Category: Infant

Breastfeeding

Breastfeeding is well established in the US (Stokowski, 2007). The extent of breastfed infants was 73% in a survey in 2005. At 6 months, 39% were being breastfed and at 1 year of age, 20% were still enjoying the breast milk. Healthy full-term infants obtain complete nutrition from breast milk (Ip et al, 2007). The latest recommendation by the WHO is to exclusively breastfeed infants up to 6 months.

Formula over breast milk

Breastfeeding is essential for the adequate growth and development of the physical and mental health of infants (Chudasama et al, 2009). Riordan says it in another way; exclusive breastfeeding and complementary feeding methods are essential for the growth and prevention of illness (2005). Exclusive breastfeeding implies that breast milk alone, even the expressed variety, allows the infant to have a series of nutritious materials like “vitamins, minerals or medicines and water, breast milk substitutes”( Chudasama et al, 2009). The breastfed children require very much less medical care when compared to the artificially-fed babies who are known to suffer more illness as formula are believed to be deleterious due to contamination through unhygienic methods of handling it (Riordan, 2005). They do not develop the autoimmune response that is exhibited in infants on breastfeeding and do not contain the health-promoting factors. Research has indicated that regular breastfeeding has reduced the risk of otitis media, gastroenteritis, respiratory infections, atopic dermatitis, asthma, obesity, diabetes mellitus, leukemia, sudden infant death syndrome and necrotizing enterocolitis (Stokowski, 2007). Higher maternal age education, more gestational age of about 37 weeks, mothers with previous experience are the factors affecting mothers. Other factors that cause a hindrance to exclusive breastfeeding are “low family income, low maternal age, primiparity and mothers returning to work” (Chudasama et al, 2009). Breastfeeding incorporates religious, traditional and social patterns. Under-nutrition between the ages of 6 and 24 months occurs due to early substitution of breast milk or late introduction of semi-solid foods. The formula has nutrients not ingested by humans and they may not be in physiologic proportions (Riordan, 2005). The mere act of bottle-feeding could harm the cardio-pulmonary system of infants. Artificial feeding also creates some dangers to mothers. Mothers could develop osteoporosis, breast cancer, or ovarian cancer (Riordan, 2005). Mothers with diabetes have greater relief of symptoms when exclusively breastfeeding. Using artificial formula stretches the purse-strings of the families. The economies of the community and nation become affected too. The cost of bringing up a breastfed child is much less than one with artificial feeds. Artificial feeds for 6 months consist of 150 cans of baby milk; the cost of baby milk for one month is $80. If the child has allergies , the cost shoots up to $300 per month. Lactation allows a faster metabolization of food aided by the water conservation of prolactin. Exclusive breastfeeding has a contraceptive effect: the chance of more frequent pregnancies is a remote possibility. The ignorance about colostrum has led mothers to avoid feeding their newborns this useful first milk. The mothers must be educated on the significance of feeding this rich milk in the initiation of breastfeeding. The families of the child who is exclusively breastfed happen to have longer hours of sound sleep (Doan et al, 2007).

Changing the attitudes of the mothers

The Public Health programs which aim to motivate exclusive breastfeeding must make a head start and target adolescent teenage girls. Among the other adolescent programs, the significance of breastfeeding may be additionally impressed upon the young girls who are to become future mothers. Meeting the ladies in the period before their pregnancies is another apt time to start talking about the health of the breast and the nipple. The antenatal period is another appropriate time to stress the importance of exclusive breastfeeding. Nurses who have been retrained in the subject must make concerted efforts at the various levels during pregnancy, labor, birth, postpartum period and routine infant care visits to motivate the mothers after identifying and overcoming the structural barriers (Cricco-Lizza, 2009). Healthcare providers need the latest information on infant nutrition to share it with new parents who have no end of doubts and questions. Parents consider the nurses as the right choice for seeking information.

Diverse feeding patterns

The breastfeeding patterns may vary from nation to nation and region to region. The diversity is also based on social and traditional values and religious beliefs. The mothers may breastfeed and complement with other foods or they may exclusively breastfeed. The duration of feeding may vary from 6 months to one year. A study found that Hawaiian women had a high breastfeeding initiation rate but native people had only 64% initiation (Dodgson et al, 2007). It was found that the women who exclusively breastfed ensured a feeding period of 6 months and weaned much later. In another study among the Israeli population, it was found that Muslim women were more prone to exclusively breastfeed and continued it for longer periods (Chertok, 2004). However successful outcomes were found for both Jewish and Muslim women. Hispanic mothers have a history of a low level of exclusive breastfeeding (Hernandez, 2006). As the low minority groups of the US have a lesser rate of exclusively breastfeeding, knowing their cultural background helps the nurse identify ways and means to motivate exclusive breastfeeding.

Guidelines for breastfeeding mothers

A well-balanced diet with an adequate intake of calories and proteins with sufficient fruits and vegetables on the “My Pyramid” lines is essential (Morin, 2008). A lactating mother needs to consume 500 more calories (Riordan, 2005). Modern mothers may take less than their recommended intakes in order to lose weight. Nurses must be able to gauge what is happening and share vital information. Breastfeeding mothers produce 750-800 ml. of milk so the maintenance of hydration is significant. Nurses must be able to convince the mothers that they have to drink more water if thirsty, having a dry mouth, scanty urination, or concentrated urine (Morin, 2008). 1000 mg. of calcium may be consumed during lactation or larger amounts of spinach, broccoli and dairy products. The mothers need to be told about the loss of bone mass in pregnancy but which returns to normal after weaning. Some foods that the mother takes affect the child by giving him gastric distress. She has to look out for vomiting, blood, and mucus in stools; they could be allergies. Keeping a record of what causes her child’s symptoms appears essential. The use of a pacifier accounts for some of the oral needs of an infant. However the infant may breastfeed less with the pacifier being used intermittently (Best practice sheet, 2005). The suckling reflex is also satisfied by the pacifier.

Feeding Preterm infants

Mothers have a feeling that premature babies are unable to feed properly due to some physical problems associated with prematurity. Current feeding practice for pre-term babies does not actually detail when bottle feeds are to be started. Infant readiness is one major factor in a premature infant in that this infant may have inadequate reflexes or accompanying defects which prevent its normal feeding habits (Welling and Waszak, 2009). Consistent feeding habits may be necessary to ensure that the child gets its quota of breast milk. Multiple caregivers as when a child is in an institution must share a common language or routine for the feeding. Parents need to be given instructions too. 40% of participants in a study which included 117 nurses, 18 assistants and 7 neonatologists could not indicate the proper features of infant readiness. They relied on gestational age and other indicators. Observed suckling was taken as the indicator for readiness by 59% of the nurses. The new protocol advised by the physician is “nipple per feeding readiness” (Welling and Waszak, 2009). Oral feeds are usually started in 32-34 week premature babies (Lessen, 2009). Lessen studied the effect of the modified version of the Beckman Oral Motor Intervention in premature infants of 29 weeks. The oral stimulation intervention included the response to pressure, movement and control for lips, cheeks, jaw and tongue. The time to reach oral feedings was reduced by 5 days; this meant a lesser hospital stay and lesser burden on the national exchequer by nearly 2 billion dollars annually for 3 days less (Lessen, 2009). Thoyre (2009) found that infants who had a risk for respiratory problems or who were on the ventilator for longer periods, with respiratory distress, continuous positive airway pressure, had taken more days to reach full oral feeding or had oxygen supplementation developed distress symptoms which interfered with proper and early feeding. The lesser feeding pattern is probably due to “behavioral disorganization, swallowing and respiratory dysregulation” (Thoyre, 2009).

Breastfeeding is good for the mothers too

Mothers also had some advantages from breastfeeding: they had lesser risk of diabetes mellitus, breast and ovarian cancers. Postpartum depression was seen in ladies who stopped breastfeeding early. However the researchers have suggested further confirmation of the facts (Stokowski, 2007). Hardly any reason exists for not breastfeeding a healthy infant. However exclusive breastfeeding is yet to take off in many hospitals in the US. Carder (2008), a Lactation Consultant, suggests that “postpartum units and birthing centers should be formula-free” and that “breastfeeding should be the gold standard for infant nutrition”. Exclusively breast-fed infants are less prone to serious illnesses than formula-fed. Many hospitals who accept the donations of free formula have to use them in their units and invariably this is an advertisement. A Baby-Friendly Hospital should use the formula only as medically indicated (Shealy, Li, Benton-Davis, & Grummer-Strawn, 2005). The breastfeeding patterns of most modern mothers depend on their obstetrician’s opinion. This person however does not realize the magnitude of his influence. Nurses are another group who can influence a mother on breastfeeding. To do this, they have to keep up with the latest information to incorporate them into their evidence-based practice (Carder, 2008). Lactation consultants take classes on breastfeeding and distribute supportive materials and they remain accessible following the discharge of the mothers. Mothers are reassured that their infants get specialized care.

How infant nutrition can be provided in palliative care

Mothers must be convinced that infants can be nourished with food and water provided they can ingest them safely (Morin, 2007). Non nutritive suckling on a pacifier meets some of the infant’s oral needs. Mothers would like to know what medically supplied nutrition is. Nurses may have to explain what this is to the mothers: any nutrition given through means other than oral like intravenous or enteral tube feeds is medically supplied nutrition (Ersek, 2003). During palliative care, supplying nutrition to the child becomes a complex situation. The ethical and legal questions may arise when a dying child is given parenteral feeds which are keeping it just alive but suffering longer. Minimizing dehydration can be maintained by “implementing conscientious and meticulous infant mouth care, providing appropriate bedding, addressing temperature changes, and encouraging infant holding by parents and caregivers” (Morin, 2007). Mothers rely much on the information provided by the nursing personnel who need to be sensitive to the needs and emotional status of the parents.

