Neonatal abstinence syndrome (NAS) in infants presents unique challenges in feeding and weight gain. The unpredictable clinical manifestations associated with the newborns withdrawal from exposure to drugs in utero can lead to costly delays in transition of the infant out of the Neonatal Intensive Care Unit (NICU).The purpose of this review of literature was to explore feeding positions and nutritional intake with the greatest impact on weight gain in infants with neonatal abstinence syndrome (NAS) following delivery. The secondary purpose was to compare the clinical manifestations of infants with NAS that influence nutritional intake and their relationship to length of time and cost of stay in the NICU. A review of literature was performed using multiple databases. Articles focusing on feeding position and nutrition intake were identified for interventions to effectively promote weight gain, while reducing clinical manifestations common in infants with NAS. Articles exploring improved feeding and weight gain in infants with NAS and reduced length of stay in the NICU were also synthesized for cost reductions to the facility. Results from 12 studies comparing various feeding positions that optimized nutrition, and reduced negative clinical manifestations in infants with NAS were synthesized for content relevant to the research questions. Results suggest a relationship between placing infants in the c-position, and side-lying position to reduce sensory stimulation, with reducing clinical manifestations for infants actively experiencing withdrawal symptoms from NAS. Providing chin and cheek support as needed, decreasing eye contact during feeding periods, and providing darker quiet environments all play an important role in allowing infants with NAS to optimize their weight gain. As previously stated, to manage nutritional intake and optimize weight gain, reduction of clinical manifestations through pharmacological and non-pharmacological interventions must be actively incorporated into the infants' plan of care.

During their very early stages of life, both healthy and ill infants go through painful routine medical procedures. Exposure to repeated painful stimuli early in life is known to have short and long-term adverse effects, particularly if the infant's pain is not well managed. The purpose of this integrative literature review was to investigate the effectiveness of breastfeeding on relieving acute pain in infants undergoing routine painful medical procedures compared to other non-pharmacologic interventions. A literature search was conducted using Cumulative Index to Nursing Allied Health Literature (CINAHL), MEDLINE, APA PsychINFO, Cochrane Database, and Google Scholar databases. The final number of articles meeting inclusion criteria and analyzed in this review was 10. The non-pharmacological interventions for reducing pain responses in infants that were compared to breastfeeding for effectiveness included the use of sweet tasting solutions, music therapy, and environmental comfort measures. Overall, findings indicated that breastfeeding was most effective in reducing pain responses among infants compared to other non-pharmacologic interventions. Further, breastfeeding in conjunction with the other non-pharmacologic interventions provided added benefit to pain reduction. Findings suggest that breastfeeding is a simple, non-pharmacologic intervention that can be used in clinical nursing practice to reduce the pain response of infants during minor medical procedures.

Despite PPD’s global extent, scarce research that addresses culturally competent alternative interventions exists. The purposes of this thesis were to 1) analyze the existing literature on non-pharmacological treatment of PPD in the US and across selected cultures; 2) determine the effectiveness of cross-cultural non-pharmaceutical therapy; and 3) examine and suggest ways health care providers can integrate non-pharmacologic interventions into PPD treatment in the US. The systematic electronic search comprised the databases Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO and SAGE Research Methods. Searches were limited to English language, peer reviewed, and research articles between 2007 and 2017. A second search was performed through global Healthcare Organizations websites. The World Bank’s country classifications by income level were adopted to present the findings. This review found that passing el calor to the newborn, yoga; and cognitive-behavioral, interpersonal, family, and bright light therapies are successful interventions. Further, seclusion periods were identified as adequate interventions only when women voluntarily adopt the practice and have family support, with less social restrictions. While other non-pharmacological treatments’ effectiveness was not ascertained, this thesis encourages healthcare professionals to integrate cultural traditions congruent with clients’ preferences. Recommended nursing interventions and suggestions for improvement of current practice are also discussed.

