Application of the Adverse Childhood Experiences Framework to the NICU.

BACKGROUND: Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. PURPOSE: Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. METHODS: An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. RESULTS: NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. IMPLICATIONS FOR PRACTICE AND RESEARCH: Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

Family nurture intervention increases term age forebrain EEG activity: A multicenter replication trial.

OBJECTIVE: This trial (RCT-2) sought to replicate the EEG findings of a randomized controlled trial of Family Nurture Intervention in the NICU (FNI-NICU) (RCT-1) comparing infants receiving standard care (SC) with infants receiving SC plus FNI . METHODS: RCT-2 (NCT02710474) was conducted at two NICUs. Subjects were randomly assigned to receive SC or FNI during their NICU stay. The primary outcome was EEG power in the frontal polar region at 39-41 weeks gestational age (GA). Sixty preterm infants (26-34 weeks GA; 33 SC, 27 FNI) were assessed. FNI-NICU consisted of repeated calming sessions (∼4 times/week) facilitated by Nurture Specialists during which mothers engaged in emotional expression during clothed or skin-to-skin holding, vocal soothing, and eye contact. EEGs were collected from 128 leads. EEG power was computed using Fast Fourier Transforms. RESULTS: RCT-2 replicated RCT-1 results; FNI-NICU led to significantly increased frontal polar power at frequencies > 12 Hz. Effects were spatially more widespread than in RCT-1, with substantial effect sizes (∼0.50) in frontal and parietal regions. CONCLUSIONS: RCT-2 results provide further evidence that FNI-NICU increases term age brain activity. SIGNIFICANCE: FNI-NICU is designed to facilitate autonomic emotional connection and coregulation between mothers and infants in the NICU resulting in profound effects on early brain development.

Scoping Review of Microaggression as an Experience of Racism and Perinatal Health Outcomes.

OBJECTIVE: To synthesize current knowledge and identify gaps in the literature related to microaggression as an experience of racism and its influence on perinatal health outcomes. DATA SOURCES: We searched PubMed, Race Relations Abstracts, Academic Search Complete, CINAHL, PsycInfo, and Scopus using the keywords "micro-aggression" and "microaggression." Because microaggression is an all-encompassing term, we included articles that used keywords such as "racism," "prejudice," and/or "discrimination" because these terms are precursors to and touch on aspects of microaggression. We also included terms related to perinatal health outcomes. STUDY SELECTION: We included articles in which researchers reported on studies conducted in the United States. Articles focused on perinatal health outcomes, referred to microaggressions or related concepts, and were published in English from January 2014 through July 2020. We chose these dates because the term microaggression became more common in the literature around 2017 and is used primarily in the United States. Following removal of duplicates, we reviewed 2,331 titles and abstracts and identified 103 articles for full-text review. Thirteen articles met inclusion for the final sample. Screening at all levels was blinded. DATA EXTRACTION: We extracted data, including setting, study type, study design, microaggression type, results, health outcomes, and definitions of microaggression. DATA SYNTHESIS: In the selected articles, researchers addressed microaggression as an experience of racism in relation to the following perinatal health outcomes: small-for-gestational-age newborns, hypertension, preterm birth, low birth weight, and symptoms of postpartum depression or anxiety. CONCLUSION: In this scoping review, inconsistencies in how it was defined, measured, and controlled made it difficult to draw conclusions about the role microaggression plays in perinatal health outcomes. We recommend more research to explore, document, and understand this phenomenon.

Brazilian Neonatal Nurses' Palliative Care Experiences.

The purpose of palliative care (PC) is to minimize suffering and improve quality of life. Although PC has been well studied, the experience of neonatal intensive care unit (NICU) nurses in Brazil, where little PC training is provided, requires further investigation. The objective of this study was to explore the PC experiences of Brazilian NICU nurses. An exploratory, qualitative, descriptive study was conducted using semistructured, individual interviews with NICU nurses. This study was conducted in a 30-bed NICU in a teaching hospital in Sao Paulo, Brazil. A convenience sample of registered nurses (N = 9) was recruited. Interviews were recorded and transcribed verbatim, and thematic analysis was used to analyze the data. Four themes were identified: (a) living with the grief, (b) identifying with the family, (c) providing humane care, and (d) feeling unprepared. Nurses experienced intense grief while providing PC. They closely identified with the families and aimed to provide humane care that respected the families' values and the infants as human beings. The nurses also felt they lacked adequate training in PC and expressed a need for additional education and emotional support. NICU nurses need adequate education and emotional support to ensure quality nursing care for this vulnerable population of infants and their families.