Ying Ju Chang

Noise and Related Events in a Neonatal Intensive Care Unit

The purposes of this study were to explore noise distribution, its timing, and sources of peak noise in the neonatal intensive care unit (NICU) of a University Hospital in Southern Taiwan. Two surveys on noise distribution and peak noise of the warmer bed were conducted. Noise at radiate heated beds located in the central sites of two areas, one near (Area A) and the other away from (Area B) the nursing station, were measured continuously for one week using an electronic sound-meter. Peak noise with a sound level of > 65 on the A-weighted decibel scale (dBA) and associated sources were recorded for 48 hours. Monitoring periods of peak noise consisted of a weekday and a day on the weekend randomly selected for Area A. Results showed that mean noise levels at the warmer bed in Areas A and B were 62 and 61.4 dBA on average. In over 70% of the total observation time for both areas the sound levels were > 59 dBA. The noise intensity was particularly high between 8 a.m. and 4 p.m. The noise level on the weekend was lower than that on weekdays. During the 48-hour observation period, 4994 peak noises were recorded. Eighty-six percent of these peak noises were within ranges of 65-74 dBA and 90% were human-related factors. The primary non-human related source was monitor alarms. Additionally, peak noises occurred primarily during the 8-11 a.m. and 2-4 p.m. hours on the weekdays and weekends. These results indicate that modifications of staff behavior, care procedures, and apparatus may reduce the noise levels in the NICU.

The effect of breast reconstruction surgery on body image among women after mastectomy: a meta-analysis

The purpose of this study was to analyze the available evidence concerning the effects of breast reconstruction (BR) on body image of women with breast cancer. BR is a potential intervention to improve the body image of women with breast cancer. Conflicting research findings about the effects of breast reconstructive surgery on body image compared to breast conservative surgery (BCS) or mastectomy exist. A meta-analysis of studies found in MEDLINE, CINAHL, PsychINFO, PubMed as well as PQDT (dissertation and theses), and other unpublished literature resources from 1970 to 2010 were searched. Comparable studies that examined the difference of body image between breast cancer women receiving mastectomy plus BR and those with BCS were included. A clear definition about the domains of body image including body stigma, body concern, and transparency were identified. Mean effect sizes were calculated. Twelve studies were included in the meta-analysis. Women with BR and BCS were no different on the body concern domain of body image. However, women with BR had a significantly worse score on body stigma domain of body image than women receiving BCS. Women with BR had a better body image score than women with mastectomy. Women who are satisfied with their body shape may still perceive deficiencies because of the stigma of mastectomy and affect on body image. Consistent application of valid and reliable measures of body image specific to breast cancer women is needed.

effects of Single-hole and Cross-cut Nipple Units on Feeding Efficiency and Physiological Parameters in Premature Infants

&NA; The purpose of this study was to compare the amount of total milk intake, feeding time, sucking efficiency, heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) of premature infants when fed with either signal-hole or cross-cut nipple units. Twenty stable infants admitted to a level II nursery in a tertiary care center with gestational ages averaging 32.2 ± 3.2 wks were enrolled. Subjects had an average postmenstrual age of 34.1 ± 1.6 wks, and average body weight of 1996 ± 112 gm. A crossover design was used and infants were observed for two consecutive meals separated by a four-hour interval. They were bottle fed with equal feeding amounts using a single-hole and cross-cut nipple administered in random order. Results showed that infants fed with single-hole nipple units took more milk (57.5 ± 8.3 ml vs. 51.6 ± 9.5 ml, p = .011), had a shorter feeding time per meal (11.5 ± 4.9 min vs. 20.9 ± 5.0 min, p <.001), and sucked more efficiently (5.8 ± 2.5 ml/min vs. 2.7 ± 1.0 ml/min, p < .001) compared to those fed through cross-cut nipples. Infants using cross-cut nipple units had a higher RR (44.4 ± 4.6 breaths/minutes vs. 40.8 ± 4.9 breaths/minutes, p = .002) and SpO2 (96.1 ± 1.4% vs. 94.6 ± 3.2%, p = .044) than those using single-hole nipples. Oxygen desaturation (SpO2 < 90% and lasting for longer than 20 sec) and bradycardia were not recorded in either group of infants during feeding. Compared to using cross-cut nipple units, premature infants using single-hole nipple units take more milk and tend to tolerate feedings better. A single-hole nipple may be a choice for physiologically stable bottle-fed premature infants.

Early oral intake and gastrointestinal function after cesarean delivery: A Systematic Review and Meta-Analysis

OBJECTIVE: To evaluate whether early oral intake after cesarean delivery has an effect on gastrointestinal outcomes during postpartum recovery. DATA SOURCES: Electronic searches of published studies between 1980 and 2011 were conducted using PubMed, Medline, CINAHL, ClinicalTrials.gov, and Airiti databases. METHODS OF STUDY SELECTION: Randomized controlled trials (RCTs) and nonrandomized trials were included. Data were extracted in a systematic manner and the quality of each study was appraised independently by two reviewers. Meta-analyses were conducted only for RCTs using the RevMan5. TABULATION, INTEGRATION, AND RESULTS: Seventeen studies met eligible criteria and were retrieved, including 14 RCTs and three non-RCTs. The majority of early oral intake was provided within 6–8 hours after cesarean delivery. Early oral intake was significantly related to the return of gastrointestinal functions compared with delayed oral intake (bowel sounds –9.2 hours; passage of flatus –10 hours; bowel evacuation –14.6 hours). Early oral intake did not significantly increase the occurrence of gastrointestinal complications compared with delayed oral intake after cesarean delivery (ileus symptoms 18.7% compared with 18%, odds ratio [OR] 0.98; vomiting 5% compared with 5.5%, OR 0.9; nausea 10.3% compared with 10.3%, OR 1.03; abdominal distention 9.3% compared with 11.6%, OR 0.82; diarrhea 3.4% compared with 5%, OR 0.62). CONCLUSION: Early oral intake after cesarean delivery improves the return of gastrointestinal function and does not increase the occurrence of gastrointestinal complications. A clinical implication based on the findings of the current evidence is proposed.

A preliminary study of bottom care effects on premature infants’ heart rate and oxygen saturation

: The purposes of this study were to explore (1) the effect of buttock care (BC) on premature infant heart rate (HR) and oxygen saturation (SpO(2)), and (2) the effect of buttock lifting angle during BCs on HR and SpO(2). The study used a repeated measure design. A convenience sample of 11 premature infants in the neonatal intensive care unit (NICU) of a medical center were studied during 30 BC events. The subjects were of a gestational age of less than and 37 weeks, and postnatal age of less than one month, without known congenital abnormalities and without having been treated with sedatives during the study. Infant HR and SpO(2) were measured at a 30-second interval 10 minutes before and during, and 15 minutes after BC. Maximal lifting angles of BCs during the procedure were recorded. Based on the infants individual responses to BC, 63.3% of BCs induced an increase in HR and a decrease in SpO(2), defined as the change in HR and SpO(2) greater than two standard deviations from the baseline. In addition, 30% of BCs resulted in cardiac decelerations. The extent of the difference found in these change patterns in HR or SpO(2) were all significant (p 30 degrees (p =.035). Buttock care can have a significant impact on premature infant physiological stability. The BC lifting angle may play an important role in HR acceleration or deceleration. Careful observation before and after BC for premature infants is recommended.

Family-centered care improved neonatal medical and neurobehavioral outcomes in preterm infants: Randomized controlled trial

Background Family‐centered care for preterm infants in Western societies has yielded short‐ to medium‐term benefits. However, the intervention effects have rarely been validated in Eastern societies. Objective The aim of this study was to examine whether a family‐centered intervention program (FCIP) could improve the short‐term medical and neurobehavioral outcomes in preterm infants with very low birth weight (VLBW; a birth weight of <1,500 g) in Taiwan over the outcomes seen with a usual care program (UCP). Design This was a multicenter, single‐blind, randomized controlled trial study. Setting Three medical centers in northern and southern Taiwan were the locations for the study. Participants The participants were 251 VLBW preterm infants without severe perinatal complications. Intervention The infants were randomly assigned to receive the FCIP or the UCP during hospitalization. Measurements Infant morbidities, feeding, growth, and neurobehavioral performance were evaluated during the neonatal period. Parental adherence to interventions was measured in the FCIP group. Results The FCIP promoted earlier full enteral feeding (&bgr; = ‐1.1 weeks; 95% CI = ‐1.9 to ‐0.2 weeks) and hospital discharge (&bgr; = ‐0.6 week; 95% CI = ‐1.1 to ‐0.1 weeks), greater weight gain (&bgr; = 3.3 g/d; 95% CI = 0.1 to 6.6 g/d), and better neurobehavioral performance than the UCP (&bgr; = 1.2 points; 95% CI = 0.2 to 2.3 points). Furthermore, a higher degree of parental motivation in interventions, goal attainment, and comprehensiveness of home activities was significantly associated with greater effects in infants’ neurobehavioral performance and weight gain (r = .20‐.31; all Ps < .05). Limitations The findings may not be generalized to preterm infants with severe perinatal diseases and parents with a low level of interest in interventions. Conclusions Family‐centered care facilitated short‐term medical and neurobehavioral outcomes in VLBW preterm infants in Taiwan; the effects were likely achieved through parental adherence to interventions. The designated strategies may be considered in a future launch of family‐centered care in Taiwan.

Predictors of Health Status in Mothers of Premature Infants with Implications for Clinical Practice and Future Research

Background Postpartum health research has focused primarily on full-term mothers. Aims To explore postpartum stress, depression, social support, health status, and predictors of health status in mothers of premature infants. Methods This study employed a cross-sectional design. With convenience sampling, a total of 203 mothers of premature infants were recruited from two medical centers and four community teaching hospitals in southern Taiwan. The Hung Postpartum Stress Scale, Social Support Scale, Beck Depression Inventory, and Chinese Health Questionnaire were used to assess the mothers’ psychosocial features during the first 6 weeks postpartum. Results Mothers’ health status differed significantly according to levels of postpartum stress and depression. The important health status predictors were age, education, postpartum stress, and depression level. Discussion The concerns and needs of mothers of premature infants differed from those of full-term mothers during the first 6 weeks postpartum; premature infants’ health status was found to be a major perceived stressor for their mothers. Linking Evidence to Action In the process of caring for premature infants’ mothers, healthcare providers should provide individualized care to meet their needs, thus facilitating the reduction of postpartum stress and depression levels. During premature infants’ hospitalizations, healthcare providers should hold regular faculty meetings to provide postpartum women with relevant information about their infants’ health and how to best care for them. Future studies should explore postpartum stress, social support, depression, and health status each postpartum week, which could serve as a guide for nursing interventions.

