Margaret E. Wilson

Feeding intolerance: a concept analysis.

Feeding intolerance is a well-known phenomenon in the NICU and is linked to morbidity and mortality in the premature infant. However, a universal definition for this concept is lacking. Properly defining a concept is a key step in a successful research project. A concept analysis is an examination of the fundamental elements of a concept to bring clarification and definition to the topic of interest. The purpose of this concept analysis was to clarify the phenomenon of feeding intolerance in the premature infant and to provide a universal conceptual and operational definition for researchers and clinicians to use in practice theory.

Norwegian families: transition to parenthood.

Our purpose in conducting this study was to explore relationships among family dynamics, parent–fetal attachment, and infant temperament in 230 mother–father pairs from the third trimester of pregnancy to when their infant was 7 to 9 months old. Mothers reported increased role conflict during this time, as well as more role conflict than their partners. First-time parents (n = 133) perceived more positive family dynamics than second-time parents (n = 97), as well as greater parent–fetal attachment. Maternal–fetal attachment was greater than paternal–fetal attachment. Health care providers can provide support for new parents as they negotiate new role relationships.

Social Status, Mother-infant Time Together, and Breastfeeding Duration

Chart review and direct observation were used to study the relationship between social status, mother-infant time together, and breastfeeding duration among 138 mothers who were breastfeeding at hospital discharge. Overall breastfeeding rate was 73 percent for patients with private insurance and 37 percent for patients without private insurance. Breastfeeding duration to six months was not related to social status. Mother-infant time together from birth through 48 hours was 3 hours greater for private insurance mothers. These three hours, which were statistically significantly different, did not correlate with breastfeeding duration in any way. Ancillary findings were that married mothers were more likely than unmarried mothers to be breastfeeding at six months, and that mothers who received epidurals were less likely to be breastfeeding at six months than mothers who did not receive epidurals.

Relations between feeding intolerance and stress biomarkers in preterm infants.

Objectives: Feeding intolerance (FI) in preterm infants is common but the etiology remains unclear. This study examined FI as a stress-related disease involving brain–gut interactions and tested the model of allostatic load and complications of prematurity. Specific aims were to describe demographic/medical variables and biomarker levels at each time and over time for the sample; describe/compare variables and biomarker levels at each time for infants with/without FI; and compare biomarker interquartile/interpercentile distributions between infants with/without FI. Methods: Preterm infants <32 weeks’ gestation were recruited. The primary outcome was FI by day 7 defined as a feeding withheld, discontinued, or decreased because the infant was not tolerating enteral feedings. Allostatic load was operationalized using cortisol and 8-hydroxydeoxyguanosine (8-OHdG) from cord blood and from saliva and urine on days 1, 7, and 14. Descriptive statistics and comparative analyses were performed. Results: Seven of 31 infants enrolled met criteria for FI. Infants with FI had lower median urinary cortisol on day 1 (P = 0.007) and trended to have lower cortisol in the cord blood (P = 0.056). Interquartile distributions were significantly different between infants with/without FI for urinary cortisol on day 1 (P = 0.034) and trended for differences in 8-OHdG on day 14 (P = 0.087). Interpercentile distributions were significantly different in salivary cortisol on day 14 (P = 0.034) and trended for differences in 8-OHdG on day 1 (P = 0.079). Conclusions: Results support further testing of the model in a larger sample; investigation of the cellular mechanisms associated with the stress and the free radical/antioxidant systems; and inclusion of prenatal factors.

Physiologic and behavioral responses to stress, temperament, and incidence of infection and atopic disorders in the first year of life: a pilot study

The purpose of this pilot study was to explore relationships among physiologic and behavioral responses to a standardized stressor (routine immunization), parent-reported temperament, and numbers of infections and atopic disorders in the first year of life. Infants were studied during 2- (n = 30) and 4-month (n = 24) routine clinic visits. Behavioral data were coded from videotapes filmed for 90 seconds after immunizations. Salivary cortisol measured physiologic arousal; specimens were obtained before and after immunizations. Two-month-old infants with higher levels of cortisol required more time to calm after immunization. Relationships were found between the temperament characteristics of persistence and adaptability and infections at 12 months.

