The newborn individualised developmental care and assessment program: A model of care for infants and families in hospital settings.

AIM: The Newborn Individualised Developmental Care and Assessment Program (NIDCAP) is an intervention and education programme that uses developmental observation for multidisciplinary healthcare professionals (HCP) caring for high-risk infants and families. Infants prosper with the ongoing co-regulation process of infant and family that is influenced by the physical and social environment. METHODS: The Template for Intervention Description and Replication (TIDieR) Guidelines were applied to the NIDCAP intervention. The estimation of the individual infant's current goals is described from direct observation of behaviour in the context of ongoing care delivery. The infant's behaviour guides all caregivers to articulate current strengths and functioning for the development of individualised plans of care and support. The NIDCAP Nursery Program supports the full integration of NIDCAP into the healthcare system. RESULTS: NIDCAP is a system-based, process-oriented, attuned and responsive intervention for individualised developmental care for infants and families. Evidence shows NIDCAP significantly improves medical outcomes, with less time on the ventilator, improved weight gain, decreased length of stay, improved developmental outcomes and enhanced infant and family relationships. Evidence suggests that NIDCAP as an intervention improves parental competence, decreases stress for HCP teams and improves HCP satisfaction. CONCLUSION: NIDCAP improves outcomes for infants and families requiring hospital care.

Caring for hearts and minds: a quality improvement approach to individualized developmental care in the cardiac intensive care unit.

Introduction: Infants with congenital heart disease (CHD) are at high risk for developmental differences which can be explained by the cumulative effect of medical complications along with sequelae related to the hospital and environmental challenges. The intervention of individualized developmental care (IDC) minimizes the mismatch between the fragile newborn brain's expectations and the experiences of stress and pain inherent in the intensive care unit (ICU) environment. Methods: A multidisciplinary group of experts was assembled to implement quality improvement (QI) to increase the amount of IDC provided, using the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), to newborn infants in the cardiac ICU. A Key Driver Diagram was created, PDSA cycles were implemented, baseline and ongoing measurements of IDC were collected, and interventions were provided. Results: We collected 357 NIDCAP audits of bedside IDC. Improvement over time was noted in the amount of IDC including use of appropriate lighting, sound management, and developmentally supportive infant bedding and clothing, as well as in promoting self-regulation, therapeutic positioning, and caregiving facilitation. The area of family participation and holding of infants in the CICU was the hardest to support change over time, especially with the most ill infants. Infants with increased medical complexity were less likely to receive IDC. Discussion: This multidisciplinary, evidence-based QI intervention demonstrated that the implementation of IDC in the NIDCAP model improved over time using bedside auditing of IDC.

Application of the Adverse Childhood Experiences Framework to the NICU.

BACKGROUND: Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. PURPOSE: Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. METHODS: An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. RESULTS: NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. IMPLICATIONS FOR PRACTICE AND RESEARCH: Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative.

Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.

Release of Oxytocin and Cortisol Is Associated With Neurobehavioral Patterns in Premature Infants.

OBJECTIVE: To examine relationships among salivary oxytocin and cortisol levels in parents and preterm infants and neurobehavioral functioning in preterm infants after skin-to-skin contact. DESIGN: A secondary analysis of a randomized crossover study. SETTING: NICU. PARTICIPANTS: Twenty-eight stable premature infants and their mothers and fathers. METHODS: Participating infants contributed 108 saliva samples that we collected 45 minutes after skin-to-skin contact and tested for oxytocin and cortisol. We randomized data collection by whether the infant was held first by the mother or by the father. We conducted linear regression to test if summary scores on the NICU Network Neurobehavioral Scale were associated with salivary oxytocin and cortisol levels. RESULTS: We found a significant negative relationship between infant oxytocin levels and the Stress scores (b = -0.07, p < .01) and the Excitability scores (b = -1.12, p = .04) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant oxytocin levels and the Self-Regulatory scores (b = 0.38, p = .05) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant cortisol level and the Stress scores (b = 0.05, p = .04), Excitability scores (b = 1.06, p = 0.05), and Asymmetrical Reflexes scores (b = 1.21, p = .03) among infants held skin-to-skin with their mothers. We only found a negative significant relationship between infant cortisol levels and the Stress scores (b = -0.03, p = .04) among infants held skin-to-skin with their fathers. CONCLUSION: We found that oxytocin is an important biomarker that may improve infant neurobehavioral functioning. The data showed a difference in oxytocin responses after skin-to-skin contact with mothers compared to fathers.

