Perinatal care in SARS-CoV-2 infected women: the lesson learnt from a national prospective cohort study during the pandemic in Italy.

BACKGROUND: Despite the growing importance given to ensuring high-quality childbirth, perinatal good practices have been rapidly disrupted by SARS-CoV-2 pandemic. This study aimed at describing the childbirth care provided to infected women during two years of COVID-19 emergency in Italy. METHODS: A prospective cohort study enrolling all women who gave birth with a confirmed SARS-CoV-2 infection within 7 days from hospital admission in the 218 maternity units active in Italy during the periods February 25, 2020-June 30, 2021, and January 1-May 31, 2022. Perinatal care was assessed by evaluating the prevalence of the following indicators during the pandemic: presence of a labour companion; skin-to-skin; no mother-child separation at birth; rooming-in; breastfeeding. Logistic regression models including women' socio-demographic, obstetric and medical characteristics, were used to assess the association between the adherence to perinatal practices and different pandemic phases. RESULTS: During the study period, 5,360 SARS-CoV-2 positive women were enrolled. Overall, among those who had a vaginal delivery (n = 3,574; 66.8%), 37.5% had a labour companion, 70.5% of newborns were not separated from their mothers at birth, 88.1% were roomed-in, and 88.0% breastfed. These four indicators showed similar variations in the study period with a negative peak between September 2020 and January 2021 and a gradual increase during the Alpha and Omicron waves. Skin-to-skin (mean value 66.2%) had its lowest level at the beginning of the pandemic and gradually increased throughout the study period. Among women who had a caesarean section (n = 1,777; 33.2%), all the indicators showed notably worse outcomes with similar variations in the study period. Multiple logistic regression analyses confirm the observed variations during the pandemic and show a lower adherence to good practices in southern regions and in maternity units with a higher annual number of births. CONCLUSIONS: Despite the rising trend in the studied indicators, we observed concerning substandard childbirth care during the SARS-CoV-2 pandemic. Continued efforts are necessary to underscore the significance of the experience of care as a vital component in enhancing the quality of family-centred care policies.

Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study.

BACKGROUND: The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed. OBJECTIVE: To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission. STUDY DESIGN: In this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices. RESULTS: A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2-9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity. CONCLUSION: In this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

The management of late preterm infants: effects of rooming-in assistance versus direct admission to neonatal care units.

Late preterm infants (LPIs) represent a significant percentage of all neonates (6-8%), but there are limited published data on their postnatal management. Our aim was to compare the frequency of neonatal intensive care unit (NICU) admission and the breastfeeding rate of LPIs born at 35+0-36+6 weeks of gestation who were cared for by initial rooming in strategy rather than directly admitted to the special care unit (SCU) and, eventually, to the NICU. We carried out a retrospective study in the perinatal centers of Careggi University Hospital (CUH) and San Giovanni di Dio Hospital in Florence, Italy, where the first and second strategies were applied, respectively. Main outcomes were LPIs admission rate at SCU/NICU and breastfeeding rate at discharge. We studied 190 LPIs born at SGDH and 240 born at CUH. The admission rate in SCU (81 vs. 43%; P < 0.001) and NICU (20 vs. 10%; P = 0.008) was higher in SGDH than in CUH, as was the exclusive breastfeeding rate (36 vs. 22%; P < 0.001). However, infants who were assisted in rooming-in at CUH and infants with similar clinical characteristics at SGDH had similar mixed (60 vs. 69%) and exclusive (35 vs. 31%) breastfeeding rates.  Conclusion: Postnatal assistance of LPIs in rooming-in, eventually followed by admission in SCU/NICU based on their clinical conditions, allowed to safely halve their hospitalization. The assistance of infants in rooming-in did not negatively affect their breastfeeding rate. These results support the possibility of assisting LPIs in rooming-in. What is Known: • Late preterm infants represent a significant percentage of all neonates. • Early rooming-in and breastfeeding is recommended for late preterm infants. What is New: • Postnatal assistance of late preterm infants in rooming-in, followed when necessary by admission in neonatal units based on clinical conditions, allowed to safely avoid about half the number of hospitalizations in comparison with direct admission in neonatal units. • This strategy did not affect breastfeeding rate. Infants who were admitted to SCU/NICU after initial rooming-in had worst breastfeeding rate.