Conclusion

Exclusive breastfeeding needs to be adopted invariably by all nursing mothers. The highly nutritious colostrum and breast milk contain autoimmune substances which enhance the child’s immunity status and nutritious materials which lead to a physically and mentally healthy infant which develops the power to overcome common illnesses of childhood. The mother’s breastfeeding pattern is influenced by social and religious values. The factors affecting a mother’s feeding pattern are higher maternal age education, more gestational age of about 37 weeks, mothers with previous experience are the factors affecting mothers. Other factors that cause a hindrance to exclusive breastfeeding are low family income, the young age of the mother, primiparity and mothers returning to their job.

References

Agency for Healthcare Research and Quality. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Web.

Chertok, I.R., Shoham-Vardi, I. & Hallak, M. (2004). Four-Month Breastfeeding Duration in Postcesarean Women of Different Cultures in the Israeli Negev, Journal of Perinatal and Neonatal Nursing.Volume 18 Number 2 Pages 145 – 160.

Chudasama, R.K., Patel, P. & Kavishwar, A. Breastfeeding initiation practice and factors affecting breastfeeding in South Gujarat region of India. The Internet Journal of Family Practice. 2009 Volume 7 Number 2, Internet Scientific Publications.

Cricco-Lizza, R. (2009). Formative Infant Feeding Experiences and Education of NICU Nurses The American Journal of Maternal/Child Nursing, Volume 34 Number 4 Pages 236 – 242.

Doan, T., Gardiner, A., Gay, C.L. & Lee, K.A. (2009). Breast-feeding Increases Sleep Duration of New Parents, Journal of Perinatal and Neonatal Nursing. Volume 21 Number 3 Pages 200 – 206.

Dodgson, J.E., Codier, E., Kaiwi, P., Oneha, M.F.M. &Pagano, I. (2007). Breastfeeding Patterns in a Community of Native Hawaiian Mothers Participating in WIC, Family & Community Health. Volume 30 Number 2 – Supplement: Pages S46 – S58.

Ersek, M. (2003). Artificial nutrition and hydration: Clinical issues. Journal of Hospice and Palliative Nursing, 5, 221-230.

Hernandez, I.F.(2006). Promoting Exclusive Breastfeeding for Hispanic Women, The American Journal of Maternal/Child Nursing. Volume 31 Number 5 Pages 318 – 324.

Ip, S., Chung, M., Raman, G., Chew, P. Magula, N., DeVine, D., et al. (2007).

Breastfeeding and maternal and infant health outcomes in developed countries. Evidence report/technology assessment No. 153.AHRQ publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality.

Joanna Brigg’s Institute, (2005), Early childhood pacifier use in relation to breastfeeding, SIDS, infection and dental malocclusion. Best Practice, Vol. 9, Issue 3.

Lessen, B.S. (2009). Effect of Oral Stimulation on Feeding Progression in Preterm Infants. Advances in Neonatal care, Vol.9, No. 4 in Research Abstracts (Eds.) Mainous, R. O. presented at the Fourth Annual NANN Research Summit held, in Scottsdale, Arizona, p. 187.

Morin, K.H. (2007). Infant Nutrition During Palliative Care. Infant nutrition, Vol. 32, No. 5 p. 320.

Morin, K.H. (2008). Helping breastfeeding mothers eat well. Infant Nutrition.

Riordan, J. (2005), Breastfeeding and human lactation, 3^rd Ed., Sudbury:M.A. Jones and Bartlett Publishers.

Shealy, K. R., Li, R., Benton-Davis, S., & Grummer-Strawn, L. M. (2005). The CDC guide to breastfeeding interventions. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Stokowski, L.H. (2007). Breastfeeding: The Evidence. Advances in Neonatal Care, Vol. 7, No. 4 pp. 169-170, Noteworthy professional news.

Thoyre, S.M. (2009). Dynamic Early Feeding Skills: An Observational System for Coding the Dynamics of Early Infant Feeding, Advances in Neonatal care, Vol.9, No. 4 in Research Abstracts (Eds.) Mainous, R. O.presented at the Fourth Annual NANN Research Summit held, in Scottsdale, Arizona.p. 188.

Welling, R. & Waszak, L. Project Preemie: Successful Promotion of Proper Feeding Techniques for “Growing Outcomes” Advances in Neonatal care, Vol.9, No. 4 in Research Abstracts (Eds.) Mainous, R. O.presented at the Fourth Annual NANN Research Summit held 2009, in Scottsdale, Arizona. p.186.

Introduction

Qualitative research may be crucial to expanding the existing breadth of post-delivery care knowledge. Thus, the paper “Parental experiences of providing skin-to-skin care to their newborn infant” by Anderzen-Carlsson, Lamy, and Eriksson (2014) aims to describe parents’ various experiences with skin-to-skin contact (SSC). As such, the article is vital for understanding the psychological processes of both participating parties and remains relevant to increasing the quality of provided post-partum care.

Methodology

The study’s impeccable methodology defends the quality of its results. The researchers used a data extraction method to obtain information about parents’ subjective experiences (Anderzen-Carlsson et al., 2014). A qualitative approach seems to be most beneficial for this type of research since the article’s objective links with analysing the sentiment felt by mothers and fathers during SSC, rather than a clear hypothesis (Cristancho, Goldszmidt, Lingard, & Watling, 2018; McCusker & Gunaydin, 2015).

Anderzen-Carlsson et al. (2014) justify the research design under a formulate-extract-appraise methodology, choosing articles with a solely qualitative methodological base using both systematic and manual searching techniques to select studies from four databases. Thus, data was collected in a way that reflected the objective of the research issue.

Analysis

The conducted analysis allows making a statement about the results’ integrity. The primary means of research was meta-data analysis using NVivo computer software, a reliable program that facilitates the research process, which analysed relevant original quotations and helped categorise the uplifted data into 19 distinct categories (Anderzen-Carlsson et al., 2014; Zamawe, 2015). Potential bias was removed by having multiple researchers appraise articles using an impartial Primary Research Appraisal Form, and the initial literature searches were performed twice to secure the result’s actuality (Anderzen-Carlsson et al., 2014).

Anderzen-Carlsson et al. (2014) tackle each of the 19 defined categories in detail, presenting a definite conclusion regarding the research question regarding the various psychological states of parents post-delivery and during SSC. It is important to note that the researchers did not explicitly discuss any ethical issues raised by the study.

Conclusion

The research attains its goals, and it could be worth continuing from a viewpoint that deals with parental experiences directly or relates to solely paternal experiences. The discussion tackles the range of experienced emotions and their implications for post-partum care, as well as the limitations of their research, such as an overabundance of mothers compared to fathers. Therefore, the paper successfully refines the existing data on the topic of SSC’s effect on parents post-delivery.

References

Anderzen-Carlsson, A., Lamy, Z. C., & Eriksson, M. (2014). Parental experiences of providing skin-to-skin care to their newborn infant – Part 1: A qualitative systematic review. International Journal of Qualitative Studies on Health and Well-Being, 9(1), 1-22. Web.

Cristancho, S. M., Goldszmidt, M., Lingard, L., & Watling, C. (2018). Qualitative research essentials for medical education. Singapore Medical Journal, 59(12), 622-627. Web.

McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed methods and choice based on the research. Perfusion, 30(7), 1-6. Web.

Zamawe, F. C. (2015). The implication of using NVivo software in qualitative data analysis: Evidence-based reflections. Malawi Medical Journal, 27(1), 13-15. Web.

Introduction

The following analysis is related to the article, “The effect of nursing quality improvement and mobile health interventions on infant sleep practices” by Moon et al. (2017). The study under review is a randomized clinical trial, which is indicated in its title. The purpose of the trial was to determine whether two interventions, nursing quality improvement (NQI) and mobile health intervention, increased mothers’ adherence to infant safe sleep practices when used separately and combined. This paper will analyze the article’s strengths and weaknesses, reliability and validity, ethics, and topic summary. Overall, the reviewed trial may be considered well-designed, providing reliable and valid results, and performed in accordance with ethics, although some limitations are also present.

Overall Strengths and Weaknesses

The article by Moon et al. (2017) explored the effectiveness of two interventions on improving infant safe sleep practices, which could be used to reduce the risk of sudden infant death syndrome (SIDS). The study used cluster randomization and provided a clear explanation of the rationale for the chosen trial design. A detailed description of interventions for experimental and control groups is also present. The findings indicated that mobile health intervention improved mothers’ self-reported adherence to infant safe sleep practices, whereas the effect of the NQI intervention appeared to be not statistically significant. These results have implications for practitioners and guide further research into this field. For example, Moon et al. (2017) stated that it was necessary to examine whether the widespread use of mobile health intervention was feasible and whether it decreased the rate of SIDS. Thus, this study has significant strengths that make it a well-designed randomized clinical trial.

Yet, the article also has certain limitations regarding the generalizability of the results. First of all, researchers excluded non-English speaking mothers from the study sample, which implies that the generalizability of the results cannot be applied to the non-English speaking population. Apart from that, the rate of participants lost to follow-up was 21%, and this group was comprised mostly of “younger, black, single, and less well educated” women (Moon et al., 2017, p. 358). As a result, the findings regarding the effectiveness of mobile health intervention in promoting infant safe sleep practices may not apply to this population. In addition, the trial did not assess adverse events and clinical outcomes, such as SIDS rates. The researchers used participants’ self-reported adherence to safe sleep practices. Although self-reported data has many advantages, its weakness is that some participants’ responses may be exaggerated or biased. Finally, the authors did not describe the procedure of blinding, which may imply that it was not used in this study.

