Application of the Adverse Childhood Experiences Framework to the NICU.

BACKGROUND: Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. PURPOSE: Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. METHODS: An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. RESULTS: NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. IMPLICATIONS FOR PRACTICE AND RESEARCH: Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

Use of a Supplemental Feeding Tube Device and Breastfeeding at 4 Weeks.

BACKGROUND: Mothers having difficulty breastfeeding their infants may use alternative supportive feeding methods. Although a supplemental feeding tube device is commonly used, efficacy for supporting sustained breastfeeding remains unknown. PURPOSE: To describe supplemental feeding tube device use by breastfeeding mothers as an alternative feeding method through exploration of associations between supplemental feeding tube device use and continued breastfeeding at 4 weeks of infant's age. METHOD: Forty mothers participated. They were interviewed during the birth hospitalization and at 4 weeks postpartum. Questions addressed use of supplemental feeding tube devices, breastfeeding issues, and continued breastfeeding relationships. We examined the relationship between LATCH scores at 2 to 3 days of life. RESULTS: Breastfeeding mothers who chose to supplement with bottle-feeding instead of use of a supplemental feeding tube device were 30% less likely to continue breastfeeding at a medium/high/exclusive level. CONCLUSION: Use of the supplemental feeding tube device may help avoid the potentially detrimental effect of bottle-feeding on continued breastfeeding.

Hospital Adhering to the Ten Steps to Successful Breastfeeding Predicts Exclusive Breastfeeding in Latinx Mothers.

Introduction: Assessing how well a hospital adheres to the Ten Steps to Successful Breastfeeding is the key to outlining necessary modifications in mother breastfeeding support. This study aimed to assess Latinx mothers' perception of how well a hospital adheres to the Ten Steps to Successful Breastfeeding and its influence on exclusive breastfeeding (EBF) rates at hospital discharge. Methods: Secondary analysis of two longitudinal studies. The combined sample (N = 74) of Latinx pregnant women residing in the US. We modified, translated, and evaluated reliability of the Questionnaire for the Breastfeeding Mother (QBFM), which was applied to evaluate mothers' perception of how well a hospital adheres to the Ten Steps to Successful Breastfeeding. Results: The QBFM obtained a standardized KR-20 of 0.77. Mothers who EBF had higher scores of the QBFM than mothers who used formula during hospitalization. For each point that the QBFM score increased, the likelihood that the mother was EBF at discharge increased by 1.30 times. Conclusion: Mothers' perceptions of how well a hospital adheres to the Ten Steps to Successful Breastfeeding were the only significant variable associated with EBF at discharge. The QBFM Spanish version is a valuable instrument that can be used to obtain measurable outcomes and outlines necessary changes after implementing the Ten Steps to Successful Breastfeeding.

Examining Health-Seeking Behaviors of Korean Immigrant Women.

OBJECTIVE: To identify specific factors that potentially influence the willingness of Korean immigrant women to seek preventive health care. DESIGN: A descriptive cross-sectional correlational pilot study examining health-seeking behaviors of Korean immigrant women. SETTING: Participants were recruited from multiple sites, including Korean churches, small businesses, e-mail, and social media. PARTICIPANTS: A convenience sample of 87 Korean immigrant women (i.e., both parents Korean), 18 years or older, able to read and understand English and/or Korean, and currently living in the United States. INTERVENTION/MEASUREMENTS: Data were collected using a 62-item bilingual questionnaire, composed of researcher-developed questions and the Risk Behavior Diagnosis Scale. Pearson's correlations were performed to analyze bivariate relationships between willingness to seek care and outcome variables. RESULTS: Korean immigrant women were significantly more willing to seek preventive health care when they were prompted by outside sources of information and exhibited greater self-efficacy. Significant positive correlations were found between participant's age, years lived in the United States, cues to action, and self-efficacy. CONCLUSION: Promoting preventive health information at every opportunity and fostering self-efficacy in culturally sensitive ways are important to increase health care use among Korean immigrant women. Developing cultural-based interventions to improve the health-seeking behaviors of Korean immigrant women was shown to be imperative.

Differences in Neonatal Outcomes Among Premature Infants Exposed to Mother's Own Milk Versus Donor Human Milk.