An observational study for appraisal of clinical outcome and risk of mother-to-child SARS-CoV-2 transmission in neonates provided the benefits of mothers' own milk.

This observational study done during April-December 2020 at a tertiary-care hospital in Haryana (India) enrolled 152 SARS-CoV-2-exposed neonates. Among them, 150 neonates had perinatal SARS-CoV-2 exposure and 2 neonates had late postnatal exposure. Stable infant-mother dyads were roomed-in with precautions to support breastfeeding. Nasopharyngeal swabs collected from neonates were tested for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (RT-PCR) test. There was a high incidence of prematurity (23%), low birth weight (31%), intrauterine fetal distress (16%), perinatal asphyxia (6%), admission to neonatal intensive care unit (24%), and mortality (1.3%) among neonates with perinatal SARS-CoV-2 exposure. In this sub-group, 20 neonates tested positive for SARS-CoV-2 in nasopharyngeal swab sample(s). A recent official publication by the World Health Organization emphasizes that the perinatal SARS-CoV-2-exposed neonates found RT-PCR positive once in upper respiratory (non-sterile) sample must document viral persistence in another non-sterile sample for confirmation of mother-to-child virus transmission. With this approach, only one neonate was confirmed intrapartum transmission. A telephonic follow-up in discharged neonates at 1 month of age or 1 month postexposure recorded them all to be asymptomatic and doing well.Conclusion: Neonates with perinatal SARS-CoV-2 exposure constitute a high-risk group and it is not uncommon to get a positive RT-PCR report in upper respiratory sample(s) from these babies. Majority of them do not demonstrate viral persistence. Clinical outcomes are favorable in breastfed infants roomed-in with their asymptomatic-mild symptomatic SARS-CoV-2-infected mothers following appropriate safety protocols. What is Known: •Neonates with perinatal exposure suffer a high burden of morbidities and mortality. •Still, an uncertainty exists about rooming-in and breastfeeding among neonates born to SARS-CoV-2 positive mothers. What is New: •With the policy of mother-infant rooming-in and supporting breastfeeding, none of the neonate suffered clinical illness compatible with postnatal SARS-CoV-2 transmission and infection. •Around 13% perinatal exposed neonates demonstrated SARS-CoV-2 RNA in nasopharyngeal swab samples but the majority of them did not demonstrate viral persistence.

Keeping Families Close: A Hospital-Sponsored Boarder Program That Facilitates Parents' Presence at the Infant's Bedside.

The Boarder Program is a unique, family-centered program designed to keep a mother and her infant together when the mother has been discharged, but her infant requires additional medical attention and hospitalization. The hospital-sponsored program includes a room in the obstetric department, meals, and services. This provides the mother and second caregiver the opportunity to participate in their infant's physical care and engage in the decision-making process. The program is designed to support families with infants in an intermediate care nursery and has been expanded to include infants experiencing neonatal abstinence syndrome (NAS). The purpose of this article is to describe the Boarder Program at a community medical center, share its history, and provide evidence-based support for the effectiveness of this model.

Impact of joint management of a COVID-19 mother and her newborn on the virus transmission: a case report.

BACKGROUND: Since last year, COVID-19, the disease caused by the novel Sars-Cov-2 virus, has been globally spread to all the world. COVID-19 infection among pregnant women has been described. However, transplacental transmission of Sars-Cov-2 virus from infected mother to the newborn is not yet established. The appropriate management of infants born to mothers with confirmed or suspected COVID-19 and the start of early breastfeeding are being debated. CASE PRESENTATION: We report a case of the joint management of a healthy neonate with his mother tested positive for Covid-19 before the delivery and throughout neonatal follow-up. The infection transmission from the mother to her baby is not described, even after a long period of contact between them and breastfeeding. CONCLUSION: It may consider an appropriate practice to keep mother and her newborn infant together in order to facilitate their contact and to encourage breastfeeding, although integration with infection prevention measures is needed.

Influence of Shared Decision Making on Decisional Conflict and Regret in Postpartum Mother-Infant Care: A Randomized Controlled Trial.

