s13063-019-4044-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/13/2019] [Accepted: 12/30/2019] [Indexed: 01/10/2023] Open
Abstract
Background There are 2.5 million neonatal deaths each year; the majority occur within 48 h of birth, before stabilisation. Evidence from 11 trials shows that kangaroo mother care (KMC) significantly reduces mortality in stabilised neonates; however, data on its effect among neonates before stabilisation are lacking. The OMWaNA trial aims to determine the effect of initiating KMC before stabilisation on mortality within seven days relative to standard care. Secondary objectives include exploring pathways for the intervention’s effects and assessing incremental costs and cost-effectiveness between arms. Methods We will conduct a four-centre, open-label, individually randomised, superiority trial in Uganda with two parallel groups: an intervention arm allocated to receive KMC and a control arm receiving standard care. We will enrol 2188 neonates (1094 per arm) for whom the indication for KMC is ‘uncertain’, defined as receiving ≥ 1 therapy (e.g. oxygen). Admitted singleton, twin and triplet neonates (triplet if demise before admission of ≥ 1 baby) weighing ≥ 700–≤ 2000 g and aged ≥ 1–< 48 h are eligible. Treatment allocation is random in a 1:1 ratio between groups, stratified by weight and recruitment site. The primary outcome is mortality within seven days. Secondary outcomes include mortality within 28 days, hypothermia prevalence at 24 h, time from randomisation to stabilisation or death, admission duration, time from randomisation to exclusive breastmilk feeding, readmission frequency, daily weight gain, infant–caregiver attachment and women’s wellbeing at 28 days. Primary analyses will be by intention-to-treat. Quantitative and qualitative data will be integrated in a process evaluation. Cost data will be collected and used in economic modelling. Discussion The OMWaNA trial aims to assess the effectiveness of KMC in reducing mortality among neonates before stabilisation, a vulnerable population for whom its benefits are uncertain. The trial will improve understanding of pathways underlying the intervention’s effects and will be among the first to rigorously compare the incremental cost and cost-effectiveness of KMC relative to standard care. The findings are expected to have broad applicability to hospitals in sub-Saharan Africa and southern Asia, where three-quarters of global newborn deaths occur, as well as important policy and programme implications. Trial registration ClinicalTrials.gov, NCT02811432. Registered on 23 June 2016.
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Affiliation(s)
- Melissa M Medvedev
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Department of Paediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA, 94158, USA. .,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Victor Tumukunde
- Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda
| | - Ivan Mambule
- Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda
| | - Cally J Tann
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda.,Department of Neonatal Medicine, University College London, 235 Euston Road, London, NW1 2BU, UK
| | - Peter Waiswa
- Centre of Excellence for Maternal, Newborn, and Child Health, School of Public Health, Makerere University, New Mulago Hill Road, Kampala, Uganda.,Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Ruth R Canter
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Christian H Hansen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Centre of Excellence for Maternal, Newborn, and Child Health, School of Public Health, Makerere University, New Mulago Hill Road, Kampala, Uganda
| | - Kenneth Katumba
- Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda
| | - Catherine Pitt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1E 7HT, UK
| | - Giulia Greco
- Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda.,Centre of Excellence for Maternal, Newborn, and Child Health, School of Public Health, Makerere University, New Mulago Hill Road, Kampala, Uganda.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1E 7HT, UK
| | - Helen Brotherton
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council Unit The Gambia at LSHTM, PO Box 273, Fajara, The Gambia
| | - Diana Elbourne
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1E 7HT, UK
| | - Moffat Nyirenda
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, PO Box 49, Entebbe, Uganda
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive, & Child Health Centre, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Tosun Güleroğlu F, Mucuk S, Özgürlük İ. The effect of mother-infant skin-to-skin contact on the involution process and maternal postpartum fatigue during the early postpartum period. Women Health 2019; 60:707-718. [PMID: 31878845 DOI: 10.1080/03630242.2019.1707747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/25/2022]
Abstract
Evidence has been limited on the effect of mother-infant skin-to-skin contact on the involution process and maternal postpartum fatigue. This study aimed to determine such effects in a randomized controlled trial conducted in a hospital in Sivas, Turkey. Seventy-five women were randomized into one of two groups. The Mother-Infant Information Form, Involution Process Evaluation Form and Visual Analogue Scale for Fatigue were used to collect data between October 1, 2015 and May 1, 2016. Repeated Measures ANOVAs were used for data analyzes. In the intervention group, routine care and mother-to-infant skin-to-skin contact were provided for 30 minutes in first postnatal hour. In the control group, routine care was provided. At the postnatal second, fourth and 24th hours, fundus heights were 13.4 ± 0.3, 12.9 ± 0.3 and 11.8 ± 0.3 cm, respectively, in the intervention group, and 14.4 ± 0.4, 13.8 ± 0.3 and 12.9 ± 0.3 cm in the control group (p < .05). At the 24th hour, women in the intervention group had higher mean energy levels (29.8 ± 10.1) than the control group (25.1 ± 10.0) (p < .05), and fatigue score, amount of lochia and number of pads were statistically similar between the groups (p > .05). Mothers expressed satisfaction with skin-to-skin practice. Thus, mother-to-infant skin-to-skin contact can be used as a care practice in the postpartum period.
