Pain in very preterm infants-prevalence, causes, assessment, and treatment. A nationwide cohort study.

Studies on pain in preterm infants have usually been confined to observations of painful procedures, and information from extremely preterm infants is limited. Using registry data from a Swedish nationwide cohort, this study explored the epidemiology of pain in very preterm infants, its causes, assessments, and treatment strategies. We included liveborn infants <32 weeks' gestational age (GA) discharged between January 2020 and June 2024.

Discharge criteria, practices, and decision-making in the transition of preterm infants to home.

Background: Early discharge to neonatal home care is common practice for preterm infants in Sweden but the evidence base for assessing infant and parent readiness is limited and there are no nationally defined discharge guidelines or criteria. To investigate potential facilitators and barriers in the transition to home, we examined discharge criteria, pre- and post-discharge practices, and staff decision-making.

Methods: All (n = 36) Swedish units participated in this descriptive mixed method study based on semi-structured interviews with one physician and one registered nurse representing each unit.

Protocol to Support Skin-to-Skin Care and Closeness Between Parents and Neonates in the NICU.

Skin-to-skin care (SSC) is essential, can help to prevent separation of parents and the neonate in the NICU, and should be a standard practice. It can safely be integrated into the routine care of preterm neonates, those who require surgery, and those who require all levels of intensive care. Years of experience with the provision of SSC in our NICU influenced our approach to care and resulted in practice guidelines for the safe provision of SSC.

Experiences of breast milk donors in Sweden: balancing the motivation to do something good with overcoming the challenges it entails.

Background: Infants requiring neonatal care often face initial breastfeeding challenges, leading them to receive expressed breast milk from their mother or donor milk. While emphasizing the mother's own milk as the gold standard for infant nutrition, the utilization of donor milk stands as the preferred alternative over infant formula due to its numerous benefits. To facilitate the provision of donor milk to preterm and ill infants in neonatal units, the active participation of women willing to contribute their breast milk is crucial.

Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences.

Background: In recent decades, modern neonatal intensive care has improved, increasing the survival of extremely preterm children. Few studies have examined the experiences of parents of extremely preterm children from a long-term perspective.

Aim: To describe parents' experiences of parenting extremely preterm children during their childhood and transition to adulthood.

Lipid Peroxidation and Antioxidative Capacity Are Unaltered in Transitional Breast Milk Exposed to Light from Women Giving Birth to Preterm Infants before 32 Weeks of Gestation.

Breast milk (BM) is the primary nutrition for infants and has a high content of lipids. Preterm infants receive expressed BM via tube feeding, and they are frequently treated with phototherapy. When parenteral nutrition (PN) is exposed to light and/or phototherapy, lipid peroxidation (LPO) increases.

Neonatal resuscitation after birth: Swedish midwives' experiences of and perceptions about separation of mothers and their newborn babies.

Introduction: This study aimed to investigate midwives' experiences of and perceptions about mother-baby separation during resuscitation of the baby following birth.

Methods: A qualitative study was conducted using an author-designed questionnaire. Fifty-four midwives from two Swedish birth units with different working methods regarding neonatal resuscitation - at the mother's bedside in the birth room or in a designated resuscitation room outside the birth room - completed the questionnaire.

Interventions for the Management of Pain and Sedation in Newborns Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: A Systematic Review.

Background: Newborn infants undergoing therapeutic hypothermia (TH) are exposed to multiple painful and stressful procedures. The aim of this systematic review was to assess benefits and harms of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing TH for hypoxic-ischemic encephalopathy.

Methods: We included randomized and observational studies reporting any intervention (either drugs or non-pharmacological interventions) to manage pain and sedation in newborn infants (> 33 weeks' gestational age) undergoing TH.

Clonidine as analgesia during retinopathy of prematurity screening in preterm infants (cloROP): protocol for a randomised controlled trial.

Introduction: Preterm infants are at risk of negative consequences from stress and pain at the same time as they often are in need of intensive care that includes painful interventions. One of the frequent painful procedures preterm infants undergo is eye examination screening to detect early signs of ROP (retinopathy of prematurity). These examinations are both stressful and painful, and despite a multitude of research studies, no conclusive pain-relieving treatment has been demonstrated.

Nursing care of infants born extremely preterm.

With improving survival at the lowest gestations an increasing number of tiny and vulnerable infants are being cared for, and optimal outcomes require an approach to care that takes their specific characteristics into account. These include immature organ function and a risk for iatrogenic injury, and parental/familial strain due to the high degree of uncertainty, infant-mother separation, and long hospital stay. While the challenges in providing nursing care to these infants are obvious it is also clear that this field has tremendous potential to influence both short and long-term outcomes of this population.