OBJECTIVES: Although postpartum rooming-in is encouraged by the World Health Organization, independent separated nursery care is still widely adopted in Eastern countries. Our aim is to evaluate the effect of shared decision making (SDM) assisted by patient decision aids on subjective decisional conflict and regret among women who are required to make choices regarding postpartum infant care. METHODS: A total of 196 pregnant women who came for routine checkups 1 month before delivery were randomly assigned to the SDM group or the classic group. Before the mothers were discharged after delivery, their decision-making difficulties were evaluated. The primary outcome was the decisional conflict, which was assessed using the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) scale. The secondary outcome was the decisional regret, which was measured using the Decision Regret scale. RESULTS: Compared with the classic group, SDM group had surer feelings about the choice (P＜.001), felt more confident about knowing the benefits and risks of each option (P＜.001), had a clearer understanding of the benefits and risks (P＜.001), and felt sufficiently supported with enough advice to make a suitable choice (P＜.001). No significant difference was noted in the Decision Regret scores between groups. The choice of 24-hour rooming-in, 12-hour rooming-in, and separated nursery care was not significantly different between groups. CONCLUSIONS: SDM reduced the decisional conflict and uncertainty of the mothers. Available choices of postpartum mother-infant care should be provided to mothers through SDM that includes individual values, health goals, and clear knowledge and transparency.

Reduction of Need for Treatment and Length of Hospital Stay Following Institution of a Neonatal Abstinence Syndrome Rooming-In Program in Ontario, Canada.

PURPOSE: To assess the impact of a rooming-in program for babies at risk of Neonatal Abstinence Syndrome (NAS) in one community hospital centre, in Belleville, Ontario. DESIGN AND METHODS: This retrospective chart review was conducted at Belleville General Hospital. The hospital developed a rooming-in program for newborns at risk of NAS in July 2015. Charts on all infants born to mothers using opioids in the 24 months prior to and after the implementation of our program, who met the inclusion criteria, were examined. RESULTS: The study consisted of 15 babies in the Special Care Nursery (SCN) group and 19 babies in the rooming-in group. Rooming-in is associated with a reduction in the need for treatment with morphine [rooming-in group (1/19, 5.3%), SCN group (14/15, 93.3%), p < 0.01], shorter length of stay in hospital [rooming-in group (days = 5), SCN group (days = 20), p < 0.01], improved exclusive breast and/or breast milk-feeding rates [rooming-in group (17/19,89.5%), SCN group (1/15,6.7%), p < 0.01] and lower total hospital cost [rooming-in group ($6458.00), SCN group ($17,851.00), p < 0.01]. CONCLUSION: Our study demonstrates that rooming-in programs for babies born to mothers using opioids has benefits in terms of quality of care and health care resource utilization. PRACTICAL IMPLICATIONS: These findings show that rooming-in can be successfully implemented in a community hospital.

Nurses' Perceptions of Rooming-in for Caregivers of Infants with CCHD.

Congenital heart disease (CHD) is the most common congenital defect. Infants with critical congenital heart disease (CCHD) require complex medical care, and their caregivers need extensive training before being discharged home to safely care for their child. The rooming-in process provides caregivers with an opportunity to learn, practice, and manage the skills required for discharge to home during hospitalization. Although the literature reflects positive implications for the use of the rooming-in process in other populations (e.g., neonatal abstinence syndrome), literature about the rooming-in process in a pediatric cardiac care setting is limited. There remains a gap in the literature pertaining to the viewpoints of nurses, specifically as it relates to implementing a rooming-in process. Therefore, a qualitative study design was chosen to explore the nurses' perceptions of the rooming-in process using focus groups. The purpose of this study was to gain insight from nurses as to strategies to enhance the rooming-in process for caregivers of infants with CCHD. Additionally, we explored potential education and interventions to improve outcomes for infants with CCHD preparing to be discharged home.

Maintaining Safe Breastfeeding Practices During the COVID-19 Pandemic: An Overview of the Evidence to Inform Clinical Guidelines.

