Elastic sac to support oral feeding performance of preterm infants: Crossover randomized controlled study.

BACKGROUND: Swaddling is recommended for preterm infants during feeding. Swaddling preterm infants with elastic cotton materials allows infants to easily stretch and move their extremities. This study aimed to assess the effect of bottlefeeding in a novel "elastic sac" on physiological parameters and feeding performance of preterm infants. METHODS: A randomized controlled, crossover trial was conducted with total of 26 preterm infants at 26-36+6 weeks of gestation. Infants randomly assigned to group 1 (n = 13) were bottlefed in an elastic sac (researcher-designed single-piece pouch made of soft, elastic cotton) for the first feeding and in normal clothes for the next feeding. Infants randomly assigned to group 2 (n = 13) were fed first in normal clothes and then in the elastic sac. The physiological parameters and feeding performance of the infants were assessed during each feeding. RESULTS: Preterm infants fed in the elastic sac had lower heart rate and higher oxygen saturation during and after feeding than infants fed in normal clothes (P < 0.05). Although all values were within clinically normal ranges, the findings suggest that feeding preterm infants in the elastic sac had a favorable effect on physiological parameters compared with feeding in normal clothes. There was no significant difference in the infants' feeding performance (P > 0.05). CONCLUSION: A semielevated right lateral position and flexed body posture are recommended while feeding preterm infants, which can be easily maintained using the elastic sac. Feeding preterm infants in an elastic sac may support physiologic stability during oral feeding.

The effect of position on feeding performance in infants with cleft lip and palate: Quasiexperimental study.

PURPOSE: This single-group, quasiexperimental study was conducted to determine the effect of feeding position on the physiological parameters and feeding performance of term-born infants with cleft lip and palate (CLP) in the preoperative period. METHODS: The study sample consisted of 45 infants aged 0-6 months with CLP followed up preoperatively in our outpatient clinic between January 2021 and 2022. Infants who were being fed with a specialty bottle for babies with CLP and whose families consented to participate in the study were included. After 2 h of fasting, the infants were fed in the elevated supine (ESU) position for the first meal, then in the elevated side-lying (ESL) position for the second meal after another 2 h of fasting. The infants' heart rate and oxygen saturation values before, during, and after each feed and indicators of feeding performance were compared between the positions. RESULTS: There was no significant difference between the positions in terms of heart rate and oxygen saturation before, during, or after feeding (p > .05). There was no statistically significant difference in measures of feeding performance according to the infants' feeding position (p > .05). CONCLUSION: According to the findings obtained in this study, infants with CLP showed no statistically significant differences in heart rate, oxygen saturation, or feeding performance when fed in the ESL and ESU positions. PRACTICE IMPLICATIONS: However, despite the lack of statistical significance, both physiological values and feeding performance tended to be better when the infants were fed in the ESL position, nurses can practice ESL position according to the infant's opposite direction of the side of the cleft lip or palate.

The Effect of Abdominal Massage on Bilirubin Levels in Term Infants Receiving Phototherapy: A Randomized Controlled Trial.

BACKGROUND: The incidence of neonatal hyperbilirubinemia in Europe and the United States is estimated to be 3.2 and 4.4 per 10,000 live births, respectively. Abdominal massage for hyperbilirubinemia is considered a safe complementary treatment for infants that may increase number of defecations and decrease bilirubin levels. PURPOSE: This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels in term infants receiving phototherapy. METHODS: The sample consisted of 43 term newborns (intervention group: 23; control group: 20) who received phototherapy in a university hospital between June 2019 and February 2021. Information and observation forms were used for data collection. The intervention group received 6 abdominal massages over 2 days, performed 3 times a day, 6 hours apart, and lasting 5 minutes each. RESULTS: Transcutaneous bilirubin levels and heart rate were significantly lower in the intervention group than in the control group at 48 hours (P = .015 and P = .033, respectively). Number of defecations was higher in the intervention group at 24 hours (P = .007) but there was no significant difference at 48 hours. The decrease in serum bilirubin between 24 and 48 hours was significantly greater in the intervention group (P = .005). IMPLICATION FOR PRACTICE AND RESEARCH: Abdominal massage was effective in reducing bilirubin levels and may increase the number of defecations. Providing massage training to the parents of infants who are discharged early could be a protective approach to prevent the rise in bilirubin levels.

