Kangaroo skin-to-skin care for premature twins and their adolescent parents.

Risk factors associated with prematurity and adolescent parenting greatly increase when combined with multiple birth. Kangaroo care (KC) for preterm infants is well documented, although KC with twins or with adolescent parents is mentioned only briefly. In this case study, adolescent parents experience KC with their 32-week twin sons beginning 19 hours postbirth. These young parents interacted with, responded to, and took responsibility for their newborn sons, behaviors that are sometimes difficult for adolescent parents. Thus, KC appeared to be an effective intervention for these adolescent parents. Additionally, three kinds of KC with twins were identified: separate, sequential, and shared.

Physiological responses of preterm infants to breast-feeding and bottle-feeding with the orthodontic nipple.

BACKGROUND: Although the orthodontic nipple has been recommended for many years to supplement breast-feeding infants, it is not known if this nipple is suitable for hospitalized preterm infants whose mothers wish to breast-feed. OBJECTIVES: To describe and compare short-term physiologic responses of preterm infants serving as their own controls for two feeding methods, breast-feeding and bottle-feeding with the orthodontic nipple. METHOD: The sample consisted of eight preterm infants, mean birth weight of 1,370 grams and mean gestational age at birth of 30.2 weeks' gestation, who served as their own controls for breast- and bottle-feeding sessions. The dependent variables, sucking, breathing, and oxygen saturation, were measured noninvasively throughout breast- and bottle-feeding sessions and recorded on a polygraph. Data were analyzed quantitatively and qualitatively for 14 breast-feeding sessions and 15 bottle-feeding sessions. RESULTS: Statistically significant differences were found in that infants breathed more during sucking bursts for breast-feeding sessions when compared to bottle-feeding sessions and had fewer episodes of oxygen desaturation during breast-feeding. A characteristic sucking waveform associated with organized breathing was observed for some infants during bottle-feeding with the orthodontic nipple. CONCLUSIONS: These data suggest that the orthodontic nipple is appropriate for supplementing breast-feeding for some preterm infants. Further research is needed to examine long-term outcomes.

Maternal kangaroo (skin-to-skin) care in the NICU beginning 4 hours postbirth.

Kangaroo care (KC) for preterm infants is becoming well known in the United States. Typically, KC is given by mothers in the neonatal intensive care unit (NICU) beginning days or weeks postbirth. This case report documents KC beginning at 4.5 hours postbirth with a healthy mother whose 32-week, 1,953 gram infant required initial care in the NICU. The nurse's role in supporting this care is described. Both parents experienced KC with their son and were soon convinced of the exceptional benefits he received. The infant was transferred to intermediate care on Day 2, regained his birth weight by Day 12, was discharged home on Day 21. He was breast-feeding exclusively at 40 weeks corrected age, and had Bayley mental and motor development scores within normal limits at 6 months corrected age.

Effects of enkephalins on perfusion pressure in isolated hindlimb preparations.

A series of studies were conducted to determine the effects of leucine-(leu-) enkephalin and methionine-(met-) enkephalin on perfusion pressure. These experiments utilized isolated perfused femoral arterial preparations in pentobarbital-anesthetized cats. The enkephalins were administered intraarterially into the femoral artery and changes in perfusion pressure recorded. Leu-enkephalin in doses of 1 microgram to 320 micrograms produced significant dose-dependent decreases in perfusion pressure (4.0 +/- 1.3% with 1 microgram to 19.1 +/- 2.1% with 320 microgram). Similar declines in perfusion pressure (5.2 +/- 2.4% with 1 microgram to 21.7 +/- 4.1% with 320 micrograms) were observed following the administration of met-enkephalin. Pretreatment with naloxone (3 mg/kg) antagonized the effects of both enkephalins. Diphenhydramine (2 mg/kg) effectively antagonized the leu-enkephalin elicited decline in perfusion pressure but blocked the effects of met-enkephalin only at lower agonist doses. Propranolol treatment (4 mg/kg) did not alter the pressure responses to either enkephalin. The results of the study show that intraarterially administered enkephalins exert a vasodilatory effect on vasculature in skeletal muscle which may be direct, indirect or both. The differential antagonism of the effects of the two enkephalins suggest that the two opioids act through different receptors or multiple receptors.

Effects of intravenously administered Leu- or Met-enkephalin on arterial blood pressure.

The purpose of these studies was to determine if two endogenous opioids, leucine (Leu) and methionine (Met) -enkephalin, alter blood pressure and, if so, by what mechanisms. Studies from our laboratory show that intravenous administration of Leu-enkephalin in doses of 0.032-320 microgram/kg induced a biphasic response in pentobarbital-anesthetized cats. A transient rise in mean arterial pressure was followed by a more prolonged decline. Administration of Met-enkephalin caused only a decline in mean arterial pressure. Neither agent significantly altered heart rate, venous pressure or the EKG. Having determined that both enkephalins altered blood pressure and observed that the responses were qualitatively different, selected pharmacological antagonists were employed to see if the alterations in blood pressure could be blocked. Naloxone blocked the hypertensive responses and antagonized the hypotensive effects seen with the administration of Leu-enkephalin. Naloxone also shifted the dose-effect curve of Met-enkephalin to the right. Diphenhydramine attenuated both the hypertensive and hypotensive responses of Leu-enkephalin. However, diphenhydramine pretreatment did not alter the decline in blood pressure seen with the higher doses of Met-enkephalin. Propranolol exerted some antagonistic activity in association with the rise in blood pressure seen with Leu-enkephalin, but propranolol did not alter the drop in pressure observed with the administration of either enkephalin. These results show that intravenous administration of the enkephalins can alter blood pressure and these effects are not alike for each enkephalin. Additionally, the enkephalins are not blocked in the same fashion by antagonists, giving support to the hypothesis that the two enkephalins interact with different receptors.