Category: Infant

Introduction

Health professionals use different indicators to understand the problems affecting different communities and implement appropriate care delivery programs. Infant mortality is one of these tools used to understand the health status of a given nation. The information gained from surveillance processes is used to inform various programs for preventing diseases. This paper discusses the rate of infant mortality in the United States and Western New York (WNY). The discussion goes further to explore how infant mortality presents a unique form of health disparity in Western New York.

Analysis of the Health Disparity

Lewis, Cogburn, and Williams (2015) define infant mortality as the number of deaths occurring in babies before attaining the age of one year. This number is usually recorded in every one thousand live births. The US government has been committed to mitigating risk factors for increased infant mortality rates. In order to achieve these goals, the state has managed to improve the health of women during and after pregnancy. This is supported by using improved prenatal care and the implementation of powerful surveillance research. The coordination of health services in the state and across the country has led to improved outcomes.

It is agreeable that the rate of infant mortality in the United States is quite low. Unfortunately, some racial groups continue to record high infant mortality rates (Guerra-Reyes & Hamilton, 2017). This disparity has been attributed to a number of factors, such as lack of appropriate health systems in rural areas. In WNY, many rural regions do not have adequate neonatal health services. Surveillance and research programs have only been taken seriously in urban regions. Additionally, some minority groups, such as Latinos and African Americans in WNY have recorded increased infant mortality rates. The nature and occurrence of this disparity explain why evidence-based approaches would be needed to support all citizens equally.

Literature Review

The United States is one of the developed nations with broad disparities in infant outcomes and maternal care (Ruiz et al., 2015). Such disparities exist along racial lines. Minority communities and groups such as Latinos and African Americans do not have access to adequate maternal services (Lewis et al., 2015). This fact explains why race is a powerful indicator of the nature and quality of health services available to every citizen (Kothari et al., 2016). Similarly, studies have indicated clearly that many minority groups do not get adequate maternal, postnatal, and prenatal services in Western New York.

Haider (2014) goes further to indicate that the rates of infant mortality and preterm births in the country continue to expose the nature of disparities affecting the healthcare sector. Unfortunately, past studies have failed to analyze how the disparity affects different ethnic or racial groups. In WNY, disparities in maternal health have been catalyzed by a lack of adequate opportunities and economic empowerment (Ruiz et al., 2015). Consequently, underage mothers and women from minority races find it hard to get adequate maternal health services.

The absence of appropriate human development programs in rural regions has contributed to this kind of disparity (Anderson et al., 2018). Similarly, many rural regions in WNY lack appropriate programs that can empower different people to achieve their potential. Such gaps have resulted in family breakdowns and a lack of superior health services. Inequality has become a major problem due to the nature of race relations experienced in the country. Additionally, underserved regions and communities record poor infant mortality rates due to a lack of appropriate welfare programs. Individuals living in such neighborhoods face numerous challenges, such as inadequate health services. Haider (2014) believes strongly that such factors have contributed to unequal infant mortality rates in regions such as WNY.

Statistical Data

In 2012, WNYs infant mortality rate stood at around 4.97/1,000 live births (Anderson et al., 2018). This was a decline of 16.6 percent within a period of ten years. It is agreeable that the Healthy People 2020s goal has been to have a national infant mortality rate of 6/1,000 live births (Haider, 2014). This is a clear indication that the targeted region fulfills this objective. However, it should be observed that disparities in infant mortality are evident in WNY. For instance, the rate for African Americans in 2012 was 8.96/1,000 live births (Ruiz et al., 2015). Haider (2014) indicates that the infant mortality rate for whites during the same year stood at 3.7/1,000 while that of Latinos was 5.27/1,000 live births.

Over the years, infant mortality rates have declined by an average of 10 percent. The rate of decline among whites has been around 20 percent (Haider, 2014). This is a clear indication that minorities in the region have not been supported with appropriate strategies in an attempt to deal with this kind of disparity. Additionally, young women below the age of 20 have recorded high infant mortality rates in WNY. For example, the current rate stands at 6.5/1,000 live births for women aged below 20 (Haider, 2014). That of women between 20 and 40 years is around 4.8/1,000 live births.

Relevance to Nursing Care

The average infant mortality rate in WNY is below 5 deaths per 1,000 live births (Anderson et al., 2018). The region has implemented adequate initiatives and programs to ensure that the health of women is improved before pregnancy. This has also been the same case for prenatal care. Unfortunately, some underserved populations and minority groups record higher mortality rates (Anderson et al., 2018). This gap explains why nurses working with childbearing women should implement powerful initiatives and programs. Health practitioners can apply their skills and competencies in different health settings to address womens health needs.

Nurses working in pediatric and maternity wards should use their skills to transform the situation. They can do so by coordinating their care delivery processes, engage in lifelong learning, and carry out evidence-based researches. These practices will make it easier for them to streamline their care delivery models. They will also meet the changing or diverse needs of underprivileged persons such as the homeless, orphans, and underage mothers. Such initiatives would also support the needs of every newborn child. This disparity is also a wakeup call for practitioners to put in place powerful strategies to monitor the causes of early childhood deaths and offer appropriate solutions (Guerra-Reyes & Hamilton, 2017). The ultimate goal of nursing should, therefore, be to promote safety and quality in prenatal care. By doing so, it will be easier for practitioners to meet the needs of underserved populations in WNY.

Conclusion

This discussion has revealed that most of the surveillance systems and care delivery processes targeting childbearing mothers in WNY have been applied disproportionately. The malpractice has resulted in different infant mortality rates for whites, young women, and minority groups. That being the case, it would be appropriate to implement powerful strategies to deal with this disparity and ensure that childbearing women in WNY have adequate, superior, and timely postnatal and prenatal health services.

References

Guerra-Reyes, L., & Hamilton, L. J. (2017). Racial disparities in birth care: Exploring the perceived role of African-American women providing midwifery care and birth support in the United States. Women and Birth, 30, e9-e16. Web.

Anderson, J. G., Rogers, E. E., Baer, R. J., Oltman, S. P., Paynter, R., Partridge, J. C., & Steurer, M. A. (2018). Racial and ethnic disparities in preterm infant mortality and severe morbidity: A population-based study. Neonatology, 113(1), 44-54. Web.

