Leveraging the Skills of Nurses and the Power of Language Nutrition to Ensure a Better Future for Children.

BACKGROUND: Early language exposure is critical for language acquisition and significantly influences a child's literacy skills. However, preterm infants may experience language deprivation in the neonatal intensive care unit. Nurses are vital to helping parents understand their critical role in early language development. PURPOSE: To discuss the impact of language-rich interactions and interventions that promote early language exposure, or Language Nutrition, by parents and caregivers on the long-term developmental, language, and educational outcomes of high-risk infants. METHODS/SEARCH STRATEGY: A literature search was conducted using PubMed and Web of Science to identify articles that examined the influence of language interactions with high-risk infants on developmental outcomes. Recent campaigns touting the importance of early language exposure were identified through the Bridging the Word Gap Research Network. FINDINGS/RESULTS: Increasing preterm infants' exposure to Language Nutrition improves their language development, promotes parent-infant attachment, and decreases parent stress. In addition, it may result in greater neuroplasticity and volume of the auditory cortex. Several campaigns have been developed to increase children's access to Language Nutrition and can be implemented into everyday pediatric and neonatal care. IMPLICATIONS FOR PRACTICE: Pediatric, neonatal nurses and advanced practice nurses are uniquely positioned to play a transformational role in high-risk infants' developmental trajectory by educating parents about the importance of Language Nutrition and supporting parents as they engage with their infant. IMPLICATIONS FOR RESEARCH: Studies investigating the population-level impact of interventions aimed at increasing infants' access to Language Nutrition as well as studies identifying effective ways to communicate messages about Language Nutrition are warranted.

Predictors of Co-occurring Neurodevelopmental Disabilities in Children With Autism Spectrum Disorders.

PURPOSE: Co-occurring neurodevelopmental disabilities (including cognitive and language delays and attention deficit hyperactivity disorder) affect over half of children with ASD and may affect later behavioral, language, and cognitive outcomes beyond the ASD diagnosis. However, no studies have examined predictors of co-occurring neurodevelopmental disabilities in children with ASD. This study investigated whether maternal sociodemographic, perinatal and neonatal factors are associated with co-occurring disabilities. DESIGN AND METHODS: This study involved a retrospective analysis of medical records for children diagnosed with ASD between 2009 and 2010 at an Autism Center in the southeast United States. Logistic regression was used to identify predictors of co-occurring neurodevelopmental disabilities. RESULTS: Of the 385 children in the sample, 61% had a co-occurring neurodevelopmental disability. Children whose mothers had less education (OR: 0.905), had never been married (OR: 1.803), or had bleeding during pregnancy (OR: 2.233) were more likely to have a co-occurring neurodevelopmental disability. Both preterm birth and African American race were associated with bleeding during pregnancy. CONCLUSIONS: Several maternal and perinatal risk factors for ASD were found to put children at risk for further diagnoses of co-occurring neurodevelopmental disabilities. While prematurity, a well-established risk factor for ASD, as well as maternal ethnicity was not found to increase the risk of a co-occurring disability, this study suggests that bleeding during pregnancy may moderate these relationships. PRACTICE IMPLICATIONS: Understanding maternal, perinatal, and neonatal risk factors may inform healthcare provider screening for ASD and co-occurring neurodevelopmental disabilities by helping providers recognize infants who present with multiple risk factors.

Maternal and Neonatal Birth Factors Affecting the Age of ASD Diagnosis.

Early diagnosis of autism spectrum disorders (ASD) enables early intervention that improves long term functioning of children with ASD but is often delayed until age of school entry. Few studies have identified factors that affect timely diagnosis. This study addressed how maternal education, race, age, marital status as well as neonatal birth factors affect the age at which a child is diagnosed with ASD. This study involved a retrospective analysis of 664 records of children treated at one of the largest autism treatment centers in the United States from March 1, 2009 to December 30, 2010. Logistic regression and Cox proportional hazards regression were used to identify maternal and neonatal factors associated with age of diagnosis. Infant gender, maternal race, marital status, and maternal age were identified as significant factors for predicting the age of ASD diagnosis. In the Cox proportional hazards regression model, only maternal race and marital status were included. Median survival age till diagnosis of children born to married mothers was 53.4 months compared to 57.8 months and 63.7 months of children born to single and divorced or widowed mothers respectively. Median survival age till diagnosis for children of African American mothers was 53.8 months compared to 57.2 months for children of Caucasian mothers. No statistically significant difference of timing of ASD diagnosis was found for children of varying gestational age. Children born to older or married mothers and mothers of minority races were more likely to have an earlier ASD diagnosis. No statistically significant differences in timing of ASD diagnosis were found for children born at varying gestational ages. Identification of these factors has the potential to inform public health outreach aimed at promoting timely ASD diagnosis. This work could enhance clinical practice for timelier diagnoses of ASD by supporting parents and clinicians around the world in identifying risk factors beyond gender and SES and developing strategies to recognize earlier signs of ASD and contribute to improved development outcomes in children with ASD.

