Objectives:Parents of infants with CHDs experience increased parenting stress compared to the gen... more Objectives:Parents of infants with CHDs experience increased parenting stress compared to the general population, potentially interfering with parenting practices and bear adverse family outcomes. The changes in stress over the critical period of infancy have yet to be studied. The current study aimed to compare parenting stress changes over time between parents of infants with CHDs and parents of healthy infants during the first year of infants’ life.Methods:Data from a larger prospective cohort study were longitudinally analysed using mixed-effects multivariable regression modelling. Sample included mothers of 129 infants with complex cardiac defects and healthy infants, recruited from the cardiac ICU of a large cardiac centre and outpatient paediatric practices in Northeastern America. Outcome was measured over four visits via the Parenting Stress Index Long Form.Results:Stress in the cardiac group has significantly decreased over time on the Parent Domain (p = 0.025), and stress...
Background: Premature infants may experience increased difficulty with nutrition and growth. Succ... more Background: Premature infants may experience increased difficulty with nutrition and growth. Successful oral feeding is an important factor associated with discharge readiness. Despite the importance of feeding as a growth-fostering process, little empiric evidence exists to guide recommendations for early interventions. Purpose: Evaluate whether specific elements of sucking, during preterm initiation of oral feeding, predict sucking organization at corrected term age. Methods: Sucking performance of 88 preterm infants born between 24 and 34 weeks of post–menstrual age was measured at baseline and term (33-35 and 40 ± 1.5 weeks). Participants were divided into 4 groups (quartiles) based on initial measures of performance including number of sucks, number of bursts, sucks per burst, and maximum pressure. Stability in sucking organization was assessed by comparing changes in infant's quartile location from baseline to term. Results: A correlation between quartile location was obse...
Background & Aims: Parents of infants with complex congenital heart defects (CHD) often describe ... more Background & Aims: Parents of infants with complex congenital heart defects (CHD) often describe their infants as especially fussy, irritable, and difficult to sooth, which together with the illness caretaking demands, add to their stress. Little is known about how the behavioral style or temperament in the early months after discharge relates to parental quality of life. This study aimed to explore the associations between early infant temperament characteristics and parental quality of life in parents of infants with complex congenital heart disease. Methods: This descriptive, cross-sectional study, utilized data collected in a previously described multisite randomized clinical trial in the United States. Multivariable linear regression models were used to examine the associations of interest. Findings: Results demonstrated negative significant associations between most infant temperament subscales and parental quality of life. Higher scores on the Activity (β=-3.03, P=0.021), App...
BACKGROUND Traumatic stressful events (TSEs) are among the most studied risk factors for subseque... more BACKGROUND Traumatic stressful events (TSEs) are among the most studied risk factors for subsequent schizotypal symptoms. However, specificity and aggregate effects of trauma exposure on schizotypal symptoms remain unclear. This study investigates these relationships among a community-based sample of US adolescents. MATERIAL AND METHODS A sub-sample of 426 adolescents (51.6% female) from the Philadelphia Neurodevelopmental Cohort study were selected for longitudinal follow-up based on presence (n = 209) or absence (n = 217) of psychosis spectrum symptoms (PSS). At baseline, they completed assessments of demographic, TSEs, other psychopathology (e.g., PSS, anxiety, depression, and behavioral disorder) and family history of psychopathology. Schizotypal symptom dimensions (cognitive-perceptual, interpersonal and disorganized) were evaluated approximately two years later. RESULTS More than half of adolescents experienced at least one type of TSE. Adolescents with assaultive trauma reported about 1.5 times as many symptoms on all three schizotypal symptom dimensions, compared to adolescents with non-assaultive TSE, adjusting for demographic and family history variables. No statistical significance was found after further adjusting for other baseline psychopathology (p > 0.05). There was a significant aggregate effect of TSEs on cognitive-perceptual symptoms with small effect size (p < 0.001, Cohen's f2 = 0.034). CONCLUSIONS We found evidence of an association between aggregate TSEs and cognitive-perceptual symptoms, but trauma type was not associated with schizotypal symptom dimensions when controlling for potential confounders. Our findings highlight the importance of considering aggregate TSE effects and potential confounds when examining associations between TSEs and schizotypy. Trauma and psychosis spectrum screening may be important in the effort to provide trauma-informed care.