Ready, Set, Start: Mentoring Graduating Nursing Students During a Pandemic.

ABSTRACT: Nurses are graduating from educational programs and entering health care systems at a time of great turmoil because of the COVID-19 pandemic. To support the transition to practice, nursing faculty implemented a postgraduation mentorship program (START). This exploratory study sought to describe the faculty mentor and new graduate mentee experience. Related variables (NCLEX pass rates, perceived stress, and professional quality of life) are provided to contextualize the results. The research is significant given the burden the pandemic places on the health care system, which may limit the resources available to new graduate nurses.

Factors That Influence NICU Health Care Professionals' Decision Making to Implement Family-Centered Care.

BACKGROUND: Neonatal intensive care unit (NICU) is a multifaceted, technology-driven high stress environment for professionals, infants and families. PURPOSE: Examine healthcare professionals' beliefs and perceptions regarding providing FCC within the context of NICU. METHODS: This exploratory descriptive study used an online-survey format. The survey comprised several instruments including the Perceived Stress Scale, symptoms of burnout subscale from the Professional Quality of Life scale, and the Family Nurse Caring Belief Scale (FNCBS). Demographic and open-ended items were also included. RESULTS: Sample consisted of 115 multidisciplinary participants working in a level IV neonatal intensive care unit. Participants report strong levels of FCC beliefs. Participants strongly agreed (82%) or agreed (18%) that no matter how sick the infant is, he or she needs to be treated as an individual. A significant correlation (r=-0.343, P < .001) exists between participant's stress composite score and FNCBS composite score. There were significant relationships between participant's years of experience (F = 5.35, P < .002) and education levels (F = 2.60, P < .05) and higher FNCBS composite scores. There were also significant relationships between participant's years of experience (F = 4.77, P < .004) and education (F = 2.89, P < .039) with higher Perceived Stress Scale composite scores. IMPLICATIONS FOR PRACTICE: Results suggest that while participants agreed that FCC is important, they also believed that inadequate staffing and inappropriate assignments may lead to rationing of care. IMPLICATIONS FOR RESEARCH: Further research is needed to explore factors that lead to rationing of FCC.

Care of hospitalized infants and their families during the COVID-19 pandemic: an international survey.

This research study explored changes in family-centered care practices for hospitalized infants and families due to the COVID-19 pandemic. This exploratory descriptive study used a 49-item online survey, distributed to health care professionals working with hospitalized infants and families. The sample consisted of 96 participants from 22 countries. Prior to the COVID-19 pandemic, 87% of units welcomed families and 92% encouraged skin-to-skin care. During the pandemic, family presence was restricted in 83% of units, while participation in infant care was restricted in 32%. Medium-sized (20-40 beds) units applied less restriction than small (<20 beds) units (p = 0.03). Units with single-family rooms that did not restrict parental presence, implemented fewer restrictions regarding parents' active participation in care (p = 0.02). Restrictions to families were not affected by geographic infection rates or developmental care education of health care professionals. Restrictions during the pandemic increased separation between the infant and family.

Neonatal Intensive Care Unit-Specific Lactation Support and Mother's Own Breast Milk Availability for Very Low Birth-Weight Infants.

BACKGROUND: Mother's own milk (MOM) is the preferred nutrition for premature infants, particularly for the very low birth-weight (VLBW) cohort. Benefits are well documented; yet, numerous barriers exist for provision of MOM in the neonatal intensive care unit (NICU). Lactation consultants (LCs) can optimize breastfeeding support for NICU mothers; however, understanding of the impact of NICU-dedicated LCs is limited. PURPOSE: Evaluate the effectiveness of NICU-dedicated LCs in improving breastfeeding outcomes and MOM provision in VLBW infants. METHODS: A retrospective chart review of 167 VLBW infants comparing breastfeeding outcomes between 2 NICUs, one with NICU-dedicated LCs (hospital A; n = 48) and one without (hospital B; n = 119). Primary outcome measures included feeding percentages of MOM received by infants at 3 intervals, throughout hospitalization, and number of direct breastfeeding events. Secondary outcome measures included number of days to first enteral feed, days to reach full feeds, days of nil per os, days on total parenteral nutrition, and length of stay. FINDINGS: Neonatal intensive care unit-specific lactation support increased the number of direct breastfeeding events on day of discharge (P = .048). No statistical significance was found at each of the 3 time intervals, or throughout hospitalization (week 1: P = .18; midpoint: P = .40; discharge: P = .16; total hospitalization: P = .19). No statistical significance was demonstrated in secondary outcome measures (days to first enteral feed: P = .22; days to full feeds: P = .25; nil per os days: P = .27; total parenteral nutrition days: P = .34; length of stay: P = .01). Length of stay not found to be significant after correcting for confounding variables. IMPLICATION FOR PRACTICE: Increased direct breastfeeding events on day of discharge with exposure to NICU-dedicated LCs in the VLBW population. IMPLICATION FOR RESEARCH: Prospective studies regarding NICU-specific lactation support with larger samples are warranted.

Oxytocin and early parent-infant interactions: A systematic review.

OBJECTIVES: Social relationships throughout lifespan are critical for health and wellbeing. Oxytocin, often called the 'hormone of attachment' has been suggested as playing an important role in early-life nurturing and resulting social bonding. The objective of this paper is to synthesize the associations between oxytocin levels and interactions between infants and parents that may trigger oxytocin release, and in turn facilitate attachments. METHODS: A comprehensive cross-disciplinary systematic search was completed using electronic databases. The inclusion criteria included studies that focused on mother-infant and father-infant interaction and measured both baseline and post-interaction oxytocin levels. RESULTS: Seventeen studies were included in the final systematic review. The reviewed studies used mother-infant and/or father-infant play and skin-to-skin contact between maternal-infant and paternal-infant dyads to examine the oxytocin role in early life bonding and parenting processes. Studies showed a positive correlation between parent-infant contact and oxytocin levels in infancy period. Increased maternal oxytocin levels were significantly related to more affectionate contact behaviors in mothers following mother-infant contact, synchrony, and engagement. Meanwhile, increased paternal oxytocin levels were found to be related to more stimulatory contact behaviors in fathers following father-infant contact. Oxytocin levels significantly increased in infants, mothers and fathers during skin-to-skin contact and parents with higher oxytocin levels exhibited more synchrony and responsiveness in their infant interactions. CONCLUSION: The review suggests that oxytocin plays an important role in the development of attachment between infants and parents through early contact and interaction. The complexities of oxytocinergic mechanisms are rooted in neurobiological, genetic, and social factors.

What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief.

BACKGROUND: Benefits of exclusive human milk diets for preterm and low birth-weight infants are well established. Despite known benefits, supporting mothers in the provision of mother's own milk for high-risk infants is challenging. Lactation support in the neonatal intensive care unit (NICU) is highly variable. Lactations consultants (LCs) are often shared between postpartum units and the NICU, potentially increasing LC workload with less time spent with high-risk mothers. Furthermore, less than half of NICUs in the United States staff an international board-certified lactation consultant. Limited understanding exists regarding impacts of NICU-specific lactation support on breastfeeding outcomes. PURPOSE: The purpose of this evidence-based practice brief is to synthesize the literature on the impact of NICU-specific lactation support, LCs who work exclusively in the NICU, and provide guidance about how NICU staffing with LCs solely focused on supporting mothers of high-risk infants impacts breastfeeding outcomes for low birth-weight infants. SEARCH STRATEGY: CINAHL PLUS, PubMed, Cochrane Library, and OVID databases were searched using key words and restricted to English language. FINDINGS: During hospitalization, NICUs staffed with dedicated board-certified LCs have increased potential to yield improved breastfeeding rates through hospital discharge, increased proportion of infants who receive mother's own milk, and increased duration of breastfeeding or human milk expression through hospital discharge. IMPLICATIONS FOR PRACTICE: Human milk nutrition is related to improved outcomes for high-risk infants. Neonatal intensive care unit-specific lactation support can potentially optimize maternal breastfeeding practices and improve outcomes for high-risk infants. IMPLICATIONS FOR RESEARCH: There is a need for further studies pertaining to NICU-specific lactation consultants and influences on breastfeeding outcomes.

