scholarly journals Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit

2020 ◽  
Author(s):  
Edith Brignoni-Pérez ◽  
Melissa Scala ◽  
Heidi M. Feldman ◽  
Virginia A. Marchman ◽  
Katherine E. Travis
Keyword(s):  
Socioeconomic Status ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Clinical Staff ◽  
Group Differences ◽  
Language Group ◽  
Kangaroo Care ◽  
Language Groups ◽  
Family Language ◽  
Family Ses

AbstractOBJECTIVESThe aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the total amount, frequency, and duration of Kangaroo Care (KC) compared to preterm infants of higher SES or primarily English-speaking families.METHODSParticipants were infants born <32 weeks gestational age (GA), N=116. We defined family SES by the infants’ health insurance (private/higher vs. public/lower) and family language by the language mothers used to communicate with clinical staff (English vs. Other language). Family SES or family language groups were compared on: (1) the total amount of KC infants experienced during hospitalization; (2) frequency of KC per visitation days; and, (3) duration of KC events per day.RESULTSInfants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant.CONCLUSIONSOur findings revealed disparities in the total amount, frequency, and duration of KC in the neonatal intensive care unit as a function of both family SES and language families used to communicate with clinical staff. These disparities reduced infants’ access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize such disparities.Table of Contents SummaryTotal amount, frequency, and duration of Kangaroo Care for preterm infants in the NICU varied as a function of family’s socioeconomic status and language.What’s Known on This SubjectIn the United States, disparities in health care delivery and medical outcomes have been identified on the basis of patient or family socioeconomic status and the language patients or families use to communicate with clinical staff.What This Study AddsExtending to the NICU, the amount, frequency, and duration of Kangaroo Care experienced by preterm infants differed both by family’s socioeconomic status and the language families use to communicate with clinical staff. Policy changes are needed to reduce these disparities.Contributors’ Statement PageDr. Brignoni-Pérez conceptualized and designed the study, acquired data from the electronic medical record, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Scala, Marchman, Feldman, and Travis conceptualized and designed the study, supervised data abstraction and analysis, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

scholarly journals What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Coutts ◽  
Alix Woldring ◽  
Ann Pederson ◽  
Julie De Salaberry ◽  
Horacio Osiovich ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthcare Provider ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Healthcare Providers ◽  
Neurodevelopmental Outcomes ◽  
Kangaroo Care ◽  
Optimal Care ◽  
Barriers And Enablers ◽  
Provider Beliefs

Abstract Background The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers’ perspectives on the barriers and enablers of implementing KC. Methods This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. Results Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. Conclusions A ‘one size fits all’ approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.

scholarly journals Effects of Kangaroo Mother Care in the NICU on the Physiological Stress Parameters of Premature Infants: A Meta-Analysis of RCTs

2022 ◽  
Vol 19 (1) ◽  
pp. 583
Author(s):  
Delia Cristóbal Cañadas ◽  
Antonio Bonillo Perales ◽  
Rafael Galera Martínez ◽  
María del Pilar Casado-Belmonte ◽  
Tesifón Parrón Carreño
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Physiological Stress ◽  
Meta Analysis ◽  
Kangaroo Mother Care ◽  
Controlled Trials ◽  
Kangaroo Care ◽  
Incubator Care ◽  
Stress Parameters

Objective: The aim of this study was to analyze the randomised controlled trials that explored the effect of kangaroo mother care on physiological stress parameters of premature infants. Methods: Two independent researchers performed a systematic review of indexed studies in PubMed, Embase, CINAHL, Cochrane and Scopus. We included data from randomized controlled trials measuring the effects of kangaroo care compared to standard incubator care on physiological stress outcomes, defined as oxygen saturation, body temperature, heart rate and respiratory rate. The PRISMA model was used to conduct data extraction. We performed a narrative synthesis of all studies and a meta-analysis when data were available from multiple studies that compared the same physiological parameters with the kangaroo method as an intervention and controls and used the same outcome measures. Results: Twelve studies were eligible for inclusion in this meta-analysis. According to statistical analysis, the mean respiratory rate of preterm infants receiving KMC was lower than that of infants receiving standard incubator care (MD, −3.50; 95% CI, −5.17 to −1.83; p < 0.00001). Infants who received kangaroo mother care had a higher mean heart rate, oxygen saturation and temperature, although these results were not statistically significant. Conclusions: Current evidence suggests that kangaroo care in the neonatal intensive care unit setting is a safe method that may have a significant effect on some of the physiological parameters of stress in preterm infants. However, due to clinical heterogeneity, further studies are needed to assess the effects of physiological stress in the neonatal intensive care unit on the development of preterm infants.

