Kim, Mi-Soon;Kim, Mi-Jin;Ham, Eun-Ha;Kim, Kyoung-Mi
Journal of Korean Academy of Fundamentals of Nursing
/
v.13
no.3
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pp.510-519
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2006
Purpose: To develop and validate a scale suitable and efficient scale for use in clinical practice as to assess pain in premature infants. Method: Pain indicators identified by observation of preform infants. A cohort of preform infants was studied prospectively to determine the construct validity, inter-rater reliability, and internal consistency of the scale. The PIPS uses four indicators of pain: corrected gestational age, heart rate, oxygen saturation, behavioral state. The validation study included 45 premature infants with gestational age of 37 weeks or less. Results: The inter-rater reliability of the PIPS was acceptable, with Pearson correlations ranging from.720 to.970. Internal consistency was high: Cronbach's alpha coefficients ranged from.551 to.653. There was a strong correlation between the PIPS and PIPP scores (each researcher's r=.743, each indicator's r=.914). Although gestational age showed no association between these factors and the sum, the other variables were positively associated with the sum. Time needed to calculate PIPS scores is was less than Premature Infant Pain Profile (PIPP) scores(p<.000). Conclusion: The validation data suggest that the PIPS is appropriate and efficient for assessing pain in premature infants. Further studies are required about to determine appropriate interventions for each pain score on the PIPS.
Purpose: Assessment of mothers' neonatal perception is important in understanding early mothering experiences and in planning future care. The purpose of this study was to identify the differences of mothers' perception and caring-confidence between normal and high-risk newborn during the early postpartum period. The ultimate goal was to contribute to healthy mother-infant relationship and development of infants. Method: The data was collected for this study at one university hospital in Daejeon from May 13, 2005 to December 20, 2005. The subjects were 53 of mothers who had normal newborn and 46 of mothers who had high-risk newborn. The instrument was the 'Neonatal Perception Inventory' by revised Ja-Hyung, Lee (1986), and the 'Caring-Confidence Scale' by revised Hyun-Joo, Oh(2000). The data were statistically analyzed by using an SPSS program and include percentage, mean, SD, t-test. Result: There were significant differences in the perception of the newborn between the mothers of normal newborn and the mothers of high-risk newborn (p<.05). There were no significant differences in the perception pattern of the newborn between the mothers of normal newborn and the mothers of high-risk newborn. There were no significant differences in the caring-confidence between the mothers of normal newborn and the mothers of high-risk newborn. Conclusion: The nursing care in the nursery have needed to various interventions for normal and high-risk newborn mothers in order to improve the interaction and caring-confidence between mother and newborn.
This study was designed to investigate effects of maternal education using Brazelton Neonatal Behavioral Assessment Scale(the following will be marked as NBAS) on the mother-infant interaction and infant behavior. The subjects of this study consisted of 48 pairs of normal mother and infant, 24 pairs for intervention group and 24 pairs for control group. The subjects were recruited from two general hospitals, and an OBGY clinic located in J city. The data were collected from July 30, 2001 to October 6, 2001. Prior to investigation and data collection, following operational hypotheses were set up in order to compare the investigative data against these operational hypotheses(H). H1: Intervention group will higher mother-infant interaction score than control group. H2: Intervention group infants will higher overall performance in infant behavior test score than control group infants. The results of this study were summarized as follows: 1. The mother-infant interaction score was 59.79 points in intervention group and 53.91 points in control group. The mother-infant interaction score of intervention group showed significant difference than control group. Therefore, hypothesis 1 was supported. 2. The infant behavior score of intervention group was significantly higher than control group, but partially. Therefore, hypothesis 2 was partially supported. 1) The social interaction(orientation) score was 46.58 points in intervention group and 43.50 points in control group. The orientation score of intervention group showed significant difference than control group. 2) The state regulation score was 26.79 points in intervention group and 25.33 points in control group. The state regulation score of intervention group showed significant difference than control group. In conclusion, present work demonstrated that maternal education using NBAS is an effective intervention method for promotion of mother-infant interaction and of infant behavior development. Author believes that many inexperience young mother may find NBAS-based maternal education beneficial for their nursing babies, therefore NBAS-based intervention is recommended to be adopted routinely as an integral part of neonatal nursing strategies.
Objectives The purpose of this study is to look for pathological mechanism of disease development caused by Taedok, by studying whether stress and diet in pregnant ICR mice affect the intestinal flora and IgA (Immunoglobulin A) concentration. Methods The mice were divided into 4 groups (n=5 per group) based on the concept of Taedok: the control group (G1), stress group (G2), capsaicin diet group (G3), high fat diet group (G4). We collected and analyzed intestinal flora from maternal feces and cecal flora from neonatal mice by group. Then, IgA concentration in the maternal feces and sIgA (secretory Immunoglobulin A) concentration in the cecal contents of newborn mice were analyzed. In addition, serum corticosterone was analyzed before and after stress application. Results Changes in maternal intestinal flora and neonatal mice cecal flora by stress and diet were observed. There were no significant changes in the IgA concentration in maternal feces and the sIgA concentration in the cecal contents of neonatal mice. No significant changes compared to the control group were observed between groups before and after applying stress. However, when comparing within one subject, a significant increase was confirmed after stress application in the stress group (G2). Conclusions Based on the results, we observed stress and diet in pregnant mice affect the intestinal flora of maternal and neonatal. We were able to interpret the pathological mechanism of Taedok based on the principle of interaction between mother and newborn intestinal flora.
Neonatal hypoxia/ischemia (H/I), injures white matter, results in neuronal loss, disturbs myelin formation, and neural network development. Neuroinflammation and oxidative stress have been reported in neonatal hypoxic brain injuries. We investigated whether Paeoniflorin treatment reduced H/I-induced inflammation and oxidative stress and improved white matter integrity in a neonatal rodent model. Seven-day old Sprague-Dawley pups were exposed to H/I. Paeoniflorin (6.25, 12.5, or 25 mg/kg body weight) was administered every day via oral gavage from postpartum day 3 (P3) to P14, and an hour before induction of H/I. Pups were sacrificed 24 h (P8) and 72 h (P10) following H/I. Paeoniflorin reduced the apoptosis of neurons and attenuated cerebral infarct volume. Elevated expression of cleaved caspase-3 and Bad were regulated. Paeoniflorin decreased oxidative stress by lowering levels of malondialdehyde and reactive oxygen species generation and while, and it enhanced glutathione content. Microglial activation and the TLR4/NF-κB signaling were significantly down-regulated. The degree of inflammatory mediators (interleukin 1β and tumor necrosis factor-α) were reduced. Paeoniflorin markedly prevented white matter injury via improving expression of myelin binding protein and increasing O1-positive olidgodendrocyte and O4-positive oligodendrocyte counts. The present investigation demonstrates the potent protective efficiency of paeoniflorin supplementation against H/I-induced brain injury by effectually preventing neuronal loss, microglial activation, and white matter injury via reducing oxidative stress and inflammatory pathways.
Purpose: To assess the validity of individual and combined prognostic effects of severe bronchopulmonary dysplasia (BPD), brain injury, retinopathy of prematurity (ROP), and parenteral nutrition associated cholestasis(PNAC). Methods: We retrospectively analyzed the medical records of 80 extremely low birthweight (ELBW) infants admitted to the neonatal intensive care unit (NICU) of the Severance Children's Hospital, and who survived to a postmenstrual age of 36 weeks. We analyzed the relationship between 4 neonatal morbidities (severe BPD, severe brain injury, severe ROP, and severe PNAC) and poor outcome. Poor outcome indicated death after a postmenstrual age of 36 weeks or survival with neurosensory impairment (cerebral palsy, delayed development, hearing loss, or blindness) between 18 and 24 months of corrected age. Results: Each neonatal morbidity correlated with poor outcome on univariate analysis. Multiple logistic regression analysis revealed that the odds ratios (OR) were 4.9 (95% confidence interval [CI], 1.0-22.6; $P$=0.044) for severe BPD, 13.2 (3.0-57.3; $P$<.001) for severe brain injury, 5.3 (1.6-18.1; $P$=0.007) for severe ROP, and 3.4 (0.5-22.7; $P$=0.215) for severe PNAC. Severe BPD, brain injury, and ROP were significantly correlated with poor outcome, but not severe PNAC. By increasing the morbidity count, the rate of poor outcome was significantly increased (OR 5.2; 95% CI, 2.2-11.9; $P$<.001). In infants free of the above-mentioned morbidities, the rate of poor outcome was 9%, while the corresponding rates in infants with 1, 2, and more than 3 neonatal morbidities were 46%, 69%, and 100%, respectively. Conclusion: In ELBW infants 3 common neonatal mornidifies, severe BPD, brain injury and ROP, strongly predicts the risk of poor outcome.
