Quantitative and qualitative predictors of development for low-birth weight infants of Latino background.

Despite the large number of Latino infants and children in the United States, little Latino-specific data are available for these children. For this study a wide variety of factors that influence the cognitive and motor development of 123 high risk infants from low socioeconomic status Latino families were examined. Because there is not a consensus on the most predictive components of development in this population, a combination of objective and subjective measures were used. The objective measures used were the Home Observation for the Measurement of the Environment (HOME), the Nursing Child Assessment Teaching Scale (NCATS), the Maternal Confidence Questionnaire (MCQ), Bayley scores, and the Parental Stress Index (PSI). Hierarchical multiple regression analysis was used to examine the effect of the objective and subjective measures on the children's mental and motor development. Multiple regression indicated that the Bayley Mental scores at 24 months were predicted from three objective variables (social support, maternal confidence, and mother-infant interaction) and two subjective variables (report of stress and maternal income). For motor development, maternal income, the home environment, and maternal confidence explained most of the variance. The fact that stress, measured subjectively, was the most significant predictor of the cognitive development of Latino low-birth weight infants points to the fact that this construct should not be overlooked and should not be measured by standardized objective measures. Furthermore, the subjective report of mothers in regard to the support they receive was not correlated to the objective measure of social support obtained. Our results indicate that certain factors may be better assessed by interview and subjective measures rather than well-tested objective measures.

Effect of less frequent bathing of preterm infants on skin flora and pathogen colonization.

OBJECTIVE: To determine if less frequent bathing alters colony count or type of organism in skin flora of preterm infants. DESIGN: Descriptive, repeated measures study. SETTING: A regional neonatal intensive-care unit. PARTICIPANTS: Forty-five preterm infants, 31 weeks mean gestational age (SD +/- 1.6 weeks) and 17 days mean postnatal age (SD +/- 3.7 days). INTERVENTIONS: Before the study, all infants received a bath every other day. On Day 1 of the study, a routine sponge bath was given, then no further bathing was performed for 4 days. MAIN OUTCOME MEASURE: Serial axillary skin cultures to identify the number of colony forming units (CFU) and type of organism were obtained within 30 minutes of the bath on Day 1 and at the same time on Days 2, 3, and 4. RESULTS: Normal skin flora CFU count, predominantly coagulase-negative staphylococci, increased within 48 hours after bathing compared to values 30 minutes after bathing. There were no differences in normal skin flora CFU on Days 2, 3, and 4. Pathogens were identified in 12 infants for at least one time point during the study. Significantly fewer pathogens were found in the cultures over time, despite longer interval since bathing, and no infant developed symptoms of infection during the study period. CONCLUSION: Findings from this study suggest that the frequency of bathing of preterm infants can be reduced without increasing the risk of infection.

Predictors of development in premature infants from low-income families: African Americans and Hispanics.

OBJECTIVE: The goal of the study was to determine the factors that affect the motor and mental development of premature Latino and African American infants from low socioeconomic backgrounds. STUDY DESIGN: A prospective study of 41 low birth weight (LBW) African American infants along with 82 LBW Hispanic infants examined the factors that influence mental and motor development at 8 months of age. Multiple regression analysis was performed to correlate perinatal, environmental, and demographic variables with mental and motor development using the Bayley scales of infant development. The perinatal variables included birth weight, gestational age, and days of hospitalization. The demographic and environmental variables chosen were: income, education, the home environment, social support, mother-infant interaction, and maternal confidence. RESULTS: The results indicated that, for African American infants, motor development was correlated with the mother's education and the number of days the infant spent in the hospital Mental development for African American infants was predicted by the home environment. For Hispanic infants, the home environment predicted motor scores while the mother-infant interaction was correlated with the mental scores. CONCLUSION: Factors contributing to the development of premature infants vary according to ethnicity, and social variables may be more predictive of development than medical factors.

Therapeutic play for hospitalized preschoolers in Lebanon.

