Haifa A. Samra

An Integrated Review of Developmental Outcomes and Late‐Preterm Birth

OBJECTIVE To evaluate existing evidence on long-term developmental outcomes of late-preterm infants (LPI; infants born 34-36 6/7 weeks gestation). DATA SOURCES Computerized bibliographic databases and hand search for English language articles published between January 1995 and November 2010 yielded 817 articles. STUDY SELECTION Twelve studies (10 cohort and two cross-sectional) were identified that defined late-preterm (LP) birth as 34 to 36 6/7 weeks gestation and addressed growth and neurodevelopmental outcomes in LPI. DATA EXTRACTION Using a modified Downs and Black scale for assessing the quality of experimental and observational studies, two reviewers who were blind to each others ratings assessed study quality. Ratings ranged from 12.5 to 14 with moderate to very good interrater agreement. Kappa (κ) values were 0.83 (reporting), 0.63 (external validity), 0.73 (internal validity), and 0.83 (design) for the four subscales and 0.56 for the whole scale, with no major systematic disagreements between reviewers. DATA SYNTHESIS Studies were divided into five categories to include the following developmental outcomes: neurodevelopment, behavioral, cognitive, growth, and function. Using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, synthesis of the findings is provided as an integrative review. CONCLUSION Significant variations in study populations, methodology, and definition of LP exist. Due to paucity and heterogeneity of the existing data especially in infants born 34 to 36 6/7 weeks, there is no clear characterization of the long-term risks, and future research is needed.

Family-centered developmental care practices and research: what will the next century bring?

Family-centered developmental care is an essential element of neonatal intensive care. It is of particular importance when the infant is vulnerable and at greater risk for poor outcomes complicated by a family unit that is easily challenged by the unique needs of the infant. Yet, all infants and their families deserve this philosophy of caregiving. Family-centered developmental care must continue to be tested through research to determine which interventions work, what does not work, and which interventions need further refinement. This article provides a brief history of where we have been in neonatal caregiving, provides definitions for family-centered developmental caregiving and offers some “predictions” about where these practices need to be in the next century. Research questions and strategies are also addressed. As we continue to forge ahead integrating this philosophy into the caregiving arena, it is important to remember that there are many unanswered questions.

Pain management during retinopathy of prematurity eye examinations: a systematic review

Retinopathy of prematurity (ROP) remains a concern for many preterm infants. Early detection and timely treatment have been shown to be effective in improving visual outcomes; moreover, it is crucial that a series of indirect ophthalmic examinations be performed until an infant is considered no longer at risk for the disease. The purpose of this systematic review is to summarize and evaluate the published evidence regarding characteristics and effectiveness of pain management interventions during the ROP examination. Implications for practice are discussed and suggestions for further research are made. Despite the general consensus that ROP examination is a painful procedure with considerable amount of discomfort, evidence shows that pain management during the ROP examination is inadequate. Although there are currently clear recommendations and guidelines for performing the ROP examination, there are no standard protocols for pharmacological and nonpharmacological pain management during the ROP examination. This is an area where much work is still needed to address the needs of the infant during this critical examination.

Patient safety in the NICU: a comprehensive review.

Patient safety is a worldwide priority aimed at preventing medical errors before they cause death, harm, or injury. Medical errors impact 1 in 10 patients worldwide (WHO), and their implications may include death, permanent, or temporary harm, financial loss, and psychosocial harm to the patient and in some cases to the caregiver. The unique aspects and the complexity of the neonatal intensive (NICU) environment, in addition to the vulnerability of the neonatal population increase the risk for medical errors. The following article offers an overview of safety issues specific to neonatal intensive care and provides strategies and examples on how to ensure safe practice. In particular, the authors focus on strategies to improve the team process. Practice recommendations and research implications are presented.

Epigenetics and family-centered developmental care for the preterm infant.

Adverse experiences early in life have the potential to disrupt normal brain development and create stress response channels in preterm infants that are different from those observed in term infants. Animal models show that epigenetic modifications mediate the effects of maternal separation and environmental stress on susceptibility to disease and psychobehavioral problems later in life. Epigenetic research has the potential to lead to the identification of biological markers, gene expression profiles, and profile changes that occur overtime in response to early-life experiences. Combined with knowledge gained through the use of advanced technologies, epigenetic studies have the promise to refine our understanding about how the brain matures and functions from multiple perspectives including the effect of the environment on brain growth and maturation. Such an understanding will pave the way for care practices that will allow the premature brain to develop to its full capacity and will lead to the best possible outcomes. Neonatal epigenetic research is emerging and rapidly advancing. As scientists overcome biological, technical, and cost-related challenges, such research has a great potential in determining key environmental factors that affect the preterm genome, allowing for targeted interventions. The purpose of this article is to explore existing literature related to epigenetic mechanisms that potentially mediate the effects of the environment on preterm infant brain development.