Haider, S. J. (2014). Racial and ethnic infant mortality gaps and socioeconomic status. Focus, 31(1), 18-20.

Ruiz, J. I., Nuhu, K., McDaniel, J. T., Popoff, F., Izcovich, A., & Criniti, J. M. (2015). Inequality as a powerful predictor of infant and maternal mortality around the world. PLOS One, 10(10), 1-12. Web.

Kothari, C. L., Paul, R., Dormitorio, B., Ospina, F., James, A., Lenz, D., & Wiley, J. (2016). The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community. SSM  Population Health, 2, 859-867. Web.

Lewis, T. T., Cogburn, C. D., & Williams, D. R. (2015). Self-reported experiences of discrimination and health: Scientific advances, ongoing controversies, and emerging issues. Annual Review of Psychology, 11, 407-440. Web.

Introduction

Infants require proper nutrition to enable them to develop their bodies physically mentally, and socially. Once a child is born, the first food the child needs is the mothers milk. This implies that breastfeeding is greatly important to a newborn baby. During this tender age, the feeding procedure of the baby is very challenging to some people, mostly in developing countries (Lande et al. 2003). Optimal infant feeding involves initiatives that empower mothers to start breastfeeding the child starting from the first day continuously for the period between six months and two years. Mental nutrition is another important aspect to observe so that the infant and the mothers nutritional status are safeguarded.

Apart from the mothers milk, the child requires additional nutrients from different kinds of food after some time. During the winning period, the child is introduced to semi-solid foods that help to boost nutrient supply in the body. This prevents the nutritional status of the child. Children who fail to get proper nutrients in addition to the mothers milk experience greater problems during their life.

Studying this topic is of great importance to both men and women. This is because parents require to understand the nutritional requirements of their children as they develop into an adult. This topic is also important to health providers (Kersting et al. 2005). They have to offer proper advice to parents who have problems with the nutritional requirements of their young kids. Through proper implementation of better programs, the developing nations can realize a reduction in the death of children from poor nutrition (Black et al. 2004). Guiding and counseling groups can also play an important role in advising parents on how to feed their children once they are born. This research provides important information to the developing nations for readjusting their health and educational organization to include feeding programs, which can greatly reduce the rate of young children who die due to malnutrition.

I intend to look at several issues in this paper. First, I will summarize each of the three researches giving a brief description of their background information. Secondly, I will describe briefly how the studies were carried out and present major findings. I will also critically analyze the researches according to assumptions, methods, and interpretations of the articles (Engle & Menon, 2000).

Summary

Complimentary food for infancy

Gibson, Ferguson, and Lehrfeld carried out this research in developing nations with the view of assessing the nutrient and energy sufficiency in various complementary foods given to children during winning period. The research was based in different countries that are still developing. For example, it included countries like Malawi, Ghana Ethiopia, India, Papua New Guinea Thailand and Philippines. The investigators collected and selected recipes of complementary foods among the mentioned countries (Lande et al. 2003). Food and Nutrient Research Institute of Manila supplied the recipes from Philippines while Institute of Nutrition of Mahidol supplied the recipes from Thailand. The other recipes were taken from the literature. Ferguson and his friends compiled the food composition data that was used to compute the nutrients, anti-contents and energy per 100g together with molar ratios of every recipe. The researchers did not include food composition quantities of nianic since only a few of them had nianic contribution and performed niacin. Trace minerals, non-starch polysaccharides together with phytic acid came from staple foods of the above countries. The staple foods were not analyzed for vitamin A.

The research only used children of 9 to 11 months because children at this stage still receive some milk from their mothers. For other cereal-based guidelines, the content matter was computed for gruel made with both ten and twenty-eight percent dry matter. Lastly, the computed intake of nutrient and energy in one day was compared with the requirement needs of energy and nutrient from the complementary foods (Engle & Menon, 2000).

Infant and young children feeding in developing countries

Mandana Arabi and Nune mangasaryan who are employees of the United Children Funds with other people carried out this research. They worked closely with Edward A. Frongillo and Rasmi Avula who are employees of the University of South Carolina.

This research indicates that feeding techniques are important in determining growth and development of the child during the early stages. The research describes seven practices in twenty-eight countries using indicators of young children feeding together with complementary feeding rules (Black, et al. 2004). They indicate that there is a substantial disparity in all the countries. Only twenty-five percent of 0-5 months children were involved in exclusive breast-feeding. On the other hand, a half of six to eight month old got complementary foods in the previous day. By living in the high HDI nations may fail to translate to desirable feeding programs. It is true in the research that there is a requirement for promotion, support and protection of best breastfeeding together with complementary feeding techniques. Additionally, it is better to adhere to all the recommendations regarding to feeding during the sick period. The table below indicates countries that the research was carried out in February this year.

This survey was carried out in a developing nation, which is Lebanon. The survey involved in identifying the importance of breastfeeding and the effect of introducing semisolid and solid foods to infants. Malek Batal, choghik Boulghoujian and Rima afifi engaged in this serious study to provide evidence on the underlying concerning breastfeeding in one of the developing nations. The main reason for this study was to clarify issues concerning breastfeeding in mothers who give birth in Lebanon (Engle & Menon, 2000). The research was carried out in mothers who gave birth in hospitals. The survey included the cross-sectional design for over ten months. The researchers observed that a good number of mothers started breast-feeding after a half an hour of giving birth while others started after a few hours and very few never breastfed their young ones. This information was collected from mothers across the country in health centers then the participants were sampled out to get real participants in the research. The research reveals that mothers reduce breastfeeding as the day count towards six and eight months (Engle & Menon, 2000).

Critical Analysis of the Articles

The article on Infant and young children feeding in developing countries did not consider countries that have low-HDI from some parts of Africa. It is possible that this aspect greatly affected the results. All countries with high or low HDI should have been included in the study to find the best results. The research revealed that children with the age between six months and eight months are given some different solid and semisolid foods as they continue to breastfeed. According to the results, the study was not able to determine the quality of the complementary food that was given to the children. This brings a gap between the results and the research objectives (Engle & Menon, 2000). This is how feeding in children takes place in the young kids together with the environment that enable the children to eat some food. They include availability of the food or care-giving services that encourage children to eat which were not considered.