scholarly journals Preseason Baseline Neurocognitive Performances and Symptom Reporting on ImPACT®: A Comparison of Adolescent Student-Athletes Tested in Spanish and English

2020 ◽  
Author(s):  
Justin E. Karr ◽  
Mauricio A. Garcia-Barrera ◽  
Jacqueline M. Marsh ◽  
Bruce Maxwell ◽  
Paul D. Berkner ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Student Athletes ◽  
Symptom Reporting ◽  
Group Differences ◽  
Language Group ◽  
Motor Speed ◽  
Language Groups ◽  
Baseline Testing ◽  
Composite Scores ◽  
The Impact

Abstract Context: Student-athletes are commonly administered the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery at preseason baseline and post concussion. The ImPACT® is available in many different languages, but few studies have examined differences in cognitive performances and symptom ratings based on language of administration. Objective: This study examined differences on ImPACT® neurocognitive composites and symptom reporting at preseason baseline testing between student-athletes completing ImPACT® in Spanish versus English. Design: Cross-sectional study. Setting: Preseason baseline testing for a high school concussion management program in STATE-XXX. Patients of Other Participants: Adolescent student-athletes completing testing in Spanish (n=169) and English (n=169) were matched on age, gender, and health/academic history. Language groups were compared on each outcome for the full sample and for gender-stratified subsamples. Main Outcome Measure(s): Neurocognitive composite scores and individual and total symptom severity ratings from the ImPACT® battery. Results: Athletes tested in Spanish had lower neurocognitive performances on two of five composite scores (i.e., Visual Motor Speed, p&lt;.001, d=.51; Reaction Time: p=.004, d=.33) and reported greater symptom severity (p&lt;.001, r=.21). When analyses were stratified by gender, similar Visual Motor Speed differences were observed between language groups among boys (p=.001, d=.49) and girls (p=.001, d=0.49), whereas Reaction Time showed a larger group difference for boys (p=.012, d=.42) than girls (p=.128, d=.21). Language group differences in symptom reporting were similar for boys (p=.003, r=.22) and girls (p=.008, r=.21), with more frequent endorsement of physical and affective symptoms by athletes tested in Spanish. Conclusions: Language group differences in total symptom severity were small (r=.21), and language group differences in neurocognitive performances were small-to-medium (d=.05–.51). Compared to previous studies comparing athletes tested in Spanish and English on ImPACT®, smaller effects were observed in the current study, which may be attributable to close matching on variables related to neurocognitive performances and symptom reporting. Key points:

scholarly journals Cardiorespiratory coupling in preterm infants

2019 ◽  
Vol 126 (1) ◽  
pp. 202-213 ◽  
Author(s):  
Rohan Joshi ◽  
Deedee Kommers ◽  
Xi Long ◽  
Loe Feijs ◽  
Sabine Van Huffel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
The Other ◽  
Regulatory Mechanisms ◽  
Kangaroo Care ◽  
Cardiorespiratory Coupling

In preterm infants, a better understanding and quantification of cardiorespiratory coupling may help improve caregiving by enabling the tracking of maturational changes and subclinical signatures of disease. Therefore, in a study of 20 preterm infants admitted to a neonatal intensive care unit, we analyzed the cardiac and respiratory regulatory mechanisms as well as the coupling between them. In particular, we selectively analyzed coupling from changes in heart rate to respiratory oscillations as well as coupling from respiratory oscillations to the heart rate. Furthermore, we stratified this coupling based on decelerations and accelerations of the heart rate and by inspiration and expiration during respiration while contrasting periods of kangaroo care, an intervention known to enhance autonomic regulation, with periods in the incubator. We identified that preterm infants exhibit cardiorespiratory coupling that is nonsymmetric with regard to the direction of coupling. We demonstrate coupling from decelerations and accelerations of the heart rate to exhalation and inhalation, respectively, both on a beat-to-beat basis as well as with sustained decelerations and accelerations. On the other hand, on average, we also observed coupling from both inspiration and expiration to marginal decelerations in the heart rate. These phenomena, especially coupling from the changes in the heart rate to respiratory oscillations, were sensitive to whether the infant was receiving kangaroo care. NEW & NOTEWORTHY Preterm infants exhibit cardiorespiratory coupling that is nonsymmetric with regard to the direction of coupling; coupling from fluctuations in the heart rate to respiratory oscillations and vice versa are asymmetric. On average, coupling is observable from decelerations or accelerations in the heart rate to inhalation or exhalation, respectively, whereas, on average, both peaks and troughs of respiration exhibit coupling to marginal decelerations in the heart rate.

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