The effects of enteral feeding improvement massage on premature infants: A randomised controlled trial.

AIMS AND OBJECTIVES: To prove the effects of an enteral feeding improvement massage for premature infants with regard to their feeding, growing and superior mesentery artery blood flow aspect by a randomised controlled trial. BACKGROUND: Premature infants have feeding-related problems related to eating and absorbing nutrition due to their immature gastrointestinal function. Studies regarding the effectiveness of premature infants' enteral feeding improvement by tactile stimulation massage are rare. DESIGN: The study group was composed of 55 patients. Of the 55 patients, 26 were randomised into an experimental group and 29 were randomised into a control group. METHODS: They were all born <34 weeks of gestational age between 1 July 2011 and 30 March 2012. Premature infants in the experimental group received enteral feeding improvement massage twice a day for 14 days, and infants in the control group received a sham exercise. The collected data were analysed by spss 19.0, through t test, chi-square test (Fisher's exact) and ANCOVA. RESULTS: (i) The experimental group had reached the day of full enteral feeding significantly faster. (ii) The experimental group had a higher superior mesentery artery peak velocity (Vmax ) and lower RI (resistant index). (iii) The experimental group of the feeding-intolerant subgroup had a higher superior mesentery artery Vmax and Vmin . (iv) The experimental group had a heavier weight and larger head circumference after 14 days. CONCLUSIONS: This study demonstrates that enteral feeding improvement massage can be helpful for achieving earlier full enteral feeding, more increased superior mesentery artery, and faster growing. In particular, it can be a therapeutic, independent and evidence-based nursing intervention for feeding-intolerant premature infants. RELEVANCE TO CLINICAL PRACTICE: Neonatal nurses in neonatal intensive care unit can apply enteral feeding improvement massage massage for feeding-intolerant infants.

Antenatal management of gestational diabetes mellitus can improve neonatal outcomes.

OBJECTIVE: Pregnancies complicated with gestational diabetes mellitus (GDM) are at a higher risk for caesarean and instrumental deliveries as well as adverse neonatal outcomes such as fetal overgrowth, hypoglycaemia and neonatal intensive care admission. Our primary objective was to describe neonatal outcomes in a sample that included term infants of both GDM mothers and mothers with normal glucose tolerance (NGT). DESIGN AND SETTING: this cross-sectional study included 599 term babies born between September and October 2010 at Royal Prince Alfred Hospital, Sydney, Australia. Maternal and neonatal data were collected from medical records and a questionnaire. Glycaemic control data was based on third trimester HbA1c levels and self-monitoring blood glucose levels (BGL). Univariate associations between GDM status and maternal demographic factors, as well as pregnancy outcomes, were estimated using χ(2) tests and t-tests, as appropriate. FINDINGS: of 599 babies, 67(11%) were born to GDM mothers. GDM mothers were more likely to be overweight/obese and of Asian ethnicity. Good glycaemic control was achieved in most GDM mothers. GDM babies were more likely to have been induced (p=0.013) and delivered earlier than non-GDM mothers (p<0.001), and they were also more likely to be breastfed within one hour of birth. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in this study, GDM infants were more likely to be induced and delivered earlier but otherwise they did not have significantly different neonatal outcomes compared to infants of NGT mothers. This can be attributed to the good GDM control by lifestyle modification and insulin if necessary. The role of labour induction in GDM pregnancies should be further investigated. Midwives have an important role in maternal education during pregnancy and in the postnatal period.

Spiritual care in a crisis: what is enough?

Nurses encounter crisis regularly. What are appropriate spiritual interventions? Christians are encouraged to use every opportunity to be a witness for Christ. Should nurses share their faith in times of crisis? The experience of a nurse caring for a mother after perinatal loss is explored by a philosopher, mental health clinical nurse specialist, and the nurse, who wonders if she should have done things differently.

Scientific ways to study intercessory prayer as an intervention in clinical research.

The purpose of this article is to share a "research journey" to study the somewhat controversial subject of Christian intercessory prayer (CIP) utilized as a clinical intervention, and the knowledge gained along the way. This article will explore the steps in the development and implementation of clinical research to scientifically examine a phenomenon that many say cannot--and should not--be studied. The sequential steps in developing this area of study are detailed and explained from the conception of the initial idea through utilization of concept analysis and literature review to develop the researchable topic. The subsequent development of both qualitative and quantitative pilot studies to investigate CIP in depth is presented to illustrate how the intervention of CIP can successfully be incorporated into clinical research. This article provides guidelines for future researchers who may want to utilize CIP as an intervention.

