A feeding protocol for healthy preterm infants that shortens time to oral feeding.

OBJECTIVE: To test the hypothesis that healthy preterm infants randomly assigned to a semi-demand feeding protocol would require fewer days to attain oral feeding and have a satisfactory weight gain compared with control infants receiving standard care. STUDY DESIGN: In 2 neonatal intensive care nurseries, 81 infants 32 to < or = 34 weeks' postconceptional age were randomly assigned to the control (n = 41) or experimental (n = 40) protocol for transition from gavage to oral feedings. The control protocol followed the standard practice of gradually increasing scheduled oral feedings, whereas the experimental protocol used a semi-demand feeding method contingent on infant behavior. Analysis of variance techniques were used to compare the study groups for number of days to attain oral feeding and weight gain. RESULTS: The semi-demand method shortened the time for infants to achieve oral feeding by 5 days (P < .001). There were no differences in weight gain between the study groups, and both groups had satisfactory weight gain. CONCLUSION: The semi-demand method for the transition from gavage to oral feeding in healthy, preterm infants 32 to < or = 34 weeks postconceptional age promotes faster attainment of oral feeding and does not compromise their weight gain.

A comparison of two enuresis alarms.

This randomized experiment was undertaken to determine if any difference in success occurred between an audio versus a vibration alarm for nocturnal enuresis. Similar rates of success were achieved for 47 children, aged 6 to 12 years, who partially or totally completed the 3-month period of alarm use.

Preterm infant behavioral and heart rate responses to antenatal phenobarbital.

The effects of antenatal phenobarbital on behavioral state and heart rate (HR) were examined in a randomized sample of 49 preterm infants > 24 and < 34 weeks postconceptional age. Behavioral state and HR observations were made during a routine care giving procedure on Days 1, 2, and 3 of life. There were no differences in behavioral state and HR responses between control and experimental subjects, suggesting that antenatal phenobarbital did not have a sedative effect on experimental subjects. Infants in both study groups responded to caregiving with changes to fussy/cry behavior and increases in HR. Older infants and nonventilated infants were more often in fussy/cry states during care giving than younger infants and ventilated infants. The HR increases were not clinically important, but the behavioral changes were, suggesting that behavioral response may be a more sensitive sign of distress than HR in very young preterm infants.

Personal illness models of diabetes: parents of preadolescents and adolescents.

The purpose of this research was to explore personal illness models of parents of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the parents' cognitive representations of the disease. Fifty-five parents of children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Parents attributed the cause of diabetes to genetics coupled with a viral infection. Most believed the diabetes would last a lifetime but they were hopeful for a cure. Parents requested ongoing education for their children, support groups, counseling, one consistent healthcare provider, and intensive insulin therapy. Parents reported that the major problems caused by diabetes were increased structure of daily routines and that their children with diabetes felt different from healthy peers. Parents' fears about diabetes included long-term complications, early death, and severe insulin reactions.

Behavioral state activity during nipple feedings for preterm infants.

The purpose of this research was to examine the effect of behavioral state activity during nipple feeding on feeding success for a group of 20 preterm infants. The infants, fed per hospital policy at scheduled three-hour intervals, were observed during four early nipple feedings. Nine of the 20 infants were able to successfully nipple their four nipple feedings; the other 11 infants were unable to successfully complete their nipple feedings. The 9 successful feeders exhibited significantly more awake behavior during feeding than unsuccessful feeders (F = 7.82; p = .012). The unsuccessful feeders spent 53 percent of their feeding in sleep states; successful feeders were in sleep states only 30 percent of their feeding time. Along with other research, these findings suggest that infant behavioral state may be a key consideration for nipple feeding success in preterm infants.

Personal illness models of diabetes: preadolescents and adolescents.

The purpose of this research study was to explore personal illness models of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the adolescents' cognitive representations of their disease. Sixty children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Although most participants expressed an understanding that their disease would last a lifetime, they were hopeful for a cure. Participants wanted healthcare professionals to provide strategies for controlling blood glucose to prevent future complications. Family and friends who followed the same diet as the adolescent with diabetes were viewed as supportive. The majority of adolescents were responsible for much of their own disease management. Their greatest fears concerned insulin reactions and long-term complications such as amputation of limbs.

Parental consent for bone marrow transplantation in the case of genetic disorders.

PURPOSE: To describe the responses of mothers and fathers who were offered bone marrow transplantation (BMT) for their children with genetic disorders. DESIGN: Qualitative. SETTING: Private hospital rooms/offices. PARTICIPANTS: Six mothers and 4 fathers of children with genetic disorders. RESULTS: The basic social-psychological problem confronting the parents was the conflicting alternatives of life versus death for their children. It was certain that these children would die from their genetic disorders but without having to endure the pain and suffering of a BMT. The BMT would be difficult, possibly resulting in death, but with a chance of survival. CONCLUSIONS: Parents believed that BMT was the only chance of survival for their children, leaving them no choice except to pursue the BMT treatment.

Comparison of upper arm and calf oscillometric blood pressure measurement in preterm infants.

