Verbal Behavior of Mothers With Opioid Use Disorder While Feeding Infants With Neonatal Opioid Withdrawal Syndrome.

BACKGROUND: An infant's cognitive development is highly dependent on early interactions with its primary caregiver, often its mother. Feeding, a frequent and early exchange between mothers and infants, is an important time for maternal-infant bonding. Mothers with opioid use disorder have been found to be more physically and verbally stimulating and more active during feeds than mothers with no opioid use. PURPOSE: The purpose of this study was to describe the characteristics of verbal interactions mothers with opioid use disorder expressed while engaged in a feeding encounter with their infant undergoing treatment for neonatal opioid withdrawal syndrome to offer insight into maternal experiences and potential challenges of feeding infants experiencing withdrawal. METHODS: A qualitative descriptive analysis of maternal verbalizations during the feeding was used in a secondary analysis using the Barnard Model as the theoretical framework for maternal-infant interaction. RESULTS: A theory-driven deductive approach was assumed to organize the identified subthemes within the concepts of the Barnard Model. Mothers frequently commented on hunger, satiation, and stress cues, while providing consolation, praise, and encouragement. Mothers expressed concerns regarding feeding volume and pace, and consequences related to feeding. IMPLICATIONS FOR PRACTICE AND RESEARCH: It is crucial that clinicians remember that feeding is an important time for maternal-infant bonding. Further research into the feeding interactions of mother-infant dyads with opioid exposure is warranted. As infants may present with subacute signs of withdrawal, including persistent feeding difficulties for months, further investigation into feeding challenges dyads experience after discharge from the hospital is needed.

Implementation of an onboard COVID-19 vaccination programme: a university partnership to vaccinate seafarers.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused many seafarers to be stranded on their ships due to lack of access to a vaccine and fear of contracting the COVID-19 virus limiting their ability to work on the ship. Once COVID-19 vaccinations were available, a lack of access to the vaccine continued to exist in the underserved seafarer population. This lack of access to the COVID-19 vaccine meant that seafarers were sometimes unable to leave their ships for months beyond their original contracts. MATERIALS AND METHODS: The University of South Florida (USF) College of Nursing collaborated with the USF Morsani Colleges of Medicine and Pharmacy in the development and implementation of an onboard COVID-19 vaccination programme at the request of the Port of Tampa Ministries. RESULTS: In 6 months, 1237 seafarers from 30 countries and 5 continents received the COVID-19 vaccination as a result of this programme. CONCLUSIONS: Partnership between a commercial port and a College of Nursing at a local university enabled hundreds of seafarers to be vaccinated against COVID-19. This programme serves as a model for industry and academic partnerships that can have a global impact on health and wellness.

Pandemic response: The identification of alternative clinical hours to ensure advanced practice nursing students meet program requirements.

ABSTRACT: The coronavirus (COVID-19) pandemic resulted in the abrupt withdrawal of clinical sites for advanced practice nursing students which worsened an already challenging placement process. Few studies to date have analyzed the use of alternative clinical practice experiences used to facilitate the completion of program requirements by advanced practice nursing students beyond direct hour requirements. The faculty team from one university decided to track and analyze their use of alternative clinical practice experiences for advanced practice nursing students actively enrolled during the first semester of the pandemic. The team collated student alternative hour entries within the clinical courses for review and statistical analysis. Data included input from advanced practice nursing students in family, pediatric primary care, adult gerontology primary care, adult gerontology acute care nurse practitioner concentrations, and nursing education, doctor of nursing practice, and nurse anesthesia programs. A total of 569 advanced practice nursing students participated in 15 distinct alternative clinical activities. There was a significant effect of students' program concentration on total number of virtual case study hours logged, F (6, 562) = 9.45, p < .0001, and a significant effect of students' program concentration on total number of continuing education hours logged, F (6, 562) = 7.79, p < .0001. Results can inform the use of concentration-specific alternative activities for advanced practice nursing students to address gaps in clinical experiences.

Developments in Nursing Practice to Address Substance Use in the Perinatal Period.

Since 1972, the year of the inaugural issue of Journal of Obstetric, Gynecologic, & Neonatal Nursing, substance use during pregnancy has remained a public health concern in the United States. This concern is currently exacerbated by factors such as the opioid and stimulant use crisis and widening health and social inequities for many women and families. The purposes of this historical commentary are to describe trends in the perception of women with substance use disorder and their infants and related sociolegal implications and to trace the evolution of related nursing practice and research during the past 50 years. We provide recommendations and priorities for practice and research, including further integration of support for the mother-infant dyad, cross-sectoral collaborations, and equity-oriented practices and policies.

Innovative Opportunities for Nurse Practitioner Education Uncovered by the Pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic resulted in the abrupt withdrawal of clinical sites for nurse practitioner (NP) students during the Spring semester of 2020. This situation necessitated the identification of innovative clinical opportunities to ensure advanced practice nursing students met course objectives and program requirements. METHOD: This article describes innovative clinical opportunities that met the needs of the community, including those impacted by the pandemic, and enabled NP students' progression toward completing clinical requirements. RESULTS: Participation in these unique opportunities provided more than 130 NP students with meaningful clinical experiences to increase competence in the care of vulnerable populations and communities during a public health crisis. CONCLUSION: Experiences supported competency development in the areas of leadership, clinical management, population health and infection control, policy and advocacy, informatics, telehealth, and ethical considerations while providing essential services to the community. These innovative clinical opportunities may be useful for graduate clinical programs worldwide. [J Nurs Educ. 2022;61(3):153-155.].

The Application of Trauma-Informed Care to Substance Use Disorder.

Trauma-informed care (TIC) has been described to apply to several groups of traumatized patient/families in the NICU. Trauma is multidimensional, including physical and psychological injuries with long-term effects on well-being and function. A newborn experiences the best outcomes when the mother also experiences the best outcomes. Thus, the TIC approach is applicable to the care of the infant with neonatal abstinence syndrome (NAS) and mother. Organizational adoption of this model is likely to provide a supportive and therapeutic environment for the infant with NAS and family.

Future roles of artificial intelligence in early pain management of newborns.

The advent of increasingly sophisticated medical technology, surgical interventions, and supportive healthcare measures is raising survival probabilities for babies born premature and/or with life-threatening health conditions. In the United States, this trend is associated with greater numbers of neonatal surgeries and higher admission rates into neonatal intensive care units (NICU) for newborns at all birth weights. Following surgery, current pain management in NICU relies primarily on narcotics (opioids) such as morphine and fentanyl (about 100 times more potent than morphine) that lead to a number of complications, including prolonged stays in NICU for opioid withdrawal. In this paper, we review current practices and challenges for pain assessment and treatment in NICU and outline ongoing efforts using Artificial Intelligence (AI) to support pain- and opioid-sparing approaches for newborns in the future. A major focus for these next-generation approaches to NICU-based pain management is proactive pain mitigation (avoidance) aimed at preventing harm to neonates from both postsurgical pain and opioid withdrawal. AI-based frameworks can use single or multiple combinations of continuous objective variables, that is, facial and body movements, crying frequencies, and physiological data (vital signs), to make high-confidence predictions about time-to-pain onset following postsurgical sedation. Such predictions would create a therapeutic window prior to pain onset for mitigation with non-narcotic pharmaceutical and nonpharmaceutical interventions. These emerging AI-based strategies have the potential to minimize or avoid damage to the neonate's body and psyche from postsurgical pain and opioid withdrawal.

A Review of Feeding Practices in Infants With Neonatal Abstinence Syndrome.

BACKGROUND: There has been an increase in infants with neonatal abstinence syndrome (NAS) in neonatal intensive care units (NICUs) over the past several decades. Infants with NAS experience withdrawal as a result of the sudden termination at birth of substance exposure during pregnancy. A serious sign related to infants diagnosed with NAS is poor feeding. The prevalence of NAS urges researchers and clinicians to develop effective strategies and techniques to treat and manage the poor feeding of infants exposed to substances in utero. PURPOSE: To synthesize current feeding methods and practices used for infants diagnosed with NAS. METHODS/SEARCH STRATEGY: PubMed, CINAHL, and Scopus were searched for articles published within the last 20 years that focused on feeding practices or feeding schedules, were written in English, were peer-reviewed, and described human studies. The search terms utilized were "neonatal abstinence syndrome" OR "neonatal opioid withdrawal syndrome" AND "feeding." FINDINGS/RESULTS: Three findings emerged regarding techniques and management of poor feeding in the NAS population. The findings included infants who received mother's own milk had decreased severity and later onset of clinical signs of withdrawal, demand feeding is recommended, and the infant's cues may be helpful to follow when feeding. IMPLICATIONS FOR PRACTICE: Clinicians should encourage mother's own milk in this population unless contraindications are present. Caregivers and clinicians must be receptive to cues when feeding infants with NAS. IMPLICATIONS FOR RESEARCH: Even with the clinical knowledge and experience that infants with NAS are difficult to feed, there is limited research assessing techniques and schedules that are effective in managing successful feeding. Future research should compare feeding schedules such as on-demand feeding versus regimented feeding schedules, as well as investigate techniques that mothers and nurses can utilize to encourage oral intake in this population.Video abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=37.

Prácticas al momento de la ablactación en Chitré, Herrera / Practices at the time of weaning in Chitre, Herrera

Resumen Introducción: Durante los años 90 en Panamá, un programa patrocinado por los EE. UU. llevo a cabo la Iniciativa para los Hospitales Amigos de los Niños (IHAN) como guía para educar a los profesionales clínicos, al público y a las mujeres en edad reproductiva sobre los beneficios de la lactancia materna. Como resultado, Panamá tiene actualmente la mayor proporción de mujeres que ofrece el pecho materno dentro de la primera hora de vida (89.9%), pero una de las menores tasas en la región de alimentación exclusiva al pecho materno hasta los 6 meses de edad. Este estudio explora la relación entre las practicas alrededor del periodo de ablactación y la historia nutricional del lactante en mujeres panameñas con un niño de hasta 1 año de edad utilizando un diseño transversal. Materiales y Métodos: Se invito una muestra por conveniencia de 35 binomios madre-hijo en dos Centros de Salud de Chitré, Herrera. Las mujeres que consintieron participar en el estudio completaron la Escala de Autoeficacia para la Lactancia Materna, Formulario Corto (BSES-SF) y se compararon las medidas antropométricas del niño utilizando los nomogramas de los CDC. Resultados: Los puntajes del BSES-SF variaron entre 29 y 56 (media = 44.2, DE = 7.9) puntos. Siete lactantes fueron considerados a riesgo para retraso en el Desarrollo; 40% estuvieron a riesgo de talla baja y 2 estuvieron a riesgo de sobrepeso. Conclusión: A pesar de que Panamá duplicó su cantidad de IHAN a 16%, muchos lactantes continúan a riesgo nutricional.

Abstract Introduction: In the 1990's, a U.S. sponsored program ran a campaign using the Baby-Friendly Hospital Initiatives (BFHI) as a guide to educate clinical professionals, the public, and women of child-bearing age in Panama about the benefits of breastfeeding. As a result, Panama has the highest proportion of women who breastfeed in the first hour of life (89.9%), but one of the lowest rates for breastfeeding at 6 months (UNICEF, 2014). This study explores the relationship between breastfeeding practices and infant nutritional history in Panamanian women with a child up to 1 year of age using a cross-sectional design. Materials and Methods: A convenience sample of 35 mother/baby dyads was recruited from two public health centers in the Azuero region of Panamá. Women who consented completed the Breastfeeding Self-Efficacy Scale, Short Form (BSES-SF), eight items from the Baby's Feeding and Health (BFH) instrument; and infant measurements were evaluated using the Centers for Disease Control standardized growth charts. Results: Breastfeeding Self-Efficacy Scale, Short Form scores ranged from 29 to 56 (mean = 44.2, SD = 7.9). Seven infants were at risk for developmental delay; 40% were at risk for short stature; 2 were at risk for overweight. Conclusion: Even though Panama has doubled its rate of Baby Friendly Hospitals to 16%, many infants remain at nutritional risk.

Feeding Infants with Neonatal Abstinence Syndrome: Finding the Sweet Spot.

PURPOSE: The purpose of this study is to learn how caregivers who are expert in feeding infants with neonatal abstinence syndrome (NAS) successfully feed these infants during withdrawal. DESIGN/SAMPLE: Focus group methodology was used to gather information from self-identified experts from three large regional NICUs. Twelve NICU nurses and speech therapists participated in open-ended, recorded discussions. Detailed flip chart notes were taken, reviewed, and verified by the participants before the group ended. RESULTS: Four major themes emerged verified by the participants: (1) optimal medication management, (2) follow the baby's cues, (3) calm and comfortable, and (4) nurture the relationship. Participants reported using both common and creative techniques. Keeping the infant calm was crucial to being successful, as well as maintaining good control of withdrawal signs. Feeding the infant facing away from them to avoid eye contact was used, as well as vertical rocking, continuous butt patting, bundling, "shhing" sound, and a novel feeding position.

Bringing Evidence-Based Practice to Latin America: Transforming Nursing Education and Practice.

