Interconception Challenges of Women Who Had Prior Preterm Births.

OBJECTIVE: To describe the interconception challenges of women who had prior preterm births. DESIGN: We used a cross-sectional design and collected data via survey. SETTING: King County, Washington. PARTICIPANTS: Ninety-two women who had prior early preterm births (20-33 weeks gestation) were included. METHODS: Women were recruited from a larger study focused on exploring the infectious pathways for early preterm birth. Participants were interviewed once using open-ended and close-ended surveys. The primary open-ended survey question was What are the five greatest challenges you experience now? We analyzed data using inductive and summative content analysis and descriptive statistics. RESULTS: Ninety-one participants described challenges. One participant had no challenge. We categorized 11 challenges during the interconception period: Mothering (n = 70, 76%), Self-Care Desires (n = 35, 38%), Finances (n = 31, 34%), Employment (n = 31, 34%), Partner Relationships (n = 29, 32%), Individualized Concerns (n = 25, 27%), Mental Health (n = 23, 25%), Balance (n = 22, 24%), Physical Health (n = 19, 21%), Housing (n = 18, 20%), and Family (n = 17, 19%). CONCLUSION: Participants described an array of challenges that often related to their roles as mothers, employees, and partners. Our research advances knowledge by describing contemporary challenges of women during the interconception period.

Quantification of neonatal amplitude-integrated EEG patterns.

BACKGROUND: Amplitude-integrated EEG (aEEG) is increasingly used in research with premature infants; however, comprehensive interpretation is limited by the lack of simple approaches for reliably quantifying and summarizing the data. AIM: Explore operational measures for quantifying continuity and discontinuity, measured by aEEG as components of infant brain function. STUDY DESIGN: An exploratory naturalistic study of neonates while in the Neonatal Intensive Care Unit (NICU). One single channel aEEG recording per infant was obtained without disruption of nursing care practices. SUBJECTS: 24 infants with mean postmenstrual age (PMA) of 33.11 weeks (SD 3.49), average age of 2.62 weeks (SD 1.35) and mean birth weights of 1.39 kg (SD 0.73). OUTCOME MEASURES: Quantification of continuity and discontinuity included bandwidth and lower border of aEEG, calculated proportion of time with signal amplitude below 10 µV, and peak counts. Variance of bandwidth and lower border denoted cycling. RESULTS: Group mean bandwidth was 52.98 µV (SD 27.62). Median peak count in 60 second epochs averaged 3.63 (SD 1.74), while median proportion < 10 µV was 22% (SD 0.20). The group mean of lower border within-subject aggregated medians was 6.20 µV (SD 2.13). Group mean lower border standard deviation was 3.96 µV. Proportion < 10 µV showed a strong negative correlation with the natural log of the lower border median (r = -0.906, p < .0001) after controlling for PMA. CONCLUSIONS: This study introduces a novel quantification process by counting peaks and proportion of time < 10 µV. Expanded definitions and analytic techniques will serve to strengthen the application of existing scoring systems for use in naturalistic research settings and clinical practice.

Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: a randomized clinical trial.

To date, patients with bony metastases were only a small fraction of the samples studied, or they were entirely excluded. Patients with metastatic cancers, such as bone metastases, are more likely to report pain, compared to patients without metastatic cancer (50-74% and 15%, respectively). Their cancer pain results in substantial morbidity and disrupted quality of life in 34-45% of cancer patients. Massage therapy (MT) appears to have positive effects in patients with cancer; however, the benefits of MT, specifically in patients with metastatic bone pain, remains unknown. The purpose of this randomized clinical trial was to compare the efficacy of MT to a social attention control condition on pain intensity, mood status, muscle relaxation, and sleep quality in a sample (n=72) of Taiwanese cancer patients with bone metastases. In this investigation, MT was shown to have beneficial within- or between-subjects effects on pain, mood, muscle relaxation, and sleep quality. Results from repeated-measures analysis of covariance demonstrated that massage resulted in a linear trend of improvements in mood and relaxation over time. More importantly, the reduction in pain with massage was both statistically and clinically significant, and the massage-related effects on relaxation were sustained for at least 16-18 hours postintervention. Furthermore, massage-related effects on sleep were associated with within-subjects effects. Future studies are suggested with increased sample sizes, a longer interventional period duration, and an objective and sensitive measure of sleep. Overall, results from this study support employing MT as an adjuvant to other therapies in improving bone pain management.