Effects of applications manual pressure and shotblocker to reduce needle-related pain and fear in children with type 1 diabetes mellitus.

BACKGROUND: Pain and fear associated with insulin injections can cause children with type 1 diabetes mellitus to avoid insulin injections and skip doses. OBJECTIVE: To evaluate and compare pain and fear levels in children aged 6-12 years receiving subcutaneous insulin injection using the manual pressure and ShotBlocker methods. METHODS: A randomized controlled study was conducted with 90 children with type 1 diabetes who were allocated using block randomization to the manual pressure, ShotBlocker, and control groups (n = 30 in each group). Fear and pain levels were rated by the children, their parents, and a member of the study team immediately before and after insulin injection using the Children's Fear Scale and Wong-Baker Faces Pain Rating Scale, respectively. RESULTS: All groups had similar self-, parent-, and researcher-reported levels of preprocedural pain and fear (p > 0.05). However, pain and fear scores were lower in the manual pressure and ShotBlocker groups than in the control group after injection (p = 0.0001). There was no significant difference in pain and fear scores between the two intervention groups (p > 0.05). CONCLUSION: Manual pressure and the ShotBlocker both reduced fear and pain associated with insulin injection in 6- to 12-year-old children with type 1 diabetes. IMPLICATIONS FOR PRACTICE: Both the manual pressure and ShotBlocker methods can easily be applied in children receiving insulin injections. As manual pressure is completely cost- and equipment-free, it is a useful option to reduce pain and fear related to insulin injection. CLINICAL TRIAL REGISTRATION NUMBER: National Institutes of Health (NIH), ClinicalTrials.gov, NCT05789810.

The Effect of Virtual Reality on Pain Experienced by School-Age Children During Venipuncture: A Randomized Controlled Study.

Objective: The use of virtual reality (VR) as a non-pharmacologic method may enable children to tolerate invasive procedures in a hospital setting easily and feel less pain. This study aimed at determining the effect of using a VR headset during venipuncture on pain level, heart rate (HR), and oxygen saturation values in children aged 7-12 years old. Materials and Methods: This was a randomized controlled experimental study. This study included 102 children (experimental group: 52; control group: 50) who visited a pediatric outpatient clinic of a university hospital in Turkey between May 2018 and May 2019. Data were collected using the Child and Family Information Form, State Anxiety Inventory for Children, Faces Pain Scale-Revised (FPS-R). Before venipuncture, state anxiety and pain scores of the children were evaluated. The children in the experimental group wore VR headsets during venipuncture. The children in the control group underwent standard venipuncture procedure. Pain scores were evaluated again in both groups after the venipuncture. Before, during, and after the venipuncture, pulse and oxygen saturation values were measured. Results: It was determined that post-procedure pain score was 1.46 ± 1.49 in the experimental group and 4.44 ± 2.26 in the control group. Post-venipuncture pain mean scores were significantly lower in the experimental group than those of the children in the control group (Z = -6.574; P = 0.001). Secondary outcomes: The mean HR during the procedure was significantly lower in the experimental group (99.27 ± 18.34/min) than in the control group (108.20 ± 21.42/min) (P = 0.026; t = -2.265). There was no statistically significant difference between the before and after the procedure difference of oxygen saturation values (Experimental group: -0.15 ± 1.54; Control Group: 0.04 ± 0.93) between groups (Z = -0.023; P = 0.982). Conclusion: It was determined that post-venipuncture pain mean scores were significantly lower in the experimental group than in the control group. VR is effective to reduce the pain of children during venipuncture. VR headsets may be recognized as effective instruments to reduce the pain level of children in hospital settings. (Clinicaltrials.gov: NCT04950478).

Evaluation of YouTube videos on complementary feeding: Content quality and reliability analysis.

