Mothers' Decision Making Concerning Safe Sleep for Preterm Infants: What Are the Influencing Factors?

BACKGROUND: Parental decisions regarding infant sleep practices vary widely, resulting in a lack of adherence to the American Academy of Pediatrics safe sleep recommendations (SSR) and consequently an increased risk of sudden infant death syndrome (SIDS). Preterm infants are among those at a highest risk for SIDS, yet few studies focus on parental decision-making surrounding sleep practices for preterm infants. PURPOSE: The purpose of this study was to identify factors influencing decisions concerning infant sleep practices of mothers of preterm infants. METHODS: This study used a mixed-methods design. Recruitment was through social media messaging by 2 parent support organizations. An online survey was used to assess factors influencing mothers' decisions regarding sleep practices for preterm infants. FINDINGS/RESULTS: Survey participants (n = 98) were from across the United States. Mothers of preterm infants (mean gestational age at birth = 29.42 weeks) most often reported positioning infants on their back to sleep (92.3%) and a low (15.4%) use of a pacifier at sleep time. Three themes emerged for the decisions made: adherence to SSR; nonadherence to SSR; and infant-guided decisions. Regardless of the decision, mothers indicated that anxiety over the infant's well-being resulted in a need for sleep practices that facilitated close monitoring of the infant. IMPLICATIONS FOR PRACTICE AND RESEARCH: The findings of this study indicate the need for understanding the underlying anxiety preventing mothers from adhering to SSR despite knowing them, along with tailoring infant sleep messaging and education to improve safety of sleep practices for preterm infants. Research is needed to examine decision making in more diverse populations.

Nivolumab plus ipilimumab, with or without enzalutamide, in AR-V7-expressing metastatic castration-resistant prostate cancer: A phase-2 nonrandomized clinical trial.

BACKGROUND: AR-V7-positive metastatic prostate cancer is a lethal phenotype with few treatment options and poor survival. METHODS: The two-cohort nonrandomized Phase 2 study of combined immune checkpoint blockade for AR-V7-expressing metastatic castration-resistant prostate cancer (STARVE-PC) evaluated nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg), without (Cohort 1) or with (Cohort 2) the anti-androgen enzalutamide. Co-primary endpoints were safety and prostate-specific antigen (PSA) response rate. Secondary endpoints included time-to-PSA-progression-free survival (PSA-PFS), time-to-clinical/radiographic-PFS, objective response rate (ORR), PFS lasting greater than 24 weeks, and overall survival (OS). RESULTS: Thirty patients were treated with ipilimumab plus nivolumab (N = 15, Cohort 1, previously reported), or ipilimumab plus nivolumab and enzalutamide (N = 15, Cohort 2) in patients previously progressing on enzalutamide monotherapy. PSA response rate was 2/15 (13%) in cohort 1 and 0/15 in cohort 2, ORR was 2/8 (25%) in Cohort 1 and 0/9 in Cohort 2 in those with measureable disease, median PSA-PFS was 3.0 (95% confidence interval [CI]: 2.1-NR) in cohort 1 and 2.7 (95% CI: 2.1-5.9) months in cohort 2, and median PFS was 3.7 (95% CI: 2.8-7.5) in cohort 1 and 2.9 (95% CI: 1.3-5.8) months in cohort 2. Three of 15 patients in cohort 1 (20%, 95% CI: 7.1%-45.2%) and 4/15 patients (26.7%, 95% CI: 10.5%-52.4%) in cohort 2 achieved a durable PFS lasting greater than 24 weeks. Median OS was 8.2 (95% CI: 5.5-10.4) in cohort 1 and 14.2 (95% CI: 8.5-NA) months in cohort 2. Efficacy results were not statistically different between cohorts. Grade-3/4 adverse events occurred in 7/15 cohort 1 patients (46%) and 8/15 cohort 2 patients (53%). Combined cohort (N = 30) baseline alkaline phosphatase and cytokine analysis suggested improved OS for patients with lower alkaline phosphatase (hazards ratio [HR], 0.30; 95% CI: 0.11-0.82), lower circulating interleukin-7 (IL-7) (HR, 0.24; 95% Cl: 0.06-0.93) and IL-6 (HR, 0.13; 95% Cl: 0.03-0.52) levels, and higher circulating IL-17 (HR, 4.53; 95% CI: 1.47-13.93) levels. There was a trend towards improved outcomes in men with low sPD-L1 serum levels. CONCLUSION: Nivolumab plus ipilimumab demonstrated only modest activity in patients with AR-V7-expressing prostate cancer, and was not sufficient to justify further exploration in unselected patients. Stratification by baseline alkaline phosphatase and cytokines (IL-6, -7, and -17) may be prognostic for outcomes to immunotherapy.