Endemic hepatitis c virus infection in a seaboard village of southwestern taiwan

This study investigated the rate of Hepatitis C Virus (HCV) infection and identified the risk factors associated with a HCV infection at Ma-Sha-Gou, a seaboard village in southwestern Taiwan. In total, 240 subjects were sampled and stratified according to age and sex from 1,200 residents aged 20-64 years old. HCV-specific antibodies (anti-HCV Ab) in blood specimens were tested for HCV seropositive by the third-generation HCV ELISA system. The subjects, later identified as 152 seropositive and 88 seronegative, were selected for analysis of the correlates of HCV infection. They were interviewed to explore a variety of possible risk factors for HCV infection with a structured questionnaire. The results showed that the anti-HCV age-adjusted seroprevalence was 55.8%. Needle injection was significant to the increased anti-HCV seroprevalence, with multivariate age-adjusted odds ratio (OR) and confidence interval (CI) of 1.9 and 1.2-3.9 respectively. This study identifies Ma-Sha-Gou as an endemic area of HCV infection, in which needle injection from any medical activity was a possible transmission pathway in the village, and suggests the health authorities/community health nurses should give the residents a comprehensive community-based education program to interrupt HCV transmission.

Effect of a Delayed Start to Oral Feeding on Feeding Performance and Physiological Responses in Preterm Infants: A Randomized Clinical Trial

Background: The efficient and safe oral feeding of preterm infants, an essential criterion for hospital discharge, is affected by neurodevelopmental maturation. However, the timing of initiating oral feeding and its relation to maturation, feeding performance, and physiological responses are unclear. Purpose: The aim of this study was to determine the effect of a 1-week delay in the initiation of oral feeding on feeding performance, transition time, weight gain, and cardiorespiratory responses in preterm infants. Methods: In this randomized controlled trial, 40 infants with a gestational age at birth of less than 32 weeks were recruited. The control group (n = 18) began oral feeding when the infants were physiologically stable, whereas the experimental group (n = 22) began oral feeding 1 week later. Infant feeding performance, heart rate, and oxygen saturation were measured before, during, and after feeding on the first day of oral feeding and 3 days later. Daily weight gain was calculated by measuring body weight every morning, and transition time was calculated by counting the number of days from the initiation of oral feeding to the termination of tube feeding. Results: There were no significant differences between the two groups in terms of feeding performance, weight gain, or postmenstrual age at the completion of full oral feeding. The transition time was significantly shorter in the experimental group than in the control group. More infants in the control group experienced episodes of oxygen desaturation during feeding than in the experimental group. Conclusions/Implications for Practice: For infants with a postmenstrual age of greater than 32 weeks who are ready to initiate oral feeding, postponing oral bottle feeding for 1 week may be considered as an intervention to reduce physiological distress.

Variations in the rancid-flavor compounds of human breastmilk under general frozen-storage conditions

BackgroundHuman breastmilk provides the best nutrition for infants. When women or infants have difficulties in breastfeeding directly, breastmilk is usually pumped and frozen for later use. However, while frozen, breastmilk may develop a rancid flavor, which induces infant feeding stress and raises the mothers’ concerns about the quality of frozen breastmilk. Nevertheless, few studies have investigated the variations in the compounds that cause the rancid flavor of breastmilk during frozen storage.MethodsA repeated-measures design was adopted to quantify the variations in rancid-flavor compounds, namely acid value (AV), total free fatty acids (FFAs), and short-and intermediate-chain FFAs of breastmilk during frozen storage. Breastmilk was obtained from ten healthy mothers of full-term infants and each milk sample was divided into three aliquots: fresh, 7-day frozen and 30-day frozen samples. The fresh samples were immediately analyzed, while the others were frozen in a domestic fridge within a temperature range of −15 to −18 °C and analyzed 7 and 30 days later.ResultsThe rancid-flavor compounds of the breastmilk, namely AV, total FFAs and intermediate-chain FFAs, significantly increased with storage time, all of which reached the sensory threshold for detecting the rancid flavor of milk. In addition, the FFAs of the breastmilk samples frozen for 7 days far exceeded the detection threshold for unpleased rancid flavor, while the 30-day samples were higher than the intolerable level for most people.ConclusionsThis study revealed that the human breastmilk develops a rancid flavor during frozen storage. Therefore, we recommend that when infants refuse thawed milk, mothers can try to provide freshly expressed milk whenever possible or provide breastmilk frozen for less than 7 days. Future studies could explore the methods for slowing breastmilk lipolysis to maintain its fresh flavor.