Teresa S. Johnson

Reliability of Length Measurements in Full-Term Neonates

Objective: To describe and compare the intra-and interexaminer reliability of four techniques for measuring length in full-term newborns and to determine whether the different techniques yield significantly different measurements. Design: A descriptive study, describing the intra- and interexaminer reliability of four length measurement techniques: crown-heel, supine, paper barrier, and Neo-infantometer. The nurses were blind to their own and to the other nurses measurements. The order of the nurses and the order in which the measurements were obtained was randomized. Setting: Mothers’rooms in a university hospital. Participants: Thirty-two healthy full-term newborns. Interventions: Length measurements using four different length techniques were obtained twice each by two experienced neonatal nurses. Main Outcome Measures: To measure the intra- and interexaminer reliability, the following statistics were calculated: mean absolute differences, standard deviations, technical error of measurement; percentage less than .5 and 1.0 cm, and percentage of error. Results: Intra- and interexaminer differences were significantly larger when examiners used the crown-heel measurement technique. Although the intra- and interexaminer reliability of length measurements obtained with the supine, paper barrier, and Neo-infantometer techniques did not differ significantly, the amount of error in these measurements was large. Conclusions: Measurements obtained using the crown-heel technique are significantly less reliable than measurements obtained using the supine, paper barrier, or Neo-infantometer techniques.

Excessive Weight Loss in Breastfed Infants During the Postpartum Hospitalization

OBJECTIVE To examine differences in breastfeeding frequency, voids, and stools in infants with weight losses < or > or =7% during the postpartum hospitalization. DESIGN Secondary analysis of data from a primary psychometric study examining the Mother Infant Breastfeeding Progress Tool (MIBPT). SETTING A midwestern community hospital in a multicultural racially diverse community. PARTICIPANTS Convenience sample of 53 breastfeeding women and infants hospitalized after birth. METHODS Data were collected during a chart review; infants were divided into < or > or =7% weight loss groups at 2 days postpartum, and breastfeeding frequency, voiding, and stooling were examined between groups and used to predict a > or =7% weight loss at 2 days postpartum. RESULTS Of the 53 infants, 20.8% lost > or =7% of their birth weight. Infants who lost > or =7% of their birth weight had significantly more total voids and a higher breastfeeding frequency on the day of birth than infants who lost <7% of their birth weight. A logistic regression analysis resulted in total voids being the only significant predictor of a > or =7% weight loss, with an odds ratio of 1.74 (95% CI=1.09, 2.75, p <; .05). CONCLUSION In the absence of other indicators of ineffective breastfeeding, breastfeeding infants who lose > or =7% of their birth weight during the first 2 days postpartum might be experiencing a physiologic diuresis after birth, unrelated to their breastfeeding behaviors. More research is necessary to determine the cause of a > or =7% weight loss in newborns during the first 48 hours after birth.

The beginning breastfeeding survey: Measuring mothers' perceptions of breastfeeding effectiveness during the postpartum hospitalization

No current breastfeeding assessment tool assesses the mothers perception of breastfeeding effectiveness during the early postpartum. Psychometric analysis of a new tool, the Beginning Breastfeeding Survey (BBS), in a multi-racial sample of 131 women revealed a coefficient alpha of .90. Factor analysis yielded three factors, (a) Maternal Breastfeeding Competence and Emotional Satisfaction, (b) Maternal Discomfort and Anxiety, and (c) Infant Breastfeeding Skill and Emotional Satisfaction. The BBS demonstrated discriminant validity in known group analyses and convergent validity with breastfeeding self-efficacy and postpartum fatigue. Future research will focus on improving the internal consistency reliability of the BBS and examining its ability to identify women at risk for breastfeeding problems during the postpartum hospitalization.

Assessment of breastfeeding and infant growth.

The purpose of this article is to provide information for health care professionals to guide the assessment of feeding and growth in breastfed infants. Tools to assist in the assessment of breastfeeding are discussed, as well as infant weight, infant test-weighing, elimination, and growth patterns. We present in detail the research surrounding the development of infant growth charts and the potential for inaccurate assessment.

Newborn behavioral and physiological responses to circumcision.

Purpose To examine the effect of preoperative acetaminophen given as analgesia before circumcision on newborns’ behavioral response. Study Design and Methods A convenience sample of 53 male newborn infants (GA 35 to 42 weeks) who were .24 hours of age and whose parents had consented to circumcision were enrolled in the study. All of the infants enrolled were the patients of providers who did not routinely use anesthesia for circumcision. They were assigned to two groups based on physician standing order for preoperative acetaminophen. The first group received oral acetaminophen during the preoperative period; the second group received no preoperative analgesia. No further analgesia or anesthesia was given, as was the customary policy. Behavioral observations using the Neonatal Inventory Pain Scale (NIPS) and physiologic monitoring occurred at 5 minutes preoperatively, during application of restraints, at 1-minute intervals intraoperatively and at 5, 15, 30, and 60 minutes postoperatively. Results There were no differences in the demographic variables between groups. The overall mean NIPS scores for the following characteristics were lower (indicating more relaxation) in newborns who received preoperative analgesia: arm movements (0.27 vs 0.52); leg movements (0.27 vs 0.59); facial expression (0.24 vs 0.27); state of arousal (0.15 vs 0.46); and breathing quality (0.20 vs 0.38). However, newborns who received pre-op analgesia had higher crying scores (0.42 vs 0.33), although both groups had mean crying scores in the lowest range. Clinical Implications Despite its small sample size, this study suggests that preoperative analgesia before circumcision could be helpful in managing the pain of circumcision. Nurses have a responsibility to advocate for policy and practices changes that provide interventions for pain relief for all newborns.

