Equity, inclusion and cultural humility: contemporizing the neonatal intensive care unit family-centered care model.

Existing NICU family centered care models lack the key elements of equity, inclusion and cultural humility. These models were conceived to support families during the stressful life event of an infant's NICU admission. Their development, however, occurred prior to recognition of the medical field's systematic shortcomings in providing equitable care and their impact on outcome disparities for marginalized communities; thus, they do not include cultural or equitable healthcare considerations.

Words matter: exploring communication between parents and neonatologists.

Objective: To evaluate how neonatologists and NICU parents perceive communication in the NICU.

Study Design: A mixed-methods approach using an online survey and three focus groups with NICU parents and neonatologists, utilizing videos of simulated conversations between a neonatologist and mother.

Results: A total of 72 participants responded to the online survey.

Improving the Assessment of Neonatal Abstinence Syndrome (NAS).

Neonatal Abstinence Syndrome (NAS) is a public health problem of epidemic proportions. The Finnegan Neonatal Abstinence Scoring System (FNASS) is the tool most widely used to evaluate NAS. However, it is limited by its lack of interrater reliability and standardized approach.

Providing Support for Neonatal Intensive Care Unit Health Care Professionals: A Bereavement Debriefing Program.

Objective: The aim of this study is to evaluate formal bereavement debriefing sessions after infant death on neonatal intensive care unit (NICU) staff.

Study Design: Prospective mixed methods study. Pre- and postbereavement debriefing intervention surveys were sent to clinical staff.

Maternal Immigrant Status and Readiness to Transition to Home From the NICU.

Background And Objectives: Evaluate effects of immigrant status on perceptions of discharge readiness in mothers of preterm infants <37 weeks' gestation and identify the impact of primary language and years in the United States.

Methods: Immigrant ( = 176) and native ( = 556) mothers of preterm infants cared for in the NICU for >5 days between 2012 and 2015 completed the Fragile Infant Parental Readiness Evaluation (FIPRE), a NICU-discharge readiness questionnaire. Group comparisons were made on the basis of immigrant status.

Maternal Mental Health and Neonatal Intensive Care Unit Discharge Readiness in Mothers of Preterm Infants.

Objective: To evaluate associations between maternal mental health disorders (MHDs) and discharge readiness for mothers of infants born preterm (<37 weeks). We hypothesized that mothers with a history of MHDs would report decreased perceptions of neonatal intensive care unit (NICU) discharge readiness compared with mothers without a history.

Study Design: Mothers of infants born preterm in the NICU >5 days between 2012 and 2015 and participating in a transition home program completed a discharge readiness questionnaire measuring perceptions of staff support, infant well-being (medical stability), maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant).

Impact of a Transition Home Program on Rehospitalization Rates of Preterm Infants.

Objectives: To evaluate the effects of a transition home program on 90-day rehospitalization rates of preterm (PT) infants born at <37 weeks gestational age implemented over 3 years for infants with Medicaid and private insurance, and to identify the impact of social/environmental and medical risk factors on rehospitalization.

Study Design: In this prospective cohort study of 954 early, moderate, and late PT infants, all families received comprehensive transition home services provided by social workers and family resource specialists (trained peers) working with the medical team. Rehospitalization data were obtained from a statewide database and parent reports.

Medical morbidities and DNA methylation of NR3C1 in preterm infants.

Background: Although there are no accepted "normal" levels of circulating cortisol in preterm infants, critically ill preterm infants show lower cortisol levels than healthy preterm infants. The regulation of cortisol reactivity by epigenetic changes in glucocorticoid receptor gene (NR3C1) expression has been demonstrated. This study aims to examine the relationship between medical morbidities in preterm infants and DNA methylation of NR3C1.

Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of Preterm Infants.

Objective: To examine the association of maternal mental health, perceptions of readiness at neonatal intensive care unit (NICU) discharge, and social risk factors with depressive symptoms 1 month postdischarge in mothers of early (<32 weeks), moderate (32-33 weeks), and late (34-36 weeks) preterm infants. A secondary objective was to compare depressive symptoms among mothers in all preterm groups.

Study Design: Mothers (n = 734) of preterm infants cared for >5 days in the NICU and participating in a Transition Home Program completed the Fragile Infant Parent Readiness Evaluation prior to discharge for perceptions of NICU staff support, infant well-being, maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant).

18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit.

Objectives: To determine whether the single-family room (SFR)-neonatal intensive care unit (NICU) is associated with improved 18-month neurodevelopmental outcome, especially in infants of mothers with high maternal involvement.