NAACOG's clinical issues in perinatal and women's health nursing, 1992
Thermoregulation is a critical component of neonatal nursing care, particularly with regard to pr... more Thermoregulation is a critical component of neonatal nursing care, particularly with regard to preterm infants. To provide appropriate care, nurses must be aware of the energy balance equation, mechanisms of heat loss, and specific factors related to preterm infants. In addition to the standard care measures implemented from birth through intensive care, nurses need to be aware of principles related to weaning an infant to an open crib.
Using a retrospective cohort of premature infants, we constructed multivariable Poisson models to... more Using a retrospective cohort of premature infants, we constructed multivariable Poisson models to determine factors associated with the receipt of antibiotics during the first year after discharge, N = 891. Black race (incidence rate ratio 1.80 compared with White infants, P = .008), male gender (incidence rate ratio 1.44; P = .007), bronchopulmonary dysplasia (incidence rate ratio 1.47; P = .04), and each additional child at home (incidence rate ratio 1.21, P = .002) increased the receipt of antibiotics for any reason. Male gender and additional children at home increased the receipt of nonrecommended antibiotics, while Black infants received care at facilities that prescribed more nonrecommended antibiotics. Even in a high-risk population of children, factors other than the medical history and presentation of the child may alter antibiotic prescription patterns and result in variations in care.
Background: The primary objective of this exploratory, feasibility study was to examine the relat... more Background: The primary objective of this exploratory, feasibility study was to examine the relationships of self-reported perceived stressors and psychological stress responses with measures of the biomarker cortisol in parents of infants hospitalized after neonatal cardiac surgery for critical congenital heart disease (cCHD). Methods: This was a prospective, cross-sectional study of 28 biological mother–father dyads of neonates with cCHD using consecutive enrollment. In the postoperative period after neonatal cardiac surgery, parents provided awakening and diurnal saliva samples and self-report measures on stress, anxiety, depression, dyadic adjustment, and perceived severity of illness of their neonate. Results: Evaluable data, including salivary cortisol samples, were obtained for 27 of the 28 dyads enrolled in the study. Compared to fathers, mothers exhibited significantly higher mean cortisol values at wakeup ( p = .032), 30-minute post-wakeup ( p = .024), and bedtime ( p = .0...
Introduction: Infants born with critical congenital heart disease (cCHD) are known to experience ... more Introduction: Infants born with critical congenital heart disease (cCHD) are known to experience growth failure in infancy, particularly those with single ventricle physiology. Differences in early weight-for-age Z-score growth trajectory (WAZ-GT) within this population have not been defined. We aimed to describe the WAZ-GT of infants with cCHD after cardiac surgery in the first 4 months of life and assess potential risk factors. Methods: This is a secondary analysis of a previously reported RCT, REACH telehealth program (2012-2017, Trial NCT01941667). Sample included both intervention and control infants (n=178). Weights over the first 4 months of life were converted to WAZ using the World Health Organization standards. WAZ-GT classes were identified using latent class growth modeling. Multinomial logistic regression models were used to examine the associations between socio-demographic and clinical characteristics and WAZ-GT classes. Results: Four distinct classes of WAZ-GT were i...
Objective. To determine whether longer stays of premature infants allowing for increased physical... more Objective. To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs. Data Sources. One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002. Study Design/Methods. Using multivariate matching with a time-dependent pro-pensity score we matched 701 ‘‘Early’ ’ babies to 701 ‘‘Late’ ’ babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes. Principal Findings. Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late– Early cost difference was $5,016 (po.0001). A sensitivity...
