Nurse-led education mitigates maternal stress and enhances knowledge in the NICU.

PURPOSE: Maternal stress common to the neonatal intensive care unit (NICU) experience often impairs bonding, plays a role in postpartum depression and anxiety, and decreases maternal milk production. This study evaluated the effect of a nurse-led intervention pertaining to the experience of having a baby in the NICU on maternal stress in a population of high-risk pregnant women at three different time points. STUDY DESIGN AND METHODS: Using a repeated measures design, 42 pregnant women cared for on the high-risk antenatal unit participated in the educational intervention. Evaluative data pertaining to the intervention included maternal stress and knowledge specific to premature birth and the NICU. Participants answered surveys at three time points: prior to the intervention, immediately following the intervention, and 48 to 72 hours after infant admission to the NICU. RESULTS: Following the intervention, mothers were significantly more knowledgeable about who would be taking care of their baby (p = .008), their baby's body (p = .002), their baby's physical needs (p = .000), and the equipment used in the NICU (p = .001). In addition, participation in the intervention significantly decreased aspects of maternal stress related to the sights and sounds of the NICU (p = .010) and infant behavior and appearance (p = .035). Participation did not significantly influence feelings related to maternal role attainment (p = .165). CLINICAL IMPLICATIONS: Nurse-led patient education is an effective intervention strategy when aiming to reduce maternal stress in the NICU. Family-centered interventions tailored to the care of the high-risk mother and infant can improve patient outcomes.

Endotoxin-directed innate immunity in tracheal aspirates of mechanically ventilated human neonates.

Mechanical ventilation of preterm infants is associated with pulmonary inflammation. Intubated infants often develop bacterial tracheal colonization, but little is known about endotoxin in tracheal aspirates (TAs) or the mobilization of innate immunity toward endotoxin, a potent stimulus that contributes to inflammatory disease. We characterized mobilization of endotoxin-directed innate immunity in TAs from an observational cohort of mechanically ventilated neonates. TA supernatants (n = 42; GA = 23-40 wk, postnatal age = 1-71 d) were assayed for endotoxin (Limulus amoebocyte lysate assay) and endotoxin-modulating proteins: bactericidal/ permeability-increasing protein (BPI), LPS-binding protein (LBP), and soluble cell differentiation antigen 14 (sCD14). TA cellular BPI was measured by ELISA, Western blot, flow cytometry, and bactericidal assay. TA mRNAs encoding endotoxin-modulating proteins were measured by quantitative real-time PCR (qRT-PCR). Endotoxin in TA supernatants was proportional to both postnatal age and polymorphonuclear leukocytes (PMN). Neonatal TAs were rich in PMN containing BPI and expressed mRNAs encoding Toll-like receptor (TLR) 4, CD14, and myeloid differentiation protein 2 (MD-2). Extracellular BPI was consistently detectable and correlated with TA PMN and GA. Both extracellular- and cellular-BPI increased during the first postnatal week. TA extracellular BPI, LBP, and sCD14 were positively correlated. TAs from intubated neonates demonstrate endotoxin accumulation and mobilization of endotoxin-directed innate immunity, potentially contributing to pulmonary inflammation.