Breastmilk feeding at birth demonstrates short- and long-term medical and neurodevelopmental advantages. Infants who are exclusively breastfed demonstrate less nausea, vomiting, and diarrhea, and they experience less upper respiratory and ear infections than do infants who are not breastfed. One strategy that supports breastfeeding initiation is providing skin-to-skin contact (STS) with mothers and newborns immediately upon birth. The purpose of this project was to evaluate the impact of a second session of STS on the postpartum unit on exclusive breastfeeding rates at discharge. A retrospective comparison design using Swanson's caring model was used to guide the evaluation study that examined and compared the rate of exclusive breastfeeding before and after the new model of care was implemented. The historical controls rate included all delivered women in a 3-month period who expressed a desire to exclusively breastfeed and who had one session of STS. In this group, the exclusive breastfeeding rates were 46% at discharge. After the practice change, the 75 women who expressed a desire to exclusively breastfeed and who had the second session of STS demonstrated exclusive breastfeeding rates of 72% at discharge. The increased rate of exclusive breastfeeding and the promotion of newborn health represent a major contribution to positive social change through the introduction of a second session of STS. The extension of the STS practice from only the immediate postdelivery setting to the postpartum setting provides a contribution to nursing practice that can be shared in any birth or similar practice setting.

No description available.

Avanços na medicina e o desenvolvimento tecnológico têm contribuído para o aumento na sobrevida dos prematuros, no entanto, em virtude da sofisticação dos recursos, um maior número de procedimentos invasivos se faz necessário, incluindo a dor como um custo à sobrevida desses pacientes. O objetivo deste estudo foi testar a efetividade do contato pele a pele na diminuição das respostas comportamentais e fisiológicas de dor no prematuro, durante a punção de calcâneo para coleta do Teste do Pezinho. Trata-se de um estudo analítico-experimental randomizado, realizado na unidade de cuidado intermediário neonatal de um hospital universitário de Ribeirão Preto - SP. A amostra constituiu-se de 59 prematuros submetidos à coleta do Teste do Pezinho, divididos aleatoriamente em dois grupos: experimental (n=31), submetido ao contato materno pele a pele por 15 minutos antes e durante todo o procedimento, e controle (n=28) cujos bebês eram mantidos no berço ou incubadora durante todo o procedimento. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da instituição, e o Termo de Consentimento Livre e Esclarecido foi firmado com as mães ou responsáveis pelos prematuros. As variáveis comportamentais (mímica facial, estado de sono e vigília e choro) foram registradas continuamente pela filmagem por uma câmera durante a coleta de dados. A variável fisiológica (freqüência cardíaca) foi mensurada por um monitor cardíaco. A coleta foi dividida em sete períodos: basal, tratamento, antissepsia, punção, ordenha, compressão e recuperação. Como não se comprovou a normalidade das variáveis quantitativas, fez-se a comparação entre os dois grupos utilizando-se o teste não-paramétrico para duas amostras independentes, Mann-Whitney. Para as variáveis qualitativas, utilizou-se o Qui-Quadrado ou Teste Exato de Fisher. Na comparação dos resultados dos escores do Neonatal Facing Coding System (NFCS), do estado de sono e vigília e da média da freqüência cardíaca intra-sujeitos e entregrupos, utilizou-se a ANOVA com medidas repetidas. Nas comparações do NFCS entre os grupos, utilizou-se a ANCOVA e estratificação direta. Os valores médios do NFCS foram inferiores no grupo experimental em todos os períodos com diferença estatisticamente significativa nos períodos de punção e ordenha em comparação ao grupo controle, mesmo ao se controlar a idade corrigida, idade pós-natal, experiência prévia de dor e o sexo. O choro