Clinical Outcomes in Preterm Infants Following Institution of a Delayed Umbilical Cord Clamping Practice Change.

BACKGROUND: Evidence supports a significant reduction in the incidence of intraventricular hemorrhage (IVH) in preterm infants receiving delayed umbilical cord clamping (DCC). PURPOSE: This study evaluated clinical feasibility, efficacy, and safety outcomes in preterm infants (<36 weeks' gestational age) who received DCC following a practice change implementation intended to reduce the incidence of IVH. METHODS: Infants receiving DCC (45-60 seconds) were compared with a sample of infants receiving immediate umbilical cord clamping (<15 seconds) in a retrospective chart review (N = 354). The primary outcome measure was the prevalence of IVH. Secondary safety outcome measures of 1- and 5-minute Apgar scores, axillary temperature on neonatal intensive care unit admission, and initial 24-hour bilirubin level were also evaluated. Gestational age was examined for its effect on outcomes. RESULTS: Although the small number of infants with IVH precluded the ability to detect statistical significance, our raw data suggest DCC is efficacious in reducing the risk for IVH. For infants 29 or less weeks' gestational age, admission axillary temperature was significantly higher in those who received DCC. No differences were found in 1- and 5-minute Apgar scores, 24-hour bilirubin level, or hematocrit level between the two groups. Infants more than 29 weeks' gestational age who received DCC had significantly higher 1-minute Apgar scores, temperature, and 24-hour bilirubin level. IMPLICATIONS FOR PRACTICE: Clinicians should advocate for the implementation of DCC as part of the resuscitative process for preterm neonates. IMPLICATIONS FOR RESEARCH: Future studies are needed to evaluate the effect of DCC on other clinical outcomes and to investigate umbilical cord milking as an alternative approach to DCC.

Caring about Preemies' Safe Sleep (CaPSS): An Educational Program to Improve Adherence to Safe Sleep Recommendations by Mothers of Preterm Infants.

Preterm infants born before 37 weeks' gestation die of sudden infant death syndrome (SIDS) at a rate more than double that of term infants. There is a need for SIDS prevention programs tailored to the specific needs of parents of high-risk infants. The purpose of this study was to pilot test an online educational module addressing SIDS risk-reduction recommendations (RRRs) for parents of preterm infants. This study was conducted in a 44-bed transitional care unit at a level IV NICU in the Midwest. A repeated-measures design was used. Two weeks before discharge, mothers completed a survey, addressing knowledge and plans for caring for their baby at home. Mothers then viewed the 5-section Caring about Preemies' Safe Sleep (CaPSS) education module and completed the postmodule evaluation. A discharge survey was completed 4 weeks postdischarge. Fifteen mothers, mean age 26.4 years, participated; 8 (53%) returned the postdischarge survey. Module evaluation rated clarity and completeness of information high. Mothers' ratings of SIDS knowledge were significantly higher after viewing the module (P = .000) and 4 weeks after discharge home (P = .012). Mothers found the use of a pacifier at sleep times to be new information and changed their plans for caring for their infant, with 28.6% of mothers always offering a pacifier before sleep after discharge compared with the 6.7% who had planned to do this before discharge. However, only 71% of infants slept in parents' room after discharge and only 41% were receiving at least some breast milk, which are not consistent with SIDS RRRs.

