Effects of Relaxation-Focused Nursing Care in Women in Preterm Labor.

BACKGROUND: Threatened preterm labor is a common problem that causes women to be hospitalized. During this period, physical problems such as a decrease in muscle functions, edema and pain, and psychological problems such as anxiety and stress may develop. OBJECTIVE: This study aimed to investigate the effect of relaxation-focused nursing care state anxiety, cortisol, contraction severity, nursing care satisfaction, knowledge, and birth weeks on threatened preterm labor. METHOD: This study was a pre-post single-blind randomized controlled trial. The study was conducted with 66 women in the threatened preterm labor process, 33 in the intervention group and 33 in the control group. The intervention group received relaxation-focused nursing care, which comprises a 2-day program in four stages. The data were collected before and after the relaxation-focused nursing care, and after the birth. RESULTS: In the intervention group, state anxiety, cortisol level, and contraction severity were lower than those in the control group (p < .05). The knowledge level about threatened preterm labor, satisfaction from nursing care, and birth weeks were higher in the intervention group (p < .05). CONCLUSION: Relaxation-focused nursing care was found to reduce the state anxiety in women, improve the knowledge level about threatened preterm labor and birth weeks, and decrease the level of cortisol. Therefore, it is recommended to use relaxation-focused nursing care in threatened preterm labor.

Extremely premature birth, informed written consent, and the Greek ideal of sophrosyne.

Most extremely premature infants die in the intensive care unit or suffer significant neurologic impairment. Many therapies result in unhealthy consequences, and the emotional and financial turmoil for families warrant reappraisal of our motives. Shared decision-making and informed consent in preference-sensitive conditions imply the family: (a) understands the medical problem, (b) grasps the risks and benefits of each therapy, (c) has the opportunity to ask questions and reflect upon options, (d) knows their values and preferences are understood, and (e) accepts or declines therapies without judgment or penalty. Mandatory resuscitation of premature infants or inflexible palliative comfort care policies are inconsistent with the principles of informed consent and shared decision-making. Physicians should emulate the Greek ideal of sophrosyne-virtue inherent to balance, reasoned limits, freedom but restraint, and humility. Informed choice is fundamental to liberty; evidence-based periviability guidelines and decision aids bolstered by structured informed consent ensure process integrity.

Neonatal nurses' response to a hypothetical premature birth situation: What if it was my baby?

BACKGROUND:: Evolving technology and scientific advancement have increased the chances of survival of the extremely premature baby; however, such survival can be associated with some severe long-term morbidities. RESEARCH QUESTION:: The research investigates the caregiving and ethical dilemmas faced by neonatal nurses when caring for extremely premature babies (defined as ≤24 weeks' gestation). This article explores the issues arising for neonatal nurses when they considered the philosophical question of 'what if it was me and my baby', or what they believed they would do in the hypothetical situation of going into premature labour and delivering an extremely premature baby. PARTICIPANTS:: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. ETHICAL CONSIDERATIONS:: Relevant ethical approvals have been obtained by the researchers. FINDINGS:: A qualitative approach was used to analyse the data. The theme 'imagined futures' was generated which comprised three sub-themes: 'choice is important', 'not subjecting their own baby to treatment' and 'nurses and outcome predictions'. The results offer an important and unique understanding into the perceptions of nursing staff who care for extremely premature babies and their family, see them go home and witness their evolving outcomes. The results show that previous clinical and personal experiences led the nurses in the study to choose to have the belief that if in a similar situation, they would choose not to have their own baby resuscitated and subjected to the very treatment that they provide to other babies. CONCLUSION:: The theme 'imagined futures' offers an overall understanding of how neonatal nurses imagine what the life of the extremely premature baby and his or her family will be like after discharge from neonatal intensive care. The nurses' past experience has led them to believe that they would not want this life for themselves and their baby, if they were to deliver at 24 weeks' gestation or less.

