Neonatal Network
May/June 2008
Vol. 27, No. 3

ABSTRACTS

Kangaroo Care and Breastfeeding of Mother-Preterm Infant Dyads 0-18 Months:
A Randomized, Controlled Trial
Sara J. Hake-Brooks, ND, MSN, CNM
Gene Cranston Anderson, PhD, RN, FAAN

Purpose: To determine the effects of kangaroo care (KC) (skin-to-skin contact) on breastfeeding status in mother–preterm infant dyads from postpartum through 18 months.Design: Randomized, controlled trial. The control group received standard nursery care; in the intervention group, unlimited KC was encouraged. Sample: A subsample of 66 mothers and their preterm infants (32–36 completed weeks gestation, 1,300–3,000 g, 5 minute Apgar =6) who intended to breastfeed.Main Outcome Variables: Breastfeeding status at hospital discharge and at 1.5, 3, 6, 12, and 18 months as measured by the Index of Breastfeeding Status.Results: KC dyads, compared to control dyads, breastfed significantly longer (5.08 months vs 2.05 months), p = .003. KC dyads also breastfed more exclusively at each measurement, p = .047. More KC dyads than control dyads breastfed at full exclusivity (100 percent breast milk, index of breastfeeding status levels 1 or 2) at discharge and at 1.5, 3, and 6 months. Mean KC contact per day was 4.47 hours.

A Model Program: Neonatal Nurse Practitioners Providing Community
Health Care for High-Risk Infants
Elias Provencio Vasquez, PhD, NNP, FAAN, FAANP
Kathleen Pitts, MSN, MPH, CPNP, NNP
Nilson Enrique Mejia, RN, MSN, FNP

Perinatal drug exposure costs our communities millions of dollars each year in hospital fees and in services such as foster care, child protection, and drug treatment. Infants and their families in this group require substantial long-term health care and community resources. Neonatal health care providers should take an active role in developing and implementing home visitation programs to support early hospital discharge and continuity of care for these high-risk infants and their families. Neonatal nurse practitioners should prepare in the future to practice not only in secondary- and tertiary-level neonatal centers, but also in follow-up clinics, long-term developmental centers, and the community. This article describes a home intervention program delivered by neonatal nurse practitioners for high-risk infants and their mothers. The target population is infants exposed prenatally to drugs and/or alcohol.

The Importance of Quiet in the Home: Teaching Noise Awareness to Parents
Before the Infant is Discharged from the NICU
Lisa Goines, RNC

Research over several decades describes various adverse health effects of noise on the hospitalized neonate. Noise is a direct cause of long-lasting auditory problems and a significant cause of cardiovascular and respiratory problems and neurologic impairment. Many hospitals have turned the NICU into a quiet environment that promotes the neonate’s health and well-being. But auditory pathways continue to develop during the neonatal period, reaching maturation at 12 months and beyond. Some of this development thus occurs after the neonate is discharged from the hospital. It is a responsibility of NICU professionals to teach families about the health benefits of noise modulation and planned quiet in the home environment. This teaching may make a world of difference to the continued healthy growth, development, and well-being of the infant.

Extrauterine Growth Restriction: A Review of the Literature
Valerie A. Ruth, PhD, NNP

extrauterine growth restriction (eUgR) is a common condition in very low birth weight (vLBW) preterm infants (=1,500 g). Most affected infants have a birth weight that is average for gestational age, but by the time of hospital discharge have a weight that is less than the tenth percentile for corrected gestational age. eUgR is the most frequent morbidity among vLBW survivors at their time of discharge from the hospital. Studies to elucidate the causes of eUgR have been inconclusive. Recent research has found an association between eUgR, developmental outcomes, and long-term morbidity. Low birth weight has also been associated with chronic diseases later in life. These findings emphasize the critical nature of understanding the phenomenon of eUgR and ways it can be prevented.

Sacrococcygeal Teratoma in the Newborn: A Case Study of
Prenatal Management and Clinical Intervention
Kara M. Fadler, RNC, NNP
Debbie Fraser Askin, MN, RNC

Sacrococcygeal teratomas (SCTs) are the most common germinal cell neoplasms of the fetus and neonate. They originate during embryonic development when the primitive streak fails to differentiate among mesodermal, ectodermal, and endodermal tissues in the embryonic disc. This article discusses the fetal pathophysiology of SCTs and the impact of the condition on the newborn. fetal SCTs can have life-threatening physiologic effects—such as premature labor, dystocia, and high-output cardiac failure—if not managed appropriately. Clinical manifestations, prenatal diagnosis, therapeutic approaches and treatment options for the fetus and newborn, and current research related to SCTs are addressed to aid practitioners caring for a fetus or infant diagnosed with an SCT.