Transition from gavage to nipple feeding for preterm infants with bronchopulmonary dysplasia.

BACKGROUND: The transition from gavage to nipple feeding is difficult for preterm infants with bronchopulmonary dysplasia because of tachypnea and hypoxemia from chronic respiratory distress. OBJECTIVE: The aim of this study was to test the hypothesis that preterm infants with bronchopulmonary dysplasia who transitioned from gavage to nipple feeding with the semidemand method would achieve nipple feeding sooner and be discharged from hospital sooner than control infants who received standard care. METHODS: Forty-two infants were randomized to the control condition and 44 to the experimental protocol. Mean gestational ages and birth weights were 25 ± 1.5 weeks and 784 g for controls and 25 ± 1.4 weeks and 787 g for experimental infants. Control infants received standard care that included gradual increases in the number of nipple to gavage feedings per day. Experimental infants received the semidemand method that used infant behavioral and cardiorespiratory signs to regulate frequency, length, and volume of nipple feedings. General linear model procedures were used to compare study groups. RESULTS: Experimental infants achieved nipple feeding at M = 5.9 ± 0.7 days compared with control infants, M = 12.3 ± 0.8 (p < .0001). Length of hospitalization was not significantly different between groups. DISCUSSION: The semidemand method significantly shortened the time for infants to attain nipple feeding in a manner taking their respiratory distress into consideration.

Heart rate variability responses to nipple feeding for preterm infants with bronchopulmonary dysplasia: three case studies.

Preterm infants with bronchopulmonary dysplasia (BPD) have cardiorespiratory compromise that prolongs the transition time from gavage to nipple feeding. Heart rate variability (HRV) provides an indirect measure of the autonomic nervous system's influence on heart rate and cardiorespiratory stability. The purpose of this case study was to describe HRV responses of three preterm infants with BPD during the transition from gavage to nipple feeding. The infants responded to nipple feeding with increases in sympathetic influence on heart rate, and the increase continued in the 10-minute postfeeding. The infants were capable of balancing sympathetic and parasympathetic influences on heart rate related to the work of feeding.

The relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of men who have sex with men.

Despite public health campaigns and safer sex messages, many men who have sex with men (MSM) continue to participate in high-risk sexual behaviors, which may make them vulnerable to HIV infection and sexually transmitted infections. The purpose of this study was to determine the relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of MSM. This correlational study sampled 205 MSM (M = 37 years of age, SD = +/-8) representing the diverse ethnic composition of South Florida. This sample consisted of ethnic minorities (79%) with a large number of foreign-born men (69%). Participants completed measures of depressive symptoms, self-esteem, and sexual behaviors. Results indicated that higher levels of depressive symptoms and higher levels of self-esteem had a statistically significant relationship to lower levels of safer sexual behaviors. Lower income, lower educational level, and preference for Spanish language were associated with higher levels of depressive symptoms; lower income was associated with lower levels of self-esteem; and foreign birth and a preference for Spanish language were associated with lower levels of safer sex behaviors. Higher levels of depressive symptoms and higher levels of self-esteem were associated with high-risk sexual behaviors in this sample of MSM. Further research needs to be directed at culturally specific mental health and HIV prevention strategies for these vulnerable MSM.

Heart rate variability responses of a preterm infant to kangaroo care.

OBJECTIVE: To examine the effect of kangaroo care on heart rate variability in a healthy preterm infant. DESIGN: Case study. SETTING: Private room on a postpartum unit. PARTICIPANT: A mother-preterm infant dyad. INTERVENTION: Kangaroo (skin-to-skin) care. MAIN OUTCOME MEASURE: Heart rate variability, a noninvasive measurement of the sympathetic and parasympathetic components of the autonomic nervous system's influence on heart rate. RESULTS: Heart rate variability, especially the parasympathetic component, was high when the infant was fussy in the open crib, indicating increased autonomic nervous system activity. With kangaroo care, the infant fell asleep, and both sympathetic and parasympathetic components of heart rate variability decreased. CONCLUSIONS: The wide fluctuations in the parasympathetic component of heart rate variability suggest immaturity of the sympathovagal response. Overall, kangaroo care produced changes in heart rate variability that illustrate decreasing stress.

Living with schizophrenia: a family perspective.

The lifetime emotional, social, and financial consequences experienced by individuals with schizophrenia have significant effects on their families. Family responses to having a family member with schizophrenia include: care burden, fear and embarrassment about illness signs and symptoms, uncertainty about course of the disease, lack of social support, and stigma. Study findings about families in which parents are hostile, critical, or overly involved are equivocal about whether this negative environment contributes to patient relapse. This review summarizes the studies related to the family responses and emotional environment of families who have a member with schizophrenia.

An evidence-based guideline for introducing oral feeding to healthy preterm infants.

The ability of a preterm infant to make the transition from gavage to oral nipple feeding depends on the infant's neurodevelopment in relation to behavioral organization, to a rhythmic suck-swallow-breathe pattern, and to cardiorespiratory regulation. Research-based knowledge about infant neurodevelopment in these three areas has led to the creation of a semidemand feeding method to aid in this transition. The method combines the use of nonnutritive sucking to promote awake behavior for feeding, use of behavioral assessment to identify readiness for feeding, and systematic observation of and response to infant behavior cues to regulate frequency, length, and volume of oral feedings. Semidemand feeding may be individualized for healthy preterm infants. This article discusses both the relevant knowledge about neurodevelopment and the semidemand feeding method itself.

Post-traumatic stress disorder in children and adolescents with motor vehicle-related injuries.

ISSUES AND PURPOSE: Motor vehicle crashes account for the greatest number of childhood injuries, but there has been little study of the psychological responses. DESIGN AND METHODS: This longitudinal, descriptive study included 143 children 7 to 15 years of age who experienced a motor vehicle-related injury. Parents/guardians completed the Child Behavior Checklist Behavioral Problem Scale. Each child and parent completed the post-traumatic stress disorder (PTSD) section of the Diagnostic Interview for Children and Adolescents at 2 and 6 months postinjury. RESULTS: Twenty-two percent of the children met criteria for PTSD. There were no associations for presence or absence of PTSD with age, gender, race, injury, or cause of injury. PRACTICE IMPLICATIONS: Children who are injured in motor vehicle crashes are at risk for PTSD. Anticipatory guidance about behavioral distress symptoms should be provided to parents of children who experience motor vehicle related injuries.