Aplicabilidade das ações preconizadas pelo método canguru / Aplicabilidad compartir recomendado por método canguro / Share applicability recommended by kangaroo method

Objective: To identify the prevalence of the actions recommended by the MC in practice care for preterm newborns and/or low birth weight, by the nursing staff of the intensive neonatal care which is state reference for the MC. Method: Quantitative descriptive research, conducted through by applying a structured questionnaire with 37 mid-level nursing professionals in the Neonatal Intensive Care Unit, from February to April 2014. Results: Welcoming, encouraging touch, breastfeeding and environmental control are the actions performed by the team, each having 97% of practical applicability, and actions less executed, the diaper in the lateral position (83%), and the bathroom wrapped in swaddling clothes (58%). Conclusion: This team performs the care of humanized actions as recommended by the MC, and understands the importance of care for the development of newborns. There is the need of permanent education process in service.

Objetivo: Identificar a prevalência das ações preconizadas pelo MC na prática de cuidados ao recém-nascido pré-termo e/ou baixo peso, pela equipe de enfermagem de uma unidade de terapia intensiva neonatal que é referência estadual para o MC. Método: Pesquisa descritiva quantitativa, realizada através da aplicação de um questionário estruturado com 37 profissionais de enfermagem de nível médio, em Unidade de Terapia Intensiva Neonatal, de fevereiro a abril de 2014. Resultados: O acolhimento, o incentivo ao toque, o aleitamento materno e o controle ambiental são as ações mais executadas pela equipe, apresentando cada uma 97% de aplicabilidade prática, e como ações menos executadas, a troca de fralda em decúbito lateral (83%), e o banho envolto em cueiros (58%). Conclusão: Esta equipe realiza as ações humanizadas de cuidado conforme preconizados pelo MC, e compreende a importância desses cuidados para o desenvolvimento infantil dos recém-nascidos. Existe necessidade de processo de educação permanente em serviço.

Objetivo: Identificar la prevalencia de las acciones recomendadas por el MC en los cuidados del recién nacido prematuro y/o bajo peso de nacimiento, por el equipo de enfermería de una unidad de terapia intensiva prenatal, referencia estatal para el MC. Método: Estudio descriptivo cuantitativo, llevado a cabo mediante la aplicación de un cuestionario estructurado con 37 profesionales de enfermería de nivel técnico, en una Unidad de Terapia Intensiva Neonatal, de febrero a abril del 2014. Resultados: La acogida, el incentivo al roce, la lactancia materna y el control ambiental son las acciones más empleadas por el equipo, presentando cada una de ellas el 97% de aplicabilidad práctica. Por otro lado, hay acciones menos ejecutadas, como el cambio de pañales en decúbito lateral (83%) y el baño envuelto en paños (58%). Conclusión: Este equipa realiza las acciones humanizadas del cuidado de acuerdo con las recomendaciones del MC y comprende la importancia de estos cuidados para el desarrollo infantil de los recién nacidos. Existe la necesidad del proceso de educación permanente en servicio.

Experience of mothers of premature babies from birth to discharge: notes of field journals. / Vivência de mães de bebês prematuros do nascimento a alta: notas de diários de campo.

OBJECTIVE: To describe the maternal care process mediated by nurses during the period of hospitalisation and discharge of premature babies. METHOD: This is a descriptive, exploratory, and qualitative study, using the methodological framework of convergent care research, with seven mothers of premature babies admitted to a hospital in southern Brazil, from October to December 2011. Data from the mother's daily journals were submitted to content analysis. RESULTS: Analysis resulted in three categories portraying the path and the adaptation process of the mothers to the care of their premature babies, from preparation for discharge to overcoming her fears and insecurities concerning home care. CONCLUSION: It is important for mothers in this initial and critical stage of hospitalisation of preterm infants to receive assistance, especially in terms of receptiveness and ongoing care, as a strategy to promote maternal autonomy and home adaptation.

Implications of Preterm Birth for Maternal Mental Health and Infant Development.

Preterm birth remains a major contributor to infant mortality and morbidity including neurodevelopmental delay and childhood disability. Mothers experiencing a preterm birth are at risk for maternal mental health issues, inclusive of depression and posttraumatic stress disorder (PTSD), which may affect mother-infant attachment and infant development. Depression and PTSD, frequently comorbid, following preterm birth and relationships between these symptoms, maternal-infant attachment, and infant development are reviewed. Assessments and interventions potentially capable of benefitting mother and infant are noted. The need for healthcare professionals to intervene prenatally and at postpartum is significant as maternal distress remains one of the most consistent factors related to infant development. Although depression has received much attention in the literature as a risk factor for preterm birth, impaired attachment, and delayed infant development, some of the consequences of PTSD have only recently gained research attention. A few studies support the role of PTSD in impaired maternal-infant attachment; yet, it is unclear whether preterm infants of mothers experiencing symptoms of PTSD following birth are at a higher risk for motor development problems. Because early mother-infant interactions are influenced by prematurity as well as maternal mental health, consideration for home interventions that stimulate infant development and encourage mother-infant relationships concurrently are important. Directed interventions may be beneficial for infant development and aid in strengthening the mother-infant relationship, potentially reducing depression and PTSD symptoms in the mother.