Objectives: Parents of a premature baby feel a pressure on their baby's growth and they are highly in need for proper education. However, the lack of proper education can cause the difficulty of follow-up care and rehospitalization. Currently, methods of education among each nurse are based on verbal explanation and can be often different. Therfore, it is true that the psychological burden is great during education. Hence, by enforcing discharge education activities, we intend to provide information; induce participation of parents; promote the level of performance; standardize education program; and increase the job satisfaction of nurses. Methods: NICU conducted a questionnaire survey of the demand and satisfaction for discharge education among mothers that left hospital. And before and after the improvement activity, the satisfaction level of mothers and nurses were studied, and rehospitalization rate were analyzed. Results 1)The survey results of the satisfaction level of mothers towards education program as followes: The level of understanding of content, general babysitting, special situation, education method, and educator attitude showed statistically significant increase. 2)The survey results of the satisfaction level of nurses towards education program as followes: While, the need for education program decreased, the adequacy of education content and method, consistency of education, understanding of learner, and learner's performance increased. All the factors except for the need for education program and the adequacy of education content showed statistically significant difference. 3)Rehospitalization rate of premature babies decreased. According to analysis of the cause of rehospitalization, breast-feeding related apnea turned out to be the highest. Conclusion: Through QI, satisfaction of mothers and nurses improved more than 10%. And rehospitalization rate of premature babies decreased by the same amount as well. Therefore, with the help of the standardized discharge education program, mothers who is not easy to take care of after leaving hospital can be seen to significantly affect their healthy growth and development.
Purpose: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. Methods: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. Results: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0-4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. Conclusion: The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.
There is a critical developmental period during which brain sexual differentiation proceeds irreversibly under the influence of gonadal hormone. Recently, kinesin superfamily-associated protein 3 (KAP3) gene expressed during the 'critical period' of rat brain differentiation was identified by us (Choi and Lee, 1999). KAP3 functions as a microtubule-based motor that transports membranous organelles anterogradely in cells, including neurons (Yamazaki et al., 1996). mRNA level of KAP3 gene markedly increased before the initiation of puberty. Neonatal treatment of estrogen clearly inhibited the prepubertal increase in KAP3 mRNA level (Choi and Lee, 1999). In the present study, we aimed to investigate the effects of polychlorinated biphenyls (PCBs), as endocrine disruptors (EDs) on the expression of KAP3 gene during the 'critical period' of rat brain development. In our data, PCBs significantly decreased the expression of KAP3 gene in the fetal (day 17) and the neonatal (day 6 after birth in) male and female rat brains. The body weight and the breeding ability were significantly decreased in the PCBs-exposed rats compared with the control. These results showed that PCBs affect the transcriptional level of brain sexual differentiation related gene, KAP3, in the fetal and the neonatal rat brains. The maternal exposure to the PCBs may lead to toxic response in embryonic brain sexual differentiation and breeding ability after sexual maturation. This study indicates that KAP3 gene may be useful as a gene marker to analyze the molecular mechanism of toxic response in the animal brain development and sexual maturation exposed to PCBs.
The possible relationship between pulmonary vascular pathologic changes and an increased pulmonary blood flow and pulmonary blood pressure has been the subject of investigation for many years. In an attempts to study the effects of increased pulmonary blood flow. long-term observations have been made in neonatal goats in which the total pulmonary vascular bed was restricted by means of ligation of left pulmonary artery, thereby diverting the total right ventricular output through the right lung. The left pulmonary artery and patent ductus arteriosus were ligated in 6 neonatal goats of under 3 weeks of age, and the goats were put to death at interval between 1 and 7 months of age. Pulmonary arterial development in both right and left lungs was studied by applying quantitative morphometric techniques, and compared with control group of goats between 1 and 6 months of age. The axial pulmonary artery and its branches were larger in the right lung than in the control group in all animals, and they were abnormally small in the left lung. In the right lung, arteries smaller than 50\ulcornerm showed abnormal increase in `% wall thickness’ in postoperative 2,3,5 and 6th months[p<0.05]. The proportion of non-muscular arteries was over 50% at postoperative 1st month in both right and left lungs, but an increase in proportion of partially muscular and wholly muscular arteries occurred thereafter. The ratio of alveoli/arteries was lower than normal in the right lung of postoperative 1st month[p<0.05], but was elevated thereafter. The failure to perfuse one pulmonary artery in neonatal goats changed growth and development of both lungs.
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