On the other hand, Malek Batal and his friend devoted themselves to providing extensive report on when mothers start breastfeeding. They came up with a design that enabled them get proper information. For instance, they used questionnaires to fill in important information. Additionally they implemented a proper strategy in getting the required members of the study. It is true from the research that they sampled out participants in different healthcares and engaged them in the research for ten good months (Dewey & Adu-Afarwuah, 2008). This reasonable time provided ample time for observation, assessment and determination of the results in Lebanon.

General Conclusion

Children born in developing nations face many challenges with regard to feeding. Some mothers willingly feed their newborn babies on breast milk. Others fail to breastfeed due to various challenges that they face. For instance, availability of food to developing nation for mothers and children is a challenge.

Complementary foods are important to a child since it provides other requirements by the body for proper growth. Mental development, physical development and social development requires that the child should receive nutrients from other sources apart from the mothers milk. This does not rule out the benefits of the breast milk just after birth.

The research in this context forms a basis for setting up more research programs. The research programs will be able to get more problems that the child in a developing nation can be facing in feeding.

References

Black, et al. (2004). Longitudinalstudies of infectious diseases and physical growth of children in rural Bangladesh. Boston: Beacon Press.

Dewey, K., & Adu-Afarwuah, S. (2008). Systematicreview of the efficacy and effectiveness of complemen-tary feeding interventions in developing countries.Maternal and Child Nutrition. New York: Perennial Classics.

Engle, P. & Menon, P. (2000). Care and nutrition: Concepts and measurement. New York: World Development Body.

Kersting, et al. (2005). Measured consumption of commercial infant food products in German infants: results from the DONALD study. Journal of Pediatric Gastroenterology and Nutrition, 100, 200-2.

Lande, et al. (2003). Infant feeding practices and associated factors in the first six months of life. London: Acta Paediatrica.

Summarize the main mortality indicators listed in this website

Total Population

The total population of a country is the summation of all individuals living in a certain particular geographical area. In this case, the total population of people living in UAE is 9,157,000 (Magyarorsza
g, 2003). This number represents the average population after estimating the population of both the death rate as well as birth rates.

Gross National Income Per Capita

The evaluation of the value of the country depends on the average income of every person in the nation. As such, Gross national income per capita is a tool that shows the total value of the nation in terms of dollar. The GNI per capita of United Arabs Emirates is $ 2012 (Felbermayr, Hiller & Sala, 2008). This represents the average income of every citizen in the country. Determination of Gross national income per capita is important to ascertain the level of income in the country and compare its value with the other nations. An economy performs fairly when GNI per capita is high.

Life Expectancy at Birth m/f (years, 2015)

Many people tend to estimate the number of years that they are likely to live after their birth. Life Expectancy at birth is the average that babies can live in the environment after birth (Koontz & Hallman, 2004). It give the people the estimates age that people are likely to die. For instance, for the case of UAE, Life Expectancy at birth in 2025 is 76/79.

Probability of Dying under Five (per 1000 live births, 0)

The probability of dying under five gives the number of people that can die before reaching five years. It calculates the number of deaths of children below five years in a group of 1000 people. From the statistics, it is apparent that there is no probability of dying under five in UAE.

Probability of Dying between 15 And 60 Years m/f (per 1000 population, 2013)

The probability of dying between 15 and 60 years represents the number of deaths of people with ages between 15 and 60 years (Anson & Luy, 2014). This statistics also represent the death rate of youths in the country. In 2013, the probability of dying at ages between 15 and 60 years is 84/59.

Total Expenditure on Health Per Capita (Intil $, 2014)

This fraction of national per capita takes care of health of individuals in the country. It represents the amount of income that people spend on health. In 2014, the average income spent on health in UAE is 2.405.

Total Expenditure on Health as % of GDP (2014)

Total health expenditure is the total of both private and public of health expenses. This total cost covers all the health care services in the country. It is normally expressed in percentage in comparison with GDP (California, 2000). The total health expenditure of UAE in 2014 is 3.6.

Infant Mortality Rate in AUE

Infant Mortality Rate= (infant deaths/live births)X1000

= 76/79 X 1000

= 962.03

Technical Problems That May Arise When Calculating IMR

Counting the Number of Deaths

Ascertaining the number of deaths in a particular geographical location becomes a problem. Usually, people assume that that the death represents the rate of death per year when the number of deaths keeps on changing (California, 2000). However, the results do not show the difficulty in counting the number of deaths, which leads to unrealistic figures.

Inaccurate Sources of Data used for Calculating IMR

The sources that provide data used for calculating IMR are not reliable. It is difficult to determine the accuracy of these data to arrive at reliable results. In this regard, people tend to assume these data and calculate IMR of the country (Ali, 2010). Such calculations may lead to wrong interpretation as well as irrelevant decision-making.

Exclusion of Stillbirth Rates

The data used in calculating IMR does not include the population of stillbirths. In this case, infant deaths should begin from the features of 28 weeks. It is not easy to determine the stillbirths because there is no data that records such deaths (Ali, 2010). For instance, IMR does not include the deaths that result from abortion. As a result, the figures from IMR may not be reliable for interpretation.

References

Ali, A. A. S. (2010). Unintentional death rates in selected medical districts among males living in the United Arab Emirates. Web.

Anson, J., & Luy, M. (2014). Mortality in an international perspective. Berlin, Germany: Springer Science & Business Media.

California. (2000). Californias infant mortality rate. Sacramento, CA: State of California, Health and Human Services Agency, Dept. of Health Services.

Felbermayr, G. J., Hiller, S., & Sala, D. (2008). Does immigration boost per capita income? Stuttgart: Inst. fur Volkswirtschaftslehre, Univ. Hohenheim.

Koontz, D. R., & Hallman, T. (2004). Life expectancy. New York, New York: Bantam Books.