Vivência de mães de bebês prematuros do nascimento a alta: notas de diários de campo / Experiencia de madres de bebés prematuros del nacimiento al alta: notas de diarios de campo / Experience of mothers of premature babies from birth to discharge: notes of field journals

RESUMO Objetivo Descrever o processo de construção do cuidar materno mediado pelo enfermeiro durante o período de internação e alta de bebês prematuros. Método Estudo descritivo, exploratório e qualitativo utilizando o referencial metodológico da pesquisa convergente assistencial, envolvendo sete mães de prematuros internados em um hospital do Sul do Brasil, no período de outubro a dezembro de 2011. Os dados oriundos dos registros maternos em diários foram submetidos à análise de conteúdo. Resultados Da análise emergiram três categorias que retratam a trajetória e o processo de adaptação da mãe aos cuidados de seu bebê prematuro, desde a preparação para a alta, até a superação de seus medos e insegurança para o cuidar no domicílio. Conclusão Conclui-se pela importância de assistir adequadamente à mãe nesta fase inicial e crítica do bebê hospitalizado, enfatizando o acolhimento e a orientação permanente para o cuidado como estratégias promotoras da autonomia materna e da adaptação domiciliar.

RESUMEN Objetivo Describir el proceso de construcción del cuidado materno mediado por el enfermero, durante la hospitalización y la alta de bebés prematuros. Método Estudio descriptivo, exploratorio y cualitativo, utilizando el marco metodológico de la investigación convergente asistencial, con siete madres de prematuros hospitalizados en un hospital en el sur de Brasil, entre octubre y diciembre 2011. Los datos originarios de los registros maternos en diarios fueron sometidos al análisis de contenido. Resultados El análisis originó tres categorías que retratan la trayectoria y el proceso de adaptación de la madre al cuidado de su bebé prematuro, desde la preparación para el alta hasta la superación de sus miedos e inseguridad para el cuidado domiciliario. Conclusión se concluye que es importante atender adecuadamente a la madre en esta fase temprana y crítica del bebé hospitalizado, subrayando la acogida y la orientación permanente para el cuidado, como estrategias promotoras de autonomía materna y adaptación domiciliaria.

ABSTRACT Objective To describe the maternal care process mediated by nurses during the period of hospitalisation and discharge of premature babies. Method This is a descriptive, exploratory, and qualitative study, using the methodological framework of convergent care research, with seven mothers of premature babies admitted to a hospital in southern Brazil, from October to December 2011. Data from the mother's daily journals were submitted to content analysis. Results Analysis resulted in three categories portraying the path and the adaptation process of the mothers to the care of their premature babies, from preparation for discharge to overcoming her fears and insecurities concerning home care. Conclusion It is important for mothers in this initial and critical stage of hospitalisation of preterm infants to receive assistance, especially in terms of receptiveness and ongoing care, as a strategy to promote maternal autonomy and home adaptation.

Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi.

Objectives Malawi is estimated to have one of the highest preterm birth rates in the world. However, care of preterm infants at facility level in Malawi has not been explored. We aimed to explore the views of health stakeholders about the care of preterm infants in health facilities and the existence of any policy protocol documents guiding the delivery of care to these infants. Methods We conducted 16 in-depth interviews with health stakeholders (11 service providers and 5 policy makers) using an interview guide and asked for any existing policy protocol documents guiding care for preterm infants in the health facilities in Malawi. The collected documents were reviewed and all the interviews were digitally recorded, transcribed and translated. All data were analysed using content analysis approach. Results We identified four policy protocol documents and out of these, one had detailed information explaining the care of preterm infants. Policy makers reported that policy protocol documents to guide care for preterm infants were available in the health facilities but majority (63.6 %) of the service providers lacked knowledge about the existence of these documents. Health stakeholders reported several challenges in caring for preterm infants including lack of trained staff in preterm infant care, antibiotics, space, supervision and poor referral system. Conclusions Our study highlights that improving health care service provider knowledge of preterm infant care is an integral part in preterm child birth. Our findings suggests that policy makers and health decision makers should retain those trained in preterm new born care in the health facility's preterm unit.

