Mindful Kangaroo Care: mindfulness intervention for mothers during skin-to-skin care: a randomized control pilot study.

BACKGROUND: Parents of babies admitted to the Newborn Intensive Care Unit (NICU) undergo considerable stress. There is evidence that mindfulness reduces stress in these parents. Kangaroo Care (KC) is practiced in NICUs across the world and is stress-relieving. Whether mindfulness practiced during KC in the NICU reduces parental distress has not yet been studied. The objective was to explore the feasibility and acceptability of teaching and practicing mindfulness during KC for mothers of premature babies. The objective was also to document preliminary outcomes of Mindful Kangaroo Care (MKC) on maternal stress, anxiety, depression, and mindful awareness. METHODS: In this pilot randomized controlled study, mothers of premature babies who were expected to stay in the NICU for at least four weeks were taught two mindfulness exercises to practice during KC and compared to mothers who received standard care with no mindfulness teaching. Mothers filled out stress, anxiety, depression and mindful awareness scales at recruitment and after four weeks. Acceptability and feasibility questionnaires were also completed. RESULTS: Fifteen mothers per group completed the study. The MKC group demonstrated a significant within-group reduction in anxiety (p = 0.003), depression (p = 0.02) and stress (p = 0.002), and a significant increase in both the curiosity (p = 0.008) and decentering (p = 0.01) scores of the Toronto Mindfulness Scale, all of which had medium to large effect sizes. Only the increases in curiosity and decentering were significant between groups. Fourteen mothers found the intervention acceptable, one neutral. CONCLUSION: MKC was acceptable, feasible and led to a reduction in stress, anxiety and depression in mothers who practiced mindfulness exercises during KC.

Congenital tuberculosis presenting as otorrhoea in a preterm infant.

A premature infant of 25 weeks' gestational age presented at 8 weeks after birth with otorrhoea from the left ear. Following a course of topical and systemic antibiotics, the patient deteriorated developing facial nerve paralysis and cervical lymphadenitis. Contrast-enhanced CT and MRI of the head showed a destructive process of the left temporal bone. These findings prompted the clinicians to send swabs from the purulent discharge from the ear for acid-fast bacilli stain. Furthermore, surgical exploration and debridement were undertaken. Cultures from ear discharge and biopsy-taken during surgical procedure-revealed the presence of Mycobacterium tuberculosis complex. The patient developed necrotizing otitis media, left temporal bone osteomyelitis and cervical lymphadenitis. The infant's mother was found to have an endometrial biopsy positive for M. tuberculosis suggesting the diagnosis of congenital tuberculosis.

Refractory tension pneumothorax as a result of an internally displaced thoracoamniotic shunt in an infant with a congenital pulmonary airway malformation.

Antenatally, congenital pulmonary airway malformation (CPAM) causing fetal hydrops can be palliated with thoracoamniotic shunts, which may become displaced in utero. We report a case of an infant born at 34 weeks gestational age with an antenatally diagnosed macrocystic lung lesion, fetal hydrops and an internally displaced thoracoamniotic shunt. The infant suffered refractory pneumothoraces despite multiple chest drains, and stabilised only after surgical resection of the lesion. Intraoperatively, the shunt was noted to form a connection between a type I CPAM and the pleural space. As the shunt was displaced internally, this complication was not immediately obvious during the initial resuscitation. In infants with large cystic lung lesions, clinicians should be aware that internally displaced thoracoamniotic shunts could contribute to refractory tension pneumothoraces and anticipate the need for advanced neonatal resuscitation, including early thoracocentesis or chest drain insertion. Furthermore, displaced shunts may require early surgical intervention.

Axillary temperature measurement during hypothermia treatment for neonatal hypoxic-ischaemic encephalopathy.

OBJECTIVE: To determine the accuracy of axillary temperature relative to core rectal temperature during whole-body therapeutic hypothermia for moderate-to-severe hypoxic-ischaemic encephalopathy. DESIGN: Retrospective audit. SETTING: Single tertiary neonatal intensive care unit at The Royal Women's Hospital in Australia. PATIENTS: Fifty-eight term newborn infants with moderate-to-severe hypoxic-ischaemic encephalopathy. Forty infants were treated with whole-body hypothermia between February 2001 and May 2010, 16 of whom were enrolled in the Infant Cooling Evaluation (ICE) trial, and 18 control infants randomised to normothermia in the ICE trial. INTERVENTION: Comparison of simultaneous axillary and rectal temperatures measured between 0 and 84 h post randomisation or induction of cooling. RESULTS: During the initiation of hypothermia (0-<6 h) axillary and rectal temperatures were similar (mean difference rectal-axillary =0.07°C), but with large variability (95% limits of agreement -1.18 to 1.33°C). There was larger variability in measurements between 6 and <72 h in the hypothermic infants (total SD 0.44) than in the normothermic group (total SD 0.24, p<0.001). In the hypothermic infants, the mean difference between the measurements during the rewarming phase (72-<84 h) was -0.19°C (95% limits of agreement -0.95 to 0.57°C). CONCLUSION: As there is wide variability in the difference between axillary and rectal temperatures at all stages of whole-body cooling, our data do not support the use of axillary temperature as a surrogate for core rectal temperature during therapeutic hypothermia.

A randomized, controlled trial of bedside versus conference-room case presentation in a pediatric intensive care unit.

OBJECTIVES: Case presentation and teaching performed at the bedside are declining. Patients' preference between bedside case presentation and conference-room case presentation is divergent in the literature. Residents seem to prefer the conference room. The objective of this study was to ascertain whether there was a difference of satisfaction and comfort between bedside case presentation and conference-room case presentation for the parents of patients hospitalized in the PICU and for the residents in training in the PICU. METHODS: Every child hospitalized in the PICU who had 2 consecutive morning rounds, performed in the presence of the same resident, attending pediatrician, and parent, was eligible for the study. The study began with the first patient's case presentation after admission in the PICU. Randomization was on the first case presentation: bedside or conference room. On the second day, the other type of case presentation was performed. After each round, the parents and the resident filled out a questionnaire. RESULTS: Twenty-seven parents of 22 patients answered both questionnaires, and 21 questionnaires were answered by residents. Parents' satisfaction was significantly higher during bedside case presentation (96 vs 92, answers reported on a 100-mm linear scale), they preferred bedside case presentation (95 vs 15), and they were more comfortable attending bedside teaching (89 vs 19). There was no difference in the residents' satisfaction nor in their comfort giving the actual case presentation. Residents, on the other hand, were significantly more comfortable asking questions (84 vs 69) and being asked questions (85 vs 67) during conference-room case presentation. A total of 81% of the parents wished that the next case presentation would take place at the bedside. CONCLUSIONS: This study demonstrates the feasibility of a clinical case presentation performed at the bedside in the PICU context that seems to satisfy parents without causing too much discomfort to residents. Thus, bedside case presentation could be a very good teaching strategy in university hospitals.