BACKGROUND: Growing evidence supports the superior benefits of exposure to mother's own milk (MOM) in reducing prematurity-related comorbidities. Neonatal exposure to donor human Milk (DHM) is a suitable alternative when MOM is insufficient or unavailable. However, the same protective composition and bioactivity in MOM are not present in DHM. Additional evidence is needed to justify and inform evidence-based practices increasing MOM provision while optimizing adequate use of DHM for premature infants. PURPOSE: A systematic review of the literature was conducted to determine differences in neonatal outcomes among premature infants exposed to predominately MOM versus DHM. METHODS/SEARCH STRATEGY: Databases including PubMed, CINAHL and Cochrane were searched (2020-2021) using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Evidence was classified using the John Hopkins evidence-based practice levels and quality of evidence. RESULTS: Eleven studies met inclusion criteria. Studied neonatal outcomes included ( a ) growth parameters (n = 8), ( b ) neonatal morbidities (n = 6), and ( c ) gut microbiome (n = 4). Overall, evidence suggests DHM exposure is beneficial but not equivalent to MOM feeding. Compared with DHM, greater doses of MOM are ideal to enhance protection primarily related to infant growth, as well as gut microbiome diversity and richness. IMPLICATIONS FOR PRACTICE: Standardized and evidence-based practices are needed to clearly delineate optimal use of DHM without undermining maternal and neonatal staff efforts to support and promote provision of MOM. IMPLICATIONS FOR RESEARCH: Additional evidence from high-quality studies should further examine differences in neonatal outcomes among infants exposed to predominately MOM or DHM in settings using standardized and evidence-based feeding practices.

Strategies to Improve Mother's Own Milk Expression in Black and Hispanic Mothers of Premature Infants.

BACKGROUND: Mother's own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants. PURPOSE: A review of the literature was conducted to answer the clinical question: "What evidence-based strategies encourage and improve mother's own milk expression in Black and Hispanic mothers of premature infants?" METHODS/SEARCH STRATEGY: Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7). FINDINGS/RESULTS: Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area. IMPLICATIONS FOR PRACTICE: Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice. IMPLICATIONS FOR RESEARCH: Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers.

Evaluation of a Home Visiting Program: Perspectives of Mothers.

Home visiting programs provide families with an array of services that contribute to decreased infant and maternal morbidity and mortality. However, little is known as to how mothers perceive participation in home visiting programs, and questions remain regarding what improvements can be made to better serve these families. The purpose of this program evaluation was to assess mothers' perceived benefits and barriers to participation in established home visiting and outreach programs at Child Developmental Resources (CDR) in Williamsburg, Virginia. The program evaluation was a descriptive project consisting of 30-minute telephone interviews. Participants included 23 English-speaking mothers enrolled in CDR programs. Maternal demographics and perception of benefits/barriers were measured. Descriptive statistics were performed to describe sample demographics and outcome variables. Overall, most mothers perceived CDR programs as beneficial and were very satisfied with the services; however, a few changes could be made to improve programs and combat barriers to participation. Potential alternatives to supplement programs were suggested including the use of mobile technology in the participant's home.

Program Evaluation of a Home Visiting Program: Perspectives of Home Visitors.

The purpose of this program evaluation was to determine if home visitors at the Child Development Resources (CDR) home visiting program perceived themselves to have adequate knowledge and resources to support the goals of the program. In addition, we aimed to determine what home visitors found to be facilitators and barriers to a successful program. The project was conducted with a convenience sample of 18 home visitors and included the following instruments: (a) demographics survey, (b) CDR Home Visiting Program Survey, and (c) Breastfeeding Knowledge Questionnaire. Results suggest (a) most of the home visitors believed they had adequate resources and knowledge necessary to support families and children, (b) some perceived barriers to carrying out goals of the home visiting program were financial limitations, lack of internet and mobile devices in many homes, and perception that programs were not designed for families with significant stressors such as poverty and mental health difficulties, (c) most of the home visitors believed their families benefit from their visiting programs, but many did not overwhelmingly feel new technology would greatly help families during home visits, and (d) most home visitors appeared to have adequate breastfeeding knowledge, however, some suggested that additional breastfeeding education would be beneficial. The information gathered from this project can be used to inform and improve home visiting programs seeking to enhance the quality of their programs which will ultimately contribute to better health outcomes for at-risk mothers and children.

Effectiveness of a Primary Care-Based Pediatric Weight Management Program.

BACKGROUND: Childhood obesity is a growing epidemic of great concern for our nation, including pediatric populations treated at military treatment facilities. OBJECTIVE: This study aims to retrospectively evaluate the effectiveness of a primary care-based structured weight management program in a sample of pediatric patients with obesity at a military treatment facility. METHODS: This study was a retrospective chart review of patients enrolled in the All About Me Program (AAMP) from August 1, 2011, through July 10, 2012. Baseline demographics, 5-2-1-0 behavioral targets, and anthropometric measures were obtained from 54 enrollees. Pre- and post-program weight, body mass index (BMI) percentile, and 5-2-1-0 behavioral targets were compared for 20 patients who completed the program which consisted of a total of five visits over 3 months. RESULTS: Participants showed a significant reduction in their BMI, improvement in daily servings of fruits and vegetables, reduction in recreational screen time from baseline, improvement in daily physical activity, and reduction in consumption of sugary beverages. CONCLUSIONS: These preliminary findings are a promising indicator that primary care-based obesity interventions may be effective for the management and treatment of pediatric obesity. IMPLICATIONS FOR NURSING: This evidence-based toolkit provides a practical point-of-care guidance on the prevention, assessment, and treatment of childhood obesity and can be easily implemented in other primary care settings.