Reliability and Validity

The study under consideration is a well-designed randomized clinical trial, which puts it at Level II in the hierarchy of evidence. The randomization procedure is clearly described and well-explained in the article. Moon et al. (2017) divided sixteen hospitals into four groups and then randomly assigned one of the four interventions to each of the groups using computer-generated random numbers and a blocked randomization scheme. The interventions assigned to the four groups included safe sleep NQI and safe sleep mHealth, and the control interventions were breastfeeding NQI and breastfeeding mHealth. The interventions were allocated in such a way as to assess the effects of each of the experimental interventions individually and in combination with each other. Cluster randomization was justified for this trial because providing nurses within the same hospital with different training was not feasible. Moreover, providing different interventions to patients in the same hospital could lead to result contamination. Therefore, cluster randomization ensured the reliability of the results in this case. The sample size was large enough to provide generalizable results for the English-speaking population. Eligibility criteria were thoroughly described, and non-eligible participants were excluded from the trial.

The results of the study can be considered valid because the researchers’ methods assessed what they intended to assess. The provided experimental interventions were aimed at increasing mothers’ awareness of infant safe sleep practices. Data were collected by means of a survey that assessed the effect of these interventions on mothers’ adherence to safe sleep practices. The statistics used for data analysis included 95% CIs, Bonferroni-adjusted P values, and post hoc imputation analyses. The findings were consistent in different groups, across all endpoints, and with the prestudy data, which proves the validity of the obtained results.

Ethics

The researchers followed the ethical standards and procedures required for conducting experimental research. The Institutional Review Board approval was received from all hospitals involved in the trial and Boston University, the University of Virginia, and Yale University. Written informed consent was obtained from all participants, and their anonymity and confidentiality were protected. The used interventions did not pose a risk of harm to the participants, and the researchers gave them the right to withdraw from the trial.

Topic Summary

The study addressed a significant research topic in the field of infant care. Moon et al. (2017) explained their interest in studying the effects of interventions directed toward promoting infant safe sleep practices by the need for reducing the rates of SIDS. The risk of SIDS may decrease when mothers adhere to infant safe sleep practices. These practices include infants’ supine sleep position, sharing rooms but not beds with parents, use of pacifiers, and non-use of soft bedding (Moon et al., 2017). Thus, examining the ways of increasing mothers’ adherence to safe sleep practices is an important research question.

Reference

Moon, R. Y., Hauck, F. R., Colson, E. R., Kellams, A. L., Geller, N. L., Heeren, T., Keer, S. M., Drake, E. E., Tanabe, K., McClain, M., & Corwin, M. J. (2017). The effect of nursing quality improvement and mobile health interventions on infant sleep practices: A randomized clinical trial. JAMA, 318(4), 351-359. Web.

Introduction

With the increase in preterm birth and the high survival rate of infants with neuro-developmental impairment, the doctors have to provide parents with prognostic information for their infants. This is done with the help of neuro imaging or medical imaging (Horsch et al., 2010, p.1).

Medical Imaging has become an integral part of modern medicine. One can understand its huge benefits after he has experienced it and then analyzed it, whether it is a patient or a physician or a professional organization (Technology and Innovation, 2011, Para1). Medical imaging technology is used to take images of the inside of the body. “It is sometimes also referred as diagnostic imaging as it helps doctors to arrive at a diagnosis” (Smith, 2011, Page 1). Medical Imaging helps in detecting and diagnosing diseases at its earliest and treatable stage and helps in determining most appropriate and effective care for the patient (Technology and Innovation, 2011, Para 4).

“Medical imaging provides a picture of the inside of the body in a non-invasive way. These pictures can be used to identify unusual things inside the body, like tumors, broken bones, leaking blood vessels, etc. X- Ray is one of the most famous types of diagnostic imaging, it uses radiation to take a static image of a specific area” (Smith, 2011, Para 1).

Smith (2010, Para 1) states if we separate ultrasound from the technologies like X-Rays and CT that is computed tomography, it also aids in sensing body from inside. This is done with the help of bouncing sound waves and MRI, which is magnetic resonance imaging, shake the cells that helps in getting a picture of the inside of the body (Smith, 2011, Para 1). Medical imaging helps in creating dynamic images in motion that can be used in diagnosing such cases where static imaging cannot be used for any visualization (Smith, 2011, Para 1).

Research confirms that medical imaging not only improves health and save lives but also reduce health care costs and spending. Medical Imaging helps in diagnosing different internal organs of the body without the help of an invasive and risky surgical process, thus improving the chances of survival (Technology and Innovation, 2011, Para 5).

The power of medical imaging can be understood more clearly by the following research finding: (Technology and Innovation, 2011, Para 7).

• “Increased regular mammography screening rave resulted in a 24 percent decrease in the death rate from breast cancer from 1990-2004” (Technology and Innovation, 2011, Para 8).
• “Physicians have reported that for all cancers, PET scanning allowed them to avoid additional tests or procedures 77 percent of the times” (Technology and Innovation, 2011, Para10).
• “Increased utilization of advanced medical imaging, such as CT and MRI, between 1991 and 2004 improved life expectancy by 0.62 to 0.71 years. This effect was greater than the increase in mortality caused by obesity” (Technology and Innovation, 2011, Para11).
• “Imaging procedures such as CT, MRI, ultrasound, etc. diagnose and treat a wide range of diseases from cancer and appendicitis to stroke and heart disease and also looks for any signs of diseases or abnormalities in the fetus” (Technology and Innovation, 2011, para12).

The aim of the current study is to compare MRI and Ultrasound for determining abnormalities in preterm infants. For this purpose lots of surveys have been done and the findings prove the importance of both the methods of imaging.

Methods

MRI and Ultrasound

MRI refers to Magnetic Resonance Imaging; in the past years it was called Nuclear Magnetic Resonance Imaging (Ballinger, 2008, Para 1). Around 15 years ago ‘Nuclear’ was dropped off to avoid any confusion of its involvement with radioactivity (Ballinger, 2008, Para 1).

Unlike regular X- rays and CAT scans, MRI takes pictures of various parts of body without the use of x-rays. “The patient lies in the MRI scanner that consists of a large and very strong magnet. Signals are sent and received from the body with the help of radio wave antenna. The computer attached to the scanner converts the returning signals into pictures” (Ballinger, 2008, Para 2). MRI can take pictures of any part of the body at almost any angle (Ballinger, 2008, Para 2).

High frequency sound waves are used in ultrasound to create visual images of tissues, organs or blood flow inside the body (What is Ultrasound (Sonography), 2011, p.1). “Similar to MRI it is non-invasive, involves no radiation (like x-ray) and avoids other hazards like bleeding, infections or reactions to chemicals of other diagnostic methods” (What is Ultrasound (Sonography), 2011, p.1)

Findings

Abnormal Neonatal Course

Perinatal Asphyxia that has been severe to cause neurologic deficits can be detected by an abnormal neonatal course. These symptoms could be in the form of delayed or impaired respiration requiring resuscitative measures like intubation or ventilation. Also delayed Apgar scores, is 3 or less for more than 10 minutes, can develop neurologic complications, like neonatal seizures, and finally evolution of cerebral palsy. However, perinatal asphyxia cannot be solely indicated by a low Apgar score as there could be other factors for low score like brain malformation, maternal drugs or anesthesia (Menkes et al, 2006, p 405).

During the neonatal period other visible abnormalities include seizures, hypotonia and a bulging fontanel. Irritability, feeding difficulties, excessive jitters or abnormal cry is some less obvious abnormalities (Menkes et al, 2006, p 405).

Neonatal cranial ultrasound has become the first choice for detecting brain injury especially in such preterm infants those who have high chances of it. Through this method the examinations can be repeated as much time as we want without affecting weak infants. Since the last few years, MRI has been providing high resolution for imaging of the brain as all the parts are easily visible through it. But simultaneously it has also been observed that this method of imaging is time consuming and most of the time it is not available repetitively (Rademaker et al., 2005, p. 489).

Medical imaging studies suggesting Prenatal Asphyxia

Prenatal Asphyxia can be detected to some extent by the examination of CSF, but a normal CSF does not exclude the possibility of prenatal asphyxia (Menkes et al, 2006, p 405).

Ultrasound scans are most commonly used to determine the extent of an intracranial hemorrhage. These scans can be done at the bed side without any harmful effects to the infant. “These scans provide excellent visualization of the ventricular system, basal ganglia, choroid plexus and corpus callosum” (Menkes et al, 2006, p 406).

In the preterm infants ultrasound is useful in providing prognostic information during the neonatal period. Horsch et al (2010, p.1) states that “It helps in detecting major intracranial wound, like intraventricular hemorrhage, parenchymal hemorrhagic infractions or cystic periventricular leukomalacia all indicating the development of cerebral palsy and severe cognitive impairment” (Horsch et al, 2010, para.1).The main advantage of Ultrasound is that it is fast and inexpensive and can be done at the bedside without any side effects (Horsch et al, 2010, para.1).

Horsch et al (2010, p.1) mentions that Conventional MRI and cUS (cranial ultrasound) were previously compared in preterm infants. Horsch et al (2010, p.1) further states “Woodward, in a recent study, demonstrated that abnormal findings on cerebral MRI at term equivalent age predict adverse neuro-developmental outcome at 2 years of age significantly better than cUS” (Horsch et al, 2010, para.1).

This type of finding insists us to mull over whether MRI can be used as a screening tool for all preterm infants. “However, the information generated from cUS at term age, in the studies of Woodward, was not taken into account as cUS scans were done only in the first 6 weeks of life and not in parallel to the MRI at term” (Horsch et al, 2010para.1). Also, MRI is an expensive, time consuming and resource consuming technique is not available in all hospitals and, where available, the waiting list is very long (Horsch et al, 2010para.1).