YouTube is an online platform that parents frequently use to access information on child health. Parents' watching YouTube videos to have information on complementary feeding requires evaluation of the videos regarding child health. This study which was conducted in descriptive design, aimed to analyze YouTube videos' content quality and reliability on complementary feeding. Searched by matching keywords "starting", "beginning", "introducing", "solid food", and "complementary feeding" through boolean operators in the English language on YouTube, on August 2022. The search identified 528 videos related to complementary feeding. Two independent researchers analyzed the content of 61 videos that met the inclusion criteria. The content quality of the videos was evaluated using the Checklist for Complementary Feeding (CCF), which was prepared by researchers in line with international guidelines, the reliability of the videos was analyzed using the DISCERN, and the content quality was evaluated using the Global Quality Score (GQS). Of the 61 videos included, 38 (62.3%) were informative, and 23 (37.7%) were misleading. The kappa value among independent observers was 0.96. The mean GQS, DISCERN, and CCF scores of the videos grouped as informative were significantly higher than the videos grouped as misleading (p = 0.000, p = 0.000, p = 0.000, respectively). There was a significant difference between the mean scores of GQS and DISCERN according to the publication source of the videos (p = 0.033 and p = 0.023, respectively). The GQS and DISCERN mean scores of the Ministrial/Academic/Hospital/Healthcare Institution channel videos were higher than the mean scores of the Individual/Parents content channel videos. Videos on YouTube about complementary feeding have high viewing rates, but also videos that are low in terms of quality and reliability.

Timing of Post-bath Skin Moisturizer Application to Newborn Infants: A Randomized Controlled Study.

OBJECTIVE: To investigate whether the timing of postbath moisturizer application affected the skin moisture (SM) and body temperature (BT) of newborn infants. METHODS: The researchers conducted a randomized controlled study with 80 newborns who were monitored in a university hospital between March 2017 and May 2018. In both the control and experimental groups, newborns were bathed and dried. However, in the control group, moisturizer was applied immediately to the newborn's body, whereas in the experimental group, moisturizer was applied 10 minutes after the completion of the bath. Researchers evaluated the BT and SM of all infants both before and immediately after the bath and at 10, 20, 40, and 60 minutes postbath. RESULTS: The control and experimental groups were similar according to the descriptive characteristics of the infants (P > .05). In both groups, infants' SM values increased in the first 10 minutes after the bath compared with the prebath values (P < .05). However, the whole-body SM value of the experimental group was significantly higher than that of the control group 60 minutes postbath (P = .027). There was also a statistically significant change in the body temperatures of infants in both groups after bathing (P = .004). CONCLUSIONS: Waiting 10 minutes postbath before applying moisturizer positively affected newborns' SM and BT. Additional research with a broader age range and a more diverse sample is needed to further clarify the effects of postbath moisturizer application timing on newborns' SM and BT.

Thermoregulation and golden hour practices in extremely preterm infants: an international survey.

BACKGROUND: Are thermoregulation and golden hour practices in extremely preterm (EP) infants comparable across the world? This study aims to describe these practices for EP infants based on the neonatal intensive care unit's (NICUs) geographic region, country's income status and the lowest gestational age (GA) of infants resuscitated. METHODS: The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021. RESULTS: We received 848 responses, from all geographic regions and resource settings. Variations in most thermoregulation and golden hour practices were observed. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). The odds for the following practices differed in NICUs resuscitating infants from 22 to 23 weeks GA compared to those resuscitating from 24 to 25 weeks: respiratory support during resuscitation and transport, use of polyethylene plastic wrap and servo-control mode, commencing ambient humidity >80% and presence of local protocols. CONCLUSION: Evidence-based practices on thermoregulation and golden hour stabilisation differed based on the unit's region, country's income status and the lowest GA of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines. IMPACT: A wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. This study provides a comprehensive description of thermoregulation and golden hour practices to allow a global comparison in the delivery of best evidence-based practice. The findings of this survey highlight a need for reducing variation in practice and aligning practices with international guidelines for a comparable health care delivery.

Global variation in skin injures and skincare practices in extremely preterm infants.

