The impact of breast milk feeding on early brain development in preterm infants in China: An observational study.

BACKGROUND: The prevailing consensus from large epidemiological studies is that breastfeeding is associated with improved IQ and cognitive functioning in later childhood and adolescence. Current research is exploring the association between breastfeeding and early brain development in preterm infants. OBJECTIVE: To explore the differences in brain gray matter between breastmilk-fed and formula-fed preterm infants using structural and functional magnetic resonance imaging. METHODS: A convenience sample of breastmilk-fed preterm infants(n = 34) and formula-fed infants (n = 22) aged approximately 32 weeks. At near term-equivalent age, MR scanning was performed. Gray matter structural and functional differences between the two groups were assessed using MATLAB software for voxel-based morphometry (VBM) and amplitude of low-frequency fluctuation (ALFF) analysis. RESULTS: Maternal and neonatal demographic characteristics showed no significant difference between the two groups. Breastmilk-fed infants had greater regional gray matter volume on MRI than formula-fed infants in multiple brain regions, including the bilateral frontal lobe (BA11, BA46), right temporal lobe (BA37), and left caudate nucleus, at a statistical threshold of p<0.01 (AlphaSim corrected) with a cluster size of >40 voxels. Compared with formula-fed infants, breastmilk-fed infants showed increased brain activation on fMRI in the right superior temporal gyrus (BA41). CONCLUSION: Breastmilk-fed infants had greater regional gray matter development and increased regional gray matter function compared with formula-fed infants at near term-equivalent age, suggesting breastmilk feeding in the early period after birth may have some degree of influence on early brain development in preterm infants.

The effect of donor human milk on the length of hospital stay in very low birthweight infants: a systematic review and meta-analysis.

BACKGROUND: Donor human milk (DHM) is an alternative to preterm infant formula if the mother's own milk is not available. Since the lactation period and preservation treatment of DHM are different from those of mother's own milk, we aimed to determine the reduction in the length of hospital stay by DHM compared to preterm infant formula. METHODS: In this systematic review, we searched PubMed/MEDLINE, EMBASE, and the Cochrane Library to retrieve studies on the impact of DHM on the clinical outcomes of preterm infants published before 1 November 2019. The study included very low birthweight (VLBW) infants taking either DHM or infant formula with data on the length of hospital stay. Data were analysed using Review Manager 5.3 software. RESULTS: The literature search yielded 136 articles, and four randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. A meta-analysis of the RCTs (N = 725) showed no reduction in the length of hospital stay in both the DHM and infant formula groups (- 0.22 days; 95% CI -6.38, 5.95 days), whereas that of the eight observational studies (N = 2496) showed a significant reduction in the length of hospital stay in the DHM group (- 11.72 days; 95% CI -22.07, - 1.37 days). A subgroup analysis of the RCTs revealed that the incidence of necrotising enterocolitis (NEC) was significantly lower in the DHM group when the analysis included high-quality RCTs (RR = 0.32; 95% CI 0.15, 0.69). CONCLUSIONS: This systematic review of RCTs showed that DHM neither prolonged nor shortened the length of hospital stay in VLBW infants compared to preterm infant formula; however, it reduced the incidence of NEC, further validating the protective role of DHM in the health and safety of VLBW infants.

Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial.

BACKGROUND: Skin-to-skin contact (SSC) is an evidence-based intervention that benefits low birth weight /preterm infants. However, China's health institutional policy inhibits parents from visiting their baby in the neonatal intensive care unit (NICU). In addition, the Chinese traditional postpartum behavioral practice of confining women to home raises barriers to mother-infant contact. Thus, to shorten the duration of parent-infant separation, father-infant SSC is considered a possible alternative. This study determines whether it is safe to perform father-infant SSC in the NICU and investigates how paternal SSC affects outcomes compared with traditional care (TC) for moderately preterm infants. METHODS/DESIGN: A randomized controlled trial will be used to investigate the effects of paternal-infant SSC in NICU wards in China. Preterm infants born at a gestational age in the range of 320-346 weeks with a birth weight > 1500 g will be eligible. A simple random sampling method will be used to allocate infants to the SSC group (n = 25) or the TC group (n = 25). After medical stability, infants in the SSC group will be provided SSC by fathers for one hour every day until discharged from hospital. The primary outcome is neurodevelopmental measures, specifically salivary cortisol and Premature Infant Pain Profile (PIPP) during hospitalization. At 40 weeks of corrected age, infants will be assessed using the Infant Neurological International Battery (INFANIB) and neuroimaging. Secondary outcomes include infants' physiological stability during SSC and throughout hospitalization and state observation at discharge. The fathers' mental health will be assessed with the State-Trait Anxiety Inventory (STAI) 1 day to 3 days after the infant's admission to the NICU and at discharge. Father-infant attachment will be evaluated at 4 and 6 months after the infants' discharge, measured by the Paternal Postnatal Attachment Scale (PPAS). Statistical analyses will be conducted using a two-sided significance level of 0.05. DISCUSSION: The effects of paternal-infant SSC on moderately preterm infants will be assessed. The data gathered in this study may have important implications for medical practice and policy in the NICU regarding the care methods of premature infants in China. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-IOR-1701274 . Registered on 20 September 2017. Retrospectively registered.