The impact of the COVID-19 pandemic upon the health care landscape has prompted many organizations to revise policies in response to ever-changing guidelines and recommendations regarding safe breastfeeding practices. The application of these professional guidelines into clinical practice is fraught with barriers, inconsistencies, and often-minimal evidential support. Key concerns for health care providers and patients include antenatal versus postnatal transmission, milk transmission, and separation care versus rooming-in, including the subsequent impacts upon breastfeeding and bonding. While SARS-CoV-2 is a novel virus, the volume of literature to support best practice for couplet care continues to be developed at a rapid pace. The benefits of breastfeeding are steeped in evidence and outweigh the potential risk of transmission of COVID-19 from mother to newborn. Health care organizations must continue to seek guidance for policy revision within the ever-growing body of evidence for best practice and evaluate current practices for feasibility during and after hospitalization.

The associations between insecure attachment, rooming-in, and postpartum depression: A 2 months' longitudinal study.

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming-in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming-in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1-4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming-in conditions. In addition, women in partial rooming-in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming-in women. A situational factor such as full rooming-in, which occurs at a critical time point for the mother-infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming-in, can be personalized and thus beneficial in moderating personal risk factors for PPD.

La depresión posterior al parto (PPD) es la complicación más común de dar a luz y estudios recientes han intentado examinar los factores de riesgo asociados con el parto. La hipótesis del principal estudio fue que un factor situacional de protección en un período temporal sensible (permitirle a la madre mantener a su bebé con ella en el mismo cuarto después del parto) moderaría las asociaciones entre las dimensiones de afectividad insegura y PPD. Trescientas doce mujeres, en situación completa o parcial de tener a su bebé en el mismo cuarto, participaron en un estudio longitudinal en la sala de partos de un centro terciario de cuidado de salud. Del primer al cuarto día después del parto, se administró un cuestionario demográfico y la Escala de Experiencias en Relaciones Cercanas; la Escala de Edimburgo de Depresión Postnatal se administró a los dos meses posteriores al parto. Significativamente se asoció la PPD tanto con las dimensiones de afectividad de tipo ansiosas como las evasivas, pero no con las condiciones de compartir el mismo cuarto. Adicionalmente, las mujeres en situaciones parciales de compartir el mismo cuarto mostraron una correlación positiva entre las dimensiones de afectividad insegura y PPD, mientras que tal correlación no se encontró en el caso de las mujeres en situaciones de compartir el cuarto completamente. Un factor situacional tal como el compartir el cuarto completamente, lo cual ocurre en un punto temporal crítico para la relación madre-infante, puede moderar la asociación entre las dimensiones de afectividad maternas evasivas o ansiosas y los niveles de PPD de la madre. Las prácticas del período posterior al parto, tales como el compartir el cuarto, pueden ser personalizadas y por tanto beneficiosas en cuanto a moderar los factores personales de riesgo de PPD.

La dépression postpartum (DPP) est la complication la plus commune de la maternité et les études récentes ont essayé d'examiner les facteurs de risque qui y sont liés. L'hypothèse principale de cette étude était qu'un facteur protecteur situationnel à une période sensible (rooming-in total postpartum) modérerait les liens entre les dimensions d'attachement insécure et la DPP. Trois cent douze femmes, soit en rooming-in partiel ou total, ont participé à une étude longitudinale à la maternité d'un centre de santé tertiaire. Un questionnaire démographique et l'Echelle d'Expériences dans les Relations Proches ont été donnés à 1-4 jours postpartum, l'Echelle de Dépression Postnatale d'Edinbourg à deux mois postpartum. La DPP a été liée de manière importante à des dimensions d'attachement à la fois anxieux et évitant, mais pas avec les conditions de rooming-in. De plus, les femmes en rooming-in partiel ont fait preuve d'une corrélation positive entre les dimensions de l'attachement insécure et la DPP, alors qu'aucune corrélation n'a été trouvée pour les femmes du groupe rooming-in. Un facteur situationnel telle que le rooming-in total, qui se passe à un moment critique pour la relation mère-bébé, peut modérer le lien entre les dimensions d'attachement évitant maternel et de l'attachement anxieux et les niveaux de DPP de la mère. Les pratiques postpartum, tel que le rooming-in, peuvent être personnalisées et donc s'avérer être un bénéfice pour la modération de facteurs de risque personnel pour la DPP.