Therapeutic play in the form of an interactive puppet show was administered to 50 preschool children one day before surgery in a hospital in Lebanon. A control group of 50 preschool children received routine care but no therapeutic play. Physiological and behavioral measures were assessed on admission, at the time of a stressful procedure (preoperative injection), after surgery, and after discharge. Although on admission there had been on significant differences between the means on physiological measures for the two groups, the children who received the therapeutic play intervention manifested markedly less anxiety and more cooperation and had significantly lower mean blood pressures and pulse rates during the injection than the control group. Following surgery, the experimental group took less time to void their bladders, another physiological indication of lower stress level. After hospital discharge, the children who had received therapeutic play had significantly lower scores on all six factors of the Post Hospital Behavior Questionnaire. This study demonstrates that therapeutic play is a valid means of reducing stressful responses to hospitalization and surgery among children in Lebanon.

Nursing care of Arab children: consideration of cultural factors.

As the number of Arabs living in the United States increases, so does the number of children of Arab descent seeking medical attention. However, despite the sizable and ever increasing number of American Arabs, their health beliefs and practices remain relatively unexplored. When cultural differences exist with regard to beliefs about health and illness, health practices, and health-seeking behavior, the process of health-related interaction becomes difficult and often detrimental to health outcomes. Among Arab immigrants, their children tend to be the least visible population. This article describes the beliefs and practices, both cultural and health-related, of Arab families, with an emphasis on child care and rearing. Nursing considerations, which take these cultural factors into account, are discussed that will accommodate the needs of Arab children receiving professional Western medical treatment.

Therapeutic play and bone marrow transplantation.

Constructive, therapeutic play is an essential part of the care of children with long-term hospitalizations. The O'Connor theoretical framework supports the importance of play in ensuring the emotional, developmental, and physical health of children. The negative effects of long-term hospitalization are particularly evident for children who have undergone bone marrow transplants and must be kept in germ-free environment and isolation for extended periods of time. This article describes a successful play therapy program in a Bone Marrow Transplant Unit, using a play cabinet designed to provide readily available, sterilized toys that are appropriate for each of four age groups. Two cases are presented that show the efficacy of the use of the play cabinet in play therapy programs.

Effects of war on the behavior of Lebanese preschool children: influence of home environment and family functioning.

To investigate the psychological effects of armed conflict on children, the behavior of preschool Lebanese children exposed to heavy shelling two years prior to data collection was compared to that of Lebanese children who had experienced no direct shelling. Although the quality of the home environment was similar in the two groups, children who lived in the area of heavy shelling had significantly more behavioral problems than did those not exposed to shelling. For children in the shelled area, negative sequelae appear to have been buffered by a positive home environment and what the mother perceived as a more functional family.

Premature infant responses to noise reduction by earmuffs: effects on behavioral and physiologic measures.

The continuous high-intensity noise in the neonatal intensive care unit (NICU) is both stressful and harmful for the premature infant. Although some researchers have found evidence that loud noise can cause hearing loss and alter physiologic and behavioral responses, no study to date has investigated the benefits of noise reduction by the use of earmuffs. In this study earmuffs were placed over the premature infants' ears to reduce noise intensity in the NICU while physiologic and behavioral responses were measured. Two sites were used to collect data: in the first setting, 17 low birth weight infants were randomly assigned to an experimental and a control group, whereas 13 infants from a second hospital acted as their own controls and were tested with and without earmuffs. Earmuffs that reduced the intensity of noise by 7 to 12 dB were worn by infants in the experimental group only during the observation periods. Infants in the control group were exposed to the usual noise in the NICU. The infant's physiologic and behavioral responses were observed for four 2-hour intervals, morning and evening, on two consecutive days. Most of the significant results were from the site at which infants acted as their own controls. When infants wore the earmuffs, they had significantly higher mean oxygen saturation levels and less fluctuation in oxygen saturation. Furthermore, these infants had less frequent behavioral state changes, spent more time in the quiet sleep state, and had longer bouts in the sleep state. It is imperative that NICUs develop aggressive antinoise policies to substantially and consistently reduce noise.

Nursing management of children with sickle cell disease: an update.

