A Systemic Review of the Difference Between Diets for Preterm Infants Containing Raw Mother's Own Milk and Frozen or Pasteurized Mother's Own Milk.

BACKGROUND: Raw, never stored or pasteurized mother's own milk (MOM) is not always available to feed preterm infants; however, storage and pasteurization of MOM diminishes some bioactive components. It can be difficult to feed raw MOM to preterm infants due to transportation and storage of small volumes that might be pumped away from the infant, and a concern that they might harbor bacteria. However, the higher availability of bioactive components in raw MOM may provide benefits to preterm infants compared to frozen or pasteurized MOM. RESEARCH AIM: To systematically review and summarize the results of studies on feeding raw MOM versus frozen or pasteurized MOM to preterm infants born at less than 37 weeks of gestation. METHODS: Four databases were searched (Cochrane, Embase, Ovid MEDLINE, and Web of Science) for this systematic review. Of 542 studies identified, nine met inclusion criteria and were critically evaluated using the quality assessment tool for quantitative studies by the Effective Public Health Practice Project. Studies were organized using the Breastfeeding Challenges Facing Preterm Mother-Infant Dyads theoretical framework. RESULTS: Included studies evaluated the outcomes of preterm infants fed raw versus pasteurized MOM (n = 7, 77.8%) or raw versus frozen MOM (n = 2, 22.2%). Researchers found that raw MOM did not increase infant infections and may have improved health and growth outcomes for study participants. CONCLUSION: There is laboratory evidence supporting the safety and efficacy of the use of raw MOM for preterm infants. A raw MOM diet is recommended for preterm infants by professional organizations. Despite this, it may not be universally prioritized and could require purposeful implementation by each institution. Further research is needed to pursue the potential benefits of a raw MOM diet for preterm infants.

Parent and Child Anxiety Evaluated During an Early Period of the COVID-19 Pandemic: A Mixed-Methods Study.

Purpose: The objective of this study was to explore parent and child anxiety during the pandemic. Unlike previous pandemics, measures implemented to prevent the transmission of the SARS-CoV-2 virus have been much more limiting. Methods: An explanatory convergent mixed-methods design was used to describe anxiety of children 9-17 years of age and their parents during August-October 2020. Adult and child versions of State-Trait Anxiety Inventory (STAI) were used to examine levels as measured on STAI's state-anxiety subscale. Web-based interviews with a subset of patients were conducted qualitatively to analyze anxiety-related themes. Results: A total of 188 parents and 140 children responded to the questionnaires. Mean overall anxiety scores for parents (49.17 [standard deviation: 12.247]) and children (35.43 [standard deviation: 7.894]) were higher than published norms. Parent and child anxiety were positively correlated (r=0.36; P=0.01). From interviews with 11 parents and 11 children; 4 major themes and 10 subthemes describing physical and emotional outcomes resulting from limited social contact, work and family role strain, and uncertainty about COVID-19 were identified. Conclusions: Parents and children reported elevated anxiety levels during the COVID-19 pandemic. Findings of this study can guide the development of strategies that mitigate the negative impact of isolation, role strain, and uncertainty related to future public health crises.

Siblings' experience during pediatric intensive care hospitalization.

PURPOSE: The impact on children who visit an ill sibling in the pediatric intensive care unit (PICU) is unknown. The aim of this study was to describe the experiences of siblings of acutely critically ill or injured children hospitalized in the PICU. DESIGN AND METHODS: A qualitative approach using one-to-one interviews was conducted to gain an understanding of the experience of 9- to 17-year-old children who visited their siblings in the PICU. Thematic analysis was used to develop a description of the experiences of the siblings. FINDINGS: Sixteen siblings (mean age, 12.5 years) indicated that visiting their critically ill sister or brother in the PICU can cause negative reactions. The data revealed two major themes within the overall sibling experience-stressors, coping-and nine subthemes. Predominant sibling stressors included pre-illness stressors, the PICU environment, the appearance of the ill child, uncertainty, and parental stress. Siblings coped mainly via distractions, social support, and spirituality and by reflecting on the sibling relationship. Support from friends, family members, and the community was reported to be helpful. CONCLUSIONS: Siblings visiting the PICU may experience a broad range of physical, emotional, and social responses. PRACTICE IMPLICATIONS: Future research should fully incorporate the sibling perspective when designing interventions to mitigate the potentially distressing effects of PICU visitation on the family.