Parenting After Infertility: Issues for Families and Infants

This article reviews the research related to parenting after assisted reproduction and uses that research to discuss clinical implications for nurses who work to support these families and the development of their children. The worldwide diagnosis of infertility continues to rise and now hovers near 20%. The increased availability and success of assisted reproductive technologies (ARTs) provides a potential option for infertile families to conceive and begin a family, but as nurses know, infertility treatments are not easy to tolerate, are time-consuming, physically taxing, and expensive. In addition, a positive outcome is far from guaranteed. Even when infertile couples successfully give birth, they can continue to struggle with the psychological aspects of infertility and the ongoing care of a child who may be premature, low birth weight, or afflicted with another high-risk condition such as long-term developmental or behavioral problems. Unfortunately, the psychological needs of the couple and the family may not be addressed during ART treatment or after the birth of a child. Parenting is a challenging life task; parenting when the partners may have to work through the psychological aspects of infertility and the care of a high-risk child is even more complex and may have long-lasting effects on the partners as well as their children.

The NICU Parent Risk Evaluation and Engagement Model and Instrument (PREEMI) for Neonates in Intensive Care Units

Engagement is a fairly new concept in practice and research and is gaining the interest of federal and private regulators, clinicians, and researchers. In this article, we offer a standard definition and outline an engagement model and an instrument for early prediction and identification of low engagement in at-risk parents of late preterm infants. The Parent Risk Evaluation and Engagement Model and Instrument (PREEMI), its theoretical underpinnings, instrument design, and practical application and future research are discussed.

Effect of Skin-to-Skin Holding on Stress in Mothers of Late-Preterm Infants: A Randomized Controlled Trial.

Purpose:To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding. Design and Methods:This was a longitudinal 2-group randomized controlled trial of 40 infant–mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest. Outcome Measure:Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions. Results:The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infants length of stay and SCRIP score. Implications for Practice:Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship. Implications for Research:The relationship between increased stress and the number of hours of SSC holding warrants further investigation.

Are former late-preterm children at risk for child vulnerability and overprotection?

BACKGROUND Parent perception of child vulnerability (PPCV) and parent overprotection (POP) are believed to have serious implications for age appropriate cognitive and psychosocial development in very low birth weight preterm children. AIM With recent concerns about suboptimal developmental outcomes in late-preterm children, this study was aimed at examining the relationship between history of late-preterm birth (34-36 6/7 weeks gestation), and PPCV, POP, and healthcare utilization (HCU). STUDY DESIGN This was a cross-sectional observational design. PARTICIPANTS Study participants were mothers of 54 healthy singleton children recruited from community centers including Women and Children Clinics (WIC), primary care clinics and daycare centers in the upper Midwest region. OUTCOME MEASURES Outcome measures included Forsyth Child Vulnerability Scale (CVS), Thomasgard Parent Protection Scale (PPS) scores, and healthcare utilization (HCU). Potential covariates included history of life-threatening illness, child and maternal demographics, and maternal stress and depression using the Center for Epidemiologic Studies Depression Scale (CESD). RESULTS HCU (p=0.02) and the PPS subscales of supervision (p=0.003) and separation (p=0.03) were significant predictors of PPCV in mothers of 3-8 years old children with late-preterm history. Age of the child (p=0.008) and CVS scores (p=0.005) were significant predictors of POP. Maternal age (p=0.04), stress (p=0.04), and CVS scores (p=0.003) were significant predictors of HCU. Dependence, a subscale of the PPS, correlated with the childs age and gender even after controlling for age. CONCLUSION History of late-preterm did not predict MPCV, MOP, or HCU in healthy children. Future research is needed in larger more diverse samples to better understand causal relationships and develop strategies to lessen risks of MPCV and MOP.

Pedometer Readings and Self-Reported Walking Distances in a Rural Hutterite Population

PURPOSE This study assessed the accuracy with which a rural population reported daily walking distances using a 7-day activity recall questionnaire obtained quarterly compared to pedometer readings. METHODS Study participants were 48 Hutterite men and women aged 11-66 years. FINDINGS Pedometer-miles quartiles were associated with self-reported daily miles (P=.008) and self-reported previous-year average miles (P=.03) quartiles. Among males, the relationship between pedometer-miles and self-reported daily miles differed depending upon walking pace, with a stronger correlation at a faster pace (interaction, P=.006). Among females, pedometer-miles correlated with age and remained associated with self-reported daily and previous-year average miles when age was in the statistical model (P=.006 and .008). The difference between pedometer-miles and self-reported previous-year average miles tended to increase with age (P=.06). CONCLUSIONS SDPAR may be a useful instrument in measuring miles walked/day among rural populations.