Abstract:Background:
Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress.
Purpose:
This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery.
Methods:
The Care Partnership Pyramid was created by a multidisciplinary team and incorp… Show more
“…Studies were published between 1989 and 2020 and included nine quantitative analyses, 28 , 45 , 56 – 62 three qualitative analyses, 63 – 65 and one mixed-methods analysis 66 (ESM, eTable 4). Of the 13 included studies, three had a primary outcome specifically related to comfort-holding 59 – 61 five assessed comfort-holding as part of end-of-life care, 56 , 58 , 63 – 65 three assessed it as part of generalized developmental care, 28 , 62 , 66 and two assessed comfort-holding as part of mobilization. 45 , 57 Holding was assessed according to four outcomes: 1) the frequency of holding and factors associated with frequency of holding (five studies), 28 , 45 , 58 , 61 , 62 2) outcomes for children who received comfort-holding (two studies) 59 , 61 3) the safety of comfort-holding (three studies), 45 , 60 , 62 and 4) the impact of comfort-holding on parental outcomes (seven studies) 56 , 57 , 60 , 63 – 66 ( Table ).…”
Section: Resultsmentioning
confidence: 99%
“… 45 , 57 Holding was assessed according to four outcomes: 1) the frequency of holding and factors associated with frequency of holding (five studies), 28 , 45 , 58 , 61 , 62 2) outcomes for children who received comfort-holding (two studies) 59 , 61 3) the safety of comfort-holding (three studies), 45 , 60 , 62 and 4) the impact of comfort-holding on parental outcomes (seven studies) 56 , 57 , 60 , 63 – 66 ( Table ). Figure Flow diagram of included studies …”
Section: Resultsmentioning
confidence: 99%
“…Frequency of comfort-holding and factors associated with comfort-holding were assessed in five studies. 28 , 45 , 58 , 61 , 62 Comfort-holding was more common in infants and young children (i.e., children younger than three years) and at the end of life. 45 , 58 , 62 When family members were present, Garros et al found that 77.8% of children were held at the end of life.…”
Section: Resultsmentioning
confidence: 99%
“… 39 – 43 Neonatal comfort-holding has also shown benefits for mothers, including decreased maternal post-traumatic stress symptoms and improved maternal attachment. 28 , 44 …”
Purpose
To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs).
Sources
This scoping review was conducted using PRISMA methodology. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials. Search strategies were developed with a medical librarian and revised through a peer review of electronic search strategies. All databases were searched from inception to 14 April 2020. Only full-text articles available in English were included. All identified articles were reviewed independently and in duplicate using predetermined criteria. All study designs were eligible if they reported on comfort-holding in a PICU. Data were extracted independently and in duplicate.
Principal findings
Of 13,326 studies identified, 13 were included. Comfort-holding was studied in the context of end-of-life care, developmental care, mobilization, and as a unique intervention. Comfort-holding is common during end-of-life care with 77.8% of children held, but rare during acute management (51% of children < three years, < 5% of children ≥ three years). Commonly reported outcomes included child outcomes (e.g., physiologic measurements), safety outcomes (e.g., accidental line removal), parent outcomes (e.g., psychological symptoms), and frequency of holding.
Conclusion
There is a paucity of literature on comfort-holding in PICUs. This scoping review identifies significant gaps in the literature, including assessment of child-based outcomes of comfort-holding or safety assessment of comfort-holding, and highlights core outcomes to consider in future evaluations of this intervention including child-based outcomes, parent-based outcomes, and safety of the intervention.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12630-021-02090-3.