L'invention concerne un procede et un systeme de calcul d'un score relatif indiquant la p... more L'invention concerne un procede et un systeme de calcul d'un score relatif indiquant la performance d'alimentation d'un enfant sur la base, au moins en partie, d'une comparaison d'une ou plusieurs mesures de facteur d'alimentation de l'enfant a une echelle correspondante memorisee dans une base de donnees qui est derivee d'un echantillon d'enfants provenant de la population, dans lesquels la comparaison fournit facultativement une association statistique entre les valeurs d'echelle normatives et les resultats negatifs enregistres pour le meme echantillon provenant de la population et ainsi, un moyen pour evaluer le risque de l'enfant teste vis-a-vis de tels resultats negatifs.
PURPOSE To identify predictors of post-traumatic stress symptomology among parents of infants wit... more PURPOSE To identify predictors of post-traumatic stress symptomology among parents of infants with complex congenital heart defects at hospital discharge and after 4 months. DESIGN & METHODS A secondary analysis utilizing data from a larger RCT performed in three pediatric cardiac centers in North America. Analysis included 158 parent-infant dyads. Generalized Linear Modeling was used to identify predictors of parental post-traumatic symptomology at hospital discharge, and after 4 months. Considered predictors included demographics/SES, illness, and psychosocial parameters. RESULTS At discharge, parenting stress, education, and infant's medication number were linked to post-traumatic stress symptomology severity; Parenting stress, education, insurance type, and medications number predicted number of symptoms; Tube-assisted feeding predicted PTSD. At 4 months, parenting stress, ethnicity, and number of ED visits predicted PTSS severity; Parenting stress, ethnicity, and cardiologist visits predicted number of symptoms; Parenting stress, single ventricle physiology, and number of children predicted PTSD. CONCLUSIONS & PRACTICAL IMPLICATIONS Parental psychosocial factors, additionally to illness and sociodemographic indicators, can potentially risk parents to experience PTSS/PTSD. Nursing and other healthcare professionals can participate in early screening of such factors to determine familial risk. TRIAL REGISTRATION NCT01941667.
OBJECTIVE To examine the associations between post-traumatic stress of parents of infants with co... more OBJECTIVE To examine the associations between post-traumatic stress of parents of infants with complex congenital heart defects, and their healthcare utilization for their infants during the early months of life. STUDY DESIGN The current study is a secondary data analysis from a randomized controlled trail, in which 216 parent-infant dyads were recruited from 3 cardiac intensive care units of large pediatric centers in Northeastern America. The current sample included 153 dyads with post-traumatic stress data at hospital discharge and at 4-months followup. Poisson regressions were used to estimate the effect of post-traumatic stress change scores on number of emergency department (ED) visits, unscheduled cardiologist visits, and unscheduled pediatrician visits outcomes. RESULTS Infants whose parents gained PTSD over the study period were at increased risk for ED visits, and unscheduled cardiologist visits. Increased symptom severity predicted more unscheduled cardiologist visits and more unscheduled pediatrician visits. Increased symprom clusters (avoidance, arousal, re-experiencing) predicted more ED visits, more unscheduled cardiologist visits, and more unscheduled pediatrician visits. CONCLUSIONS Parents of infants with cardiac conditions may experience post-traumatic stress following cardiac surgery, which can be linked to greater healthcare utilization. Findings highlight the importance of screening and treating post-traumatic stress to preserve parental mental health and prevent adverse outcomes.
Journal of Obstetric, Gynecologic & Neonatal Nursing
OBJECTIVE To estimate the effect of skin-to-skin contact (SSC) on biobehavioral measures of stres... more OBJECTIVE To estimate the effect of skin-to-skin contact (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants' neonatal cardiac surgery. DESIGN A prospective interventional, baseline response-paired pilot study. SETTING Cardiac center of a large, metropolitan, freestanding children's hospital. PARTICIPANTS Thirty women whose infants were hospitalized for neonatal cardiac surgery. METHODS Participants acted as their own controls before, during, and after SSC at two time points: once before and once after surgery. We measured the stress response of mothers, as indicated by self-reported scores of anxiety and maternal salivary cortisol, and maternal-infant attachment, as indicated by self-reported scores and maternal salivary oxytocin. CONCLUSION Our findings provide initial evidence of the benefits of SSC as a nurse-led intervention to support maternal attachment and reduce physiologic and psychological stress responses in mothers of infants with critical congenital heart disease before and after neonatal cardiac surgery.
