Nutritional needs of the preterm infant after hospital discharge

Infections related to central venous catheters (CVCs) increase hospital costs, length of stay, and patient mortality. Review of the literature and research pertaining to CVCs have provided some guidelines to reduce the risk of infections related to CVCs. Recommended guidelines include use of sterile technique with insertion, maintenance of site dressings, avoidance of routine changes of CVCs, and reduction of hub manipulation. Critical care nurses have the primary opportunity to improve patient outcomes by reducing CVC infections.     

Patients' perceptions of their quality of life 11 years after discharge from a state hospital

OBJECTIVE: Fifty-three state hospital patients discharged to group homes in the community in 1978-79 were followed up at three and 11 years to assess their quality of life and several other dimensions of their community experience. METHODS: A structured interview was used to obtain data on patients' perceptions of and degree of satisfaction with aspects of their lives one month before hospital discharge and at three and 11 years after. Group home staff rated patients' functioning at follow-up. Data on rehospitalizations over the 11-year period were collected. RESULTS: At 11-year follow-up, 30 of the surviving 40 patients were living in noninstitutional settings: nine in independent or semi-independent settings and 21 in group homes. The 30 patients perceived that their quality of life outside the hospital had improved in several ways, including the extent of their social networks, the quality of their living environment, and their capacity to meet basic needs. When data were averaged over the 11 years and corrected for the shorter time in the study of subjects who died, patients spent only 2.6 percent of the follow-up period in the hospital. Only one patient at 11 years wanted to return to the hospital. CONCLUSIONS: The finding that even the small minority of patients who required multiple rehospitalizations preferred community life may have important clinical and policy implications for setting the threshold of hospital discharge.     

Multiple perceptions of discharge planning in one urban hospital

Since the advent of diagnosis-related groups (DRGs), advocacy groups have claimed that although hospital discharge planners perceive the discharge planning process as helpful, elderly patients and their families do not. This article explores how the discharge planning process was perceived by 40 discharge planners and 40 family caregivers. Planners greatly overrated caregiver influence and the amount adequacy of information shared about posthospital health care, choice of discharge to home or nursing home, and time to decide. Caregivers perceived that nursing homes were forced on patients by social workers and physicians. DRGs, physicians, and hospital administrators appeared to pressure social workers to coerce mentally competent patients into nursing homes. Excessive concern by hospital staff about patient safety after discharge may override patients' rights to autonomy and self-determination, violating the NASW Code of Ethics. Implications for practice, policy, and future research are discussed.     

Mothers' and fathers' singing to infants.

Mothers and fathers sang a song of their choice, once to their infant and once as if to their infant (simulated). The pitch of songs was higher and the tempo slower for infant-directed than for simulated versions. Listeners varying in child-care experience, musical background, and cultural origin reliably identified which of the two versions was infant-directed (Experiment 1) . Identification accuracy was enhanced by musical training, knowledge of the singers' language and culture, and by greater pitch and tempo differences between versions. Other adult listeners who rated the singer's emotional engagement assigned significantly higher ratings to infant-directed than to simulated versions (Experiment 2). Differences in pitch and tempo between both versions predicted emotional engagement ratings. Finally, rating differences between infant-directed and simulated versions were highly correlated with identification accuracy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Growth and body composition of preterm infants: influence of nutrient fortification of mother''s milk in hospital and breastfeeding post-hospital discharge

Enhanced oxidative stress is a feature of inflammatory and infectious conditions. Proteins may be important targets of oxidation and this may alter their function. We evaluated whether metal-catalyzed oxidation of IgG could alter its ability to bind to Fc receptors on macrophages. Human IgG incubated with an FeCl3/EDTA/ascorbate metal-catalyzed oxidation system resulted in a significant increase in carbonyl content, a measure of protein oxidation, compared to IgG treated with EDTA alone (control). Western blot analysis using an antibody to oxidized protein revealed an increase in antibody binding to both the heavy (Fc portion-containing) and light chains of IgG treated with the oxidizing system. Western blot analysis of papain-digested IgG confirmed oxidative modification of the Fc portion. Binding studies carried out with J774.16 macrophages demonstrated significantly diminished ability of the oxidized IgG to bind to macrophage Fc receptors compared to control IgG. These data demonstrate that IgG is susceptible to metal-catalyzed oxidation and that this impairs its ability to bind to macrophage Fc receptors. Oxidation of IgG might play a role in modulating immune function in infection and disorders associated with immune complex formation by diminishing IgG binding to phagocytic cells.     

Mothers' supervision of their children's peer play: Relations with beliefs, perceptions, and knowledge.

Mothers (N?=?76) of 3- to 5-year-old children completed questionnaires assessing beliefs in the importance and modifiability (vs. innateness) of children's peer relationship skills, perceptions of their children's social competence with peers, and strategies they would use in response to children's peer interaction problems. A subsample of mothers (n?=?34) was observed supervising the play of their own children and a peer. Maternal perceptions of children's competence were negatively associated with the extent of mothers' involvement in children's play, whereas the quality of supervision was predicted by knowledge of socialization strategies and the interaction of beliefs and knowledge. Beliefs appeared to moderate the effects of maternal knowledge on mothers' behavior in that knowledge was associated with the quality of supervision only when mothers believed social skills were important and modifiable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents' perceptions of medical diagnoses and related issues for their high-risk infants

INTRODUCTION: The objectives of this study were (a) to compare maternal and paternal perceptions of infant medical diagnoses with hospital-chart diagnoses, (b) to examine whether parental perceptions of infant medical condition (using three variables) were related to eight other parental perceptions, and (c) to determine what medical diagnoses were associated with parental expectations that neonatal diagnoses were having current effects of would have future effects on their infant. METHOD: With a questionnaire format 76 parents reported information about medical diagnoses and their perceptions about eight other issues for their infants who had been hospitalized in an NICU. RESULTS: Parents reported approximately 62% of the medical diagnoses for their infants during NICU hospitalization; these significantly differed from hospital-chart diagnoses. Parents who reported current or future effects of neonatal diagnoses also (a) had fears for their infants while in the hospital or currently, (b) perceived prematurity as having current or future effects, (c) reported restrictions for their infants caused by neonatal diagnoses, and (d) gave less optimal ratings for their infants' current health status. Parents' perceptions of current or future effects of neonatal diagnoses appeared to be inaccurate given the actual diagnoses for their infants. DISCUSSION: The underreporting of diagnoses by parents raises several issues as to how accurately parents are perceiving their infants. Parents who perceived continued effects of neonatal diagnoses also had less optimal perceptions of other related issues. Parent's perceptions of continued effects of neonatal diagnoses appeared to be unwarranted with respect to the actual diagnoses assigned to their infants.     

Postdischarge telephone follow-up program for breastfeeding preterm infants discharged from a special care nursery

There is little research about mothers' concerns and management strategies for breastfeeding preterm infants in the postdischarge period. However, preterm infants have unique needs, and their mothers often face overwhelming challenges when trying to breastfeed in the early postdischarge period. The purpose of this project was to provide support to breastfeeding mothers whose babies had been recently discharged and to help the SCN team to develop a discharge plan. A telephone follow-up form was developed to help identify real or potential problems, plan realistic interventions, and evaluate the effectiveness of the plan. The first part of the form includes information about the baby's stay in the hospital. The second part of the form is used postdischarge. Space is provided to document any identified problems and suggested interventions. Feedback from the mothers who have received the telephone follow-up has been very favorable.     

Mothers' ratings of the temperament characteristics of Down Syndrome infants.

Using Carey's Infant Temperament Questionnaire, mothers' ratings of temperament characteristics of 74 Down's syndrome (DS) infants (aged 4–24 mo) were obtained and compared with those in Carey's standardization sample of normal infants. The stability of the ratings over a 6-mo interval was also examined. Mothers' assessments of their DS infants' behavior did not support the stereotype that DS infants are easier, more placid, and less intense than normal infants. On 6 of the 9 temperament dimensions rated (Activity, Intensity, Mood, Adaptability, Distractibility, and Rhythmicity), no significant differences between the ratings of DS and normal infants were found. Moreover, when the DS infants were considered as members of the Carey sample, a greater percentage of DS than of normal infants were found in more difficult temperament categories. Ss scored lower than the standardization sample on the dimensions of Persistence, Approach, and Threshold. Findings are discussed in terms of qualitative differences in the development of affect in DS infants and the impact that such differences may have on caregiver–infant interactive processes and mothers' assessments of infant behavior. Finally, comparison of individual- and group-level analyses of the stability of temperament ratings revealed discrepancies that suggest the importance of distinguishing the meaning of these types of stability analyses. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skin-to-skin contact beginning in the delivery room for Colombian mothers and their preterm infants

