Breastfeeding Characteristics and Duration of Feeding Human Milk in Infants With Congenital Heart Disease

Future efforts to support feeding human milk in infants with CHD should emphasize practices that support maximal human milk production.

source: JPNN

Summary

[Posted 5/Mar/2024]

AUDIENCE: Nursing

KEY FINDINGS: Future efforts to support feeding human milk in infants with CHD should emphasize practices that support maximal human milk production.

BACKGROUND: Although infants with congenital heart disease (CHD) are able to breastfeed successfully, the factors that affect feeding human milk across the first year are not well established. The aim of this study was to examine breastfeeding characteristics and their relationships to the exclusivity and duration of feeding human milk among infants with CHD.

DETAILS: Breastfeeding characteristics data from a cohort of 75 infants with CHD enrolled in a study that examined relationships among milk type and infant growth in the first year of life were analyzed. Infants whose mothers reported not having enough milk were exclusively fed human milk for a shorter duration than those who did not have this challenge ( P = .04); however, the duration of feeding any human milk did not differ ( P = .18). Average daily volume expressed at 1 month was positively related to the duration of exclusive human milk (β = .07, P = .04) and any human milk (β = .07, P = .04) feeding.

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Source: Russel, S. M., Lessen, R., Rovner, A. J., et al. (2024). Breastfeeding Characteristics and Duration of Feeding Human Milk in Infants With Congenital Heart Disease. The Journal of Perinatal & Neonatal Nursing. 2024; 38(1): 46-53. Published: January/March, 2024. DOI: 10.1097/JPN.0000000000000740.



Neonatal Diet Type and Associations With Adverse Feeding Outcomes in Neonates With Critical Congenital Heart Defects

Human milk and direct chest/breastfeeding may be protective against some adverse feeding outcomes for CCHD neonates. Larger, multicenter cohort studies are needed to continue investigating the effects of neonatal diet type and feeding modality on the development of adverse feeding outcomes in this unique population.

source: JPNN

Summary

[Posted 9/Apr/2024]

AUDIENCE: Nursing

KEY FINDINGS: Human milk and direct chest/breastfeeding may be protective against some adverse feeding outcomes for CCHD neonates. Larger, multicenter cohort studies are needed to continue investigating the effects of neonatal diet type and feeding modality on the development of adverse feeding outcomes in this unique population.

BACKGROUND: Neonates with critical congenital heart defects (CCHD neonates) experience high rates of feeding intolerance, necrotizing enterocolitis (NEC), and malnutrition. The benefits of human milk and direct chest/breastfeeding are well known, but research is limited in CCHD neonates. Therefore, the purpose of this study is to examine the impact of neonatal diet and feeding modality on the incidence of feeding intolerance, NEC, and malnutrition among a cohort of CCHD neonates.

DETAILS: A single-center retrospective study was conducted using electronic health record data of CCHD neonates admitted to a cardiac intensive care unit between April 2016 and April 2020. Regression models were fit to analyze associations between neonatal diet, feed modality, and adverse feeding outcomes. Seventy-four CCHD neonates were included. Increased days of direct chest/breastfeeding were associated with fewer signs of gastrointestinal distress (P = .047) and bloody stools (P = .021). Enteral feeding days of "all human milk" were associated with higher growth trajectory (P < .001).

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Source: Davis, J. A., Baumgartel, K., Baust, T., et al. (2024). Neonatal Diet Type and Associations With Adverse Feeding Outcomes in Neonates With Critical Congenital Heart Defects. The Journal of Perinatal & Neonatal Nursing. 2024; 38(1): 54-64. Published: March, 2024. DOI: 10.1097/JPN.0000000000000790.



Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians

The study shows a moderate interrater reliability and lower predictive accuracy of a HEART score calculated by Ambulance Nurse (AN) versus EP. AN underestimate the risk of patients with acute chest pain, with the largest discrepancies in the elements History and Risk factors. Reconsidering the cut-off values of the low-risk HEART category, as well as a carefully developed training program, will possibly lead to a higher interrater reliability of the HEART score and higher predictive accuracy used by AN.

source: AENJ

Summary

[Posted 22/Mar/2024]

AUDIENCE: Nursing, Emergency Medicine

KEY FINDINGS: The study shows a moderate interrater reliability and lower predictive accuracy of a HEART score calculated by AN versus EP. AN underestimate the risk of patients with acute chest pain, with the largest discrepancies in the elements History and Risk factors. Reconsidering the cut-off values of the low-risk HEART category, as well as a carefully developed training program, will possibly lead to a higher interrater reliability of the HEART score and higher predictive accuracy used by AN.

BACKGROUND: Chest pain is a common complaint for consultation of emergency medical services worldwide. Currently, ambulance nurses (AN) base their decision to transport a patient to the hospital on their own professional experience. The HEART score could improve prehospital risk stratification and patient treatment. The aim of this study is to investigate the interrater reliability and predictive accuracy of the HEART score between AN and emergency physicians (EP).

DETAILS: A retrospective analysis on data of 569 patients 18 years and older included in two prehospital HEART score studies. The endpoints are interrater reliability (intraclass correlation [ICC]) and predictive accuracy for major adverse cardiac events within 30 days of the HEART score calculated by AN versus EP. Predictive accuracy is sensitivity, specificity, positive predicted value (PPV) and negative predicted value (NPV). Interrater reliability was good for total HEART score (ICC 0.78; 95% CI 0.75-0.81). However, focusing on the decision to transport a patient, the ICC dropped to 0.62 (95% CI 0.62-0.70). History and Risk factors caused the most variability. Predictive accuracy of HEART differed between AN and EP. The HEART score calculated by AN was sensitivity 91%, specificity 38%, PPV 26%, and NPV 95%. The HEART score calculated by EP was sensitivity 98%, specificity 32%, PPV 26%, and NPV 99%. With a cut-off value of 0-2 for a low HEART score, predictive accuracy significantly improved for the HEART score calculated by AN: sensitivity 98%, specificity 18%, PPV 22%, and NPV 98%.

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Source: van der Waarden, N. W. P. L., de Wolf, G. S., van Meerten, K. F., et al. (2024). Assessment of the Diagnostic Accuracy and Reliability of the HEART Score Calculated by Ambulance Nurses Versus Emergency Physicians. Advanced Emergency Nursing Journal. 2024; 46(1): 49-57. Published: January/March, 2024. DOI: 10.1097/TME.0000000000000497.



Exploring the Interrelationships Between Physical Function, Functional Exercise Capacity, and Exercise Self-Efficacy in Persons Living with HIV

While physical activity can mitigate the metabolic effects of HIV disease and HIV medications, many HIV-infected persons report low levels of physical activity.

source: Clinical Nursing Research

Summary

[Posted 12/Mar/2024]

AUDIENCE: Nursing

KEY FINDINGS: Making Time for Exercise Self-efficacy was more significant than Resisting Relapse for both physical function and functional exercise capacity. Interventions to promote achievement of physical activity need to use multiple measurement strategies.

BACKGROUND: Objective of this study is to determine if there were differences between the subjective and objective assessments of physical activity while controlling for sociodemographic, anthropometric, and clinical characteristics. A total of 810 participants across eight sites located in three countries. Both univariate and multivariant analyses were used.

DETAILS: Subjective instruments were the two subscales of Self-efficacy for Exercise Behaviors Scale: Making Time for Exercise and Resisting Relapse and Patient-Reported Outcomes Measurement Information System, which measured physical function. The objective measure of functional exercise capacity was the 6-minute Walk. Physical function was significantly associated with Making Time for Exercise (β = 1.76, p = .039) but not with Resisting Relapse (β = 1.16, p = .168). Age (β = -1.88, p = .001), being employed (β = 16.19, p < .001) and race (βs = 13.84–31.98, p < .001), hip–waist ratio (β = -2.18, p < .001), and comorbidities (β = 7.31, p < .001) were significant predictors of physical functioning. The model predicting physical function accounted for a large amount of variance (adjusted R2 = .938). The patterns of results predicting functional exercise capacity were similar. Making Time for Exercise self-efficacy scores significantly predicted functional exercise capacity (β = 0.14, p = .029), and Resisting Relapse scores again did not (β = -0.10, p = .120). Among the covariates, age (β = -0.16, p < .001), gender (β = -0.43, p < .001), education (β = 0.08, p = .026), and hip–waist ratio (β = 0.09, p = .034) were significant. This model did not account for much of the overall variance in the data (adjusted R2 = .081). We found a modest significant relationship between physical function and functional exercise capacity (r = 0.27).

