Journal articles on the topic 'Infants Care Australia'
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Liamputtong, Pranee, and Charin Naksook. "Infant Feeding Practices: The Case of Thai Immigrant Women in Australia." Australian Journal of Primary Health 7, no. 1 (2001): 46. http://dx.doi.org/10.1071/py01007.
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This paper examines the perceptions and experiences of infant feeding among 30 Thai women in Australia. Ethnographic interviews and participant observation were used to elicit information in the study. Most Thai mothers breastfed their infants, but there were some women who chose bottlefeeding or mixfeeding. Their main reasons were the health and wellbeing of their infants as well as their own needs and illnesses. Nearly all mothers offered water after each feed in order to prevent jaundice and dehydration in their infants. Mothers who breastfed also offered early supplementary foods but continued to breastfeed past one year. The introduction of solid food was in accordance with recommendations of health care providers but some mothers commenced it earlier. The paper argues that infant feeding practices must be considered within the context of Thai culture and women's social situations. This will prevent misunderstanding and only then can health services and care be made more meaningful to the many women who want to implement best feeding practices for their children in their new homeland.
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Liamputtong, Pranee. "Childrearing Practices and Child Health among the Hmong in Australia: Implications for Health Services." International Journal of Health Services 32, no. 4 (October 2002): 817–36. http://dx.doi.org/10.2190/ttlq-yc48-gtvq-3djh.
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This study of cultural beliefs and practices related to childrearing and child health among the Hmong in Melbourne, Australia, used in-depth interviews and participant observation of 27 Hmong mothers and some Hmong traditional healers between 1993 and 1998. Traditional Hmong beliefs and practices include: taking notice of the birth date and time, placing a silver necklace on the newborn, not praising the newborn, not taking the infant out during the first 30 days, breastfeeding, the infant's sharing a bed with the parents, and a soul-calling ceremony on the third day after birth. All Hmong mothers follow cultural beliefs and practices to prevent the ill-health or death of their newborn infants, but some aspects of these practices have had to be modified to suit the new living environment in Australia. Health care professionals need to acknowledge the different ways of caring for a young child among the Hmong so as to avoid misunderstandings and to provide sensitive care. Hmong beliefs and practices also have implications for health promotion campaigns and can be a valuable source of ideas in the efforts to promote infant health and reduce infant deaths in Australia and elsewhere.
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Hegedus, Jessica, and Judy Mullan. "Are we adequately providing support services for optimal infant nutrition in Australia? A study in regional NSW." Australian Journal of Primary Health 21, no. 3 (2015): 293. http://dx.doi.org/10.1071/py14044.
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Evidence from the literature suggests that parents of infants in Australia may not be receiving appropriate professional assistance to support best practice in infant feeding. This study aimed to investigate whether services for infant nutrition (including breastfeeding, infant formula feeding and support for at-risk infants) complied with current recommendations. Relevant services in a regional area of NSW completed a questionnaire to characterise the assistance they provided for parents of infants in the first 6 months of life. Services for breastfeeding, unlike services for use of infant formula, were consistent with recommendations in the literature. Services were significantly more likely to provide education (χ2 (1, n = 44) = 5.939, P < 0.025) and various forms of professional support (χ2 (1, n = 44) = 20.29, P < 0.0001) for breastfeeding compared with infant formula. At-risk infants were mostly identified through growth monitoring, and extra support services were mostly provided on site. Parents of at-risk infants were encouraged to attend services; strategies included involving family in consultations, offering multiple services on site, free services and home visits. Other important measures recommended in the literature, such as providing continuous care from the antenatal period and transport, were provided infrequently.
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Sibbin, Kristina, Tara M. Crawford, Michael Stark, and Malcolm Battin. "Therapeutic hypothermia for neonatal encephalopathy with sepsis: a retrospective cohort study." BMJ Paediatrics Open 6, no. 1 (March 2022): e001420. http://dx.doi.org/10.1136/bmjpo-2022-001420.
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ObjectiveNeonatal encephalopathy remains a major cause of infant mortality and neurodevelopmental impairment. Infection may exacerbate brain injury and mitigate the effect of therapeutic hypothermia (TH). Additionally, infants with sepsis treated with TH may be at increased risk of adverse effects. This study aimed to review the clinical characteristics and outcomes for infants with sepsis treated with TH.Design and settingRetrospective cohort study of infants treated with TH within Australia and New Zealand.Patients1522 infants treated with TH, including 38 with culture-positive sepsis from 2014 to 2018.InterventionAnonymised retrospective review of data from Australian and New Zealand Neonatal Network. Infants with culture-positive sepsis within 48 hours were compared with those without sepsis.Main outcome measuresKey outcomes include in-hospital mortality, intensive care support requirements and length of stay.ResultsOverall the rate of mortality was similar between the groups (13% vs 13%). Infants with sepsis received a higher rate of mechanical ventilation (89% vs 70%, p=0.01), high-frequency oscillatory ventilation (32% vs 13%, p=0.003) and inhaled nitric oxide for persistent pulmonary hypertension (38% vs 16%, p<0.001). Additionally, the sepsis group had a longer length of stay (20 vs 11 days, p<0.001).ConclusionInfants with sepsis treated with TH required significantly more respiratory support and had a longer length of stay. Although this may suggest a more severe illness the rate of mortality was similar. Further research is warranted to review the neurodevelopmental outcomes for these infants.
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Kostenzer, Johanna, Charlotte von Rosenstiel-Pulver, Julia Hoffmann, Aisling Walsh, Silke Mader, and Luc J. I. Zimmermann. "Parents’ experiences regarding neonatal care during the COVID-19 pandemic: country-specific findings of a multinational survey." BMJ Open 12, no. 4 (April 2022): e056856. http://dx.doi.org/10.1136/bmjopen-2021-056856.
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ObjectivesThe COVID-19 pandemic has disrupted healthcare systems, challenging neonatal care provision globally. Curtailed visitation policies are known to negatively affect the medical and emotional care of sick, preterm and low birth weight infants, compromising the achievement of the 2030 Development Agenda. Focusing on infant and family-centred developmental care (IFCDC), we explored parents’ experiences of the disruptions affecting newborns in need of special or intensive care during the first year of the pandemic.DesignCross-sectional study using an electronic, web-based questionnaire.SettingMulticountry online-survey.MethodsData were collected between August and November 2020 using a pretested online, multilingual questionnaire. The target group consisted of parents of preterm, sick or low birth weight infants born during the first year of the COVID-19 pandemic and who received special/intensive care. The analysis followed a descriptive quantitative approach.ResultsIn total, 1148 participants from 12 countries (Australia, Brazil, Canada, China, France, Italy, Mexico, New Zealand, Poland, Sweden, Turkey and Ukraine) were eligible for analysis. We identified significant country-specific differences, showing that the application of IFCDC is less prone to disruptions in some countries than in others. For example, parental presence was affected: 27% of the total respondents indicated that no one was allowed to be present with the infant receiving special/intensive care. In Australia, Canada, France, New Zealand and Sweden, both the mother and the father (in more than 90% of cases) were allowed access to the newborn, whereas participants indicated that no one was allowed to be present in China (52%), Poland (39%), Turkey (49%) and Ukraine (32%).ConclusionsThe application of IFCDC during the COVID-19 pandemic differs between countries. There is an urgent need to reconsider separation policies and to strengthen the IFCDC approach worldwide to ensure that the 2030 Development Agenda is achieved.
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Shannon, Jaylene, Kath Peters, and Stacy Blythe. "The Challenges to Promoting Attachment for Hospitalised Infants with NAS." Children 8, no. 2 (February 22, 2021): 167. http://dx.doi.org/10.3390/children8020167.
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The postnatal period is crucial for infants in establishing a connection with and security in primary caregivers and can have enduring effects on attachment patterns. However, due to the need for symptom management, many infants diagnosed with neonatal abstinence syndrome (NAS) may be separated from primary caregivers and cared for in a neonatal intensive care unit (NICU) or special care nursery (SCN) soon after birth. Research has shown that substance-exposed infants are more likely to experience insecure attachment patterns with their primary caregivers and that mothers with a history of substance abuse are less sensitive to their infants’ cues. Therefore, the aim of this research was to explore nurses’ and midwives’ experiences in promoting the attachment relationship for infants admitted to an NICU/SCN with NAS. A qualitative research design was used to gather data on the experiences of nine nurses/midwives from various NICU and SCN settings in Australia. Individual, semi-structured interviews were conducted, and transcribed interviews were coded using thematic analysis. While nurses/midwives valued the attachment relationship for infants with NAS, facilitation of the attachment relationship was mainly promoted when the mother was present. However, parents were often reported to be absent from the nursery. Difficulties in promoting an attachment relationship were also identified when an infant had child protection involvement. This research identifies areas in need of innovative change regarding the approach taken to promote the attachment relationship for infants with NAS when they are admitted to an NICU/SCN.