To determine if the transition to extrauterine life is facilitated by skin-to-skin contact, six relatively low risk preterm infants experienced six continuous hours of skin-to-skin contact on their mothers' chests beginning within 30 minutes of birth. Heart and respiratory rates and oxygen saturation remained within normal limits and all infant temperatures rose rapidly to thermoneutral range. Two infants developed grunting respirations by the time skin-to-skin contact began, but the grunting disappeared with warm, humidified oxygen and continuous skin-to-skin contact. All infants were fully breastfeeding and ready for discharge by 24-48 hours postbirth. Early skin-to-skin contact was safe and seemed beneficial for these relatively low risk preterm infants.     

Deformation of the palate in preterm infants

AIM: To investigate the effect of gestation, postmenstrual age, and orotracheal intubation on palate morphology. METHODS: A prospective study was made of 76 newborn infants of 25 to 41 weeks' gestation. Palate dimensions were measured on plaster models produced from serial palatal impressions. Palate size relative to that of the mouth was assessed using a ratio of palate depth to palate width (Palatal Index). RESULTS: Palate depth and width were related to postmenstrual age and gestation. Palatal Index ranged from 0.15 to 0.57, indicating a wide variation in palate shape, but gestation and postmenstrual age had no effect. Prolonged intubation had a small effect, equivalent to an increase in palatal depth of less than 2 mm at 32 weeks' postmenstrual age. The effect was transient. CONCLUSION: Prolonged orotracheal intubation (> 10 days) leads to a small and temporary increase in palatal depth. However, this is unlikely to account for palatal grooving, which is probably caused by an overgrowth of the lateral palatine ridges.     

Mothers' perceptions of sibling adjustment and family life in childhood chronic illness

Researchers who study the effects of chronic illness on well siblings have generally focused on individual characteristics and their relationships with psychological adjustment. More recently, researchers suggest that sibling adjustment can be best understood within the context of the family. The purpose of this study was to examine variations in sibling behavioral adjustment in relation to mothers' perceptions of the illness experience and family life. Based on mothers' ratings on the behavior problem scale of the Child Behavior Checklist (CBCL), five siblings considered poorly adjusted and five very well-adjusted siblings were compared with respect to mothers' reports of individual family member's response to illness, illness management, parenting philosophy, presence of other stressors, availability of social supports, and impact of illness on family members and family life. Two major differences were found between mothers who rated healthy siblings either poorly or very well adjusted: (a) effects of illness on the healthy sibling, the ill child, and the marital relationship and (b) perceived controllability of the chronic illness. Devising ways of helping mothers feel confident in managing their child's illness is integral to creating an environment that promotes optimal development of their ill child and the child's siblings.     

Responses of preterm infants to unimodal and multimodal sensory intervention

PURPOSE: To examine the immediate responses of preterm infants to two forms of unimodal [auditory only (A) and tactile only (T)] and two forms of multimodal sensory stimulation [auditory, tactile and visual (ATV); auditory, tactile, visual and vestibular (ATVV)]. METHOD: A convenience sample of 54 clinically stable preterm infants (33-34 postconceptional weeks) was randomly assigned to 1 of 5 experimental groups [Control (C); (A); (T); (ATV); and (ATVV)]. Stimulation was applied for 15 minutes once daily for 4 consecutive days. RESULTS: Outcome measures included pulse (PR) and respiratory rate (RR), oxygen saturation, behavioral state (BS), and body temperature. Repeated measures ANOVA identified significant differences among the groups during intervention for PR (p < .001), RR (p = .01), and BS (p < .02). Infants receiving any intervention with a tactile component showed increasing arousal (change in BS), and increased PR and RR during stimulation. Group T infants had higher proportions of PR > 180 while Group ATVV had higher proportions of PR < 140 (p = .0001). Group ATVV showed increased alertness following stimulation (24%) in contrast to having the least alertness during stimulation (11%). CONCLUSIONS: Tactile stimulation alone may be too arousing for these infants while the addition of vestibular stimulation may modulate arousal and facilitate optimal arousal prior to feeding.     