Study Design: An 18-month follow-up was undertaken that compared infants born <30 weeks gestational age; 123 from a SFR-NICU vs 93 from an open-bay NICU. Infants were divided into high vs low maternal involvement based on days/week of kangaroo care, breast/bottle feeding, and maternal care.

The Contributions of Maternal Sensitivity and Maternal Depressive Symptoms to Epigenetic Processes and Neuroendocrine Functioning.

This study tested whether maternal responsiveness may buffer the child to the effects of maternal depressive symptoms on DNA methylation of NR3C1, 11β-HSD2, and neuroendocrine functioning. DNA was derived from buccal epithelial cells and prestress cortisol was obtained from the saliva of 128 infants. Mothers with depressive symptoms who were more responsive and who engaged in more appropriate touch during face-to-face play had infants with less DNA methylation of NR3C1 and 11β-HSD2 compared to mothers with depressive symptoms who were also insensitive.

Neurobehavior related to epigenetic differences in preterm infants.

Unlabelled: Preterm birth is associated with medical problems affecting the neuroendocrine system, altering cortisol levels resulting in negative effects on newborn neurobehavior. Newborn neurobehavior is regulated by DNA methylation of NR3C1 and HSD11B2.

Aim: Determine if methylation of HSD11B2 and NR3C1 is associated with neurobehavioral profiles in preterm infants.

Single-family room care and neurobehavioral and medical outcomes in preterm infants.

Objective: To determine whether a single-family room (SFR) NICU, including factors associated with the change to a SFR NICU, is associated with improved medical and neurobehavioral outcomes.

Methods: Longitudinal, prospective, quasi-experimental cohort study conducted between 2008 and 2012 comparing medical and neurobehavioral outcomes at discharge in infants born <1500 g. Participants included 151 infants in an open-bay NICU and 252 infants after transition to a SFR NICU.

Major depressive disorder during pregnancy and emotional attachment to the fetus.

While there is good evidence that depression negatively impacts mother-to-infant emotional attachment in the postpartum period, the impact of depression in pregnancy on maternal emotions and cognitions about the fetus (often termed "maternal-fetal attachment" or MFA) is unclear. This study compared MFA scores from women meeting clinical criteria for Major Depressive Disorder (MDD) with scores from nondepressed women. Participants were 161 women enrolled at 23-36 weeks gestation, of whom 65 met criteria for MDD via the Structured Clinical Interview for the DSM-IV-TR during their second and/or third trimesters.

Infant neurobehavioral development.

The trend toward single-room neonatal intensive care units (NICUs) is increasing; however scientific evidence is, at this point, mostly anecdotal. This is a critical time to assess the impact of the single-room NICU on improving medical and neurobehavioral outcomes of the preterm infant. We have developed a theoretical model that may be useful in studying how the change from an open-bay NICU to a single-room NICU could affect infant medical and neurobehavioral outcome.

The effects of perinatal morbidity and environmental factors on health status of preterm children at age 12.

Children born prematurely have later morbidity, yet little is known about their health in adolescence. This study examined multiple dimensions of health at age 12 and the predictors of biological, behavioral, social, and physical environmental factors. Analysis of variance and logistic regression models were tested.

Developmental origins theory from prematurity to adult disease.

Developmental Origins Theory has received little coverage in the nursing literature, even though it has received much attention in other sciences. The theory proposes that prenatal stress provokes adaptive changes in endocrine and metabolic processes that become permanently programmed and impact later adult health. This paper reviews the theory and describes the primary neuroendocrine mechanism of hypothalamic-pituitary-adrenal axis function.

Growth trajectories of preterm infants: birth to 12 years.

Introduction: Birth weight often is used to predict how preterm infants will grow, but scant attention has been paid to the effect of neonatal morbidities on growth trajectories. We investigated birth weight and neonatal morbidity in preterm infants' growth to age 12 years.

Method: A five-group, prospective, longitudinal study was conducted with 194 infants: 46 full term; 29 healthy preterm without morbidity; 56 preterm with medical illness (MPT); 34 preterm with neurologic illness; and 29 preterm small for gestational age (SGA).

A decade comparison of preterm motor performance at age 4.

This was a prospective longitudinal study of two cohorts comprised of one full term and three premature infant groups born 10 years apart. Birth cohort, perinatal morbidity, and birth weight effects were investigated at age 4. Cohort 1 (1985-1989) had longer gestation, higher birth weight, and better Apgar scores than Cohort 2 (1996-1999), which had more intraventricular hemorrhage and bronchopulmonary dysplasia.