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Affiliation(s)
| | - Salime Mucuk
- Faculty of Health Sciences, University of Erciyes , Kayseri, Turkey
| | - İzzet Özgürlük
- Gynecology, Dr. Abdurrahman Yurtarslan Oncology Education and Research Hospital , Ankara, Turkey
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Gutiérrez Martínez MDM, González Carrión P, Quiñoz Gallardo MD, Rivas Campos A, Expósito Ruiz M, Zurita Muñoz AJ. [Evaluation of good practices about breastfeeding in a mother and child hospital.]. Rev Esp Salud Publica 2019; 93:e201911088. [PMID: 31690715] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE Protection, promotion and support to the breastfeeding is considered as an area of priority in public health care and as a determining factor of child and maternal health. The use of good practice guides improves health outcomes and patients safety. The aim of study was to assess the impact on breastfeeding of a Guide of Good Clinic Practices about breastfeeding in the Mother and Child Center of the Virgen de las Nieves University Hospital in Granada. METHODS Cross-sectional descriptive study. Mothers and newborns attended from 2015 to 2018 were studied. Process and outcome variables were considered to perform a descriptive and bivariate analysis for the comparison between years. RESULTS The rate of exclusive breastfeeding at discharge went from 58.3% to 72.2%. Significant differences were found for the first intake of exclusive breastfeeding in eutocic births and in C-sections, from 90.8% to 93.2% in the first and from 21.7% to 60% in the second. Improvements were detected in the assessment of intake, postnatal education and onset and duration of skin-to-skin contact. CONCLUSIONS Postnatal protocolized actions carried out by health professionals, such as the assessment of the intake of breastfeeding and postnatal education, were effective for the establishment of breastfeeding. The first moment of skin-to-skin contact and its duration are aspects to be reinforced for effective support.
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Affiliation(s)
| | - Pilar González Carrión
- Hospital Universitario Virgen de las Nieves. Granada. España
- Facultad de Ciencias de la Salud. Universidad de Granada. Granada. España
| | | | | | - Manuela Expósito Ruiz
- Unidad de Investigación del Hospital Universitario Virgen de las Nieves. Fundación FIBAO. Granada. España
- Instituto de Investigación Biosanitaria Ibs Granada. Granada. España
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Owusu-Ansah FE, Bigelow AE, Power M. The effect of mother-infant skin-to-skin contact on Ghanaian infants' response to the Still Face Task: Comparison between Ghanaian and Canadian mother-infant dyads. Infant Behav Dev 2019; 57:101367. [PMID: 31654883 PMCID: PMC6891253 DOI: 10.1016/j.infbeh.2019.101367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/09/2022]
Abstract
The effect of mother-infant skin-to-skin contact on Ghanaian infants' developing social expectations for maternal behavior was investigated. Infants with high and low mother-infant skin-to-skin contact experience in the infants' first month engaged with their mothers in a Still Face Task at 6 weeks of age. Infants with high skin-to-skin contact experience, but not those with low skin-to-skin contact experience, demonstrated the still face effect with their smiles. Infants with both high and low skin-to-skin contact experience demonstrated the still face effect with their visual attention. The behaviors of the Ghanaian infants and their mothers during the task were compared to archival evidence of Canadian mother-infant dyads' behaviors in skin-to-skin and control groups who engaged in the Still Face Task at the infant ages of 1 and 2 months. Similarities and differences between the behaviors of the mother-infant dyads in the two cultures were assessed.