CDC COVID-19 Vaccine Pregnancy Registry: Design, data collection, response rates, and cohort description.

The U.S. Centers for Disease Control and Prevention (CDC) developed and implemented the CDC COVID-19 Vaccine Pregnancy Registry (C19VPR) to monitor vaccine safety. Potential participants who received a COVID-19 vaccine in pregnancy or up to 30 days prior to their pregnancy-associated last menstrual period were eligible to participate in the registry, which monitored health outcomes of participants and their infants through phone interviews and review of available medical records. Data for select outcomes, including birth defects, were reviewed by clinicians. In certain cases, medical records were used to confirm and add detail to participant-reported health conditions. This paper serves as a description of CDC C19VPR protocol. We describe the development and implementation for each data collection aspect of the registry (i.e., participant phone interviews, clinical review, and medical record abstraction), data management, and strengths and limitations. We also describe the demographics and vaccinations received among eligible and enrolled participants. There were 123,609 potential participants 18-54 years of age identified from January 2021 through mid-June 2021; 23,339 were eligible and enrolled into the registry. Among these, 85.3 % consented to medical record review for themselves and/or their infants. Participants were majority non-Hispanic White (79.1 %), residents of urban areas (93.3 %), and 48.3 % were between 30 and 34 years of age. Most participants completed the primary series of vaccination by the end of pregnancy (89.7 %). Many participants were healthcare personnel (44.8 %), possibly due to the phased roll-out of the vaccination program. The registry continues to provide important information about the safety of COVID-19 vaccination among pregnant people, a population with higher risk of poor outcomes from COVID-19 who were not included in pre-authorization clinical trials. Lessons learned from the registry may guide development and implementation of future vaccine safety monitoring efforts for pregnant people and their infants.

Safety and Effectiveness of Maternal COVID-19 Vaccines Among Pregnant People and Infants.

Evidence has consistently demonstrated that COVID-19 messenger RNA (mRNA) vaccines are safe when given during pregnancy. COVID-19 mRNA vaccines protect pregnant people and their infants who are too young to receive COVID-19 vaccines. Although generally protective, monovalent vaccine effectiveness was lower during SARS-CoV-2 Omicron variant predominance, in part due to changes in the Omicron spike protein. Bivalent vaccines, that combine ancestral strain and Omicron variant, may improve protection against Omicron variants. Everyone, including pregnant people, should stay up to date with recommended COVID-19 vaccines and bivalent booster, when eligible.

Comparison of Virtual Simulation to Clinical Practice for Prelicensure Nursing Students in Pediatrics.

BACKGROUND: The COVID-19 (coronavirus disease) pandemic has required a transition from in-person clinical practice to virtual learning. PURPOSE: This study compares the standardized assessment test scores of prelicensure nursing students who completed their pediatric clinical practicum in person for both the clinical and simulation practice settings versus virtually. METHODS: This study included 186 students in a pediatric clinical course. Half the students completed in-person pediatric clinical practice and simulation, and half the students used i-Human to complete their pediatric clinical practicum virtually. Scores on the Assessment Technologies Institute (ATI) Nursing Care of Children examination were compared using independent-samples t tests. RESULTS: There were no significant differences in ATI scores between students who completed their pediatric clinical practicum in the clinical setting compared with virtually (P = .485; 95% confidence interval, -2.24 to 4.71). CONCLUSIONS: Using the i-Human platform, along with prebriefing and debriefing, is an effective pedagogical approach to simulating a pediatric clinical practicum.

Influence of Quiet Time on the Auditory Environment of Infants in the NICU.

OBJECTIVE: To determine the influence of quiet time on the auditory environment of infants in the NICU and to compare the effect of quiet time by room type, bed type, and infant clinical acuity. DESIGN: Cross-sectional, descriptive comparison study. PARTICIPANTS: Sixty-six infants born at less than 38 weeks gestation who were between 32 and 40 weeks postmenstrual age. SETTING: The auditory environments of infants in two level 3 NICUs within a pediatric hospital system in the Southeastern United States. Each NICU implemented quiet time for 4 hours per day. METHODS: We assessed the auditory environment of the participants using Language Environmental Analysis technology. We used paired t tests to assess differences in the auditory environment during quiet versus nonquiet time and to compare the effect of quiet time by room type, bed type, and clinical acuity. RESULTS: During quiet time, the auditory environment of participants had 13% more silence, 17% fewer electronic sounds, 25% less speech, and 30% fewer words than during nonquiet time. We observed greater differences in quiet time versus nonquiet time for infants in open bays and incubators and infants who had greater acuity. CONCLUSION: Our results support the implementation of quiet time to increase silence and reduce exposure to electronic sounds for infants in the NICU. Additional research is necessary to further examine the effect of quiet time on the auditory environment of infants in the NICU with consideration of environmental and clinical variables.