Neonatal intensive care nurses' knowledge and beliefs regarding kangaroo care in China: a national survey.

OBJECTIVE: Kangaroo care (KC), a well-established parent-based intervention in neonatal intensive care units (NICUs), with documented benefits for infants and their parents. However, in China there remains a lack of knowledge and a reluctance to implement KC in hospitals. Therefore, our aim was to investigate the current knowledge, beliefs and practices regarding KC among NICU nurses in China using the 'Kangaroo Care Questionnaire'. METHODS: A quantitative descriptive survey was designed. This questionnaire comprised 90 items classified according to four domains: knowledge, practice, barriers and perception. Data were analysed using SPSS V.20.0, and content analysis was used to summarise data derived from open-ended questions. RESULTS: The survey involved 861 neonatal nurses from maternity and general hospitals across China (response rate=95.7%). The findings showed that 47.7% (n=411) of the nurses had participated in the implementation of KC. Neonatal nurses in the 'experienced in KC' group showed an overall better understanding of KC and its benefits with a higher 'correct response' rate than those in the 'not experienced in KC' group. In the 'experienced in KC' group, over 90% considered KC beneficial to the parent-baby relationship and attachment, and over 80% believed that KC positively affected outcomes of preterm infants. The 'not experienced in KC' group perceived more barriers to KC implementation than did the 'experienced in KC' group. CONCLUSION: Although most nurses working in NICUs in China were aware of the benefits of KC, there remain substantial barriers to its routine use in practice. Education for both staff and parents is necessary, as is the provision of appropriate facilities and policies to support parents in providing this evidence-based intervention.

Factors that have an impact on knowledge, attitude and practice related to kangaroo care: National survey study among neonatal nurses.

AIMS AND OBJECTIVES: To explore factors that impact nurses' knowledge, perceptions and practice related to kangaroo care in neonatal intensive care units in China. BACKGROUND: It is recognised extensively that kangaroo care is an effective intervention for improving the outcomes of preterm infants and has been recommended as a routine practice for neonatal care. However, this practice is uncommon in China and little is known about neonatal nurses' knowledge and attitude. DESIGN: A descriptive cross-sectional survey. METHODS: An online questionnaire was completed by 830 neonatal nurses. Data were analysed using measures of central tendency, dispersion, ANOVA, t tests and the general linear model. RESULTS: A total of 48.2% of the participants reported practicing kangaroo care. Range of score for each scale was knowledge 0-16 (M = 9.62), perceptions 28-103 (M = 79.99), barriers 17-85 (M = 65.40) and practice 11-55 (M = 34.44). Experience in using kangaroo care was a primary factor for the scores of four scales. Particularly, experienced nurses had higher level of knowledge and perceived less barriers. Respondents' role in neonatal intensive care units considerably influenced perceptions and practice level. Nurses' highest education and neonatal intensive care unit level also influenced the knowledge and practice score, separately. A major barrier to practice was the reluctance of physicians, nurses and parents. CONCLUSION: Neonatal nurses' knowledge, attitude and practice levels related to kangaroo care were relatively low. Results suggested that leadership and knowledgeable practitioners could initiate education and clinical training to improve nurses' knowledge and awareness on the efficacy of kangaroo care. Moreover, initiatives and behaviours would be enhanced following increased knowledge and perceived value. Such barriers as the reluctance of medical staff may likewise be lowered or removed after experiencing kangaroo care. RELEVANCE TO CLINICAL PRACTICE: Neonatal nurses' knowledge and belief need to be improved for optimal practice of kangaroo care. Organisational support and clear guidelines are also in need for successful kangaroo care.