Parent Engagement Correlates With Parent and Preterm Infant Oxytocin Release During Skin-to-Skin Contact.

BACKGROUND: Preterm infants remain increasingly neurodevelopmentally disadvantaged. Parental touch, especially during skin-to-skin contact (SSC), has potential to reduce adverse consequences. PURPOSE: To examine relationships between parental engagement and salivary oxytocin and cortisol levels for parents participating in SSC intervention. METHODS: A randomized crossover design study was conducted in a neonatal intensive care unit; 28 stable preterm infants, mothers, and fathers participated. Parental engagement was measured using the Parental Risk Evaluation Engagement Model Instrument (PREEMI) prior to hospital discharge. Saliva samples for oxytocin and cortisol levels were collected 15-minute pre-SSC, 60-minute during-SSC, and 45-minute post-SSC. RESULTS: Data were analyzed using Pearson's correlation to measure relationships between parental engagement composite scores and salivary oxytocin and cortisol levels. A significant negative correlation between paternal engagement and paternal oxytocin levels (r = -0.43; P = .03) and a significant negative correlation between infant oxytocin levels and maternal engagement (r = -0.54; P = .004) were present. Adjusted linear regression models demonstrated that as infant oxytocin levels increased during SSC, maternal engagement scores significantly decreased at discharge (ß = -.04; P = .01). Linear regression, adjusting for infant oxytocin and cortisol levels, showed that as paternal oxytocin levels increased, there was a significant decrease in paternal engagement (ß = -.16; P = .03) and as paternal cortisol levels increased, there was a significant decrease in paternal engagement (ß = -68.97; P =.05). IMPLICATIONS FOR PRACTICE: Significant relationships exist between parental engagement and salivary oxytocin and cortisol levels. Defining parent engagement facilitates identification of parent risks and needs for intervention to optimize preterm outcomes. IMPLICATIONS FOR RESEARCH: The PREEMI can serve as a standardized instrument to examine parent engagement.

Individualized Family-Centered Developmental Care: An Essential Model to Address the Unique Needs of Infants With Congenital Heart Disease.

BACKGROUND: Infants born with critical congenital heart disease (cCHD) who require surgical intervention in the newborn period are often hospitalized in a cardiac intensive care unit (CICU). Cardiac surgery and the CICU environment are traumatic to infants and their families. Infants are exposed to overwhelming stress, which can result in increased pain, physiologic instability, behavioral disorganization, disrupted attachment, and altered brain development. Individualized Family-centered Developmental Care (IFDC) is a model that can address the unique needs and developmental challenges of infants with cCHD. PURPOSE: The purpose of this article is to (1) clearly describe the uniqueness of the infant with cCHD, including the medical, neurological, and parental challenges, and (2) propose methods to apply IFDC to support recovery of infants with cCHD in the CICU. CONCLUSIONS: The experiences in the CICU shape the developing brain and alter recovery and healing, thus adversely impacting development. Individualized Family-centered Developmental Care is a promising model of care that nurses can integrate into the CICU to promote neuroprotection and development. Nurses can effectively integrate IFDC into the CICU by understanding the unique characteristics of infants with cCHD and applying IFDC interventions that include both maturity and recovery perspectives. CLINICAL IMPLICATIONS: The incorporation of IFDC interventions is essential for the infant with cCHD and should be a standard of care. Applying IFDC with a recovery perspective in all aspects of caregiving will provide opportunities for individualization of care and parent engagement, allowing infants in the CICU to recover from surgery while supporting both short- and long-term neurodevelopment.

Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship.