The History and State of Neonatal Nursing Quality Improvement Practice and Education.

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

Implementing a Systematic Process for Consistent Nursing Care in a NICU: A Quality Improvement Project.

AIM: The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. METHODS: A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. RESULTS: Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days. CONCLUSION: Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.

Adherence to Safe Sleep Recommendations by Families With Higher-order Multiples.

BACKGROUND: More than 95% of higher-order multiples are born preterm and more than 90% are low birth weight, making this group of infants especially vulnerable to sudden infant death syndrome (SIDS). Emerging evidence suggests that families with twins face challenges adhering to the American Academy of Pediatrics (AAP) recommendations to reduce SIDS risks. Adherence to the AAP recommendations in families with higher-order multiples has not been described. PURPOSE: This study describes SIDS risk reduction infant care practices for higher-order multiples during the first year of life. METHODS: Mothers caring for higher-order multiple-birth infants were recruited from an online support group. An online survey was used to assess infant care practices when the infants were first brought home from the hospital as well as at the time of the survey. RESULTS: Ten mothers of triplets and 4 mothers of quadruplets responded. Less than 80% of the mothers practiced "back to sleep" immediately postdischarge. Supine sleep positioning decreased over time, particularly during daytime naps. Only 50% of the infants shared the parents' bedroom and approximately 30% bed-shared with their siblings. Sleep-time pacifier use was low. IMPLICATIONS FOR PRACTICE: Safe sleep education must include specific questions regarding home sleeping arrangements, encouragement of breast milk feedings, supine positioning, and pacifier use at every sleep for higher-order multiple infants well before discharge in order for parents to plan a safe sleep environment at home. IMPLICATIONS FOR RESEARCH: Prospective studies to identify barriers and facilitators can inform future strategies supporting adherence to safe sleep practices for higher-order multiple infants.

A Password-Protected Web Site for Mothers Expressing Milk for Their Preterm Infants.

BACKGROUND: Research has demonstrated that breast milk significantly decreases morbidities that impact length of stay for preterm infants, but there is a need to test interventions to improve breastfeeding outcomes. Since many Americans are using technologies such as the Intranet and smartphones to find health information and manage health, a Web site was developed for mothers who provide breast milk for their preterm hospitalized infants. PURPOSE: This study examined the efficacy of a Web site for mothers to educate them about breast milk expression and assist them in monitoring their breast milk supply. METHODS: Quantitative and qualitative data were collected from mothers whose preterm infants were hospitalized in a level IV neonatal intensive care unit (NICU) or transitional care unit (TCU) in an urban academic medical center in the Midwest. RESULTS: Eighteen mothers participated in evaluation of the Web site. Thirteen mothers consistently logged on to the password-protected Web site (mean [standard deviation] = 13.3 [11.7]) times. Most participants, (69.2%), reported they used the breast milk educational information. Most mothers indicated that using the Web site log helped in tracking their pumping. These findings can be used to direct the design and development of web-based resources for mothers of preterm infants IMPLICATIONS FOR PRACTICE:: NICU and TCU staffs need to examine and establish approaches to actively involve mothers in monitoring the establishment and maintenance of an adequate supply of breast milk to improve neonatal health outcomes. IMPLICATIONS FOR RESEARCH: An electronic health application that incorporates the features identified in this study should be developed and tested.

Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes.

BACKGROUND: Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. PURPOSE: To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. METHODS: This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. FINDINGS: Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. IMPLICATIONS FOR PRACTICE: Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. IMPLICATIONS FOR RESEARCH: Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.

Safe Sleep Infant Care Practices Reported by Mothers of Twins.

