What Is the Experience of Babywearing a NICU Graduate?

OBJECTIVE: To understand the experiences of caregivers using baby carriers to hold their infant after discharge from the NICU. DESIGN: The qualitative research design was transcendental phenomenology. SETTING/LOCAL PROBLEM: Caregiving of NICU graduates is associated with greater incidence of depression, anxiety, and posttraumatic stress disorder, which can impair caregivers' abilities to form secure attachments with their infants. In addition, lack of paid parental leave, especially among those of low socioeconomic status, can result in prolonged separations between infants and caregivers in the NICU, producing toxic stressors. PARTICIPANTS: Eight caregivers ages 21 to 41 years whose infants were discharged from the NICU of a regional referral academic medical center in Oklahoma City, Oklahoma. Homogenous convenience sampling was used by posting recruitment flyers in common areas of the NICU frequented by family members. INTERVENTION/MEASUREMENTS: Participants were educated before discharge on using baby carriers that held their infants in kangaroo position. They were asked to carry their infant in the carrier for 3 hours a day for the 2-month study period. RESULTS: Six total themes were identified; four were previously identified in kangaroo care and skin-to-skin care research: Decreased Stress and Anxiety, Calmness and Sleep, Attachment, and Parental Empowerment; two were independent to this study: Ease of Work and Self-Care. CONCLUSION: The themes identified indicate that babywearing has the potential to address harms-such as stress, fear, depression, anxiety, and posttraumatic stress disorder-that may be experienced by caregivers of infants discharged from the NICU. Babywearing can be used as an intervention to support caregivers and promote positive health outcomes after a NICU discharge.

Pressure Redistribution Crib Mattress: A Quality Improvement Project.

BACKGROUND: Selective use of pressure-redistributing support surfaces is considered an essential component of a pressure injury prevention bundle. Critically ill children who are too big for an isolette but too little for a bed are usually placed in critical care cribs that have unique features such as moveable side rails and a built-in scale for weighing the patient, but they do not have a mattress designed to redistribute pressure. The primary aim of this quality improvement project was to evaluate a pressure redistribution mattress designed for use in critical care cribs. CASES: We retrospectively reviewed 22 charts of critically ill pediatric patients who participated in a product trial completed over a 12-week period in a stand-alone children's hospital in the Western United States. We reviewed demographic data, skin assessments, Braden Q Scale score, and support surface use. Our review revealed no pressure injury occurrences over the 12-week data collection period. CONCLUSIONS: Findings from this quality improvement project suggest that the pressure-redistributing mattress, when used as part of an intervention bundle, prevents pressure injuries in critically ill pediatric patients.

Concurrent validity between instruments of assessment of motor development in infants exposed to HIV.

BACKGROUND: Exposure to HIV during pregnancy is a risks to development. Exposed child should have assessed its development since birth. Alberta Infant Motor Scale is a tool which assess gross motor skills, with easy application and low cost. Up to now, this scale had not proven its validity for the population exposed to HIV. It's necessary to compare its with a gold standard tool, Bayley scale, which assess gross and fine motor skills, has a high cost and longer application time required. Studies compare results of Alberta with Bayley's total motor score (gross + fine). However, it's also necessary to compare Alberta's result with only Bayley's gross motor result, because it's what both evaluate in common. AIMS: to verify the concurrent validity of AIMS in infants exposed to HIV; to verify the correlation of AIMS and BSITD III for this population and to compare if these coefficients differ in the central age groups and extremities of the AIMS. METHODS: 82 infants exposed to HIV evaluated in 1st, 2nd, 3rd, 4th, 8th, 12th, 15th, 16th, 17th and 18th months, with Alberta Infant Motor Scale and Bayley Scale (motor subscale). For analysis of concurrent validity, results of raw scores of the scales were compared with the correlation analysis. First analysis: Alberta's score with Bayley's total (gross + fine) motor score. Second analysis: Alberta's score with Bayley's gross motor score. RESULTS: In the first correlation analysis, results were: r = 0.62 in 1 st month, r = 0.64 in 2nd month, r = 0.08 in 3rd month, r = 0.45 in 4th month; r = 0.62 in 8th month, r = 0.60 in the 12th month. In the second correlation analysis, results were: r = 0.69 in 1 st month; r = 0.58 in 2nd month; r = 0.25 in 3rd month; r = 0.45 in the 4th month; r = 0.77 in 8th month; r = 0.73 in 12th month. Analyzes of the 15th, 16th, 17th and 18th months couldn't be performed because at these ages all the children had already reached the maximum score in the AIMS. Results were significant and indicate correlation between scales. Found results agree with other studies that found high correlations between the scales in premature and risk groups. However, these studies compare results of gross motor skills assessments with gross and fine motor skills assessments. Our results show that correlation only between the gross motor skills have higher coefficient values, and we believe this is the best way to compare the scales, with what both assessed in common. CONCLUSIONS: Alberta scale has correlation with Bayley scale in assessing of children exposed to HIV, and can be a substitute to Bayley in assessing of these children. Results are stronger when comparing only what both scales assess in common.

Assessing tether anchor labeling and usability in pickup trucks.

OBJECTIVE: The objective of this study was to investigate vehicle factors associated with child restraint tether use and misuse in pickup trucks and evaluate 4 labeling interventions designed to educate consumers on proper tether use. METHODS: Volunteer testing was performed with 24 subjects and 4 different pickup trucks. Each subject performed 8 child restraint installations among the 4 pickups using 2 forward-facing restraints: a Britax Marathon G4.1 and an Evenflo Triumph. Vehicles were selected to represent 4 different implementations of tether anchors among pickups: plastic loop routers (Chevrolet Silverado), webbing routers (Ram), back wall anchors (Nissan Frontier), and webbing routers plus metal anchors (Toyota Tundra). Interventions included a diagram label, Quick Response (QR) Code linked to video instruction, coordinating text label, and contrasting text tag. RESULTS: Subjects used the child restraint tether in 93% of trials. However, tether use was completely correct in only 9% of trials. An installation was considered functional if the subject attached the tether to a tether anchor and had a tight installation (ignoring routing and head restraint position); 28% of subjects achieved a functional installation. The most common installation error was attaching the tether hook to the anchor/router directly behind the child restraint (near the top of the seatback) rather than placing the tether through the router and attaching it to the anchor in the adjacent seating position. The Nissan Frontier, with the anchor located on the back wall of the cab, had the highest rate of correct installations but also had the highest rate of attaching the tether to components other than the tether anchor (seat adjustor, child restraint storage hook, around head restraint). None of the labeling interventions had a significant effect on correct installation; not a single subject scanned the QR Code to access the video instruction. Subjects with the most successful installations spent extensive time reviewing the vehicle manuals. CONCLUSION: Current implementations of tether anchors among pickup trucks are not intuitive for child restraint installations, and alternate designs should be explored. Several different labeling interventions were ineffective at achieving correct tether use in pickup trucks.

Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep.

There have been various campaigns and recommendations to decrease the incidence of sudden unexpected infant death. Despite this, caregivers continue to place infants in unsafe sleeping environments. These environments, such as sitting devices, slings, carriers, and car seats, pose a significant risk to an infant's safety because of the risk from suffocation and cardiorespiratory instability. It is important for health care providers to understand the appropriate use of car seats, slings, and other sitting devices, to model appropriate behaviors, and to educate parents and caregivers. All parents, hospital staff, and other caregivers should understand the potential dangers associated with the inappropriate use of sitting devices for routine sleep.

Safe Sleep Guideline Adherence in Nationwide Marketing of Infant Cribs and Products.