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Taylor, Lee, Delyse Hutchinson, Ron Rapee, Lucy Burns, Christine Stephens, and Paul S. Haber. "Clinical Features and Correlates of Outcomes for High-Risk, Marginalized Mothers and Newborn Infants Engaged with a Specialist Perinatal and Family Drug Health Service." Obstetrics and Gynecology International 2012 (2012): 1–8. http://dx.doi.org/10.1155/2012/867265.
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Background. There is a paucity of research in Australia on the characteristics of women in treatment for illicit substance use in pregnancy and the health outcomes of their neonates.Aims. To determine the clinical features and outcomes of high-risk, marginalized women seeking treatment for illicit substance use in pregnancy and their neonates.Methods. 139 women with a history of substance abuse/dependence engaged with a perinatal drug health service in Sydney, Australia. Maternal (demographic, drug use, psychological, physical, obstetric, and antenatal care) and neonatal characteristics (delivery, early health outcomes) were examined.Results. Compared to national figures, pregnant women attending a specialist perinatal and family drug health service were more likely to report being Australian born, Aboriginal or Torres Strait Islander, younger, unemployed, and multiparous. Opiates were the primary drug of concern (81.3%). Pregnancy complications were common (61.9%). Neonates were more likely to be preterm, have low birth weight, and be admitted to special care nursery. NAS was the most prevalent birth complication (69.8%) and almost half required pharmacotherapy.Conclusion. Mother-infant dyads affected by substance use in pregnancy are at significant risk. There is a need to review clinical models of care and examine the longer-term impacts on infant development.
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Hartley, Stefanie, Georgina Sutherland, Stephanie Brown, and Jane Yelland. "‘You’re more likely to tell the GP if you’re asked’: women’s views of care from general practitioners in the first postpartum year." Australian Journal of Primary Health 18, no. 4 (2012): 308. http://dx.doi.org/10.1071/py11111.
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New mothers and their infants are high frequency users of primary health care services in Australia providing opportunities for GPs to engage with women about common postnatal morbidities. This study aimed to explore women’s views of GP care in the first year following birth. We used semistructured interviews with a subsample of women who had participated in a population-based survey of women who gave birth in two Australian states (Victoria and South Australia) in 2007. Twenty-nine women were interviewed. Prominent themes that emerged were around issues of disclosure, including women’s views on ways practitioner interactions and systems of care facilitate or hinder disclosure and subsequent discussion of health problems. Women reflected on the role GPs played in their health and wellbeing after childbirth, the importance of enquiry, communication style and the way access to, and time in, consultations impact on disclosure, perceived support and discussions. To improve care for women after childbirth we need to know the contexts that facilitate disclosure. Findings from this qualitative study deliver an important message to clinicians: women value primary care, identify issues that facilitate and hinder disclosure and describe ‘good’ encounters as ones where they feel understood, supported and reassured.
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Gc, Vijay S., Donna Franklin, Jennifer A. Whitty, Stuart R. Dalziel, Franz E. Babl, Luregn J. Schlapbach, John F. Fraser, et al. "First-line oxygen therapy with high-flow in bronchiolitis is not cost saving for the health service." Archives of Disease in Childhood 105, no. 10 (April 10, 2020): 975–80. http://dx.doi.org/10.1136/archdischild-2019-318427.
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BackgroundBronchiolitis is the most common reason for hospital admission in infants. High-flow oxygen therapy has emerged as a new treatment; however, the cost-effectiveness of using it as first-line therapy is unknown.ObjectiveTo compare the cost of providing high-flow therapy as a first-line therapy compared with rescue therapy after failure of standard oxygen in the management of bronchiolitis.MethodsA within-trial economic evaluation from the health service perspective using data from a multicentre randomised controlled trial for hypoxic infants (≤12 months) admitted to hospital with bronchiolitis in Australia and New Zealand. Intervention costs, length of hospital and intensive care stay and associated costs were compared for infants who received first-line treatment with high-flow therapy (early high-flow, n=739) or for infants who received standard oxygen and optional rescue high-flow (rescue high-flow, n=733). Costs were applied using Australian costing sources and are reported in 2016–2017 AU$.ResultsThe incremental cost to avoid one treatment failure was AU$1778 (95% credible interval (CrI) 207 to 7096). Mean cost of bronchiolitis treatment including intervention costs and costs associated with length of stay was AU$420 (95% CrI −176 to 1002) higher per infant in the early high-flow group compared with the rescue high-flow group. There was an 8% (95% CrI 7.5 to 8.6) likelihood of the early high-flow oxygen therapy being cost saving.ConclusionsThe use of high-flow oxygen as initial therapy for respiratory failure in infants with bronchiolitis is unlikely to be cost saving to the health system, compared with standard oxygen therapy with rescue high-flow.
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Corr, L., H. Rowe, and J. Fisher. "Mothers’ perceptions of primary health-care providers: thematic analysis of responses to open-ended survey questions." Australian Journal of Primary Health 21, no. 1 (2015): 58. http://dx.doi.org/10.1071/py12134.
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General practitioners and maternal, child and family health nurses have a central role in postpartum primary health care for women and their infants. Positive client-provider relationships are particularly important for women experiencing mental health problems or unsettled infant behaviour. However, little is known about their experiences of postnatal primary health care. The study aimed to describe views of postnatal primary health care among women completing a residential early parenting programme and to identify potential strategies to enhance provider-patient interactions. Participants (n = 138) were women admitted with their infants to a private or a public early parenting service in Melbourne, Australia. Women completed a detailed self-report survey, including open-ended questions about experiences of primary health-care services, and a structured psychiatric interview to diagnose anxiety and depression. Survey responses were analysed thematically. Womens’ experiences of primary health care were influenced by their perceptions of provider competence and the quality of interactions. While similar positive characteristics of doctor and nurse care were valued, medical and nursing practices were judged in different ways. Women described GPs who listened, understood and were thorough as providing good care, and maternal, child and family health nurses were valued for providing support, advice and encouragement. Threats to therapeutic relationships with doctors included feeling rushed during consultations, believing that GPs were not mental health-care providers and the clinician not being ‘good’ with the infant; with nurses, problems included feeling judged or given advice that was inconsistent or lacked an evidence-base. Postpartum primary health care will be improved by unhurried consultations, empathic recognition, encouragement, evidence-informed guidance and absence of criticism.
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Anusha, Kaneshapillai, Usha Hettiaratchi, Dulani Gunasekera, Shamini Prathapan, and Guwani Liyanage. "Maternal Vitamin D Status and Its Effect on Vitamin D Levels in Early Infancy in a Tertiary Care Centre in Sri Lanka." International Journal of Endocrinology 2019 (July 9, 2019): 1–6. http://dx.doi.org/10.1155/2019/9017951.
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Epidemiologic studies from South Asian countries have reported vitamin D deficiency among all age groups. However, there is very little information on vitamin D levels, especially in the vulnerable populations (pregnant/breast feeding mother and infants) in Sri Lanka. More data on vitamin D status of such populations will be important for policy decisions to be made at a national level. Similarly, it will be valuable for healthcare programs in other countries (e.g., United States, Australia, Europe, and Canada) as Sri Lankans are a fast-growing migrant population to those countries. The purpose of this study was to investigate maternal vitamin D status and its effects on infants in a state sector tertiary care centre in Sri Lanka. This prospective cohort study was conducted on 140 healthy pregnant mothers in the third trimester (mean gestational age 39±1 weeks). Blood was collected for 25(OH)D and parathyroid hormone (PTH). Sun exposure and feeding patterns of the infants were recorded based on maternal reporting. Mean age of the infants at follow-up visit was 36±7 days. Vitamin D (25 (OH)D) deficiency (<25 nmol/L) was observed in 12% pregnant mothers, 5% lactating mothers, and 63% infants. Insufficiency (<50 nmol/L) was found in an additional 51% and 43% in pregnant and lactating mothers and 25% of infants. Mean 25(OH)D was higher in pregnant (46.4±17.5 nmol/L) and lactating (51.9±17.0 nmol/L) mothers than infants (28.1±13.7 nmol/L). Maternal vitamin D level during pregnancy was a significant risk factor (OR: 6.00, 95%CI: 1.522-23.655) for infant deficiency and insufficiency. Sun exposure of infants showed a significant positive correlation with vitamin D level (OR: 3.23, 95%CI: 1.19-8.68). In conclusion, the presence of Vitamin D deficiency/insufficiency is higher in infants compared to pregnant/lactating mothers. Low maternal 25(OH)D during pregnancy was a risk factor for deficiency in infants. Although majority of lactating mothers had sufficient vitamin D, most of their exclusively breastfed offspring were deficient.
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Edwards, Danielle J., Kristin Wicking, Wendy Smyth, Linda Shields, and Tonia Douglas. "Information needs of parents of infants diagnosed with cystic fibrosis: Results of a pilot study." Journal of Child Health Care 22, no. 3 (February 27, 2018): 382–92. http://dx.doi.org/10.1177/1367493518760734.
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This study investigated the information needs, priorities and information-seeking behaviours of parents of infants recently diagnosed with cystic fibrosis (CF) following newborn screening, by piloting the ‘Care of Cystic Fibrosis Families Survey’. The questionnaires were posted to eligible parents ( n = 66) attending CF clinics in hospitals in two Australian states; reply-paid envelopes were provided for return of the questionnaires. Twenty-six were returned (response rate 39.4%). The most common questions to which parents required answers during their initial education period related to what CF is, how it is treated and how to care for their child. Parents preferred face-to-face consultations to deliver information, and yet all reported using the Internet to search for more information at some point during the education period. Many parents provided negative feedback about being given their child’s CF diagnosis via telephone. The timing, content and method of information delivery can all affect the initial education experience. We can deliver education to better suit the information needs and priorities for education of parents of infants recently diagnosed with CF. The Care of Cystic Fibrosis Families Survey was successfully piloted and recommendations for amendments have been made for use in a larger study across Australia.
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Cole, Roni, Jeanine Young, Lauren Kearney, and John M. D. Thompson. "Awareness of infant safe sleep messages and associated care practices: findings from an Australian cohort of families with young infants." BMJ Paediatrics Open 5, no. 1 (February 2021): e000972. http://dx.doi.org/10.1136/bmjpo-2020-000972.
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ObjectiveTo investigate primary infant caregiver awareness of the current national public health safe sleep messages and the associations of awareness with care practices.Design and settingA cross-sectional survey in Queensland, Australia. All families with live babies birthed during April–May 2017 were eligible. Questionnaires were distributed when infants were approximately 3 months old.ParticipantsOf the 10 200 eligible families, 3341 (33%) primary caregivers participated.Main outcome measuresParticipants were asked: to recall key safe sleeping messages they were aware of (unprompted); questions about their infant care practices; and to select the current, national six safe sleeping messages (prompted multi-choice).ResultsOverall, the majority of families are aware of sleep-related infant mortality and sudden infant death (3178/3317, 96%); however, approximately one in four caregivers (867/3292, 26%) could not identify the current six messages to promote safer infant sleep in a multi-choice question. Despite being aware of the six key messages, some caregiver practices did not always align with advice (336/2423, 14% were not smoke-free; 349/2423, 14% were not usually supine for sleep; 649/2339, 28% employed practices which may increase risk of head or face covering; 426/2423, 18% were not receiving breastmilk).ConclusionsThere is considerable scope for improvement in parent awareness and ability to recall key safe sleep messages. Awareness of advice does not always translate into safe infant care. Health promotion messaging to encourage safer infant sleep, ultimately aimed at reducing sudden unexpected infant deaths, needs more effective supportive strategies and dissemination if future campaigns are to be successful.
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Galbally, M., A. Sved-Williams, D. Kristianopulos, K. Mercuri, P. Brown, and A. Buist. "Comparison of public mother–baby psychiatric units in Australia: similarities, strengths and recommendations." Australasian Psychiatry 27, no. 2 (November 8, 2018): 112–16. http://dx.doi.org/10.1177/1039856218810165.
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Background: Mother–baby units are innovative and important models of care that allow inpatient treatment of postpartum maternal mental disorders whilst preserving and promoting the attachment relationship with their young infants. Objectives: To report data across five public mother–baby units in Australia in order to explore similarities and distinguishing features of each model. Method: Each unit also provided 12 months of data on key characteristics of their unit. Results: Despite the geographic differences, the diagnostic profiling, length of stay, and child protection involvement were similar across the units. Conclusions: Acute care for perinatal mental illness offered in public mother–baby units in Australia shows consistency across units, raising concerns for where such treatment is unavailable.
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McPharlin, Nancy, Hugh Stewart, Deanna Gibbs, Holly Bowen-Salter, and Kobie Boshoff. "Neonatal Occupational Therapy in Australia: A Survey and Recommendations for Developing Guidelines for Clinical Practice." Allied Health Scholar 1, no. 1 (July 26, 2020): 1–28. http://dx.doi.org/10.21913/tahs.v1i1.1558.
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Aim and Background: Occupational Therapists form an essential part of the development and care of infants and families in Neonatal Units (NNU) across the world, however, little is documented about their practice in Australia. This article aims to develop a greater understanding of the role of Occupational Therapy in NNU in Australia, compared with international practice guidelines, and recommends the adoption of UK guidelines until Australia specific guidelines emerge. Method: An online questionnaire was developed from a systematic scoping review and piloted by an expert panel. Invitations were sent to thirty Occupational Therapists working in NNUs around Australia. Data analysis included using descriptive statistics and qualitative themes. Results: Twenty two (73%) of NNU Occupational Therapists responded to the survey, representing all levels of NNU. Results describe the current Occupational Therapy role in Australia as encompassing assessment, intervention, teamwork and a variety of ‘other’ activities, all of which required advanced knowledge, skills and paediatric experience, and involved ongoing high-level professional development. Occupational Therapy has a unique role to play in neonatal units. Future development of the role is reliant upon good advocacy and promotion, specialised training opportunities, prospects for networking, support and mentorship for the many Therapists working part-time, and ongoing research. The Australian Occupational Therapy NNU role compares similarly with those cited internationally (UK & US). The development of guidelines for evidence based clinical practice of neonatal Occupational Therapy in Australia was highly sought by clinicians. The adoption of the ‘Occupational Therapy in neonatal services and early intervention: practice guideline’ (RCOT 2017) is proposed until the emergence of specific Australian guidelines.
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Springall, Tanisha, Della Anne Forster, Helen L. McLachlan, Pamela McCalman, and Touran Shafiei. "Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study." BMJ Open 13, no. 1 (January 2023): e066978. http://dx.doi.org/10.1136/bmjopen-2022-066978.
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ObjectivesThere is an urgent need to improve breast feeding rates for Australian First Nations (Aboriginal and Torres Strait Islander) infants. We explored breast feeding outcomes of women having a First Nations infant at three sites that introduced a culturally specific continuity of midwife care model.DesignWomen having a First Nations infant booking for pregnancy care between March 2017 and November 2020 were invited to participate. Surveys at recruitment and 3 months post partum were developed with input from the First Nations Advisory Committee. We explored breast feeding intention, initiation, maintenance and reasons for stopping and factors associated with breast feeding.SettingThree tertiary maternity services in Melbourne, Australia.ParticipantsOf 479/926 eligible women approached, 343 (72%) completed the recruitment survey, and 213/343 (62%) the postnatal survey.OutcomesPrimary: breast feeding initiation and maintenance. Secondary: breast feeding intention and reasons for stopping breast feeding.ResultsMost women (298, 87%) received the culturally specific model. Breast feeding initiation (96%, 95% CI 0.93 to 0.98) was high. At 3 months, 71% were giving ‘any’ (95% CI 0.65 to 0.78) and 48% were giving ‘only’ breast milk (95% CI 0.41 to 0.55). Intending to breast feed 6 months (Adj OR ‘any’: 2.69, 95% CI 1.29 to 5.60; ‘only’: 2.22, 95% CI 1.20 to 4.12), and not smoking in pregnancy (Adj OR ‘any’: 2.48, 95% CI 1.05 to 5.86; ‘only’: 4.05, 95% CI 1.54 to 10.69) were associated with higher odds. Lower education (Adj OR ‘any’: 0.36, 95% CI 0.13 to 0.98; ‘only’: 0.50, 95% CI 0.26 to 0.96) and government benefits as the main household income (Adj OR ‘any’: 0.26, 95% CI 0.11 to 0.58) with lower odds.ConclusionsBreast feeding rates were high in the context of service-wide change. Our findings strengthen the evidence that culturally specific continuity models improve breast feeding outcomes for First Nations women and infants. We recommend implementing and upscaling First Nations specific midwifery continuity models within mainstream hospitals in Australia as a strategy to improve breast feeding.
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Brodribb, Wendy E., Benjamin L. Mitchell, and Mieke L. Van Driel. "Continuity of care in the post partum period: general practitioner experiences with communication." Australian Health Review 40, no. 5 (2016): 484. http://dx.doi.org/10.1071/ah15144.
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Objectives Informational and management continuity of care assists in providing a seamless transition for women and infants from tertiary or secondary to primary care during the post partum period. Few studies have evaluated the interaction between different aspects of the health system following a woman’s discharge from hospital after the birth of her infant. The present study describes how general practitioners (GPs) experience communications with hospitals and other post partum care providers relevant to continuity of care. Methods In the present cross-sectional study, a 52-item questionnaire adapted from a previously used survey was mailed to 932 GPs in southern Queensland, Australia, between February and July 2013. Questionnaire items included participant demographics, the timeliness and usability of discharge summaries, communication with other post partum care providers and consultation practices. Results The response rate was 17.4%. Nearly one-quarter of participants never or rarely received a hospital discharge summary in a timely manner and most considered the summaries somewhat useful. Few GPs (14.3%) had contact with or received information from domiciliary midwives who conducted post partum home visits. A higher proportion (38%) had some communication with a Child and Family Health nurse in the month before the survey. Conclusions Information flow from hospital to general practice and between other post partum care providers is less than ideal and may affect ongoing care for mothers and infants, especially those at risk. Knowledge exchange between healthcare services and initiatives to improve information sharing needs to be developed and implemented. What is already known on this topic? Transitions from tertiary or secondary care to primary care and between primary care providers are often times of vulnerability for patients, including women and infants in the post partum period. There is little information documenting communications between different maternity services and GPs that facilitate ongoing care. What does this paper add? There are significant gaps in the exchange of information about post partum women and infants from hospitals to GPs and a lack of communication between GPs and other post partum care providers, such as domiciliary midwives and Child and Family Health nurses. What are the implications for practitioners? Improvements in the timeliness, presentation and content of hospital discharge summaries, as well as enhancing channels of communication, collaboration, cooperation and information sharing between providers of community post partum care, are necessary if mothers are to receive the best care possible.
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Eronen, Ritva, Helen Calabretto, and Jan Pincombe. "Improving the professional support for parents of young infants." Australian Journal of Primary Health 17, no. 2 (2011): 186. http://dx.doi.org/10.1071/py10062.
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The objective of this study was to discuss ideas for improving child health services on the basis of findings of an observational study that was designed to explore the role of child health nurses in supporting parents during the first 6 months following the birth of an infant. As part of a larger study in a child health service in urban Australia, surveys were used to collect data from two independent samples of both parents and nurses at an 8-month interval. Data were condensed using factor analysis; regression analyses were used to determine which aspects of care were most important for the parents, and importance–performance analysis was used to determine which aspects of care needed improvement. While the majority of parents valued support from child health nurses, a need for improvement was identified in empowering parents to make their own decisions, discussing emotional issues with parents, providing continuity of care and giving consistent advice. Organisations should value and provide support for child health nurses in their invisible, non-quantifiable work of supporting families. The structure of child health services should also provide child health nurses continuity of care with the families they support.
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Douglas, Pamela S., Renata E. Mares, and Peter S. Hill. "Interdisciplinary perspectives on the management of the unsettled baby: key strategies for improved outcomes." Australian Journal of Primary Health 18, no. 4 (2012): 332. http://dx.doi.org/10.1071/py11073.
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The objectives of this study were to analyse the perspectives of key informants with clinical expertise in the care of unsettled babies in the first few months of life and their families, concerning changes required to improve outcomes. The research used a purposive selection strategy and thematic analysis of key informant interviews of 24 health professionals from 11 disciplines. Informants were selected for extensive experience in the management of unsettled babies and their families.Participants corroborated existing evidence that post-birth care in Australia is fragmented. All held the view that, first, early primary care intervention for unsettled infants and their families, and second, improved cross-professional communication, are vital if the burden of this problem to the infant, family and health system are to be minimised. There was consensus, third, that significant gaps exist in health professionals’ knowledge base and management behaviours.The development of education resources, best practice guidelines, shared assessment frameworks for primary care practitioners and strategies for improved cross-professional communication are necessary to improve the health outcomes and decrease the burden of this common yet complex post-birth problem.
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Harrison, Celine, Carol Bahemia, and Debbie Henderson. "Infant removal and the lack of representation for parents." Children Australia 45, no. 4 (September 3, 2020): 215–21. http://dx.doi.org/10.1017/cha.2020.34.
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AbstractThis paper throws a spotlight on the systemic disadvantage experienced by parents who have their children removed from their care. With data drawn from the annual reports of the Legal Aid of Western Australia, the child protection agency in Western Australia, and the Productivity Commission, the authors illustrate the disconnection between the agency’s policy to reunify children once removed from their birth parents; the resources made available to support families to overcome their difficulties; and how the gap is further widened when parents without financial means and who are disempowered face legal proceedings on their own. We profile the increasing numbers of infants who are removed, the decreasing numbers of these infants who are discharged from care, and the shortfall of grants of legal aid that are provided to parents when they go to court. For this group of parents, permanent loss of their children is a reality. The aim of the paper is to capture the extent to which there is a fundamental blemish on the principles of due process and fairness, and once statutory processes are triggered, the best interests of the child and the support of parents are contingent, with poverty being the key mediating factor.
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MOHSIN, M., A. E. BAUMAN, and B. JALALUDIN. "THE INFLUENCE OF ANTENATAL AND MATERNAL FACTORS ON STILLBIRTHS AND NEONATAL DEATHS IN NEW SOUTH WALES, AUSTRALIA." Journal of Biosocial Science 38, no. 5 (July 11, 2005): 643–57. http://dx.doi.org/10.1017/s002193200502701x.
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This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2000 g) contributed 75·6% of the population-attributable risks to stillbirths and 59·4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77·7% of stillbirths and 87·9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study.
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Stanton, Pauline. "Managing the healthcare workforce: cost reduction or innovation." Australian Health Review 25, no. 4 (2002): 92. http://dx.doi.org/10.1071/ah020092.
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Few studies have explored the socio-economic profile, service utilisation, obstetric history and pregnancy outcomes of ethnic women who utilise ethno-specific obstetric services in Australia. The purpose of this study was to form a profile of women who accessed the Ethnic Obstetric Liaison Services (EOLO) in South Western Sydney Area Health Service (SWSAHS), New South Wales and explore their beliefs about using maternal and infant health services. We found that the prevalence of risks and special needs varied significantly by language groups in this study sample. Our results suggest that equity of access to quality care for this group of mothers and infants can be assured if models similar to the EOLO in SWSAHS are thoroughly planned and developed, and take account of cultural appropriateness for the population served.
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Tran, Mai, Hai Phung, Lisa Young, Ursula Hopper, and Ken Hillman. "Patterns and characteristics of ethnic Australian women utilising ethno-specific maternal and child health services." Australian Health Review 25, no. 4 (2002): 107. http://dx.doi.org/10.1071/ah020107.
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Few studies have explored the socio-economic profile, service utilisation, obstetric history and pregnancy outcomes of ethnic women who utilise ethno-specific obstetric services in Australia. The purpose of this study was to form a profile of women who accessed the Ethnic Obstetric Liaison Services (EOLO) in South Western Sydney Area Health Service (SWSAHS), New South Wales and explore their beliefs about using maternal and infant health services. We found that the prevalence of risks and special needs varied significantly by language groups in this study sample. Our results suggest that equity of access to quality care for this group of mothers and infants can be assured if models similar to the EOLO in SWSAHS are thoroughly planned and developed, and take account of cultural appropriateness for the population served.
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Scott, Jane Anne, Sharyn K. Burns, Yvonne L. Hauck, Roslyn C. Giglia, Anita M. Jorgensen, Becky Kate White, Annegret Martin, et al. "Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial." JMIR Pediatrics and Parenting 4, no. 2 (April 12, 2021): e24579. http://dx.doi.org/10.2196/24579.
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Background Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. Objective The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. Methods The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. Results A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. Conclusions This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 International Registered Report Identifier (IRRID) RR2-10.1186/s12884-015-0601-5
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Goel, D., A. Wilson, A. O'Donnell, S. Rao, H. Herbert, N. Pachter, B. Hamden, and D. Gillett. "O009 Keep The Chin Up: Evidence-based standardised care pathway for infants with Pierre Robin Sequence (PRS)." SLEEP Advances 3, Supplement_1 (October 1, 2022): A4—A5. http://dx.doi.org/10.1093/sleepadvances/zpac029.008.
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Abstract Background Management of upper airway obstruction in neonates with Pierre Robin Sequence (PRS) is challenging given difficulties in grading severity of disease, difficulties obtaining early polysomnography (PSG) and variable practices with no widely accepted standard protocol. We aimed to develop a standardised care pathway for infants with PRS. Methods Total 190 publications were identified of which 21 were reviewed in detail. Majority were review articles or retrospective studies. Consultation was obtained from the Complex Airway Team (multidisciplinary team of neonatologist, paediatric sleep specialist, otolaryngologist, plastic surgeon, clinical nurse specialist and speech pathologist), geneticists, audiologists, the consumer group “PRS Australia” and ANZ paediatric sleep physicians. Final recommendations were based on consensus and quality of the evidence. Results We developed a pathway outlining sequential interventions to manage OSA based on functional assessment by PSG (7-14 day of life) and structural assessment by flexible nasal endoscopy “FNE” (0-7 day of life). Conduct of bedside PSG in NICU instead of sleep lab enables innovative, timely, patient-centred and cost-effective service delivery. We standardised reporting of glossoptosis (Yellon classification), laryngomalacia (Olney et.al) and airway (Seattle DISE scoring) on FNE. Early multidisciplinary involvement, structured assessment of feeding, synchronous airway lesions and associated genetic syndromes is also considered. The pathway allows for standardised management and discharge planning with clearly defined multidisciplinary follow-ups. Intended outcome/impact This project is likely first in Australia to standardise care pathway for infants with PRS encompassing collaborative, innovative and structured care delivery principles. The project provides foundation for future clinical and research collaboration.
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Schell, D., A. Ampt, M. Festa, and N. Nassar. "P0366 / #1043: A POPULATION-BASED STUDY OF INFANTS AND CHILDREN ADMITTED TO INTENSIVE CARE IN AUSTRALIA." Pediatric Critical Care Medicine 22, Supplement 1 3S (March 2021): 192–93. http://dx.doi.org/10.1097/01.pcc.0000739804.68410.32.
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Caffery, Liam, Natalie Bradford, Maria Meurer, and Anthony Smith. "Association between patient age, geographical location, Indigenous status and hospitalisation for oral and dental conditions in Queensland, Australia." Australian Journal of Primary Health 23, no. 1 (2017): 46. http://dx.doi.org/10.1071/py15105.
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A retrospective analysis of hospitalisation due to oral and dental conditions (ODC) was performed for patients in Queensland. The aim was to identify the rate and cost of hospitalisation and to examine the association between hospitalisation and age, geographical location and Indigenous status. There were 81528 admissions to Queensland’s hospitals due to ODC during the 3-year study period (2011–2013). The annual cost of ODC-related hospitalisation was estimated to be AU$87million. Indigenous infants (Z=4.08, P<0.001) and primary school children (Z=2.01, P=0.046) were significantly more likely to be hospitalised than their non-Indigenous counterparts. A non-Indigenous high school child was almost fourfold more likely to be hospitalised. There was no significant difference in the rate of hospitalisation for adults. Infants (Z=6.70, P<0.001) and primary school children (Z=8.73, P<0.001) from remote areas were significantly more likely to be hospitalised than their age-matched metropolitan counterparts. Whereas high school children (Z=2.74, P=0.006) and adults (Z=6.02, P<0.001) from remote areas were significantly less likely to be hospitalised. Our findings suggest that there is a need for alternative models of primary dental care to service remote areas of Queensland and Indigenous populations. Strategies that enable Indigenous Health Workers to provide dental care, and the use of teledentistry, are models of care that may reduce potentially preventable hospitalisations and lead to cost savings and better health outcomes.
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Hill, Rebecca, Daphne Law, Chris Yelland, and Anne Sved Williams. "Treatment of postpartum psychosis in a mother-baby unit: do both mother and baby benefit?" Australasian Psychiatry 27, no. 2 (January 21, 2019): 121–24. http://dx.doi.org/10.1177/1039856218822743.
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Objectives: To describe characteristics and treatments of mother-baby dyads affected by postpartum psychosis admitted to a specialist mother-baby inpatient psychiatric unit in Australia. Methods: A retrospective review of medical records for all mothers with postpartum psychosis and their babies admitted to a mother-baby unit over a 5-year period was conducted. Results: A total of 25 dyads met the study criteria. Affected women were found to be severely ill with a high rate of involuntary status (64%). They waited an average 4.7 days for a bed in the mother-baby unit. All received an atypical antipsychotic, with 16% receiving lithium augmentation. Infants were found to have generally normative growth and development, with relationship concerns noted in 5. A total of 36% of the cohort maintained some breastfeeding, and all had their infants in their care at discharge. Conclusions: The mother-baby unit enabled severely ill women to remain with their infants during treatment. While a minority of infants showed developmental concerns, appropriate development was noted in most. Future efforts should focus on determining the most effective treatments and further defining the risks and benefits for infants in mother-baby units.
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Hewitt, Lyndel, Carolyn Frohmuller, Li Ming Wen, and Anthony D. Okely. "Effect of a multicomponent intervention in postnatal mothers’ groups on meeting the Australian Physical Activity Guidelines for infants: protocol for a randomised controlled trial." BMJ Open 12, no. 4 (April 2022): e054183. http://dx.doi.org/10.1136/bmjopen-2021-054183.
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IntroductionGiven the importance of tummy time and the low levels of tummy time reported globally, there is a need for high-quality intervention strategies to promote tummy time. This study describes the protocol of a randomised controlled trial that aims to determine the effectiveness of a multicomponent intervention delivered in postnatal mothers’ groups in increasing infant tummy time.Methods and analysisA randomised controlled trial will be conducted. Eligible participants will be mothers and their infants attending postnatal mothers’ groups (New South Wales, Australia). Participants will be randomised to participate in either (1) infant tummy time intervention group (practice, education, WhatsApp) plus usual care; or (2) usual care group. Randomisation process and outcome assessors will be blinded. The intervention will comprise an online education and practice session (60 min) and 4 weeks of WhatsApp messaging (standardised, three times per week). Usual care will be attendance at a mothers group once per week for 3 weeks for information and support for ad hoc mother craft activities (standard practice provided by early childhood nurses for this local health district). The primary outcome will be the amount of infant tummy time using the GENEActiv accelerometer and a questionnaire (post intervention). The accelerometer will be worn on the right hip secured by an elastic belt around the waist. Wear and non-wear time will be classified using temperature and z-axis cut points as per previous research. This protocol paper presents the scientific background and proposed methods of the randomised controlled trial. Findings will inform the design of practically based strategies to inform clinicians, educators and parents about infant physical activity.Ethics and disseminationThe University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee approved the study (2020/ETH02970). Dissemination plan is publication, staff training and conference presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry ACTRN12621000575831; Pre-results.
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Dodd, Jodie M., Andrea R. Deussen, and Jennie Louise. "A Randomised Trial to Optimise Gestational Weight Gain and Improve Maternal and Infant Health Outcomes through Antenatal Dietary, Lifestyle and Exercise Advice: The OPTIMISE Randomised Trial." Nutrients 11, no. 12 (December 2, 2019): 2911. http://dx.doi.org/10.3390/nu11122911.
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There are well-recognised associations between excessive gestational weight gain (GWG) and adverse pregnancy outcomes, including an increased risk of pre-eclampsia, gestational diabetes and caesarean birth. The aim of the OPTIMISE randomised trial was to evaluate the effect of dietary and exercise advice among pregnant women of normal body mass index (BMI), on pregnancy and birth outcomes. The trial was conducted in Adelaide, South Australia. Pregnant women with a body mass index in the healthy weight range (18.5–24.9 kg/m2) were enrolled in a randomised controlled trial of a dietary and lifestyle intervention versus standard antenatal care. The dietitian-led dietary and lifestyle intervention over the course of pregnancy was based on the Australian Guide to Healthy Eating. Baseline characteristics of women in the two treatment groups were similar. There was no statistically significant difference in the proportion of infants with birth weight above 4.0 kg between the Lifestyle Advice and Standard Care groups (24/316 (7.59%) Lifestyle Advice versus 26/313 (8.31%) Standard Care; adjusted risk ratio (aRR) 0.91; 95% confidence interval (CI) 0.54 to 1.55; p = 0.732). Despite improvements in maternal diet quality, no significant differences between the treatment groups were observed for total GWG, or other pregnancy and birth outcomes.
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Lei, Donna, Kenneth Tan, and Atul Malhotra. "Decreasing Hypothermia-Related Escalation of Care in Newborn Infants Using the BEMPU TempWatch: A Randomised Controlled Trial." Children 8, no. 11 (November 19, 2021): 1068. http://dx.doi.org/10.3390/children8111068.
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Objective: To determine whether incorporating BEMPU TempWatch into the care of LBW/SGA neonates for continuous temperature monitoring decreases the rate of hypothermia requiring escalation of care. Methods: This was a randomised controlled trial conducted in a tertiary hospital in Melbourne, Australia. Participants were late preterm and term LBW/SGA neonates on the postnatal wards. Neonates were randomly assigned to receive either the BEMPU TempWatch in addition to standard care, or to receive standard care alone for the first 28 days of life. The primary outcome was hypothermia requiring escalation of care during initial hospital stay after birth. Results: Trial was discontinued after planned interim feasibility analysis, due to very low rates of hypothermia requiring escalation of care. In total, 75 neonates were included, with 36 in the intervention (TempWatch) group and 39 in the control group. The rate of hypothermia requiring escalation of care was 2/36 (5.6%) in the TempWatch group and 1/39 (2.6%) in the control group (relative risk (RR) 2.17, 95% CI 0.21 to 22.89). Rates of exclusive breastfeeding at discharge were 22/36 (61.1%) in the TempWatch and 13/39 (33.3%) in the control group (RR 1.83, 95% CI 1.10 to 3.07, p = 0.02). All other secondary outcomes were similar between the groups. Conclusions: Low rates of hypothermia requiring escalation of care in a tertiary, high-income setting meant it was not feasible for studying the effects of the TempWatch for this outcome. TempWatch may have a role in promoting exclusive breastfeeding, and this needs to be explored further.
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Mengistu, Tesfaye S., Veronika Schreiber, Christopher Flatley, Jane Fox, and Sailesh Kumar. "Factors Associated with Increased Risk of Early Severe Neonatal Morbidity in Late Preterm and Early Term Infants." Journal of Clinical Medicine 10, no. 6 (March 23, 2021): 1319. http://dx.doi.org/10.3390/jcm10061319.
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Although the risk of neonatal mortality is generally low for late preterm and early term infants, they are still significantly predisposed to severe neonatal morbidity (SNM) despite being born at relatively advanced gestations. In this study, we investigated maternal and intrapartum risk factors for early SNM in late preterm and early term infants. This was a retrospective cohort study of non-anomalous, singleton infants (34+0–38+6 gestational weeks) born at the Mater Mother’s Hospital in Brisbane, Australia from January 2015 to May 2020. Early SNM was defined as a composite of any of the following severe neonatal outcome indicators: admission to neonatal intensive care unit (NICU) in conjunction with an Apgar score <4 at 5 min, severe respiratory distress, severe neonatal acidosis (cord pH < 7.0 or base excess <−12 mmol/L). Multivariable binomial logistic regression analyses using generalized estimating equations (GEE) were used to identify risk factors. Of the total infants born at 34+0–38+6 gestational weeks, 5.7% had at least one component of the composite outcome. For late preterm infants, pre-existing diabetes mellitus, instrumental birth and emergency caesarean birth for non-reassuring fetal status were associated with increased odds for early SNM, whilst for early term infants, pre-existing and gestational diabetes mellitus, antepartum hemorrhage, instrumental, emergency caesarean and elective caesarean birth were significant risk factors. In conclusion, we identified several risk factors contributing to early SNM in late preterm and early term cohort. Our results suggest that predicted probability of early SNM decreased as gestation increased.
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Liamputtong Rice, Pranee. "Childhood Health and Illness: Cultural Beliefs and Practices among the Hmong in Victoria." Australian Journal of Primary Health 4, no. 4 (1998): 44. http://dx.doi.org/10.1071/py98060.
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This paper examines the cultural construction of childhood illness among Hmong refugees from Laos who are living in Australia. It focuses on traditional patterns of beliefs and practices related to health and illness of newborn infants and young children. The Hmong treat childhood health and illness seriously, and for them there are several causes of childhood illness, including nature, souls, supernatural beings and human aggression. The roles of traditional healers who play an important part in childhood health and illness are also discussed. Lastly, the paper attempts to make clear some implications for child health services for immigrants such as the Hmong in Australia and elsewhere. The paper intends to contribute an anthropological perspective on child health which is particularly important in a multicultural society. A clear understanding by health professionals of cultural beliefs and expectations is essential if misunderstanding is to be avoided, and culturally appropriate and sensitive health care for immigrant children, such as the Hmong to be available.
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Attwell, Katie, Samantha Carlson, Jordan Tchilingirian, Tauel Harper, Lara McKenzie, Leah Roberts, Marco Rizzi, et al. "Coronavax: preparing community and government for COVID-19 vaccination: a research protocol for a mixed methods social research project." BMJ Open 11, no. 6 (June 2021): e049356. http://dx.doi.org/10.1136/bmjopen-2021-049356.
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IntroductionAhead of the implementation of a COVID-19 vaccination programme, the interdisciplinary Coronavax research team developed a multicomponent mixed methods project to support successful roll-out of the COVID-19 vaccine in Western Australia. This project seeks to analyse community attitudes about COVID-19 vaccination, vaccine access and information needs. We also study how government incorporates research findings into the vaccination programme.Methods and analysisThe Coronavax protocol employs an analytical social media study, and a qualitative study using in-depth interviews with purposively selected community groups. Participant groups currently include healthcare workers, aged care workers, first responders, adults aged 65+ years, adults aged 30–64 years, young adults aged 18–29 years, education workers, parents/guardians of infants and young children (<5 years), parents/guardians of children aged 5–18 years with comorbidities and parents/guardians who are hesitant about routine childhood vaccines. The project also includes two studies that track how Australian state and Commonwealth (federal) governments use the study findings. These are functional dialogues (translation and discussion exercises that are recorded and analysed) and evidence mapping of networks within government (which track how study findings are used).Ethics and disseminationEthics approval has been granted by the Child and Adolescent Health Service Human Research Ethics Committee (HREC) and the University of Western Australia HREC. Study findings will be disseminated by a series of journal articles, reports to funders and stakeholders, and invited and peer-reviewed presentations.
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Stubbs, Joanne M., and Helen M. Achat. "Health home visiting for vulnerable families: what has occurred and what is yet to arrive?" Australian Journal of Primary Health 18, no. 1 (2012): 23. http://dx.doi.org/10.1071/py11035.
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Sustained health home visiting (SHHV) is a valuable means of implementing early intervention for vulnerable families with infants or young children. This first of a two-part report describes clients and identifies nurses’ activities with or on behalf of clients as part of a pilot SHHV program undertaken within a socioeconomically disadvantaged suburban area of Sydney, New South Wales, Australia. A forthcoming report describes the results of the intervention. Child and family health nurses visited vulnerable clients who were pregnant and/or had an infant aged 36 months or younger. Interventions consisted of direct and indirect (i.e. services involving a third party) client contact. Nurses documented all activities undertaken with or on behalf of clients using pre-determined codes. Over 29 months, the program accepted 136 referrals and 118 (87%) consented to the evaluation. Families had a mean of eight risk factors, which commonly included current mental health symptoms or disorders (49%), a history or current experience of domestic violence (51%) and being known to the Department of Community Services (40%). Nurses’ most frequent interventions addressed the main carer’s emotional and health needs, and infant development. Clients’ level of need required coordinated care from a specialised multidisciplinary team, which was unavailable to program clients and their families.
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Ashman, A. M., C. E. Collins, L. Weatherall, L. J. Brown, M. E. Rollo, D. Clausen, C. C. Blackwell, et al. "A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study." Journal of Developmental Origins of Health and Disease 7, no. 4 (April 15, 2016): 357–68. http://dx.doi.org/10.1017/s204017441600009x.
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Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child’s first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5–43.2, n=110), median birth weight was 3180 g (910–5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.
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Fink, Daniel, Afif El-Khuffash, Patrick McNamara, Itamar Nitzan, and Cathy Hammerman. "Tale of Two Patent Ductus Arteriosus Severity Scores: Similarities and Differences." American Journal of Perinatology 35, no. 01 (August 8, 2017): 055–58. http://dx.doi.org/10.1055/s-0037-1605576.
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Introduction Several echocardiographic scoring systems have been developed to assess the severity of patent ductus arteriosus (PDA) shunting in preterm infants. Objective The objective of this study was to compare the ability of two different scoring systems to evaluate the hemodynamic significance of the PDA and to predict long-term PDA-associated morbidities. Subjects El-Khuffash cohort (previously described) was derived from a multicenter, prospective, observational study conducted in tertiary neonatal intensive care units in Ireland, Canada, and Australia. Results A total of 141 infants with a mean gestational age of 26 ± 1.4 weeks and a mean birth weight of 952 ± 235 g were evaluated on day 2 of life. The two scores were well correlated with each other and both scores positively predicted chronic lung disease/death in this population. Conclusion There appears to be an overall stepwise progression in the incidence of poor outcome parameters from “closed” to “borderline” to “hemodynamically significant” PDA. Both the El-Khuffash and Shaare Zedek scores are predictive of PDA-associated morbidities.
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Hodgson, Kate A., Louise S. Owen, Camille Omar Kamlin, Calum T. Roberts, Susan M. Donath, Peter G. Davis, and Brett James Manley. "A multicentre, randomised trial of stabilisation with nasal high flow during neonatal endotracheal intubation (the SHINE trial): a study protocol." BMJ Open 10, no. 10 (October 2020): e039230. http://dx.doi.org/10.1136/bmjopen-2020-039230.
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IntroductionNeonatal endotracheal intubation is an essential but potentially destabilising procedure. With an increased focus on avoiding mechanical ventilation, particularly in preterm infants, there are fewer opportunities for clinicians to gain proficiency in this important emergency skill. Rates of successful intubation at the first attempt are relatively low, and adverse event rates are high, when compared with intubations in paediatric and adult populations. Interventions to improve operator success and patient stability during neonatal endotracheal intubations are needed. Using nasal high flow therapy extends the safe apnoea time of adults undergoing upper airway surgery and during endotracheal intubation. This technique is untested in neonates.Methods and analysisThe Stabilisation with nasal High flow during Intubation of NEonates (SHINE) trial is a multicentre, randomised controlled trial comparing the use of nasal high flow during neonatal intubation with standard care (no nasal high flow). Intubations are randomised individually, and stratified by site, use of premedications, and postmenstrual age (<28 weeks’ gestation; ≥28 weeks’ gestation). The primary outcome is the incidence of successful intubation on the first attempt without physiological instability of the infant. Physiological instability is defined as an absolute decrease in peripheral oxygen saturation >20% from preintubation baseline and/or bradycardia (<100 beats per minute).Ethics and disseminationThe SHINE trial received ethical approval from the Human Research Ethics Committees of The Royal Women’s Hospital, Melbourne, Australia and Monash Health, Melbourne, Australia. The trial is currently recruiting in these two sites. The findings of this study will be disseminated via peer-reviewed journals and presented at national and international conferences.Trial registration numberACTRN12618001498280.
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Oliver, Colleen, Caitlin Watson, Elesa Crowley, Melissa Gilroy, Denise Page, Katrina Weber, Deanna Messina, and Barbara Cormack. "Vitamin and Mineral Supplementation Practices in Preterm Infants: A Survey of Australian and New Zealand Neonatal Intensive and Special Care Units." Nutrients 12, no. 1 (December 23, 2019): 51. http://dx.doi.org/10.3390/nu12010051.
