Developmentally Supportive Care of the Preterm Neonate

AIM: This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units.BACKGROUND: Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model.DATA SOURCES: Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue.DISCUSSION: Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads.CONCLUSION: Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes.

Introduction: Skin-to-skin contact (CPP) is the placement of the naked newborn on the mother’sbreast, covered only with a cap, sheet or gown.Objective: To determine the effect of skin-to-skin contact in the breastfeeding of infants in theNational Institute of Perinatology.Material and methods: Prospective, descriptive, observational, and cross-sectional study wasperformed, including a search for the information in the database of the Immediate Care Unitfor the Newborn from 1 August 2015 to 31 July 2016. The data obtained were Gestational age,weight, Apgar, maternal pathology, skin-to-skin contact, duration, and feeding.Results: There were 3175 births, with 2228 term neonates. CPP was performed in 1486 neona-tes (78.95%), with a weight of 2,045 to 4,200 g. The majority of patients who were breastfed(78.7%) had had skin-to-skin contact. Likewise, it was observed that CPP significantly favouredbreastfeeding (RR=143.28; 95% CI: 75.5-271.7).Discussion: CPP favours breastfeeding (99.2%), making the first food human milk, and reducingthe use of substitutes.Conclusions: Skin-to-skin contact is the best opportunity for the initiation of breastfeeding.The separation of mothers and their children at birth has become a common practice in thedelivery and operating rooms, due to hospital routines, placing the infant in a cradle of radiantheat, and initiating breastfeeding after one hour of life.

Hypocalcemia is a frequently observed clinical and laboratory abnormality in neonates. Ionic calcium is crucial for many biochemical processes including blood coagulation, neuromuscular excitability, cell membrane integrity, and many of the cellular enzymatic activities. Healthy term infants undergo a physiological nadir in serum calcium levels by 24-48 h of age. This nadir may drop to hypocalcemic levels in high-risk neonates including infants of diabetic mothers, preterm infants and infants with perinatal asphyxia. The early onset hypocalcemia which presents within 72 h requires treatment with calcium supplementation for at least 72 h. In contrast, late onset hypocalcemia usually presents after 7 days and requires longer term therapy.

This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time.

Immediate pain warns of harm or injury to the person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair.

Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions.

This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management.

Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019.

Introduction: The preterm infants’ developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/ father–infant interactions and the parents’ ability to respond to the trauma of premature birth. In the case of premature birth, the father’s ability to take an active part in the care of the infant from the start is essential. The parents’ emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent–infant affective relationship and the parents’ confidence in their ability to provide care for their baby.
Methods and analysis: This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother–infant and father–infant interaction in the NICU; (3) a semistructured interview with fathers during the infants’ hospital stay; (4) 3-minute video recordings of mother–infant and father–infant face-toface interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions.
Ethics and dissemination: The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother–infant relationship.

Developmental care for high-risk infants is practiced in most neonatal units around the world. Despite its wide acceptance, inconsistency in its definition and application has resulted in criticism regarding its scientific merit. The universe of developmental care model proposed in this article is the first major reformulation of neonatal developmental care theory since Als' synactive theory. Neither the developing brain nor the environment exists in isolation, and therefore are dependent on each other for all caregiving activities. Central to this model is the concept of a shared surface, manifested most obviously by the skin that forms the critical link between the body/organism and environment and becomes the focal point for human interactions. The components of the model and its theoretical underpinnings, its practical application and direction for future clinical practice, education, and research are presented.

The first days of life are dificult and crucial for the future of the tiny human. His first steps in life are shaped by his vulner-ability. The thin red line between life and death and the bor-derline between health and hindered development will never be as narrow as they are now. Expectations, responsibility, and hopes are great at this time; both commitment and emotional involvement of the family and the ones in charge of the baby are very high.

Neonatology has made amazing advances lately and develops swiftly. Nurses working in neonatal intensive care units, neonatology wards, pediatrics departments, or general practic-es and midwives are the ones most close to the infants, in the front line of the defense of their health and welfare.
Neonatology for Nurses. It includes chapters on prenatal infant care, infant adjustment to extrauterine life, how to feed a newborn baby, pharmacology of the neonatal age, high-risk babies, delivery room care of the neonate, birth asphyxia, birth trauma, respiratory distress syndrome, neonatal sepsis, neonatal jaundice, neonatal transport, neonatal bleeding disorders, parents- staff dialogue, and care of the well-baby.

Background: Hospitalization of preterm babies in Neonatal Intensive Care Unit (NICU) exposes mothers to critical care environment for as much period as it is determined by the condition of their babies. The purpose of the study is to explore the experiences of mothers about prolonged hospitalization of their babies in NICU. Methods: A literature search was conducted using electronic data base such as EBSCOHOST, GOOGLE SCHOLAR; PUBMED and CINAHL for articles published between 2000 and 2015 that explore mothers' experiences regarding hospitalization of the preterm babies in NICU. Lastly, authors also made inferences from their personal experiences as players in nursing practice/education Themes were derived from the articles which included mothers' interaction with their own babies, other mothers, health care personnel and the NICU environment. Results: The admission of preterm babies in NICU is stressful to the mothers. It is associated with fear, anxiety frustration which consequently interferes with bonding between the mother and the baby. This paper seeks to explore mothers' experiences regarding prolonged hospitalization of their preterm babies in NICU.