Magyarorsza
g, T. (2003). Gross domestic product. Budapest: Kulturtrade Publishing Ltd.

The role of long-chain essential polyunsaturated fatty acids (LCPs) such as DHA and AA in the normal development of infants, and consequences of deficiency

Fats are the main component of the brain, up to 60 percent. This is usually a high concentration of fatty acids, which are mainly long-chain polyunsaturated fatty acids (LCPs). The main LCPs in the brain are usually docosahexaenoic acid (DHA) and arachidonic acid (AA). Tissues of the retina of the eye and the brain have DHA as the main structural part. During the early developmental stages of children, DHA is necessary to support the rapid development of the eye and the brain. Any deficiency of DHA can cause children to have poorly developed eye and brain functions.

Arachidonic acid (AA) mainly comes from omega-6 fatty acids. The body cells require AA for the usual transmission of messenger using the nerves. It also enhances the proper function of the memory. Both AA and DHA play vital roles in developing vision, coordination, and learning ability. Some studies conclude children with learning disorders usually have low amounts of DHA and AA in the red blood cell membranes and their plasma. ¹

Good consumption of DHA and AA enhance the development of a good brain. This is why during the formative years, omega-3 and omega 6 are crucial. Some of these LPCs are readily available in nutritional diets. However, children do not take most foods, which contain these fatty acids for brain and eye development. Thus, using these fatty acids as supplements can provide solutions to perceived deficiency.

Low level or lack of both AA and AA have other serious health problems in infants and young children cause pediatric conditions such as cystic fibrosis, fetal alcohol syndrome, unipolar depression, attention deficit hyperactivity disorder, congenital metabolic disorders, and aggressive hostility. Some of these conditions have shown that the use of supplements may provide positive changes in infants and young childrens conditions. Still, studies on the effectiveness of DHA supplements are ongoing to justify the use of DHA as supplements with infants with such conditions.

An argument supporting the use of LCP-supplemented infant formula over non-supplemented formula in infants

DHA has a fundamental function during the early stages of pregnancy and early childhood in functional brain development. ADH also shows anti-inflammatory properties. This has led some scientists to suggest that DHA can act as a supplement for therapeutic and preventive uses. ⁵

Researchers think that DHA is conditionally necessary for the early growth and functional development of the brain. However, they have not been able to prove this claim apart from some exceptional fish species. A comparison between plasma and red blood cells of infants with supplemental DHA and those without reveals infants with no supplements can only produce up to 70 percent of the DHA they need. ⁷ Currently, studies cannot establish that the deficit of 30 percent may cause impairments in infants and young children though some studies suggest it may do so. ²

DHA is predominant in the n-3 fatty acid of the brain with an exceptional turnover rate. According to Henriksen and other authors, AA presence in the brain occurs in n-6 fatty acid with a stable level probably due to the presence of its precursor, linoleic acid (LA). ² According to recent studies, researchers established that supplementing AA and DHA together may exert additional positive effects on neurotransmission and membrane maturation. ³

Kramer and other authors note that both preterm and term infants with a supply of AA and DHA in ratios and amounts as those of the human breast milk show excellent neurofunctional results mainly in short-term duration. ¹ However, we need further studies to determine medium and long-term outcomes on the persistence use of AA and DHA as supplements. Some of these findings may be different as a result of various study designs that provide different results and subsequent conclusions and recommendations. ⁶

According to Simmer, only a little proof from randomized trials of LCPs supplementation using term infants studies to support supplement claims. ⁴ He argues that LCPs show little in terms of benefits to the brain and vision development. Other experts have also concluded infant formulas for term infants should contain at least 0.2% of total fatty acids like DHA and 0.35% as AA, while formulas for preterm infants should include at least 0.35% DHA and 0.4% AA. ⁴ These studies show that LCPs supplementations have no known adverse effects.

A majority of health experts believe that preterm infants require a large amount of DHA. This is because these infants miss out on LPCs transfer from their mothers during the late stages of pregnancy. They also argue that changes in the formula compositions may affect infants. ⁸

Several studies indicate that preterm infants who received supplements containing ADHA had better visual functions than those who received non-supplemented formulas. These studies conclude that preterm and term infants benefit more from supplements than full-term babies. Other studies indicated that the effects of formulas were transient and reduced as the infant grew. They conclude that the effects of LPCs supplements are stronger for preterm infants than for full-term infants. The only controversies surrounding these studies are only small samples of infants participated in the study over a relatively short time. ⁹

These experts agree that there is an urgent need to study the long-term effects of using LPCs supplementation in preterm infants. Many preterm infants born early or with low birth find it difficult to develop. Therefore, Fang and other researchers note that the use supplements in formulas may be the best possible source of nutrition to help such infants increase their chances of living and reduce their exposure to long-term health risks. ⁹

Experts have also established that provision of DHA supplements to pregnant women during early developmental stages resulted in improved offspring. ¹⁰

Summary

Recent studies highlight that providing certain supplements of LPCs fatty acids, such as DHA and AA, to infants and pregnant women may offer preventive and therapeutic benefits, especially concerning the development of the brain and vision. In addition, supplementing LPCs together in given amounts may enhance their impacts on neurotransmission and membrane development. ¹⁰ Recently, some groups of health experts concluded infant formulas for term infants should contain at least 0.2% of total fatty acids like DHA and 0.35% as AA, while formulas for preterm infants should include at least 0.35% DHA and 0.4% AA. ⁴

At the same time, all recent studies and recommendations have shown the lack of adverse effects from LPCs supplementations. ⁵ Furthermore, these experts discovered that providing supplements of DHA to pregnant women improve the early developmental outcome of the offspring. ¹ However, further studies are necessary to establish the long-term effects of these supplements.