BACKGROUND: Sudden infant death syndrome and sleep-related sudden unexpected infant death remain leading causes of infant mortality in the United States despite 4 safe sleep guideline restatements over the previous 24 years. Advertising and retail crib displays often promote infant sleep environments that are counter to the most recent American Academy of Pediatrics (AAP) guidelines. METHODS: Magazine advertisements featuring sleep in parenting magazines from 1992, 2010, and 2015 were reviewed for adherence. Crib displays from nationwide retailers were surveyed for adherence to the latest AAP safe sleep guidelines. The primary outcome was adherence to the guidelines. RESULTS: Of 1758 retail crib displays reviewed, only half adhered to the latest AAP guidelines. The most common reasons for nonadherence were the use of bumper pads and loose bedding. The depiction of infant cribs and sleep products in magazine advertising has become significantly more adherent over time; however, 35% of current advertisements depict nonadherent, unsafe sleep environments. Magazine advertising portraying safe sleep environments revealed racial and ethnic disparities. CONCLUSIONS: Although improvements have been made over time with increased adherence to AAP safe sleep guidelines, significant deficiencies remain. Advertising continues to depict unsafe sleep environments. Crib manufacturers and retail establishments continue to market and sell bedding and sleep products considered unsafe by the AAP in approximately half of retail crib displays. Pediatric and public health care providers should continue educational and advocacy efforts aimed at the public, but should also include retailers, manufacturers, and advertising professionals to foster improved sleep environments for all children.

The recent fall in postperinatal mortality in New Zealand and the Safe Sleep programme.

AIM: Postneonatal mortality rates changed very little from 2000 until recently. There has been a decrease in mortality in New Zealand from 2009 to 2015. This study describes an infant Safe Sleep programme and postulates it is the cause for the recent decrease in deaths. METHODS: The Safe Sleep programme involved as follows: a focus on preventing accidental suffocation, a 'blitz' approach to SUDI education, the targeted provision of portable infant Safe Sleep devices (ISSD) and the development of Safe Sleep policy across all district health boards (DHBs). RESULTS: Participation in the education 'blitz' by health professionals exceeded one in 23 live births, distribution of Safe Sleep leaflets exceeded two for every live birth, and over 16 500 ISSDs have been distributed to vulnerable infants. Postperinatal mortality fell 29% from 2009 to 2015 (2.8 to 2.0/1000 live births). The fall has been greatest for Maori and in regions with the most intensive programmes. CONCLUSION: The recent fall in postperinatal mortality has not happened by chance. It is likely that the components of end-stage prevention strategy, a focus on preventing accidental suffocation, the education 'blitz', the targeted supply of ISSDs and strengthened health policy, have all contributed to varying degrees.

Evaluation of bedtime basics for babies: a national crib distribution program to reduce the risk of sleep-related sudden infant deaths.

Rates of sleep-related infant deaths have remained stagnant in recent years. Although most parents are aware of safe sleep recommendations, barriers to adherence, including lack of access to a safe crib, remain. The objective of this study was to describe parental knowledge and practices regarding infant sleep position, bedsharing, pacifier use, and feeding practices before and after receipt of a free crib and safe sleep education. Bedtime Basics for Babies (BBB) enrolled high-risk families in Washington, Indiana, and Washington, DC and provided them with cribs and safe sleep education. Parents completed surveys before ("prenatal" and "postnatal") and 1-3 months after crib receipt ("follow-up"). Descriptive and bivariate analyses were completed. 3,303 prenatal, 1,483 postnatal, and 1,729 follow-up surveys were collected. Parental knowledge of recommended infant sleep position improved from 76% (prenatal) and 77% (postnatal) to 94% after crib receipt (p < 0.001). Intended use of supine positioning increased from 84% (prenatal) and 80% (postnatal) to 87% after the intervention (p < 0.001). Although only 8% of parents intended to bedshare when asked prenatally, 38% of parents receiving the crib after the infant's birth reported that they had bedshared the night before. This decreased to 16% after the intervention. Ninety percent reported that the baby slept in a crib after the intervention, compared with 51% postnatally (p < 0.01). BBB was successful in changing knowledge and practices in the majority of high-risk participants with regards to placing the infant supine in a crib for sleep. Crib distribution and safe sleep education positively influence knowledge and practices about safe sleep.

Factors affecting tether use and correct use in child restraint installations.

