Pediatric Resident Attitudes and Knowledge of Critical Congenital Heart Disease Screening.

This study aimed to understand the knowledge, attitudes and confidence level related to critical congenital heart disease (CCHD) screening among pediatric residents. Pediatric residents were assessed via an anonymous survey related to CCHD guidelines and procedures as set out by the New York State Department of Health. The survey was emailed to pediatric residents at a large academic institution. A teaching intervention was performed after the initial survey, which was followed by an identical after-intervention survey. Forty-two residents responded to the pre-intervention survey (n = 42), and forty post-intervention (n = 40). The mean composite knowledge score was 76 % pre-intervention and 92 % post-intervention, p < .001. Pre-intervention only 12 % of the respondents could answer all the questions correctly which increased to 60 % post-intervention. Confidence among residents regarding guidelines increased from 38 to 95 % post-intervention, p < .001. There was a positive correlation between the residents who felt confident of the guidelines and who answered correctly, r = .514, p < .001, n = 82. There was no significant difference between knowledge, attitudes or confidence level scores by year of training or the gender of the residents. Our study demonstrated a significant gap of knowledge among residents related to CCHD screening mandated by New York State health law. There was also a corresponding lack of confidence demonstrated by the residents in the guidelines. These data suggest that residents would benefit from further education on the proper implementation of a CCHD screening program. Further multicenter studies are warranted to assess similar gaps in other residency training programs in New York and wherever these screenings guidelines have been adopted.

The Effect of Breastfeeding in the First Hour and Rooming-In of Low-Income, Multi-Ethnic Mothers on In-Hospital, One and Three Month High Breastfeeding Intensity.

Despite the known benefits of exclusive breastfeeding, the value of Baby-Friendly Hospital Interventions in increasing breastfeeding rates has been challenged, particularly the interventions of breastfeeding in the first hour of life and rooming-in. This study aimed to measure the association of breastfeeding in the first hour of life and rooming-in with high breastfeeding intensity of low-income, multi-ethnic mothers intending to breastfeed. A prospective, longitudinal cohort study was performed on 149 postpartum mothers who intended to breastfeed their infants. Structured interviews were performed at birth and one and three months. Breastfeeding intensity was defined as the percentage of all feedings that were breast milk, and high breastfeeding intensity was defined as a breastfeeding intensity >80%. The data were analyzed by chi-square, t-test, binary logistic regression analysis, and multivariate logistic regression analysis. Breastfeeding in the first hour was associated with increased high breastfeeding intensity in the hospital (AOR = 11.6, 95% CI = 4.7-28.6) and at one month (AOR = 3.6, 95% CI = 1.6-7.7), but not at three months. Rooming-in was associated with increased high breastfeeding intensity in the hospital (AOR 9.3, 95% CI = 3.6-23.7) and at one month (AOR = 2.4 (1.1-5.3) and three months (AOR 2.7, 95% CI 1.2-6.3). Breastfeeding in the first hour and rooming-in are associated with increasing breastfeeding and should be incorporated into practice.

Factors Influencing Paternal Attachment Among Preterm Infants in an Urban Neonatal Intensive Care Unit.

The aim of this study is to elucidate factors that may influence paternal attachment to preterm infants in an urban hospital setting. Fathers of preterm infants admitted to a level III neonatal intensive care unit (NICU) were eligible for this study. The Paternal Postnatal Attachment Scale (PPAS) is a questionnaire that invokes paternal attachment in five domains: patience, tolerance, pleasure, affection and pride. Clinical and demographic data were collected along with the PPAS to identify factors influencing paternal attachment. Infants studied were 28.1 ± 3.3 weeks gestational age with a birth weight of 1,070 ± 70 grams. Paternal age was 29.2 ± 6.6 years. Infants of fathers who scored in the lowest quartile of attachment were significantly smaller (756 ± 17 grams vs 1,210 ± 76 grams, p = 0.03) and more immature (26.4 ± 1.9 weeks vs 28.8 ± 3.5 weeks, p = 0.04) than infants of fathers with higher attachment scores. Subscores of patience and tolerance (p = 0.05) and pleasure in interaction (p = 0.01) were also significantly lower although there was no significant difference in subscores of affection and pride (p = 0.36). There were no significant differences between attachment scores for paternal age, educational level, marital status, number of children or breastfeeding status. Paternal attachment scores appear to be dependent on infant factors, such as birth weight and gestational age, rather than paternal or demographic factors.