foi o estado de sono e vigília mais incidente na punção e ordenha em ambos os grupos, sendo que, na ordenha, os bebês do grupo controle permaneceram chorando em maior proporção do que no experimental (85,7 vs 58,1%). Na recuperação, 71,0% do grupo experimental estavam em sono profundo em comparação com 21,4% no controle. O tempo médio de choro diferiu significativamente entre os grupos, sendo maior no controle. Houve elevação da freqüência cardíaca como resposta ao procedimento, mas a diferença não foi estatisticamente significativa entregrupos, todavia no grupo experimental houve retorno próximo ao valor médio basal na recuperação; no controle manteve-se acima de 160 bpm da antissepsia à recuperação. Comprovou-se a efetividade do contato pele a pele no alívio da dor em prematuros, constituindo-se em medida simples e natural, sem custos adicionais, podendo ser aplicada em diversas situações de dor aguda. / Advances in medicine and technological development have contributed to increase in preterm infants? survival. However, due to resource sophistication, more invasive procedures are needed, including pain as a price to pay for these patients? survival. This research aimed to test the efficacy of skin-to-skin contact to decrease preterm infants? behavioral and physiological pain response during heel lancing to collect the PKU test. This analytic randomized trial was carried out at the intermediary neonatal care unit of a university hospital in Ribeirão Preto - SP. The sample consisted of 59 preterm infants who were submitted to PKU test collection, randomly divided in two groups: experimental (n=31), submitted to skin-to-skin contact with the mother for 15 minutes before and during the entire procedure, and control (n=28), whose babies were held in the cot or incubator during the entire procedure. The project was approved by the institutional Research Ethics Committee, and the mothers or responsibles for the infants signed the Free and Informed Consent Term. The behavioral variables (facial mimics, sleep-wake state and cry response) were continuously recorded by a camera during data collection. The physiological variable (heart frequency) was measured by a heart monitor. Data collection was divided in seven periods: baseline, treatment, antisepsis, heel lancing, heel squeezing, compression and recovery. As the normality of the quantitative variables was not proved, the two groups were compared, using Mann-Whitney?s nonparametric test for two independent samples. For the qualitative variables, Chi-Square or Fisher?s Exact Test was applied. Variance analysis with repeated means was used to compare NFCS scores, sleep-wake state and mean heart frequencies within and between subjects. Covariance analysis and direct stratification were used to compare NFCS scores between the groups. Mean NFCS scores were lower in the experimental group across all periods, with statistically significant differences during heel lancing and squeezing in comparison with the control group, even when controlling for corrected age, postnatal age, previous pain experience and gender. Crying was the most incident sleep-wake state during lancing and squeezing in both group. During squeezing, babies in the control group continued crying longer than in the experimental group (85.7 vs. 58.1%). During recovery, 71.0% of the experimental group was in deep sleep, against 21.4% of controls. Mean crying time differed between the groups, with statistical significance, and was longer in the control group. Heart frequencies increased in response to the procedure, but intergroup differences were not statistically significant. However, during recovery, babies in the experimental groups returned close to mean baseline levels, while heart rates in the control group continued above 160 bpm from antisepsis until recovery. Results prove the efficacy of skin-to-skin contact proved to be effective for pain relief in preterm infants, constituting a simple and natural measure, without additional costs and easily applicable in different acute pain situations.

