Cross-Sectional Study of Influences on Maternal Decisions Regarding Feeding Premature and Ill Neonates.

This cross-sectional study investigated the influences on feeding decisions made by mothers of infants admitted to neonatal intensive care units. The primary aims were to describe discrete influences on maternal behavior and to test Fishbein and Azjen's Theory of Planned Behavior in the neonatal intensive care unit (NICU) setting. The study included a convenience sample of 445 mothers in North Texas and Wisconsin. An investigator-designed tool was administered to subjects by research team members in the study units. Significant differences between minority and dominant racial groups emerged, which highlight known disparities in perinatal outcomes. Results supported the Theory of Planned Behavior and demonstrated predictors of exclusive breastfeeding at discharge including intention, race/ethnicity, length of stay in the NICU, and beliefs that the following factors influenced feeding decisions: having help with chores or childcare at home, talking with mothers in the NICU, having the NICU nurse help with feeding, and space for breastfeeding in the NICU. Incidental findings included the observation that mothers in the only NICU with private rooms were significantly more likely to report fatigue and to perceive that unit busyness, space, and privacy affected their feeding decisions, although there was no difference in breastfeeding at discharge between this NICU and others.

Integrative Review of Lower Extremity Nerve Injury During Vaginal Birth.

OBJECTIVE: To describe the incidence, health effects, risk factors, and practice implications of lower extremity nerve injury (LENI) related to vaginal births. DATA SOURCES: We searched MEDLINE, CINAHL, and PubMed from 2000 to 2020 for peer-reviewed published case reports and research studies of LENI related to vaginal births. STUDY SELECTION: We identified 188 potential records, and 20 met inclusion criteria (six research studies and 14 case studies). DATA EXTRACTION: Three independent reviewers extracted details of injuries and births into an Excel spreadsheet and analyzed data using SPSS. DATA SYNTHESIS: Using birth data from each case study and from four of the six research articles, we found the incidence of LENI in vaginal births was 0.3% to 1.8%. The description of health effects includes affected nerves and the location, description, and duration of symptoms. Analyses of risk factors were limited by missing birth data (length of second stage, birth weight, etc). Vaginal births with LENI were 76% spontaneous, 77% with neuraxial anesthesia, and 64% first vaginal birth. Practice implications focused on prevention through specific positioning strategies. Despite nurses being the primary caregivers during labor, LENI was reported most often in anesthesia journals with virtually no reports in nursing journals. CONCLUSION: LENI is a potential complication of vaginal birth, and little published research is available on prevention and prognosis. While obstetric and anesthesia factors can cause or contribute to nerve injury, LENI is usually caused by positioning and is considered preventable. Care recommendations include the following: avoid prolonged hyperflexion of women's thighs and knees; minimize time in lithotomy, squatting, or kneeling positions; prevent hand or other deep pressure on lateral knee and posterior thigh areas; avoid motor-blocking neuraxial (epidural) anesthesia; and implement frequent repositioning. The paucity of literature contributes to the lack of awareness of LENI among clinicians.

Informing New Mothers about Newborn Screening Bloodspot Repositories during Postpartum Hospitalization.

PURPOSE: The primary goals of the study were to assess maternal knowledge and attitudes about the newborn screening bloodspot repository program in Texas and to evaluate the effect of a video about the bloodspot repository on the rate of parental permission to store infant bloodspots. DESIGN: This descriptive, comparative study used descriptive statistics, nonparametric tests, and multivariable analyses to describe the sample, compare groups, and determine associations between factors that influenced parents' decisions to permit state storage of infant bloodspots. RESULTS: There were 465 mothers in the study. Maternal knowledge about basic genetics and risks of genetic testing was poor, but mothers reported strong trust in the state to make good decisions about using genetic material for research. Race, ethnicity, and attitude toward research significantly influenced decisions to opt-in to the bloodspot storage program. Postpartum nurses provided the bulk of information about newborn screening and dried bloodspots, although 2/3 of respondents would have preferred to obtain this information prior to birth. CLINICAL IMPLICATIONS: Although postpartum nurses are the most common source of information about newborn screening, genuine informed consent for bloodspot storage is questionable. Information about newborn screening and bloodspot storage needs to be addressed in community venues prior to birth.

Response to a National Issue: Moving Beyond "Back to Sleep" at Three Hospitals.