MRI versus Ultrasound in preterm infants

Conventional MRI is supposed to be superior to cranial ultrasound that is helpful in identifying white matter abnormalities and then analyzing effects in preterm infants (Horsch et al, 2010, 2010, para.1)

Based on the study done in Stockholm from August 2004 to November 2006 on all infants born with GA below 27 weeks, “all infants with severe abnormalities (n=3) were scored as severely abnormal on cUS and MRI” ” (Horsch et al, 2010, Para 3). Horsch et al (2010, p.3) discovers that out of 28 infants with normal ultrasound at term age, 18 had a completely normal MRI and 10 had only mild WM abnormalities on MRI. Thus, none of the infants who went through normal cUS had any severe WM abnormalities or abnormal grey matter (shown in Table 1). “In all, 10 infants who were scored as normal on MRI were scored as mild to moderate in cUS” (Horsch et al, 2010, Para 3).

“In four infants small punctuate cerebellar hemorrhage was diagnosed using MRI while no hemorrhage were diagnosed using cUS” (Horsch et al, 2010, p.3).

Earlier also there had been systematic comparison between cUS and MRI. Horsch et al (2010, p.4) further mentions that Woodward feels that MRI could predict better results of adverse neurodevelopment and cerebral palsy at 2 years than ultrasound. Still, in Woodward’s studies the sensitivity of cUS was inferior compared to results published by other groups, possibly, due to a major difference in both study patterns.

“Woodward did only 3 ultrasounds within the first 6 weeks of life while the other group by De Vries scanned weekly from birth until term age” (Horsch et al, 2010, p.4). “Information about impaired brain growth, diffuse grey and WM loss can be detected by late cUS, as it is proven that signs of poor brain growth are related to adverse neuro-developmental outcome at 3 years” (Horsch et al, 2010, p.4). Hence it is difficult to establish the superiority of MRI at term to sequential cUS from birth to term (Horsch et al, 2010, p.4).

MRI and cUS both methods showed similar severe abnormalities. “Moreover, cUS’s at term age was normal for approximately 40% of extremely low gestation age infants and also MRI did not show moderate or severe WM abnormalities or abnormal grey matter” (Horsch et al, 2010, p.4). As a result, “all infants with normal cUS have either normal MRI which was 64% or only mild which was 36% WM abnormalities on MRI” (Horsch et al, 2010, p.4).

There had been many studies to identify and compare the cUS and MRI in determining abnormalities in preterm infants. Inder et al (2003, p.1) states that one such study, whose purpose was to assess the sensitivity and specificity of cUS during the first 6 weeks of life in comparison with MRI at term, was done, in describing the presence of WM injury in a group of 96 very low birth infants (Inder et al, May 2003, p.1).The results of this study are defined in the Table 6; Table 7 and Table 8. The study concluded that though “neonatal cUS of the VLBW infants showed high reliability in detecting cystic WM injury but has limitations in showing of non-cystic WM injuries”. As non-cystic WM injury is more common than cystic WM injury, this deficiency of neonatal cUS is important (Inder et al, May 2003, p.1).

The study was done on a large unselected group of VLBW infants. It shows that the “finding of cUS WM echo densities lacks sensitivity and positive prognostic assessment for the existence of WM injury but was clearly highlighted by MRI at term” (Inder et al, May 2003, p.1). Here a clinician has restrictions to exactly diagnose this common cerebral disease in premature infants who suffer severely (Inder et al, May 2003, p.1).

Discussion

“Hence it can be stated that conventional MRI adds marginally clinically relevant information to the infants with normal cUS at term age” (Horsch et al, 2010, p.4).This means that for identifying low risk of severe disabilities in infant ultrasound can be equally beneficial and cost effective than conventional MRI. Also, MRI is an expensive, time consuming and resource consuming technique, is not available in all hospitals. The study is based on the results of cUS and conventional MRI. The results of much advanced MRI methods such as diffusion tensor imaging, volumetry, tractography, spectroscopy and functional MRI will definitely be more precise and accurate in diagnosing the symptoms at an earlier stage in infants (Horsch et al, 2010, p.4).

A series of studies which have been done within the span of 30 years have proved that a normal ultrasound scan can be very effective in establishing the outcome of a normal neuromotor development in an infant (Nongena et al., 2010, p.1). Nongena et al (2010, p.1) further mentions that “the accuracy is high: in one typical study the PPV was 99% (95% CI 98% to 99%); combining suitable studies, the pooled probability for normal outcome was 94% (95% CI 92% to 96%), though heterogeneity between studies was high at 88%” (Nongena et al., 2010, p.1).

“Normal cognitive function was predicted by a normal ultrasound with a PPV of 77% (95 CI 74%to 80%) in another typically large study” (Nongena et al., 2010, p.1). “The pooled probability was 82% (95% CI79% to 85%) of a normal cognitive outcome of a normal ultrasound scan” (Nongena et al., 2010, p.1)

In different studies using Grade 1 or 2 IVH, Grade 3 IVH, Grade 4 IVH, cystic PVL, Ventricular dilatation, post hemorrhagic hydrocephalus, etc. showed varied results confirming the accuracy of diagnosis done by normal ultrasound. Shown below, in Table 2, prediction of abnormal neuromotor function by cranial ultrasound (Nongena et al., 2010, p.2)

Table 2 : Prediction of abnormal neuromotor function by cranial ultrasound (Nongena et al., 2010, p.2)

MRI or Magnetic Resonance Imaging

Comparatively fewer studies have tried to assess the value of MRI for predicting abnormal motor development or cognitive impairment. Here also different imaging and outcome criteria are used which is similar to ultrasound studies. Below defined are the results of studies using widely available MRI techniques (Nongena et al., 2010, p.2).

White Matter Abnormalities

Woodword premeditated the existence of white matter abnormalities to tell long term neurodevelopment consequences. This he did after using a blend of imaging appearances. “Using a white matter grading score ranging from normal to moderate to severe, the PPV of moderate to severe white matter abnormalities for abnormal motor development was 31% (95% CI17% to 49%) and for cognitive impairment was 34% (95% CI 20% to 52%)” (Nongena et al., 2010, p.2). “Combined studies suggested that moderate to severe white matter abnormalities predicted abnormal neuromotor development with a pooled probability of 35% (95% CI 19% to 55%) and cognitive impairments with a pooled probability of 52% (95% CI 36% to 67%)” (Nongena et al., 2010, p.2).

Ventricular Enlargement

“In one study, ventricular enlargement with a ventricular diameter >8mm predicted long-term neurodevelopmental impairment with a PPV of 86% (95% CI 42% to 99%)” (Nongena et al., 2010, p.2). “Another study found that a combination of ventriculomegaly and white matter abnormality predicted abnormal motor development with a PPV of 55% (95% CI 23% to 85%)” (Nongena et al., 2010, p.2).

Another study done by T. Debillion, S N’Guyen, A Muet, J C Roze, of Neonatal Intensive care unit, University Hospital, Nanates, France shows the result in the below mentioned table 3, 4 and 5. The main objective was “to compare the accuracy of US and MRI in diagnosing white matter abnormalities in preterm infants and to determine the specific indications for MRI” (Debillon et al., 2003, p.1).“The early Us and MRI findings correlated closely for severe lesions but not for moderate lesions” (Debillon et al., 2003, p.1). “Overall, early MRI findings predicted late MRI findings in 98% of patients (95% CI89.5% to 99.9%) compared with only 68% for early US (95% CI 52.1% to 79.2%)” (Debillon et al., 2003, p.1).

Conclusion

Many different studies regarding both the methods sturdily favor Ultrasound which is highly effective in sensing severe abrasions of white matter in preterm infants, but such studies equally give weightage to MRI that is useful for the diagnosis of less severe damage (Debillon et al., 2003, p.1). If MRI is done within the three weeks of life, it is very effective of the final diagnosis at term (Debillon et al., 2003, p.1).

Though ultrasound seems to be preferred method of imaging for detecting CNS pathology in preterm infants as it is a sensitive matter to detect hemorrhagic lesions and ventriculomegaly, yet current reports support MRI since it can detect a great range of ‘white and gray matter abnormalities’ which are not possible through ultrasound scanning. Some suggest that MRI should be on a routine basis for preterm babies that helps in prognostication (Dunn, 2010, Para 5).

List of References

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.

Introduction

The first experience of Neonatal Intensive Care Unit (NICU) is naturally an overpowering desire to flee. Time seem to pass swiftly. People always in hurry and loud; alarms buzzing, doors slamming frequently and intercoms blaring. Clearly, such environment induces a desire to learn to work in such an environment and care for the susceptible preemie. Incubators containing premature infants born at 28 weeks’ gestation and weighing less than 1000g, is common sight. The sight of the infant in an incubator is contritely moving; visible scratches and cuts. Tape cutting across the infant’s face to fasten an endotracheal tube in place. The right arm fixed to the bed to fasten an intravenous tube in place to mention but a few (Kenner & Lott, 2007).

Neonatal medicine has been used for more than four decades to give specialized and intensive care interventions to promote the health and survival of high-risk and critically ill infants. During this period, significant progresses have been made with respect to fast and accurate diagnoses, useful monitoring, and specific treatment (Carter, 2009). Although the present trend of registering premature infants in the neonatal care affords them an increased level of medical treatment which enhances their chances of survival, it deprives the mothers the opportunity to induce an attachment process (Ahn, Lee, & shin, 2010).

Mother’s involvement in premature infant care is very critical because it enhances rapid adoption to the extrauterine conditions and determines long-term development of the child. Hence this paper will compare interventions in care of premature infants.

