Effect of Skin-to-Skin Holding on Stress in Mothers of Late-Preterm Infants: A Randomized Controlled Trial.

PURPOSE: To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding. DESIGN AND METHODS: This was a longitudinal 2-group randomized controlled trial of 40 infant-mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest. OUTCOME MEASURE: Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions. RESULTS: The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infant's length of stay and SCRIP score. IMPLICATIONS FOR PRACTICE: Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship. IMPLICATIONS FOR RESEARCH: The relationship between increased stress and the number of hours of SSC holding warrants further investigation.

The NICU Parent Risk Evaluation and Engagement Model and Instrument (PREEMI) for neonates in intensive care units.

Engagement is a fairly new concept in practice and research and is gaining the interest of federal and private regulators, clinicians, and researchers. In this article, we offer a standard definition and outline an engagement model and an instrument for early prediction and identification of low engagement in at-risk parents of late preterm infants. The Parent Risk Evaluation and Engagement Model and Instrument (PREEMI), its theoretical underpinnings, instrument design, and practical application and future research are discussed.

Embrace: addressing anticipatory grief and bereavement in the perinatal population: a palliative care case study.

Anticipatory grief is experienced by families who are informed that their unborn child may not survive in utero or during or after delivery. The child who survives delivery, but is critically ill, brings a combination of emotions to the family: joy in welcoming a new life and fear for the future. The healthcare team members caring for the patient and family often witness this grief and are impacted. In the perinatal setting, the care continuum for these patients begins at diagnosis, typically in the prenatal setting, and continued support extends beyond the presumed life expectancy of the child. This case study is provided to demonstrate the utilization of a palliative care interdisciplinary approach to meeting the complex bereavement needs of a family who was expecting a child with a life-impacting congenital condition.

Three phase II cytokine working group trials of gp100 (210M) peptide plus high-dose interleukin-2 in patients with HLA-A2-positive advanced melanoma.

PURPOSE: High-dose interleukin-2 (IL-2) induces responses in 15% to 20% of patients with advanced melanoma; 5% to 8% are durable complete responses (CRs). The HLA-A2-restricted, modified gp100 peptide (210M) induces T-cell immunity in vivo and has little antitumor activity but, combined with high-dose IL-2, reportedly has a 42% (13 of 31 patients) response rate (RR). We evaluated 210M with one of three different IL-2 schedules to determine whether a basis exists for a phase III trial. PATIENTS AND METHODS: In three separate phase II trials, patients with melanoma received 210M subcutaneously during weeks 1, 4, 7, and 10 and standard high-dose IL-2 during weeks 1 and 3 (trial 1), weeks 7 and 9 (trial 2), or weeks 1, 4, 7, and 10 (trial 3). Immune assays were performed on peripheral-blood mononuclear cells collected before and after treatment. RESULTS: From 1998 to 2003, 131 patients with HLA-A2-positive were enrolled. With 60-month median follow-up time, the overall RR for 121 assessable patients was 16.5% (95% CI, 10% to 26%); the RRs were 23.8% in trial 1 (42 patients), 12.5% in trial 2 (40 patients), and 12.8% in trial 3 (39 patients). There were 11 CRs (9%) and nine partial responses (7%), with 11 patients (9%) progression free at >or= 30 months. Immune studies including assays of CD3-zeta expression and numbers of CD4(+)/CD25(+)/FoxP3(+) regulatory T cells, CD15(+)/CD11b(+)/CD14(-) immature myeloid-derived cells, and CD8(+)gp100 tetramer-positive cells in the blood did not correlate with clinical benefit. CONCLUSION: The results again demonstrate efficacy of high-dose IL-2 in advanced melanoma but did not demonstrate the promising clinical activity reported with vaccine and high-dose IL-2 in any of three phase II trials.