Shared decision-making for infant feeding and care during the coronavirus disease 2019 pandemic.

Despite decades of research establishing the importance of breastfeeding, skin-to-skin contact and mother-infant closeness, the response to the coronavirus disease 2019 (COVID-19) pandemic has underscored the hidden assumption that these practices can be dispensed with no consequences to mother or child. This article aims to support shared decision-making process for infant feeding and care with parents and health care providers during the unprecedented times of the pandemic. It proposes a structure and rationale to guide the process that includes (1) discussing with parents evidence-based information and the different options to feed and care for an infant and young child in the context of the pandemic as well as their potential benefits, risks and scientific uncertainties; (2) helping parents to recognize the sensitive nature of the decisions and to clarify the value they place on the different options to feed and care for their infant or young child; and (3) providing guidance and support needed to make and implement their decisions. A shared decision-making process will help parents navigate complex feeding and care decisions for their child as we face the different stages of the COVID-19 pandemic.

Perspectives of patients, relatives and nurses on rooming-in for adult patients: A scoping review of the literature.

AIM: To explore the perspectives of patients, their relatives and nurses on rooming-in for adult patients. BACKGROUND: The practice of having family stay overnight with an adult patient in hospital is quite new. To support rooming-in programs, the perspectives from all stakeholders should be taken into account. METHODS: All types of studies on rooming-in in adult healthcare settings were included in this scoping review. Rooming-in has been defined as the practice where 'family members or trusted others are facilitated to continuously stay with the patient and are provided with facilities to sleep in the patient's room'. RESULTS: Seven studies were included: one randomized controlled trial, three qualitative studies, and three correspondence articles. Generally, patients felt safe in the presence of a family member, but could also feel restricted in their freedom and privacy. Family members saw a benefit for the patient, considered rooming-in a moral duty, and were happy to help. Nonetheless, family members reported rooming-in as physically and emotionally stressful. Nurses described that patients were less anxious and more easily adjusted to the hospital environment. CONCLUSIONS: The reviewed studies suggest that patients, family members, and nurses have both positive and negative experiences with rooming-in. The concept of rooming-in varies from continuous presence and involvement of relatives to one overnight stay in the patient's room. Each interpretation has its own implications for policy, design, guidelines and feasibility of rooming-in. Nursing staff should be included in decision-making processes for this practice.

A Hospital-Level Intervention to Improve Outcomes of Opioid Exposed Newborns.

PURPOSE: The purpose of this quality improvement project was to determine if non-pharmacologic strategies such as a rooming-in approach to care for newborns at risk of developing neonatal abstinence syndrome (NAS) would reduce total length of stay (LOS) and reduce the need for pharmacologic treatment. DESIGN AND METHODS: This was a quality improvement project utilizing a retrospective chart review. Records of newborns with in-utero methadone or buprenorphine exposure were reviewed who were born between January 2016-July 2017 and July 2017-August 2018 at Wellspan Health York Hospital. Starting in July 2017, newborns exposed to opioids who transitioned normally remained with their mothers for monitoring in the newborn nursery. Monitoring for withdrawal was continued on the pediatric floor after the mother's discharge from the post-partum floor. RESULTS: The primary outcome of total LOS was reduced from 14 days to 10.1 days (p = 0.014). The total length of pharmacologic treatment decreased from 15.68 days to 9.71 days (p = 0.023). CONCLUSIONS: A rooming-in approach to care including management on a pediatric floor can reduce total length of stay and the duration of pharmacologic treatment in newborns with NAS. Newborns with NAS can be safely managed in an inpatient pediatric floor. PRACTICE IMPLICATIONS: Implementing a rooming-in approach to care of newborns at risk of developing NAS can improve outcomes through a decreased length of hospital stay and decreased duration of pharmacologic treatment. This approach improves access to critical care services by safely monitoring newborns with NAS on an inpatient pediatric floor.

Trends in rooming-in practices among hospitals in the United States, 2007-2015.