High-Resolution Metabolomics: Review of the Field and Implications for Nursing Science and the Study of Preterm Birth.

Most complex health conditions do not have a single etiology but rather develop from exposure to multiple risk factors that interact to influence individual susceptibility. In this review, we discuss the emerging field of metabolomics as a means by which metabolic pathways underlying a disease etiology can be exposed and specific metabolites can be identified and linked, ultimately providing biomarkers for early detection of disease onset and new strategies for intervention. We present the theoretical foundation of metabolomics research, the current methods employed in its conduct, and the overlap of metabolomics research with other "omic" approaches. As an exemplar, we discuss the potential of metabolomics research in the context of deciphering the complex interactions of the maternal-fetal exposures that underlie the risk of preterm birth, a condition that accounts for substantial portions of infant morbidity and mortality and whose etiology and pathophysiology remain incompletely defined. We conclude by providing strategies for including metabolomics research in future nursing studies for the advancement of nursing science.

Extremely premature birth and the choice of neonatal intensive care versus palliative comfort care: an 18-year single-center experience.

OBJECTIVE: Review all live births 22 0/7 through 26 6/7 weeks gestation born 1996 through 2013 at our institution to describe the decision process and immediate outcomes of palliative comfort care (PCC) versus neonatal intensive care (NICU) and whether any significant family complaints or quality assurance concerns arose. STUDY DESIGN: Retrospective chart review, physician and ethicist interview process and database review focused upon our established periviability counseling guidelines that are directive of PCC at 22 weeks gestation and NICU at 26 weeks but supportive of informed family choice of either option at 23, 24 and 25 weeks. RESULT: At 22 weeks--all 54 infants had PCC; at 23 weeks--29/78 (37%) chose NICU care, 6/29 (21%) infants survived; at 24 weeks--79/108 (73%) chose NICU care, 47/79 (59%) survived; at 25 weeks--147/153 (96%) chose NICU care, 115/147 (78%) survived; and at 26 weeks--all infants had NICU care, 176/203 (87%) survived. Over 18 years and 606 births, we identified only three significant concerns from families and/or physicians that required formal review. CONCLUSION: Most pregnant women and families choose NICU care for their extremely premature infant, but if given the option via shared decision making, a significant proportion will choose PCC at gestational ages that some NICUs mandate resuscitation. We support a reasoned dialogue and bioethical framework that recognizes human values to be irreducibly diverse, sometimes conflicting, and ultimately incommensurable--value pluralism. Respectful shared decision making requires thoughtful and compassionate flexibility, nuanced and individualized suggestions for PCC or NICU and the reduction of hierarchical directives from physicians to families. We continue to advocate and rely upon informed family preference between 23 and 25 weeks gestation in our updated 2015 periviability guidelines.

Vivências de mães de bebês prematuros no contexto da espiritualidade / Experiencias de las madres de niños prematuros en el contexto de la espiritualidad / Experiences of mothers of premature infants in the context of spirituality

Objective: to understand how mothers of preterm infants perceive the relationship between health and spirituality and its benefits on the severity health picture of their children. Method: qualitative research with 32 mothers whose children were admitted to a Neonatal Intensive Care Unit of a maternity hospital in Natal/RN/Brazil. There were semi-structured interviews and focus groups between February and May 2012, after a favorable opinion from the Ethics Committee in Research of UFRN and CAAE 0336.0.051.000.1. Data analysis was thematic analysis. Results: the relationship between health and spirituality was unveiled in the study as a positive phenomenon helping mothers avoiding discouragement and keeping hope in restoring the health of the child in the Intensive Care Unit. Conclusion: it is suggested after the results, actions and projects that promote soft technologies, aiming at promoting and completeness in health care.

