A. Kirsten Woodend

An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss

BackgroundNewborn weight measurements are used as a key indicator of breastfeeding adequacy. The purpose of this study was to explore non-feeding factors that might be related to newborn weight loss. The relationship between the intravenous fluids women receive during parturition (the act of giving birth, including time in labour or prior to a caesarean section) and their newborns weight loss during the first 72 hours postpartum was the primary interest.MethodsIn this observational cohort study, we collected data about maternal oral and IV fluids during labour or before a caesarean section. Participants (n = 109) weighed their newborns every 12 hours for the first three days then daily to Day 14, and they weighed neonatal output (voids and stools) for three days.ResultsAt 60 hours (nadir), mean newborn weight loss was 6.57% (SD 2.51; n = 96, range 1.83-13.06%). When groups, based on maternal fluids, were compared (≤1200 mls [n = 21] versus > 1200 [n = 53]), newborns lost 5.51% versus 6.93% (p = 0.03), respectively. For the first 24 hours, bivariate analyses show positive relationships between a) neonatal output and percentage of newborn weight lost (r(96) = 0.493, p < 0.001); and b) maternal IV fluids (final 2 hours) and neonatal output (r(42) = 0.383, p = 0.012). At 72 hours, there was a positive correlation between grams of weight lost and all maternal fluids (r(75) = 0.309, p = 0.007).ConclusionsTiming and amounts of maternal IV fluids appear correlated to neonatal output and newborn weight loss. Neonates appear to experience diuresis and correct their fluid status in the first 24 hours. We recommend a measurement at 24 hours, instead of birth weight, for baseline when assessing weight change. Because practices can differ between maternity settings, we further suggest that clinicians should collect and analyze data from dyads in their care to determine an optimal baseline measurement.

Telehome monitoring in patients with cardiac disease who are at high risk of readmission

Patients with chronic conditions are heavy users of the health care system. There are opportunities for significant savings and improvements to patient care if patients can be maintained in their homes. A randomized control trial tested the impact of 3 months of telehome monitoring on hospital readmission, quality of life, and functional status in patients with heart failure or angina. The intervention consisted of video conferencing and phone line transmission of weight, blood pressure, and electrocardiograms. Telehome monitoring significantly reduced the number of hospital readmissions and days spent in the hospital for patients with angina and improved quality of life and functional status in patients with heart failure or angina. Patients found the technology easy to use and expressed high levels of satisfaction. Telehealth technologies are a viable means of providing home monitoring to patients with heart disease at high risk of hospital readmission to improve their self-care abilities.

Correlation of the Heart Rate‐Minute Ventilation Relationship with Clinical Data: Relevance to Rate‐Adaptive Pacing

The heart rate (HR)‐minute ventilation (VE) relationship has been shown to be nonlinear and can be expressed as two distinct straight lines. This study is to assess the correlation of the initial HR‐VE slope to clinical parameters. Maximum treadmill exercise tests were performed in 100 healthy volunteers (age 19–77 years) using a ramp protocol in which work‐rate increases linearly with exercise. Breath‐by‐breath VO2, VCO2, and VE were measured, and HR and RP were monitored throughout the exercise. The HR‐VE curve demonstrated nonlinearity with a breakpoint determined by a change point analysis. This breakpoint was significantly higher than that of the anaerobic threshold. The VEat the HB‐VE breakpoint was 56.4 ± 19.4 and VE at the VE‐VO2 and VCO2‐VO2 breakpoints were 48.0 ± 18.3 (P < 0.0001) arid 40.1 ± 16.5 (P < 0.0001). respectively. TheHR at this HR‐VE breakpoint was 77.7 ± 12.9% of the HR range. The first slope. Si (1.76 ± 0.64) was steeper than the second slope, S2 (0.66 ± 0.39). Although there was a gender difference for S1, the best clinical predictor on a stepwise multiple regression analysis was body surface area (BSA) which explained 47% of the variance. It was concluded that nonlinearity of the HR‐VE curve can be expressed as two straight lines. The breakpoint is beyond the anaerobic threshold and can be estimated to be approximately 75% of the maximal predicted HR. RSA is the only clinical parameter that significantly predicts the initial slope of the HR‐VE curve. This can be of great importance in the programming of rate‐adaptive pacemakers using a VE.

A longitudinal view of factors that influence the emotional well-being of family caregivers to individuals with heart failure.

ABSTRACT Objectives: Caring for community-residing patients with heart failure can affect caregivers’ emotional wellbeing. However, few studies have examined caregivers’ well-being longitudinally, or identified factors associated with positive and negative outcomes. The objective of this longitudinal cohort study was to examine changes in caregivers’ well-being over time, and to identify patient and caregiver factors associated with positive and negative outcomes. Method: Fifty caregiver/heart failure patient dyads were recruited from an acute care facility and followed in the community. All participants completed surveys at hospital admission and 3, 6 and 12 months later. Caregivers completed assessments of depression symptoms and positive affect and standardized measures to capture assistance provided, mastery, personal gain, social support, participation restriction, and patients’ behavioral and psychological symptoms. From patients, we collected demographic characteristics and health-related quality of life. Individual Growth Curve modelling was used to analyze the data. Results: Caregivers’ negative and positive emotions remained stable over time. Depression symptoms were associated with higher participation restriction in caregivers. Positive affect was associated with more personal gain and more social support. Patients’ health-related quality of life and their behavioral and psychological symptoms were not significantly associated with caregivers’ emotional outcomes. Conclusion: Interventions should be offered based on caregivers’ needs rather than patients’ health outcomes, and should focus on fostering caregivers’ feelings of personal gain, assisting them with securing social support, and engaging in valued activities.

Lactation and Breastfeeding Research Studies: Who Should Provide Consent for the Neonate?

Research ethics guidelines do not provide sufficient direction for breastfeeding and human lactation studies. This article presents the principles of consent for research studies and discusses rationales for who should consent for infants in lactation and breastfeeding research studies.