PURPOSE: To measure changes in registered nurse (RN) knowledge/beliefs and practices, parents' recall of infant safe sleep (ISS) teaching, and inpatient infant sleep environments and safety after implementing an ISS initiative. DESIGN AND METHODS: This longitudinal quasi-experimental study took place in three hospitals in the United States. An existing infant safe sleep tool was revised and updated to align with current recommendations on sleep environments. A bundled intervention included educating nurses, changing unit processes and implementing crib cards and room signs. Paired questionnaires surveyed 62 nurses before and 2 months after the intervention. Audits of 462 cribs/sleep environments with parent conversations assessed infant sleep conditions and parents' recall of RN teaching before and after the intervention. RESULTS: After Bonferroni correction, eight of 19 items for RN knowledge/beliefs and self-reported practice showed statistically significant improvements with moderate effect sizes. All 11 items for parents' recall of RN teaching showed statistically significant improvements, with odds ratios ranging from 7 to 76. Five of six real-time sleep safety conditions (from crib/sleep environment audits) had statistically significant improvements. Odds ratios ranged from eight to 83. CONCLUSION: An updated educational tool improved nurses' and parents' knowledge and practices related to current and updated safety factors for infant sleep conditions. Inpatient adherence to infant sleep safety recommendations improved. PRACTICE IMPLICATIONS: A two-hour investment of nurses' time yielded statistically significant improvements. Factors critical to the success of the ISS project roll-out are reported. Improvements in parents' recall of teaching and actual sleep environments suggest potential for long-term changes in infant safety at home.

Epithelioid myxofibrosarcoma developing at the injection site of Adalimumab therapy for psoriatic synovitis.

The interplay between inflammation and cancer is the subject of intense interest. The recent approval of a number of checkpoint inhibitors has opened novel therapeutic pathways for several cancers. Conversely, biologic suppressors of inflammation, such as Tumor Necrosis Factor (TNF) inhibitors, have been utilized over the past two decades for the management of chronic inflammatory autoimmune diseases. While the overall rates of malignancy in patients using anti TNF therapies are not elevated, increased risk has been established for cutaneous malignancy, particularly carcinoma. In subsets of patients, such as those with rheumatoid arthritis, a modestly increased incidence of melanoma is also documented. Herewith, we present the first reported instance of a sarcoma of the dermis and superficial subcutaneous tissue at the injection site of Adalimumab in a woman being treated for psoriatic synovitis. We review the literature and suggest that a more nuanced documentation of adverse events is needed to clarify the iatrogenic risk of rare cancers, such as soft tissue sarcomas, in patients taking these biological therapies.

Developing and Testing a Vaginal Delivery Safety Checklist.

Communication failures are the most common root causes of perinatal deaths and injuries. We designed and tested a Vaginal Delivery Safety Checklist to improve communication and assist delivery teams' risk assessments and plans for potential complications of vaginal birth. Delivery teams found the checklist easy, convenient, and helpful. Teams completed the checklist within 2 to 3 minutes and showed improved teamwork, communication, and decision making.

Maternal attitudes and knowledge about newborn screening.

PURPOSE: To determine whether mothers of newborns understand basic facts about newborn screening (NBS), and how they feel about state retention of dried bloodspots (DBS) for research use. DESIGN: This study was a cross-sectional survey administered to 548 mothers of newborns in postpartum units in five different hospitals in north Texas after Institutional Review Board approval. Each participating site delivered and collected surveys using systems that were convenient for them. The survey instrument used in this study is the Maternal Attitudes and Knowledge about Newborn Screening Survey. The survey was developed by the investigators. Summary statistics were provided for each participating site and surveys were combined for final data analysis. Multiple regression analysis was used to quantify associations between responses and demographic variables. RESULTS: Overall, knowledge about details of NBS and DBS retention was inadequate. The most frequent source of information about NBS was the postpartum nurse. Mothers tended to believe that using newborn bloodspots for research was a good thing, but Medicaid recipients and minorities were more reluctant than others to share dried bloodspots for research. CLINICAL IMPLICATIONS: Mothers are not fully informed about NBS or the use of infant bloodspots for research. Bloodspot storage in Texas could shrink under new opt-in policies, constraining a resource needed for genetic and other research. Further research to design and test educational interventions that are sensitive to the concerns of parents about DBS storage and that can be efficiently implemented antenatally is needed.