El papel de la enfermera en los cuidados paliativos del recién nacido / The role of neonatal nursing in palliative care of the newborn

El cuidado de los recién nacidos que van a fallecer es una tarea propia del trabajo en una unidad de cuidado intensivo neonatal (UCIN). Los cuidados holísticos implican reconocer las necesidades físicas, emocionales y espirituales del niño que va a morir y de su familia. El propósito de este artículo fue reflexionar acerca de cómo proporcionar la mejor asistencia en el cuidado paliativo (CP) del neonato en 3 áreas: ayuda en la toma de decisiones del CP; atención del dolor y el confort, y apoyo en el proceso del duelo con competencia cultural. Estos resultados tienen repercusiones para mejorar la práctica asistencial enfermera

Nursing dying newborns is an inherent part of working in a neonatal intensive care (NICU). Holistic care involves recognizing the physical, emotional and spiritual needs of the dying infant and the family. The present article aims to explore how nurses can provide the best practices in neonatal palliative care. Palliative care is composed of three components: assistance with end-of-life decision making; pain and comfort management, and bereavement support with cultural competence. These issues have implications for improving nursing practice

Nuchal cord management and nurse-midwifery practice.

Nuchal cord, or cord around the neck of an infant at birth, is a common finding that has implications for labor, management at birth, and subsequent neonatal status. A nuchal cord occurs in 20% to 30% of births. All obstetric providers need to learn management techniques to handle the birth of an infant with a nuchal cord. Management of a nuchal cord can vary from clamping the cord immediately after the birth of the head and before the shoulders to not clamping at all, depending on the provider's learned practices. Evidence for specific management techniques is lacking. Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence.

The hypothalamus.

The hypothalamus is an integral part of the neuroendocrine system. The anatomy, embryologic development, and normal function of the hypothalamus are described here. Pathophysiology of congenital abnormalities and brain injury is discussed and a case study examined. In addition, nursing implications of caring for such an infant are addressed.

Music therapy: fertile ground for application of research in practice.

When participating in research studies in the clinical setting it is important to remember the goals of the interventions under study. Frequently the parameters and design of the research, while necessary to validate findings, are not written in stone for future application. It is possible to consider other situations in which the intervention might be applied that lie outside the current research protocols. To fully utilize research findings, apply them to your own unique practice and then set up your own study using the original work as a starting place.

Infants of diabetic mothers: current perspectives.

A thorough understanding of the metabolic alterations seen in pregnancies complicated by diabetes can help to provide the framework for comprehensive care of the mother and her infant. Nursing research may help to clarify the scope of problems encountered as well as delineating strategies to reduce mortality and morbidity. The problems encountered in infants of diabetic mothers can be better managed with a thorough understanding of the physiologic changes encountered. Assessment strategies can then be developed specific to the identified needs. Finally, interventions can be selected that promote healthy infant and family function and reduce long-term complications. Although perinatal outcomes have improved in diabetic pregnancies, there are still opportunities to reduce major complications and to improve quality of life.

Continuous arteriovenous hemofiltration: an alternative dialysis therapy in neonates.

Modifications have made it possible to perform CAVH in the neonate. One of these is decreasing the extravascular volume in the tubing and filter to a minimal amount to allow for adequate intravascular blood volume in the infant. Another is utilizing predilutional fluid to decrease the need for heparinization. A third modification is utilizing the suction-assist pumps to help control the amount of fluid removed from the infant. With modifications of this system to fit the special needs of neonates and intensive nursing and medical management, CAVH can be a successful alternative to traditional dialysis therapies in neonates.

Common hematologic problems of the immediate newborn period.

Hematologic problems in the early periods of postnatal life are common. Many complications of the common hematologic problems in the newborn, including death, might be prevented with astute nursing care. Frequently encountered blood disorders of the immediate newborn period, clinical manifestations, common treatments, and nursing management are presented.

High-risk infants: the need for nursing follow-up.

The goal of perinatal care can no longer focus only on the medical management of mother and infant, but instead must take a more global approach and focus on the entire family. One aspect of family care is to provide comprehensive nursing follow-up to the high-risk family at the time of the mother's and infant's discharge. To meet this need, a program was developed to educate all interested community nurses to the specific needs of the high-risk family. Evaluation indicates that the program helped nurses to provide consistent comprehensive care to these families, who were very grateful for home visits by a community nurse.