Azza H. Ahmed

Paternal Postpartum Depression: What Health Care Providers Should Know

Paternal postpartum depression (PPD) is a clinically significant problem for families that is currently underscreened, underdiagnosed, and undertreated. Maternal PPD is a well-known condition and has been extensively researched. In comparison, PPD in fathers and its potential effects on the family are not widely recognized. Studies have shown the importance of optimal mental health in fathers during the postpartum period. Negative effects of paternal PPD affect marital/partner relationships, infant bonding, and child development. To promote optimal health for parents and children, pediatric nurse practitioners must stay up to date on this topic. This article discusses the relationship of paternal PPD to maternal PPD; the consequences, signs, and symptoms; and the pediatric nurse practitioners role in assessing and managing paternal PPD.

Effect of Pre- and Postdischarge Interventions on Breastfeeding Outcomes and Weight Gain Among Premature Infants

OBJECTIVE To investigate the effect of pre- and postdischarge interventions on breastfeeding outcomes and weight gain among preterm infants. DATA SOURCES PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched for study selection using MeSH terms infant/premature, breastfeeding, weight gain, patient discharge, postnatal care, and counseling. STUDY SELECTION Inclusion criteria included studies that involved preterm infants who were born less than or equal to 37 weeks of gestation, randomized controlled trials that were in English, conducted in developed countries, and had breastfeeding and weight gain outcomes. A total of 8 articles met inclusion criteria. DATA EXTRACTION All data related to breastfeeding outcomes including duration, exclusivity, maternal satisfaction, and weight gain were extracted from the randomized controlled trials for the purpose of data synthesis. DATA SYNTHESIS A total of 310 studies were reviewed. Eight randomized controlled trials met the inclusion criteria. Gestational age of the infants in the studies ranged from 26 to 37 weeks. The results revealed that kangaroo care, peer counseling, in-home breast milk intake measurement, and postdischarge lactation support improved breastfeeding outcomes among preterm infants, and that maternal satisfaction improved with postdischarge interventions. No significant evidence of pre- and postdischarge interventions on weight gain was found. CONCLUSIONS Pre- and postdischarge interventions were effective in promoting breastfeeding exclusivity, duration, and maternal satisfaction among mothers of preterm infants. These findings have important clinical implications that support the need for evidence-based breastfeeding interventions for preterm infants before discharge and vigilant postdischarge support. Research to determine more effective interventions to promote exclusive and long-term breastfeeding among preterm infants is required.

Impact of Telemedicine in Managing Type 1 Diabetes Among School-age Children and Adolescents: An Integrative Review

Patients with diabetes who have limited access to healthcare services are less likely to maintain adequate diabetes control. Telemedicine represents a useful solution to the strict follow up required in diabetes management. This review analyzes the impact that telemedicine has on the management of type 1 diabetes among school-age children and adolescents, as measured by compliance with blood glucose monitoring, glycemic control, satisfaction, and self management. In general, this review supports the use of telemedicine in maintaining glycemic control. Further studies are desired to observe the impact of telemedicine in managing type 1 diabetes in school-age children and adolescents.

Role of the Pediatric Nurse Practitioner in Promoting Breastfeeding for Late Preterm Infants in Primary Care Settings

The preterm birth rate has been increasing steadily during the past two decades. Up to two thirds of this increase has been attributed to the increasing rate of late preterm births (34 to < 37 gestational weeks). The advantages of breastfeeding for premature infants appear to be even greater than for term infants; however, establishing breastfeeding in late-preterm infants is frequently more problematic. Because of their immaturity, late preterm infants may have less stamina; difficulty with latch, suck, and swallow; temperature instability; increased vulnerability to infection; hyperbilirubinemia, and more respiratory problems than the full-term infant. Late preterm infants usually are treated as full term and discharged within 48 hours of birth, so pediatric nurse practitioners in primary care settings play a critical role in promoting breastfeeding through early assessment and detection of breastfeeding difficulties and by providing anticipatory guidance related to breastfeeding and follow-up. The purpose of this article is to describe the developmental and physiologic immaturity of late preterm infants and to highlight the role of pediatric nurse practitioners in primary care settings in supporting and promoting breastfeeding for late preterm infants.

Interactive Web-Based Breastfeeding Monitoring Feasibility, Usability, and Acceptability

Background: Strategies that promote higher exclusive breastfeeding rate and duration are highly recommended. To date, no study has tested the feasibility of Web-based monitoring among breastfeeding mothers. Goals: To develop an interactive Web-based breastfeeding monitoring system (LACTOR) and examine its feasibility, usability, and acceptability among breastfeeding mothers. Methods: A prospective, descriptive, mixed-methods study was conducted. Mothers who met the study inclusion criteria were recruited from mother infant units in 2 Midwestern hospitals in the United States. Mothers were asked to enter their breastfeeding data daily through the system for 30 days and then submit an online exit survey. This survey consisted of a system usability scale and mothers’ perceptions form. Twenty-six mother/infant dyads completed the study. Results: The Feasibility of LACTOR was established by mothers’ compliance in entering their breastfeeding data. The mean was 8.87 (SD = 1.21) daily entries, and the range was 6-13 times per day. Usability scale total mean score was 3.35 (SD = 0.33; scale range 0-4). Ninety-two percent of the mothers thought that they did not need to learn many skills before they started to use LACTOR and did not need any technical support. Mothers reported that the monitoring was beneficial and gave them the chance to track their infants’ feeding patterns and detect any problems early. Conclusions: This study demonstrated the feasibility of LACTOR, and it was user-friendly and acceptable among mothers. Further studies to test its effect on breastfeeding outcomes are needed.