BACKGROUND: Globally, are skincare practices and skin injuries in extremely preterm infants comparable? This study describes skin injuries, variation in skincare practices and investigates any association between them. METHODS: A web-based survey was conducted between February 2019 and August 2021. Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes. The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions. RESULTS: Responses from 848 neonatal intensive care units, representing all geographic regions and income status groups were received. Diaper dermatitis (331/840, 39%) and medical adhesive-related skin injuries (319/838, 38%) were the most common injuries. Following a local skincare guideline reduced skin injuries [medical adhesive-related injuries: adjusted odds ratios (aOR) = 0.63, 95% confidence interval (CI) = 0.45-0.88; perineal injuries: aOR = 0.66, 95% CI = 0.45-0.96; local skin infections: OR = 0.41, 95% CI = 0.26-0.65; chemical burns: OR = 0.46, 95% CI = 0.26-0.83; thermal burns: OR = 0.51, 95% CI = 0.27-0.96]. Performing skin assessments at least every four hours reduced skin injuries (abrasion: aOR = 0.48, 95% CI = 0.33-0.67; pressure: aOR = 0.51, 95% CI = 0.34-0.78; diaper dermatitis: aOR = 0.71, 95% CI = 0.51-0.99; perineal: aOR = 0.52, 95% CI = 0.36-0.75). Regional and resource settings-based variations in skin injuries and skincare practices were observed. CONCLUSIONS: Skin injuries were common in extremely preterm infants. Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries. Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations.

Attitudes Toward Neonatal Palliative Care Among Turkish Nurses and Physicians: A Comparative Cross-sectional Study.

Few studies have examined and compared neonatal physicians' and nurses' attitudes toward palliative care. This comparative study sought to evaluate attitudes toward neonatal palliative care in neonatal nurses and physicians and identify associated facilitators and barriers. This comparative, cross-sectional study included 173 neonatal intensive care unit staff (149 neonatal nurses and 24 neonatal physicians) in 2 hospitals in Istanbul, Turkey. Data were collected using the Turkish version of the Neonatal Palliative Care Attitude Scale. The results of the study revealed 8 facilitators and 9 barriers to neonatal palliative care. Nurses were significantly more likely than physicians to agree that parents are informed about palliative care options in their unit ( P = .008), that caring for dying infants is traumatic ( P = .007), and that their willingness to provide palliative care is influenced by their personal attitudes toward death ( P = .015). This study demonstrates the importance of parents' active involvement in the palliative care process, the establishment of standard policies and guidelines, and the provision of vocational and in-service education programs to support palliative care. Initiatives to strengthen facilitators and mitigate barriers are needed to optimize the implementation of palliative care in NICUs.

Effect of different positions on gastric residuals in preterm infants initiating full enteral feeding.

BACKGROUND: This study was conducted to determine the effect of feeding in different positions on the gastric residual volume after feeding in preterm infants who initiated full enteral feeding. METHODS: This quasi-experimental study was conducted with the hypothesis that testing the right lateral position leads to less gastric residual than left lateral position and the prone position leads to less gastric residual than the supine position. The data were collected in four stages from 35 preterm infants. Initially, the infants were positioned in supine position and were fed. After feeding, the infant rested in the supine position for 3 h. The stomach content was aspirated, and the volume of gastric residual was measured at the 60th, 120th, and 180th min after feeding. These steps are repeated in order of in the right lateral, left lateral, and prone position. Total gastric residual volume and type of enteral feeding were evaluated. RESULTS: There was no significant difference among the positions in terms of the volume of gastric residuals in the measurements made at 60th (P = 9.552), 120th (P = .505), and 180th min (P = .430). When the amount of decrease in the gastric residual volumes was a significant difference between all measurement times in right lateral and prone positions (P < .001). CONCLUSION: Although no significant difference was determined between the positions, the smallest residual volumes were determined in the right lateral and prone positions. The amount of decrease in residual volume was significant in right lateral and prone positions.

Effect of Left and Right Semi-Elevated Side-Lying Positions on Feeding Performance of Preterm Infants.