Urinary tract infections (UTI) in neonates are caused by many types of risk factors such as increased length of maternal labor, physiologic maternal conditions, prematurity, and decreased birth weight. Identification of potential risk factors for UTI in neonates can lead to rapid assessment and early interventions to treat urinary infection in the neonate before it transitions to a severe or life-threatening condition, such as a kidney infection or septicemia. The primary purpose of this literature review was to examine risk factors predisposing neonates to UTI. The secondary purpose was to identify if length of time to drug therapy used to treat UTI in neonates decreased complications and recurrence in the preterm infant. A comprehensive literature review was performed using research articles available from 2007 to 2021 regarding the factors influencing the occurrence of urinary tract infections in neonates. Databases used to search for articles include EBSCOhost databases, Medical Literature On-Line (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar. Searches used a combination of the following terms: ‘UTI’, OR ‘urinary tract infection’, AND ‘neonates’, OR ‘infants’, ‘risk factors’. Of the articles reviewed, 15 met the inclusion criteria and answered the research questions. Two studies showed circumcision in male infants increases the risk of urinary tract infection in infants. Two studies revealed vesicourethral reflux in female infants compared to male infants increases the risk of UTIs. One article suggested women with longer labor (>24 hours) from onset had an increased likelihood of the newborn having a UTI within the first week of life. Preliminary data suggests there are significant precursors and risk factors that can be identified to diagnosis UTIs early and having them treated promptly. All the reviewed articles focused on collection of urine samples within hours of birth and physiologic findings of a UTI can decrease the length of stay and costs related to infection treatment. Antibiotic therapy being administered empirically due to rapid assessment of risk factors for UTI in the neonate decreases time to treatment by three to five days, which improves health outcomes. Rapid assessment and diagnosis of UTI is of value for preventable measures to be ordered sooner to avoid repeat and resistant UTIs in the neonate.

The overutilization of cesarean deliveries is a major public health issue in the United States (U.S.). The rates of cesarean deliveries have increased substantially from the mid 1990s. Low-risk, defined as nulliparous, term, singleton, vertex (NTSV) pregnancies with no medical indication of need, and elective cesarean deliveries have been implicated as drivers of these increases. Elective cesarean deliveries are NTSV cesarean deliveries in which no trial of labor was attempted. There is a lack of clear rationale as to the noted increases in cesarean delivery rates as the evidence shows that these procedures provide no additional health benefits to mothers or infants. In fact, excessive use of cesarean sections has been associated with poorer health outcomes and quality of care, and higher health care expenditures. The purpose of this dissertation is to examine the current variation in NTSV and elective cesarean deliveries in the U.S., and further to examine the extent to which national trends are mirrored in Appalachia, a region disproportionately burdened by lack of health care resources and poor health outcomes. A repeated cross-sectional analysis of the prevalence of NTSV and elective cesarean deliveries in the U.S. between 2016 and 2020 was conducted using individual-level vital records data. Differences were examined by rurality and Appalachian designation. Logistic regression and marginal analyses were used to examine changes in the prevalence of these outcomes over time while adjusting for additional pertinent covariates. Approximately 25% of NTSV births are delivered via cesarean section, and 37% of those NTSV cesarean deliveries are elective. No practically significant differences in the prevalence of NTSV cesarean deliveries were noted based on rurality or Appalachian designation. However, there were significant variations in the prevalence of elective cesarean deliveries by geography. Rates of elective cesarean deliveries were significantly lower in rural communities compared to metropolitan, or urban, communities. Non-Appalachia had predominantly higher prevalence of elective cesarean deliveries compared to the Appalachian sub-regions. The findings of this dissertation suggest that while variations in health outcomes may be driven by geographic designations, variations in health services utilization are likely driven by other factors, such as institutional and provider characteristics.