Recruitment of Immigrant Hispanic Mothers in Research: An Application of the EERC Guidelines.

Introduction: Innovative and culturally sensitive strategies are needed to promote research participation among minorities and develop targeted interventions aimed at decreasing health disparities. The purpose of this article is to illustrate application of the EERC (evaluate, engage, reflect, and carefully match) guidelines in facilitating participant recruitment in a study exploring infant feeding practices of Hispanic mothers. Methodology: Retrospective application of the EERC guidelines assessed using data extracted from the researcher-study recruitment field notes. A systematic categorical process was used to determine if each of the guidelines' key concepts were incorporated in the recruitment process. Results: Successful recruitment of 62 immigrant Hispanic mothers (approximately 82% of target goal) was accomplished through implementation of most of EERC criteria (90%) in planning and recruitment phases of the study. Discussion: Application of EERC guidelines facilitates recruitment of minority populations. Enhanced participant recruitment assists in assessment of population-unique conditions and targeted interventions leading to disease prevention and improved outcomes.

Label-Free Telomerase Activity Detection via Electrochemical Impedance Spectroscopy.

In the last decade, researchers have been searching for innovative platforms, methods, and techniques able to address recurring problems with the current cancer detection methods. Early disease detection, fast results, point-of-care sensing, and cost are among the most prevalent issues that need further exploration in this field. Herein, studies are focused on overcoming these problems by developing an electrochemical device able to detect telomerase as a cancer biomarker. Electrochemical platforms and techniques are more appealing for cancer detection, offering lower costs than the established cancer detection methods, high sensitivity inherent to the technique, rapid signal processing, and their capacity of being miniaturized. Therefore, Au interdigital electrodes and electrochemical impedance spectroscopy were used to detect telomerase activity in acute T cell leukemia. Different cancer cell concentrations were evaluated, and a detection limit of 1.9 × 105 cells/mL was obtained. X-ray photoelectron spectroscopy was used to characterize the telomerase substrate (TS) DNA probe self-assembled monolayer on gold electrode surfaces. Atomic force microscopy displayed three-dimensional images of the surface to establish a height difference of 9.0 nm between the bare electrode and TS-modified Au electrodes. The TS probe is rich in guanines, thus forming secondary structures known as G-quadruplex that can be triggered with a fluorescence probe. Confocal microscopy fluorescence images showed the formation of DNA G-quadruplex because of TS elongation by telomerase on the Au electrode surface. Moreover, electrodes exposed to telomerase containing 2',3'-dideoxyguanosine-5'-triphosphate (ddGTP) did not exhibit high fluorescence, as ddGTP is a telomerase inhibitor, thus making this device suitable for telomerase inhibitors capacity studies. The electrochemical method and Au microchip device may be developed as a biosensor for a point-of-care medical device.

Las Dos Cosas Versus Exclusive Breastfeeding: A Culturally and Linguistically Exploratory Intervention Study in Hispanic Mothers Living in Kentucky.

INTRODUCTION: Formula supplementation among infants of breastfeeding Hispanic immigrants is common practice known as las dos cosas. The purpose of this study was to assess the feasibility, effectiveness, and acceptability of a culturally and linguistically diverse intervention to promote exclusive breastfeeding (EBF) for the first 6 months. METHODS: A sample of 39 Hispanic pregnant women was recruited and randomly assigned to intervention (n = 20) and control groups (n = 19). The intervention included a peer counselor and professional support, and mothers were followed from pregnancy to 6 months after birth. RESULTS: After the study, women assigned to the intervention group were over three times more likely to EBF their baby through all four postpartum assessed time points (odds ratio = 3.1, 95% confidence interval: 1.1-8.7). DISCUSSION: This culturally and linguistically diverse intervention contributed to increased EBF duration and decreased formula supplementation in Hispanic mothers up to 6 months postpartum.

Associations between Introduction of Age-Inappropriate Foods and Early Eating Environments in Low-Socioeconomic Hispanic Infants.

