Safe Sleep Knowledge and Use of Provided Cribs in a Crib Delivery Program

Introduction. Risk of infant sleep-related death can be reducedthrough safe sleep practices. Barriers to infant safe sleep have beenmitigated through education and crib distribution, however, previousstudies have not explored whether distributed cribs are put to use. Methods. In a rural Michigan county, the Great Start Sleep Initiativesupplied cribs and education shortly after infant birth to familieswith high-risk of infant mortality, as assessed through comprehensiveinterviews with families by program staff. Participant knowledgewas evaluated using structured pre- and post-assessments beforeand after education. Further, a home visit was conducted to evaluatethe infant’s sleeping environment. Data from the program, collectedbetween January 2012 and December 2014, were evaluated. Results. Cribs and concomitant education were delivered to 75caregivers. Knowledge of safe sleep practices increased significantlyat follow-up with 67 caregivers (89%) affirming back positioning,68 (91%) endorsing removal of unsafe items or soft objects, suchas blankets, from the sleeping area, and 42 (56%) renouncing bedsharing.At the home visit, 74 caregivers (99%) were using a crib toput their infant down to sleep, 70 (93%) were using the providedcrib, and 67 (89%) had no unsafe items in the child’s sleeping area. Conclusion. Providing education to high-risk mothersresulted in improved safe sleep knowledge and providedcribs are used in these homes. KS J Med 2017;10(3):59-61

Total and Fractionated Bilirubin during the First Week in the Neonatal Intensive Care Unit

Background. Fractionated bilirubin requires more blood (0.6 ml) than total bilirubin alone (0.2 ml). Our focus during the first week in the Neonatal Intensive Care Unit (NICU) is on prevention of Bilirubin Induced Neurologic Dysfunction and kernicterus, which do not require fractionation. We wanted to determine the benefit of knowing fractionated bilirubin in the first week. Methods. In this retrospective study, data were obtained from the first week for 1202 NICU inborn admissions. Results. Direct bilirubin was more than 2.0 mg/dl in only six infants (0.6%). Five had multisystem injury from hypoxic ischemic events. One also had congenital cytomegalovirus and another had a postoperative liver hematoma. Weekly multichem profiles would have detected these abnormalities. No specific therapy was initiated for any of these infants. Conclusions. Converting to total bilirubin alone would not alter treatment, but could reduce iatrogenic blood loss by 2.4 ml per infant

Evaluation of Community Baby Showers to Promote Safe Sleep

Background. In recent years, Kansas has ranked 40th among all states for worst infant mortality rates. For African American infant mortality, Kansas had the highest rate in the nation. Because of these statistics, initiatives have been implemented to reduce these rates by the KIDS Network, in partnership with the Black Nurses Association and the National Association of Hispanic Nurses. The purpose was to describe participants’ knowledge and intentions regarding safe sleep following a Community Baby Shower. Methods. The Community Baby Shower was targeted to African American women via black churches, physician offices, clinics, black sororities, word of mouth, radio, and print. All Baby Shower participants were asked to complete a brief survey following the shower. Results. The majority were African American (61%) with a high school diploma or less schooling (63%). Nearly all (97%) planned to place their baby supine for sleep. However, less than half (47%) planned to have the baby sleep in the parents’ room in a separate crib. Attendees exhibited high levels of safe sleep knowledge, stated intentions to utilize most safe sleep recommendations, and reported babies would have slept in unsafe environments without the portable crib. Conclusions. Our Baby Showers were attended by the target audience, who exhibited high levels of safe sleep knowledge, and stated intentions to utilize most safe sleep recommendations following the Shower. However, some participants were resistant to following at least some of the recommendations. Additional venues and other educational strategies may be needed to maximize the uptake of these recommendations

Using Simulation to Improve Medical Students' Comfort with Selected Pediatric Procedures

BACKGROUND: Simulation in pediatrics is described often in more procedurally-heavy areas, such as in intensive care, emergency medicine, and neonatology. However, there is a paucity of literature related to simulation in general pediatrics. We sought to improve students’ comfort with and knowledge about selected procedures using simulation mannequins during their pediatric rotation. METHODS: During a workshop, third year medical students received a lecture on male circumcisions, lumbar punctures, the Ortolani and Barlow maneuvers, and ear examinations. Following the lecture, the students were given hands-on instruction and feedback on the techniques for performing ear and hip exams, lumbar punctures, and circumcisions. Students took a pre- and post-encounter assessment regarding their confidence level, procedural knowledge, and perceived usefulness of the training. Wilcoxon Signed Rank tests were used to determine changes in the students’ confidence levels and knowledge. Alpha was set at 0.05 for all comparisons. RESULTS: Sixty medical students (100%) participated in the study during the 2012/2013 academic year. Confidence and knowledge increased significantly on all procedures following the simulation experience (p < 0.001). Perception of usefulness of the training also increased significantly at post-test (p = 0.019). CONCLUSION: Medical students benefited from using simulation to demonstrate and practice common pediatric procedures, both in their confidence and knowledge. The use of simulation for general pediatric procedures should improve patient safety, as well as remove some of the anxiety of performing procedures in actual clinical scenarios