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung condition that is diagnosed among neonates who are on oxygen therapy for longer than 28 days. BPD causes insufficient gas exchange due to prematurely developed lungs and is the most common condition that causes morbidity of prematurity. Many risk factors contribute to the development of this condition and relate to care from the delivery room to the first few days of life. Purpose: The purpose of this literature review is to examine risk factors related to the development of BPD in neonates from the gestational ages of 24 to 32 weeks. Methods: To examine the risk factors of BPD, a literature review was conducted using CINAHL Plus with Full Text. Ancestry searching was used as another method of extracting articles. The time frame of literature was within the last ten years, 2013-2023. Results: The literature review revealed that common risk factors for BPD include intubations, prolonged time intubated, reintubations, low birth weight, sepsis, low 5- minute APGAR score, delayed caffeine, invasive surfactant administration, antenatal steroid treatment, and less than 32 weeks gestational age. Conclusion: Nurses can recognize risk factors that place their patients at risk for BPD and can mediate the risks or anticipate the care of a patient with a high-risk potential for BPD. Overall, the care provided by the nurse should reflect preventative measures and anticipatory care to ensure positive patient outcomes. Some of these measures include kangaroo care, clustering care, noise reduction, decreased environmental stimulation, respecting sleep, teaching parents about breastfeeding, and advocating for prenatal care. Nurses need education to increase awareness and decrease the incidence of these risk factors.

The Healthy People 2010 Objectives for the population of the United States include the objective for women to sustain breastfeeding at a higher rate than they are currently.The American Academy of Pediatrics (AAP) now recommends that all infants be fed human milk for the first year of life instead of the previously recommended first six months of life. Breastfeeding initiation rates are rising, but breastfeeding duration rates continue to fall. It was hypothesized that the support system of the women may play a role in the duration of breastfeeding. The purpose of this research study was to investigate the support system and breastfeeding rates of mothers during the first six weeks after delivery and to determine if income level had an effect on these systems and rates. Mothers were interviewed during their hospitalization for childbirth regarding their perception of their support system currently in place. A questionnaire was administered regarding support from friends, family members, co-workers, and health care professionals and the responses were quantified. Mothers were contacted weekly to determine if breastfeeding was being sustained and who was the most supportive person to them. At the end of six weeks or when breastfeeding was discontinued, the mothers were interviewed a second time to determine if the support system had changed. The results of this study showed that income level affected the duration of breastfeeding and the mother's perception of her support system. Additionally, the results showed that the evaluation of the support system changed only slightly over time. The results showed preliminary ability of the study tool to predict breastfeeding at six weeks by income.This document was created using Microsoft Word 2003. The statistical package used for data analysis was JMP version 6.

The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.

Introduction: Eosinophilic Esophagitis (EoE) is a rare allergic inflammatory disease affecting approximately 1-4 in every 10,000 individuals in the United States. With the dramatic increase in prevalence of EoE in recent years and the increasing use of the internet as a source of health care information, we sought to evaluate the educational quality of EoE videos on YouTube. Methods: We performed a YouTube search using the keyword “eosinophilic esophagitis” from September 8-27, 2016. All available videos were included and analyzed for video characteristics, source, and content. Source was further classified as health-care provider, alternative-medicine provider, patient and/or patient's parents, company, media, or professional society. A scoring system was created based on current guidelines to evaluate the quality of information (-10 to +30 points).Negative points were assigned for misleading information. Six blinded reviewers scored each video independently. Results: Two hundred and nine videos were analyzed, with a median of 507 views, 1 like, 0 dislikes, and 0 comments. More video presenters were male (50.9%), and the most commonly depicted race was Caucasian (73.6%). The most common type of video source was professional society (39.7%), and the least represented video source was company and media (8.6%). Among the four video sources, the mean scores showed a statistically significant difference from each other (pConclusion: Youtube videos on EoE were shown to be a poor source of valid health care information. Videos by health care providers were a better source of information compared to other sources. This study reiterates the need for higher quality educational videos on EoE by the medical community.

The sequential-touching procedure is employed by researchers studying nonlinguistic categorization in toddlers. TouchStat 3.00 is introduced in this article as an adjunct to the sequential-touching procedure, allowing researchers to compare children’s actual touching behavior to what might be expected by chance. Advantages over the Thomas and Dahlin (2000) framework include ease of use, and fewer assumptive limitations. Improvements over TouchStat 1.00 include calculation of chance probabilities for multiple “special cases” and for immediate intercategory alternations. A new feature for calculating mean run length is also included.