Interventions for the management of Pain and Sedation in Newborns undergoing Therapeutic hypothermia for hypoxic-ischemic encephalopathy (IPSNUT): protocol of a systematic review.

Background: Clinical research has shown that therapeutic hypothermia after neonatal hypoxic-ischemic injury improves survival without disability. There is no consensus regarding pain relief or sedation during therapeutic hypothermia in newborns; however, therapeutic hypothermia seems to be associated with pain and stress, and adequate analgesia and sedation are central to maximize the effect of therapeutic hypothermia. Pain needs to be adequately managed in all patients, especially the newborn infant due to the potential short- and long-term negative effects of inadequately treated pain in this population.

Symptoms of depression in parents after discharge from NICU associated with family-centred care.

Aims: The aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents' depressive symptoms at discharge and at 4 months corrected for infant age.

Design: A longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries.

Methods: Parents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants' hospitalizations.

Developing the Preterm Breastfeeding Attitudes Instrument: A tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive care.

Objective: The aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care.

Design: The study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme.

"Paying it Forward" - Swedish Women's Experiences of Donating Human Milk.

Background: Human milk is recommended as the only nutritional source during the first 6 months of life. For preterm infants, the benefits of human milk are even more important and can alleviate the negative influences of preterm birth.

Research Aim: To describe how Swedish human milk donors experienced the donation process.

Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy.

Background: Skin-to-skin contact (SSC) has been demonstrated to allow adequate thermal stability in high-technology settings with extremely preterm infants, while other aspects on how SSC influences basic physiological parameters have been less extensively investigated.

Purpose: To evaluate physiological stability during SSC and incubator care in a group of preterm infants born at a gestational age (GA) of 32 weeks or less and receiving respiratory support.

Methods: Descriptive, observational study including 10 preterm infants (GA 22-32 weeks, postnatal age 2-48 days) were evaluated during SSC compared with flanking time periods in the incubator.

Pain Assessment and Management in Swedish Neonatal Intensive Care Units.

Aims: To investigate registered nurses' (RNs') and physicians' knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden.

Design: Descriptive and explorative study using an online questionnaire.

Methods: A researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden.

Parental participation during therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy.

Objectives: To examine parental participation in the care of newborn infants receiving therapeutic hypothermia, and to explore the possible impact of in-born vs out-born status, and location of hospital accommodation.

Study Design: Retrospective, quantitative and descriptive design.

Main Outcome Measures: Infants medical charts were reviewed for defined aspects of parental participation (infant holding, tube feeding, and diaper change), and related to their in-born vs out-born status, and whether the parents were accommodated in the NICU or elsewhere.

Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit.

Background: There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care.

Purpose: To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions.

Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial.

Introduction: Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory.

Becoming a mother - Mothers' experience of Kangaroo Mother Care.

Objective: To describe mothers' experiences of providing their preterm infants with Kangaroo Mother Care (KMC).

Study Design: A qualitative descriptive design.

Setting: Two level III neonatal intensive care units (NICUs) in Sweden.

Parents need support to find ways to optimise their own sleep without seeing their preterm infant's sleeping patterns as a problem.

Aim: This study described how parents perceived their own sleep, and their infants', during neonatal intensive care unit (NICU) admission and after discharge. It also explored the infants' sleeping location at home.

Methods: The study was conducted in the NICUs of two Swedish university hospitals.

Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks.

Background: Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.

Objective: This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.

Methods: As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age.

Fathers' perception of information received during their infants' stay at a neonatal intensive care unit.

Objective: To explore fathers' perception of information received during their infants' care at a neonatal intensive care unit (NICU).

Methods: An inductive, qualitative and descriptive study. Eight fathers in two units were interviewed.

Kangaroo mother care in the neonatal intensive care unit: staff attitudes and beliefs and opportunities for parents.

Aim: To compare attitudes towards Kangaroo mother care (KMC) among staff in two high-tech neonatal intensive care units, which provided parents with different opportunities to get involved in their infants' care.

Method: Questionnaires were completed by healthcare staff in Unit A, which provided parents with unrestricted access so that they could provide continuous KMC, and Unit B, where parents could only practice KMC intermittently.

Results: Unit A staff were more positive about the benefits and use of KMC, including its use in unstable infants, and rated their knowledge and practical skills more highly than staff in the other unit.

Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units.

Aim: To describe initiation and extent of parents' application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units.

Methods: The duration of SSC was recorded in 104 infants' medical charts during their hospital stay, and the parents answered a questionnaire.

Results: Both parents were involved in the practice of SSC.