INTRODUCTION: Field studies show that top tethers go unused in half of forward-facing child restraint installations. METHOD: In this study, parent volunteers were asked to use the Lower Anchors and Tethers for Children (LATCH) to install child restraints in several vehicles to identify tether anchor characteristics that are associated with tether use. Thirty-seven volunteers were assigned to four groups. Each group tested two forward-facing child restraints in four of 16 vehicle models. Logistic regression models were used to identify predictors of tether use and correct use. RESULTS: Subjects used the tether in 89% of the 294 forward-facing child restraint installations and attached the tether correctly in 57% of the installations. Tethers were more likely to be used when the anchor was located on the rear deck as typically found in sedans compared with the seatback, floor, or roof. Tethers were less likely to be attached correctly when there was potentially confusing hardware present. No vehicle tether hardware characteristics or vehicle manual directions were associated specifically with correct tether routing and head restraint position. CONCLUSION: This study provides laboratory evidence that specific vehicle features are associated with tether use and correct use. PRACTICAL APPLICATIONS: Modifications to vehicles that make tether anchors easier to find and identify likely will result in increases in tether use and correct use.

Estudio sobre las propiedades térmicas, la toxicidad emitida y la reinhalación de CO2 en los colchones de bebés como factores estresores externos relacionados con el lactante. Recomendaciones de diseño / No disponible

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Perioral movements and sucking pattern during bottle feeding with a novel, experimental teat are similar to breastfeeding.

OBJECTIVE: To measure intraoral pressure and perioral movement in infants during breastfeeding (BF) and feeding with experimental teat (ET). The teat has a wide base, firm shaft and a valve at the base, such that milk flows only when the baby provides a hold pressure. STUDY DESIGN: Twenty healthy term infants, between 1 and 8 months old, were enrolled in the study. Feeding sessions (BF and ET) were recorded using a digital video camera. During both BF and ET feeding sessions, recordings during feeding were taken of jaw and throat movements (n=20) as well as intraoral pressure (n=18). The efficiency of milk transfer and the angle of the mouth were also measured. RESULT: There was no significant difference in either the jaw or throat movements between BF and ET. The sucking burst pattern, the efficiency (ml min(-1)), and the angle of the mouth did not differ between both feeding methods. The intraoral negative pressure observed during ET was significantly smaller than that observed during BF. CONCLUSION: There were no significant differences in perioral movements. Although the value was smaller, a hold pressure was observed during ET. From these results, the novel, ET may decrease BF problems related to bottle use.

An ergonomic evaluation of infant life jackets: Donning time & donning accuracy.

Canada is considering the development of a new standard for infant/child life jackets. Eight currently available (approved and non-approved) infant/child life jackets were procured for evaluation. Fifty-six participants were chosen as a sample of convenience from the general public for testing. The life jackets were divided into two groups of four, which were donned on a soft infant manikin procured from the Red Cross. In 224 attempts at donning, only 43 (19%) attempts resulted in the life jacket being donned correctly in less than 1 min. Only one life jacket came close to a good design and passed the life jacket standard for donning time and accuracy. Failure rates were observed across all the participants irrespective of age, gender, experience with children and experience with recreational marine equipment. Accuracy and speed of donning the life jacket were hampered as the number of donning sub-tasks increased. It was concluded that it is possible to design a life jacket that can be donned correctly in under 1 min. The life jacket must be of simple, intuitive design and fall naturally into the anatomical shape of the child. A minimum number of ties, zips and clips should be used in the design, and if such connectors are used they should be color coded or of different shapes and sizes to avoid confusion.

Motor vehicle occupant injury and related hospital expenditures in children aged 3 years to 8 years covered versus uncovered by booster seat legislation.

BACKGROUND: Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined injury and expenditures for motor vehicle traffic (MV) occupant injury among 3 year to 8 year olds covered versus uncovered by booster seat legislation. METHODS: Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in children covered versus uncovered by booster seat legislation. Data sources included Kids Inpatient Database 2003 and Web-based Injury Statistics Query and Reporting System. Statistical analyses used chi, Fisher's exact, and analysis of variance. Odds ratios were calculated with 95% confidence intervals (CI). RESULTS: Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than uncovered children (odds ratio, 0.78; 95% CI, 0.69-0.88). MV occupant injury constituted a smaller proportion of total injury expenditures in children covered (4.9%) versus uncovered (6.9%) by booster seat legislation. Covered children residing in areas with zip code incomes above the median had 26% lower MV occupant/total injury (p = 0.001) compared with 13% lower MV occupant/total injury for those below the median income (p = 0.0712). The proportion of injury dollars spent for MV occupant injury was higher in self-pay children for covered (7.8%) and uncovered (8.9%) children. CONCLUSIONS: This study suggests that booster seat laws are associated with a lower proportion of injury expenditures for MV occupant injuries in booster seat-aged children. Observed income disparities raise questions regarding whether access to booster seats, quality of affordable seats, and proper use and/or enforcement strategies impede legislative effectiveness.