PURPOSE: To examine the associations between feeding practices and eating environments of low-socioeconomic Hispanic infants. METHODS: Secondary analysis of cross-sectional data from a sample of 62 low-income immigrant Hispanic mothers and their infants (age range = 4-12 months). Measures of infant feeding practices (food groups and beverages consumption) and eating environment domains were included using the Infant Feeding Scale. RESULTS: TV exposure and allowing the infant to play with toys during meals significantly correlated with intake of energy-dense foods in 4- to 6-month-olds (p = .05). Among 7- to 9-month-olds, mealtime TV watching correlated with consumption of snacks (p = .05) and sweetened beverages (p = .01). Consumption of energy-dense foods was significantly different among groups with higher mean intake in older infants (p = < .01). CONCLUSION: Findings highlight the need for culturally and socioeconomically sensitive approaches to improve infant feeding practices and support low-income Hispanic families in providing healthy and nurturing eating environments required to prevent later obesity risk.

Differences in modifiable feeding factors by overweight status in Latino infants.

PURPOSE: Obesity prevalence remains disproportionally high for young American children from low-socioeconomic and ethnic minorities. Modifiable feeding factors may lead to infant overfeeding and an increased risk for obesity. This study explored differences in modifiable feeding factors by overweight status (>85% weight-for-length) in the first year of life of Latino infants. METHODS: Data were obtained from a cross-sectional pilot study of 62 low-income immigrant Latina mothers and their infants (ages 4-12 months). Measures included maternal feeding practices, feeding pattern, infant's 24-hour dietary recall, and maternal perception of infant weight. Chi-square and t-tests were used for comparisons between healthy weight and overweight infants. RESULTS: Birth weight z-scores did not significantly differ by weight status. Overweight status was not associated with maternal feeding practices, feeding pattern or infant dietary intake. A trend toward significance was seen in the maternal perception of infant weight. CONCLUSION: Overweight infants were similar to healthy weight infants in their birth weight z-scores and supports the premise that modifiable feeding factors are in play and thus targeted early feeding interventions may prove effective in decreasing obesity risk in Latinos.

Factors contributing to infant overfeeding in low-income immigrant Latina mothers.

BACKGROUND: Approximately 10% of U.S. infants and toddlers are considered overweight. Hispanic infants persistently show higher prevalence rates for being overweight compared to other infants. Little is known about factors promoting excessive infant weight gain in Latinos. PURPOSE: The aim of this study was to describe multidimensional factors and maternal feeding practices that may correlate with infant overfeeding in Latina mothers. METHODS: Participants were 62 low-income immigrant Latina mothers and their infants. Study measures were: acculturation; maternal feeding beliefs and practices; food availability; temperament; 24-hour dietary recall; and infant's weight-for-height z score. RESULTS: In regression models adjusted for infant's age, healthier feeding practices were significantly predicted by maternal education and infant's age. Most mothers preferred feeding their infants either formula or a combination of breast milk and formula. A significant proportion of the infants were overweight or obese and yet some mothers displayed difficulty recognizing this problem. CONCLUSION: Future intervention efforts should focus primarily on the promotion of healthy feeding practices that discourage overfeeding and support exclusive breastfeeding among this ethnic group.

Factors contributing to infant overfeeding with Hispanic mothers.

OBJECTIVE: To evaluate existing evidence on factors potentially contributing to infant overfeeding among Hispanic mothers that may explain the high infant overweight rates often seen among this ethnic group. DATA SOURCES: Electronic databases including CINHAL and MEDLINE were searched for relevant studies published from 1998 to January 2012. Related article searches and reference list searches were completed on all included studies. STUDY SELECTION: Thirty-five studies (nine qualitative, 15 cross-sectional, nine cohort, and two longitudinal) were identified that met the following inclusion criteria: (a) studies of Hispanic-only or multiethnic mothers, (b) studies of healthy full-term infants or toddlers, (c) studies in which a majority of the sample included children within the target age group (0-24 months of age), and (d) studies conducted in the United States. The methodological quality of the studies ranged from fair to excellent. DATA EXTRACTION: Data extraction included content related to Hispanic infant feeding and weight gain. DATA SYNTHESIS: Reviewed research fell into three main foci of inquiry: breastfeeding and formula-feeding beliefs, attitudes, and practices; family and cultural influences of maternal feeding beliefs and practices; and maternal perceptions of infant feeding satiety and weight gain. The Preferred Reporting Items of Systematic Reviews Meta-Analysis (PRISMA) guidelines were followed for data extraction and reporting the results of this integrative review. CONCLUSION: Three major feeding practices and beliefs among Hispanic mothers potentially contribute to infant overfeeding. Hispanic mothers are more likely to practice nonexclusive breastfeeding, initiate early introduction of solid foods including ethnic foods, and perceive chubbier infants as healthy infants. Cultural norms driving family influences and socioeconomic factors play a role in the feeding tendencies of Hispanics. Empirical research is needed to further define the primary factors that influence Hispanic mothers feeding decisions and practices that contribute to excessive weight gain in their infants.