Limits of Professional Competency in Nurses Working in NICU.

Our study aimed to find out the views of nurses working in neonatal intensive care units about the limits of professional competencies and to identify situations where the limits are crossed. METHODS: The research employed the focus group method. For this research we had three focus groups with nurses working in neonatal intensive care units. The results of the study were analysed using the thematic analysis described in Braun and Clarke. RESULTS AND CONCLUSIONS: Based on our research findings, it can be stated that the limits of professional competence of nursing staff working in neonatal intensive care units are defined and clear, but nurses often perform actions exceeding their competencies. This is usually done on the initiative of the nurses themselves, in cases of the deterioration of the state of the newborn, or when doctors delegate their functions to them. Confidence expressed by doctors leads to conflicting feelings of concern and, at the same time, pride in themselves.

PREDICTORS OF EMOTIONAL AND BEHAVIORAL PROBLEMS IN 1-YEAR-OLD CHILDREN: A LONGITUDINAL PERSPECTIVE.

Emotional and behavioral problems at an early age can reasonably be considered a high-risk factor for later mental health disorders. The aim of the article is to reveal predictive factors of 1½-year-old children's emotional and behavioral problems. The study was a part of a prospective birth-cohort study. The study sample consisted of 172 full-term infants (born during Gestational Weeks 37-42) and their mothers. Emotional and behavioral problems at the age of 1½ years were measured using the Child Behavior Checklist for Ages 1½-5 (T. Achenbach & L. Rescorla, 2000), which was completed by mothers. Emotional and behavioral problems at age of 1½ years were more prevalent in infants born via cesarean section, as compared to infants born vaginally without administration of medication. Newborns' suboptimal functioning after birth, complicated emotional acceptance of pregnancy, a couple's nonsatisfactory relationship during pregnancy, maternal distress during pregnancy and in the first months after childbirth, and inflexible and parent-oriented attitudes toward infant-rearing also predicted children's emotional and behavioral problems independent of sociodemographic factors. Results suggest that biomedical and psychosocial factors which manifest themselves in the prenatal and perinatal periods can have associations with later infant and child mental health.

Smoking during pregnancy in association with maternal emotional well-being.

OBJECTIVE: The aim of the study was to investigate psychosocial predictors of smoking during pregnancy. MATERIALS AND METHODS: It was a cross-sectional analysis of a prospective birth-cohort study. The participants were 514 mothers of full-term infants. Women completed questionnaires during hospital stay after delivery. Questionnaire included items on sociodemographic characteristics, planning and emotional acceptance of pregnancy, reproductive history, health-related behavior, emotional well-being, and relationships with a partner. RESULTS: Smoking during pregnancy was reported by 14.8% of the participants. Prenatal smoking was associated with secondary or lower education, maternal age less than 20 years, childbirth outside of marriage, history of elective abortion, unplanned pregnancy, lack of positive emotional acceptance of pregnancy by mother and father, emotional distress and alcohol consumption during pregnancy. Smoking during pregnancy remained significantly associated with prenatal alcohol consumption, previous elective abortion, and lack of positive emotional acceptance of pregnancy by mother even after adjustment for maternal age, education, and family structure. CONCLUSIONS: Results support an idea of complexity of the relationships among smoking, alcohol use, and emotional well-being. Lack of positive emotional acceptance of pregnancy by mother and history of elective abortions can be considered as possible associates of smoking during pregnancy and suggest that strengthening of positive attitudes toward motherhood could add to lower smoking rates among pregnant women.

Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment.