Reference List

1. Kramer MS, Aboud F, Mironova E, Breastfeeding and child cognitive development: new evidence from a large randomized trial. Archives of General Psychiatry 2008; 65: 578-84.
2. Henriksen C, Haugholt K, Lindgren M, Improved cognitive development among preterm infants attributable to early supplementation of human milk with docosahexaenoic acid and arachidonic acid. Pediatrics 2008; 121: 1137-45.
3. Clandinin MT, et al. Growth and development of preterm infants fed infant formulas containing docosahexaenoic acid and arachidonic acid. The Journal of Pediatrics 2005; 146: 461-8.
4. Simmer K, Schulzke S2, Patole S. Long chain polyunsaturated fatty acid supplementation in preterm infants. Cochrane Database of Systematic Reviews 2008, Issue 1.
5. Carnielli VP, et al. Synthesis of long-chain polyunsaturated fatty acids in preterm newborns fed formula with long-chain polyunsaturated fatty acids. The American Journal of Clinical Nutrition 2007; 86: 1323-30.
6. Makrides M, Gibson RA, McPhee AJ. Neurodevelopment outcomes of preterm infants fed high-dose docosahexaenoic acid: a randomized controlled trial. JAMA: The Journal of the American Medical Association 2009; 301: 175-82.
7. McCann JC, Ames BN. Is docosahexaenoic acid, an n-3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals. American Journal of Clinical Nutrition 2005; 82: 281-95.
8. Birch EE, et al. Visual maturation of term infants fed long-chain polyunsaturated fatty acid-supplemented or control formula for 12 mo. American Journal of Clinical Nutrition 2005; 81: 871-9.
9. Fang PC, Kuo HK, Huang CB, Ko TY, Chen CC. The effect of supplementation of docosahexaenoic acid and arachidonic acid on visual acuity and neurodevelopment in larger preterm infants. Chang Gung Medical Journal 2005; 28: 708-15.
10. Groh-Wargo S, et al. Body composition in preterm infants who are fed long-chain polyunsaturated fatty acids: A prospective, randomized, controlled trial. Pediatric Research 2005; 57: 712-8.

Data collection

To begin with, testing appears to be the most appropriate method that could contribute to the health programs seeking a reduction in racial disparities in maternal and infant mortality cases. Speaking of this data collection strategy, it is vital to explain that it requires participants to complete examinations measuring skills, knowledge, and so on (Teddlie & Tashakkori, 2009). Drawing ones attention to the combination of data techniques, tests appear to be a mixture of standardized and researcher-developed closed-ended test items and open-ended essay questions (Teddlie & Tashakkori, 2009). Answering the question of how testing could contribute to the problem solution, Taylor, Novoa, Hamm, and Phadke point out that by focusing on five easily identifiable characteristicsheart rate, respiratory effort, muscle tone, reflex irritability, and colorthe Apgar score introduces consistency in how infants are assessed and eliminates some of the medical personnels subjectivity and potential biases (2019, p. 73). In other words, testing seems to be the number one method that could become a significant factor in decreasing the disparities in the rates of maternal and infant fidelity.

What is more, a questionnaire is another means that could facilitate the elimination of such disparities in the aspect of the healthcare system under discussion. This methods idea is that participants complete instruments measuring attitudes, behaviors, and others (Teddlie & Tashakkori, 2009). According to Taylor, Novoa, Hamm, and Phadke, healthcare providers can screen the risk factors through a questionnaire (2019). Moreover, in some states like Florida,  State law requires every prenatal care provider to offer a Healthy Start Risk Screen to all pregnant women to assess risk for preterm birth and referral services. (Taylor et al., 2019, p. 38). Thus, the practice is already applied due to its rationally explained effect on the issue under discussion.

Sampling approach

Another point to be made deals with the sampling model. Firstly, there are various types of the approach mentioned above: probability, purposive, convenience, and mixed-method (Teddlie & Tashakkori, 2009). Secondly, describing this touch requires explaining the techniques that vary from random and cluster sampling to sampling for unique cases, and the one aimed to achieve representativeness and comparability. In a word, the sampling approach can serve various research objectives.

Finally, it is essential to address the question of racial disparities in the realm. To illustrate the current situation in the United States, one should focus on the statistics: Non-Hispanic black women are three to four times more likely to die from pregnancy-related causes than Non-Hispanic white women (Howell, 2018, p. 388). Racial disparities in the field of maternal and infant health in the United States are comparable to developing countries (Novoa & Taylor, 2018). Moreover, what seems to be even more illustrative is that Non-Hispanic black women&had the fastest rate of increase in maternal deaths between 2007 and 2014 and have maternal death rates up to 12 times higher in some cities than Non-Hispanic white women (Howell, 2018, p. 389). Some seek an explanation in African-Americans exposure to risk factors  for instance, lower socio-economic status or even poverty that leads to limited access to prenatal care (Novoa & Taylor, 2018). Therefore, it is fair to claim that the problem of higher maternal and infant death rates is present in the United States. Hence, the application of the techniques mentioned above is necessary for society.

References

Howell, E. (2018). Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol, 61(2), 387  399.

Novoa, C., and Taylor, J. (2018). Exploring African Americans high maternal and infant death rates. Center for American Progress.

Taylor, J., Novoa, C., Hamm, K., and Phadke, S. (2019). Eliminating racial disparities in maternal and infant mortality. Center for American Progress.

Teddlie, C., and Tashakkori, A. (2009). Foundations of mixed methods research: Integrating quantitative and qualitative approaches in the social and behavioural sciences. Sage.

Environmental Factor

Ensuring the safety of a newborn child becomes the primary and most important task of parents. Especially in the first year of life, the child is unable to protect himself from damaging environmental factors. Examples of such harmful effects may be air and water pollution, excessive sun exposure, or dust and chemicals. This work analyzes the harmful environmental factors for a child under one year old and offers health promotion to protect newborns from harm.

Sources emphasize that in 2012, almost two million children under the age of five in the world died due to the environment (Childrens environmental health, n.d.). The causes were respiratory tract infections, malaria, and various injuries and injuries. The most dangerous is that once experienced, illnesses and injuries can affect the childs further development and its formation in adolescents.

The main environmental factor is air and water pollution.

Adverse environmental impacts and pollution substantially impact morbidity, disability, and in some cases, death. Thus, among the aspects that are involved in this factor are air pollution, inadequate water, and hazardous chemicals and waste that also pollute everything. Among the dangers are lower-respiratory infections, diarrheal diseases, brain damage and inflammation, blood disorders, and jaundice (Air Pollution, n.d., para. 2). Air pollution can be hazardous during the mothers pregnancy since already at this stage, the childs health will deteriorate. In addition to chemicals, there may also be harmful particles of dust and dirt in the air, which can enter the newborns body through the respiratory tract.