BACKGROUND: The high prevalence of prematurity and low birth-weight places twin infants at increased risk for sudden unexpected infant death (SUID) and/or sudden infant death syndrome (SIDS). Risk for these SUID and SIDS is affected by a combination of nonmodifiable intrinsic risk factors and modifiable extrinsic stressors including infant care practices related to sleep. Although adherence to the full scope of American Academy of Pediatrics (AAP) 2011 recommendations is intended to decrease risk, these recommendations are aimed at singleton infants and may require tailoring for families with multiple infants. PURPOSE: The study describes infant care practices reported by mothers of twins in the first 6 months postpartum. METHODS: Mothers caring for twin infants (N = 35) were surveyed online both longitudinally (at 2, 8, 16, and 24 weeks after infant hospital discharge) and cross-sectionally. AAP recommendations (2011) guided survey content. RESULTS: The degree of adherence to AAP recommendations varied over time. For example, mothers of twins reported 100% adherence to placing twins supine for sleep initially, but many reported putting babies on their stomachs for naps as twins became older. Sharing a parent's bedroom decreased over time as did frequency of crib sharing. Fewer than half of mothers offered a pacifier most or all of the time for sleep. IMPLICATIONS FOR PRACTICE: Opportunities exist for development of an educational program geared specifically for postpartum parents of twins. IMPLICATIONS FOR RESEARCH: Barriers affecting adherence to AAP recommendations and effectiveness of educational programs addressing needs of this unique population need further exploration.

A phase I study of muscadine grape skin extract in men with biochemically recurrent prostate cancer: Safety, tolerability, and dose determination.

BACKGROUND: New therapies are being explored as therapeutic options for men with biochemically recurrent prostate cancer (BRPC) who wish to defer androgen deprivation therapy. MPX is pulverized muscadine grape (Vitis rotundifolia) skin that contains ellagic acid, quercetin, and resveratrol and demonstrates preclinical activity against prostate cancer cells in vitro. METHODS: In the phase I portion of this phase I/II study, non-metastatic BRPC patients were assigned to increasing doses of MPX (Muscadine Naturals. Inc., Clemmons, NC) in cohorts of two patients, with six patients at the highest dose, using a modified continual reassessment method. Initial dose selection was based on preclinical data showing the equivalent of 500 to 4,000 mg of MPX to be safe in mouse models. The primary endpoint was the recommended phase II dosing regimen. RESULTS: The cohort (n = 14, 71% Caucasian, 29% black) had a median follow-up of 19.2 (6.2-29.7) months, median age of 61 years, and median Gleason score of 7. Four patients had possibly related gastrointestinal symptoms, including grade 1 flatulence, grade 1 soft stools, and grade 1 eructation. No other related adverse events were reported and one patient reported improvement of chronic constipation. Six of 14 patients came off study for disease progression (five metastatic, one rising PSA) after exposure for a median of 15 months. One patient came off for myasthenia gravis that was unrelated to treatment. Seven patients remain on study. The lack of dose-limiting toxicities led to the selection of 4,000 mg/d as the highest dose for further study. Median within-patient PSADT increased by 5.3 months (non-significant, P = 0.17). No patients experienced a maintained decline in serum PSA from baseline. CONCLUSION: These data suggest that 4,000 mg of MPX is safe, and exploratory review of a lengthening in PSADT of a median of 5.3 months supports further exploration of MPX. Both low-dose (500 mg) and high-dose (4,000 mg) MPX are being further investigated in a randomized, multicenter, placebo-controlled, dose-evaluating phase II trial.

Neonatal nurses' beliefs, knowledge, and practices in relation to sudden infant death syndrome risk-reduction recommendations.

