Sources of Sound Exposure in Pediatric Critical Care.

Background: Sound levels in the pediatric intensive care unit (PICU) are often above recommended levels, but few researchers have identified the sound sources contributing to high levels.

Objectives: To identify sources of PICU sound exposure.

Methods: This was a secondary analysis of continuous bedside video and dosimeter data (n = 220.

Using the life course health development model to address pediatric mental health disparities.

Topic: Early-life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long-term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods.

Screen time and sleep duration in pediatric critical care: Secondary analysis of a pilot observational study.

Purpose: Quantify and describe screen time (screen type, child engagement, adult co-viewing) in eight critically ill children and determine its association with sleep duration before (parent report) and during (actigraphy) a 24-h period in the PICU.

Design And Methods: Exploratory secondary analysis of 24-h video and actigraphy recordings in eight children 1-4 years old in the PICU. Videos were coded for screen time using Noldus Observer XT® software.

Predictors of Stress Exposure in Hospitalized Preterm Infants.

Background: Stress exposure in the neonatal intensive care unit (NICU) is associated with poor outcomes in preterm infants. However, factors predicting subsequent NICU stress exposure have not been identified.

Purpose: To characterize NICU stressors experienced by preterm infants during the first 2 weeks of life and identify demographic, perinatal, and institutional variables associated with stress exposure.

An observational pilot study of sleep disruption and delirium in critically ill children.

Background: Sleep disruption is frequently observed in children with delirium in the pediatric intensive care unit (PICU).

Objectives: This observational pilot study explores relationships among modifiable characteristics of the PICU environment (i.e.

Neurodevelopment in the Congenital Heart Disease Population as Framed by the Life Course Health Development Framework.

Background: Adverse neurodevelopment is a common comorbidity associated with congenital heart disease (CHD). The consequences of adverse neurodevelopment are seen across the life course. The cause of adverse neurodevelopment is multifactorial, and use of a life course perspective can assist with understanding and enhancing neurodevelopment in individuals with CHD.

Developmental Care for Hospitalized Infants With Complex Congenital Heart Disease: A Science Advisory From the American Heart Association.

Developmental disorders, disabilities, and delays are a common outcome for individuals with complex congenital heart disease, yet targeting early factors influencing these conditions after birth and during the neonatal hospitalization for cardiac surgery remains a critical need. The purpose of this science advisory is to (1) describe the burden of developmental disorders, disabilities, and delays for infants with complex congenital heart disease, (2) define the potential health and neurodevelopmental benefits of developmental care for infants with complex congenital heart disease, and (3) identify critical gaps in research aimed at evaluating developmental care interventions to improve neurodevelopmental outcomes in complex congenital heart disease. This call to action targets research scientists, clinicians, policymakers, government agencies, advocacy groups, and health care organization leadership to support funding and hospital-based infrastructure for developmental care in the complex congenital heart disease population.

Touch Experiences of Preterm Infants During Essential Nursing Care.

To characterize and quantify touch experienced by preterm infants in the NICU during essential nursing care, identify instances of skin-to-skin touch between infants and caregivers, and identify clinical/demographic variables associated with touch experiences. Cross-sectional study. Preterm infants ( = 20) born 27-32 weeks post-menstrual age.

Guided Participation Support of Coparenting an Infant With Complex Congenital Heart Disease: A Randomized Pilot Feasibility Study.

Parents' competencies in coparenting are critical to adaptive and competent caregiving of an infant with complex congenital heart disease. To date, feasible interventions to support parents in working together-coparenting-for caregiving of these infants have not been developed and systematically examined. The purpose of this feasibility study was to examine the efficacy of the participatory teaching/learning intervention, Guided Participation (GP) on parent dyads' competencies in interactive problem-solving tasks in preparation for a randomized controlled trial.

Feeding at 6-12 months in infants with CHD.

Background: Feeding difficulty is common in infants with CHD.

Objective: The purpose of this study was to describe the feeding skills and behaviours of infants with CHD at 6-12 months of age and explore relationships between feeding, gastrointestinal distress, and gastroesophageal reflux.

Methods: Parents of 30 infants with CHD completed online surveys when their infant was 6, 8, 10, and 12 months old.

An integrative review of clinician-administered comforting touch interventions and acute stress responses of preterm infants.

Problem: Preterm infants experience numerous stressors in the neonatal intensive care unit. Non-pharmacological interventions, including maternal comforting touch, reduce stress responses of preterm infants; however, the effects of clinician-administered comforting touch are unclear. The purpose of this integrative review was to synthesize findings from clinical trials to determine the effect of clinician-administered comforting touch on preterm infants' acute stress responses.

Sleep disruption and delirium in critically ill children: Study protocol feasibility.