Routine Neuroimaging of the Preterm Brain.

Neuroimaging of the preterm infant is a common assessment performed in the NICU. Timely and focused studies can be used for diagnostic, therapeutic, and prognostic information. However, significant variability exists among neonatal units as to which modalities are used and when imaging studies are obtained. Appropriate timing and selection of neuroimaging studies can help identify neonates with brain injury who may require therapeutic intervention or who may be at risk for neurodevelopmental impairment. This clinical report reviews the different modalities of imaging broadly available to the clinician. Evidence-based indications for each modality, optimal timing of examinations, and prognostic value are discussed.

Respiratory syncytial virus immunoprophylaxis in an urban population: a comparison of delivery strategies and outcomes.

Prophylaxis with palivizumab has been shown to decrease hospitalizations in at-risk infants. Compliance was higher with a home-based rather than a clinic-based system and was associated with decreased hospitalizations and unscheduled medical visits. Home-based delivery of respiratory syncytial virus prophylaxis may be more efficacious in preventing disease through increased compliance and decreased exposure of the high-risk infant to the clinic environment.

The effects of positioning on the Hering-Breuer reflex in the preterm infant.

The aim of this study was to determine the effect of positioning on the Hering-Breuer inflation reflex (HBIR) in the preterm infant. Seven, non-intubated, premature infants, ranging in birthweight from 732 to 1450 g with post-conceptual ages of 32-36 weeks were studied. In each infant, pulmonary function testing, including the HBIR was obtained using the SensorMedics 2600 during quiet sleep in the supine and prone position. The strength of the HBIR was quantified by the measurement of the percent prolongation of expiration after an occluded breath. Sleep states were categorized by the criteria of Prechtl. There was a significant difference in Hering-Breuer activity in the prone position versus the supine position with a consistently stronger reflex in the prone position. The mean percent prolongation of expiration was 237 +/- 108% in the prone position versus 95 +/- 32% in the supine position. Analysis of the data, using paired t-testing revealed a mean difference of 142 +/- 119% between prone and supine positions (P=0.028). Significant differences in the strength of the HBIR occur in relation to positioning in the preterm infant. Newborn positioning may affect pulmonary reflexes and may play a role in control of breathing.

Hering-Breuer reflex and sleep state in the preterm infant.

The aim of this study was to determine the effect of sleep state on the Hering-Breuer inflation reflex in the preterm infant. Seventeen nonintubated, premature infants, ranging in birth weight from 980-2,440 g with postconceptual ages of 30-36 weeks, were studied. In each infant, pulmonary function testing, including the Hering-Breuer inflation reflex, was obtained using the SensorMedics 2600 during active and quiet sleep states in supine position. The strength of the Hering-Breuer inflation reflex was quantified by the measurement of the percent prolongation of expiration after an occluded breath. Sleep states were categorized by the criteria of Prechtl. There was a significant difference in Hering-Breuer activity in active (REM) vs. quiet (non-REM) sleep, with a consistently stronger reflex in the active sleep state. The mean percent prolongation of expiration was 419% in active sleep vs. 87% in quiet sleep. Analysis of the data, using a paired t-test, revealed a mean difference of 331 +/- 185% between active and quiet sleep (P = 0.000). In conclusion, significant differences in the strength of the Hering-Breuer inflation reflex occur in relation to sleep state, and may explain the variability of the reflex described in previous studies. Measurement of the Hering-Breuer inflation reflex may be affected by pulmonary stretch receptors as well as chest wall afferents in the preterm infant.

COVERS Neonatal Pain Scale: Development and Validation.