OBJECTIVE: To examine changes that occur in infant and parent salivary oxytocin (OT) and salivary cortisol (SC) levels during skin-to-skin contact (SSC) and whether SSC alleviates parental stress and anxiety while also supporting mother-father-infant relationships. METHODS: This randomized crossover study was conducted in the neonatal intensive care unit (NICU) with a sample of 28 stable preterm infants and their parents. Saliva samples were collected from infants, mothers, and fathers on Days 1 and 2 (1/parent) for OT and cortisol measurement pre-SSC, during a 60-min SSC session, and a 45-min post-SSC. Parental anxiety was measured at the same time points. Parent-infant interaction was examined prior to discharge on Day 3 via video for synchrony and responsiveness using Dyadic Mutuality Coding. RESULTS: Salivary OT levels increased significantly during SSC for mothers ( p < .001), fathers ( p < .002), and infants ( p < .002). Infant SC levels decreased significantly ( p < .001) during SSC as compared to before and after SSC. Parent anxiety scores were significantly related to parent OT and SC levels. Parents with higher OT levels exhibited more synchrony and responsiveness ( p < .001) in their infant interactions. CONCLUSION: This study addresses a gap in understanding the mechanisms linking parent-infant contact to biobehavioral responses. SSC activated OT release and decreased infant SC levels. Facilitation of SSC may be an effective intervention to reduce parent and infant stress in the NICU. Findings advance the exploration of OT as a potential moderator for improving responsiveness and synchrony in parent-infant interactions.

Neurobiological Consequences of Early Painful Experience: Basic Science Findings and Implications for Evidence-Based Practice.

As healthcare teams have worked to improve infant survival rates, the management of painful events experienced by these hospitalized neonates has increased and yet pain management remains highly variable between healthcare institutions. At the same time, emerging evidence suggests that these early painful experiences may alter the trajectory of development for pain-processing pathways both peripherally and centrally. This concise review highlights findings from both the basic and clinical science literature supporting the hypothesis that early painful experiences can have long-lasting negative effects on biological, psychological, and socioemotional functions. Implications for pain management in neonates and considerations for evidence-based practice change are discussed.

FKBP5 genotype and early life stress exposure predict neurobehavioral outcomes for preterm infants.

PROBLEM: This study evaluated the relationship between stressful early life neonatal intensive care unit (NICU) experiences, genetic variation of a stress response-associated gene (FKBP5), and neurobehavioral outcomes. METHOD: The impact of genetic variation and stress experience on neurobehavioral outcomes was examined for 41 preterm infants. Statistical analyses explored the main effects of FKBP5 genotype and NICU stress experience, as well as their interaction on infant neurobehavioral development prior to discharge. RESULTS: Statistical analyses demonstrated a relationship between both FKPB5 genotype and stress related to NICU care that were independently associated with neurobehavioral outcomes; indicating a main effect of genotype and a main effect of stress on neurodevelopment. Additionally, we found an interaction between the minor allele genotype and NICU stress potentially associated with less favorable developmental progress at discharge. IMPLICATIONS: Evidence of genetic and environmental risk factors for neurodevelopmental impairment suggests the need for improved evidence-based practice initiatives to protect those most vulnerable to the combination of genetic susceptibility to stress and medical fragility.

The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU.

BACKGROUND: Vulnerable preterm infants experience repeated and prolonged pain/stress stimulation during a critical period in their development while in the neonatal intensive care unit (NICU). The contribution of cumulative pain/stressors to altered neurodevelopment remains unclear. The study purpose was to investigate the impact of early life painful/stressful experiences on neurobehavioral outcomes of preterm infants in the NICU. METHODS: A prospective exploratory study was conducted with fifty preterm infants (28 0/7-32 6/7weeks gestational age) recruited at birth and followed for four weeks. Cumulative pain/stressors (NICU Infant Stressor Scale) were measured daily and neurodevelopmental outcomes (NICU Network Neurobehavioral Scale) were examined at 36-37weeks post-menstrual age. Data analyses were conducted on the distribution of pain/stressors experienced over time and the linkages among pain/stressors and neurobehavioral outcomes. RESULTS: Preterm infants experienced a high degree of pain/stressors in the NICU, both in numbers of daily acute events (22.97±2.30 procedures) and cumulative times of chronic/stressful exposure (42.59±15.02h). Both acute and chronic pain/stress experienced during early life significantly contributed to the neurobehavioral outcomes, particularly in stress/abstinence (p<0.05) and habituation responses (p<0.01), meanwhile, direct breastfeeding and skin-to-skin holding were also significantly associated with habituation (p<0.01-0.05). CONCLUSION: Understanding mechanisms by which early life experience alters neurodevelopment will assist clinicians in developing targeted neuroprotective strategies and individualized interventions to improve infant developmental outcomes.

A survey of skin-to-skin contact with perinatal nurses.