Polluted water or lack of clean water for the child and family can be very serious. This problem is particularly acute in developing countries, where peoples access to water resources can be severely limited. It is important to note that newborns are given water only on the recommendation of a doctor in the first months of pregnancy. However, water plays a valuable role in the functioning of the childs body and must meet specific criteria to ensure safety. Minimal consequences can be poisoning or allergies, which can develop into more serious diseases.

Another factor of harmful effects on the child during the first few years that are involved in environmental pollution is harmful chemicals and garbage. This is because children begin to explore the world around them after getting the opportunity to become mobile. Therefore, one of the ways to get acquainted with the new is a touch and a taste test. Hence, there is a possibility of stumbling upon substances that can be spilled on the street. Examples may be chemical poisoning or skin burn. Exactly the same properties are swinging garbage, which can harm the health of the child and affect the further development of the body.

Health Promotion Plan

This part of the scientific work provides a health promotion plan that can which provide knowledge for caregivers on how to prevent and protect newborns from environmental risk.

1. Monitor what the child is doing both at home and on the street
2. Carry out water purification before use with the help of special filters. An alternative may be the purchase of bottled water, which will be intended for newborns.
3. If possible, avoid places where there is a high level of air and water pollution near factories and production.

In other words, it is necessary to maintain the necessary air quality, which is determined by the absence of excess gases, dust, and odors. To do this, it is essential to ensure constant ventilation in the room and to maintain a moisture balance in order to limit the occurrence of mold harmful to the newborn. All these actions are due to the fact that newborns have a high respiratory rate and a larger lung surface area in relation to their body weight. Due to the faster and more intensive immune system development, they are most susceptible to external environmental factors.

1. Ensure compliance with hygiene standards, which also apply to being on the street or in a public place.
2. To avoid poisoning with toxic substances, it is necessary to thoroughly wash vegetables and fruits before giving them to a child.
3. Avoid tobacco smoke and the smoke from burning things.

Consultation with the attending pediatrician is necessary about what actions should be taken in emergency situations and the basics that are important to ensure the safety of the childs health.

This article raises the topic of such danger for newborns and the growing spread of sudden infant death syndrome. This is influenced by multiple external and internal factors, such as the high vulnerability of the body, the negative impact of environmental factors, and exogenous stress, such as sleeping on the stomach or a soft bed, during a critical period of development (Carlin & Moon, 2017). The source is a valuable source of information for highlighting recommendations for the care of infants. Thus, caregivers should take care of such aspects as proper sleep, a bed for the baby, soft bedding, tobacco smoke limitation, cohabitation, and immunization.

This source provides information and recommendations in the event of a collision with air pollution. This problem is a threat to the health of society, especially to children. Due to the high level of urbanization, more and more infants are exposed to polluted air from vehicles and various industrial plants. The source emphasizes the importance of creating strategies aimed at preventing the adverse effects of pollution on childrens health (Gouveia et al., 2018). Moreover, caregivers should pay special attention to airing the premises and avoiding the close proximity of the child to sources of polluted air. The information provided in the scientific article can also help monitor changes in health effects due to strategic interventions.

One of the problems that external factors can cause is growth retardation in infants, which will have particularly serious consequences in adulthood. This health problem can worsen in the first few years of a childs life. The authors state that climate change will cause significantly more stunting through a reduction of food security (2018, p. 551). This source provides recommendations and generalizations on environmental risk factors that were associated with growth retardation. Hence, if there is a threat, it is necessary to carry out measures to strengthen the health of infants, including steps to improve nutrition and take care of the condition of the room in which the child is located.

References

Air pollution. (n.d.). State of Global Air. Web.

Carlin, R. F., & Moon, R. Y. (2017). Risk factors, protective factors, and current recommendations to reduce sudden infant death syndrome: a review. JAMA pediatrics, 171(2), 175-180. Web.

Childrens environmental health. (n.d.). World Health Organization. Web.

Gouveia, N., Junger, W. L., Romieu, I., Cifuentes, L. A., de Leon, A. P., Vera, J.,& & Tzintzun-Cervantes, G. (2018). Effects of air pollution on infant and children respiratory mortality in four large Latin-American cities. Environmental Pollution, 232, 385-391. Web.

Vilcins, D., Sly, P. D., & Jagals, P. (2018). Environmental risk factors associated with child stunting: a systematic review of the literature. Annals of Global Health, 84(4), 551. Web.

Initiatives Specifics

The initiative related to reducing the number of infant deaths will primarily solve the issue of the high mortality rates, which pose a threat at a national level. Hence, the target audience chosen for this project is infants, mothers, and medical staff. More precisely, nurses and clinicians will be primarily exposed to the initiative as they are responsible for treating newly born children and their mothers. Infants and mothers are targeted for the purpose of observing their health after birth. The implementation will take at least six months since it requires thorough preparation, including the revision of legal, ethical, and administrative issues. What is more, the project aimed at eliminating infant deaths will be realized at the local level; however, it can become impactful at the national level since the healthcare personnel is endowed with a right to advocate for policy passing.

Evaluation of Resources

For the project realization, attracting public and private investors is necessary since it would require thousands of dollars. Moreover, governmental organizations could invest money in the initiative and raise awareness about the issue on the state level to serve as an incentive for solving the selected problem. The significant financial burden will fall on the educational part  the majority of professionals are still underqualified within the initiatives framework. In addition, in order to facilitate information transmission, the organizations will have to buy special equipment for emergency cases. These expenses will help specialists reduce the number of infant deaths and further impact health outcomes. The expenditures are likely to diminish the costs spent on restoration from mistakes. In general, attracting external capital is vital for initiative promotion as it contributes to the improvement of the public health sector.

