Characteristics Associated with Sudden Unexpected Infant Death in a Rural Hispanic Population: A Case-Control Study.

INTRODUCTION: Sudden unexpected infant death (SUID) is the leading cause of death among U.S. infants aged 28 days to 1 year. In Kansas, Hispanic infant mortality is nearly 50% higher than non-Hispanic White. Further, the SUID rate did not change between 2005-2018, while rates for non-Hispanic Black and White infants decreased significantly. This study sought to identify characteristics and behaviors of Hispanic birthing persons related to SUID. METHODS: Linked Kansas birth/death vital statistics data (2005-2018) identified Hispanic birthing persons with a singleton birth who experienced SUID. To reduce confounding effects, greedy nearest neighbor matching paired each SUID case sequentially with the four nearest controls based on age, race, payor source and parity. Matching procedures, likelihood-ratio χ2, Fisher exact test and multiple logistic regression model with Firth's penalized maximum likelihood estimation were computed. RESULTS: Of 86,052 Hispanic singleton births, 66 involved SUID and were matched with 264 controls. No differences were related to marital status, population density of residence, education level, language spoken, prenatal BMI, weight gained during pregnancy, adequacy of prenatal care, enrollment in WIC, or state immunization registry participation (all p>0.05). However, tobacco use during pregnancy contributed to a three times greater risk of SUID (OR=3.208; 95% CI=1.438 to 7.154). Multivariable models for behavioral variables revealed low predictive accuracy with area under the ROC curve=0.6303. CONCLUSION: This study suggests SUID deaths to rural Hispanic families are likely multifaceted. Study results inform educational programs on the importance of addressing tobacco cessation in SUID risk reduction interventions for Hispanic families.

Concerns of women regarding pregnancy and childbirth during the COVID-19 pandemic.

OBJECTIVE: Better understand knowledge, attitudes and practices of pregnant women and mothers of infants around coronavirus disease 2019 (COVID-19). METHODS: A 58-item electronic survey was distributed to pregnant and postpartum women (infants <12 months) who were >15 years, English-speaking and enrolled in prenatal programs. Data is summarized using central tendency, frequencies and nonparametric statistics. RESULTS: Of 114 (51 % response rate) participants, 82.5 % reported negative changes in mental status measures (e.g. stress, anxious thoughts, changes in sleep patterns). All reported risk-reduction behavior changes (e.g. handwashing/use of sanitizer, social distancing). Significant changes were reported in employment and financial status due to the pandemic. Increases in alcohol consumption among postpartum women were also reported. Few reported changes in prenatal, infant or postpartum healthcare access. CONCLUSION: This study provides initial insight into the knowledge, attitudes and practices of pregnant and postpartum women during the COVID-19 pandemic. This study is limited as participants represent a single Midwest community and social desirability response bias may have impacted responses. However, results may inform future interventions to support pregnant women and mothers of infants during pandemics. PRACTICE IMPLICATIONS: Providers should consider the impact of such events on mental status, access to resources and changes in behaviors.

Assessing Work-Related Burnout and Job Satisfaction among Obstetrics and Gynecology Residency Program Coordinators.

INTRODUCTION: This study explored the prevalence of and the relationship between job satisfaction and burnout among obstetrics and gynecology residency program coordinators. METHODS: This cross-sectional study involved members of the American Program Managers of Obstetrics and Gynecology. The Copenhagen Burnout Inventory and Spector's Job Satisfaction Survey were used to measure the participants' burnout and job satisfaction rates respectively. Data were collected between August 2017 and December 2017. The authors used Fisher's exact tests, Spearman's r correlations, and multiple linear regression to analyze the data. RESULTS: There was an 83% (171/207) response rate. Thirteen percent of the coordinators reported high, 70% moderate, and 17% low job satisfaction scores. Thirty-nine percent of the coordinators reported high, 25% moderate, and 36% slight work-related burnout rates. Correlation coefficient showed a significantly negative relationship between job satisfaction and work-rated burnout, (r s [169] = -0.402, p < 0.01). Regression analysis showed co-workers (ß = -0.47) and supervision (ß = -0.16) domains of the job satisfaction scale were significant predictors of work-related burnout (R = 0.55; F[5, 195] = 11.05; p < .001). CONCLUSIONS: The findings highlight the importance of job satisfaction factors, such as support from coworkers and supervisors, in dealing with work-related burnout among residency coordinators.

Management of Hypertension on the Labor and Delivery Unit: Delivering Care in the Era of Protocols and Algorithms.

INTRODUCTION: Preeclampsia with severe hypertension, which occurs in 5% to 8% of pregnancies, is a leading cause of maternal and perinatal morbidity and mortality in the US. Early recognition and treatment of hypertensive crises can significantly reduce poor outcomes. A protocol to ensure prompt treatment with antihypertensive medication (intravenous labetalol) was implemented at our institution. OBJECTIVE: To determine adherence to this protocol on the Labor and Delivery Unit. DESIGN: Retrospective chart review was performed for patients admitted to the Labor and Delivery Unit between April 2015 and June 2015. Charts were reviewed if the patient had a diagnosis of chronic hypertension, gestational hypertension, superimposed preeclampsia, preeclampsia with severe features, eclampsia, or stroke in pregnancy. Only patients with confirmed severe blood pressures, in which the protocol would be initiated, were included in the final analysis. MAIN OUTCOME MEASURE: Overall compliance with the entire protocol. RESULTS: Of 178 cases reviewed, 58 (32.6%) had confirmed severe blood pressures. Most patients (n = 46, 79.3%) received a diagnosis of preeclampsia with severe features, and most delivered via cesarean delivery (n = 38, 65.5%). No cases were compliant with the entire labetalol protocol. Of 58 patients, 2 (3.5) adequately repeated a confirmation blood pressure within 5 minutes, and 34 (58.6%) were adequately treated with intravenous labetalol according to protocol requirements. CONCLUSION: Labetalol treatment was appropriately initiated in many cases; however, protocol adherence could greatly improve. Potential factors affecting protocol compliance include shift changes, communication issues, and conflicting protocols. Institutions should review protocol compliance to improve care.

