Comparison of continuous versus intermittent sucking in very-low-birth-weight infants.

OBJECTIVE: To examine the effects of continuous and intermittent sucking on breathing and sucking during oral feedings in very-low-birth-weight infants. DESIGN: A quasi-experimental, within-subjects design with random assignment. Infants were observed twice in 1 day, once with a nasogastric tube and once without, in random order. SETTING: A Midwestern university-affiliated tertiary neonatal medical center. PARTICIPANTS: Eighteen very-low-birth-weight infants without severe neurologic problems or physical anomalies. On the day of the study, postnatal days were 17-82 days (M = 47.7, SD = +/- 19.3). INTERVENTIONS: Continuous sucking and intermittent sucking periods. MAIN OUTCOME MEASURES: Breathing parameters from prefeed to continuous sucking, and intermittent sucking to postfeed periods; and sucking parameters from continuous sucking to intermittent sucking were examined. RESULTS: Continuous sucking had more detrimental effects on infants' breathing (p < .05), with stronger sucking (p < .05) and more formula milk intake (p < .05) than intermittent sucking. Different patterns of change between continuous sucking and intermittent sucking indicated that continuous sucking affected breathing, oxygenation, and sucking more than did intermittent sucking. CONCLUSIONS: Nurses who feed very-low-birth-weight infants should learn to observe different sucking periods and breathing pauses during continuous sucking periods, particularly during the 1st minute of bottle feeding.

Nursing research in Taiwan.

Nursing research in Taiwan has evolved over the past 30 years. This review focused on refereed publications, research published in English, and specifically the 27 studies produced by doctorally prepared first authors. Most investigators used surveys and interviews. Designs were at the levels of description, association, and evaluation, not at the level of experiment. Problems are identified for this body of research. Further evolution of nursing science in Taiwan needs to incorporate the scientific and technologic resources of the world to develop nursing knowledge.

Meta-analysis of the effects of nonnutritive sucking on heart rate and peripheral oxygenation: research from the past 30 years.

A meta-analysis of the effects of nonnutritive sucking (NNS) on heart rate and transcutaneous oxygen tension (TcPaO2) was performed. Four studies of NNS on heart rate without stimulations, three studies on heart rate during painful stimulations, and three studies on TcPaO2--all conducted over the past 30 years--were found through a computer search. Using the Fisher combined test, NNS significantly decreased heart rate without stimulations (p = .002) and during painful stimulations (p = .0001), and significantly increased TcPaO2 (p = .0001). The total weighted effect size for heart rate without stimulations was small (0.17); however, it was large for heart rate during painful stimulations (1.05) and TcPaO2 (0.69). Larger effects were noticed for preterm infants than for term infants and for longer NNS. More studies of NNS effects with independent treatment and control groups, using the physiological outcome variables of heart rate and oxygenation for different age groups of preterm infants, are needed to examine the fundamental mechanisms of NNS effects. Clinically, a low-risk intervention such as NNS can be more broadly used during any painful procedures to decrease infant distress.

The history of the neonatal nurse practitioner in the United States.

Emergence of the neonatal nurse practitioner role in the 1970s was influenced by improved care for high-risk neonates, the expanding role of neonatal nursing, medical staff shortages, and the nurse practitioner movement. The role continued to evolve in the 1980s and 1990s. This article chronicles the development of the neonatal nurse practitioner role, education, and certification.

A survey of gastric tube practices in level II and level III nurseries.

Gastric tube placement practices were identified by a telephone survey of 113 Level II and Level III nurseries in five states (Indiana, Kentucky, Michigan, Ohio, and Pennsylvania). The purpose was to examine current practice and the rationale for practice with fragile preterm infants. Twenty-one percent of the nurseries inserted only orogastric (OG) tubes, 13% used only nasogastric (NG) tubes, and 66% used both NG and OG tubes. Of those that placed an NG or OG tube, 50% did so continuously, 5% placed it intermittently, and 45% placed the tube both continuously and intermittently, for different reasons. The average time interval to change a tube was 47.81 hr (+/-36.37), and the range was 8 to 168 hr. To calculate the length of tube insertion. 98% of nurseries measured from nose or mouth to earlobe then to the xiphoid process. To validate tube placement, 82% used an auscultation technique, and 60% had rules about replacing gastric aspirates. These findings indicate a great variability of practices in gastric tube placements and a reliance on tradition of practitioners working with preterm infants. The findings point to the need for further research on the most efficient practices and the importance of using research findings in nurseries.

Desaturation events during oral feedings with and without a nasogastric tube in very low birth weight infants.

OBJECTIVE: To examine the desaturation events with the presence and absence of a nasogastric tube during an entire oral feeding in 20 very low birth weight (VLBW) infants. DESIGN: Prospective, quasi-experimental, random assignment. SETTING: Midwestern, university-affiliated, tertiary neonatal medical center. PATIENTS: Twenty VLBW infants without severe neurologic problems or physical anomalies. On the day of the study, postnatal days were 17 to 82 days (49+/-18.91). OUTCOME MEASURES: Desaturation events. INTERVENTION: These infants were observed during oral feedings, once with a nasogastric tube and once without, at 9 am and 3 pm feedings within 1 day, decided in random order. RESULTS: Fifteen infants experienced 166 desaturation events (<90%), 83 desaturation events without the nasogastric tube, and 83 events with the nasogastric tube present. Infants for whom desaturation events developed has a longer transition period from tube feedings to oral feedings (p<0.05), and started feedings with lower oxygen saturation (p<0.05). Nearly all desaturation events (97%) occurred with breathing pauses (11.32+/-6.67 seconds), a change in heart rate, and an increase in end-tidal CO2. The presence of a nasogastric tube increased the duration of desaturation by an average of 8 seconds (p<0.05). CONCLUSION: Infants' oxygen saturation needs to be monitored with feedings, and feedings may need to be started with a baseline lowest saturation of 95% or higher, monitored with breathing and heart rate to prevent desaturation.