Newborns and infants are often exposed to painful procedures during hospitalization. Several different scales have been validated to assess pain in specific populations of pediatric patients, but no single scale can easily and accurately assess pain in all newborns and infants regardless of gestational age and disease state. A new pain scale was developed, the COVERS scale, which incorporates 6 physiological and behavioral measures for scoring. Newborns admitted to the Neonatal Intensive Care Unit or Well Baby Nursery were evaluated for pain/discomfort during two procedures, a heel prick and a diaper change. Pain was assessed using indicators from three previously established scales (CRIES, the Premature Infant Pain Profile, and the Neonatal Infant Pain Scale), as well as the COVERS Scale, depending upon gestational age. Premature infant testing resulted in similar pain assessments using the COVERS and PIPP scales with an r = 0.84. For the full-term infants, the COVERS scale and NIPS scale resulted in similar pain assessments with an r = 0.95. The COVERS scale is a valid pain scale that can be used in the clinical setting to assess pain in newborns and infants and is universally applicable to all neonates, regardless of their age or physiological state.

Cultural competence of healthcare professionals caring for breastfeeding mothers in urban areas.

OBJECTIVE: Breastfeeding is strongly influenced by cultural considerations. Therefore, culturally competent healthcare professionals can provide more appropriate breastfeeding support and information. The purpose of this study was to measure the general cultural competence of healthcare professionals caring for breastfeeding mothers in an urban area. METHODS: Healthcare professionals involved in the care of breastfeeding mothers in New York, NY were surveyed utilizing Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) and a demographic data instrument. RESULTS: Of 141 surveyed healthcare professionals, 128 completed the questionnaire. There were 18 physicians, 69 nurses, and 41 other allied health professionals in this sample. Of those surveyed, 76% reported a majority of their clients' cultural background differed from their own, 56% had studied cultural diversity in school, and 68% had attended a continuing education class on the subject. The mean score on the IAPCC-R was 68 +/- 9, which is culturally aware on Campinha-Bacote's continuum of culturally incompetent, culturally aware, culturally competent, and culturally proficient. There was no statistical difference in IAPCC-R scores whether or not the respondents had attended courses in school or worked with a more diverse population. Professionals who had attended continuing education courses on cultural diversity had significantly higher total scores (69 +/- 9 vs. 65 +/- 7, P = 0.021) and scores for cultural skill (14 +/- 2 vs. 13 +/- 2, P = 0.002) and desire (17 +/- 2 vs. 16 +/- 2, P = 0.011). Twenty-three percent of the participants achieved a score of cultural competence. They were more likely to have attended continuing education courses on cultural diversity (31% vs. 7%, P = 0.0003). CONCLUSIONS: The majority (77%) of healthcare professionals caring for breastfeeding mothers in urban areas did not achieve a score of cultural competence.

Psychiatric symptoms among postpartum women in an urban hospital setting.

The object of this study was to evaluate postpartum women for psychiatric symptomatology including cognitive disturbances, anxiety, depression, and anger to better meet their needs for support and involve them in the care of their infants. We interviewed 52 postpartum mothers at the Bronx Lebanon Hospital Center within 5 days of delivery and determined the presence of psychiatric symptoms using the 29-item Psychiatric Symptom Index. Despite the fact that adult mothers were happier they were pregnant (71.4% versus 29.4%; P = 0.010) and less likely to be worried about their baby's health (25.7% versus 52.9%; P = 0.003), adult mothers demonstrated higher depressive symptomatology ( P = 0.009), higher amounts of anger ( P = 0.004), and greater overall psychiatric symptomatology ( P = 0.005) than adolescent mothers. Mothers whose infants were in the neonatal intensive care unit did not report significantly higher psychiatric symptomatology than mothers whose infants were healthy. Physicians need to be aware of the high levels of depression and anger present among postpartum women so appropriate support can be given.

Preterm brain injury: imaging and neurodevelopmental outcome.

Although neonatal survival has dramatically improved during the last decade, there remain a significant number of infants who sustain brain injury and exhibit developmental delay. This review identifies the current modes of brain imaging available to the neonatologist and the correlation between neonatal imaging and clinical outcomes to facilitate early identification of these at-risk newborns.