BACKGROUND: Rooming-in, or keeping mothers and infants together throughout the birth hospitalization, increases breastfeeding initiation and duration, and is one of the Ten Steps to Successful Breastfeeding. METHODS: The Centers for Disease Control and Prevention's (CDC) Maternity Practices in Infant Nutrition and Care (mPINC) survey is a biennial census of all birth facilities in the United States and its territories. Data from the 2007-2015 mPINC surveys were used to assess trends in the prevalence of hospitals with most (≥90%) infants rooming-in more than 23 hours per day (ideal practice). Hospital practices among breastfed infants not rooming-in at night and reasons why hospitals without ideal rooming-in practices removed healthy, full-term, breastfed infants from their mothers' rooms were also analyzed. RESULTS: The percentage of hospitals with ideal practice increased from 27.8% in 2007 to 51.4% in 2015. Most breastfed infants who were not rooming-in were brought to their mothers at night for feedings (91.8% in 2015). Among hospitals without ideal rooming-in practices, the percentage removing 50% or more of infants from their mothers' rooms at any point during the hospitalization decreased for all reasons surveyed during 2007-2015; however, in 2015, hospitals still reported regularly removing infants for hearing tests (73.2%), heel sticks (65.5%), infant baths (40.2%), pediatric rounds (35.5%), and infant photos (25.4%). CONCLUSIONS: Hospital implementation of rooming-in increased 23.6 percentage points during 2007-2015. Continued efforts are needed to ensure that all mothers who choose to breastfeed receive optimal lactation support during the first days after giving birth.

Evaluation of factors contributing to the decline in exclusive breastfeeding at 6 months postpartum: The 2011-2016 National Surveys in Taiwan.

BACKGROUND: Since 1992, breastfeeding promotion in Taiwan considerably raised the breastfeeding rates; however, more recent surveillance showed that breastfeeding indicators stagnated or even decreased. METHODS: We analyzed 6 cross-sectional national surveys of 69 159 postpartum women to examine the breastfeeding trends at 6 months postpartum during 2011-2016 in Taiwan and the contributing role of maternal and environmental factors. Data were collected through telephone interviews, using structured questionnaires with randomly selected mothers, who gave birth in those years. A multinomial logistic regression was used to analyze the data. RESULTS: Partial breastfeeding rates at 6 months postpartum increased from 2011 to 2016 (25.4%-45.1%, crude odds ratio [OR] = 1.14 per year of study); however, the rates of exclusive breastfeeding at 6 months postpartum declined (24.5%-14.8%, crude OR = 0.91 per year of study). During this period, increases in maternal age and educational level, employment outside the house, and prepregnancy obesity were observed. Despite a growing number of births at certified baby-friendly hospitals, fewer mothers experienced early skin-to-skin contact and rooming-in in 2016 than in 2011. Adjustment for breastfeeding-related factors did not appreciably change the odds ratio for year of birth. Prenatal intention to breastfeed was most strongly associated with breastfeeding at 6 months postpartum (OR > 5). CONCLUSIONS: Maternal and environmental factors in the study could not explain the decline in exclusive breastfeeding. The decline in exclusive breastfeeding, accompanying the increase in partial breastfeeding, suggests that more support is needed for mothers who intend to breastfeed exclusively.

A Novel Nesting Protocol to Decrease Readmission and Increase Patient Satisfaction Following Congenital Heart Surgery.

BACKGROUND: Pediatric patients post-cardiac surgery have complex care needs requiring extensive discharge education and skill competency by caregivers to transition from the hospital environment to a medical home. The purpose of this quality improvement project was to implement a nesting protocol in the cardiovascular intensive care unit (CVICU) to improve discharge teaching and care coordination, with a goal to reduce readmission rates and increase caregiver satisfaction and understanding. METHODS: A nesting protocol was created to provide clear and consistent guidelines to the multidisciplinary team. Pre- and post-intervention data was collected from caregiver satisfaction surveys, using a Likert scale, to determine understanding of nesting and feeling of preparedness upon discharge. In 2016 and 2017, retrospective chart reviews were performed to evaluate readmission data. SQUIRE 2.0 guidelines were utilized when writing this article (Ogrinc et al., 2015). RESULTS: Caregivers reported an increase in satisfaction and understanding of the nesting process post-intervention with an increase of 4.48%. Readmission rates did not improve from 2016 to 2017. However, only 6 months of 2017 were reviewed. CONCLUSIONS: Readmission is a significant problem for children with complex CHD. Post-discharge care requires caregivers to understand the medical care that their children require. Pre-intervention data revealed deficiencies in understanding regarding care regimens, infection control, and nutrition, which correlated with the most frequent causes for readmission among this population. The protocol developed addressed multiple issues concerning discharge readiness.

Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review.

Rates of breastfeeding uptake are lower after a caesarean birth than vaginal birth, despite caesarean rates increasing globally over the past 30 years, and many high-income countries reporting overall caesarean rates of above 25%. A number of factors are likely to be associated with women's infant feeding decisions following a caesarean birth such as limited postoperative mobility, postoperative pain, and ongoing management of medical complications that may have triggered the need for a caesarean birth. The aim of this systematic review was to evaluate evidence of interventions on the initiation and duration of any and exclusive breastfeeding among women who had a planned or unplanned caesarean birth. Seven studies, presenting quantitative and qualitative evidence, published in the English language from January 1994 to February 2016 were included. A limited number of interventions were identified relevant to women who had had a caesarean birth. These included immediate or early skin-to-skin contact, parent education, the provision of sidecar bassinets when rooming-in, and use of breast pumps. Only one study, an intervention that included parent education and targeted breastfeeding support, increased initiation and continuation of breastfeeding, but due to methodological limitations, findings should be considered with caution. There is a need to better understand the impact of caesarean birth on maternal physiological, psychological, and physical recovery, the physiology of lactation and breastfeeding and infant feeding behaviors if effective interventions are to be implemented.

[The Efficacy of Rooming-In in the Context the Physical and Mental Health of New Mothers].

The Breastfeeding-Friendly Policy promotes successful breastfeeding by encouraging postpartum rooming-in and other practices that have been shown to increase breastfeeding success. Puerperium is a key transition period in a woman's life during which she faces physical changes as well as changes in roles and tasks as she transitions into motherhood. During this transition period, postpartum women typically follow the rooming-in and breastfeeding practices that are recommended by the hospital. However, without suitable assistance, the physical and mental problems that often accompany childbirth may impact the postpartum health of the mother. This article reflects on the potential health problems that are encountered by postpartum women who adopt 24-hour rooming-in practices from the perspective of their health rights and proposes suggestions for improving these practices as a reference for related government and healthcare workers.

Early skin-to-skin contact, rooming-in, and breastfeeding: a comparison of the 2004 and 2011 National Surveys in Taiwan.

OBJECTIVES: We examined progress in the practice of early skin-to-skin contact and rooming-in, and their association with breastfeeding, using national samples of postpartum women in the years 2004 and 2011 in Taiwan. METHODS: This study was a secondary data analysis using 2004 and 2011 national surveys of 12,201 and 12,405 postpartum women, respectively. RESULTS: More women had early skin-to-skin contact in 2011 than in 2004 (54.9% vs 20.6%, p < 0.001). Although fewer women practiced rooming-in in 2011 than in 2004 (33.8% vs 45.8%, p < 0.001), the percentage of women rooming-in for 24 hours improved from 6.1 percent to 22.7 percent from 2004 to 2011, and for rooming-in from 12 to less than 24 hours, the percentage improved from 4.3 percent to 10.9 percent (p < 0.001). The rate of breastfeeding increased by 50 percent during hospitalization (from 57.4% to 85.6%) and by 150 percent at 6 months postpartum (from 20.1% to 50.2%). After adjustment for background characteristics, women who had early skin-to-skin contact were more than twice as likely to breastfeed their infants during hospitalization, and about 1.2 times as likely to breastfeed at 6 months postpartum. The odds ratio for breastfeeding at 6 months generally increased as the duration of rooming-in increased in 2004 (OR ranged from 1.37 to 2.47). In 2011, only rooming-in for 12 to less than 24 hours (OR = 1.31) and 24 hours (OR = 1.98) daily significantly increased the odds ratio for breastfeeding at 6 months postpartum. CONCLUSIONS: Significant improvements in early skin-to-skin contact, the duration of rooming-in, and breastfeeding were observed in Taiwan. Early skin-to-skin contact and rooming-in for more than 12 hours were associated with increased chances for exclusive breastfeeding and breastfeeding at 6 months postpartum.