Ethical and Legal Issues

In order to trace the initiative strictly following ethical and legal guidelines, its developers will study several documents. Primarily, the Code of Ethics plays a vital role in the non-disclosure of private data of employees, patients, and other stakeholders involved in the process (Alomari et al., 2018). In addition, the code will provide a clear understanding of facing challenging situations on-site where the error occurs. In addition, the state documents can offer a legal perspective on the liability of medical personnel to register death based on the reason (Sudden unexpected Infant Death Legislation, n. d.). This document may help establish the understanding of prevention measures regarding infant deaths and contribute to their further elimination by suggesting the legal requirements for being an official administrative source. Finally, the project will undergo a certified assessment by the healthcare organizations of the state to ensure every aspect is legally determined. In addition, Congressional Chronicle S. 1804 is the public federal document regarding infant and maternal deaths, which provides strategies for the elimination of such cases. The document may be used as a recommendation for reducing the mortality rate and as a protective measure to protect ones rights. In Georgia, there is the III.E.2.c. State Action Plan, which suggests preventive measures against infant mortality. In order to trace federal and state regulations followed, the infant mortality and childbirth rates can be measured.

References

Alomari, A., Wilson, V., Solman, A., Bajorek, B., & Tinsley, P. (2018). Pediatric nurses perceptions of medication safety and medication error: A Mixed methods study.Comprehensive child and adolescent nursing, 41(2), 94110. Web.

Sudden unexpected Infant Death Legislation. (n. d.). NCSL. Web.

How MRI and Ultrasound Works

• Magnetic resonance imaging (MRI) does not use X-rays to take images of body organs.
• It is possible to take pictures of any part of the body at almost any angle using MRI.
• Ultrasound uses high frequency sound waves to create images of various body parts and organs.
• Both MRI and ultrasound are non-invasive procedures.

MRI vs. Ultrasound

• Neonatal cranial ultrasound is used in detecting brain injury in preterm infants and can be used repetitively without harming the infant.
• MRI is used for the same purpose of imaging the brain but it is time consuming and is hardly used repetitively.
• Ultrasound scans help in determining the extent of intracranial hemorrhage.
• Ultrasound is fast and inexpensive and can be done at the bedside without any side effects.
• MRI is expensive, time consuming and resource consuming thus not readily available.
• MRI is however better in predicting adverse neurodevelopmental outcomes even at the age of 2 years compared to cranial ultrasound.
• Conventional MRI is powerful in detecting white matter abnormalities and analyzing effects in preterm babies, but ultrasound cannot.
• There is difficulty in establishing superiority of MRI at term to sequential cranial ultrasound from birth to term.
• Cranial ultrasound in very low birth weight infants has high reliability in determining cystic white matter injury.
• However, it is poor in detecting non-cystic injuries, which are more common.
• MRI however at term is sensitive enough to WM injury of non-cystic form.

General Observations

• Conventional MRI adds insignificant clinical information to term age infants with normal cranial ultrasound.
• Ultrasound therefore emerges as not only beneficial but also cost effective than MRI in detecting low risk disabilities.
• MRI techniques can however be useful in detecting abnormalities at an earlier age in infants.
• Ultrasound has been widely used in effective detection of abnormal motor development.

Conclusion

• Ultrasound is highly favored in sensing severe abrasions of white matter in preterm infants.
• MRI is however useful for diagnosis of less severe damage.
• MRI is very effective for final diagnosis at term if it is done within 3 weeks of life.
• MRI has the potential of detecting a wide range of white and gray matter defects and it should be considered on a routine basis for preterm babies.

Reference List

Bellinger, R. 2008. What is MRI. MRI Tutor. Web.

Debillion et al, 2003. Limitations of ultrasonography for diagnosing white matter damage in preterm infants. Arch Dis Fetal Neonatal Ed; 88:F275-F279.

Dunn, M. 2010. Ultrasound versus MRI at term. Neo Notes Journal Club. Web.

Horsch et al, 2010. Cranial ultrasound and MRI at term age in extremely preterm infants. Arch Dis Child Neonatal Ed; 95:F310-F314.

Inder, T E. 2003. White Matter Injury in the Premature Infant: A comparison between serial cranial sonographic and mr findings at term. AJNR Am J Neuroradiol 24: 805-809.

Menkes, J H. et al. 2006. Child neurology. Lippincott Williams & Wilkins. Philadelphia. P.1186.

Nongena et al. 2010. Confidence in the prediction of neurodevelopmental outcome by cranial ultrasound and MRI in preterm infants. Arch Dis Child Fetal Neonatal Ed. Vol 95. No. 6.

Rademaker et al, 2005. Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in children born preterm. Arch Dis Child Neonatal Ed; 90:F489-F493.

Smith, S E 2011. What is medical imaging. WiseGeek. Web.

Technology & Innovation. 2011. MITA. Web.

What is Ultrasound (Sonography). 2011. ARDMS. Web.

Rationale

The exposure to narcotic substances before birth has tremendously adverse effects on a child, leading to multiple health complications, the development of the Narcotic Abstinence Syndrome (NAS) being the most negative one. The presence of chemical dependency in infants requires an elaborate treatment strategy to alleviate the health complications in infants (Klaman et al., 2017). To study the effects of the Eat, Sleep and Console therapy as a possible solution to the problem of NAS in the target population, a quantitative study will be needed (Oostlander et al., 2019). The choice of the quantitative design is justified by the necessity to prove the superiority of the proposed solution to the one that is currently deployed as the alternative way of managing the needs of the specified population. Specifically, it is suggested that a randomized controlled trial (RCT) should be deployed to compare the effects of the Eat, Sleep and Console therapy on infants with NAS and the outcomes of the present strategy for handling the specified health issue.

Clinical Significance

The study of managing NAS in infants with the help of the Eat, Sleep and Console therapy has a moderate level of clinical significance. While this paper is not going to revolutionize the management of NAS in infants since it does not offer a groundbreaking innovation, it will contribute to the discourse substantially (Grisham et al., 2019). By testing the efficacy of the Eat, Sleep and Console therapy on infants ability to fight the challenges caused by the exposition to drugs, particularly, opioids, before birth. Since the described concern affects a large number of infants, it is critical to research the available opportunities.