This article reviews current trends in managing children with sickle cell disease (SCD). The pathophysiology, medical and nursing management, and complications of SCD are discussed. Current trends and research findings related to improving the prognosis of children with SCD are offered. The importance of the nurse's role in educating the family about the disease process and clinical interventions to prevent or manage complications are stressed. Lastly, a nursing care plan is offered which focuses on pertinent nursing diagnosis.

Responses of premature infants to routine nursing interventions and noise in the NICU.

This study documents the effects of routine nursing procedures and loud noise events on the behavioral and physiological responses of premature infants in the neonatal intensive care unit (NICU). The subjects were 55 premature infants ranging in weight from 480 to 1930 g and in age from 23 to 37 weeks gestation. Nineteen nursing activities common in the NICU as well as loud noises such as alarms, telephones, loud speech, or infant crying were recorded every 5 minutes. The infants' physiological and behavioral responses were recorded at 5-minute intervals for 2 hours in the morning and 2 hours in the evening. Nursing interventions and noise resulted in significant changes in both the behavioral and physiological responses of infants. The presence of noise alone and nursing interventions alone resulted in similar physiological responses; however, the combination of these events was not cumulative. Infants changed their behavioral states an average of six times each hour during the 12 observation periods, and the number of enduring states (10 minutes or longer) averaged 10 times in the 48 observation periods of 4 hours.

An integrative research review of intervention studies with premature infants from disadvantaged backgrounds.

The recent emphasis on intervention programs to better the prospects of children from poor and minority backgrounds sparked this integrative review of studies looking at disadvantaged families with premature infants. The author uses three areas to characterize the studies reviewed: The type of intervention, attrition rates, and outcome measures. Thirteen studies are abstracted and examined. Suggestions are offered related to the characteristics of successful interventions, how to decrease attrition rates, and which assessment measures should be used to improve documentation of the efficacy of interventions.

Chronic illness in Lebanese preschoolers: impact of illness and child temperament on the family.

The impact on their families of chronic illness in young Lebanese children and the relationship between such impact and perceived temperament of the child were assessed. The effect was greater in families of children with leukemia than in families of children with congenital heart defects. Chronically ill children were rated as more persistent/unstoppable, difficult, and irregular, and as less adaptable than were healthy children. Culturally determined perceptions of child temperament were examined with regard to differential impact of illness on the family.

The confidence of Latina mothers in the care of their low birth weight infants.

The growing numbers of Latina mothers with low birth weight (LBW) infants in U.S. hospitals prompted an investigation of maternal confidence and caretaking ability in this group. A sample of 54 Mexican-born, Latina mothers with LBW infants was compared with a group of 25 who had full-term infants. Unexpectedly, there was no significant difference in the perceived maternal confidence of the two groups. Behaviors indicative of sensitivity and competence in caretaking, assessed in mothers with LBW infants, did not correlate with maternal confidence. Factors correlated with maternal confidence and caretaking behavior were the mother's age, education, and parity, as well as the infant's birthweight, weight at discharge, and medical complications. Weight at discharge correlated with caretaking behaviors. The strongest predictor of maternal confidence was parity, followed by infant health (fewer medical complications). These factors together accounted for 25% of the variance in confidence, suggesting that other factors that contribute to maternal confidence of Latina mothers need to be identified.

The benefits of home care for sick premature infants.

The care of sick premature infants at home is evaluated in terms of the benefits related to the health outcome of infants. The home care was provided by trained pediatric nurses through a service-oriented community agency. Pediatric nurses delivered home care 24 hours or less to sick very low birth weight infants discharged from the neonatal intensive care unit in lieu of continued hospitalization. Nursing care at home is described along with a sample nursing care plan for an infant with bronchopulmonary dysplasia. The efficacy of home care on medical utilization indicated that there were less hospitalizations, emergency room visits, and visits to the specialty clinics than previously reported in the literature. Home visitation appeared to improve the health of high-risk premature infants, is cost effective, and may be less stressful for parents.

The short bowel syndrome: an update and a case study.

Infants with the short-bowel syndrome are living longer and are increasing in number due to new medical treatments and a larger number of survivals with very low birth weights. This article reviews the medical and nursing management of these infants. A case study of an infant with the short-bowel syndrome is presented with a detailed nursing care plan emphasizing the physical, emotional, and social care of these infants.