Development of attention in preterm infants

The quality of the awake state and attention in preterm infants has been evaluated by rating indices of attention such as widening of the eye, type of fixation, brightening, scanning, and cessation of sucking measured during visual fixation of patterns. Twenty-six infants ranging from 28 to 32 weeks' gestation at birth (mean, 31 weeks) were tested from one to four weeks postnatally until 36 weeks' gestation. Indices of attention were rated on a scale of 4 with an optimal mean index of 4. A progressive increase in behaviors associated with fixation of visual stimuli has been shown from 32 to 36 weeks of conceptual age. Mean scores ranged from 0.7 at 31 weeks' gestation to 1.8 at 34 weeks' and 2.7 at 36 weeks' gestation. The possibility therefore exists that by as early as 31 to 32 weeks from conception the human brain may be capable of waking states and thus able to process some sensory stimulation.rease in behaviors associated with fixation of visual stimuli has been shown from 32 to 36 weeks of conceptual age. Mean scores ranged from 0.7 at 31 weeks' gestation to 1.8 at 34 weeks' and 2.7 at 36 weeks' gestation. The possibility therefore exists that by as early as 31 to 32 weeks from conception the human brain may be capable of waking states and thus able to process some sensory stimulation.     

The racial segregation of hospital care revisited: Medicare discharge patterns and their implications

OBJECTIVES: This paper measures current patterns of hospital segregation among Medicare beneficiaries. METHODS: Data from the fiscal year 1993 Medicare Provider Analysis and Review (MEDPAR) file, the index of dissimilarity, and a linear regression model are used to test the effects of standard metropolitan area characteristics on hospital segregation. RESULTS: The overall hospital segregation index was 0.529, ranging by state from 0.154 to 0.746. Hospital segregation in 126 standard metropolitan areas was positively related to population size, hospital density, and residential segregation and negatively related to income inequities and location in the South. CONCLUSIONS: Racial segregation remains high and may produce both reporting biases and unequal effects of public policy.     

Mothers' representations of their relationships with their toddlers: Links to adult attachment and observed mothering.

Mothers (N?=?125) and their firstborn sons were studied over an 11-month period to examine relations between mothers' representations of their relationships with their children (measured at 15 months by using the Parent Development Interview [PDI]), adult representations of attachment (measured at 12 months by using the Adult Attachment Interview [AAI]), and observed mothering (measured at 15 and 21 months). Results indicate (a) that mothers classified as autonomous on the AAI scored highest on the joy-pleasure/coherence dimension of the PDI and mothers classified as dismissing on the AAI scored highest on the anger dimension of the PDI and (b) that mothers scoring higher on the joy-pleasure/coherence dimension of the PDI engaged in less negative and more positive mothering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early and supported hospital discharge: the hospital and community interface

An agent pathogenic for laboratory albino Swiss mice was isolated from a pool of Haemaphysalis punctata ticks collected from cattle on a farm located in Alcácer do Sal county, southern Portugal. The isolated virus was shown to be distinct from but serologically related to virus members of the Bhanja antigenic group. This new virus in the family Bunyaviridae was named Palma for the farm where ticks have been collected for several studies.     

Quality control of hospital discharge data

Data based on medical records of discharged hospital patients are widely used. However, recent studies of the reliability of discharge data have found error rates which appear to be high, in view of the important data uses. In this paper, the procedures reportedly followed to control the quality of discharge data by private abstracting services, the national Hospital Discharge Survey and the Medicare system are described. Some weaknesses of the quality controls of the existing systems are identified. Recommendations are made for reducing duplicate data collection efforts, and for studies of the relative effectiveness and costs of various quality control procedures.     

Cortical response of preterm infants to phonetic and nonphonetic speech stimuli.

Auditory evoked responses (AERs) were recorded from left and right hemispheres of 11 male preterm infants (mean conceptional age 35.9 wks) in response to synthesized speech syllables and their nonphonetic and nonspeech analogs. Discrete components of the scalp-recorded AERs to these different stimuli were isolated and identified. One component reflected the presence of a left hemisphere mechanism that was sensitive to differences in phonetic and nonphonetic transitional characteristics. Other components of the AER were identified as sensitive to hemisphere differences and formant bandwidth changes. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)