Moreover, given the fact that the effects of NAS are likely to affect an individuals health status throughout their entire life, early interventions aimed at alleviating the effects of exposure to drugs will have a massive effect on reducing the negative health outcomes in the future (Cree et al., 2019). In turn, this paper will contribute to fighting the NAS issue and evaluate the effects of one of the possible options. Therefore, the significance of this paper is moderate due to the urgency of the issue.

Determination of Data

The scope of the research will be restricted to a local healthcare facility, where infants with NAS are treated. To reduce the biases associated with the lack of diversity in the sample due to the location issue, the simple random sampling strategy will be used. A sample of 100 participants will be selected to ensure that the results are representative enough. The specified sample will allow determining possible connections between the research variables, as well as the existence of variation in the sample.

Statistical Analysis

To analyze the information collected during the trial, Students t-test will be utilized. The specified framework will allow finding the connections between the variables under analysis, specifically, the positive correlation between the use of the Eat, Sleep and Console therapeutic strategy and the intensity of the NAS symptoms in infants. The integration of Students t-test will be particularly helpful in determining whether the statistical hypothesis or the null hypothesis represents the situation with the management of NAS in infants by using the Eat, Sleep and Console method (Sanlorenzo et al., 2018). Namely, by evaluating the significance of differences in outcomes in the target group and the control group, one will be able to infer critical conclusions about the effects of the proposed therapy on the well-being of infants with NAS.

References

Cree, M., Jairath, P., & May, O. (2019). A hospital-level intervention to improve outcomes of opioid exposed newborns. Journal of Pediatric Nursing, 48, 77-81. Web.

Grisham, L. M., Stephen, M. M., Coykendall, M. R., Kane, M. F., Maurer, J. A., & Bader, M. Y. (2019). Eat, Sleep, Console approach: a family-centered model for the treatment of neonatal abstinence syndrome. Advances in Neonatal Care, 19(2), 138-144. Web.

Klaman, S. L., Isaacs, K., Leopold, A., Perpich, J., Hayashi, S., Vender, J.,& Jones, H. E. (2017). Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: literature review to support national guidance. Journal of Addiction Medicine, 11(3), 178-190. Web.

Oostlander, S. A., Falla, J. A., Dow, K., & Fucile, S. (2019). Occupational therapy management strategies for infants with Neonatal Abstinence Syndrome: Scoping review.Occupational Therapy in Health Care, 33(2), 197-226. Web.

Sanlorenzo, L. A., Stark, A. R., & Patrick, S. W. (2018). Neonatal abstinence syndrome: an update. Current Opinion in Pediatrics, 30(2), 182-186. Web.

Infants develop very quickly and are influenced by various factors, for example, nutrition and the environment. Physical development refers to changes in body size  height, weight, and organ size (Graber, 2021). Certain growth milestones will help parents and pediatricians assess the babys health. Even though nutrition has the most significant impact on a childs development, parents should also take care of some exercise and activity.

The first year after birth is a period of very rapid physical development. During the first year, the childs body length increases by about 25 centimeters or almost 50% compared to birth (Graber, 2021). Their weight also gradually increases  after some fluctuations in the first two months, babies begin to gain a pound per month (Graber, 2021). Doctors use special tables adopted by the World Health Organization to monitor changes.

Other crucial physical development aspects are changes in head size, teeth appearance, and motor skills development. The heads circumference reflects the brains size, and therefore it is measured until the child is three years old (Graber, 2021). The period and peculiarity of the appearance of teeth may differ in children as they depend on the heredity and presence of diseases. On average, they begin to appear at 5-9 months, and by the end of the first year, children have about six teeth (Graber, 2021). Motor skills are also essential: the fine motor is the hands movements responsible for grasping and taking, and the gross motor is body movements (Choi, Kang, & Chung, 2018). Parents must create favorable conditions for infants development and track all indicators.

Rapid growth requires much energy, so nutrition becomes critical in the childs development. Most infants receive breast milk from their mothers for some time after birth, gradually transitioning to baby formula. A study by Choi et al. (2018) found that children who receive exclusively breastfeeding for up to 4 months better correspond to the developmental milestones. In turn, children receiving breast milk less than this period may have delays in development (Choi et al., 2018). Breastfeeding and stopping it is a crucial decision in the family affecting the baby. Bigman, Homedes, and Wilkinson (2021) note that cultural and social norms influence feeding duration. Given the importance of nutrition to infants, parents need to consider the best recommendations.

In addition to nutrition, parents need to take care of the physical activity and calmness of the baby. In particular, some exercises and massages recommended by specialists can have a beneficial impact on development (Alves & Alves, 2019). The psychological well-being of the child and mother is also significant. A study by Racine et al. (2018) found that the adverse experience of a child and a mother can lead to various diseases and interfere with a childs development. Therefore, parents should carefully prepare for the appearance of babies and follow doctors instructions in the first months of their lives.

Thus, infants experience rapid physical development requiring consideration of various factors and careful monitoring. Babies height and weight increase, the heads circumference changes, and they have their first teeth. Parents and doctors can track key milestones using special tables recommended by specialists. Moreover, children develop motor skills  they begin to move and grab various things. The infants must receive the necessary nutrition for the correct development and absence of problems. Parents contribute to the better growth of babies by creating favorable and calm conditions for them.

References

Alves, J. G. B., & Alves, G. V. (2019). Effects of physical activity on childrens growth. Jornal de Pediatria, 95, S72-S78.

Bigman, G., Homedes, N., & Wilkinson, A. V. (2021). A commentary on A systematic review examining the association between body image and infant feeding methods (breastfeeding vs. bottle-feeding). Journal of Health Psychology, 26(8), 1126-1131.

Choi, H. J., Kang, S. K., & Chung, M. R. (2018). The relationship between exclusive breastfeeding and infant development: A 6-and 12-month follow-up study. Early Human Development, 127, 42-47.

Graber, E. G. (2021). Physical growth of infants and children. Web.

Racine, N., Plamondon, A., Madigan, S., McDonald, S., & Tough, S. (2018). Maternal adverse childhood experiences and infant development. Pediatrics, 141(4), 1-9.