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Affiliation(s)
- Frances Emily Owusu-Ansah
- Department of Behavioral Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Ghana
| | - Ann E Bigelow
- Department of Psychology, St. Francis Xavier University, Canada.
| | - Michelle Power
- Department of Psychology, St. Francis Xavier University, Canada
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Vamour C, De Jonckheere J, Mestdagh B, Storme L, Richart P, Garabedian C, Rakza T. Impact of skin-to-skin contact on maternal comfort in patients with elective caesarean section: A pilot study. J Gynecol Obstet Hum Reprod 2019; 48:663-668. [PMID: 31386917 DOI: 10.1016/j.jogoh.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/17/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Caesarean section is a well-known cause of difficulties in breastfeeding initiation. Mother-infant skin-to-skin contact allows to improve breastfeeding and maternal comfort but remains few practiced during caesarean section. Our objective was to evaluate maternal comfort before and after immediate skin-to-skin contact in case of elective caesarean section. METHODS This was a prospective, observational, monocenter study including patients with elective caesarean section. Mother-infant skin-to-skin contact was begun immediately after birth. The Analgesia Nociception Index (ANI) is a well know heart rate variability (HRV) index, currently used in anesthesia, which decreases during painful stimulation and increases with maternal comfort. The Analgesia Nociception Index was compared before and after skin-to-skin contact. RESULTS 53 patients were included. Skin-to-skin contact was started on average 4min (2-14, IIQ (3-5)) after birth. The median duration was 21min (4-40, IIQ (12.3-29.5)). It was interrupted in 24 patients: 9 from mother's wish, 11 for maternal reasons (drowsiness, stress, pain, maternal hypothermia, lipothymia, vertigo, nausea, cough) and 4 for the newborn (respiratory distress, low pH). The median Analgesia Nociception Index at the end of skin-to-skin contact and at the end of the intervention was statistically higher than that before skin-to-skin contact (p=0.034 and p<10-3 respectively). CONCLUSION Skin-to-skin contact is possible during caesarean section and allows a better maternal comfort. It should be encouraged and proposed to patients during elective caesarean section. It will be interesting to evaluate it in case of caesarean section during labor.
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Affiliation(s)
- Clémence Vamour
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France.
| | - Julien De Jonckheere
- CHU Lille, CIC-IT, F-59000 Lille, France; University of Lille, EA4489, Perinatal Growth and Health, F-59000 Lille, France
| | - Béatrice Mestdagh
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France
| | - Laurent Storme
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France; University of Lille, EA4489, Perinatal Growth and Health, F-59000 Lille, France; CHU Lille, Jeanne de Flandre Hospital, Department of Neonatology, F-59000 Lille, France
| | - Pierre Richart
- CHU Lille, Jeanne de Flandre Hospital, Department of Anesthesiology, F-59000 Lille, France
| | - Charles Garabedian
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France; University of Lille, EA4489, Perinatal Growth and Health, F-59000 Lille, France
| | - Thameur Rakza
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, F-59000 Lille, France; University of Lille, EA4489, Perinatal Growth and Health, F-59000 Lille, France
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Kristoffersen L, Støen R, Bergseng H, Follestad T, Theodorsson E, Vederhus B, Adde L, Austeng D. Skin-to-skin contact during eye examination did not reduce pain compared to standard care with parental support in preterm infants. Acta Paediatr 2019; 108:1434-1440. [PMID: 30561825 DOI: 10.1111/apa.14699] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/24/2018] [Revised: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
AIM We compared the pain relieving effect of skin-to-skin contact versus standard care in the incubator during screening for retinopathy of prematurity. METHODS This randomised crossover study included 35 preterm infants of less than 32 weeks of gestational age admitted to St Olavs University Hospital, Trondheim, Norway, between January 2014 and June 2016. Randomisation was for skin-to-skin with one of the parents or standard care with supportive positioning by parents for the first of two consecutive eye examinations. The pain score was measured twice using the Premature Infant Pain Profile (PIPP) during and after the eye examination. The infants' movement activity was video recorded after the examination. RESULTS There was no difference in mean pain scores with skin-to-skin contact versus standard care during (10.2 vs. 10.3, p = 0.91) or after (7.0 vs. 6.8, p = 0.76) the procedure. Independent of the randomisation group, PIPP scores were lower than previous comparable studies have found. Bouts of movement activity were also the same whether the examination was conducted in skin-to-skin position or in the incubator (p = 0.91). CONCLUSION Skin-to-skin contact during the eye examination did not provide additional pain relief compared to standard care where the parents were already a part of the multidimensional approach.