Objetivo: compreender como mães de bebês prematuros percebem a relação entre saúde e espiritualidade e seus benefícios diante da gravidade do quadro de saúde de seus filhos. Método: pesquisa qualitativa realizada com 32 mães, cujos filhos estavam internados em uma Unidade de Terapia Intensiva Neonatal de uma Maternidade Escola em Natal/RN/Brasil. Realizaram-se entrevistas semiestruturadas em grupos focaisno período de fevereiro a maio de 2012. A pesquisa teve parecer favorável do Comitê de Ética em Pesquisada UFRN com CAAE 0336.0.051.000.1. Para análise dos dados, optou-se pela técnica de análise temática. Resultados: a relação entre saúde e espiritualidade desvelou-se no estudo como fenômeno positivo que auxilia as mães a evitar o desânimo e a manter a esperança no restabelecimento da saúde do filho na Unidade de Terapia Intensiva. Conclusão: após os resultados, sugere-se ações e projetos que promovam tecnologias leves, visando promoção e integralidade do cuidar em saúde.

Objetivo: entender cómo las madres de bebés prematuros perciben la relación entre la salud y la espiritualidad y los beneficios de la gravedad de la salud de sus hijos. Método: investigación cualitativa con 32 madres, cuyos niños fueron ingresados en una Unidad de Cuidados Intensivos Neonatal de una Maternidad Escuela en Natal/RN/Brasil. Hubo entrevistas semi-estructuradas y grupos focales entre febrero y mayo de2012, luego de la aceptación favorable del Comité de Ética en Investigación de UFRN y CAAE0336.0.051.000.1 Para análisis de datos se eligió técnica de análisis temática. Resultados: la relación entre la salud y la espiritualidad dio a conocer en el estudio como un fenómeno positivo ayudando a las madres evitar el desánimo y mantener la esperanza en la restauración de la salud del niño en la Unidad de Cuidados Intensivos. Conclusión: se sugiere después de los resultados, las acciones y proyectos que promuevan tecnologías leves, con miras a la promoción y la integridad en la atención de la salud.

Método canguru: percepções das mães que vivenciam a segunda etapa / Método canguro: percepciones de las madres que experimentan la segunda etapa / Kangaroo method: perceptions of mothers who experience the second stage

Objective: Understanding the perceptions of mothers of newborn preterm and/or low birth weight about the second stage of Kangaroo method. Method: This is a descriptive exploratory research of a qualitative approach performed at a teaching hospital in Southern Brazil, through semi-structured interviews and observation with five mothers who were in the neonatal unit accompanying their children. For data analysis there was used the content analysis. Results: Three categories emerged: "The importance ofearly", "Dilemmas and difficulties in carrying out the Method" and the "Kangaroo method facilitating the care of your child". Conclusions: The experience of the second stage allows overcoming the negative feelings that surfaced with preterm birth and promotes the empowerment of mothers in relation to caring for their children. However, it is necessary that the nursing staff develop different skills to the Kangaroo Method be effectively implemented in practice.

Objetivo: Conhecer as percepções das mães de recém-nascidos pré-termo e/ou baixo peso sobre a segunda etapa do Método Canguru. Método: Trata-se de uma pesquisa exploratório descritiva, de abordagem qualitativa realizada em um hospital escola do sul do Brasil, através de entrevista semiestruturada e observação com cinco mães que se encontravam na unidade neonatal acompanhando seus filhos. Para a análise dos dados utilizou-se a análise de conteúdo. Resultados: Emergiram três categorias: “A importância do início”, “Dilemas e dificuldades na realização do Método” e o “Método Canguru facilitando o cuidado ao seu filho”. Conclusões: A vivência da segunda etapa possibilita a superação dos sentimentos negativos que afloraram com o nascimento prematuro e promove o empoderamento das mães em relação ao cuidado com seu filho, entretanto é necessário que a equipe de enfermagem desenvolva diferentes habilidades para que o Método Canguru seja implementado efetivamente na prática.