BACKGROUND: Sudden infant death syndrome (SIDS) remains the third leading cause of infant death in the United States and the leading cause of death beyond 1 month of age. In 2011, the American Academy of Pediatrics (AAP) released the newest SIDS risk-reduction recommendations, which address healthcare providers in neonatal intensive care units (NICUs). Little is known about neonatal nurses' SIDS prevention strategies since the release of these newest recommendations. PURPOSE: To assess neonatal nurses' beliefs, knowledge, and practices regarding SIDS prevention in both the NICU and step-down transitional care unit (TCU). METHODS: A prospective-descriptive design was used. The 33-item SIDS Risk-Reduction Questionnaire was distributed to a convenience sample of nurses in a level III NICU/TCU in the Midwest. RESULTS: Two hundred questionnaires were distributed; 96 (48%) were returned completed. Fifty-three percent of nurses strongly agreed that SIDS recommendations make a difference in preventing SIDS and 20% strongly believed that parents model SIDS prevention practices employed by staff. A majority of nurses correctly identified 2011 recommendations. Sixty-three percent of nurses often or always gave parents verbal information and 28% often or always gave parents written information regarding SIDS. Differences were seen between NICU and TCU nurses concerning beliefs and practices, suggesting that TCU nurses more consistently follow SIDS recommendations. IMPLICATIONS FOR PRACTICE: Increased neonatal nursing and parental education regarding SIDS prevention and updated hospital policies promoting safe sleep are paramount. IMPLICATIONS FOR RESEARCH: Larger multicenter studies in level II/III NICUs are needed to provide further data on SIDS attitudes and practices.

Writing for publication: perspectives of graduate nursing students and doctorally prepared faculty.

Publication is a common expectation for both faculty and graduate students in schools of nursing. Little is known about the perceptions of students and faculty regarding what supports or interferes with students' success in writing for publication. Perceptions of supports and barriers to writing for publication and the differences in perceptions between graduate nursing students and faculty were examined. A descriptive comparative design was used to sample master's (n = 62), Doctor of Nursing Practice (n = 66), and Doctor of Philosophy (n = 7) students and graduate faculty (n = 35) using two investigator-developed surveys. Students (71.1%) and faculty (57.6%) identified working with faculty and mentors as the greatest support. Students' primary barrier was finding time (64.5%). Faculty identified not knowing how to get started (63.6%) as the students' greatest barrier. Findings support that mentoring and finding sufficient time for writing are priorities for the development of a plan to support students in writing for publication.

Mothers' experiences expressing breast milk for their preterm infants: does NICU design make a difference?

PURPOSE: This study examined differences in outcomes of provision of mothers' milk before and after implementation of a single-family room (SFR) neonatal intensive care unit (NICU) and described issues related to long-term milk expression. SAMPLE: The sample included 40 mothers (15 in the original NICU and 25 in the SFR NICU). DESIGN: Descriptive comparative. METHODS: Mothers were recruited 2 months before and 3 months after opening an SFR NICU. Nutritional data were collected throughout hospitalization. Mothers used a milk expression diary during hospitalization and completed a survey, "My Experiences With Milk Expression" immediately before infant discharge. RESULTS: Seventy-five percent of mothers planned to express breast milk or breastfeed before delivery. The majority of the mothers (55%) were most comfortable pumping in their own homes because of the increased privacy. There were no statistically significant differences between the 2 groups regarding the place where they were most comfortable pumping or where they usually pumped, although more mothers pumped in their babies' rooms in the SFR NICU. The majority of the mothers reported concern about their milk supply at some time during hospitalization and 47.5% reported having breast problems. At discharge, 71.8% of the total group was providing some breast milk and 44.7% of the total group was providing breast milk exclusively. There were no significant differences between the groups in outcomes concerning the provision of breast milk. CONCLUSIONS: Individual mother's needs for privacy need to be determined and interventions to support mothers' feeding plans throughout hospitalization and at discharge need to be developed.

The impact of a Donor Human Milk Program on the provision of mothers' own milk at discharge in very low birth weight infants.

OBJECTIVE: Examine the effect of a donor human milk (DHM) program on mothers' own milk feedings at discharge for very low birth weight (VLBW) infants. STUDY DESIGN: A single center retrospective analysis of feeding outcomes in preterm infants. Data were assigned as: (1) pre DHM era (2) Bridge DHM era (3) Full DHM era. Each era was divided into infants <1500 g (n = 724) or ≥1500 g (n = 784). RESULTS: Both the percentage of mothers' own milk feeds and percent of infants exclusively receiving mothers' own milk at discharge were increased in the <1500 g (p = 0.003, p = 0.002) and the ≥1500 g group (p = 0.007, p = 0.004) respectively, following the introduction of DHM for VLBW infants. CONCLUSION: Practice changes that accompany a donor milk program likely play a prominent role in the provision of mothers' own milk and exclusivity of breast milk feedings at discharge for very low birth weight infants.