Supplemental Digital Content is available in the text. Objectives: To determine the effect of ski... more Supplemental Digital Content is available in the text. Objectives: To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery. Design: A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2). Setting: Cardiac ICU and step-down unit in a large metropolitan freestanding children’s hospital. Subjects: Convenience sample of 30 infants admitted preoperatively for critical congenital heart disease. Interventions: Eligible infants were placed into skin-to-skin care for 1 hour with their biological mothers once each at T1 and T2. Measurements and Main Results: Measurements of stress (salivary cortisol), pain and behavior state (COMFORT scale), and physiologic stability (vital signs) were assessed immediately before skin-to-skin care, 30 minutes into skin-to-skin care, and 30 minutes after skin-to-skin care ended. At both T1 and T2, infant pain scores were significantly decreased (p < 0.0001) and infants moved into a calmer behavior state (p < 0.0001) during skin-to-skin care as compared to baseline. At T1, infants also had significantly reduced heart rate (p = 0.002) and respiratory rate (p < 0.0001) and increased systolic blood pressure (p = 0.033) during skin-to-skin care. At both T1 and T2, infant cortisol remained stable and unchanged from pre-skin-to-skin care to during skin-to-skin care (p = 0.096 and p = 0.356, respectively), and significantly increased from during skin-to-skin care to post-skin-to-skin care (p = 0.001 and p = 0.023, respectively). Exploratory analysis revealed differences in cortisol reactivity for infants with higher baseline cortisol (> 0.3 μg/dL) versus lower (≤ 0.3 μg/dL) prior to skin-to-skin care. Infants with higher baseline cortisol at T2 experienced significantly reduced cortisol during skin-to-skin care (p = 0.025). No significant differences in demographics or baseline variables were found between infants in either group. Conclusions: Skin-to-skin care is a low-cost, low-risk intervention that promotes comfort and supports physiologic stability in infants before and after neonatal cardiac surgery.
Objectives:Parents of infants with CHDs experience increased parenting stress compared to the gen... more Objectives:Parents of infants with CHDs experience increased parenting stress compared to the general population, potentially interfering with parenting practices and bear adverse family outcomes. The changes in stress over the critical period of infancy have yet to be studied. The current study aimed to compare parenting stress changes over time between parents of infants with CHDs and parents of healthy infants during the first year of infants’ life.Methods:Data from a larger prospective cohort study were longitudinally analysed using mixed-effects multivariable regression modelling. Sample included mothers of 129 infants with complex cardiac defects and healthy infants, recruited from the cardiac ICU of a large cardiac centre and outpatient paediatric practices in Northeastern America. Outcome was measured over four visits via the Parenting Stress Index Long Form.Results:Stress in the cardiac group has significantly decreased over time on the Parent Domain (p = 0.025), and stress...
Background: Premature infants may experience increased difficulty with nutrition and growth. Succ... more Background: Premature infants may experience increased difficulty with nutrition and growth. Successful oral feeding is an important factor associated with discharge readiness. Despite the importance of feeding as a growth-fostering process, little empiric evidence exists to guide recommendations for early interventions. Purpose: Evaluate whether specific elements of sucking, during preterm initiation of oral feeding, predict sucking organization at corrected term age. Methods: Sucking performance of 88 preterm infants born between 24 and 34 weeks of post–menstrual age was measured at baseline and term (33-35 and 40 ± 1.5 weeks). Participants were divided into 4 groups (quartiles) based on initial measures of performance including number of sucks, number of bursts, sucks per burst, and maximum pressure. Stability in sucking organization was assessed by comparing changes in infant's quartile location from baseline to term. Results: A correlation between quartile location was obse...