Avanços na medicina e o desenvolvimento tecnológico têm contribuído para o aumento na sobrevida dos prematuros, no entanto, em virtude da sofisticação dos recursos, um maior número de procedimentos invasivos se faz necessário, incluindo a dor como um custo à sobrevida desses pacientes. O objetivo deste estudo foi testar a efetividade do contato pele a pele na diminuição das respostas comportamentais e fisiológicas de dor no prematuro, durante a punção de calcâneo para coleta do Teste do Pezinho. Trata-se de um estudo analítico-experimental randomizado, realizado na unidade de cuidado intermediário neonatal de um hospital universitário de Ribeirão Preto - SP. A amostra constituiu-se de 59 prematuros submetidos à coleta do Teste do Pezinho, divididos aleatoriamente em dois grupos: experimental (n=31), submetido ao contato materno pele a pele por 15 minutos antes e durante todo o procedimento, e controle (n=28) cujos bebês eram mantidos no berço ou incubadora durante todo o procedimento. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da instituição, e o Termo de Consentimento Livre e Esclarecido foi firmado com as mães ou responsáveis pelos prematuros. As variáveis comportamentais (mímica facial, estado de sono e vigília e choro) foram registradas continuamente pela filmagem por uma câmera durante a coleta de dados. A variável fisiológica (freqüência cardíaca) foi mensurada por um monitor cardíaco. A coleta foi dividida em sete períodos: basal, tratamento, antissepsia, punção, ordenha, compressão e recuperação. Como não se comprovou a normalidade das variáveis quantitativas, fez-se a comparação entre os dois grupos utilizando-se o teste não-paramétrico para duas amostras independentes, Mann-Whitney. Para as variáveis qualitativas, utilizou-se o Qui-Quadrado ou Teste Exato de Fisher. Na comparação dos resultados dos escores do Neonatal Facing Coding System (NFCS), do estado de sono e vigília e da média da freqüência cardíaca intra-sujeitos e entregrupos, utilizou-se a ANOVA com medidas repetidas. Nas comparações do NFCS entre os grupos, utilizou-se a ANCOVA e estratificação direta. Os valores médios do NFCS foram inferiores no grupo experimental em todos os períodos com diferença estatisticamente significativa nos períodos de punção e ordenha em comparação ao grupo controle, mesmo ao se controlar a idade corrigida, idade pós-natal, experiência prévia de dor e o sexo. O choro foi o estado de sono e vigília mais incidente na punção e ordenha em ambos os grupos, sendo que, na ordenha, os bebês do grupo controle permaneceram chorando em maior proporção do que no experimental (85,7 vs 58,1%). Na recuperação, 71,0% do grupo experimental estavam em sono profundo em comparação com 21,4% no controle. O tempo médio de choro diferiu significativamente entre os grupos, sendo maior no controle. Houve elevação da freqüência cardíaca como resposta ao procedimento, mas a diferença não foi estatisticamente significativa entregrupos, todavia no grupo experimental houve retorno próximo ao valor médio basal na recuperação; no controle manteve-se acima de 160 bpm da antissepsia à recuperação. Comprovou-se a efetividade do contato pele a pele no alívio da dor em prematuros, constituindo-se em medida simples e natural, sem custos adicionais, podendo ser aplicada em diversas situações de dor aguda. / Advances in medicine and technological development have contributed to increase in preterm infants? survival. However, due to resource sophistication, more invasive procedures are needed, including pain as a price to pay for these patients? survival. This research aimed to test the efficacy of skin-to-skin contact to decrease preterm infants? behavioral and physiological pain response during heel lancing to collect the PKU test. This analytic randomized trial was carried out at the intermediary neonatal care unit of a university hospital in Ribeirão Preto - SP. The sample consisted of 59 preterm infants who were submitted to PKU test collection, randomly divided in two groups: experimental (n=31), submitted to skin-to-skin contact with the mother for 15 minutes before and during the entire procedure, and control (n=28), whose babies were held in the cot or incubator during the entire procedure. The project was approved by the institutional Research Ethics Committee, and the mothers or responsibles for the infants signed the Free and Informed Consent Term. The behavioral variables (facial mimics, sleep-wake state and cry response) were continuously recorded by a camera during data collection. The physiological variable (heart frequency) was measured by a heart monitor. Data collection was divided in seven periods: baseline, treatment, antisepsis, heel lancing, heel squeezing, compression and recovery. As the normality of the quantitative variables was not proved, the two groups were compared, using Mann-Whitney?s nonparametric test for two independent samples. For the qualitative variables, Chi-Square or Fisher?s Exact Test was applied. Variance analysis with repeated means was used to compare NFCS scores, sleep-wake state and mean heart frequencies within and between subjects. Covariance analysis and direct stratification were used to compare NFCS scores between the groups. Mean NFCS scores were lower in the experimental group across all periods, with statistically significant differences during heel lancing and squeezing in comparison with the control group, even when controlling for corrected age, postnatal age, previous pain experience and gender. Crying was the most incident sleep-wake state during lancing and squeezing in both group. During squeezing, babies in the control group continued crying longer than in the experimental group (85.7 vs. 58.1%). During recovery, 71.0% of the experimental group was in deep sleep, against 21.4% of controls. Mean crying time differed between the groups, with statistical significance, and was longer in the control group. Heart frequencies increased in response to the procedure, but intergroup differences were not statistically significant. However, during recovery, babies in the experimental groups returned close to mean baseline levels, while heart rates in the control group continued above 160 bpm from antisepsis until recovery. Results prove the efficacy of skin-to-skin contact proved to be effective for pain relief in preterm infants, constituting a simple and natural measure, without additional costs and easily applicable in different acute pain situations.