Dynamics of families during the third trimester of pregnancy in southwest Finland

Transition to a changed family structure during pregnancy brings into focus the familys dynamics. To describe these dynamics during the third trimester of a healthy pregnancy, the Family Dynamics Measure was administered to 136 mothers and 131 fathers in southwest Finland. Mothers and fathers reported differences in 4 of the 6 dimensions of family dynamics. Clearer communication was perceived by mothers of higher social status. Second-time parents perceived greater isolation and role conflict than first-time parents. Findings contribute cues for specific family guidance by nurses during the transition to parenthood regarding partner differences, parity and social status.

Cross-national comparison of family dynamics during the third trimester of pregnancy in the United States and Iceland.

In a cross-national analysis of family dynamics in the United States and Iceland, we examined several factors that influence family life during the third trimester of pregnancy. Three hundred five women and 113 of their partners completed the Family Dynamics Measure (Lasky et al., 1985). Marital status and social status had differential effects on family dynamics in each country. Unmarried families in the United States reported more negative family dynamics than did married families in the United States and both married and unmarried families in Iceland. Although higher social status was associated with more positive family dynamics in both countries, the effects of low social status were more pronounced in the United States. This comparison of families in two modern Western nations points to possible effects of the presence or absence of national family policies supporting childbearing families and contributes to the development of international family science.

A New Way of Thinking About Complications of Prematurity

The morbidity and mortality of preterm infants are impacted by their ability to maintain physiologic homeostasis using metabolic, endocrine, and immunologic mechanisms independent of the mother’s placenta. Exploring McEwen’s allostatic load model in preterm infants provides a new way to understand the altered physiologic processes associated with frequently occurring complications of prematurity such as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity. The purpose of this article is to present a new model to enhance understanding of the altered physiologic processes associated with complications of prematurity. The model of allostatic load and complications of prematurity was derived to explore the relationship between general stress of prematurity and complications of prematurity. The proposed model uses the concepts of general stress of prematurity, allostasis, physiologic response patterns (adaptive–maladaptive), allostatic load, and complications of prematurity. These concepts are defined and theoretical relationships in the proposed model are interpreted using the four maladaptive response patterns of repeated hits, lack of adaptation, prolonged response, and inadequate response. Empirical evidence for cortisol, inflammation, and oxidative stress responses are used to support the theoretical relationships. The proposed model provides a new way of thinking about physiologic dysregulation in preterm infants. The ability to describe and understand complex physiologic mechanisms involved in complications of prematurity is essential for research. Advancing the knowledge of complications of prematurity will advance clinical practice and research and lead to testing of interventions to reduce negative outcomes in preterm infants.

Recognizing new perspectives in eating difficulties following stroke: a concept analysis.

Purpose: To describe and identify various perspectives on eating difficulties following stroke to enable theory development and facilitate advancement of interventions. Methods: Concept analysis in line with Morse’s principles of exploring pragmatic utility was used throughout the data collection and analysis. Peer-reviewed research on eating difficulties was systematically and critically appraised. Literature included the bibliographic databases, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and PsycInfo, published up until November 2011. A total of 33 key articles were included in the final analysis. Results: A conceptual model of eating difficulties is presented showing the multiple affecting factors, namely meaning-related, functional and contextual factors and the consequences of non-intervention, feeling of loss, social isolation, negative sensations and depression – all of which potentially increase the impact of disease severity, functional outcome and quality of life. Based upon the dimensions identified, the definition of eating difficulties was synthesized as “any activity and emotional requirement and relations, which alone or in combination interfere with the process of preparing food, transferring food into the mouth, chewing and swallowing”. Conclusion: Eating difficulties have profound effects on people. The conceptual model serves to guide health care professionals to assess and help stroke patients in facing a life with eating difficulties. Implication for rehabilitation Eating difficulties is a complex concept that touches essential areas of life following stroke. Attending to eating difficulties in a structured way that encompasses meaning, functional and contextual issues might facilitate successful rehabilitation. The conceptual framework suggests a focus for developing effective, holistic interventions with initial screening and following assessment, so that appropriate interventions can commence and adverse consequences prevented. Items to consider in the assessment of eating difficulties are offered.

Social Regulation of the Stress Response in the Transitional Newborn: A Pilot Study

The purpose of the study was to explore relationships between caregiver holding and feeding behaviors and the transitional newborn infants cortisol response. Behaviors of 46 mothers, fathers, and their term transitional newborn infants were measured with the Index of Mother-Infant Separation (IMIS). Repeated measures of infant salivary cortisol were used to calculate area under the curve. A higher percentage of observations in which mother was holding infant was related to lower infant total cortisol during the first 6 hours after birth (r = -.24, p = .05, one-tailed).