Objetivo: Comprender las percepciones de las madres de los recién nacidos prematuros y/o de bajo peso al nacer acerca de la segunda etapa del Método Canguro. Método: Un estudio exploratorio descriptivo, de enfoque cualitativo realizado en un hospital universitario en el Sur de Brasil, a través de entrevistas semiestructuradas y observación con cinco madres en la unidad neonatal. Para el análisis de los datos se utilizó el análisis de contenido. Resultados: Tres categorías surgieron: "La importancia de la primera", "Dilemas y dificultades para llevar a cabo el Método" y “El Método Canguro para facilitar el cuidado de su hijo".Conclusiones: La experiencia de la segunda etapa se permitía superar los sentimientos negativos que surgieron con el parto prematuro y promueve el empoderamiento de las madres en relación con el cuidado a su hijo. El personal de enfermería debe desarrollar habilidades para que el Método sea efectivamente aplicado en la práctica.

Madres descubriendo el amor incondicional en el proceso adaptativo de hospitalización de su bebé prematuro / Mothers discovering the unconditional love in the adaptive process of the hospitalization of your premature infant

Introducción: El nacimiento prematuro tiene un impacto social y emocional para la familia, por lo tanto, enfermería tiene el reto de indagar y profundizar sobre las diversas experiencias; para proponer intervenciones que favorezcan el desempeño del rol materno. Objetivo: Describir los resultados de un metaestudio sobre la adquisición del rol materno de la madre con un recién nacido prematuro hospitalizado. Materiales y Métodos: El metaestudio, involucra 3 fases analíticas: análisis metadatos, meta-método, meta-teoría, consideradas a la luz del contexto histórico, sociocultural y disciplinar. La búsqueda se realizó en: CINAHL, Medline, PsycINFO, Dissertation Abstracts. Resultados: Se incluyeron 26 investigaciones de 13 países publicadas en inglés, portugués y español (durante los años 2001-2013). Las expresiones categóricas que emergen de estas investigaciones, son: pérdida de autocontrol; experimentando dolor; buscando significado a los eventos; adaptándose a la situación; adquiriendo el rol materno y descubriendo el amor incondicional. Discusión: El metaestudio permitió el análisis crítico de la información, orientando la investigación dentro de un contexto de patrones sistemáticos, con la construcción de una alternativa de cambio del enfoque tradicional de pérdida y sufrimiento al del redescubrimiento desde la visión positiva y transformativa. Conclusiones: Reconocer la carga emocional de las madres de recién nacido prematuro obliga al equipo de salud a intervenir e idear estrategias de apoyo, para hacer menos doloroso el proceso de hospitalización de sus hijos. Por ello el cuidado humanizado en la unidad neonatal, debe centrar sus acciones en un cuidado individual, singular, en la integralidad y respeto por la vida.

Introduction: Preterm birth has a social and emotional impact on the family, therefore, nursing is challenged to explore and elaborate on the various experiences; to propose interventions that promote maternal role performance. Objective: To describe the results of a meta-study of the experiences of mothers in the NICU. Materials and Methods: The meta-study involves three analytical steps: analysis metadata, meta-method, meta-theory, considered in light of the historical, sociocultural and disciplinary context. The search was conducted in: CINAHL, Medline, PsycINFO, Dissertation Abstracts. Results: 26 studies from 13 countries published in English, Portuguese and Spanish (in the years 2001-2013) were included. Categorical expressions that emerge from this research are loss of self-control; experiencing pain; seeking meaning to events; adapting to the situation; acquiring the maternal role and finding unconditional love. Discussion: The meta-analysis allowed critical information to guide research in a context of systematic patterns, with the construction of an alternative approach to the traditional exchange of loss and suffering to the rediscovery from the positive and transformative vision. Conclusions: Recognizing the emotional burden of mothers of preterm infants requires the health care team to intervene and devise support strategies to make the process less painful hospitalization of their children. Therefore, humanized care in the NICU, should focus its actions in individual care, singular, in the integrity and respect for life.

Evidence-based practice to improve outcomes for late preterm infants.

Infants born between 34 weeks 0 days to 36 weeks 6 days gestation have been identified as late preterm infants (LPIs) and account for 70% of preterm births and 9% of all births. The rise in elective deliveries in the past decade is believed to have contributed to the number of late preterm births. An interprofessional team including labor and delivery, neonatal intensive care, and postpartum care providers collaborated to address this issue at an urban academic medical center.

Incremental Hospital Costs Associated With Comorbidities of Prematurity.