This dissertation research explored mechanisms of human milk (HM) expulsion by describing the effects of skin to skin contact (SSC) on maternal basal oxytocin (OT) secretion among 20 premature mothers with hospitalized premature infants. This one-group, repeated measures design consisted of: 1) daily SSC with covariant data via self-report diary and 2) maternal salivary OT with and without SSC at 4 time points were collected over a 7 day time frame. Results indicate that mean levels of basal OT increase over time (M 234 pg/ml, SD 108 pg/ml time point 1; M 257 pg/ml, SD 125 pg/ml time point 3). Through multilevel model data analysis basal OT was found to have a meaningful amount of dependence on SSC frequency (t(16) = 6.389, p = < 0.001) and SSC duration (t(17) = 6.867, p = < 0.001) with coefficient estimates that indicate that basal OT exposed to 75-85 minutes of SSC per day are 92 pg/ml higher. These findings provide preliminary data that suggest that lactating mothers with premature infants sustain positive effects of SSC that increase basal OT secretion over time.

Family-centered care (FCC) is considered the gold standard for care delivery in the Neonatal Intensive Care Unit (NICU). However, there are challenges with the implementation of FCC in practice and there is limited literature about how to tailor this approach for specialized NICU populations. To explore FCC for surgical neonates in the NICU, the concept was explored using Roger’s evolutionary concept analysis. Results illustrate that FCC in the NICU is a philosophy or care, rather than a set of interventions. The subsequent cross-sectional descriptive exploratory study showed that the surgical infants in our sample (n=11) received a limited amount of skin-to-skin care (median 0 mins/day) and parents reported challenges to being involved in their infant’s care. This thesis supports the challenges with the implementation of FCC in practice and both the need to consider multiple perspectives and the need for broader systemic change in order to support a FCC philosophy.

Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway within a multifaceted champion-based simulated educational training program for NICU staff and parents. Published outcomes and generated organizational data for program synthesis connected the gap in practice. Kolcaba's comfort theory served as the guiding framework to ensure a partnership in care. This quasi-experimental quantitative study used the generalized liner model for data analysis. Study findings indicated that KC occurred 2.4 more times after the intervention compared to before (p = 0.001). Descriptive data revealed that KC episodes for intubated patients nearly doubled after implementation (11.1% from 6.2%). Post-survey scores for nursing knowledge and comfort level also improved after the intervention. Although earlier KC practice was non-conclusive (p = 0.082), future trials should control groups for day of life since admission. Disseminating the KC pathway can have a positive social change on family-centered care by increasing NICU nurses' knowledge, comfort, and adoption of this evidence-based practice as an expected routine standard of care.

No description available.

Yes / Aim and Objectives: To explore fathers' views and experiences of providing Kangaroo Care (KC) to their baby cared for in a Neonatal Intensive Care Unit (NICU). Kangaroo Care has been known to improve the health outcome for preterm, low birth weight and medically vulnerable term infants and achieve the optimal perinatal health wellbeing for parents and infants. Historically, mothers are considered as the dominant KC providers, whereas fathers are spectators and have been overlooked. Little is known about the fathers' perspectives in providing KC in NICUs. Methods: Individual semi-structured interviews were conducted with 10 fathers who delivered KC to their baby when in the NICU. Data were analysed using Braun and Clarke's six-phase thematical framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed to report this qualitative study. Findings: Fathers in this study identified they were passing a silent language of love and connecting with their baby by the act of KC in a challenging environment. Three themes emerged: ‘Positive psychological connection’, ‘Embracing father-infant Kangaroo Care’ and ‘Challenges to father-infant Kangaroo Care’. Conclusion: The findings of this study show KC enhances the bonding and attachment between fathers and infants. The conceptualisation of the paternal role in caregiving to a newborn is evolving as a contemporary practice. Further research is warranted to confirm or refute the study findings. Policies and facilities should be modified to include father–infant KC within the fields of neonatal care. Relevance to Clinical Practice: It is important for nurses and other health professionals to support and enable fathers to give KC. Father–infant KC is recommended in neonatal care settings. / Open access publishing facilitated by University of South Australia, as part of the Wiley - University of South Australia agreement via the Council of Australian University Librarians.

Yes / . Kangaroo care (KC) has been used widely in neonatal care to promote bonding/attachment and neurodevelopment for preterm and term infants. However, current literature suggests that research mainly focuses on infants' and mothers' experiences. The role of fathers in caring for their infant/child is changing and evolving in many countries around the globe. Yet little is known about fathers' experiences of KC in neonatal units. This review, therefore, aims to scope the current evidence of Father-infant KC (Father KC) in Neonatal Intensive Care Units (NICUs). Research question. What impact does KC have upon fathers when their baby is cared for in NIUCs? Search method. A scoping review was conducted and guided by the framework of Arksey and O'Malley (2005). The data sources consisted of Medline, Embase, America Psychological Association (APA) PsycInfo, Emcare, Cochrane Central, Web of Science, Google Scholar and ProQuest. The study inclusion criteria were: (1) studies involving fathers who had experience of KC with their baby whilst in Neonatal Intensive Care Units (NICUs), and other neonatal care settings, such as Special Care Baby Nursery (SCBU), delivery/labour room and postnatal ward; (2) literature published from 2000 to 2020; (3) primary studies including qualitative, quantitative, and mixed methods studies; (4) studies published in English. Results. The total number of studies identified were 13. Seven studies were qualitative and six were quantitative. None were mixed methods. Studies reported several positive KC benefits on fathers, such as reduced stress, promotion of paternal role and enhanced father-infant bond. It was highlighted that KC could be time-consuming for fathers and challenging to practise when balancing work and family life commitments. Conclusion. This review provides evidence that KC practice has health and wellbeing benefits for fathers and infants in NICUs and other relevant neonatal care settings, The findings of this review support the justification to promote Father KC in NICU environments, and guide policies to include father involvement. Implementing Father KC in NICU settings will assist fathers to care and connect with their baby. Further research is needed to explore how to facilitate and evaluate KC education for fathers from diverse s and cultures.