Addressing Unmet Maternal Health Needs at a Pediatric Specialty Infant Care Clinic.

OBJECTIVE: The objective of this intervention was to evaluate the feasibility of screening mothers of medically fragile infants in the domains of 1) depression, 2) tobacco exposure, and 3) family planning at a post-neonatal intensive care unit (NICU) developmental pediatric visit. Additionally, we sought to estimate the percentage who met criteria for further evaluation in the three domains assessed. METHODS: A cross-sectional questionnaire was administered to 100 caregivers of medically fragile infants at a specialty, post-NICU clinic visit. Participants' responses in three domains were evaluated and appropriate referrals were provided. Analysis was then restricted to the 87 biological mothers who completed the screening. Study staff contacted the mothers 2 months later to determine whether services had been accessed and to assess overall satisfaction with the screening within the pediatric visit. Qualitative interviews were conducted with pediatric clinic staff. RESULTS: Screening questionnaires were completed by 87 biological mothers. Twenty-two mothers (25%) met referral criteria. Pediatric clinic staff and providers were comfortable administering the screening instrument, and there was minimal disruption to clinic flow. CONCLUSIONS: Mothers of medically fragile infants are likely to have unmet health care needs that can be identified at a specialty pediatric clinic visit. A screening and referral intervention can be implemented with minimal interruption in pediatric clinic flow and is acceptable to mothers and pediatric providers.

Parental Perceptions of Weight Status in Preterm Compared with Term Infants.

Background Parents of overweight children frequently under-recognize their child's overweight status. We hypothesized that parents of preterm children would be more likely than parents of term children to incorrectly perceive their child's weight. Methods We recruited parents of term and preterm when children were 2 months to 2 years of age. Small for gestational age infants were excluded. We compared parents' perceived weight category with child's actual weight category, based on normative data (underweight, normal weight, or overweight). We based analyses on encounters and adjusted for within-child clustering across repeated measures. Results In the preterm (n = 94) and term (n = 1,263) cohorts, 12 and 13% of children, respectively, were overweight (weight-for-length ≥ 95th percentile). Among parents of overweight children, 91% in the preterm cohort and 90% in the term cohort reported their child as healthy weight. Among healthy weight children (weight-for-length 6th-94th percentile), parents in the preterm cohort were more likely to report their child as underweight compared with parents in the term cohort (24 vs. 7%; p < 0.001). Conclusion Parental perception of weight status was impaired among parents of overweight children regardless of gestational age. However, parents were more likely to perceive their healthy weight child as underweight if their child was preterm.

Antenatal and early postnatal antecedents of parent-reported attention problems at 2 years of age.

OBJECTIVES: To assess antenatal and early postnatal antecedents of attention problems identified by the Child Behavior Checklist in extremely preterm children. STUDY DESIGN: In a cohort of 826 children born between 23 and 27 weeks' gestation, we collected demographic, birth, and postnatal information. We then identified behavior problems by using parent ratings from the Child Behavior Checklist at 2 years' adjusted age. We created time-oriented logistic regression risk models to identify significant risk factors for attention problems and Diagnostic and Statistical Manual of Mental Disorders-compatible attention deficit/hyperactivity problems (ADHP(DSM)). RESULTS: Children were at increased risk of both attention problems if they were born to a woman who had no formal education beyond high school and/or a woman who was exposed to secondhand smoke. Recovery of a single organism from the placenta was associated with increased risk of an attention problem, and fetal stem vessel thrombosis and recovery of Mycoplasma species were associated with increased risk of ADHP(DSM). Infants of multifetal gestations were at reduced risk of both attention problems. The only postnatal risk factor for an attention problem was recovery of bacteria from a tracheal aspirate. CONCLUSION: Among extremely preterm infants, several potentially modifiable antenatal and perinatal antecedents are associated with increased risk for attention problems and ADHP(DSM) at 2 years adjusted age.

Factors Influencing the Accuracy of Noninvasive Blood Pressure Measurements in NICU Infants.

OBJECTIVE: Compare invasive blood pressure (IBP) and noninvasive blood pressure (NIBP) measurement methods in the neonatal intensive care unit (NICU) across various gestational age and postmenstrual age (PMA), and determine the effect of gestational age and PMA on accuracy of NIBP measurements. STUDY DESIGN: Retrospective chart review of paired mean IBP and NIBP measurements from infants admitted to a single NICU from January 2008 through December 2010. Infants with congenital anomalies or receiving therapeutic hypothermia were excluded. Difference between paired measurements was analyzed using Bland-Altman method. We examined the association between PMA, sex, race, mechanical ventilation, medications, and axillary temperature, and the difference in measurements using a mixed effects linear regression model. RESULTS: Eighty-seven infants had 243 observations. The mean (range) gestational age at birth was 31.9 (23-41) weeks and PMA at time of measurement ranged from 26 to 52 weeks. We found poor agreement between IBP and NIBP measurements, with mean difference (95% limits of agreement) of -8.8 (11, -28.7) mm Hg. The mean blood pressure percent difference ( ± SD) was -28.3 ( ± 35.6%). A greater blood pressure percent difference between the two measurement techniques was associated with lower PMA and lower mean IBP. CONCLUSION: NIBP measurements overestimate IBP measurements particularly in smaller, sicker infants at lower IBP measurements.

A quality improvement project to improve the rate of early breast milk expression in mothers of preterm infants.

Providing breast milk is challenging for non-nursing mothers of premature infants. Early breast milk expression results in successful and longer lactation in mothers of very low birth weight (VLBW) infants. This quality improvement initiative sought to increase the rate of early milk expression in mothers of VLBW infants and increase the proportion of infants receiving maternal breast milk (MBM) at 28 days of age and at discharge. Phase 1 (n = 45) occurred between April 1, 2012, and August 31, 2012. Phase 2 (n = 58) occurred between September 1, 2012, and February 28, 2013. Pre-phase 2 actions included increased lactation consultant workforce, early lactation consultation, tracking of MBM supply, and physician education. Inborn infants < 1500 grams were eligible. Primary outcomes were the time of first maternal milk expression (TFME) and infant feeding type at 28 days of age and at discharge. The median TFME decreased from 9 (25th, 75th percentile; 6, 16) hours to 6 (5, 11) hours after implementation (P = .06). The proportion of infants receiving exclusive MBM at 28 days and at discharge was 64% and 74%, respectively (P = .40), and the proportion of infants receiving exclusive MBM at discharge increased from 37% to 59% (P = .046). In conclusion, a multidisciplinary initiative aimed at improving the rate of early milk expression was associated with more VLBW infants receiving exclusive MBM at discharge.