Background & Aims: Parents of infants with complex congenital heart defects (CHD) often describe ... more Background & Aims: Parents of infants with complex congenital heart defects (CHD) often describe their infants as especially fussy, irritable, and difficult to sooth, which together with the illness caretaking demands, add to their stress. Little is known about how the behavioral style or temperament in the early months after discharge relates to parental quality of life. This study aimed to explore the associations between early infant temperament characteristics and parental quality of life in parents of infants with complex congenital heart disease. Methods: This descriptive, cross-sectional study, utilized data collected in a previously described multisite randomized clinical trial in the United States. Multivariable linear regression models were used to examine the associations of interest. Findings: Results demonstrated negative significant associations between most infant temperament subscales and parental quality of life. Higher scores on the Activity (β=-3.03, P=0.021), App...
BACKGROUND Traumatic stressful events (TSEs) are among the most studied risk factors for subseque... more BACKGROUND Traumatic stressful events (TSEs) are among the most studied risk factors for subsequent schizotypal symptoms. However, specificity and aggregate effects of trauma exposure on schizotypal symptoms remain unclear. This study investigates these relationships among a community-based sample of US adolescents. MATERIAL AND METHODS A sub-sample of 426 adolescents (51.6% female) from the Philadelphia Neurodevelopmental Cohort study were selected for longitudinal follow-up based on presence (n = 209) or absence (n = 217) of psychosis spectrum symptoms (PSS). At baseline, they completed assessments of demographic, TSEs, other psychopathology (e.g., PSS, anxiety, depression, and behavioral disorder) and family history of psychopathology. Schizotypal symptom dimensions (cognitive-perceptual, interpersonal and disorganized) were evaluated approximately two years later. RESULTS More than half of adolescents experienced at least one type of TSE. Adolescents with assaultive trauma reported about 1.5 times as many symptoms on all three schizotypal symptom dimensions, compared to adolescents with non-assaultive TSE, adjusting for demographic and family history variables. No statistical significance was found after further adjusting for other baseline psychopathology (p > 0.05). There was a significant aggregate effect of TSEs on cognitive-perceptual symptoms with small effect size (p < 0.001, Cohen's f2 = 0.034). CONCLUSIONS We found evidence of an association between aggregate TSEs and cognitive-perceptual symptoms, but trauma type was not associated with schizotypal symptom dimensions when controlling for potential confounders. Our findings highlight the importance of considering aggregate TSE effects and potential confounds when examining associations between TSEs and schizotypy. Trauma and psychosis spectrum screening may be important in the effort to provide trauma-informed care.
NAACOG's clinical issues in perinatal and women's health nursing, 1992
Thermoregulation is a critical component of neonatal nursing care, particularly with regard to pr... more Thermoregulation is a critical component of neonatal nursing care, particularly with regard to preterm infants. To provide appropriate care, nurses must be aware of the energy balance equation, mechanisms of heat loss, and specific factors related to preterm infants. In addition to the standard care measures implemented from birth through intensive care, nurses need to be aware of principles related to weaning an infant to an open crib.
Using a retrospective cohort of premature infants, we constructed multivariable Poisson models to... more Using a retrospective cohort of premature infants, we constructed multivariable Poisson models to determine factors associated with the receipt of antibiotics during the first year after discharge, N = 891. Black race (incidence rate ratio 1.80 compared with White infants, P = .008), male gender (incidence rate ratio 1.44; P = .007), bronchopulmonary dysplasia (incidence rate ratio 1.47; P = .04), and each additional child at home (incidence rate ratio 1.21, P = .002) increased the receipt of antibiotics for any reason. Male gender and additional children at home increased the receipt of nonrecommended antibiotics, while Black infants received care at facilities that prescribed more nonrecommended antibiotics. Even in a high-risk population of children, factors other than the medical history and presentation of the child may alter antibiotic prescription patterns and result in variations in care.
Background: The primary objective of this exploratory, feasibility study was to examine the relat... more Background: The primary objective of this exploratory, feasibility study was to examine the relationships of self-reported perceived stressors and psychological stress responses with measures of the biomarker cortisol in parents of infants hospitalized after neonatal cardiac surgery for critical congenital heart disease (cCHD). Methods: This was a prospective, cross-sectional study of 28 biological mother–father dyads of neonates with cCHD using consecutive enrollment. In the postoperative period after neonatal cardiac surgery, parents provided awakening and diurnal saliva samples and self-report measures on stress, anxiety, depression, dyadic adjustment, and perceived severity of illness of their neonate. Results: Evaluable data, including salivary cortisol samples, were obtained for 27 of the 28 dyads enrolled in the study. Compared to fathers, mothers exhibited significantly higher mean cortisol values at wakeup ( p = .032), 30-minute post-wakeup ( p = .024), and bedtime ( p = .0...