OBJECTIVE: To determine the effect of right and left semi-elevated side-lying positions on the feeding performance and skills of bottle-fed preterm infants. DESIGN: A single-group, crossover experimental study. SETTINGS: Level 3 NICU of a training and research hospital in Istanbul. PARTICIPANTS: A total of 60 preterm infants born at 24 to 36 6/7 weeks gestation. METHODS: We collected data using an infant information form, feeding observation form, and the Turkish version of the Early Feeding Skills Assessment (EFS-Turkish). For each infant, we collected data for two feeds: one in the right and one in the left semi-elevated side-lying position. RESULTS: We found no difference between the right and left semi-elevated side-lying positions in the volume or percentage of food taken (p = .582 and p = .625, respectively), feeding duration (p = .901), or feeding efficiency (p = .423). We observed no significant differences between feedings in the left and right semi-elevated side-lying positions in mean EFS-Turkish total score (p = .251) or subscale scores (p > .05). CONCLUSION: Neonatal nurses can feed preterm infants in both directions of the semi-elevated side-lying position when following evidence-based feeding guidelines.

The Effect of Training on Neonatal Nurses' Knowledge about Transitioning Preterm Infants to Oral Feeding.

BACKGROUND: Neonatal nurses require knowledge of evidence-based interventions that can be utilized for supporting oral feeding skills in preterm infants. Little is known about the impact of education/training programs on neonatal nurses' knowledge of this topic. PURPOSE: This study was conducted to determine the effect of a training program about evidence-based interventions for the transition to and support of oral feeding in preterm infants on the knowledge levels of neonatal nurses. METHODS: We conducted a pretest-posttest studywith 73 neonatal nurses in a research and training hospital. Participants completed a demographic information form and their knowledge about oral feeding in preterm infants was assessed before and after a 240-min training about the transition to oral feeding and evidence-based therapeutic interventions to promote preterm infants' oral feeding skills. RESULTS: Posttest scores evaluated at 1 week (81.6 ± 6.8) and 1 month (79.5 ± 6.5) after the training were significantly higher than pre-test scores (66.8 ± 6.9) (p < 0.001). CONCLUSION: Neonatal nurses showed higher levels of knowledge about evidence-based interventions for supporting oral feeding skills in preterm infants at 1 week and 1 month after the training program compared to their knowledge before training. IMPLICATIONS FOR PRACTICE: Providing training to neonatal intensive care nurses on the transition to oral feeding in preterm infants will increase their level of knowledge and ensure that oral feeding interventions for preterm infants can be implemented using evidence-based therapeutic methods.

Nonnutritive Sucking Before Oral Feeding of Preterm Infants in Turkey: A Randomized Controlled Study.

BACKGROUND: The use of a pacifier is recommended to support sucking reflex during transition from gavage feeding to oral feeding and ensure readiness for feeding. PURPOSE: A randomized controlled experimental design was used to determine the effect of a pacifier given before feeding on physiological characteristics and feeding performance in preterm infants initially fed orally. DESIGN AND METHODS: The data were obtained from preterm infants (N = 72) born before 31st gestational week, who were admitted to Newborn Intensive Care Unit of a training and research hospital affiliated with Ministry of Health between January 2017-July 2018 and met the case selection criteria. Heart rates, oxygen saturation levels and feeding performances of preterm infants in both groups before, during, and after feeding were compared. RESULTS: Heart rates of preterm infants in the experimental group were statistically significantly lower (Experimental: 139.64 ± 10.16; Control: 149.31 ± 8.40; p < 0.01) and their oxygen saturation levels were higher (Experimental: 97.22 ± 2.22; Control: 96.33 ± 1.93; p < 0.05). Feeding efficiency rates (Experimental: 1.94 ± 1.19; Control: 0.69 ± 0.34; p < 0.01) and the percentage of food intake (Experimental: 89.5 ± 23.93; Control: 70.86 ± 27.41; p < 0.01) of newborns in the experimental group were statistically significantly higher and their feeding duration was shorter (Experimental: 10.58 ± 8.29; Control: 16.14 ± 8.31; p < 0.01). CONCLUSIONS: It was determined that a pacifier given before feeding is effective on regulating physiological parameters and supporting feeding performance in preterm infants. PRACTICE IMPLICATIONS: The use of a pacifier in the first transition to oral feeding in preterm infants supports their sucking reflex, calms them down, and ensures the readiness for feeding.

The Evaluation of Oral Feeding in Preterm Infants: Turkish Validation of the Early Feeding Skills Assessment Tool.