Transporting children with special health care needs: comparing recommendations and practice.

OBJECTIVE: We compare the use of the American Academy of Pediatrics (AAP) guidelines for the safe transportation of children with special health care needs (CSHCN) with reported and observed practices. METHODS: This observational study was based on a convenience sample of vehicles exiting the garage of a tertiary children's hospital. Certified child passenger safety technicians with a health care background and specialized training in the transportation of CSHCN gathered the driver's demographic information and the child's reported medical condition, weight, age, clinic visited, and relation to the driver. The safety technicians observed the car safety seat (CSS) type, vehicle seating position, and if the child required postural support. RESULTS: During the study, 275 drivers transporting 294 CSHCN were observed. Overall, most drivers complied with AAP recommendations by using a standard CSS seat (75.4%). Among the seats evaluated, 241 (82.0%) were the appropriate choice, but only 75 (26.8%) of 280 assessed had no misuses. Approximately 24% of the drivers modified the CSS, and 19.4% of the children would have benefited from additional body-positioning support. Only 8% of medical equipment was properly secured. CONCLUSIONS: Although most drivers seemed to choose the appropriate seat, many had at least 1 misuse. Drivers complied with most AAP recommendations; however, some deviated to facilitate care of the child during transport. Discussions with parents or caregivers about the proper transportation of CSHCN and referrals to child passenger safety technicians with special training may improve safety, care, and comfort in the vehicle.

Child restraint system misuse and/or inappropriate use in Australia.

OBJECTIVE: Motor vehicle crashes are one of the leading causes of child death and acquired disability. Child restraint systems (CRS) for vehicles are designed to provide specialized protection for child occupants in the event of a crash. However, the effectiveness of a CRS is critically dependent on: correct installation of the CRS in the vehicle, the correct harnessing of the child in the CRS, and use of an appropriate CRS. The current study aimed to investigate the incidence misuse and/or inappropriate use of CRS through a CRS inspection program in the Australian states of New South Wales (NSW), Victoria (VIC), Queensland (QLD), South Australia (SA), Western Australia (WA), and Tasmania (TAS). METHODS: Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, the CRS fitting specialist inspected and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use if the child restraint(s) and or system(s). RESULTS: The following results are based on the inspection of 1386 vehicles, in which there were 1995 restraints. Of all the restraints inspected, the majority (79%) were reported as having at least one instance of misuse. The most common forms of misuse included harness strap errors such as the straps being adjusted, faulty, twisted, and/or incorrectly positioned (38%); seat belt errors such as the seatbelt being incorrectly routed, twisted, and/or incorrectly adjusted (32%); missing or incorrect fitting of gated buckle/locking clip (23%); the need for a missing sash guide (8%); tether errors such as the tether being incorrectly routed and/or adjusted (7%); inappropriate use of a CRS for the size of the child (6%); anchor errors such as the anchor was fitted incorrectly or not the correct type (5%); and the H Harness(1) being used incorrectly (5%). In addition, there were significant differences across restraint types in terms of the proportion of restraints with CRS misuse or fitment errors, chi(2) (2) = 51.42, p < 0.001. The rate of misuse was highest for the forward-facing CRS (88%), compared to infant seats (67%) and booster seats or cushions (63%). DISCUSSION: The results show that CRS misuse and fitment errors are widespread in Australia. Based on the findings of this study, it is recommended that educational and awareness materials and programs that provide information on the safety benefits associated with correct CRS use (as well as the injury risk associated with CRS misuse) be developed for both parents and children.