BACKGROUND: Problems experienced within the first year of an infant's life can be precursors of later mental health conditions. The purpose of this study was to examine the frequency and continuity of difficult behaviors in infants at 3 and 6 months of age and the associations of these difficulties with biomedical and psychosocial factors. METHODS: This study was a part of an ongoing prospective birth-cohort study. Study participants were 189 uniparous mothers and their full-term newborns. The index of infant difficult behavior was constructed. This index was then associated with the following factors: delivery mode, newborn function after birth, maternal emotional well-being, risk behavior, subjective evaluation of the quality of the relationship of the couple, and attitudes toward infant-rearing. RESULTS: Common difficult behaviors, including crying, sleeping and eating problems, were characteristic for 30.2% of 3 month old and for 22.2% of 6 month old full-term infants. The expression of infant difficult behaviors at the age of 3 months increased the likelihood of the expression of these difficulties at 6 months by more than 5 times. Factors including younger maternal age, poor prenatal and postnatal emotional well-being, prenatal alcohol consumption, low satisfaction with the couple's relationship before pregnancy, and deficiency of infant-centered maternal attitudes towards infant-rearing increased the likelihood of difficult behaviors in infants at the age of 3 months. Low maternal satisfaction with the relationship of the couple before pregnancy, negative emotional reactions of both parents toward pregnancy (as reported by the mother) and the deficiency of an infant-centered maternal attitude towards infant-rearing increased the likelihood of infant difficult behaviors continuing between the ages of 3 to 6 months. Perinatal biomedical conditions were not related to the difficult behaviors in infants. CONCLUSIONS: Our study suggests that early onset of difficult behavior highly increases the risk for the continuation of difficult behavior during infancy. In general, the impact of prenatal psychosocial environment on infant behavior decreases from the ages of 3 to 6 months; however, some prenatal and preconceptional psychosocial factors have direct associations with the continuity of difficult behaviors through the first half-year of an infant's life.

Escherichia coli colonization in neonates: prevalence, perinatal transmission, antimicrobial susceptibility, and risk factors.

UNLABELLED: Escherichia coli is one of the leading causes of early-onset neonatal sepsis in many industrialized countries. However, there is a lack of studies on Escherichia coli colonization in women and neonates. The study aimed at determining the prevalence Escherichia coli among pregnant women and newborns, perinatal transmission, antimicrobial susceptibility, and risk factors for neonatal colonization. MATERIAL AND METHODS: In this prospective, cross-sectional study, 827 infants born to 808 mothers were enrolled. The study was carried out from October 1, 2006, to June 30, 2007. Women were screened for E. coli carriage at 35-37 weeks of gestation or on admission for premature rupture of membranes and delivery; neonates, within 15 minutes of their lives. Risk factors for colonization were collected by a questionnaire and were recorded during labor. RESULTS: Maternal E. coli colonization rate was 19.9%; neonatal, 14.4%; and transmission rate, 21.4%. Less than one-fourth (22.7%) of neonatal E. coli strains were resistant to ampicillin. Logistic regression analysis revealed that anal sexual intercourse (OR, 3.91; 95% CI, 1.87-8.19), one sexual partner (OR, 2.01; 95% CI, 1.30-3.11), maternal vaginal Escherichia coli colonization (OR, 1.81; 95% CI, 1.12-2.93), maternal body mass index of ≤27 (OR, 1.77; 95% CI, 1.15-2.73), and maternal education lower than university level (OR, 1.70; 95% CI, 1.06-2.74) were associated with neonatal Escherichia coli colonization. CONCLUSIONS: The prevalence of maternal Escherichia coli colonization was higher in this study than other studies (19.9%). Neonatal Escherichia coli colonization was 14.4%. The resistance of Escherichia coli isolates to ampicillin was not high (22.7%). Improvement of maternal education and modification of mothers' sexual habits need to be undertaken to prevent neonatal Escherichia coli colonization.

The value of transcutaneous method of bilirubin measurement in newborn population with the risk of ABO hemolytic disease.

OBJECTIVE OF THE STUDY. To evaluate the correlation between total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) levels in newborn infants at risk of ABO hemolytic disease. MATERIAL AND METHODS. During a prospective study, 130 full-term (>or=37 weeks of gestation) newborn infants with diagnosed ABO blood group incompatibility were examined. TSB level was measured at the age of 6 hours; further measurements were performed at 24, 48, and 72 hours following the first measurement. Blood samples were collected from the peripheral veins. In clinical laboratory, total serum bilirubin level was measured using Jendrassik-Grof method. TcB level in the forehead was measured using a noninvasive bilirubinometer BiliCheck (SpectRX Inc, Norcross, GA) according to the manufacturer's instructions within +/-30 min after getting a blood sample. RESULTS. During the study, 387 double tests were performed to measure TSB and TcB levels. TSB level (114.83 [62.85] micromol/L) closely correlated with TcB level (111.51 [61.31] micromol/L) (r=0.92, P<0.001). The strongest correlation was reported at the age of 54 hours (r=0.873, P<0.001), the weakest - at the age of 6 hours (r=0.729, P<0.001). TSB and TcB levels showed a strong correlation; the difference between these values was significant (95% CI, 0.70; 5.93; P<0.05). The greatest difference between TSB and TcB levels was detected at the age of 6 hours (5.58 [17.46] micromol/L, 95% CI, 2.55; 8.61; P<0.001). No significant difference was reported at the age of 30, 54, and 78 hours. Using linear regression analysis, it was established that correlation of TSB and TcB was described by equation y=14.13+0.903x. Transcutaneously measured bilirubin level underestimated serum bilirubin level. When at the age of 6 hours TcB level is >or=98 micromol/L, ABO hemolytic disease in newborns may be diagnosed with 100% sensitivity and 98% specificity; positive predictive value was 62% and negative predictive value was 100%. While a newborn's age increases, TcB sensitivity and specificity for diagnosing ABO hemolytic disease decrease. CONCLUSION. While evaluating bilirubin level transcutaneously according to nomograms of serum bilirubin level, the results should be considered with caution, especially for newborns with a risk of ABO hemolytic disease. The hour-specific nomograms of transcutaneous bilirubin level should be used to evaluate hyperbilirubinemia using only a noninvasive method.

[The evaluation of psychomotor development in preterm infants]. / Pirma laiko gimusiu kudikiu psichomotorines raidos ivertinimas.

UNLABELLED: The aim of this study was to assess psychomotor development of very-low-birth-weight infants. MATERIAL AND METHODS: A prospective study was carried out in the Clinic of Neonatology, Kaunas University of Medicine Hospital. Two groups of infants were selected: the study group consisted of 79 preterm infants treated in the Clinic of Neonatology; the control group consisted of 31 term infants. Psychomotor development of the infants was evaluated five times at the age of 1, 3, 6, 9, and 12 months by using the Bayley Scales of Infant Development. RESULTS: The results showed that at the age of 1 month, a significantly delayed psychomotor development was noted in 15.2% of preterm infants and in none of term infants; moderately delayed development - in 25.3% of preterm infants and in none of term infants; normal - in 54.4% and 90.3%, respectively; and accelerated development - 5.1% and 9.7%, respectively. At the age of 12 months, 21.8% of preterm infants and none of term infants showed a significantly delayed psychomotor development; 26.9% of study group patents and none in control group - moderately delayed development; 51.3% and 93.5%, respectively - normal development; and 6.5% and none, respectively - accelerated development. CONCLUSION: Psychomotor development of preterm infants is retarded during all first year of life.

[Breastfeeding and medications]. / Zindymas ir medikamentai.

Breastfeeding is the most healthful method of feeding neonates and infants. In 2001 about 98% of new mothers in Lithuania started breastfeeding their neonates. One-third of nursing women (34%) discontinued breastfeeding at the time when infant reached the age of 3 months. About 56% of women breastfed their infants longer than 4 months. Only 3-6% of nursing women discontinued breastfeeding after the fourth month. Discontinuation of breastfeeding in 21-23% of all cases was directly or indirectly associated with use of medications. Such data suggest that there is a lack of information often leading physicians to advise mothers to discontinue breastfeeding because of medication use. The aim of this article was to survey the situation about classification of drugs used during breastfeeding and factors influencing drug transfer into milk in order to give more information for physician concerning the use of medication during breastfeeding. In this review, a short description of main pharmacokinetic characteristics, influencing drug transfer into milk; information on the classification of drugs used during breastfeeding; some considerations on drug safety and possible adverse effects of medications on breastfed infant; the list of drugs preferred for nursing women are presented.