Clustered Pain Procedures in Skin-to-Skin Contact (SSC) Position for Full Term Newborns

As a part of their routine care, full term newborns face many painful procedures immediately after birth and during the first couple days of life. Skin-to-Skin Contact (SSC) has been recommended as a non-pharmacological pain management intervention in newborns. However, the use of SSC in labor and delivery rooms as well as in postnatal units and nurseries is limited due to the discomfort that the nurses and phlebotomists themselves experience during positioning the newborns and themselves to complete these routine procedures. The objective of this paper is to describe a step-by-step procedure that was developed and used in a randomized clinical trial to manage newborns pain during clustered pain procedures. The procedure worked well and no complaints of discomfort were reported by the nurses during the study

Clustered Pain Procedures in Skin-to-Skin Contact (SSC) Position for Full Term Newborns

As a part of their routine care, full term newborns face many painful procedures immediately after birth and during the first couple days of life. Skin-to-Skin Contact (SSC) has been recommended as a non-pharmacological pain management intervention in newborns. However, the use of SSC in labor and delivery rooms as well as in postnatal units and nurseries is limited due to the discomfort that the nurses and phlebotomists themselves experience during positioning the newborns and themselves to complete these routine procedures. The objective of this paper is to describe a step-by-step procedure that was developed and used in a randomized clinical trial to manage newborns pain during clustered pain procedures. The procedure worked well and no complaints of discomfort were reported by the nurses during the study

Kangaroo Care (Skin-to-Skin) for Clustered Pain Procedures: Case Study

Background: Pain management for term newborns undergoing clustered painful procedures has not been tested. Kangaroo Care (chest-to-chest, skin-to-skin position of infant on mother) effectively reduces pain of single procedures, but its effect on pain from clustered procedures is not known. Aim: The aim was to test Kangaroo Care’s effect on pain in one term infant who received clustered painful procedures while determining feasibility of the Kangaroo Care intervention. Design, Setting, and Participant: A case study design was used with one healthy term newborn who received two heel sticks and one injection in one session in the mother’s postpartum room. Method: Heart rate and oxygen saturation (recorded from Massimo Pulse Oximeter every 30 seconds), crying time (total seconds of crying on videotape) and behavioral state (using Anderson Behavioral State Scoring system every 30 seconds) were measured before (5 minutes), during (10.5 minutes) and after (30 minutes) the three clustered painful procedures in a newborn who was in Kangaroo Care during all observations. One staff nurse administered the clustered procedures. Results: Heart rate increased sequentially with each heelstick, oxygen saturation remained unchanged, sleep predominated, and crying was minimal throughout the procedures. Conclusion: Kangaroo Care appeared to reduce pain from clustered painful procedures and can be further tested

Phytohemagglutinin-Induced Mitotic Index in Blood Lymphocytes: A Potential Biomarker for Breast Cancer Risk

Background Cell proliferation is associated with the pathogenesis of cancer because it provides opportunities for accumulating genetic mutations. However, biomarkers of cell proliferation in response to environmental stimuli have not been adequately explored for breast cancer risk. Methods In a case-control study of 200 breast cancer patients and 360 healthy controls, we investigated the association between phytohemagglutinin (PHA)-induced mitotic index in blood lymphocyte and breast cancer risk. Results Having high mitotic index (>3.19%) was associated with an increased risk of breast cancer, with adjusted odds ratios (95% confidence interval) of 1.54 (1.03–2.30) and 2.03 (1.18–3.57) for all women and post-menopausal women, respectively. Mitotic index was correlated with some reproductive factors and body mass index in controls. Conclusions Our data suggest increased PHA-induced mitotic index in blood lymphocytes is associated with an increased breast cancer risk and that this association may be modulated by reproductive and other hormones

Female but not male zebra finches adjust heat output in response to increased incubation demand

In many incubating birds, heat transfer from parent to egg is facilitated by the brood patch, an area of ventral abdominal skin that becomes highly vascularised, swells and loses its down feathers around the time of laying. Only the female develops a brood patch in most passerine species, but males of some species can incubate and maintain the eggs at similar temperatures to females even without a brood patch. Here we used a novel application of infrared thermography to examine sex differences in parental care from a physiological perspective. Using incubating male and female zebra finches (Taeniopygia guttata), a species in which the male lacks a brood patch, we measured the surface temperature of the ventral plumage overlying the abdomen and a reference area that does not contact the eggs (thorax) twice per pair. In half of the pairs, clutch size was experimentally enlarged between the two sets of measurements to increase incubation demand. We found that the temperature differential between abdomen and thorax plumage was greater in females than in males, and that abdomen plumage was warmer after clutch enlargement than before in females but not in males. These findings are consistent with morphological sex differences in brood patch development and suggest that male and female zebra finches differ in the way they regulate abdomen versus general body surface temperature in response to variation in incubation demand

Towards universal kangaroo mother care : recommendations and report from the first european conference and seventh international workshop on kangaroo mother care

Q2Q1820-826The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin-to-skin vertically between the mother's breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high-tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother-infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC. The other components in KMC are exclusive breastfeeding (ideally) and early discharge in kangaroo position with strict follow-up. Current evidence allows the following general statements about KMC in affluent and low-income settings: KMC enhances bonding and attachment; reduces maternal postpartum depression symptoms; enhances infant physiologic stability and reduces pain, increases parental sensitivity to infant cues; contributes to the establishment and longer duration of breastfeeding and has positive effects on infant development and infant/parent interaction. Therefore, intrapartum and postnatal care in all types of settings should adhere to a paradigm of nonseparation of infants and their mothers/families. Preterm/low-birth-weight infants should be regarded as extero-gestational foetuses needing skin-to-skin contact to promote maturation. CONCLUSION: Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin-to-skin contact to the extent that this is possible and appropriate and continue for as long as appropriate

Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale.

AIM: Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS: The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS: The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION: In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale