The Role of Skin-to-Skin Contact and Breastfeeding on Atonic Postpartum Hemorrhage.

Objectives: were to (a) determine incidence of postpartum hemorrhage (PPH) in all women delivering between 2009 and 2015, and (b) determine the amount of Estimated Blood Loss (EBL) and duration of the third stage of labor in each subgroup for women with or without PPH, and (c) compare EBL and duration of 3rd stage of labor between subgroups in groups of women with or without PPH. Design: A retrospective chart review conducted using codes for atonic PPH. Setting: Records from a University based tertiary setting, 264 charts were reviewed and data from 154 charts were analyzed. One-way ANOVAs followed with post-hocs and a 2-way ANOVA were conducted. Results: PPH rate increased by 47.50% from 2009-2015. For women with PPH, EBL was lower in skin to skin contact (SSC) + Breastfeeding (BF) subgroup. For women without PPH, EBL was lower in SSC only subgroup. Third stage of labor duration was longer in women with PPH. Conclusions: Study confirmed the increasing trends of PPH due to uterine atony and proposed role of SSC and BF in decreasing EBL and shorten the duration of the 3rd stage of labor for PPH women, usefulness of SSC and BF as physiologic practices merit further study.

Physiologic brain dysmaturity in late preterm infants.

Neonatal EEG sleep was used to determine whether differences are expressed between healthy late preterm and full-term (FT) groups. Twenty-seven 24-channel multihour studies were recorded at similar postmenstrual ages (PMA) and analyzed for eight asymptomatic late preterm infants (LPT) compared with 19 healthy FT infants as a preliminary analysis, followed by a comparison of a subset of eight FT infants, matched for gender, race, and PMA. Z scores were performed on data sets from each group pair comparing each of seven EEG/Sleep measures for entire recordings, active sleep (AS) and quiet sleep (QS) segments and artifact-free intervals. Six of seven measures showed differences between the eight LPT and eight matched FT cohort pair comparisons of >0.3; rapid eye movements, arousals during QS, spectral correlations between homologous centrotemporal regions during QS, spectral beta/alpha power ratios during AS and QS, a spectral measure of respiratory regularity during QS, and sleep cycle length. Quantitative neurophysiologic analyses define differences in brain maturation between LPT and FT infants at similar PMA. Altered EEG/Sleep behaviors in the LPT are biomarkers of developmental neuroplasticity involving interconnected neuronal networks adapting to conditions of prematurity for this largest segment of the preterm neonatal population.

Access to and utilization of oral health care by homeless children/families.

The Surgeon General called dental caries the silent epidemic, suffered disproportionately by the poor. Homeless mothers/children are especially vulnerable as they lack access to dental care. This prospective study elucidated predictors of access, oral health, and the effectiveness of shelter-based care. A convenience sample of 120 homeless families (children n=236) provided predictor factors at intake and one month later. Nearly half the children (n=98) had dental caries. Ten independent variables explained 33% of the variance of access barriers; the most influential were mental health (B=-.426), oral health beliefs (B=.243), and victimization (B=.185). Ten independent variables explained 24.3% of the variance of oral health: mother's age (B5.351), number of children at the shelter (B=.337), and race (B=.154) had the most influence. Shelter-based care was effective in improving access: 43% of families secured dental appointments and perceived access barriers decreased after shelter-based care (t=4.695; p=<.001).