OBJECTIVE: The Early Feeding Skills Assessment Tool (EFS) is a valid and reliable tool for evaluating preterm infants' oral feeding skills and readiness during the transition to oral feeding. There is currently no instrument with tested validity and reliability available to evaluate the oral feeding skills and readiness of preterm infants in Turkey. The aim of this study was to fill the need for such an instrument for use in the Turkish population by adapting and validating the EFS for the assessment of Turkish preterm infants during the transition to oral feeding. MATERIAL AND METHODS: This methodological, cross-sectional study included 107 preterm infants. Validity of the EFS-Turkish was tested with linguistic, content, and construct validity analyses, and its reliability was tested using internal consistency and item analyses. RESULTS: A panel of experts confirmed the content validity of the items in the EFS-Turkish (content validity index = 0.97). Cronbach's alpha for the total instrument was 0.95, supporting its internal consistency reliability. Item-total correlations ranged from 0.58 to 0.83 (P < .001). Confirmatory factor analysis confirmed the established EFS structure of 19 items and 5 factors. The tool demonstrated good model fit statistics (χ2/df = 2.24; P < .001). CONCLUSION: The EFS-Turkish is a valid and reliable instrument for use in neonatal intensive care units to evaluate the feeding skills of preterm infants during the transition to oral feeding. The use of the EFS-Turkish is recommended to facilitate the safe and successful development of preterm infants' oral feeding skills and to plan evidence-based initiatives.

Turkish Neonatal Nurses' Knowledge and Practices Regarding the Transition to Oral Feeding in Preterm Infants: A Descriptive, Cross-sectional Study.

PURPOSE: Neonatal nurses play an important role in preterm infants' safe and successful transition to oral feeding. Little is known about neonatal nurses' knowledge and practices regarding the transition to oral feeding in preterm infants. The aim of this study was to determine neonatal nurses' knowledge levels and clinical practices related to the process of transitioning preterm infants to oral feeding. DESIGN AND METHOD: This descriptive cross-sectional study was conducted with 275 neonatal nurses working in the neonatal intensive care units of 9 different hospitals in Istanbul, Turkey. Data were collected using a participant demographic form and a questionnaire about the neonatal nurses' knowledge and practices regarding oral feeding. RESULTS: The mean knowledge score of the nurses in this study was 64.7 out of 100 (SD = ±8.7; range = 40-87.5). Rates of correct responses were particularly low for items related to cue-based feeding, interventions to promote oral-motor development, non-nutritive sucking, and infant positioning for oral feeding. All of the NICU nurses participating in the study did not use the protocols developed for transitioning preterm infants to oral feeding. CONCLUSIONS: Nurses need knowledge and practical training on evidence-based therapeutic interventions that promote oral feeding skills in preterm infants during the transition to oral feeding. The use of protocols developed for transitioning preterm infants to oral feeding is limited in NICUs. PRACTICE IMPLICATIONS: In order to facilitate safe and successful feeding, nurses should improve their knowledge and practical skills regarding the transition to oral feeding and evidence-based therapeutic interventions for preterm infants.

Transcutaneous bilirubin levels of newborn infants performed abdominal massage: A randomized controlled trial.

PURPOSE: This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels of newborn infants. DESIGN AND METHODS: The sample group consisted of 90 newborn infants (experimental group: 44; control group: 46) who were followed in a university hospital after birth between March and August 2017. The data were collected using an Information Form, Observation Form, and Transcutaneous Bilirubin Level Meter. Bilirubin levels were measured 1 hr after the first breastfeeding in both groups. The abdominal massage was performed for 5 min in each session, was continued in three sessions per day; was completed in totally six sessions for 2 days in infants in the experimental group. The second bilirubin measurements were repeated at the 48th hour after the birth and bilirubin levels were compared in two groups. The Student t test was used to evaluate the normally distributed data and the Mann-Whitney U test was used to carry out statistics in nonnormal distribution of quantitative data. RESULTS: The bilirubin levels of the groups (experimental group: 1.06 ± 0.92; control group: 1.01 ± 0.98) were statistically similar before abdominal massage, t(88) = 0.25, p = 0.803. The difference of the bilirubin levels was compared in the groups before and after abdominal massage. The increase of bilirubin levels in the experimental group (1.96 ± 1.69 mg/dl) was statistically significantly lower compared with the control group (2.80 ± 2.30 mg/dl), t(88) = -1.974, p = 0.048. PRACTICE IMPLICATIONS: Abdominal massage is effective to reduce bilirubin levels of newborn infants.