PURPOSE: Preterm birth (PTB), defined as birth at a gestational age (GA) of less than 37 weeks, is associated with increased hospital costs. Lower GA at birth is negatively correlated with the presence of neonatal comorbidities, further increasing costs. This study evaluated incremental costs associated with comorbidities of PTB following spontaneous labor at 24-36 weeks. DESIGN: Birth records from January 2001 to December 2010 at the Medical University of South Carolina were screened to identify infants born at GA 23-37 weeks after uncomplicated singleton pregnancies and surviving to discharge. METHODOLOGY: Comorbidities of interest and incremental costs were analyzed with a partial least squares (PLS) regression model adjusted for comorbidities and GA. Incremental comorbidity-associated costs, as well as total costs, were estimated for infants of GA 24-36 weeks. RESULTS: A total of 4,292 delivery visit records were analyzed. Use of the PLS regression model eliminated issues of multicollinearity and allowed derivation of stable cost estimates. Incremental costs of comorbidities at a mean GA of 34 weeks ranged from $4,529 to $23,121, and exceeded $9,000 in 6 cases. Incremental costs rangedfrom a high of $41,161 for a GA 24-week infant with a comorbidity of retinopathy of prematurity requiring surgery (ROP4) to $3,683 for a GA 36-week infant with a comorbidity of convulsions. Incremental comorbidity costs are additive, so the costs for infants with multiple comorbidities could easily exceed the high of $41,161 seen with ROP4. CONCLUSIONS: The PLS regression model allowed derivation of stable cost estimates from multivariate and highly collinear data and can be used in future cost analyses. Using this data set, predicted costs of all comorbidities, as well as total costs, negatively correlated with GA at birth.

Perceptions and experiences of community members on caring for preterm newborns in rural Mangochi, Malawi: a qualitative study.

BACKGROUND: The number of preterm birth is increasing worldwide, especially in low income countries. Malawi has the highest incidence of preterm birth in the world, currently estimated at 18.1 percent. The aim of this study was to explore the perceived causes of preterm birth, care practices for preterm newborn babies and challenges associated with preterm birth among community members in Mangochi District, southern Malawi. METHODS: We conducted 14 focus group discussions with the following groups of participants: mothers (n = 4), fathers (n = 6) and grandmothers (n = 4) for 110 participants. We conducted 20 IDIs with mothers to preterm newborns (n = 10), TBAs (n = 6) and traditional healers (n = 4). A discussion guide was used to facilitate the focus group and in-depth interview sessions. Data collection took place between October 2012 and January 2013. We used content analysis to analyze data. RESULTS: Participants mentioned a number of perceptions of preterm birth and these included young and old maternal age, heredity, sexual impurity and maternal illness during pregnancy. Provision of warmth was the most commonly reported component of care for preterm newborns. Participants reported several challenges to caring for preterm newborns such as lack of knowledge on how to provide care, poverty, and the high time burden of care leading to neglect of household, farming and business duties. Women had the main responsibility for caring for preterm newborns. CONCLUSION: In this community, the reported poor care practices for preterm newborns were associated with poverty and lack of knowledge of how to properly care for these babies at home. Action is needed to address the current care practices for preterm babies among the community members.

Lactação em mulheres com bebês prematuros: reconstruindo a assistência de enfermagem / La lactación em mujeres con bebes prematuros: reconstruyendo la asistencia de enfermería / The lactation in women with premature babies: reconstructing the nursing care

Objective: understanding the strategies used by nurses in the Neonatal Intensive Care Unit of HUAP (University Hospital Antonio Pedro) in the clinical management of breastfeeding with mothers of newborn preterm. Method: a descriptive, exploratory and qualitative survey approved by the Ethics Committee in Research of the Faculty of Medicine of HUAP under Protocol: 0199.0.258.000-11, enabling the beginning of data collection conducted between June and August 2012 through semi-structured interviews with twenty-two (22) nurses working in that unit. Results: there was an insufficient knowledge and skills of the subjects to properly manage situations that may hinder a successful breastfeeding. Nurses must act as educators, responsible for managing the care, being also able defining strategies for success there in the process of breastfeeding. Conclusion: thus, the educational process of the nurse is essential for the promotion, protection and support of breastfeeding.