Background: Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones.

Recent medical ethics literature has proposed the acceptability of killing new-born infants, calling it “after-birth abortion” which is another euphemism of infanticide. This letter to the editor looks at the history behind this thinking and analyzes the serious problems associated with this proposal.

ntroducción: Los prematuros pueden presentar lesiones por reperfusión hiperóxica, por lo quese deben evitar niveles nocivos de oxígeno.Objetivo: Determinar, durante la reanimación neonatal de recién nacidos de 27 a 30 semanasde edad gestacional, los requerimientos de oxígeno, el porcentaje de saturación y su relacióncon la morbilidad neonatal.Material y métodos: Estudio transversal observacional y analítico. Se incluyeron neonatos de27 a 30 semanas de gestación; se excluyeron neonatos con malformaciones congénitas mayoresy las defunciones antes de las 36 semanas de edad gestacional corregida. Se dividieron en grupo1, neonatos de 27 y 28 semanas, y grupo 2, neonatos de 29 y 30 semanas; se analizaron variablesmaternas y neonatales con requerimiento de FiO2y saturación de oxígeno a los 5 y 10 minutos,así como el desarrollo de morbilidad neonatal.Resultados: Ingresaron 39 neonatos en el grupo 1 y 31 en el grupo 2. La FiO2en promediopara el grupo 1 a los 5 minutos fue del 77.56%, y para el grupo 2, del 64.9% (p = 0.045). Elgrupo 1 necesitó mayor concentración de oxígeno para alcanzar saturaciones > 80%. Hubo unaumento de riesgo para hemorragia intraventricular (OR 3.21; IC95%: 1.07-9.60) en el grupo 1.La morbilidad no tuvo relación con la saturación de oxígeno durante la reanimación neonatal

Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. This study aimed to test the feasibility and acceptability of th...

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains ("study design," "statistical methods," and "reporting methods") were assessed in each study. Each item was scored as a "low" or "high" risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of "low risk" of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains ("study design," "statistical methods," and "reporting methods") were assessed in each study. Each item was scored as a "low" or "high" risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of "low risk" of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...

Evidence-based practice supports the patient care process by integrating patient values and preferences with clinician expertise and the best available evidence. This approach to patient care focuses on quality and safety with the aim of improving patient outcomes. Despite its obvious value, healthcare professionals struggle to integrate evidence-based best practices into their clinical practice Keywords research implementation, neuroprotective care, neonatal intensive care, evidence-based practice, age-appropriate care

Factors affecting bone turnover in premature infants are not entirely clear but certainly are different from those influencing bones of adults and children. To identify fetal and maternal factors that might influence bone turnover, we prospectively studied 50 infants (30 preterm and 20 full-term) born at Ain Shams University Obstetric Hospital in Cairo, Egypt. Maternal parity and medical history and infant's weight, gestational age, gender and anthropometrical measurements were recorded. Cord blood samples were collected and serum type I collagen Cterminal propeptide (PICP) was assessed as a marker for fetal bone formation. First morning urine samples were collected and pyridinoline cross-links of collagen (Pyd) were measured as an index for bone resorption. Serum PICP was higher in premature infants when compared with full-term infants (73.30 Ϯ 15.1 versus 64.3 Ϯ 14.7, p ϭ 0.022) and was higher in male premature infants when compared with females (81.64 Ϯ 9.06 versus 66.0 Ϯ 15.7, p ϭ 0.018). In a multiple regression model using PICP as the dependent variable and controlling for different infant and maternal conditions, PICP significantly correlated with infant gender (r ϭ 8.26 Ϯ 4.1, p ϭ 0.05) maternal parity (r ϭ Ϫ2.106 Ϯ 0.99, p ϭ 0.041) and diabetes (r ϭ 22.488 Ϯ 8.73, p ϭ 0.041). Urine Pyd tended to increase in premature infants (612 Ϯ 308 versus 434 Ϯ 146, p ϭ 0.057) and correlated significantly with gestational age (r ϭ Ϫ63.93 Ϯ 19.55, p ϭ 0.002). Therefore, bone formation (PICP) is influenced by fetal age and gender, as well as maternal parity and diabetes. Bone resorption (Pyd) is mostly dependent on gestational age only. Further in-depth studies are needed to enrich management of this vulnerable population. (Pediatr Res 57: 708-711, 2005) Abbreviations PICP, procollagen type-I carboxy-terminal propeptide Pyd, pyridinoline

Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. This study aimed to test the feasibility and acceptability of th...

Intraventricular haemorrhage (IVH) is the most frequent neurological complication of the premature infant, and is associated with an adverse neurological outcome. The objective of this study was to identify risk factors associated with IVH in preterm infants less than 1500 g in the NICU.

Material and methods
A cohort of preterm infants less than 1500 g, admitted to the NICU during 2016, were followed up during their hospital stay until their discharge to home, or death. Perinatal and neonatal variables were analysed. For the statistical analysis, those that developed IVH were compared with those that did not, using the chi-squared test, Student's t-test, odds ratio (OR), and mean difference, with a 95% confidence interval.