Introduction: Infants born with critical congenital heart disease (cCHD) are known to experience ... more Introduction: Infants born with critical congenital heart disease (cCHD) are known to experience growth failure in infancy, particularly those with single ventricle physiology. Differences in early weight-for-age Z-score growth trajectory (WAZ-GT) within this population have not been defined. We aimed to describe the WAZ-GT of infants with cCHD after cardiac surgery in the first 4 months of life and assess potential risk factors. Methods: This is a secondary analysis of a previously reported RCT, REACH telehealth program (2012-2017, Trial NCT01941667). Sample included both intervention and control infants (n=178). Weights over the first 4 months of life were converted to WAZ using the World Health Organization standards. WAZ-GT classes were identified using latent class growth modeling. Multinomial logistic regression models were used to examine the associations between socio-demographic and clinical characteristics and WAZ-GT classes. Results: Four distinct classes of WAZ-GT were i...
Objective. To determine whether longer stays of premature infants allowing for increased physical... more Objective. To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs. Data Sources. One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002. Study Design/Methods. Using multivariate matching with a time-dependent pro-pensity score we matched 701 ‘‘Early’ ’ babies to 701 ‘‘Late’ ’ babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes. Principal Findings. Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late– Early cost difference was $5,016 (po.0001). A sensitivity...
L'invention concerne un procede et un systeme de calcul d'un score relatif indiquant la p... more L'invention concerne un procede et un systeme de calcul d'un score relatif indiquant la performance d'alimentation d'un enfant sur la base, au moins en partie, d'une comparaison d'une ou plusieurs mesures de facteur d'alimentation de l'enfant a une echelle correspondante memorisee dans une base de donnees qui est derivee d'un echantillon d'enfants provenant de la population, dans lesquels la comparaison fournit facultativement une association statistique entre les valeurs d'echelle normatives et les resultats negatifs enregistres pour le meme echantillon provenant de la population et ainsi, un moyen pour evaluer le risque de l'enfant teste vis-a-vis de tels resultats negatifs.
PURPOSE To identify predictors of post-traumatic stress symptomology among parents of infants wit... more PURPOSE To identify predictors of post-traumatic stress symptomology among parents of infants with complex congenital heart defects at hospital discharge and after 4 months. DESIGN & METHODS A secondary analysis utilizing data from a larger RCT performed in three pediatric cardiac centers in North America. Analysis included 158 parent-infant dyads. Generalized Linear Modeling was used to identify predictors of parental post-traumatic symptomology at hospital discharge, and after 4 months. Considered predictors included demographics/SES, illness, and psychosocial parameters. RESULTS At discharge, parenting stress, education, and infant's medication number were linked to post-traumatic stress symptomology severity; Parenting stress, education, insurance type, and medications number predicted number of symptoms; Tube-assisted feeding predicted PTSD. At 4 months, parenting stress, ethnicity, and number of ED visits predicted PTSS severity; Parenting stress, ethnicity, and cardiologist visits predicted number of symptoms; Parenting stress, single ventricle physiology, and number of children predicted PTSD. CONCLUSIONS & PRACTICAL IMPLICATIONS Parental psychosocial factors, additionally to illness and sociodemographic indicators, can potentially risk parents to experience PTSS/PTSD. Nursing and other healthcare professionals can participate in early screening of such factors to determine familial risk. TRIAL REGISTRATION NCT01941667.
