Authors
- Section Editor(s): Tiedje, Linda Beth PhD, RN, FAAN
- Bakewell-Sachs, Susan PhD, CPNP, RN, CS
Article Content
Binge Drinking in Pregnancy-Frequency and Methodology
Kesmodel, U. (2001).American Journal of Epidemiology, 154(8), 777-782.
We already know the association between drinking alcohol in pregnancy and adverse outcomes for babies. Surprisingly, most studies have found little or no effect of binge drinking on neonatal outcomes. This study: 1. examines why the connection between binge drinking and adverse outcomes may not have been found, and 2. makes specific suggestions about obtaining more accurate information about binge drinking in pregnancy. First, the connection between binge drinking and adverse outcomes has been missed because most studies ask only about the average alcohol intake per day or week. If it is peak blood alcohol concentration rather than average intake that determines damage (brain growth is especially susceptible to high blood alcohol concentrations), and if the fetus is most susceptible to the teratogenic effects of alcohol during organogenesis in the first trimester, we should be asking about the number of binge episodes, as well as the timing of binge drinking.
What does this have to do with clinical practice? Two specific questions can help us specifically assess binge drinking in early pregnancy. First, we need to make sure the woman knows how we are defining binge drinking and that we want to know not only if she binged, but how often (number of episodes). Second, the timing issue is critical and highly dependent on a woman's definition of pregnancy. Women define pregnancy variably as when they knew they were pregnant; when they conceived; or as starting with their last menstrual period (because we always ask about it). This study found the best time frame to accurately pinpoint early pregnancy binge drinking was the first day of the last menstrual period (using a gestation wheel, the first 7 weeks of gestation can then be easily identified). Finally, the potential consequences of asking these questions should not be overlooked. Framed in the context of care and empathy, they may be the first step in helping an alcohol-using pregnant woman begin the slow journey to recovery.
Comment by
Linda Beth Tiedje
Women's Voices Reflecting Changed Expectations for Pregnancy After Perinatal Loss
Cote-Arsenault, D., & Morrison-Beedy, D. (2001).Journal of Nursing Scholarship, 33(3), 239-244.
In the past year I have had numerous perinatal loss experiences with patients, colleagues, childrens' friends, and friends' children, graphic reminders of the 20% to 45% of all pregnancies in Europe and North America ending in loss (Woods & Woods, 1998). This article provides specific suggestions for helping women who experience perinatal loss. Focus groups were held with 21 women who had a diverse perinatal loss and obstetrical history (miscarriage, stillbirth, ectopic pregnancy). Data analysis was qualitative and followed Colaizzi's procedures. There were three surprises in the results: 1. similarities in the women's experiences far outweighed their differences, despite their different histories and time since loss; 2. Effects of perinatal loss were far-reaching and extended well beyond the childbearing years; and 3. Ways in which women responded were not related to the gestational age at which the loss occurred, having other live children, or the number of losses experienced. The implications for nursing care for these women are numerous (the article liberally quotes from the women and their advice to healthcare providers). For example, we should acknowledge the loss; give women permission to talk about the dead baby (and then listen, really listen); encourage women to telephone or visit whenever they need to; normalize feelings (what they are feeling is not abnormal); avoid trying to convince mothers that "everything will be okay"; and appreciate that repressing emotions, including not attaching to a subsequent pregnancy, is an "emotional cushioning" coping mechanism to protect them from the pain of potential future loss. One woman said, "If I...had [received] more empathy, I think I would have gotten over it better." She continued that maybe you never get "over it," but at least "you get past it." Now we need new nursing research that describes the effect of empathic nurses helping women through the pain of perinatal loss.
Comment by
Linda Beth Tiedje
Reference
1. Woods, J. R., & Woods, J. I. (Eds.). (1998). Loss during pregnancy or in the newborn period. Pittman, NJ: Jannetti. [Context Link]
Parent-Adolescent Communication and Sexual Risk Behaviors Among African American Adolescent Females
DiClemente, R. J., Wingood, G. M., Crosby, R., Cobb, B. K., Harrington, K., & Davies, S. L. (2001).Journal of Pediatrics, 139, 407-412.
This study is important because of its targeted group (African American adolescent females are a vulnerable subgroup at high risk for sexually transmitted diseases [STDs] and HIV infection), the recruitment sites (neighborhoods with high rates of unemployment, substance use, violence, and STDs), the high response rates (85.7% of those eligible), the interdisciplinary team of researchers (including a nurse), and the message to healthcare providers.
An interview was administered to 522 sexually active African American females 14 to 18 years old. The interview asked about parent-adolescent sex-related communication, and also about the teens' sexual risk behaviors and their communication with sex partners (including self-efficacy and their ability to negotiate about condom use and refusing an unsafe sexual encounter). Results indicated that the adolescent girls who talked less frequently with their parents about sex-related topics were less likely to use condoms and other contraceptives (recall they were already self-defined as sexually active). The findings also indicated that adolescent girls who reported less frequent sex-related conversations with parents were more then three times less likely to communicate with male partners about 1. how/whether to use a condom and 2. the partner's sexual history. These findings strongly suggest that parents may be key agents in promoting open and honest communication between their adolescents and the sexual partners they select.