Results
IVH was present in 45 (33.3%) neonates, out of a total of 135, being grade 1 in 22 (16%), grade 2 in 6 (4.4%), grade 3 in 8 (5.9%), and grade 4 in 9 (6.6%). C-section had a favourable effect on those babies without IVH (OR: 0.18; 95% CI: 0.07-0.45). The mortality was higher in babies with IVH (OR: 4.63; 95% CI: 1.76-12.11). The birth weight and gestational age were less in those with IVH (887 vs 979 g, and 28.1 vs 29.26 GW). The mortality in severe IVH (grade 3+4) was 64.7%, and in grade 1+2 IVH it was 10.7% (P=.0006).

Conclusions
IVH in infants less than <1500 g is a frequent morbidity, especially in those with low gestational age and birth weight. Severe IVH was associated with mortality.

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains (&quot;study design,&quot; &quot;statistical methods,&quot; and &quot;reporting methods&quot;) were assessed in each study. Each item was scored as a &quot;low&quot; or &quot;high&quot; risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of &quot;low risk&quot; of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...

Factors affecting bone turnover in premature infants are not entirely clear but certainly are different from those influencing bones of adults and children. To identify fetal and maternal factors that might influence bone turnover, we prospectively studied 50 infants (30 preterm and 20 full-term) born at Ain Shams University Obstetric Hospital in Cairo, Egypt. Maternal parity and medical history and infant's weight, gestational age, gender and anthropometrical measurements were recorded. Cord blood samples were collected and serum type I collagen Cterminal propeptide (PICP) was assessed as a marker for fetal bone formation. First morning urine samples were collected and pyridinoline cross-links of collagen (Pyd) were measured as an index for bone resorption. Serum PICP was higher in premature infants when compared with full-term infants (73.30 Ϯ 15.1 versus 64.3 Ϯ 14.7, p ϭ 0.022) and was higher in male premature infants when compared with females (81.64 Ϯ 9.06 versus 66.0 Ϯ 15.7, p ϭ 0.018). In a multiple regression model using PICP as the dependent variable and controlling for different infant and maternal conditions, PICP significantly correlated with infant gender (r ϭ 8.26 Ϯ 4.1, p ϭ 0.05) maternal parity (r ϭ Ϫ2.106 Ϯ 0.99, p ϭ 0.041) and diabetes (r ϭ 22.488 Ϯ 8.73, p ϭ 0.041). Urine Pyd tended to increase in premature infants (612 Ϯ 308 versus 434 Ϯ 146, p ϭ 0.057) and correlated significantly with gestational age (r ϭ Ϫ63.93 Ϯ 19.55, p ϭ 0.002). Therefore, bone formation (PICP) is influenced by fetal age and gender, as well as maternal parity and diabetes. Bone resorption (Pyd) is mostly dependent on gestational age only. Further in-depth studies are needed to enrich management of this vulnerable population. (Pediatr Res 57: 708-711, 2005) Abbreviations PICP, procollagen type-I carboxy-terminal propeptide Pyd, pyridinoline

Re-use of this article is permitted in accordance with the Terms and Conditions set out at Abstract Title. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Aim. This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Background. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease-and procedure-independent measures based on the Universe of Developmental Care model. Data sources. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion. Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Conclusion. Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes. were responsible for the study conception and design. MC, SG and SH were responsible for the drafting of the manuscript. MC, SG and SH made critical revisions to the paper for important intellectual content. MC, SG and SH provided administrative, technical or material support.

Introduction: After congenital hydrocephalus, spinal dysraphisms represent the second cause of neurosurgical consultation within the National Institute of Perinatology ‘Isidro Espinosa de los Reyes’ in Mexico City (INPer). The objective of the present study is to establish the demographic and epidemiological characteristics of live newborns with neural tube defects, during the past year. Material and methods: We carried out a descriptive, observational, retrospective study, including all live births within the Institute and diagnosis at discharge of cranial and/or spinal neural tube defects. The analysis is presented with descriptive statistics, using frequency tables, medians and ranges. Results: Fifteen live births with neural tube closure defects were recorded, of which 3 had more than one defect other than the Chiari malformation, and 80% presented hydrocephalus. All the mothers reported adequate intake of folate. There was no history of relatives with dysraphisms or maternal consumption of anti epileptic drugs. One patient with a closed defect developed fistula and infectious ventriculitis as a surgical complication. Conclusion: The number of cases attended in the INPer, due to neural tube defects, tripled compared to the previous year. The post natal care provided showed fewer complications than those reported in the literature, specifically infectious complications, due to timely multidisciplinary care and possibly due to the surgical closure of all open neural tube defects within the first 24 h

There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. A systematic review of observational longitudinal studies, whose primary objective was to create postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains (&quot;study design,&quot; &quot;statistical methods,&quot; and &quot;reporting methods&quot;) were assessed in each study. Each item was scored as a &quot;low&quot; or &quot;high&quot; risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of &quot;low risk&quot; of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included st...