Safe Sleep Practices of Kansas Birthing Hospitals

Introduction. Sleep-related death is tied with congenital anomaliesas the leading cause of infant mortality in Kansas, and externalrisk factors are present in 83% of these deaths. Hospitals can impactcaregiver intentions to follow risk-reduction strategies. This projectassessed the current practices and policies of Kansas hospitals withregard to safe sleep. Methods. A cross-sectional survey of existing safe sleep practicesand policies in Kansas hospitals was performed. Hospitals were categorizedbased on reported delivery volume and data were comparedacross hospital sizes. Results. Thirty-one of 73 (42%) contacted hospitals responded. Individualsurvey respondents represented various hospital departmentsincluding newborn/well-baby (68%), neonatal intensive care unit(3%) and other non-nursery departments or administration (29%).Fifty-eight percent of respondents reported staff were trained oninfant safe sleep; 44% of these held trainings annually. High volumehospitals tended to have more annual training than low or mid volumebirth hospitals. Thirty-nine percent reported a safe sleep policy,though most of these (67%) reported never auditing compliance. Thetop barrier to safe sleep education, regardless of delivery volume, wasconflicting patient and family member beliefs. Conclusions. Hospital promotion of infant safe sleep is being conductedin Kansas to varying degrees. High and mid volume birthhospitals may need to work more on formal auditing of safe sleeppractices, while low volume hospitals may need more staff training.Low volume hospitals also may benefit from access to additional caregivereducation materials. Finally, it is important to note hospitalsshould not be solely responsible for safe sleep education.KS J Med 2018;11(1):1-4

Pediatric Resident Knowledge, Confidence, and Experience in Transitioning Youth with Special Healthcare Needs

Background. The transition from pediatric to adult healthcare is vital to the 17% of adolescents with special healthcare needs (SHCN). Barriers to successful transition exist. The purpose of this study was to assess the baseline knowledge, confidence, and experience of pediatric residents in our state on transitioning adolescents with SHCN from pediatric to adult-oriented health care. Methods. An anonymous, voluntary, self-report survey was distributed electronically via Survey Monkey® to 2011-2012 pediatric residents in the state of Kansas (n = 39). Results. Of 39 pediatric residents, 21 (54%) completed the survey. Most (71%) had two or fewer adolescents with SHCN on their patient panel. Overall, the majority categorized their knowledge (71%) and experience (81%) transitioning adolescents with SHCN as minimal or very minimal. Conclusions. Pediatric residents report a general lack of knowledge, confidence, and experience in transitioning youth with SHCN. Additional training opportunities are needed to overcome the barriers in successful transition planning

Intention to Read to Newborns Following a Brief Reading Promotion Intervention among Low-Income Pregnant Women

Introduction. Reading to children can increase word knowledge andsuccess in school. The American Academy of Pediatrics recommendsbeginning reading at birth. However, children from low-incomefamilies are exposed to less words, including reading exposure, thanchildren from high-income families.Methods.xPregnant women attending a community prenatal educationprogram targeted at high-risk and low-income populationswere recruited into this study. Participants completed a pre-survey,engaged with a brief educational intervention, then completed amatched post-survey. Surveys assessed perceived benefits, intendedbehaviors, and self-efficacy regarding reading to their child.Results. Of 61 eligible participants, 54 (89%) completed the study.Participants reported being Black (33%), White (30%), Hispanic(28%), and other race (9%). Average gestational age at enrollmentwas 27 weeks (range 13 to 38 weeks). The average age of respondentswas 26 years (SD = 7.2); 46% reported being pregnant for the firsttime. Following the intervention, no change in knowledge regardingbenefits of reading was observed, however, baseline knowledge washigh (58% - 94%). At post-test, significantly more women reported itwas important to start reading to their child at birth (83% vs 56%; p< 0.001) and that they planned to start reading to their child at birth(70% vs 50%; p = 0.001).Conclusions. A brief educational intervention showed promise inincreasing pregnant women’s intentions to read to their children andshould be considered in conjunction with other reading promotionprograms. Follow-up to assess actual reading behavior is needed.Kans J Med 2019;12(2):50-52