“…Studies were published between 1989 and 2020 and included nine quantitative analyses, 28 , 45 , 56 – 62 three qualitative analyses, 63 – 65 and one mixed-methods analysis 66 (ESM, eTable 4). Of the 13 included studies, three had a primary outcome specifically related to comfort-holding 59 – 61 five assessed comfort-holding as part of end-of-life care, 56 , 58 , 63 – 65 three assessed it as part of generalized developmental care, 28 , 62 , 66 and two assessed comfort-holding as part of mobilization. 45 , 57 Holding was assessed according to four outcomes: 1) the frequency of holding and factors associated with frequency of holding (five studies), 28 , 45 , 58 , 61 , 62 2) outcomes for children who received comfort-holding (two studies) 59 , 61 3) the safety of comfort-holding (three studies), 45 , 60 , 62 and 4) the impact of comfort-holding on parental outcomes (seven studies) 56 , 57 , 60 , 63 – 66 ( Table ).…”
Section: Resultsmentioning
confidence: 99%
“… 45 , 57 Holding was assessed according to four outcomes: 1) the frequency of holding and factors associated with frequency of holding (five studies), 28 , 45 , 58 , 61 , 62 2) outcomes for children who received comfort-holding (two studies) 59 , 61 3) the safety of comfort-holding (three studies), 45 , 60 , 62 and 4) the impact of comfort-holding on parental outcomes (seven studies) 56 , 57 , 60 , 63 – 66 ( Table ). Figure Flow diagram of included studies …”
Section: Resultsmentioning
confidence: 99%
“…Frequency of comfort-holding and factors associated with comfort-holding were assessed in five studies. 28 , 45 , 58 , 61 , 62 Comfort-holding was more common in infants and young children (i.e., children younger than three years) and at the end of life. 45 , 58 , 62 When family members were present, Garros et al found that 77.8% of children were held at the end of life.…”
Section: Resultsmentioning
confidence: 99%
“… 39 – 43 Neonatal comfort-holding has also shown benefits for mothers, including decreased maternal post-traumatic stress symptoms and improved maternal attachment. 28 , 44 …”
Purpose
To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs).
Sources
This scoping review was conducted using PRISMA methodology. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials. Search strategies were developed with a medical librarian and revised through a peer review of electronic search strategies. All databases were searched from inception to 14 April 2020. Only full-text articles available in English were included. All identified articles were reviewed independently and in duplicate using predetermined criteria. All study designs were eligible if they reported on comfort-holding in a PICU. Data were extracted independently and in duplicate.
Principal findings
Of 13,326 studies identified, 13 were included. Comfort-holding was studied in the context of end-of-life care, developmental care, mobilization, and as a unique intervention. Comfort-holding is common during end-of-life care with 77.8% of children held, but rare during acute management (51% of children < three years, < 5% of children ≥ three years). Commonly reported outcomes included child outcomes (e.g., physiologic measurements), safety outcomes (e.g., accidental line removal), parent outcomes (e.g., psychological symptoms), and frequency of holding.
Conclusion
There is a paucity of literature on comfort-holding in PICUs. This scoping review identifies significant gaps in the literature, including assessment of child-based outcomes of comfort-holding or safety assessment of comfort-holding, and highlights core outcomes to consider in future evaluations of this intervention including child-based outcomes, parent-based outcomes, and safety of the intervention.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12630-021-02090-3.
“…this essential experience by providing education on infant care and medical needs, and by inviting and supporting parent partnership in care. 26 Models of care, such as Individualised Family-centred Developmental Care, may meet this parenting need by engaging parents in the process of learning to read and respond to their infant's unique behavioural cues. 3 Parents in this study also reported the need for support around becoming their infant's primary decision-maker.…”
Objective:
To characterise the parenting priorities of mothers and fathers of infants hospitalised with CHD and generate recommendations to support parenting during infant hospitalisation.
Study design:
Through online crowdsourcing, an innovative research methodology to create an online community to serve as a research sample, 79 parents of young children with CHD responded to questions about parenting during hospitalisation via private social networking site. Responses were analysed using qualitative research methods.
Results:
Three broad themes were identified: (1) establishing a bond with my baby, (2) asserting the parental role, and (3) coping with fear and uncertainty. Parents value provider support in restoring normalcy to the parenting experience during infant hospitalisation.
Conclusions:
Care teams can support parenting during infant hospitalisation by promoting parents’ roles as primary caretakers and decision-makers and attending to the emotional impact of infant hospitalisation on the family.
Key Points
Question
What are the associations between maternal milk feeding and cognitive, academic, and behavioral outcomes of preterm infants born at less than 33 weeks’ gestation?
Findings
In this cohort study of 586 preterm infants, higher maternal milk intake during neonatal hospitalization was associated with higher performance IQ, better academic achievement in reading and math, and fewer attention-deficit/hyperactivity symptoms at 7 years of age. These associations persisted after adjustment for clinical and social confounders and were generally more pronounced among infants born at lower gestational ages.
Meaning
These findings affirm recommendations to provide maternal milk to hospitalized very preterm infants based on potential long-term benefits to neurodevelopment.
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