OBJECTIVE To examine the associations between post-traumatic stress of parents of infants with co... more OBJECTIVE To examine the associations between post-traumatic stress of parents of infants with complex congenital heart defects, and their healthcare utilization for their infants during the early months of life. STUDY DESIGN The current study is a secondary data analysis from a randomized controlled trail, in which 216 parent-infant dyads were recruited from 3 cardiac intensive care units of large pediatric centers in Northeastern America. The current sample included 153 dyads with post-traumatic stress data at hospital discharge and at 4-months followup. Poisson regressions were used to estimate the effect of post-traumatic stress change scores on number of emergency department (ED) visits, unscheduled cardiologist visits, and unscheduled pediatrician visits outcomes. RESULTS Infants whose parents gained PTSD over the study period were at increased risk for ED visits, and unscheduled cardiologist visits. Increased symptom severity predicted more unscheduled cardiologist visits and more unscheduled pediatrician visits. Increased symprom clusters (avoidance, arousal, re-experiencing) predicted more ED visits, more unscheduled cardiologist visits, and more unscheduled pediatrician visits. CONCLUSIONS Parents of infants with cardiac conditions may experience post-traumatic stress following cardiac surgery, which can be linked to greater healthcare utilization. Findings highlight the importance of screening and treating post-traumatic stress to preserve parental mental health and prevent adverse outcomes.
Journal of Obstetric, Gynecologic & Neonatal Nursing
OBJECTIVE To estimate the effect of skin-to-skin contact (SSC) on biobehavioral measures of stres... more OBJECTIVE To estimate the effect of skin-to-skin contact (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants' neonatal cardiac surgery. DESIGN A prospective interventional, baseline response-paired pilot study. SETTING Cardiac center of a large, metropolitan, freestanding children's hospital. PARTICIPANTS Thirty women whose infants were hospitalized for neonatal cardiac surgery. METHODS Participants acted as their own controls before, during, and after SSC at two time points: once before and once after surgery. We measured the stress response of mothers, as indicated by self-reported scores of anxiety and maternal salivary cortisol, and maternal-infant attachment, as indicated by self-reported scores and maternal salivary oxytocin. CONCLUSION Our findings provide initial evidence of the benefits of SSC as a nurse-led intervention to support maternal attachment and reduce physiologic and psychological stress responses in mothers of infants with critical congenital heart disease before and after neonatal cardiac surgery.
Supplemental Digital Content is available in the text. Objectives: To determine the effect of ski... more Supplemental Digital Content is available in the text. Objectives: To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery. Design: A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2). Setting: Cardiac ICU and step-down unit in a large metropolitan freestanding children’s hospital. Subjects: Convenience sample of 30 infants admitted preoperatively for critical congenital heart disease. Interventions: Eligible infants were placed into skin-to-skin care for 1 hour with their biological mothers once each at T1 and T2. Measurements and Main Results: Measurements of stress (salivary cortisol), pain and behavior state (COMFORT scale), and physiologic stability (vital signs) were assessed immediately before skin-to-skin care, 30 minutes into skin-to-skin care, and 30 minutes after skin-to-skin care ended. At both T1 and T2, infant pain scores were significantly decreased (p < 0.0001) and infants moved into a calmer behavior state (p < 0.0001) during skin-to-skin care as compared to baseline. At T1, infants also had significantly reduced heart rate (p = 0.002) and respiratory rate (p < 0.0001) and increased systolic blood pressure (p = 0.033) during skin-to-skin care. At both T1 and T2, infant cortisol remained stable and unchanged from pre-skin-to-skin care to during skin-to-skin care (p = 0.096 and p = 0.356, respectively), and significantly increased from during skin-to-skin care to post-skin-to-skin care (p = 0.001 and p = 0.023, respectively). Exploratory analysis revealed differences in cortisol reactivity for infants with higher baseline cortisol (> 0.3 μg/dL) versus lower (≤ 0.3 μg/dL) prior to skin-to-skin care. Infants with higher baseline cortisol at T2 experienced significantly reduced cortisol during skin-to-skin care (p = 0.025). No significant differences in demographics or baseline variables were found between infants in either group. Conclusions: Skin-to-skin care is a low-cost, low-risk intervention that promotes comfort and supports physiologic stability in infants before and after neonatal cardiac surgery.
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Papers by Barbara Medoff-cooper