Formulas and donors breast milk

Maternal breast milk is the upheld form of enteral nutrition for preemie, although adequate maternal breast milk is not always available. In absence of the mother’s own breast milk for feeding her premature infant, the two popular alternatives available are usually formula milk or donor breast milk. Studies of 8 randomized trials indicate that using formulas enhance short-term growth rates; nevertheless, it increases risks of developing the serious gut abnormality known as necrotizing enterocolitis. Their impact on long-term growth or on development has not been proofed (Quigley, Henderson, Anthony, & McGuire, 2007).

Expressed donor’s breast milk from mothers, who have delivered at term, relatively has a decreased energy and protein content than term formula milk. The nutritional value of donor breast milk can be compromised more by Pasteurization. Moreover, donor breast milk variation in fat, protein and calories constituent is determined by the stage of lactation of its collection. Expressed donor’s milk from the donor’s breast contains increased energy and protein content compared to the contralateral breast (Quigley et al., 2007).

Concerns has been raised regarding the nutritional necessity of premature infants or low birth weight infants, who have comparatively depleted nutrients reserves and are susceptible to metabolic disturbances relative to the term infants, cannot be fully satisfied by enteral feeding using donor mother’s milk. Such inadequacies may have adverse implications for growth and development. Nevertheless, a key putative benefit of human donor milk is in its potential to supply growth and immunoprotective factors to the underdeveloped GIT mucosa which may stop severe adverse consequences, such as invasive infections and necrotising enterocolitis (Quigley et al., 2007).

Role of mothers

The present trend of registering premature infants in the neonatal care affords them an increased level of medical treatment which helps increase their chances of survival. However, this division deprives the mothers the opportunity to induce an attachment process. Thus, some programs such as Kangaroo Programs have been designed to bring back together mothers with their infants in the Neonatal Intensive Care Unit (NICU) (Ahn, Lee, & shin, 2010).

Research conducted by Ahn et al. (2010) have revealed that mothers of premature infants experienced challenges in sustaining the parent’s responsibilities due to the infant’s declined chances of survival, escalated incidence of abnormalities and long-term severance.

Affonso, Bosque, and Wahlberg (1993) argue that treatment in the NICUs can hinder the process of nurturing an optimistic baby’s perception and stimulating the attachment process through reduction on the mother-infant contact period. Nevertheless, based on Shin (2003) frequent parental visits should be checked to reduce incidence of nosocomial disease, physical and environmental barriers, and staff loading.

Noteworthy, mothers’ involvement in premature infant care is both beneficial to both the infant and the mothers as revealed by the Ahn et al., (2010) research. The research indicates that mother’s engagement in care stimulated desirable physiological outcomes including; improved infant stature and head circumferences. Also, mothers who initially indicated moderate level of depression depicted no symptoms of depression after a 3-week attachment period.

Breast feeding

When an infant is enrolled into the neonatal intensive care unit (NICU), parent’s opportunity to engage in their child’s care is usually limited by their newborn’s condition and by the range of technological devices used in the support of NICU patient (Lee, 2008).

Driscoll (2005 cited in Lee 2008) argues that “breastfeeding is a relationship and a method of communication. Breastfeeding success or failure is a personally defined experience that is based on woman’s individual perception and self definition.” This means that a mother’s personal objectives affect her viewpoint of her effectiveness (Lee, 2008).

However, since most preterm newborns are not strong or mature to nourish completely from the breast until they are almost attaining their due date, feeding expressed milk to the infant is more logical initial expectation. Instituting and sustaining a mother’s milk provision with breast pump is more challenging compared to instituting and sustaining provision for a full-term infant. When the preemie finally attains the coordination of breathing consistent with sucking and swallowing necessary for oral feeding, adopting to suck from the breast may in addition be difficult and long process (Lee, 2008).

Benefits of mother’s milk

Premature infants require the immunologic and metabolic advantage of maternal milk. In spite of the limited data from randomized controlled studies, breast milk seems to confer increased protection to preterm infants from morbidity including late-onset sepsis and necrotizing enterocolitis. In addition, they benefit by getting less frequent and/or reduced severity of diseases, lesser incidence of numerous chronic conditions, and perhaps better developmental results (Lee, 2008).

Milk secreted by mothers to premature infant distinguishes in constituent from that of mothers of full term newborns. Preterm milk has more protein and fat and lower lactose, hence more caloric content, than full term milk for no less than the first month following perturbation (Lee, 2008).

Kangaroo Mother Care

Kangaroo Mother Care comprise of three segments. First, it involves the kangaroo position in which premature infants who have acclimatized to the extrauterine conditions and able to breastfeed, are discharged and placed in an upright position against the mother’s chest, with bare skin-to-skin contact. Noteworthy, the kangaroo position has a resemblance property of temperature-regulating function to the incubator.

The mother and the preemie can then be discharged without consideration of the infant’s gestational age or weight. Preemies are sustained consistently in this position the entire day even at night until they express through their behaviors their readiness to leave hospital care; normally at 37 or 38 gestational weeks old. Moreover, other caregivers such as the father and grandparents may switch with the mother as the kangaroo position giver (Tessier et al., 2011).

The second segment involves kangaroo nutrition. In spite of breastfeeding being the core source of nutrition, newborn may also get preterm formula and vitamin additives appropriately. The third segment is clinical management which involves monitoring infants routinely until a weight increase of a minimum of 20 g daily is evident. Subsequently, weekly visits are programmed until term that is 40 weeks’ gestational age, which makes up the ambulatory least neonatal care, (Tessier et al., 2011).

On the other hand, the Traditional Care (TC) intervention involves keeping infants in incubators until they achieve control of their temperature and have the necessary weight gain. They are released based on the recent hospital practice, which is normally until they weigh 1700g. This stage is when intensive care is not necessary any longer, and retention in hospital distinguishes them from their counterparts in the KMC intervention (Tessier et al., 2011).

Challenges of breastfeeding

A previous study indicated that women, who continued to smoke during breastfeeding, depicted a decrease incidence of respiratory infections among their preemies relative to the infants of their smoking counterparts who adopted bottle feeding. The speculation is that smoking and breastfeeding is less harmful to the infant (Kenner & Lott, 2007).

The American Academy of Pediatrics (AAP) has permitted breastfeeding for women using methadone. While there is transfer of methadone into breast milk, studies have estimated that the amount receive by the infant is about 2.8% of the amount consumed by the mother. Certain studies speculate that milk from methadone-treated mothers improve symptoms of neonatal abstinence in preterm infants. Nevertheless, further studies have not substantiated these outcomes (Kenner & Lott, 2007).

When a lactating mother uses alcohol, below 2% of the dose gets into her breast milk. Although alcohol is not reserved in the breast milk, its levels correlate with that in the maternal circulation. Hence, the breast milk will contain alcohol as long as the maternal breast milk carries a considerable amount of alcohol. Siphoning the breasts and disposing the breast milk directly following alcohol consumption does not accelerate the clearance of alcohol. Alcohol will still sustain in the freshly produced breast milk depending on its levels in the circulation. Because no threshold for alcohol’s adverse impact on the developing preterm brain has been determined, the AAP and the American College of Obstetricians and Gynecologist (ACOG) encourages total abstinence through pregnancy (Kenner & Lott, 2007).

Conclusion

Breastfeeding sustenance for premature infants differs across entity NICUs and broader geographic regions. In the United States, maternal attendance in the NICU mainly is limited by the requirements of employment. In either way, it is obvious that premature infants gain approximately as much from breast feeding as full term infants, and that their mothers also benefit. Thus with appropriate support and supervision, it is achievable for care practitioners to support families in addressing the unique challenges of accomplishing such benefits (Lee, 2008).

Reference List

Affonso DD, Bosque E, Wahlberg V, et al., (1993). Reconciliation and healing for Mothers through skin-to-skin contact provided in an American tertiary level intensive care nursery. Neonatal Network, 12:25-32.

Ahn, H. Y., Lee, J. & Shin, H. J. (2010). Kangaroo Care on Premature Infant Growth and Maternal Attachment and Post-partum Depression in South Korea. Journal of tropical pediatrics, 56 (5). 342-344.

Carter, B. S. (2009). Ethical issues in neonatal care. Medscape. Web.

Kenner, C. & Lott, W. (2007). Comprehensive neonatal care an interdisciplinary approach.Westline industrial drive, st Louis; Missouri: Saunders Elsevier Inc.

Lee, K. G. (2008). Breastfeeding and the premature infant. In Brodsky, D., & Ouellette, A. (Eds) Primary care of the premature infant. (pp. 61-69). John F. Kennedy Boulevard Suite, Philadelphia; Saunders Elsevier Inc.

Quigley, M. A, Henderson, G., Anthony, M. Y., & McGuire W. (2007). Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Library.

Shin, Y. H. (2003). Current status of Korean premature infant care and its perspective. J Korean Acad of Child Health Nur, 9, 96-106.

Tessier, R., Cristo, M., Velez, S., Giron, M., Ruiz-Palaez, J. G., Charpak, Y., & Charpak, N. (2011). Kangaroo mother care and the bonding hypothesis. Pediatrics. 102(2). Web.

Introduction

Infant mortality defined as the number of deaths that occur to children, one year old or below per one thousand live births, has been used as an important indicator of a nation’s health status and well-being (DPHP, 2003). Compared to other European nations particularly Sweden, United States’ infant mortality rate has been consistently higher for at least the last three decades. For instance, in 1960 United States was ranked 12^th internationally and later 23^rd in 1988 (Navarro, 2004, p.31). The recent rankings are not any better, with the latest Center for Disease Control and Prevention’s release placing the country at position 30 out of 31 countries from Europe, ranked with statistical average of 6.0 deaths for every 1000 live births (Newell, 2009). This is in line with other statistical showing that one out of eight births in the United States were preterm, a comparatively higher rate as compared to a number of industrialized nations (Newell, 2009).

In stack contrast to the United States is Sweden. In fact, at the turn of 19^th century, Sweden had a consistently lower rate of infant mortality compared to many European counterparts like Germany and Britain, i.e. in 1880s the country experienced 112 per 10000 infant deaths, compared with 228 in Germany and 143 in Great Britain; in the 1920s 60 per 1000 in Sweden, compared with 72 in Britain and 112 in Germany (Navarro, 2004). In 1982, Sweden had the lowest infant mortality rate, considering the fact that both neonatal and postneonatal mortality rates of Sweden were relatively lower (Navarro, 2004). Before in 1960s the neonatal mortality rate of Sweden was substantially reduced and additionally, incidences of low birth weight are significantly lower in Sweden (Newell, 2009). Moreover, the latest rankings (2009) show Sweden as only second to Singapore, with the former having 2.4 deaths in every 1000 births and the latter 2.1 (Newell, 2009). Just to emphasize Sweden’s consistency in their performance, the turn of 19^th century produced an overall infant mortality rate of about 100 per 1000 live births; in 1997 it was about 4 per 1000 (Navarro, 2004, p.31). In fact, it is said that none of the U.S states has reached the level of Sweden in terms of low infant mortality. This paper will highlight the reasons behind the Sweden’s success in the consistent lowering of the infant mortality rate in comparison with the United States; what they do better than United States; and what the United States (as a country) and New York State are doing to lower infant mortality rate to be at per with the likes of Sweden.

Why is Sweden’s rate lower than the United States?

The Swedish experience, which has been well studied, provides quite relevant information on declines in infant mortality. In 1986, a study conducted in the country indicated that the social difference gap is narrowed due to the minimal gap between the highly educated vs. the middle level and low level groups, a complete contrast to the United States where education has been found to discriminate between social groups (Pankhurst, 2005). When the Swedish infant mortality was measured in relation to groups’ sources of death, an obvious social pattern, as measured by length of education, was found for sudden infant death syndrome only (Pankhurst, 2005). However, the sudden infant mortality was found to be preventable, as long as quick measures are taken in terms of seeking healthcare services, in this perspective, it is prudent to state that Sweden’s free healthcare for all has boosted even detection and reduction of sudden infant death syndrome than the United States, who’s healthcare services are not a free-for-all service.

Again, during this period and after, social class in Sweden as measured by length of mother’s education played a major role as a risk factor for all causes of infant death (Pankhurst, 2005). This study also revealed a peculiar scenario where the increased risk for sudden infant death syndrome among infants to mother with short education was substantially related to differences in maternal age, parity, and smoking habits (Pankhurst, 2005). From this study, the authors concluded that it is reasonable to assume that the relatively minor instances of maternal education on infant survival was a consequence of a generally high standard of living; of high medical, technical, and economic development; and of the nationwide, free prenatal and child healthcare system (Pankhurst, 2005). Newell (2009) states that the relatively unfavorable international standing of the United States in terms of infant mortality is largely as a result of the substantial racial disparity in infant survival and associated socioeconomic inequality that have existed in the country for a long period. It is significant to note that substantial differences in infant mortality have been well documented, with various literature highlighting certain important socioeconomic variables such as education as and family income as factors that play their independent roles in the infant mortality rate.

Interestingly, the CDC reported that among the preterm infants born less than 37 weeks into gestation, United States scored much better than the European countries including Sweden (Newell, 2009). However, the concern is mainly in the later stages of gestations, where the mortality rate for infants is generally higher than most of other countries in the same category of industrialized (Newell, 2009). This finding is in line with the other findings by Frey & Field (2000), which indicated that the major cause of high infant mortality rate in the United States is as a result of preterm birth since 12% of the infants are born as preterm. It further illustrate that if United States had the similar distribution of gestational age of birth as Sweden, the cases of infant mortality will drastically reduce by an average of 33% (Frey & Field, 2000). As such it would be logical to state that any effort to prevent preterm births will considerably reduce the infant death incidences in the United States as seen in the Sweden model.

What is Sweden doing to keep their rate low?

Sweden as a country developed a national health insurance programs that are under the government watch, i.e. the program is run by the government with the financial support from the general tax (Navarro, 2004). As earlier stated, all the Swedish citizens have access to primary healthcare system and even the specialized treatment for free or at a relatively low cost (Navarro, 2004). In other words, the country has a universal access to healthcare. In contrast, American citizens do not have an entitlement to such services, despite the fact that the healthcare services has gone under significant changes in terms of cost, access and quality (Shi & Singh, 2009). Shrtell at al. 1996, as cited in Shi & Singh (2009) states that one barrier to the universal healthcare coverage is the unnecessary fragmentation of the U.S. delivery system, which is probably its main feature (p.2).

The government of Sweden has had long term initiative in their healthcare programs with the main aim of reducing the overall health of the people. In essence they identified several multiple factors that affect these parameters such as family characteristics (Social differences) social support system that includes healthcare services (Navarro, 2004).

Several empirical studies have revealed that in Sweden, there is a small gap between the low and high social class, which has decreased considerably throughout the last three decades (Navarro, 2004). There are no social differences regarding availability of and access to healthcare for the mother and the child, i.e. the parental and child healthcare system is available for everyone, and specialized hospitals are also available at no or low cost for those who need special care (Navarro, 2004). The housing conditions are described as generally good, the differences in income have become smaller and there is hardly any real poverty (Navarro, 2004).

Theories and the Infant mortality

The modernization theory states that industrialization increases the chances of infant mortality prevention; that “economic growth fosters improvement in education, housing, nutrition, healthcare, sanitation, and various public services that reduce infant mortality” (Frey & Field, 2000, p.215). It is therefore prudent to state that when an economy improves, the people get encouraged with new form of energy and develops much interest to work; this positivism means healthy mothers parents (especially mothers) and subsequently healthy babies. However, the United States scenario does not seem to comply with this line of argument.

However, one would argue that the theory of gender stratification is more relevant to the United States and Sweden scenarios. In this theory, it is stated that where a female gender is empowered, her role as a mother is empowered too (Frey & Field, 2000, p.217). In this case, education is one of the ways of improving the mother’s ability to care for the newly born child. This is because a mother who is educated will most likely seek healthcare services for her child, and more importantly will be bale to communicate effectively to the healthcare (Frey & Field, 2000). Furthermore, it is said that educated mothers do have higher self-esteem as compared to uneducated mothers, hence boosting their health outcomes as well as that of their babies (Frey & Field, 2000). There is also the theory of economic disarticulation, which states that a country’s disorganization is dependent on the disjointed economy and the uneven development, i.e. social services are not distributed in equal measure and that thus causing unequal economic development and strenuous relationship between the rich and the poor (Frey & Field, 2000)

From the above theories, it can be substantially clarified that a country’s low infant mortality does not depend on its wealth, as illustrated by Sweden whose overall national wealth is far much behind the United States’.

What the United States (as a country) does

Being a multifaceted problem, Infant mortality has brought with it numerous challenges for the United States as whole. Basically, about 201.7 million Americans have private health insurance coverage, 40.3 million are beneficiaries of the Medicare, and 38.3 million are recipient of Medicaid (Shi & Singh, 2009). Even though the said health insurance is available in over 1000 health insurance companies and 70 Blue Cross/Blue Shield plans (Shi & Singh, 2009), it is not sufficient as not everyone is able to afford the cost of buying health insurance. In lieu to this, there are numerous organizations under the managed care sector, i.e. with approximately 405 licensed health maintenance organizations and 925 preferred provider organizations (Shi & Singh, 2009). They are supported by a number of government agencies that are responsible for the financing of the various organizations involved in healthcare services, research as well as regulatory aspects of several of the healthcare delivery system (Shi & Singh, 2009, p.3).

After realizing the importance of community in reducing infant mortality, the government established a public health organization, the Disease Prevention and Human Promotion in target of “Healthy people 2010” (Frey & Field, 2000). It was comprised of diverse groups of specialists including scientists to help improve the quality of life to eliminate disparities, focusing on many areas including maternal, infant, and Child Health (Frey & Field, 2000). This was meant to instill the culture of healthy living among the population. However, so far no significant change has occurred since this initiative kicked off more than 5 years ago considering the fact that infant mortality has remained stagnantly high for almost a decade (Newell, 2009).

This kind of failure has posed a lot of concern to most researchers and the general public alike, prompting some experts to believe that the solution purely lies in the policy issues that will address all aspects of healthcare in a multidimensional aspect rather than the current focus on the health sector alone (Newell, 2009).

New York City and New York State Infant Mortality Rate Reduction Initiative

In an effort to reduce the infant mortality in the New York City and New York State as a whole, the state government introduced a program that they described as “cross-cutting” with a numerous programs through partnership initiatives with the local community (BMIRH, 2009). The central aim of the project was to reduce infant mortality and reduce the racial, ethnic, as well as geographical disparities that have existed for decades (DPHP, 2003; BMIRH, 2009).

According to the statement from the Department of Health Planning Council Cross-Cutting Project, infant mortality was identified as the priority among other cross-cutting issues that required multifaceted approach (BMIRH, 2009). Additionally, the impact of psychological, behavioral, and environmental factors, which have influence on the infant mortality provoked the idea of solving infant mortality through such a program that would be long term based by applying the resources that would be got from different departments, hence maximizing the impact (BMIRH, 2009). According to BMIRH (2009) Central Brooklyn was selected as the community district to launch the pilot project after an extensive data analysis, literature review as well as community resource inventory that was carried out by Infant Mortality Task Force. Its plans are to expand the initiative to encompass communities from New York City suffering from the same effect of infant mortality. The highlighted actions were identified as partnership development and intra-department of health cross-cutting participation (BMIRH, 2009).

Conclusion

The contrast between United States and Sweden in terms of healthcare services and in particular infant mortality has a long historical background. While Sweden’s infant mortality reduction has been above average and improving almost annually since 19^th century, the United States’ case has been a complete contrast, with the rate either increasing or stagnating throughout. This may be attributed to the difference in health and social policies and particularly those touching on the general healthcare and social issues such as poverty and education. That is to say Sweden realized the importance of reducing the gap between the poor and the rich, increasing opportunities to empower its citizens through education and making healthcare services a free-for-all. This is in stack contrast to the United States which has basically faltered in its policy issues coupled with the historically wide gap between the rich and the poor.

Reference List

Disease Prevention and Health Promotion (DPHP). (2003). Healthy People. Web.

Frey, S. R. & Field C. (2000). The Determinants of Infant Mortality in the Less Developed Countries: A Cross-National Test of Five Theories. Social Indicators Research 52: 215-234. Netherlands: Kluwer Academic Publishers.

Navarro, V. (2004). The Political and Social Context of Health. New York: Sage Publishers.

Newell, J. (2009). Infant Mortality Rates: U.S. Ranks Poorly Among Industrialized Nations. Web.

New York City Department of Health and Mental Hygiene (BMIRH). (2009). Infant Mortality Reduction Initiative. Web.

Pankhurst, C. (2005). Infant Mortality: Public Health Management and Policy. Cleveland: Bolton School of Nursing.

Shi, L. & Singh D. (2009). Essentials of the U.S. Health Care System, 2nd edition. Sudbury, MA: Jones and Bartlett Publishes.

Academy of breastfeeding in medicine protocol. (2008). Guideline on co-sleeping and breastfeeding. Washington, DC: Academy of breastfeeding Medicine

According to this article, several studies have shown a noteworthy link between breastfeeding and a lowered sudden infant death syndrome risk, mainly when breastfeeding was the restricted form of feeding during the first four months of living. This article states that there is inadequate evidence to show an informal link between breastfeeding and the prevention of the syndrome. There is an increased risk of the syndrome when babies share beds with mothers who smoke cigarettes.

Horne, R, Parslow, P, Ferens, D, Watts, A and Adamson, T. (2010). Comparison of evoked arousability in breast and formula fed infants. Web.

According to this article, there is no dependable confirmation that breastfeeding decreases the threat of sudden infant death syndrome (SIDS). This article gives proof that breast-fed babies are more readily awakened from active sleep than formula-fed babies at the period when this syndrome’s risk is at the maximum.

International Lactation Consultant Association (2005) Journal of Human Lactation. Newbury Park, CA: Sage Publications. Web.

This article states that, breastfeeding and the use of pacifiers have been equally linked with a decreased risk of sudden infant death syndrome. The journal states that even though the protective connection between breastfeeding and SIDS has not been regular as there are several healths, cognitive, mental, social and cost-effective benefits of breastfeeding.

Joanna Briggs Institute. (2006). Early childhood pacifier use in relation to breastfeeding, SIDS, infection and dental malocclusion. Web.

According to this article, pacifier use in babies has been mixed up, and viewed as a barrier to breastfeeding for some time, leading to incomplete rather than a lot of breastfeeding or a shorter period. This article finds out that it is credible that pacifier use in babies causes infants to breastfeed in a smaller amount because the pacifier fulfills the instinctive sucking reflex of the infant, thus eradicating the yearning for contact with the nipple and breast. This article states that the proof for a connection between pacifier use and a decline in risk for the syndrome is trustworthy, while the precise method of the effect is not well comprehended.

McKenna, J, Mosko, S and Richard, C. (1997). Bedsharing promotes breastfeeding. Elk Grove Village, Illinois: American Academy of Pediatrics. Web.

This article talks about bed-sharing babies’, breastfed around three times longer during the night than babies who regularly slept separately. These authors of this article suggest that bed-sharing might be protecting against SIDS at least in some circumstances.

Moon, R, Kington, M, Oden, R, Iglesias, J and Hauck, F. (2007). Physical recommendations regarding SIDS Risk Reduction: A National Survey of Pediatricians and family physicians and family physicians. Newbury Park: Sage Publications. Web.

This article states that sleep positions play a major role in the syndrome and they recommend babies to change from horizontal to supine sleeping as this has been proved to reduce the syndrome effectively. Dependable with these authors’ perceptions, bed-sharing facilitates breastfeeding however growing proof contradicts this, as there is a bigger risk of sudden unexpected death in babies in bed-sharing circumstances

New England Medical Centre Evidence-Based Practice Centre. (2007) Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services.

This article talks about the history of breastfeeding and that it is linked with a reduced risk of SIDS in babies in developed countries. This article also states that it is the chief reason for demise in infants of the age between two months and four months of living. The authors of this article suggest that a lot of breastfeeding as well as placing the babies on their backs when sleeping plays a major role in reducing the risk of babies getting sudden infant death syndrome.

Reite, M, Weissberg, M and Ruddy, J. (2008). Clinical manual for evaluation and treatment of sleep disorders. Arlington, VA: American Psychiatric Publishers. Web.

According to this article, during the last twenty years, the avoidance fight to reduce the danger of unexpected baby deaths disorder was very triumphant. This article talks about the German Study of sudden infant death, which was a case power study of 333 babies who perished from sudden infant death syndrome. This article looked to observe the connection between the kind of baby nourishment and sudden infant death syndrome of these 337 babies with 999 time-matched controls (Reite et al, 2008). An overall of 55% of cases and 80% of cases were breastfed at two weeks of age (Horne et al, 2005). A lot of breastfeeding during one month of age also reduced the threat of the sudden infant death syndrome, but after adjustment, this risk was not major (International Lactation Consultant Association, 2005). Being breastfed a lot in the last one month of life before the discussion reduced the menace of the syndrome, as did being moderately breastfed. Breastfeeding survival curves showed that both fractional breastfeeding and a lot of breastfeeding were related to a condensed threat of Sudden infant death syndrome (Reite et al, 2008). This book states that the study shows that breastfeeding condensed the threat of this condition by around 55% at all times throughout babyhood and for as long as the baby is breastfed. This book highlights that the allegation of their findings is that breastfeeding should keep on until the baby is six months old as the threat of the condition is low by that stage. This book therefore advocates including the recommendation to breastfeed through a period of six months in this condition as it lessens the threat of the syndrome occurring.

Stuebe, A. (2009). The Risks of not breastfeeding for mothers and infants. Chapel Hill, NC: University of North Carolina

According to this article, for babies, not being breastfed is related to an increased prevalence of infectious morbidity, together with otitis media, gastroenteritis, pneumonia and sudden infant death syndrome. Amid premature babies, not getting breast milk is connected with an increased risk of necrotizing enterocolitis.

Vennemann, M, Bajanowski, T, Brinkmann, G, Jorch, K, Yucesan, C, Sauerland, E, Mitchel, A and GeSID Study Group. (2009)Does breastfeeding reduce the risk of sudden infant death syndrome? Elk Grove Village, Illinois: American Academy of Pediatrics. Web.

This article states that the sudden infant syndrome is a significant health problem as it is the principal reason for baby fatalities in the developed world. The factors include; smoking cigarettes while being pregnant, resting while face down and sharing a bed with an older place. In studies conducted by these authors who have stated them in this book, they conclude that breastfeeding also lowered the risk of babies contracting the syndrome considerably. However, this article states that it is not known for sure if the probable “defensive” features of breastfeeding are restricted to a lot of breastfeeding or if a little breastfeeding is adequate to minimize the risk of sudden infant syndrome. These authors state that any type of breastfeeding, whether a lot or little was linked with a 58% reduction in the risk of the syndrome. Additionally, they state that a lot of breastfeeding was linked with a risk reduction of 48%. They also state that a lot of breastfeeding did not appear to provide considerably added advantage from being breastfed a little. These authors conclude that it is the total lack of breastfeeding, which posed a major risk to a baby getting the sudden infant death syndrome. This article also states that baby sleep studies have illustrated that breastfed babies are more easily awakened than formula-fed babies, which may be a substitute method for the protective effect of breastfeeding against sudden infant death syndrome. The authors of this article also suggest that breastfeeding should be continued until the baby is 6 months old when the risk of the syndrome is low.

In 2004, the Health Department created a citywide health policy called ‘Take Care New York (TCNY)’ to help improve the health of New Yorker residents (New York City Department of Health and Mental Hygiene, 2012). The department established 10 areas of focus, which they noted to be important factors in the increase of illnesses. These reports analyze how the community in Southeast Queens is doing to achieve its health goals. In this case, nine out ten are graded average and above average respectively. However, “having a healthy baby” is an important goal, but it falls under the “below average” category. Thus, this health problem in the community was motivated me to focus on “Maternal, Infant, and Child Health” as my health topic area from the Healthy People 2020 program. Pregnant women in the Southeast Queens region receive late or no prenatal care, which means that the community fails on this aspect of health as a whole (NYC DOH, 2010). Low birth weight and infant mortality are higher in Community District 13 than in any other region of New York City. I concluded that the primary causes of low health grades on “Healthy Baby” are the lack of prenatal and pregnancy education.

Women with education beyond a high school degree had a lower infant mortality rate (4.0) than high school graduates (5.1) or those who have not completed high school (6.5) (New York City Department of Health and Mental Hygiene, 2011.) Queens Village has the third highest count of infant mortality rate in the Queens County. The leading cause of infant death is birth defects, followed by short gestation and low birth weight, cardiovascular disorders, while the highest cause of death in the neonatal period is short gestation and low birth weight (NYC department of health, 2012)

Going back to the ethnicity and demographics section of this essay, the dominant ethnic groups are the African-Americans, which constitute 71% of the community population. According to the New York City Department of Health and Mental Hygiene (2011), African American women consistently had the highest percentage of low-birth weight infants (12.9% in 2009), and whites had the lowest (7.2% in 2009) (Hamilton, Martin & Ventura, 2010).

As stated earlier, there is the only hospital in the community and the location is inconvenient for many expectant mothers. However, neighboring hospitals also offer prenatal health at a low cost or free of charge. However, a good number of women in the area actually fail to take advantage of this for a number of social, economic and personality reasons. For instance, it is noteworthy that some women fail to attend postnatal care within their neighborhoods to avoid their friends, neighbors and other people who know them noting their conditions. This is especially common among pregnant adolescent girls who feel embarrassed by their conditions and would like to remain out of sight of their friends and neighbors.

Secondly, some women would like to attend prenatal programs in the hospitals of their choice, especially where their friends, family members of spouses recommend them to attend. Others would like to visit prenatal care from the hospitals recommended by their doctors, workmates or the tradition of their places of work. According to the Department of Health and Mental Hygiene (2010), two programs are being offered for prenatal care: “Nurse-Family Partnership” and “Prenatal Care Assistance Program (PCAP).” In Nurse Family Partnership, a trained nurse specializing in Women’s Health will visit the pregnant patient at home and will do a follow-up until the child reaches 2 years old. This program is free of charge, and women would only need to apply for this program when they are under the prenatal care program. For a woman to qualify for this program, she will be supposed to be confirmed for pregnancy at least two weeks after conception before being followed up throughout pregnancy. Secondly, membership will be based on their won consent and any woman who do not consent will have her decision respected accordingly. A woman who consents and applies for the program will undergo specialized training in a group, where discussions among the women and their nurses will be a fundamental task.

Prenatal Care Assistance Program provides prenatal care for teens and adult women who live in New York City and meet the income bracket (NYC dept. of mental hygiene). In addition, the department of social services offers “Prenatal Care Services through Medicaid.” Under this program, they offer an array of services such as HIV tests, nutritional screening, and post-pregnancy care two months after two months and babies receive pediatric care at least a year after birth.

Since the government has available programs focusing on prenatal care, they should be creating more awareness and announcing it publicly. They should make posters, place a booth in public places and give out flyers on how to obtain medical assistance on prenatal care and the importance of folic acid, especially on women of childbearing age. I would also propose a tie-up commitment between the hospital and the health system. Here, healthy people, 2020 suggests that “Regular and reliable access to health services can prevent disease and disability, detect and treat illnesses or other health conditions, increase the quality of life, reduce the likelihood of premature (early) death and Increase life expectancy” (Healthy People 2020, 2012). Individuals, especially teens, should seek help when they suspect pregnancy. They have the option of seeking help from their family or within the available health clinics. Pregnancy should not be hidden from parents even if they are scared of the consequences the parents will give them.

These Individuals are not only responsible for themselves but also for the life that is growing within them. The Family of the pregnant woman should be supportive and understanding about the situation. Whether the pregnancy is planned or unplanned, they should support the pregnant family member because it is not easy to go through pregnancy alone. Educational facilities should expand their sex education on not only sexually transmitted diseases but also unexpected pregnancy and how to care for the baby in the womb.

References

Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2010). Births: Preliminary data for 2010. National Vital Statistics Reports, 58(16), 4-16.

Healthy People. (2012). Access to Health Services. New York: NYCDH

New York City department of health and mental hygiene. (2012). Take Care New York 2012: A Policy for a Healthier New York City. New York: NYCDH

Introduction

As neonatal intensive care improves, the likelihood of a baby delivered preterm surviving increases. Babies born preterm are at a higher risk of experiencing delays in cognitive development. Ensuring that these babies are cared for and grow in a safe environment that accounts for their unique issues, therefore, is critical. Public and professional perception of delays in cognitive delays can be negative, putting such babies at risk of worse treatment, which can ultimately lead to negative outcomes. Measures to address this issue, such as the introduction of new information programs, professional training, or policy changes, can be implemented. However, before they can be developed, research into the prevailing attitudes is necessary.

Two critical vectors of research are the attitudes towards developmental delays in a baby’s cognitive abilities of medical care professionals and parents. The former is responsible for formulating care strategies and treatment of their patients. Their attitude can also influence the critical information about caring for the baby and facilitating its development they can impart to the baby’s parents. The parents, meanwhile, provide crucial care for the baby at home, whose quality can be significantly diminished by a negative attitude. Ultimately, the views of both the parents and professionals are critical, and a clearer understanding of these views can help inform future practices related to preterm babies and their risks of developmental delays.

Overview of the Article

The article, “A journey through follow‐up for neurodevelopmentally at‐risk infants—A qualitative study on views of parents and professionals in Liverpool” was published in the Child: Care, Health and Development, volume 45, issue 6. Its first publication date is July 22, 2019. The authors of the article are Ayuko Komoriyama, Fauzia Paize, Esme Littlefair, Chris Dewhurst, and Melissa Gladstone. The purpose of the study is described as “to explore where, how and who parents get their information from regarding development and future outcomes for their infants” (Komoriyama, et al., 2019, p. 808). The study used in-depth interviews conducted with patients and health care professionals to assess their views and subjective perceptions on the subject. Purposive sampling was used to recruit both patients and professionals; specific criteria were preferred among parents, such as age, fluency in English, and age of the baby (Komoriyama, et al., 2019). As the study was conducted in the Merseyside county in the UK, it attracted a limited sample size.

The study relied on the theoretical framework of interpretative subjectivism. Under this theory, the researchers focused on their respondents’ different worldviews and perceptions of reality (Komoriyama, et al., 2019). The consolidated criteria for reporting qualitative research (COREQ) was followed (Komoriyama, et al., 2019). The researchers then identified three major themes in the recorded interviews, described as “what’s the future?”, “what’s the journey?” and “Who can help me?” (Komoriyama, et. al., 2019). These themes outline the general concerns of parents and professionals related to babies at risk of delays in cognitive development.

Research Design and Methodology

The study by Komoriyama, et al. contributes to the growing field of research into the relationships between health care professionals and patients. Additionally, it reflects the medical community’s increased interest in patient perceptions of health care and the search for methods that can support and empower patients as the recognition of their role in health care increases. The authors of the study point out that although the importance of providing information about caring for their child post-discharge is acknowledged, the specifics of what information should be provided and how it should be provided is underexplored (Komoriyama, et al., 2019). As such, the results of this study can be applied to develop guidelines detailing this instructional process.

In-depth reviews are generally a reliable way to collect subjective information, such as opinions, attitudes, and views. The study recruited 27 parents and 11 health care professionals in a single UK county; the limited sample size and geographical restrictions made conducting these interviews feasible and realistic (Komoriyama, et al., 2019). However, the same limitations negatively affect the study’s validity and generalizability. As the study’s research question concerns views and attitudes, in-depth interviews can be used to reveal these things directly and, as such, directly answer the research question. The inherent subjectivity of the respondents’ answers is an issue with interviews in general, as their understanding of the issue is likely to be different from that of the researcher, creating a significant limitation for the method. Thus, the validity and generalizability of the study are questionable, and although the authors acknowledge that external factors such as the baby’s age can influence the parents’ view, they do not explain whether they controlled for these factors.

Another issue is the usage of fluency in English as a criterion for inclusion in the study. The authors claim this allows to “minimize misunderstandings and miscommunication” (Komoriyama, et. al., 2019, p. 810). However, this can be seen as the exclusion of ethnocultural minorities, which can be viewed as contradictory to the tri-council guidelines’ core principle of justice. Moreover, this further limits the study’s generalizability as its results may be less applicable to populations who are not as fluent in the dominant culture’s language.

Interpretation of Findings

The research did not attempt to find correlations or causation, only identified themes in patients’ and professionals’ views. The provided interpretation points to an overall lack of information provided to parents, particularly about the long-term prospects of their child’s development; no alternative interpretations are offered. The generalizability of the research findings is not explained, but as described above, it is questionable: the limited sample size and geographic area make the research less applicable outside of a specific subset of the UK’s health care system.

Clarity

The article reflects the increased interest in the social side of health care and similar qualitative research in this field. However, the information presented in it is not always clear; as mentioned above, critical concerns about the validity and generalizability of the research are not addressed. While the authors identify three themes, they do not mention how prevalent they are or whether they correlate with factors such as the respondent’s age. Furthermore, the quotations are organized in an unclear way; the labeling system is unexplained. Thus, the information in the article is not presented in sufficient detail and clarity, and its findings are inherently subjective.

Conclusion

Overall, the study is attempting to answer an important question in health care practice. However, its interpretation is limited and, as such, presents limited value besides identifying potential areas of improvement in neonatal care. This information, by itself, is not sufficient to inform policy or guidelines and is further hampered by its limited scope. It can, however, guide and direct future research in the field by identifying areas of concern and helping to formulate more specific research questions. Ultimately, it is an initial examination of an issue whose value is in providing direction for potential future research rather than any direct practical applicability or advancement of theory.

Reference

Komoriyama, A., Paize, F., Littlefair, E., Dewhurst, C., & Gladstone, M. (2019). A journey through follow‐up for neurodevelopmentally at‐risk infants—A qualitative study on views of parents and professionals in Liverpool. Child: Care, Health and Development, 45(6), 808-814. Web.