An international study on implementation and facilitators and barriers for parent‐infant closeness in neonatal units

Pediatric Investigation, Journal Year: 2022, Volume and Issue: 6(3), P. 179 - 188

Published: Aug. 13, 2022

ABSTRACT Importance Parent‐infant closeness and active parent participation in neonatal care are important for infant health. Objective To give an overview of current settings gain in‐depth understanding facilitators barriers to parent‐infant closeness, zero‐separation, 19 countries. Methods Neonatal intensive unit (NICU) professionals, representing 45 NICUs from a range geographic regions Europe Canada, were purposefully selected interviewed June–December 2018. Thematic analysis was conducted identify, analyze report patterns (themes) across the entire series interviews. Results separation during and/or maternity is very common (42/45 units, 93%), despite implementation family integrated (FICare) practices, including medical rounds (17/45, 38%), structured education sessions parents (16/45, 36%) training healthcare professionals (22/45, 49%). NICU encountered four main themes with on between hospital, unit, staff, level: Culture (jointly held characteristics, values, thinking behaviors about parental presence unit), Collaboration (the act working together within different levels), Capacities (resources policies), Coaching (education acquire transfer knowledge skills). Interpretation Implementing still challenging professionals. Further optimization towards zero‐separation can be achieved by enforcing ‘four Cs Closeness’: Culture, Collaboration, , .

Language: Английский

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First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined

Frontiers in Nutrition, Journal Year: 2023, Volume and Issue: 9

Published: Jan. 17, 2023

In March 2020, the World Health Organization (WHO) published clinical guidance for care of newborns mothers with COVID-19. Weighing available evidence on SARS-CoV-2 infection against well-established harms maternal-infant separation, WHO recommended proximity and breastfeeding even in presence maternal infection. Since then, WHO's approach has been validated by further research. However, early pandemic there was poor global alignment recommendations.We assessed documents collected November December 2020 from 101 countries two regional agencies COVID-19 recommendations. Recommendations considered were: (1) skin-to-skin contact; (2) initiation breastfeeding; (3) rooming-in; (4) direct (5) provision expressed breastmilk; (6) donor human milk; (7) wet nursing; (8) breastmilk substitutes; (9) relactation; (10) psychological support separated mothers; (11) infants.In less than one-quarter country were three key facilitation practices contact, rooming-in, recommended. Donor milk under guidance. Psychological their infants 38%. Few relactation, nursing, or mothers. three-quarters guidance, unable to directly breastfeed The United Kingdom's Royal College Obstetricians Gynecologists each cited half States Centers Disease Control Prevention indirectly 40%.Despite recommendations, many newborn guidelines failed recommend as standard care. Irregular updates discordant, but influential, may have contributory. It appeared that once recommendations made separation they difficult reverse. absence quality necessity, should not be disease epidemics.

Language: Английский

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Family integrated care: State of art and future perspectives

Acta Paediatrica, Journal Year: 2024, Volume and Issue: unknown

Published: May 13, 2024

Abstract Family integrated care (FICare) represents a contemporary approach to health that involves the active participation of families within healthcare team. It empowers acquire knowledge about specialised required for their newborns admitted neonatal intensive unit (NICU) and positions them as primary caregivers. Healthcare professionals in this model act mentors facilitators during hospitalisation period. This innovative has exhibited notable enhancements both short‐ long‐term outcomes neonates, alongside improved psychological well‐being heightened satisfaction among professionals. Initially designed stable premature infants families, FICare evolved include critically ill full‐term infants. Findings from recent studies affirm safety feasibility NICU‐wide care, benefiting all families. The envisioned expansion focusses on sustainability extending its implementation, recognising necessity tailored adaptations suit varying diverse cultural socio‐economic contexts.