Electrode challenges in amplitude-integrated electroencephalography (aEEG): research application of a novel noninvasive measure of brain function in preterm infants.

Continuous real-time brain function monitoring of preterm infants offers a novel way to evaluate neurological development in neonatal intensive care. Direct measurement of brain function is difficult and complicated by vulnerabilities of the preterm infant population. This study illustrates the feasibility of using noninvasive hydrogel electrodes with amplitude-integrated electroencephalography (aEEG) as a simplified brain monitor in preterm infants. This article presents a systematic exploration of factors influencing the accuracy of aEEG measurement, especially skin preparation procedures and skin condition after electrode placement. The authors conducted aEEG recordings on 16 medically stable preterm infants at 31-36 weeks postmenstrual age in the neonatal intensive care unit between feedings and caregiving for approximately 3 hr. The authors systematically performed several strategies to improve electrode placement procedures and reduce skin impedance, including (a) examination of possible influences of environmental electrical equipment, (b) comparison of different hydrogel electrode types, (c) modification of skin preparation procedures, and (d) assessment of impacts of different skin conditions. The authors achieved improvements in the impedance value, length of uninterrupted recording, and percentage of the recording duration with measured impedance <20 kΩ (recommended acceptable limit). There was no report of skin irritation during or after the recording. The aEEG measurement at the bedside using hydrogel electrodes is noninvasive and feasible for reliable brain monitoring in preterm infants. This study demonstrated the importance of establishing systematic methods to ensure the accuracy and feasibility of physiologic measurements for nurse researchers.

Individual and gender differences matter in preterm infant state development.

OBJECTIVE: To further understand state development of preterm infants throughout hospitalization and the effects of selected infant characteristics on state development. DESIGN: Secondary data analysis of a 2-group, experimental design study. SETTING: Two nurseries in a Northwest medical center. PARTICIPANTS: Ninety-seven hospitalized, medically stable, preterm infants. Fifty-one subjects were females. METHODS: Two hundred and eighty-five real-time video recordings of infants performed during 4 hour interfeeding intervals. Sleep-wake states were coded at 15 second intervals. RESULTS: Active sleep was the dominant state across postmenstrual ages. Although not statistically significant, preterm infants showed developmental changes in state organization with increased quiet sleep, drowsy, and awake, decreased active sleep, and more defined and less diffuse states over age. A significant gender effect was found, with males having less active sleep (p=.012), more drowsy (p=.03), more awake (p=.043), less defined (p=.002), and more diffuse (p=.001) states compared with females. CONCLUSION: The predominance of active sleep during the preterm period reflects level of brain maturation. The results emphasize individual variations in state organization influenced by endogenous and environmental factors. Gender differences are potential sources of individual variation.

Infant sleep and feeding pattern: effects on maternal sleep.

Factors contributing to maternal sleep when infants are 4 to 10 weeks of age were examined. Twenty-four-hour sleep-wake diaries collected from 37 mother-infant dyads in the home environment were summarized to describe total, longest, and mean sleep period; synchrony of maternal and infant sleep; and feeding frequency and duration. Regression and post hoc analysis of variance were used to examine factors contributing to maternal and infant sleep. Maternal sleep is driven by infant sleep and feeding pattern. The minimum and maximum numbers of infant sleep episodes per day were 6 and 15, respectively, and mean infant total sleep was 13.47 hours (SD 1.73). Mean maternal total sleep was 7.18 hours (SD 1.51), with half of the mothers reporting less than 7 hours of sleep per 24 hours. Mean number of infant feedings was 11.14 (SD 3.27), with 11 infants (29.7%) receiving 13 or more feedings per 24 hours; minimum and maximum times per feeding were 15 and 41.7 minutes, respectively. Male infants had more sleep episodes, shorter sleep periods, and less sleep than females, and these gender differences resulted in shorter and more fragmented sleep for mothers. Findings suggest there is continued need for interventions to improve maternal sleep following childbearing.