Variation in Neonate Swaddling Techniques.

BACKGROUND: It is common practice for healthcare practitioners to swaddle infants in newborn nursery and neonatal intensive care unit settings. Despite the widespread use of this practice, the American Academy of Pediatrics neither bans nor recommends swaddling. To date, there has been no standard protocol developed for either healthcare professionals or parents to establish optimal swaddling techniques in terms of infant arm positioning, infant leg positioning, and tightness of wrap. PURPOSE: To evaluate the variability in swaddling techniques used for infants in the newborn nursery and neonatal intensive care unit. METHODS: Across 2 pediatric hospitals, the swaddling positioning of each open-crib infant in the newborn nursery and neonatal intensive care unit was examined. For each infant, the following data were collected: gender, left and right arm position, left and right leg position, and tightness of wrap. RESULTS: In total, 132 swaddle observations were recorded. There was significant variability in swaddling positioning of arms and legs. The most common combination of arm/leg positioning was "mixed arm positioning" and "both legs flexed" (25.0% of all observations). In 9.1% of cases, tightness of wrap around chest was "tight," and in 30.3% of cases, tightness of wrap around legs was "tight." IMPLICATIONS FOR PRACTICE: There was a large variability in swaddling positioning of both arms and legs. For such a widespread practice, the lack of medical guidelines results in inconsistent, and potentially harmful, positioning. Parents and healthcare professionals would benefit from specific, research-driven guidelines regarding proper swaddling techniques. IMPLICATIONS FOR RESEARCH: Different variations on swaddling should be evaluated for consideration of best practice swaddling.

Parental Perception of Risk Associated With Their Premature Infant.

BACKGROUND: Preterm birth has been linked to increased parental stress, depression, and anxiety. Although the rate of neonatal morbidity and mortality decreases with increasing gestational age, recent research has revealed that there is no threshold age for risk or parental concern. PURPOSE: This study examines parental concern about medical and developmental outcomes of their premature infant. METHODS: Parents of 60 premature infants were surveyed in a follow-up clinic regarding their level of concern about 11 morbidities and their child's gestation-adjusted age; these were compared with the infant's inpatient chart. "Concern scores" were tallied and compared across gestational age groups and knowledge of gestation-adjusted age using Chi-square tests of independence. FINDINGS: Many parents reported concerns about morbidities that were unsupported by their child's diagnoses. Across parents of extremely, very, and moderate-late preterm children, the mean concern scores were 13.9, 15.7, and 19.7, respectively. Overall, 62% of parents incorrectly reported the gestation-adjusted age of their child. Parents who were correct were significantly more likely to correctly anticipate abnormal developmental patterns (70%) and growth patterns (65%) than those who were incorrect (33% and 31%, respectively). IMPLICATIONS FOR RESEARCH: Future research should focus on whether NICU graduate parental stress levels are directly linked to the severity of their child's condition, and how physicians can help decrease NICU graduate parental stress. IMPLICATIONS FOR PRACTICE: Parental anxiety regarding all gestational age neonatal intensive care unit infant outcomes can be decreased by a thorough explanation of gestation-adjusted age and a discussion of expected prematurity-related issues.

Challenging the Chatbot: An Assessment of ChatGPT's Diagnoses and Recommendations for DBP Case Studies.

OBJECTIVE: Chat Generative Pretrained Transformer-3.5 (ChatGPT) is a publicly available and free artificial intelligence chatbot that logs billions of visits per day; parents may rely on such tools for developmental and behavioral medical consultations. The objective of this study was to determine how ChatGPT evaluates developmental and behavioral pediatrics (DBP) case studies and makes recommendations and diagnoses. METHODS: ChatGPT was asked to list treatment recommendations and a diagnosis for each of 97 DBP case studies. A panel of 3 DBP physicians evaluated ChatGPT's diagnostic accuracy and scored treatment recommendations on accuracy (5-point Likert scale) and completeness (3-point Likert scale). Physicians also assessed whether ChatGPT's treatment plan correctly addressed cultural and ethical issues for relevant cases. Scores were analyzed using Python, and descriptive statistics were computed. RESULTS: The DBP panel agreed with ChatGPT's diagnosis for 66.2% of the case reports. The mean accuracy score of ChatGPT's treatment plan was deemed by physicians to be 4.6 (between entirely correct and more correct than incorrect), and the mean completeness was 2.6 (between complete and adequate). Physicians agreed that ChatGPT addressed relevant cultural issues in 10 out of the 11 appropriate cases and the ethical issues in the single ethical case. CONCLUSION: While ChatGPT can generate a comprehensive and adequate list of recommendations, the diagnosis accuracy rate is still low. Physicians must advise caution to patients when using such online sources.

Prevalence and Longevity of PTSD Symptoms Among Parents of NICU Infants Analyzed Across Gestational Age Categories.

Objective. This study aims to investigate whether posttraumatic stress disorder (PTSD) symptoms exist >1 year after neonatal intensive care unit (NICU) experience and whether PTSD symptomatology differs across parents of infants of different gestational age categories. Methods. A survey was given to parents at routine NICU follow-up visits. Parents completed the PTSD CheckList-Civilian (PCL-C), a standardized scale comprising 17 key symptoms of PTSD. Parents also rated how traumatic their birth experience, first day in the NICU, and first week in the NICU were from "Not Traumatic at All" to "Most Traumatic." Fisher's exact test was used to compare PCL-C responses across gestational age categories (Extremely Preterm, Very Preterm, Moderate to Late preterm, and Full Term). Results. Eighty parents participated. In total, 15% of parents had "Moderate to High Severity" PTSD symptoms. There were no statistical differences in PTSD prevalence between parents of children <1 year old and parents of children >1 year old (P = .51). There was also no statistical difference in prevalence of "Moderate to High Severity" level of PTSD symptoms across gestational age (P = .16). Overall, 38% of parents rated at least one experience as "Most traumatic." Conclusion. A high percentage of parents who had a recent NICU experience and parents who had a NICU experience more than a year ago demonstrated PTSD symptoms. In light of these results, many parents of NICU graduates-both mothers and fathers-would benefit from access to long-term counseling services.

Household Diversion of Prescription Stimulants: Medication Misuse by Parents of Children with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVES: The primary objective of this study is to investigate household diversion of stimulant medication. Secondary objectives are to examine clinical/demographic predictors of diversion, types of formulations diverted, exposure to household diversion in the media, and storage of prescription stimulants within households. METHODS: Questionnaires were completed by 180 parents of youth who were currently taking stimulant medication for treatment of attention-deficit/hyperactivity disorder (ADHD). Parents were asked whether they or another adult in the home had ever taken their child's stimulant medication or given one child's stimulant medication to another child in the home. Additionally, data regarding demographics, parental ADHD (diagnosed or suspected), past suspicions of missing medication, and medication storage were also collected. Responses were compared using Pearson's chi-squared test with Yates' continuity correction. RESULTS: Sixteen percent of parents reported diversion of stimulant medication to another household member, with the majority admitting to taking the medication themselves. Another 13% had been tempted to illicitly self-administer their child's medication. Parents with suspected or diagnosed ADHD showed greater risk of self-administration or temptation to do so, compared to parents without (33% vs. 17%, p = 0.01). The majority of parents (71%) stored prescription stimulants "in plain sight," or "out of sight but available to all." CONCLUSION: Although previous research has focused on peer diversion among adolescents and young adults, clinicians must be vigilant for the possibility of diversion by parents of children treated with stimulant medication.