Moral distress in neonatal intensive care unit RNs.

BACKGROUND: Moral distress is a significant problem for nurses (RNs). It has physical, emotional, and psychological sequelae and a negative impact on the quality, quantity, and cost of patient care. Moral distress leads to loss of moral integrity and job dissatisfaction and is a major cause of burnout and RNs leaving the profession. The majority of research has been carried out with RNs working in acute care, adult inpatient settings, especially critical care areas. Neonatal intensive care unit (NICU) RNs confront ethically and morally challenging situations on a regular basis. There are limited data clarifying their moral distress. AIMS: The purpose of this study was to describe the moral distress of RNs working in NICUs and to identify the situations that are associated with their moral distress. RESEARCH QUESTIONS: What are the intensity and frequency of moral distress in NICU RNs, what situations are associated with moral distress in NICU RNs, and what personal characteristics are correlated with moral distress in NICU RNs? DESIGN AND METHODS: This descriptive, correlational study was conducted with RNs in the level III NICUs of a healthcare system in the northeastern United States. Participation was voluntary and anonymous. A convenience sample of RNs completed a demographic data sheet and the Moral Distress Scale Neonatal-Pediatric Version. Data were collected during October 2008. Ninety-four of 196 eligible RNs (48%) participated in the study. FINDINGS: As a whole, the subjects did not perceive that the situations described in the instrument occurred frequently and did not cause great distress. Subjects' individual scores displayed wide variations for all dimensions of moral distress ranging from low to high, indicating that individual RNs may be experiencing moral distress.The situations receiving the highest scores are comparable with the areas that are problematic for other critical care nurses as described in the literature. In this study, 4 RN characteristics were significantly related to moral distress: the desire to leave their current position, lack of spirituality, altered approach to patient care, and considering but not leaving a previous job because of moral distress. CONCLUSIONS: The results of this study add to the understanding of the moral distress in NICU RNs. The data will provide evidence for eventual psychometric testing and factor analysis of the Moral Distress Scale Neonatal-Pediatric Version.

Using enteral sterile water feeds for hypernatremia in extremely low birth-weight infants.

Extremely low birth-weight infants are prone to fluid and electrolyte imbalance due to multiple etiologies. Hypernatremia can occur in this gestational age group during the first week of life. One therapy that many NICUs initiate to treat hypernatremia is enteral sterile water feeds (SWFs). The use of free water is an adjunct therapy in place of large volumes of intravenous fluids. This article presents a review of renal physiology and 3 case studies of infants, less than 27 weeks' gestational age and less than 1000-g birth weight, treated with SWFs for hypernatremia. Commonalities and differences in treatment are addressed. There is limited evidence-based research using enteral SWFs for the treatment of hypernatremia.

Reliability and validity of the Preterm Infant Feeding Survey: instrument development and testing.

No instruments have been located that examine attitudes concerning feeding decisions of mothers of preterm infants. The purpose of this study was to describe the development and psychometric testing of the Preterm Infant Feeding Survey (PIFS). The PIFS was adapted from the Breastfeeding Attrition Prediction Scale. The five-subscale, 78-item PIFS was tested with 105 mothers of preterm infants shortly after hospital admission. Individual subscale Cronbach's alpha values ranged from .75 to .82. Factor analysis demonstrated a five-factor solution. The PIFS is the first instrument to examine factors that contribute to feeding decisions of mothers of high-risk preterm infants; this knowledge will support the planning of interventions to improve breastfeeding outcomes for this population. Further psychometric testing with larger samples is recommended.