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Preterm infants are at increased risk of micronutrient deficiencies as a result of low body stores, maternal deficiencies, and inadequate supplementations. The aim of this survey was to investigate current vitamin and mineral supplementation practices and compare these with published recommendations and available evidence on dosages and long-term outcomes of supplementations in preterm infants. In 2018, a two-part electronic survey was emailed to 50 Australasian Neonatal Dietitians Network (ANDiN) member and nonmember dietitians working in neonatal units in Australia and New Zealand. For inpatients, all units prescribed between 400 and 500 IU/day vitamin D, compared to a recommended intake range of 400–1000 IU/day. Two units prescribed 900–1000 IU/day at discharge. For iron, 83% of respondents prescribed within the recommended intake range of 2–3 mg/kg/day for inpatients. Up to 10% of units prescribed 6 mg/kg/day for inpatients and at discharge. More than one-third of units reported routine supplementations of other micronutrients, including calcium, phosphate, vitamin E, and folic acid. There was significant variation between neonatal units in vitamin and mineral supplementation practices, which may contribute to certain micronutrient intakes above or below recommended ranges for gestational ages or birth weights. The variations in practice are in part due to differences in recommended vitamin and mineral intakes between expert groups and a lack of evidence supporting the recommendations for supplementations.
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Gilby, Damien M., J. Bridie Mee, C. Omar Farouk Kamlin, Louise H. Kornman, Peter G. Davis, and Brett James Manley. "Outcomes following antenatal identification of hydrops fetalis: a single-centre experience from 2001 to 2012." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 3 (May 16, 2018): F253—F258. http://dx.doi.org/10.1136/archdischild-2017-313604.
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ObjectiveTo describe the aetiologies and outcomes of pregnancies complicated by hydrops fetalis (HF).Study designCase series of all pregnancies complicated by HF managed at The Royal Women’s Hospital (RWH), Melbourne, Australia, between 2001 and 2012. Multiple pregnancies, and cases where antenatal care was not provided at RWH were excluded. Cases were identified from neonatal and obstetric databases. Data were extracted from maternal and neonatal case files, electronic pathology and radiology reports, and obstetric and neonatal databases.ResultsOver 12 years, 131 fetuses with HF with a median (IQR) gestational age (GA) at diagnosis of 24 (20–30) weeks were included in the analysis. There were 65 liveborn infants with a median (IQR) GA at birth of 33 (31–37) weeks and a median (IQR) birthweight Z-score of 1.4 (0.4–2.2). Overall survival from diagnosis was 27% (36/131) increasing to 55% (36/65) if born alive.ConclusionsThe perinatal mortality risk for fetuses and newborn infants with HF is high with important differences dependent on underlying diagnosis and the time at which counselling is provided. Clinicians need to be aware of the outcomes of both fetuses and neonates with this condition.
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Prentice, Michele, and Colleen Stainton. "Outcomes of Developmental Care in an Australian Neonatal Intensive Care Nursery." Neonatal Network 22, no. 6 (January 2003): 17–23. http://dx.doi.org/10.1891/0730-0832.22.6.17.
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Objective: To evaluate the outcomes of implementation of a developmental care model in an Australian tertiary NICU.Study Design: A retrospective chart audit was used to determine the differences between predevelopmental and developmental care outcomes for infants, parents, the unit, and nursing.Sample: Two subsets of infants were selected for comparison: one of infants receiving predevelopmental care (n = 42) and another of infants receiving developmental care (n = 42).Results: Infants receiving developmental care required less time on total parenteral nutrition, required less exogenous surfactant, and had less documented feeding intolerance. Changes were observed in ambience and in the use of space for providing parent-infant care. Also observed was the individualized expertise of nursing staff and of parents.
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Adams, Mark, Dirk Bassler, Brian A. Darlow, Kei Lui, Brian Reichman, Stellan Hakansson, Mikael Norman, et al. "Preventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis." BMJ Open 9, no. 10 (October 2019): e031086. http://dx.doi.org/10.1136/bmjopen-2019-031086.
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ObjectivesTo compare necrotising enterocolitis (NEC) prevention practices and NEC associated factors between units from eight countries of the International Network for Evaluation of Outcomes of Neonates, and to assess their association with surgical NEC rates.DesignProspective unit-level survey combined with retrospective cohort study.SettingNeonatal intensive care units in Australia/New Zealand, Canada, Finland, Israel, Spain, Sweden, Switzerland and Tuscany (Italy).PatientsExtremely preterm infants born between 240to 286weeks’ gestation, with birth weights<1500 g, and admitted between 2014–2015.ExposuresNEC prevention practices (probiotics, feeding, donor milk) using responses of an on-line pre-piloted questionnaire containing 10 questions and factors associated with NEC in literature (antenatal steroids, c-section, indomethacin treated patent ductus arteriosus and sepsis) using cohort data.Outcome measuresSurgical NEC rates and death following NEC using cohort data.ResultsThe survey response rate was 91% (153 units). Both probiotic provision and donor milk availability varied between 0%–100% among networks whereas feeding initiation and advancement rates were similar in most networks. The 9792 infants included in the cohort study to link survey results and cohort outcomes, revealed similar baseline characteristics but considerable differences in factors associated with NEC between networks. 397 (4.1%) neonates underwent NEC surgery, ranging from 2.4%–8.4% between networks. Standardised ratios for surgical NEC were lower for Australia/New Zealand, higher for Spain, and comparable for the remaining six networks.ConclusionsThe variation in implementation of NEC prevention practices and in factors associated with NEC in literature could not be associated with the variation in surgical NEC incidence. This corroborates the current lack of consensus surrounding the use of preventive strategies for NEC and emphasises the need for research.
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Gora, Hannah, Simon Smith, Ian Wilson, Annie Preston-Thomas, Nicole Ramsamy, and Josh Hanson. "The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019." PLOS ONE 17, no. 3 (March 21, 2022): e0265410. http://dx.doi.org/10.1371/journal.pone.0265410.
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Background The epidemiology of central nervous system (CNS) infections in tropical Australia is incompletely defined. Methods A retrospective study of all individuals in Far North Queensland, tropical Australia, who were diagnosed with a CNS infection between January 1, 2000, and December 31, 2019. The microbiological aetiology of the infection was correlated with patients’ demographic characteristics and their clinical course. Results There were 725 cases of CNS infection during the study period, meningitis (77.4%) was the most common, followed by brain abscess (11.6%), encephalitis (9.9%) and spinal infection (1.1%). Infants (24.3%, p<0.0001) and Aboriginal and Torres Strait Islander Australians (175/666 local residents, 26.3%, p<0.0001) were over-represented in the cohort. A pathogen was identified in 513 cases (70.8%); this was viral in 299 (41.2%), bacterial in 175 (24.1%) and fungal in 35 (4.8%). Cryptococcal meningitis (24 cases) was diagnosed as frequently as pneumococcal meningitis (24 cases). There were only 2 CNS infections with a S. pneumoniae serotype in the 13-valent pneumococcal vaccine after its addition to the National Immunisation schedule in 2011. Tropical pathogens–including Cryptococcus species (9/84, 11%), Mycobacterium tuberculosis (7/84, 8%) and Burkholderia pseudomallei (5/84, 6%)–were among the most common causes of brain abscess. However, arboviral CNS infections were rare, with only one locally acquired case—a dengue infection in 2009—diagnosed in the entire study period. Intensive Care Unit admission was necessary in 14.3%; the overall case fatality rate was 4.4%. Conclusion Tropical pathogens cause CNS infections as commonly as traditional bacterial pathogens in this region of tropical Australia. However, despite being highlighted in the national consensus guidelines, arboviruses were identified very rarely. Prompt access to sophisticated diagnostic and supportive care in Australia’s well-resourced public health system is likely to have contributed to the cohort’s low case-fatality rate.
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Batta, Vamsi, Shripada Rao, Deepika Wagh, Jason Khay Ghim Tan, Ian Gollow, Karen Simmer, Max K. Bulsara, and Sanjay Patole. "Early neurodevelopmental outcomes of congenital gastrointestinal surgical conditions: a single-centre retrospective study." BMJ Paediatrics Open 4, no. 1 (August 2020): e000736. http://dx.doi.org/10.1136/bmjpo-2020-000736.
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BackgroundEvidence is emerging that surgery in the neonatal period is associated with increased risk of suboptimal neurodevelopmental outcomes (SNDO). The aim of this study was to describe neurodevelopmental outcomes (at 1 year) of neonatal surgery for congenital gastrointestinal surgical conditions (CGSC) and to explore risk factors.MethodsRetrospective study (2005–2014) of infants born ≥34 weeks gestation with CGSC and admitted to the surgical neonatal intensive care unit of Perth Children’s Hospital, Western Australia. Clinical details and 1-year developmental outcomes based on Griffiths Mental Developmental Assessment Scales were collated from the database and by reviewing the medical records of study infants. SNDO was defined as one or more of the following: a general quotient less than 88 (ie, >1 SD below mean), cerebral palsy, blindness or sensorineural deafness. Univariable and multivariable logistic regression analyses were carried out to explore risk factors for SNDO. A total of 413 infants were included, of which 13 died. Median gestation was 37.6 weeks (IQR: 36.4–39.1). Information on developmental outcomes was available from 262 out of 400 survivors. A total of 43/262 (16.4%) had SNDO. On univariable analysis, lower z scores for birth weight, prolonged duration of antibiotics, increased episodes of general anaesthesia and prolonged duration of hospital stay were associated with SNDO. On multivariable analysis, lower z scores for birth weight and prolonged hospital stay were associated with increased risk of SNDO.ConclusionsLate preterm and term infants undergoing neonatal surgery for CGSC may be at risk for SNDO. Studies with longer duration of follow-up are needed to further evaluate the role of potentially modifiable risk factors on their neurodevelopmental outcomes.