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Source: Nokes, K. M., Sokhela, D. G., Orton, P, M., et al. (2024). Exploring the Interrelationships Between Physical Function, Functional Exercise Capacity, and Exercise Self-Efficacy in Persons Living with HIV. XXXXXXXX. 2024; 33(2-3): 165-175. Published: March, 2024. DOI: 10.1177/10547738241231626.



Family Integrated Care Shortens the Duration of Home Oxygen Therapy in Infants With Bronchopulmonary Dysplasia

FIC (Family Integrated Care) improved the optimal target oxygen saturation ratio before discharge and shortened the duration of HOT (Home Oxygen Therapy) in premature infants with moderate and severe BPD (bronchopulmonary dysplasia). FIC should be promoted in China's neonatal intensive care units, though it puts forward new requirements for nursing education and training.

source: Advances in Neonatal Care

Summary

[Posted 27/Feb/2024]

AUDIENCE: Nursing

KEY FINDINGS: FIC improved the optimal target oxygen saturation ratio before discharge and shortened the duration of HOT in premature infants with moderate and severe BPD. FIC should be promoted in China's neonatal intensive care units, though it puts forward new requirements for nursing education and training.

BACKGROUND: There have been few reports on whether family integrated care (FIC) can help premature infants with moderate to severe bronchopulmonary dysplasia (BPD) to shorten the duration of home oxygen therapy (HOT). Objective of this study is to investigate the effect of FIC on the duration of HOT in premature infants with moderate to severe BPD.

DETAILS: The subjects were retrospectively selected from premature infants with moderate to severe BPD in authors' center between June 2019 and December 2021. Patients were divided into the FIC group (n = 47) and the non-FIC group (n = 34). For univariate analysis, t test, Mann–Whitney U test, Pearson χ2 test, or Fisher exact test was performed to explore the differences between the 2 groups. For multivariate analysis, simple and multiple linear regression was conducted to explore the effect of FIC on the duration of HOT. (1) The duration of HOT and length of stay after grouping were significantly shorter in the FIC group than in the non-FIC group (P < .05). (2) The results of linear regression further revealed that FIC could significantly shorten the duration of HOT (simple linear regression, FIC [A] B: -12.709, 95% confidence interval (CI): -21.665 to -3.753; multiple linear regress

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Source: Shen, F., Wu, X., Chen, X., et al. (2024). Family Integrated Care Shortens the Duration of Home Oxygen Therapy in Infants With Bronchopulmonary Dysplasia. Advances in Neonatal Care. 2024; 24(1): 27-34. Published: February, 2024. DOI: 10.1097/ANC.0000000000001119.



Skin-To-Skin Contact During Cesarean Birth in the United States over the Last Decade

There are differences in incidence and access to skin-to-skin contact during cesarean birth. Study findings emphasize the continued need to address disparities in care, increase maternal health care equity, and make skin-to-skin contact during cesarean birth available for all women who desire it.

source: MCN

Summary

[Posted 20/Feb/2024]

AUDIENCE: Nursing

KEY FINDINGS: There are differences in incidence and access to skin-to-skin contact during cesarean birth. Study findings emphasize the continued need to address disparities in care, increase maternal health care equity, and make skin-to-skin contact during cesarean birth available for all women who desire it.

BACKGROUND: Objective of the study is to assess skin-to-skin contact during cesarean birth, including incidence and maternal characteristics.

DETAILS: A cross-sectional, retrospective study using survey methods was conducted. Women who had a cesarean birth within the last 10 years prior to January 2022 were recruited via social media. Descriptive statistics, chi square, and binary logistic regression analyses were calculated. There were 2,327 participants, of which 29.7% experienced skin-to-skin contact during their cesarean birth. This was reported to be less often than desired. Significant associations were found among skin-to-skin contact during cesarean birth and planned cesarean birth, previous cesarean birth, maternal age, level of education, and birth region. Previous vaginal birth and race were not significantly associated with skin-to-skin contact during cesarean birth. Most (93.65%) respondents identified as White. Barriers to skin-to-skin contact during cesarean birth may be birth region, unplanned or emergency cesarean births, younger age, lacking a college degree, and lack of previous cesarean births.

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Source: Junk-Wilson, J. S., King, E. K., Murphy, L. M., et al. (2024). Skin-To-Skin Contact During Cesarean Birth in the United States over the Last Decade. MCN, The American Journal of Maternal/Child Nursing. 2024; 49(1): 8-14. Published: January/February 2024. DOI: 10.1097/NMC.0000000000000960.



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