What is the message for us? In clinical interactions with parents of adolescents we can encourage and support communication about sexuality by asking, "Do you talk with your daughter/son about topics related to sex?" and by asking adolescents, "Are you able to talk with your parents about sex?" Indeed, if we believe verbal and nonverbal sexual communication begins at birth, we talk with all parents about it to increase their comfort and skill. We do not have to facilitate group sessions for parents about parent-child sex-related communication, although doing so might be prudent. We can role model comfort in discussing sexually related topics in many small ways and situations, such as birth control, circumcision, siblings' questions in changing a new sister's/brother's diaper, and children's questions when they accompany mothers to prenatal appointments. The list is endless. Finally, there are many Web sites to help providers and parents, among the best are the American Academy of Pediatrics (see the bookstore at this site) http://www.aap.org and the Sexuality Information and Education Council of the United States (see the "for parents and other adults" section of this site) http://www.siecus.org.
Comment by
Linda Beth Tiedje
Comment by
Susan Bakewell-Sachs
Physiologic Stability of Intubated VLBW Infants During Skin to-Skin Care and Incubator Care
Smith, S. L. (2001).Advances in Neonatal Care, 1, 28-40.
Many nurseries have adopted skin-to-skin care (SSC) (also called kangaroo care) as a result of research in several populations of term and premature infants yielding positive physiologic results. The practice has also been used with intubated very low birthweight (I-VLBW) infants despite a paucity of research evidence of its effectiveness in this population. This well-designed experimental study tested the effect of 2-hour periods of SSC on physiologic responses in stable I-VLBW infants compared to routine incubator care. Specific variables measured included central/peripheral temperature difference, fraction of inspired oxygen (FIO2), and oxygen saturation. Mean central/peripheral temperature difference (normally 1-28C) decreased significantly and central and peripheral temperatures increased in the study infants during SSC. Such thermal changes may pose physiologic stress for infants by potentially increasing metabolic rate and oxygen consumption. In addition, infant skin temperature consistently dropped below 36.58C during transfer from the incubator to SSC despite an actual transfer time of #30 seconds. The mean FIO2 was significantly higher and oxygen saturation was lower during SSC, but these differences were not statistically significant. This study should serve as a reminder of the importance of individual nursing assessment and care. More research is needed to comprehensively study the effects of SSC on this most fragile infant population. However, it may be that incubator care is less stressful for these infants while they still require mechanical ventilation.
Comment by
Susan Bakewell-Sachs
Comparison of Caloric Intake and Weight Outcomes of an Ad Lib Feeding Regimen for Preterm Infants in Two Nurseries
Pridham, K. F., Kosorok, M. R., Greer, F., Kayata, S., Bhattacharya, A., & Grunwald, P. (2001).Journal of Advanced Nursing, 35, 751-759.
Infant feeding is a major clinical issue for preterm infants. It is a significant nursing issue in neonatal intensive care units where great variation in a nurse's personal criteria of appropriate feeding practice may influence caloric intake. Feeding is also an important consideration for parents preparing to take their infants home, particularly the understanding of infant hunger and satiety cues in preparation for ad lib feedings after discharge. This is often described but not realized for parents prior to their infant's discharge because infants frequently remain on a prescribed feeding regimen in the nursery to control caloric intake. Such controlled caloric intake does not allow infants to develop self-regulatory capacities in terms of initiating and ending feedings because time, caloric density, and volume are controlled. In this randomized clinical trial, researchers studied feeding regimen effects (prescribed vs. ad lib) on caloric intake and weight gain of fully nipple-fed preterm infants for 5 days prior to discharge in two nurseries. Infants on an ad lib feeding regimen in both nurseries had a lower caloric intake over the study period than infants on a prescribed regimen, but trended toward increasing intake by the end of 5 days. In both nurseries, when caloric intake was accounted for, feeding regimen did not affect weight gain. Ad lib infant feeding and the development of self-regulatory capacities require further study. Incorporating such practices into infant care prior to discharge may assist preterm infants in developing expectancies for initiating and terminating feedings.
Comment by
Susan Bakewell-Sachs
Effectiveness of a Home Intervention for Perceived Child Behavioral Problems and Parenting Stress in Children with in utero Drug Exposure
Butz, A. M., Pulsifer, M., Marano, N. L., Belcher, H., Lears, M. K., & Royall, R. (2001).Archives of Pediatric and Adolescent Medicine, 155, 1029-1037.
Several studies with at-risk maternal child populations have demonstrated benefits of home-based skilled nursing interventions. In utero drug-exposed infants are biologically and socially at risk due to the drug exposure and the stressful postnatal environment in which they are raised. This randomized clinical trial examined the effectiveness of an intent-to-treat (INT) design where urban families received a series of home visits from birth to 18 months by pediatric nurse specialists trained with assessment skills for in utero drug-exposed infants. The pediatric nurse specialists were supervised by a pediatric nurse practitioner. They provided emotional support, parenting education, and specific skills to enhance caregiver-infant interaction. They also monitored the health of the infants. Results showed that between the ages of 2 and 3 years, the children who received the home-based nurse INT had significantly fewer behavioral problems than did the children who received standard care. In addition, caregivers who received the home-based INT reported a trend toward lower total parenting distress versus caregivers of children who received standard care. The authors suggest that more aggressive and intensive home-based services with more home visits over a longer duration should be studied as they may have a greater impact on perceived behavioral problems and parenting stress. Such nursing intervention strategies could be considered as a treatment option for drug-using mothers and their children.
Comment by
Susan Bakewell-Sachs