The Effect of Interactive Web-Based Monitoring on Breastfeeding Exclusivity, Intensity, and Duration in Healthy, Term Infants After Hospital Discharge

OBJECTIVE To determine whether a Web-based interactive breastfeeding monitoring system increased breastfeeding duration, exclusivity, and intensity as primary outcomes and decreased symptoms of postpartum depression as a secondary outcome. DESIGN Two-arm, randomized controlled trial. SETTING Three hospitals in the Midwestern United States. PARTICIPANTS One hundred forty one (141) mother-newborn dyads were recruited before discharge. METHODS Postpartum women were randomly assigned to the control or intervention groups. Women in the control group (n = 57) followed the standard hospital protocol, whereas women in the intervention group (n = 49) were given access to an online interactive breastfeeding monitoring system and were prompted to record breastfeeding and infant output data for 30 days. A follow-up online survey was sent to both groups at 1, 2, and 3 months to assess breastfeeding outcomes and postpartum depression. RESULTS For mothers and infants, there were no significant differences in demographics between groups. No significant differences in breastfeeding outcomes were found between groups at discharge (p = .707). A significant difference in breastfeeding outcomes was found between groups at 1, 2, and 3 months (p = .027, p < .001, and p = .002, respectively). Members of the intervention group had greater exclusive breastfeeding rates at 1, 2, and 3 months. By the end of the third month, 84% of the intervention group was breastfeeding compared with 66% of the control group. Postpartum depression symptom scores decreased for both groups at 1, 2, and 3 months (control group: 4.9 ± 3.9, 4.3 ± 4.9, and 3.2 ± 3.9, respectively; intervention group: 4.7 ± 4.5, 3.0 ± 3.4, and 2.8 ± 3.6, respectively). However, there was no significant difference between groups at 1, 2, and 3 months (p = .389, .170, and .920, respectively) for depression. CONCLUSION The Web-based interactive breastfeeding monitoring system may be a promising intervention to improve breastfeeding duration, exclusivity, and intensity.

Parental Opioid Abuse: Barriers to Care, Policy, and Implications for Primary Care Pediatric Providers

Parental opioid use is affecting the physical, developmental, and mental health of the pediatric population nationwide and raises questions of safety when these children remain in the care of opioid-addicted parents. Pediatric providers face many barriers to identifying and caring for children beyond the neonatal period who have been affected by parental opioid abuse both in utero and in the home. These barriers include communication between providers and services, identification of intrauterine exposure, parental opioid abuse screening, and knowledge of child protective services involvement. In addition, understanding current state and national health policy regarding parental opioid abuse helps providers navigate these barriers. The purpose of this article is to identify barriers to care of children affected by parental opioid abuse both in utero and in the home, to discuss current health policy surrounding the issue, and to identify implications for the care of these children in the primary care pediatric setting.

Child Passenger Safety Policy and Guidelines: Why Change Is Imperative.

Despite dramatic advances in child passenger safety during the past decade, motor vehicle collisions (MVCs) remain the leading cause of unintentional injury deaths for children ages 1 year and older (Centers for Disease Control and Prevention [CDC], 2010). The risk of injury or death related to MVCs increases as the child ages, which is attributable to lower rates of child safety restraint use (Yingling, Stombaugh, Jeffrey, LaPorte, & Oswanski, 2011). It has been found that children ages 4 to 8 years have the lowest rates of child safety restraint use, ranging from 36% to 43% (Yingling et al., 2011).

Does circadian disruption play a role in the metabolic-hormonal link to delayed lactogenesis II?

Breastfeeding improves maternal and child health. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, with continued breastfeeding for at least 1 year. However, in the US, only 18.8% of infants are exclusively breastfed until 6 months of age. For mothers who initiate breastfeeding, the early post-partum period sets the stage for sustained breastfeeding. Mothers who experience breastfeeding problems in the early post-partum period are more likely to discontinue breastfeeding within 2 weeks. A major risk factor for shorter breastfeeding duration is delayed lactogenesis II (DLII; i.e., onset of milk “coming in” more than 72 h post-partum). Recent studies report a metabolic–hormonal link to DLII. This is not surprising because around the time of birth the mother’s entire metabolism changes to direct nutrients to mammary glands. Circadian and metabolic systems are closely linked, and our rodent studies suggest circadian clocks coordinate hormonal and metabolic changes to support lactation. Molecular and environmental disruption of the circadian system decreases a dam’s ability to initiate lactation and negatively impacts milk production. Circadian and metabolic systems evolved to be functional and adaptive when lifestyles and environmental exposures were quite different from modern times. We now have artificial lights, longer work days, and increases in shift work. Disruption in the circadian system due to shift work, jet-lag, sleep disorders, and other modern life style choices are associated with metabolic disorders, obesity, and impaired reproduction. We hypothesize that DLII is related to disruption of the mother’s circadian system. Here, we review literature that supports this hypothesis, and describe interventions that may help to increase breastfeeding success.

Strategies for neonatal hyperbilirubinemia: a literature review.

Abstract“Common” neonatal jaundice can lead to dangerous levels of hyperbilirubinemia, causing neurological damage and even death. This article outlines evidence-based assessment techniques, management guidelines, and treatments for neonatal hyperbilirubinemia, addressing complexities that have arisen with new technologies and research results. We also explicate the role of the nurse in both prevention and care of patients and families who are affected by hyperbilirubinemia and jaundice.