First bathing time of newborn infants after birth: A comparative analysis.

PURPOSE: The study was designed as an experimental study to describe the effect of the first bathing time on the body temperature and skin moisture of a newborn after birth. DESIGN AND METHODS: The study population consisted of term newborns between January and June 2016 in the Istanbul University, Cerrahpasa Medical Faculty Hospital at Istanbul. The sample group was randomly divided into two groups according to different bathing times. The first group (39 infants) was given a bath 24 hr after birth, and the second group (34 infants) was given a bath 48 hr after birth. The infants in both the groups were dried with the first towel and then wrapped in a second dry towel, and a cap put to prevent hypothermia and to minimize any minor fluid loss. The body temperature and skin moisture level were measured before the bath, after the bath, and 10 min after the bath. RESULTS: It was determined that the 10th-minute body temperatures of the infants with the first bathing time 48 hr after birth were significantly higher compared with the infants with the first bath time 24 hr after birth (Z = -2.654; p = .008). PRACTICAL IMPLICATIONS: Postponing of the first bathing time of newborns to 48 hr after birth was effective in preserving the body temperature of the infant. Postponing the bath to the 48th hr improved moisture, which may improve skin integrity and aid with skin development.

What do Neonatal Nurses Know and Feel About Pain Management During Retinopathy of Prematurity Examination: A Qualitative Research.

AIM: The purpose of this study was to determine feelings, pain-related knowledge, and pain management-related practices of neonatal intensive care nurses during the retinopathy of prematurity examination. METHOD: The descriptive qualitative research design was used. In the study, the individual in-depth interviews were conducted with nurses by using the interview form with semi-structured open-ended questions. The data were evaluated by using the MAXQDA12. RESULTS: Two main themes were formed as "neonatal pain" and "retinopathy of prematurity examination" in line with the thematic analysis. In the study, it was determined that the nurses were able to limitedly identify the pain-induced physiological and behavioral symptoms in newborns, could not evaluate the symptoms and levels of pain by using pain scales with proven validity and reliability. The results indicated that the nurses provided the care based on their observations rather than evidence-based knowledge in the pain management. CONCLUSION: Nurses should be informed through evidence-based training programs and supported to transfer the acquired knowledge into practice. And the results emphasizes that the subject of pain and pain management should be inserted in nursing education cirruculum.

Effects of Underrunning Water Bathing and Immersion Tub Bathing on Vital Signs of Newborn Infants: A Comparative Analysis.

BACKGROUND: Newborn infants are susceptible to hypothermia during bathing due to environmental conditions. PURPOSE: This study examined the effects of 2 common newborn bathing methods used in Turkey, underrunning water bathing (URWB) and immersion tub bathing (ITB), on infant heart rate (HR), oxygen saturation, and body temperature. METHODS: In this randomized controlled study, 44 newborns were allocated to the ITB group and 36 newborns to the URWB group. Body temperature, HR, and oxygen saturation values of the newborns were compared between groups every hour during 4 hours before the bath to evaluate infants' vital sign stability. All measurements were compared at 10, 20, 40, and 60 minutes after the bath too. RESULTS: No statistically significant differences were found in vital signs performed prior to bathing as compared with after bathing; however, changes in oxygen saturation at 20 minutes after the bath were significantly higher in the ITB group (P < .05). CONCLUSION: Although both bathing methods decreased overall infant body temperature, ITB positively affected newborn oxygen saturation and HR to a greater degree compared with URWB. IMPLICATIONS FOR PRACTICE: ITB facilitated maintenance of oxygen saturation and HR during the bath and should be preferred for newborn infants to feel more relaxed. IMPLICATIONS FOR RESEARCH: These findings indicate a need for additional studies with larger sample sizes to further evaluate the effect of different bathing methods on newborn comfort.