Comparing the effects of neonatal intensive care unit intervention on premature infants at different weights.

This study investigated the efficacy of an intervention program in the neonatal intensive care unit (NICU) on the development of premature infants from low socioeconomic status (SES) backgrounds. Sixty premature infants born at a county hospital over an 8-month period and their mothers were the focus of this study. The infants were assigned to either a control group or an experimental group. The experimental group received teaching and reinforcement about their babies' behavior from a child development specialist when they visited the NICU. Of the initial 60 infants, 49 completed the study at 8 months, but because data from only the first born of twin pairs were used, 41 infants were included in the final analysis. Infants were divided into two weight groups: one below and one above 1500 g. There was a significant effect of the intervention on the infants' mental and motor scores at 4 and 8 months. Significant differences on the total Home Observation for Measurement of the Environment (HOME) were noted between the groups. There were some significant differences between intervention and control groups on the interaction of the mother with the infant at 4 months but not in the play situation at 8 months. The lighter premature infants had a greater boost from the intervention than did the heavier premature infants. The intervention had no effect on the mother's perception of her infant's temperament or on her confidence skills. In line with other research findings, the infants who weighed less than 1500 g seemed to have benefited most from the intervention, and the effect of the intervention was most notable at 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome after developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status.

The efficacy of developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status was evaluated. Mothers were assigned to an experimental group in which they met at least weekly with an infant-development specialist or to a control group in which they did not. During the sessions, they participated in a structured developmental and behavioral assessment of their infants, with the goal of enhancing their ability to provide appropriate interactions and environmental stimulation for their infants. When the infants were 4 and 8 months of age, follow-up home visits by a nurse who was unaware of group assignment showed that the experimental-group infants performed more optimally on the Bayley Mental scale (Bayley Scales of Infant Development) at 4 and 8 months of age and on the Bayley Motor scale at 4 months. In addition, the home environment was more developmentally appropriate at 4 months of age, and the mothers rated their babies as temperamentally less difficult at 4 and 8 months. We conclude that a mother-focused, neonatal intensive care unit-based program that utilizes the assessment process in a therapeutic way is an effective strategy in the initiation of interventions for families of low socioeconomic status whose infants were born prematurely.

Assessing maternal competence and sensitivity to premature infants' cues.

Because it is becoming increasingly evident that the sensitivity of mothers to their premature infants can affect the mother-infant relationship, means to assess maternal sensitivity to infants are essential. The Boston City Hospital Assessment of Parental Sensitivity (BCHAPS) was the tool used in this study to assess maternal competence and sensitivity to premature infants in the Neonatal Intensive Care Unit (NICU). The concurrent validity of the tool was determined by examining the relation between scores on the BCHAPS and several maternal characteristics (i.e., family income, education, and parity) and infant characteristics (i.e., weight, gestational age, APGAR scores, and severity of illness). The predictive validity of the BCHAPS was determined by comparing the BCHAPS scores to mother-infant interaction behaviors when infants were 8 months old. Scores obtained on the BCHAPS correlated with mother-infant interaction scores at 8 months and to parity. There was no correlation between the BCHAPS scores and other maternal-infant characteristics. The results of this study indicate that the BCHAPS is a tool that can be used clinically to assess maternal behaviors in the NICU and that can predict the mother-infant relationship long after the discharge of the infant.

The relationship between maternal confidence and mother-infant behaviors in premature infants.

The purpose of this study was to investigate the relationship between maternal confidence in mothers of premature infants, maternal behaviors and skills, and infant temperament. The relationship between certain prenatal and background variables and maternal confidence also was assessed. The sample consisted of 49 mother--infant pairs from low socioeconomic backgrounds who were followed for 8 months. Maternal behaviors were assessed in the neonatal intensive care unit and during 4- and 8-month follow-up visits at home. Infant temperament was assessed using the Bates Infant Characteristics Questionnaire. The results revealed that maternal confidence was related to education, income, and parity as well as the presence and severity of intraventricular bleed. There was no relationship between observed maternal behaviors and skills and perceived confidence by mothers. Maternal confidence was related to infant temperament ratings.