Language: Английский

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Nurturescience versus neuroscience: A case for rethinking perinatal mother–infant behaviors and relationship

Birth Defects Research, Journal Year: 2019, Volume and Issue: 111(15), P. 1110 - 1127

Published: May 30, 2019

Abstract Behavioral and emotional outcomes for babies who experienced maternal separation due to prematurity or birth defects have not improved significantly the last 20 years. Current theories treatment paradigms based on neuroscience generated explanatory mechanisms that work, provided testable hypotheses. This article proposes a new field of scientific investigation, “nurturescience” within which hypotheses can be tested with novel instruments. Key distinctions between nurturescience are described. Our definition is basic needs all newborns mothers their families. understanding drawn from biology, anthropology, sociology, physiological, clinical research. Mechanisms described studies microbiota, epigenetics, allostasis, brain imaging, developmental origins health adult disease. The converging message these other fields mother–infant dyad should separated. Ongoing connection cornerstone development, leading life‐long resilience. has implications making correct diagnosis (emotional disconnection vs. attachment disorder), providing appropriate care (infant family centered care) in biologically expected place (skin‐to‐skin contact), potential rehabilitation (calming cycle theory). Nurturescience particular relevance “small sick” infants, profound decreasing “likelihood developing problems.”

Language: Английский

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Mother‐Newborn Couplet Care from theory to practice to ensure zero separation for all newborns

Acta Paediatrica, Journal Year: 2021, Volume and Issue: 110(11), P. 2951 - 2957

Published: June 19, 2021

With an increasing awareness of the importance nurturing care and within a framework Infant- Family-Centred Developmental Care (IFCDC), zero separation, keeping parent infant in continuous close physical psychological proximity to each other, is key. In modern neonatology, high technological pharmaceutical treatments are consistently integrated with caregiving considerations. Mother-Newborn Couplet concept where dyad ill or prematurely born mother, needing medical her own, cared for together, from birth baby its discharge. requires systems changes both obstetrics paediatrics considering planning organisation care, equipment design units. Accordingly, strong leadership setting clear goals changing professional mindset by providing targeted education training crucial ensure warranted quality all mother-baby dyads.

Language: Английский

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An equitable, community-engaged translational framework for science in human lactation and infant feeding—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 5

American Journal of Clinical Nutrition, Journal Year: 2023, Volume and Issue: 117, P. S87 - S105

Published: May 1, 2023

Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding human biology. As part addressing these gaps, Breastmilk Ecology: Genesis Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated state knowledge regarding infant-human milk-lactating parent triad. However, to optimize impact newly generated across all stages research, need remained a translational research framework specific field. Thus, with inspiration from simplified environmental sciences Kaufman and Curl, Group 5 BEGIN developed science lactation infant feeding, which includes nonlinear, interconnected stages, T1: Discovery; T2: health implications; T3: Clinical public T4: Implementation; T5: Impact. The accompanied by 6 overarching principles: 1) Research spans continuum nonhierarchical manner; 2) Projects engage interdisciplinary teams continuous collaboration cross talk; 3) Priorities study designs incorporate diverse range contextual factors; 4) include community stakeholders outset through purposeful, ethical, equitable engagement; 5) conceptual models respectful care birthing address implications lactating parent; 6) real-world settings account factors surrounding feeding milk, including exclusivity mode feeding. To demonstrate application presented its principles, case studies are included, each illustrating framework. Applying approach an important step toward aligned goals optimizing contexts as well all.

Language: Английский

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New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care

Frontiers in Psychology, Journal Year: 2024, Volume and Issue: 15

Published: July 9, 2024

In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from moment of birth, every "small and sick" newborn should remain with mother in immediate continuous skin-to-skin contact (SSC), receiving required clinical care that place. This was prompted by startling results randomized controlled trial 2021: 1,609 infants SSC were compared 1,602 controls separated their mothers but otherwise received identical conventional state-of-the-art care. The intervention showed 25% reduction mortality after 28 days.