Delirium is a serious complication of pediatric critical illness. Sleep disruption is frequently observed in children with delirium, and circadian rhythm dysregulation is one proposed cause of delirium. Children admitted to the pediatric intensive care unit (PICU) experience multiple environmental exposures with the potential to disrupt sleep.

Omega-3 fatty acids and autonomic function in adolescents with anorexia: A randomized trial.

Objectives: Patients with anorexia nervosa (AN) have autonomic nervous system (ANS) dysfunction as measured by heart rate variability (HRV). Omega-3 fatty acids may improve heart rate regulation. Our aim was to describe ANS response to a mid-day meal in adolescent females with AN in a 12-week treatment program, randomized to receive either omega-3 supplements or placebo.

Screening and Evaluation of Neurodevelopmental Impairments in Infants Under 6 Months of Age with Congenital Heart Disease.

Clinical evaluation of neurodevelopmental impairments before 6 months of age is needed in congenital heart disease (CHD) to promote early referral to developmental interventions. The objective was to identify the risk of cerebral palsy (CP) and to compare neurodevelopment outcomes in infants with and without CHD. In a longitudinal study, 30 infants with CHD and 15 infants without CHD were assessed at 1 month, 3 months, and 6 months of age.

Gloving and Touch Practices of Neonatal Nurses.

Positive tactile experiences in the newborn period are critical to normal sensory development. Universal gloving in the neonatal intensive care unit has become a controversial issue in neonatal nursing practice. Intended to prevent infection among neonatal patients, universal gloving also hinders the provision of human touch.

Prenatal Motivation for Caregiving Issues: A Pilot Study of Mothers Expecting Healthy Infants and Infants With Complex Congenital Heart Disease.

Background And Purpose: The prenatal preparing women do for infant caregiving is understudied. In this pilot, multimethods study, we examined motivation for preparing for infant caregiving of women in their third trimester of pregnancy expecting either a healthy infant or an infant with complex congenital heart disease (CCHD).

Methods: Eleven women expecting a healthy infant and four expecting an infant with CCHD completed a questionnaire and were interviewed.

Postnatal Cytokine Trajectories in Very Preterm Infants.

Inflammation often accompanies preterm birth and contributes to poor neurodevelopment in preterm infants. The purpose of this study was to describe postnatal cytokine trajectories among non-infected very preterm infants during the first weeks of life. Blood samples for cytokine analysis were collected weekly from infants born between 28 and 31 weeks post-menstrual age.

Documentation of Sleep Hygiene With Melatonin Use in Management of Sleep Disturbance in Children With Neurodevelopmental Disorders: A Quality Improvement Project.

Introduction: The purpose of this quality improvement project was to improve health-care provider consistency in addressing and documenting the use of sleep hygiene in children with neurodevelopmental disorders in alignment with evidence-based strategies.

Method: The project took place over 12 weeks and used a parent-completed screening tool and SmartPhrase technology incorporated into the patient note and discharge summary. A preimplementation and postimplementation query of the electronic medical record was used to determine change effectiveness.

Obesity across the lifespan in congenital heart disease survivors: Prevalence and correlates.

Background: Congenital heart disease (CHD) survivors are at risk for cardiovascular comorbidities exacerbated by obesity.

Objectives: Determine relationships between overweight/obesity and medical factors across the lifespan of CHD.

Methods: Lesion severity, weight, blood pressure, cardiac and other comorbidities, and cardiac medications were abstracted from the medical records of 3790 CHD patients, aged ≥6 years, who attended CHD care in the Midwestern U.

Effects of Massage on Postoperative Pain in Infants With Complex Congenital Heart Disease.

Background: Pain management is an essential component of care for pediatric patients following surgery. Massage reduces self-reported postoperative pain in adults with heart disease but has received little attention in postoperative pediatric patients with complex congenital heart disease (CCHD).

Objectives: The aim of the study was to evaluate the effectiveness of massage compared to a rest period on postoperative pain scores and physiological responses in infants with CCHD.

Losing touch.

The need for human touch is universal among critical care patients and is an important component of the nurse-patient relationship. However, multiple barriers to human touch exist in the critical care environment. With little research to guide practice, we argue for the importance of human touch in the provision of holistic nursing care.

State of the science in pediatric ICU delirium: An integrative review.

Delirium is a complication of critical illness associated with poor outcomes. Although widely studied in adults, comparatively little is understood about delirium in pediatric intensive care units (ICUs). The purpose of this integrative review is to determine the extent and nature of current evidence, identify gaps in the literature, and outline future areas for investigation of pediatric ICU delirium.

Feasibility Case Series of Environment and Sleep in Infants With Congenital Heart Disease.

Background: Developmental delay is a significant concern for infants born with complex congenital heart disease (CCHD). Environmental exposures (e.g.

Measures of Stress Exposure for Hospitalized Preterm Infants.

Background: Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures.

Objectives: The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior.