Poster group
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poster
The rate of exclusive breastfeeding in Taiwan has declined between 1954 and 1996 from 94% (Huang, 1990) to 5.8% (Department of Health of Taiwan, 1998), and infant mortality rate remains high (6.35/1000 live births) (Department of Health of Taiwan, 1998). At the same time, urbanization, hospital birth, nursery-based infant care, and bottlefeeding have increased. In general, the mother and infant are separated following delivery, and thereafter the infant is usually in the nursery. Bottlefeeding is common for numerous reasons. Separation of mothers from their infants may undermine breastfeeding and cause anxiety for mothers who choose to breastfeed. This is unfortunate because breastfed infants are healthier than bottlefed infants, if the breastfeeding experience is managed well. Mothers may breastfeed more successfully if they have more contact with their infants. Contact increases milk volume and stimulates the letdown reflex; suckling stimulates prolactin production, a hormone known to promote lactogenesis. The closest contact occurs when mothers are giving skin-to-skin (kangaroo) care because they hold their diaper-clad infants underneath their clothing skin-to-skin and allow self-regulatory breastfeeding. The purpose of this randomized controlled trial was to investigate the effects of kangaroo care (KC) on maternal anxiety, breastmilk maturation, breast engorgement, and breastfeeding status. This research was based on Roy's Adaptation Model of Nursing and Anderson's Mutual Caregiving Model. Healthy mothers and their fullterm infants were randomly assigned within four hours after delivery to standard nursery care (n 29) or kangaroo care (n 29). Control dyads received routine nursery care. KC dyads were assisted in providing early KC on the postpartum ward for eight hours on Days 1, 2, and 3. Mothers who received KC had more frequent mother-infant contact on Days 1, 2, and 3 (p < .001). Hypothesis testing was done using repeated measures analysis for variance and Mantel-Haenszel Chi-Square test. Findings were that mothers who received KC had less maternal state anxiety (F (2, 108) 5.0, p .007), less breast engorgement (F (5, 270) 6.4, p .000 for chest circumference; F (5, 270) 2.8, p .016 for Six-Point Breast Engorgement Scale), and better breastfeeding status (F (2, 108) 15.0, p .000). No significant difference was found in breastmilk maturation between the two groups (p > .05). These findings can be used to further develop and refine the knowledge of mutual caregiving and maternal adaptation postbirth.
poster
Human milk is generally acknowledged as optimal nutrition for infants. Thus, it is important to encourage women to breastfeed, breastfeed more exclusively, and breastfeed longer. In 1954 in Taiwan, 94.3% of mothers breastfed and most breastfed exclusively. In 1996, only 39.8% of mothers breastfed and only 5.8% breastfed exclusively (Department of Health of Taiwan, 1998). If mothers and infants can remain together after birth, this may facilitate the establishment of lactation and thus the breastfeeding process. However, mother-infant separation is standard practice in most Taiwanese hospitals. Kangaroo care (KC), which is known to decrease engorgement and anxiety (Shiau, 1997) and increase milk volume (Bier, 1996), may be an effective way to avoid mother-infant separation postbirth as well as encourage mothers to breastfeed their infants more exclusively and longer. This randomized controlled trial (RCT) was done to test the effects of KC on breastfeeding status and duration in mother-fullterm infant dyads from Day 3 postbirth to one year. Fifty-eight eligible and consenting mothers who wanted to breastfeed were randomly assigned to the KC group or control group using computerized minimization (Conlon & Anderson, 1990; Zeller, Good, Anderson & Zeller, 1997). Beginning within 4 hours postbirth, dyads in the KC group provided KC 8 hours daily for three consecutive days. Control dyads received standard care with no rooming-in. The Index of Breastfeeding Status (the IBS) was used to measure breastfeeding status. The IBS was developed by representatives from UNICEF, WHO, and other breastfeeding agencies to measure breastfeeding more accurately and consistently worldwide (Labbok & Krasovec, 1990). Follow-up phone calls were made on Days 7, 14, 28, 42, 90, 180, and 365 after delivery to collect the data. The hypotheses were that KC dyads would breastfeed more exclusively and longer. The final sample consisted of 52 dyads and was balanced on important prognostic variables. Six mothers were withdrew because loss of contact. Findings were that (1) KC dyads began to have better breastfeeding status than control dyads by Day 28 (6.16 ± 2.06 vs. 4.0 ± 1.60, p .004). (2) KC dyads breastfed longer (91.1 ± 126.6 days vs. 24.8 ± 21.1 days, p .011). (3) More KC dyads were still breastfeeding at one year (4 vs. 0). We conclude that, for this sample, KC beginning within 4 hours postbirth and given 8 hours on each of Days 0, 1, and 2 had positive effects on breastfeeding status.
poster
In an earlier experiment with newborns separated from their mothers atbirth, the first author documented that lambs given self-regulatorynonnutritive sucking had large numbers of radioactive labeled microspheresin their kidneys compared to control lambs. This finding indicates thatnonnutritive sucking, which has a generalized vagal effect, improvesvascular perfusion. Optimal functioning for preterm infants followingbirth depends on generalized effects as well. One objective of this 4-yearrandomized controlled trial in progress (N3D100) is to investigate theeffect of early kangaroo care (EKC) on toe temperature (TT) as a possibleindex of generalized vascular perfusion in non-ventilated 32-36 weekpreterm infants. All 100 dyads will be enrolled by March 2000 and will beincluded in the ISIS presentation. For this report, we studied a subsample(n3D31 dyads) during the first holding (EKC or control). Randomization wasdone by minimization. EKC mothers held their diaper-clad infants upright, chest-to-chest, andskin-to-skin between their breasts; control infants were wrapped in 1-2blankets and held at the parent's request (standard care). TT was measuredusing a skin sensor (Yellow Springs Instruments) with a protective coverplaced on the ventral surface at the base of each infant's right toe andconnected to an electronic monitor (Space Labs). Informed consent wasobtained during early labor. EKC began as soon as possible after birth andoccurred as often and for as long as possible during the first five dayspostbirth. Control infants were wrapped and held at the parent's request(standard care). TT was measured continuously by monitor. During thefirst 6 hours postbirth, TT was also recorded from the monitor every 15minutes concurrently with quality of contact using the MICS (amother-infant scoring system). Recording time was objectively determinedby a preset electronic timer. Single and two to 10 consecutive 15-minuteperiods of EKC or holding were used in the analysis. Three consecutiveperiods just before EKC or holding and three consecutive periods just afterwere used for the pretest and posttest analyses. For pretest, test/control, posttest periods, mean TT was 31.2, 32.8, and33.0 B0C for EKC infants and 32.4, 32.1, and 32.0 B0C for controls. Longerperiods of EKC yielded greater increases in TT; longer periods of wrappedholding yielded greater decreases. No normative data are available forpreterm infant TT during maternal EKC Hours 0-6 postbirth. Conclusions aretentative due to small sample size. Mean TT increased during and after EKCand decreased during wrapped holding in control infants, suggesting thatEKC is safe for similar infants. Perhaps warmer TT in the EKC group onlyreflects heat from the mother's current or recent presence. Conceivably,however, 1) TT and generalized vascular perfusion of internal organs (e.g.,the lungs, liver, gut, brain) are positively correlated, and 2) higher TTin the posttest period for EKC infants reflects stimulation ofthermoregulatory processes by ECK. These possibilities suggest hypothesesfor future testing.
poster
Preterm infants are routinely placed in incubators immediately after birth in Taiwan. Mothers can be with their infants only during scheduled visitingtimes in the nursery. However, some health professionals propose that infants are atincreased physiological and developmental risk if on-cue self-regulatory access totheir mothers is not provided. Kangaroo (skin-to-skin) care may be nurturing formedically stable, lower-risk preterm infants because it supports their efforts towardself-regulation and competent functioning (Anderson, 1999). This randomized controlled trialwas done to test the hypotheses that infants given kangaroo care (KC) would havehigher tympanic core temperature, less weight loss, more optimal behavioral state,and lower acuity. Thirty-four healthy preterm infants and their mothers were selected fromChung Gung Memorial Hospital in Taiwan. Maternal inclusion criteria were nopre-existing medical problems, willingness to breastfeed, and no problems that wouldkeep the mother from the nursery. Infant inclusion criteria were 34-36 completed weeks gestation, 5-minute Apgar score ? 7, stable respirations, and admission tothe normal newborn or observation nursery. Eligible dyads were recruited after birth (Day 0). On Day 1 they wererandomly assigned by minimization just before the first study feeding to the control(n 3D 17) or KC group (n 3D 17). Stratification variables were gender, birth weight,delivery method, and parity. On Days 1 and 2, control infants wore a shirt anddiaper, were wrapped in a blanket, and held by their mothers for one hour, three times aday at scheduled feeding times; KC infants wore a diaper and were held uprightskin-to-skin on their mothers' chest except during breastfeeding. Hypothesis testing was done using repeated measures analysis of variance and independent sample t-tests. KC infants compared to control infants hadhigher mean tympanic temperature (37.3 ?C vs. 37.0 ?C), more quiet sleep (62% vs. 22%),more inactive awake behavior (14% vs. 7%), less drowsiness (2% vs. 15%), andless crying (2% vs. 6%) all at p 3D .000. No significant difference was found for weightloss and acuity (length of hospital stay). These findings can be used for evidence-based nursing practice in Taiwan.This is the first randomized controlled trial to provide information about the effectof early KC on tympanic temperature, weight loss, behavioral state, and acuity for34-36 week gestation preterm infants in Taiwan. KC as given in this study is a safeintervention.
poster
Many studies report an increase in premature infant quiet sleep when heldskin-to-skin by their mothers (Kangaroo Care or KC) compared to when experiencing incubator case (IC), based on behavioral observations that are subject to observer bias and recording error. To objectively determine if sleep changes occurred during KC, electrophysiologic recording was conducted during three hours each of IC and KC on one day of study. METHOD: A convenience sampleof 14 subjects was obtained to determine effect size for a clinical trial. Medically stable premature infants of 32 weeks ( 4 days postconceptional age, mean gestational age 29 weeks (SD2.12), mean birthweight 1019 grams(SD230gms) were studied over one year. All infants were in the transitional nurseryof a tertiary hospital's neonatal intensive care unit in which the mean soundlevel was 82 dB (SD10.20) and mean lighting level was 18 Lux (SD2.50)throughout IC and KC. IC and KC began when feedings were complete. In IC the infant was prone, nested, and at 40 degree inclined position in a hooded OHIO ICincubator. For KC the infant was positioned chest-to-chest, skin-to-skin betweenmaternal breasts as the mother reclined at a 40 degree incline in a stationarylounger at incubator side. Grass gold 7 mm electrodes were attached to infants 30minutes before testing for calibration and warm-up. Electroencephalogram (EEG) was obtained over O2 and C4 points, electromyogram by two submental electrodes, electrooculogram by outer canthus electrodes for each eye, and respiratory waveform by strain-gauge (Grass). EEG, EOG, EMG, and respiratory waveformwere recorded using the Grass K2GR polygraph with Model 12 Neurodata Acquisition system (Astromed-Grass). Thermal paper ran at 30 mm/s for 5 minutesfollowed by one minute at 10 mm/s speed to capture delta brushes. Infant yawning, body movement, eyes open or closed, crying and visible rapid eye movements were recorded by EEG technician. Tracings were read and scored on aminute-by-minute basis by one neurologist who specialized in neonatal polysomnographic interpretation and who was blind to period. Outcome measures were thenumber of epochs of Quiet Sleep, Active Sleep, Indeterminate Sleep, number of Delta Brushes, and Total Sleep Time. Sleep states were determined by 3 of 5criteria (EOG, EMG, EEG, Respiratory patterns, and behavior) being met for eachstate. Delta brushes were delta waves of .3-1.5 Hz with superimposed fast activityin the beta range. Analyses are based on repeated observations for eachsubject; linear, logistic, or Poisson regression analyses will be reported. RESULTS: Descriptive data from 10 subjects show: Quiet Sleep episodesnearly double (IC M23 [SD11] vs. KC M38 [12]), Active Sleep drops (IC M58 [SD21.7], KC M26 [SD14.5], Indeterminate Sleep does not change, and Delta Brushes increase (IC M9 [SD6.2], KC M12 [SD8.7]) during KC, suggestingthat sleep patterns do change and intensification of sleep may be occurring when infants are held by their mothers.