Language: Английский

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Immediate parent-infant skin-to-skin study (IPISTOSS): study protocol of a randomised controlled trial on very preterm infants cared for in skin-to-skin contact immediately after birth and potential physiological, epigenetic, psychological and neurodevelopmental consequences

BMJ Open, Journal Year: 2020, Volume and Issue: 10(7), P. e038938 - e038938

Published: July 1, 2020

In Scandinavia, 6% of infants are born preterm, before 37 gestational weeks. Instead continuing in the in-utero environment, maturation needs to occur a neonatal unit with support vital functions, separated from mother's warmth, nutrition and other benefits. Preterm face health neurodevelopment challenges that may also affect family society at large. There is evidence benefit immediate continued skin-to-skin contact (SSC) for term moderately preterm their parents but there knowledge gap on its effect unstable very when initiated immediately after birth. this ongoing randomised controlled trial Stavanger, Norway Stockholm, Sweden, we studying 150 28+0 32+6 weeks, receive care birth SSC parent or conventionally an incubator. The primary outcome cardiorespiratory stability according system score. Secondary outcomes autonomic stability, thermal control, infection time, breastfeeding growth, epigenetic profile, microbiome infant behaviour, stress resilience, sleep integrity, cortical maturation, neurodevelopment, mother-infant attachment attunement, experience mental health. study has ethical approval Swedish Ethical Review Authority (2017/1135-31/3, 2019-03361) Norwegian Regional Committee (2015/889). conducted good clinical practice Helsinki declaration. results will increase about mechanisms behind effects by dissemination scientific community through articles conferences, parenting classes magazines. Recruiting since April 2018. Expected termination June 2021. NCT03521310 (ClinicalTrials.gov).

Language: Английский

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Mother-newborn couplet care: Nordic country experiences of organization, models and practice

Journal of Perinatology, Journal Year: 2023, Volume and Issue: 43(S1), P. 17 - 25

Published: Dec. 1, 2023

Abstract Mother-Newborn Couplet Care is a concept and defined as the provision of care for sick or preterm newborn in close proximity to coupled with mother from birth infant long needs hospital care. This requires system change both obstetrics pediatrics terms planning organization care, equipment design units. Accordingly, strong leadership setting clear goals emphasizing culture cohesive supported by targeted education training crucial ensure high-quality all mother-newborn dyads without separation. We describe various organizational models used Sweden Finland implementation processes. envision future where newborns mothers are always together, irrespective medical needs, form an inseparable center around which healthcare services providers organized.

Language: Английский

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Skin-to-skin contact—An effective intervention on pain and stress reduction in preterm infants

Frontiers in Pediatrics, Journal Year: 2023, Volume and Issue: 11

Published: March 22, 2023

The outcomes of pain and stress in preterm infants the neonatal intensive care units (NICUs) compel continued search for pain- stress-reducing interventions.To investigate how skin-to-skin contact (SSC) influences chronic NICU.The study included 140 NICU with gestational age less than 34 weeks. overall design was a baseline-response design. Urine saliva were collected before (baseline) after SSC to measure markers by enzyme immunoassay method. behavioral indicators assessed using EDIN (Échelle Douleur Inconfort Nouveau-Né-neonatal discomfort).There significant decrease dopamine level comparison baseline values (85.99 [69.35; 112.20] pg/ml vs. 132.20 [104.80; 183.70] pg/ml), p < 0.001. β-endorphin serotonin levels increased (40.09 [26.81; 70.63] 29.87 [20.61; 46.94] pg/ml, = 0.009 25.49 [20.45; 40.08] ng/ml 22.30 [15.13; 31.65] ng/ml, 0.011, respectively). A cortisol urine (0.125 [0.079; 0.225] μg/dl 0.371 [0.188; 1.002] μg/dl, 0.000 27.06 [14.59; 35.35] 35.25 [19.78; 61.94] 0.001, simultaneous increase oxytocin (57.00 [36.55; 88.49] 38.20 [28.78; 56.04] revealed. total score below 6 points, significantly decreasing compared (p 0.05).Preterm experience pain, which confirmed scale laboratory markers. as hormones reliably high, normalized regular SSC. Simultaneously, pain-relieving anti-stress oxytocin, response

Language: Английский

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