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Affiliation(s)
- Laila Kristoffersen
- Department of Neonatology; St. Olavs University Hospital; Trondheim Norway
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Ragnhild Støen
- Department of Neonatology; St. Olavs University Hospital; Trondheim Norway
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Håkon Bergseng
- Department of Neonatology; St. Olavs University Hospital; Trondheim Norway
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Turid Follestad
- Department of Public Health and Nursing; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Elvar Theodorsson
- Faculty of Health Sciences; Division of Microbiology and Molecular Medicine; Department of Clinical and Experimental Medicine; Department of Clinical Chemistry; Center for Diagnostics; Linköping University; Region Östergötland Sweden
| | - Bente Vederhus
- Department of Pediatrics; Haukeland University Hospital; Bergen Norway
- Faculty of Health and Social Science; Western Norway University of Applied Sciences; Bergen Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Clinic of Clinical Services; St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Dordi Austeng
- Department of Neuromedicine and Movement Science (INB); Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Ophthalmology; St. Olavs University Hospital; Trondheim Norway
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Lewis TP, Andrews KG, Shenberger E, Betancourt TS, Fink G, Pereira S, McConnell M. Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy Childbirth 2019; 19:227. [PMID: 31272398 PMCID: PMC6610951 DOI: 10.1186/s12884-019-2363-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 12/24/2018] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preterm birth is a leading cause of morbidity and mortality in children under five and often requires a newborn to have an extended stay in a neonatal intensive care unit (NICU). Maternal engagement, such as visiting the NICU to provide kangaroo mother care (KMC), can improve outcomes for preterm infants but requires significant investment of time and resources. This study sought to understand barriers and facilitators to provision of KMC in the NICU. METHODS We conducted semi-structured in-depth interviews with mothers of preterm infants (N = 20) at a large academic medical center in Massachusetts. A series of open-ended interview questions were designed to elicit all aspects of mothers' experiences and to understand how these experiences influence provision of KMC. All interviews were recorded and transcribed verbatim. We conducted an inductive thematic analysis to identify themes in the data with a focus on the barriers and facilitators of KMC provision in the NICU. RESULTS Findings show that engaging in KMC is heavily influenced by the mental, emotional, and physical effects of preterm birth on the birth mother, such as stress around preterm birth and difficulty recovering from birth. These challenges are compounded by structural barriers such as costly accommodations, unreliable transportation, lack of child care, and inadequate maternity leave policies that limit the frequency and duration of KMC and parental ability to provide care. CONCLUSIONS A complex array of mental, emotional, physical, and structural factors determine a mother's ability to visit the NICU and provide kangaroo mother care. Providing social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation services, may address the structural barriers that inhibit KMC, reduce burdensome costs, and improve the health of mothers and their preterm infants.
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Affiliation(s)
- Todd P Lewis
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Building 1, 11th Floor, Boston, MA, 02115, USA.
| | - Kathryn G Andrews
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Building 1, 11th Floor, Boston, MA, 02115, USA
| | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Building 1, 11th Floor, Boston, MA, 02115, USA
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50
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Widström A, Brimdyr K, Svensson K, Cadwell K, Nissen E. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr 2019; 108:1192-1204. [PMID: 30762247 PMCID: PMC6949952 DOI: 10.1111/apa.14754] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 01/28/2019] [Accepted: 02/11/2019] [Indexed: 12/20/2022]
Abstract
AIM This paper integrates clinical expertise to earlier research about the behaviours of the healthy, alert, full-term infant placed skin-to-skin with the mother during the first hour after birth following a noninstrumental vaginal birth. METHOD This state-of-the-art article forms a link within the knowledge-to-action cycle, integrating clinical observations and practice with evidence-based findings to guide clinicians in their work to implement safe uninterrupted skin-to-skin contact the first hours after birth. RESULTS Strong scientific research exists about the importance of skin-to-skin in the first hour after birth. This unique time for both mother and infant, individually and in relation to each other, provides vital advantages to short- and long-term health, regulation and bonding. However, worldwide, clinical practice lags. A deeper understanding of the implications for clinical practice, through review of the scientific research, has been integrated with enhanced understanding of the infant's instinctive behaviour and maternal responses while in skin-to-skin contact. CONCLUSION The first hour after birth is a sensitive period for both the infant and the mother. Through an enhanced understanding of the newborn infant's instinctive behaviour, practical, evidence-informed suggestions strive to overcome barriers and facilitate enablers of knowledge translation. This time must be protected by evidence-based routines of staff.
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Affiliation(s)
| | | | - Kristin Svensson
- Karolinska InstitutetStockholmSweden
- Karolinska University HospitalKarolinska InstitutetStockholmSweden
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