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Fernando, Mindi, Nalin Choudhary, Beena Kumar, Natasha Juchkov, Kathryn Shearer, Stacey J. Ellery, Miranda Davies-Tuck, and Atul Malhotra. "Influence of Maternal Region of Birth on Placental Pathology of Babies Born Small." Children 9, no. 3 (March 10, 2022): 388. http://dx.doi.org/10.3390/children9030388.
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Background: Placental pathology is a common antecedent factor in infants born small for gestational age. Maternal region of birth can influence rates of SGA. Aims: To determine the association of maternal region of birth on placental pathology in babies that are born small, comparing a South Asian born population with Australia and New Zealand born women. Materials and methods: A retrospective cohort study was conducted at Monash Health, the largest public health service in Victoria. Mother-baby pairs above 34 weeks’ gestation and birth weight less than 10th centile born in 2016 were included. Placental pathology reports and medical records were reviewed. Statistical analyses of placental and selected neonatal outcomes data were performed. Results: Three hundred and eleven small for gestational age babies were included in this study, of which 171 were born to South Asian mothers and 140 to Australian and New Zealand mothers. There were no significant differences in gestational age at birth between the groups (38.7 (1.6) vs. 38.3 (1.7) weeks, p = 0.06). Placental pathology (macroscopic and microscopic) data comparisons showed no significant differences between the two groups (81% major abnormality in both groups). This was despite South Asian small for gestational age babies being less likely to require admission to a special care nursery or neonatal intensive care unit (35 vs. 41%, p = 0.05), or have a major congenital abnormality (2.3 vs. 4.3%, p = 0.04). Conclusion: In this observational study, maternal region of birth did not have an influence on placental pathology of babies born small, despite some differences in neonatal outcomes.
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Hossain, Sadia, Prakesh S. Shah, Xiang Y. Ye, Brian A. Darlow, Shoo K. Lee, and Kei Lui. "Outcome comparison of very preterm infants cared for in the neonatal intensive care units in Australia and New Zealand and in Canada." Journal of Paediatrics and Child Health 51, no. 9 (March 25, 2015): 881–88. http://dx.doi.org/10.1111/jpc.12863.
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Schlapbach, Luregn J., Lahn Straney, Ben Gelbart, Janet Alexander, Donna Franklin, John Beca, Jennifer A. Whitty, et al. "Burden of disease and change in practice in critically ill infants with bronchiolitis." European Respiratory Journal 49, no. 6 (June 2017): 1601648. http://dx.doi.org/10.1183/13993003.01648-2016.
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Bronchiolitis represents the most common cause of non-elective admission to paediatric intensive care units (ICUs).We assessed changes in admission rate, respiratory support, and outcomes of infants <24 months with bronchiolitis admitted to ICU between 2002 and 2014 in Australia and New Zealand.During the study period, bronchiolitis was responsible for 9628 (27.6%) of 34 829 non-elective ICU admissions. The estimated population-based ICU admission rate due to bronchiolitis increased by 11.76 per 100 000 each year (95% CI 8.11–15.41). The proportion of bronchiolitis patients requiring intubation decreased from 36.8% in 2002, to 10.8% in 2014 (adjusted OR 0.35, 95% CI 0.27–0.46), whilst a dramatic increase in high-flow nasal cannula therapy use to 72.6% was observed (p<0.001). We observed considerable variability in practice between units, with six-fold differences in risk-adjusted intubation rates that were not explained by ICU type, size, or major patient factors. Annual direct hospitalisation costs due to severe bronchiolitis increased to over USD30 million in 2014.We observed an increasing healthcare burden due to severe bronchiolitis, with a major change in practice in the management from invasive to non-invasive support that suggests thresholds to admittance of bronchiolitis patients to ICU have changed. Future studies should assess strategies for management of bronchiolitis outside ICUs.
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Benjamin, Bruce, Peter Robb, and Martin Glasson. "Esophageal Stricture following Esophageal Atresia Repair: Endoscopic Assessment and Dilation." Annals of Otology, Rhinology & Laryngology 102, no. 5 (May 1993): 332–36. http://dx.doi.org/10.1177/000348949310200502.
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A retrospective review from 1981 to 1986 was made of 51 neonates who were treated for congenital esophageal atresia at the Royal Alexandra Hospital for Children, Sydney, Australia. Thirty of the 51 had primary repair and 15 (50%) developed esophageal stricture requiring one or more dilations. Stricture dilations were performed with open-tube rigid esophagoscopes, rigid telescopes, and Jackson dilators. The number of dilations performed until the patient was asymptomatic ranged from 1 to 12 (mean 4.5). The minimal follow-up time was 4 years. There was one esophageal perforation with full recovery following conservative management. One child died of septicemia caused by continued aspiration of unknown cause. A surprising finding, contrary to other reports, was that stricture formation did not appear to be related to the size of the “gap” found at the time of esophageal repair. Gastroesophageal reflux, however, was an important factor. We conclude that esophageal stricture following repair of tracheoesophageal atresia can be satisfactorily and relatively safely managed by direct vision antegrade endoscopic dilation using graduated dilators, although treatment may be prolonged and repeated. New esophagoscopes and dilators, in graduated sizes and designed for pediatric use, are recommended. The technique of esophageal dilation in infants is described in detail. Pediatric laryngobronchoesophagologists will become more involved in the care of infants born with esophageal atresia with or without tracheoesophageal fistula.
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Kinshella, Mai-Lei Woo, Sangwani Salimu, Brandina Chiwaya, Felix Chikoti, Lusungu Chirambo, Ephrida Mwaungulu, Mwai Banda, et al. "“So sometimes, it looks like it’s a neglected ward”: Health worker perspectives on implementing kangaroo mother care in southern Malawi." PLOS ONE 15, no. 12 (December 17, 2020): e0243770. http://dx.doi.org/10.1371/journal.pone.0243770.
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Introduction Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother’s chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of this study is to understand barriers and facilitators to KMC practice at tertiary and secondary health facilities in southern Malawi from the perspective of health workers. Methods This study is part of the “Integrating a neonatal healthcare package for Malawi” project in the Innovating for Maternal and Child Health in Africa initiative. In-depth interviews were conducted between May-Aug 2019 with a purposively drawn sample of service providers and supervisors working in newborn health at a large tertiary hospital and three district-level hospitals in southern Malawi. Data were analyzed using a thematic approach using NVivo 12 software (QSR International, Melbourne, Australia). Findings A total of 27 nurses, clinical officers, paediatricians and district health management officials were interviewed. Staff attitudes, inadequate resources and reliance on families emerged as key themes. Health workers from Malawi described KMC practice positively as a low-cost, low-technology solution appropriate for resource-constrained health settings. However, staff perceptions that KMC babies were clinically stable was associated with lower prioritization in care and poor monitoring practices. Neglect of the KMC ward by medical staff, inadequate staffing and reliance on caregivers for supplies were associated with women self-discharging early. Conclusion Though routine uptake of KMC was policy for stable low birthweight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualized as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and KMC wraps. Strengthening hospital capacities to support KMC is needed as part of a continuum of care for premature infants.
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Blythe, Stacy, Kath Peters, Emma Elcombe, Elaine Burns, and Karleen Gribble. "Australian Foster Carers’ Views and Concerns Regarding Maternal Drug Use and the Safety of Breastmilk." Children 8, no. 4 (April 7, 2021): 284. http://dx.doi.org/10.3390/children8040284.
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Parental substance misuse and mental health issues are major factors associated with infant placement into out-of-home care. Such placements may result in disruption and/or cessation of breastfeeding. Provision of breastmilk to infants in out-of-home care (OOHC) is desirable in terms of infant health and development, and also in supporting maternal caregiving. However, little is known about how breastfeeding is supported for infants in out-of-home care. This study used an online survey to explore the facilitation of breastfeeding in the context of OOHC and foster carers’ management of expressed breastmilk (EBM). Foster carers were generally open to the idea of maternal breastfeeding and infants in their care receiving EBM from their mothers. However, the majority of respondents expressed concern regarding the safety of EBM for infant consumption due to the possibility of harmful substances in the milk. Concerns regarding the safety of handling EBM were also prevalent. These concerns caused foster carers to discard EBM. Findings suggest foster carers’ may lack knowledge related to maternal substance use and breastmilk. Better integration between health care and social service systems, where the voices of mothers, foster carers and child protection workers are heard, is necessary to develop solutions enabling infants living in OOHC access to their mother’s breastmilk.