OBJECTIVE: This study explored perinatal nurses' knowledge, attitudes and practices of SSC, to identify knowledge-practice gaps. STUDY DESIGN: A descriptive cross-sectional survey design was completed by 101 perinatal nurses. Descriptive statistics and ordered logistical regression were used to describe and compare nurses' responses. RESULTS: The participants strongly agreed that it is nurses' responsibility to advocate for SSC. Significant differences (p<0.01) were reported in provision of SSC with eligible infants between nurses within and between practice settings, education levels, year experience and age differences. Education levels significantly influenced attitudes and implementation of SSC. Perinatal nurses' responses about how difficult it is to initiate SSC changes were affected by years of nursing practice (p<0.04). CONCLUSIONS: Perinatal nurses strongly believe in SSC practices, yet additional training regarding SSC implementation is needed. Education levels, primary practice settings and years of practice appear to influence nurses' implementation of SSC.

Immigrant latino couples and postpartum contraception: Attitudes, perceptions, and sexual decision-making

BACKGROUND: The number of Latinos in the US is increasing, and they are at higher risk for unintended pregnancies and short interpregnancy intervals. PURPOSE: This study examined immigrant Latino couples' attitudes and perceptions towards contraception in relation to sexual decision-making. METHODS: Pregnant Latinas and their partners (n=40 couples) were recruited from prenatal care clinics in the southeastern US. This was amixed-method study with a concurrent embedded strategy. Descriptive statistics, paired t-tests, interclass correlation, and the Actor-Partner Interdependence Model (APIM) were used to analyze the quantitative data. Data from open ended questions were analyzed with content analysis. RESULTS: On the group-level analysis, men's Contraceptive Attitudes and Perception Scale scores were significantly different from women's in four key dimensions: partner (comfort in communicating with partner and partner's attitude), side effects, hassle, and cost (p<0.002, 0.046, 0.018, and 0.02). On the dyad-level analysis (between individual couples), no significant correlations were identified. In the dyad analysis using the APIM, only men's contraceptive attitudes and perceptions were negatively associated with women's sexual decision-making (ß=−0.158, p = 0.005). Nearly two-thirds of the couples disagreed on postpartum contraceptive methods. Seven overlapping categories emerged as rationales for choosing specific postpartum contraceptive methods among men and women. CONCLUSIONS: Understanding the dyad-level influence on contraceptive attitudes/perceptions, sexual decision-making helps researchers,and practitioners design evidence-based, culturally tailoredinterventions to assist couples in choosing the best postpartum contraceptives for their family. Decreasing men's contraceptive barriers by providing correct information may be the first step in mediating the dyad-level factor.

TRASFONDO: El número de Latinos en EEUU está creciendo, y ellos tienen alto riesgo de embarazo sin intención y corto intervalo. PROPÓSITO: Este estudio examinó actitudes y percepciones sobre anticonceptivos (APSA) de parejas Latinas inmigrantes relacionado con la toma de decisiones sexuales. MÉTODOS: Latinas embarazadas y sus parejas (n=40 parejas) fueron parte del estudio. Se utilizó el método mixto con la estrategia de concurrente empotrado. Se utilizó la estadística descriptiva, examen de t, correlación entre-clase, y el Modelo de Interdependencia Actor-Pareja (MIAP) para analizar datos cuantitativos. Las preguntas abiertas fueron analizadas con el método de análisis contento. RESULTADOS: En el análisis del nivel grupal, marcas de los APSA de los hombres fueron significativamente diferente de los de mujeres en cuatro dimensiones: parejas, efectos secundarios, molestia, y costo (p<0.002, 0.046, 0.018, y 0.02). En el análisis del MIAP, solo APSA de los hombres fueron asociados negativamente con tomas de decisiones de las mujeres (ß=−0.158, p = 0.005). Casi dos tercios de las parejas estaban en desacuerdo con los métodos anticonceptivos después del parto. Siete categorías surgieron como razones para escoger los métodos anticonceptivos después del parto. CONCLUSIONES: Entender la influencia de APSA y toma de decisiones entre parejas ayudará a los investigadores y enfermeros a diseñar intervenciones basados en evidencia y culturalmente diseñados para ayudar a parejas a escoger anticonceptivos post-parto. Reducir las barreras que tienen los hombres a los anticonceptivos proveyendo información correcta será el primero paso en afectar el factor en el nivel entre parejas.