Although the practice of using calf blood pressure (BP) measurement is widespread, virtually no information is available about calf site BP measurements in preterm infants. This research compared oscillometric upper arm BP measurements with calf BP measurements in 65 preterm infants with a mean weight of 1629 +/- 437 gm. Differences between arm and calf BP measurements were analyzed with repeated-measures multivariate analysis of variance of systolic, diastolic, and mean arterial pressures. There were no significant differences between arm and calf systolic BP on days 1, 3, and 5 of life. With post hoc testing there was a significant difference on day 7 between systolic arm BP (60.4 +/- 8.4 mm Hg) and calf BP (57.7 +/- 7.1 mm Hg) (t = 3.68, p < 0.01). There were no significant differences between arm and calf measurements for diastolic and mean arterial pressures and no main effect from infant weight on differences between arm and calf BP. It may be reasonable to use either arm or calf BP during the first 5 days of life.

Pediatric nurses' knowledge and practice related to infant pain.

A convenience sample of 181 registered nurses completed questionnaires about their knowledge, attitudes, and clinical practice related to infant pain. The majority of respondents thought infants felt pain with the same intensity as adults and were comfortable administering narcotic and nonnarcotic pain medications. The most frequently identified infant pain cues were: crying, irritability, and inability to be consoled. There were associations between greater numbers of pain cues and higher pain severity ratings and between postlicensure education about pain and number of strategies proposed to relieve pain. There were no associations for noncritical versus critical care unit assignment or participation in postlicensure education about pain with number of assessment cues. There were no associations for pain severity or noncritical versus critical care unit assignment with pain management strategies. Until the research base about management of infant pain is expanded, nurses should continue to use and evaluate a variety of pain management interventions on a case-by-case basis.

Promotion of preterm infant nipple feeding with nonnutritive sucking.

Transition of preterm infants from enteral to nipple feeding is a necessary milestone for hospital discharge. This study tested the efficacy of one potential intervention to facilitate the transition process. Ten minutes of nonnutritive sucking (NNS) and a control condition were administered randomly before first nipple feedings. The sample consisted of 20 preterm infants (gestational ages 27-33 weeks, M = 31.6, SD = 1.7; birth weights 931-2, 140 g, M = 1,649, SD = 373) who served as their own controls. NNS resulted in fewer behavioral state changes during feedings and produced quiet, awake states more frequently during feedings. Heart rates did not differ between feedings following NNS compared with those in the control condition.

The experience of high-risk pregnancy.

OBJECTIVE: To describe the experience of high-risk pregnancy from the perspectives of mothers and fathers. DESIGN: A naturalistic inquiry using selected grounded-theory techniques. SETTING: Interviews occurred within the hospital. PARTICIPANTS: A sample of 21 parents who experienced high-risk pregnancy and the birth of a preterm infant. MAIN OUTCOME MEASURES: Responses and management of responses to high-risk pregnancy. RESULTS: Emotional responses to high-risk pregnancy were (a)vulnerability--the realization that pregnancy outcome was at risk, (b)heightened anxiety--the transition from normal activities to bed rest and hospitalization, and (c)inevitability--the imminent premature delivery of an infant with a guarded prognosis. CONCLUSIONS: These findings have relevance for perinatal nurses. Nurses who have knowledge of the emotional responses parents experience during high-risk pregnancy can provide supportive care to these individuals.

Adherence behaviors in research protocols: comparison of two interventions.

The effectiveness of an enhanced preparation intervention was compared with the standard preparation intervention for accuracy in overnight urine specimen collections. The sample consisted of 179 individuals with type I insulin-dependent diabetes mellitus (IDDM). Subjects were assigned randomly to an enhanced or standard preparation group. The enhanced preparation included written instructions, a reminder to post instructions in the bathroom, a toilet seat cover with a reminder to save urine, and a nurse-initiated telephone call to review the instructions. The standard preparation included written instructions and a telephone number to call with any questions. For subjects without previous collection experience, significantly fewer inaccurate collections were reported in the enhanced preparation group than in the standard group (chi 2 = 4.61, P < .05). There were no differences in collection accuracy between enhanced and standard groups for subjects with collection experience (chi 2 = .4598, P > .05).

Facilitating inactive awake states in preterm infants: a study of three interventions.

Inactive awake behavioral states have been associated with reduced heart rates and more successful feeding in preterm infants. The purpose of this study was to test the efficacy of three different interventions to facilitate these optimal feeding states. Twenty preterm infants (gestational ages 27-33 weeks, M = 31.6, SD = 1.7; birth weights 931-2,140 grams, M = 34, SD = 373) serving as their own controls were randomly administered nonnutritive sucking, nonnutritive sucking plus rocking, and stroking interventions; and a control condition. There were significantly more inactive awake states with the nonnutritive sucking and nonnutritive sucking plus rocking interventions than with the stroking intervention and the control conditions. The results suggest that there are interventions that can help preterm infants in the transition from gavage to oral feeding and potentially shorten their hospital stays.

Parenting growing preterm infants.

A convenience sample of 24 parents of growing preterm infants reported concerns related to their preterms' health and development, parenting abilities, family relationships, and finances.

Family functioning 2 to 4 years after preterm birth.

The purpose of the study was to determine if selected risk factors related to preterm birth continued to be associated with family functioning when preterm children were 2 to 4 years of age. A convenience sample of 55 mothers and 27 fathers participated in the survey. Parents completed the Family Dynamics Measure and the family APGAR. Multiple regression analyses were computed to examine the associations between the dependent variables for family functioning and the independent variables, which included child's developmental status, neonatal hospitalization length, adequacy of family economics, parental age, and marital status. Of these risk factors, longer neonatal hospitalizations continued to be associated with poorer family role functioning for mothers (R2 = .237, F = 2.43, p = .039).