Nasogastric tube placement: effects on breathing and sucking in very-low-birth-weight infants.

Eighteen very-low-birth-weight (VLBW) infants who met study criteria were observed during routinely scheduled feedings, twice in one day, once with a nasogastric (NG) tube and once without, in random order. Breathing and sucking measurements were compared with and without NG tube placement. During the prefeed period, minute ventilation and tidal volume were significantly lower with an NG tube than without the tube. During the continuous sucking (CS) period after commencement of oral feeding, minute ventilation, tidal volume, pulse rate, and oxygen saturation were also lower with the tube. During both CS and subsequent intermittent sucking periods, infants sucked less forcefully and took less formula with the tube. Based on these findings, if VLBW infants have an NG tube in place, clinicians are urged to monitor for breathing compromise, oxygen desaturation, and bradycardia during oral feeding.

Comparison of morning and afternoon feedings in very low birth weight infants.

The purpose of this study was to compare sucking and breathing rhythmicity in very-low-birth-weight (VLBW, < 1,500 g) infants during morning feedings and afternoon feedings. Nine infants were fed at 9 a.m., and nine at 3 p.m. Eight morning-fed infants and 8 afternoon-fed infants had a continuous sucking (CS) period at the beginning of the feeding; 9 morning- and 8 afternoon-fed infants had an intermittent sucking (IS) period during which sucking bursts alternated with sucking pauses. Morning-fed infants had a lower respiratory rate during CS (p < .1) and IS (p < .05), a greater decrease in minute ventilation from the pre-feed period to the CS period (p < .05), and lower sucking pressure during IS (p < .05) than afternoon-fed infants. Breathing and sucking rhythmicity scores were calculated as an indicator of the coordination of sucking and breathing. Morning-fed infants had lower scores than afternoon-fed infants (p < .05). These findings suggest that morning feedings are more difficult than afternoon feedings for VLBW infants and point to the need for further studies to compare morning and afternoon feedings.

Child and family reactions during and after pediatric ICU hospitalization: a pilot study.

OBJECTIVE: To describe child behaviors and level of family functioning after discharge from the pediatric ICU (PICU) and to begin to explore the relationship of family reactions and the child's severity of illness to child and family outcomes after discharge. DESIGN: Exploratory, repeated measures: Time 1 (T1) at 24 hours after admission; Time 2 (T2) at 2 to 4 weeks after hospital discharge. SUBJECTS: Nine mothers and fathers of children who were 5 years of age or younger, hospitalized in a PICU for at least 1 day, expected to survive. MAIN STUDY MEASURES: Parental Concern Scale and Parental Stressor Scale: PICU at T1; Posthospitalization Behavior Questionnaire at T2; Feetham Family Functioning Survey and FACES III, at both T1 and T2; and Pediatric Risk of Mortality to measure illness severity. RESULTS: Mothers' cohesion scores decreased significantly from T1 to T2. Scores from the Pediatric Risk of Mortality were not related to family measures. Mothers' family cohesion and satisfaction with family after discharge were negatively related to time the child was intubated. Few family measures were related to the Parental Concern Scale and Parental Stressor Scale: PICU subscales. CONCLUSIONS: PICU admission of a child is a stressful event for parents, independent of the child's illness severity. Mothers' perceptions of family may be negatively affected.

Characteristics of a child's critical illness and parents' reactions: preliminary report of a pilot study.

OBJECTIVE: To explore the relationships between parents' reactions to the pediatric intensive care unit admission of a child and characteristics of the child's illness. METHOD: A convenience sample, consisting of 16 mothers and 13 fathers of 16 children aged 5 years and younger, was used. The Pediatric Risk of Mortality scale was used to measure severity of illness. Parental reactions were measured at about 24 hours after the child's admission with the Parental Stressor Scale: PICU and the Parental Concerns Scale. RESULTS: Mothers' concerns and stressors were not related to the child's Pediatric Risk of Mortality score. However, fathers reported greater concern about the child's experience and about parenting as the child's Pediatric Risk of Mortality score increased. CONCLUSIONS: Parents' reactions to their child's critical illness and admission to the pediatric intensive care unit were not related to characteristics of the child's condition in this small sample. Future research needs are suggested.

Fluid and electrolyte problems of infants of very low birth weight.

Advances in providing care for infants of very low birth weight have improved their survival status. Because the fundamental problem for these infants is physical immaturity, the balance of fluids and electrolytes is a complex phenomenon to assess and manage. In managing the major problems of fluid and electrolyte balance for these infants, the controversy of fluid restriction versus fluid replenishment has persisted to the present. Thus, the challenge of managing fluid and electrolyte therapy remains to be conquered in the next decade, providing chances for nurses' to expand their role in neonatal intensive care units. They will become more involved and will take on supervisory roles in managing the fluid and electrolyte balance of these infants.