Longitudinal Evaluation of a Pediatric Rapid Response System with Realist Evaluation Framework.

BACKGROUND: Rapid response (RR) systems' impact on clinical outcomes is influenced by institutional social factors. This study applied the realist evaluation (context-mechanism-outcomes) framework to review significant RRs defined as REACT (Rapid Escalation After Critical Transfer) events for appraising a pediatric RR system. METHODS: REACT events included all RRs with cardiopulmonary arrest (CPA) and/or ventilation and/or hemodynamic support instituted within 24 hours after RR. A continuous quality improvement process was employed to identify, debrief, and review REACT events to recognize and act on RR mechanistic and contextual deficiencies. The aim was to decrease REACT events with mechanistic/contextual gaps categorized into crisis resource management (CRM) themes by 25% over three years while ensuring process sustainability. RESULTS: From 2015 to 2019, 5,581 RR events occurred, of which 67.2% transferred to ICU, and 1,392 (24.9%) were identified as REACTs. In the first two years, 100% identification and review within three months of 90% REACTs was accomplished. One hundred percent of the 17 providers ascertained that the process was safe and transparent, and 80.0% of respondents expressed their commitment from perceived benefit to patient care. Over five years, the proportion of REACTs with CRM gaps decreased from 62.3% to 26.5%, those with multiple deficiencies reduced from 72.5% to 23.2%, and CPAs outside ICUs decreased from 15 to 3 per year. Improvement actions included modifications to RR system (activation, process, and management), hospital (resources and policies), dedicated RR training, and sharing of positive feedback. CONCLUSION: The realist evaluation framework facilitated holistic assessment of an RR system. Review of REACTs was feasible, sustainable, and yielded useful information to guide systemwide improvement.

Impact of Pediatric Critical Illness and Injury on Families: An Updated Systematic Review.

PROBLEM: Pediatric ICUs (PICU) that have adopted family-centered care models welcome families to the critically ill child's bedside to partner with clinicians in decision-making and the provision of care. The aim of this review was to synthesize the evidence on the impact of critical illness and injury on families of children admitted to the PICU to identify research needs in pediatric critical care. ELIGIBILITY CRITERIA: This systematic review included quantitative and qualitative studies that examined the experiences of families of children admitted to a PICU published between 2005 and 2019. SAMPLE: 33 articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, PsycINFO, and reference lists of included publications. RESULTS: Main parental stressors included the sights and sounds within the PICU, child acuity, changes to family functioning and parenting role, and uncertainty of the child's outcome. The most common need of parents was to be well-informed. Psychological, physical, and social impact of hospitalization were experienced by parents from days after admission to years after discharge. Spirituality was identified as a coping mechanism in half of the studies. CONCLUSIONS: Parents experience negative effects of the ill child's admission to the PICU and to PICU exposure. IMPLICATIONS: Careful consideration of the impact of the PICU admission on family members of critically ill or injured children is needed when implementing family-centered care strategies. Future research on other family members including the healthy sibling needs to be conducted.

Customizing Trauma Nursing Education to Incorporate All Departments: A Cost-Effective Way to Educate Nurses From Every Trauma-Associated Unit.

Trauma education is crucial for optimizing the outcomes of trauma patients. Available trauma nursing education courses are not inclusive of all areas that a trauma patient may interact with but are targeted toward subsets of nurses who care for trauma patients. In addition, these courses can be costly for organizations and often divert resources away from departments for several days. We identified a need for convenient, cost-effective trauma nursing education delivered such that all nursing units that care for trauma patients would benefit. Based on data collected from needs assessments and literature reviews, content experts from many specialties developed and delivered content via interactive lectures, discussion panel, large group activities, case studies, and skills stations. Four internal courses were offered in 2018 with a total of 141 attendees. This resulted in cost savings of up to $86,715 when compared to external trauma courses. Attendees rated the courses very good or excellent (84.00%-95.23%). On average, 99.59% of the activity learning objectives were met, and 91.42% of learners intended to make changes to professional practice. Engaging key resources within an organization to deploy an internal approach to trauma nursing education can be valuable, cost-effective, and accessible to a broader nursing audience, inclusive of all units that care for trauma patients.