Evidence-based practice (EBP) continues to gain global attention. In the Latin American country of Panama, nursing practice has largely been guided by oral tradition and clinical experience rather than the use of best evidence. The authors used a conference-based approach in a joint effort between the University of South Florida and the University of Panama to introduce EBP to nursing leaders in Panama to bring change to the nursing curricula and, ultimately, change in nursing practice. J Contin Educ Nurs. 2017;48(11):512-516.

Neonatal abstinence syndrome and the gastrointestinal tract.

Development of a healthy gut microbiome is essential in newborns to establish immunity and protection from pathogens. Recent studies suggest that infants who develop dysbiosis may be at risk for lifelong adverse health consequences. Exposure to opioid drugs during pregnancy is a factor of potential importance for microbiome health that has not yet been investigated. Since these infants are born after an entire gestation exposed to mu opioid receptor agonists and have severe gastrointestinal and neurological symptoms, we hypothesize that these infants are at risk for dysbiosis. We speculate that opioid exposure during gestation and development of NAS at birth may lead to a dysbiotic gut microbiome, which may impair normal microbiome succession and development, and impact future health of these children.

Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome.

Parents of infants with neonatal abstinence syndrome (NAS) in the NICU may have questions about the long-term consequences of prenatal exposure to methadone, both asked and unasked. Although the signs of withdrawal will abate relatively quickly, parents should be aware of potential vision, motor, and behavioral/cognitive problems, as well as sleeping disturbances and ear infections so their infants can be followed closely and monitored by their pediatrician with appropriate referrals made. Furthermore, this knowledge may inspire parents to enroll their infants in an early intervention program to help optimize their outcomes. There are still many unanswered questions about epigenetic consequences, risk for child abuse/neglect, and risk of future substance abuse in this population.

Characteristics of Maternal-Infant Interaction During Treatment for Opioid Withdrawal.

PURPOSE: The purpose of this study was to describe the interactions between mothers in a methadone treatment program and their infants during a bottle feeding and compare the findings with normed data. DESIGN: A comparative-descriptive design was used. SAMPLE: Data from 12 opiate-exposed mother-infant dyads were compared with normed data. MAIN OUTCOME VARIABLE: Nursing Child Assessment Satellite-Training Scale scores. RESULTS: The opiate-exposed dyads scored significantly lower than the normed dyads in the infant subscales of clarity of cues (p < .001, 95% confidence interval [CI], 1.56-4.08) and responsiveness to caregiver (p < .01, 95% CI, 0.27-2.5), as well as the total score (p < .001, 95% CI, 2.42-6.15). Parent sensitivity to infant cues subscale (p < .01, 95% CI, 0.42-2.37) and parent contingency score (p < .01, 95% CI, 0.55-3.81) were also significantly lower. The cognitive growth fostering subscale scores were significantly higher in the neonatal abstinence syndrome (NAS) group (p < .01, 95% CI,- 2.94 to- 0.7).

A Systematic Review: The Utility of the Revised Version of the Score for Neonatal Acute Physiology Among Critically Ill Neonates.

The revised version of the Score for Neonatal Acute Physiology (SNAP-II) has been used across all birth weights and gestational ages to measure the concept of severity of illness in critically ill neonates. The SNAP-II has been operationalized in various ways across research studies. This systematic review seeks to synthesize the available research regarding the utility of this instrument, specifically on the utility of measuring severity of illness sequentially and at later time points. A systematic review was performed and identified 35 research articles that met inclusion and exclusion criteria. The majority of the studies used the SNAP-II instrument as a measure of initial severity of illness on the first day of life. Six studies utilized the SNAP-II instrument to measure severity of illness at later time points and only 2 studies utilized the instrument to prospectively measure severity of illness. Evidence to support the use of the SNAP-II at later time points and prospectively is lacking and more evidence is needed.

Patterns of Disruptive Feeding Behaviors in Infants With Neonatal Abstinence Syndrome.

BACKGROUND: Severe irritability in infants with neonatal abstinence syndrome often impacts their ability to feed successfully, which challenges a mother's ability to demonstrate this most basic parenting skill. There is little empiric evidence to guide recommendations for practice in this population. PURPOSE: Describe the infant behaviors that disrupt feeding in infants with neonatal abstinence syndrome. METHODS: A mixed-method approach was used to describe digitally recorded infant feeding behaviors. Qualitative methodology was first used to identify categories of behaviors during the feeding. The categories were used as a coding scheme to identify the temporal sequence, duration, and frequency of behaviors observed during a feeding. RESULTS: The behavior categories that disrupted feeding were identified as fussing, resting, crying, and sleeping/sedated. Infants spent almost twice as much time in fussing as in feeding. The majority of the infants were fussing between 1 and 11 minutes during the feeding, and fussing disrupted feeding in every subject at least once. Feeding behavior occurred only 24% of the time, while fussing and crying occurred 51%. Fussing was the primary transitional behavior from one category to another. Infants who did not complete their feeding had nearly twice the mean number of fussing episodes as those who completed their feeding. IMPLICATIONS FOR PRACTICE: Fussing is a transitional state and appears to provide an opportunity to test interventions that help the mothers re-engage their infants in feeding. The frequency of the behavioral transitions provides a measure of irritability that has not been previously described in this population. IMPLICATIONS FOR RESEARCH: Additional study is needed to evaluate the impact and contributions of maternal behaviors and external variables on infant behavioral transition.

Care of the infant with neonatal abstinence syndrome: strength of the evidence.

There is little empirical evidence that guides management of infants with neonatal abstinence syndrome. The standard of care first described in the 1970s is still prevalent today, although it has never been tested in this population. Standard of care interventions include decreasing external stimulation, holding, nonnutritive sucking, swaddling, pressure/rubbing, and rocking. These interventions meet the goals of nonpharmacologic interventions, which are to facilitate parental attachment and decrease external stimuli. Many nursing interventions used in infants with neonatal abstinence syndrome have been tested in low-birth-weight infants, whose treatment often includes the same goals. Those interventions include music therapy, kangaroo care, massage, and use of nonoscillating water beds. Nursing attitude has also been shown to be impactful on parental attachment. The American Academy of Pediatrics recommends breast-feeding in infants whose mothers are on methadone who do not have any other contraindication. It also provides guidelines for pharmacologic management but cannot provide specific recommendations about a standard first dose, escalation, or weaning schedule. Buprenorphine has some evidence about its safety in newborns with neonatal abstinence syndrome, but high-powered studies on its efficacy are currently lacking. There are many opportunities for both evidence-based projects and nursing research projects in this population.

Ethical issues related to caring for low birth weight infants.

BACKGROUND: Currently preterm births are the leading causes of newborn deaths and newborn mortality in developed countries. Infants born prematurely remain vulnerable to many acute complications and long-term disabilities. There is a growing concern surrounding the moral and ethical implications of the complex and technological care being provided to extremely low birth weight infants in neonatal intensive care units in the developed nations. RESEARCH PURPOSE: The purpose of this study was to describe the ethical and moral issues that neonatal intensive care nurses experience when caring for low birth weight preterm infants and their families. RESEARCH DESIGN: A phenomenological method design was used to describe the lived experiences of nurses with ethical and moral issues encountered in the neonatal intensive care unit. One-on-one, semi-structured interviews using open-ended questions were used to gather data from the participants. RESEARCH PARTICIPANTS: The setting for this study was a 97-bed neonatal intensive care. A total of 16 female nurses were interviewed. ETHICAL CONSIDERATIONS: Approval to conduct the research study was obtained from the institutional review board of the hospital where the study was conducted. Formal signed consent was obtained from each participant. To ensure confidentiality, each participant was asked to choose a confederate name to be used in the interview and the transcriptions. FINDINGS: The thematic analysis identified five recurring themes: (a) at the edge of viability, (b) infant pain and discomfort, (c) crucial decisions, (d) communicating with parents, and (e) letting go. CONCLUSION: Neonatal intensive care unit nurses indicated that they often had challenges to their own sense of morality as they struggled to protect the infant from pain and unnecessary discomfort, provide care to an infant and their family whom they thought was faced with a lifetime of challenges and poor health, accepting decisions made by parents, and feeling as if parents were not adequately informed about outcomes.

Drug addiction in pregnancy: disease not moral failure.

Nurses have demonstrated concern for years about their interactions with pregnant women who abuse drugs. Reports of nurses' concern with substance abuse have been reported in the literature since the 1980s. As with any chronic disease, drug addiction causes physiologic changes, and the pathology that occurs in the brain drives characteristic behaviors. Research suggests that choices that addicts make are driven by pathology rather than by failure of a moral compass. This article reviews the theoretical explanations for addictive behaviors, describes the pathophysiology of drug addiction that is responsible for the predictable symptoms and behaviors exhibited by women who abuse prescription drugs and other opioids, and identifies nursing interventions to impact positive outcomes. Nurses who have a working knowledge of this disease will provide more effective nursing care to the women they encounter and are better prepared to make a difference in the lives of both women and their children.