Objetivo: compreender as estratégias utilizadas pelos enfermeiros na Unidade de Terapia Intensiva Neonatal do HUAP, no manejo clínico da amamentação junto às mães de recém-nascidos pré-termo. Método: pesquisa descritiva, exploratória, qualitativa, aprovada pelo Comitê de Ética em Pesquisa da Faculdade de Medicina do HUAP sob o protocolo: 0199.0.258.000-11, viabilizando o início da coleta de dados realizada entre junho e agosto de 2012, mediante entrevista semiestruturada junto a vinte e dois (22) enfermeiros atuantes naquela Unidade. Resultados: verificou-se insuficiência de conhecimento e habilidade dos sujeitos para manejar adequadamente as situações que podem obstaculizar a amamentação bem sucedida. Os enfermeiros devem atuar como educadores, responsáveis pelo gerenciamento do cuidado, sendo também capazes de definir estratégias para que haja sucesso no processo de aleitamento materno. Conclusão: assim, o processo educativo do enfermeiro é essencial para a promoção, proteção e apoio do aleitamento materno.

Objetivo: comprender las estrategias utilizadas por las enfermeras en la Unidad de Cuidados Intensivos Neonatal de HUAP (Hospital Universitario Antonio Pedro) en el manejo clínico de la lactancia junto a las madres de recién nacidos prematuros. Método: es una investigación descriptiva, exploratoria y cualitativa, aprobada por el Comité de Ética en Investigación de la Facultad de Medicina HUAP, en virtud del protocolo: 0199.0.258.000-11, lo que permite el inicio de la recogida de datos realizada entre junio y agosto de 2012, a través de entrevistas semi-estructuradas con veintidós (22) enfermeras que trabajan en esa unidad. Resultados: había una suficiencia de conocimientos y capacidad del sujeto para manejar adecuadamente las situaciones que pueden dificultar la lactancia materna exitosa. Las enfermeras deben actuar como educadores, responsables por la gestión de la atención, siendo además capaces de definir estrategias para el éxito allí en el proceso de la lactancia materna. Conclusión: por lo tanto, el proceso educativo de la enfermera es fundamental para la promoción, protección y apoyo de la lactancia materna.

High environmental temperature and preterm birth: a review of the evidence.

OBJECTIVE: to examine the evidence in relation to preterm birth and high environmental temperature. BACKGROUND: this review was conducted against a background of global warming and an escalation in the frequency and severity of hot weather together with a rising preterm birth rate. METHODS: electronic health databases such as: SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for research articles, that examined preterm birth and high environmental temperature. Further searches were based on the reference lists of located articles. Keywords included a search term for preterm birth (preterm birth, preterm, premature, <37 weeks, gestation) and a search term for hot weather (heatwaves, heat-waves, global warming, climate change, extreme heat, hot weather, high temperature, ambient temperature). A total of 159 papers were retrieved in this way. Of these publications, eight met inclusion criteria. DATA EXTRACTION: data were extracted and organised under the following headings: study design; dataset and sample; gestational age and effect of environmental heat on preterm birth. Critical Appraisal Skills Programme (CASP) guidelines were used to appraise study quality. FINDINGS: in this review, the weight of evidence supported an association between high environmental temperature and preterm birth. However, the degree of association varied considerably, and it is not clear what factors influence this relationship. Differing definitions of preterm birth may also add to lack of clarity. KEY CONCLUSIONS: preterm birth is an increasingly common and debilitating condition that affects a substantial portion of infants. Rates appear to be linked to high environmental temperature, and more especially heat stress, which may be experienced during extreme heat or following a sudden rise in temperature. When this happens, the body may be unable to adapt quickly to the change. As global warming continues, the incidence of high environmental temperature and dramatic temperature changes are also increasing. This situation makes it important that research effort is directed to understanding the degree of association and the mechanism by which high temperature and temperature increases impact on preterm birth. Research is also warranted into the development of more effective cooling practices to ameliorate the effects of heat stress. In the meantime, it is important that pregnant women are advised to take special precautions to avoid heat stress and to keep cool when there are sudden increases in temperature.

Early term birth: understanding the health risks to infants.

Early term birth, which occurs at 37 to 38 weeks gestation, is often elective and can carry significant health risks to infants, including short-term and long-term health outcomes. Nurses and other health care providers involved in the care of pregnant women and infants need to be aware of these infants' physiologic vulnerability and potential short- term and long-term care requirements. Nurses can educate patients and raise awareness of the risks associated with early term birth.