Elastic Abdominal Binders Reduce Cesarean Pain Postoperatively: A Randomized Controlled Pilot Trial.

BACKGROUND: A potential non-pharmacologic way to reduce postoperative pain and bleeding is using an abdominal binder during postoperative recovery. This study aims to determine the effect an elastic abdominal binder has on postoperative pain and hemorrhage after cesarean delivery. METHODS: A randomized, single-site, pilot trial was conducted at two prenatal care clinics and an academic hospital in Kansas. Beginning in April 2013, 60 patients were enrolled if delivering via cesarean. Participants were randomized to receive an abdominal binder or to a control group (did not use binder). Pain levels were reported by questionnaire one day after surgery using a 0 to 10 scale, with 10 being the worst pain. Patient characteristics and blood loss were assessed by medical record review. RESULTS: Of the 56 patients completing the study, 29 (51.8%) were randomized to the binder group and 27 (48.2%) were randomized to the control group. The binder group reported significantly lower pain score (p = 0.019) and average pain score (p = 0.024). There was no difference in body mass index, age, previous surgery, infant birth weight, estimated blood loss, and average dose of pain medication during the first 24 hours after the cesarean delivery between the two groups. There was no difference in pre- and post-operative hemoglobin levels by treatment group (p = 0.406). CONCLUSIONS: Abdominal binders may be associated with improved postoperative pain scores but did not affect postoperative hemorrhage.

Developing a state-wide infrastructure for safe sleep promotion.

OBJECTIVES: Sleep-related deaths are the third leading cause of infant death in Kansas. This manuscript describes implementation of an infrastructure of regional trainers to educate on the American Academy of Pediatrics safe sleep recommendations. DESIGN: Prospective evaluation of training program on knowledge transfer. SETTING: Instructors were recruited from throughout the state of Kansas and trained to provide safe sleep education in their communities. PARTICIPANTS: Instructors were a mix of healthcare workers and community members. Their trainees encompassed both professionals and caregivers. INTERVENTION: Instructors attended a 2-day training, including completing 18-item pre and post-training knowledge tests, a training evaluation survey, and performing a portion of the structured safe sleep presentation and crib demonstration for feedback. MEASUREMENT: Instructors were evaluated before and after training. After conducting trainings in their region, instructors submitted trainees' pre and post-test results. Scores were compared using t-test. RESULTS: Twenty-three instructors were trained. Scores averaged 13.5 (SD=2.4) for the pre-test and 15.3 (SD=2.4) for the post-test. Those scoring <80% post-training (n=6) received additional instruction. In the subsequent year, 13 trainers provided safe sleep education at 21 events to a total of 378 trainees. Trainee scores averaged 11.4 (SD=2.7) on the pre-test and increased to 13.9 (SD=2.5) on the post-test (P<.001). Findings were consistent when adjusting for variation between individual trainers. CONCLUSIONS: Safe sleep instructors can be trained to disseminate safe sleep guidelines; however, only half provided at least 1 training within 1 year. Future recommendations include over-recruiting potential instructors, incorporating trainings into existing positions or otherwise incentivizing trainers.

Collaborating with obstetrical providers to promote infant safe sleep guidelines.

OBJECTIVES: To partner with obstetrical providers to increase promotion of the American Academy of Pediatrics guidelines for infant safe sleep. Specifically, this study evaluates the effectiveness of the Safe Sleep Toolkit during obstetrical visits. Secondary objectives include improving provider and maternal knowledge of safe sleep. METHODS: Obstetrical providers (n=11) and staff at an outpatient clinic were trained using the Safe Sleep Toolkit and encouraged to discuss infant safe sleep with pregnant women at their 28- or 36-week gestation appointment (n=111, 56 pre- and 55 post-intervention). Provider-reported time spent counseling women on safe sleep recommendations and safe sleep knowledge was measured before and after the intervention. Surveys were conducted with women assessing safe sleep knowledge, intention to follow guidelines, and whether safe sleep was discussed at the appointment. RESULTS: Significantly more post-intervention women reported their provider had discussed safe sleep (78% vs 32%) (P<.001). Similarly, provider-reported discussion with women increased significantly for all safe sleep guidelines (82%-90% vs 8%-12%) (all P<.001). Maternal knowledge, especially surrounding unsafe sleep practices, improved significantly post-intervention. CONCLUSION: Training obstetricians to use a toolkit to promote infant safe sleep guidelines increases the prenatal delivery of this information, and improves pregnant women's knowledge and intentions regarding safe infant sleep.