Fetal Growth Curves: Does Classification of Weight-for-Gestational Age Predict Risk of Hypoglycemia in the Term Newborn?

Our objective was to determine whether classification of birth weight as small, average, or large for gestational age using published fetal growth curves is predictive of a term infants risk of hypoglycemia. This prospective, descriptive study measured and plotted birth weight measurements on six published fetal growth curves to classify infant birth weight as small, average, or large for gestational age. Glucose levels were measured 2 hours after birth to determine the prevalence of hypoglycemia. The sensitivity, specificity, and positive/negative predictive values were calculated for each fetal growth curve, and odds ratios were calculated. The patients were 157 clinically stable term Caucasian and African American infants of nondiabetic mothers from a community hospital in midwestern United States. Ten of the 20 (50%) infants with hypoglycemia were classified as average for gestational age on all six published fetal growth curves. Calculated odds ratios demonstrated that none of the six published fetal growth curves significantly predicted the risk of hypoglycemia based on classification of birth weight as small, average, or large for gestational age. The risk of hypoglycemia in term infants was not accurately predicted by classification of birth weight as small, average, or large for gestational age. Clinicians should use other methods to predict which term infants are at risk for hypoglycemia.

Domperidone for Treatment of Low Milk Supply in Breast Pump-Dependent Mothers of Hospitalized Premature Infants: A Clinical Protocol.

Mothers of hospitalized premature infants who choose to provide breast milk are at increased risk of an inadequate breast milk supply. When nonpharmacologic interventions to increase milk supply fail, clinicians are faced with limited options. There is no current evidence to support the use of herbal galactogogues in this population and a black box warning for metoclopramide for potential serious side effects. Thus, domperidone was the only known, effective option for treatment of low milk supply in this population. With a thorough review of the literature on domperidone and coordination with the obstetrical, neonatal, lactation, and pharmacology teams, a domperidone treatment protocol for mothers of hospitalized premature infants with insufficient milk supply was developed at our institution and is presented in this article. A comprehensive understanding of domperidone for use as a galactogogue with a standard treatment protocol will facilitate safer prescribing practices and minimize potential adverse reactions in mothers and their hospitalized premature infants.

Understanding Genetics and Pediatric Cardiac Health

UNLABELLED Congenital heart defects (CHD) continue to be the most prevalent birth defect that occurs worldwide in approximately 6-8 of every 1,000 live births. High rates of morbidity and mortality in infants, children, and adults living with CHD place a growing need for health care professionals (HCPs) to better understand potentially modifiable genetic and environmental influences. This paper will present examples of research and governmental initiatives that support genetics education and research and a review of known genetic factors associated with CHD development. ORGANIZING CONSTRUCT A review of the known genetic factors on risk for CHD formation in infants will be provided to help health care professionals gain a greater understanding of the genetic influences on pediatric cardiac health. CONCLUSIONS There are known genetic pathways and risk factors that contribute to development of CHD. This paper is a primer for nurses and HCPs providing information of the genetics and inheritance patterns of CHD to be useful in daily clinical practice. CLINICAL RELEVANCE Nurses work in multiple communities where they are uniquely positioned to educate and provide information about research and current models of care with families affected by CHD. Nurses and HCPs who better understand genetic risk factors associated with CHD development can more promptly refer and offer treatment for these children and families thus providing individuals of childbearing age with the necessary resources and information about risk factors.

Using Fetal and Infant Mortality Reviews to Improve Birth Outcomes in an Urban Community

OBJECTIVE To describe the implementation of a Fetal and Infant Mortality Review (FIMR) in a small urban community to improve perinatal birth outcomes. DESIGN Descriptive study. SETTING Urban community within a Wisconsin city, population 85,000. PARTICIPANTS Between January 1, 2007 and December 31, 2008, all women (N=82) in a targeted five zip-code area within an urban city were identified who experienced a fetal loss >14 weeks, neonatal or infant death (<1 year of age). METHODS The National Fetal and Infant Mortality Review Manual: A Guide for Communities developed by the American College of Obstetricians and Gynecologists and the Maternal and Child Health Bureau (2008) provided the framework for the systematic review of available records for all fetal and infant deaths during a 2-year period. Based on these findings, targeted evidence-based interventions were implemented. RESULTS The infant mortality rate was higher in two of the five targeted zip-code areas. The mean ages of women who experienced fetal and infant mortality were in their 20s as opposed to teenage mothers. A higher proportion of Black women experienced fetal/perinatal losses than other race/ethnicities, many of which were related to prematurity. CONCLUSIONS Many social, environmental, and maternal health issues such as poverty, racism, and perception of stress negatively contributed to the general health of womens subsequent birth outcomes. Nurses have the opportunity to promote and improve health to eliminate racial disparities in birth outcomes within their communities.

Breast Care During Pregnancy

In 1972, breast care during pregnancy by nurses primarily concentrated on preparation of the nipples for breastfeeding. There is now a vast amount of research evidence that demonstrates the positive impact breastfeeding has on maternal and infant health. In this article, we compare the principles of 1972 with contemporary research-based information. Nurses continue to have an important role on the outcomes of breastfeeding initiation, duration, and exclusivity.