12189 (169, 170, 171) Paper Presentation 2 – Environmental Effects on Infants and Parents


(169) Beyond the Hospital: Experience of Mothers on Methadone
Amy Johnson, PhD RNC, University of Delaware, Newark, DE
Coauthor: Katy Griffith,MSN RN CPN, Union Hospital of Cecil County, Elkton,MD

Abstract

Purpose: Childbirth can be physically, mentally, and emotionally challenging for a woman, especially with the added variable of substance use. In this situation, that transition to motherhood is compounded by associated legal, social, and environmental problems that can negatively impact the ability to provide newborn care This session describes these maternal experiecnes and introduces New Beginnings, a support group network to improve outcome.

Background & Importance: Drug use and the use of methadone during pregnancy is a major concern to nurses when trying to promote positive pregnancy outcomes and support women during the motherhood transition. Although newborn treatment through withdrawal is established in most hospitals, there is a gap in how we address the needs of mothes on drugs beyond discharging the infant home. Family-centered care that addresses the needs of the mother-baby dyad and works with the parents to positively influence parenting pratices has potential to be more effective than approaches that focus solely on the neonate, yet this has not moved forward into practice.

Description: NAS literature is reviewed as well as the postpartum needs of addicted mothers to frame the discussion of nursing interventions to support the maternal transition at home.

Future Directions: Support groups for addicted mothers like New Beginnings offer important safety information and techniques for parenting a newborn while dealing with an addiction. Nework opportunities to share concerns and fears with other new mothers of drug exposed infants may be the needed support to improve outcome.

Learning Objectives
1. Discuss infant and maternal needs for infants with neonatal abstinence syndrome in the neonatal period.
2. Dexeribr maternal experiences of addiction and parenting and discuss support internventions.

Bibliography
Beauman, S.S. (2005). Identification and mangement of neonatal abstinence syndrome. Journal of Infusion Nursing, 28(3): 159-167.
Fowles, E.R. & Horowitz, J.A. (2006), Clinical assesment of mothering during infancy. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35(5): 662-670.
Experiences in caring for newborns of drug-dependent parents. International Journal of Nursing Studies, in press.
McCarthy, J.J., Leamon, M.H., Parr, M.S., & Anania, B. (2005). High-dose methadone maintenance in pregancy: Maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 193(3, Part 1): 606--610.

(170) Mean Oxygen Saturation in Well Neonates at Altitudes Between 4498 and 8150 Feet
Tracie Line, MSN, Yampa Valley Medical Center, Steamboat Springs,
CO Coauthor: Patricia Ravert, PhD RN, CNE , Brigham Young University, Provo, UT


Abstract
Background/Significance
Practitioners make decisions to initiate and discontinue oxygen based on clinical assessments including SpO2 readings. Current research also indicates saturation levels may be useful in detecting critical congenital heart defects (CCHD). We know as altitude increases, mean SpO2 in neonates decreases. However data are absent for several altitude levels.

Purpose
The study examined mean SpO2 in well neonates at altitudes from 4498-8100ft.

Research Questions
What is the mean SpO2 in well neonates at altitudes of 4498-8150ft?
Do SpO2 levels in well neonates at altitude differ by sleep state or season?
Do the SpO2 levels of late pre-term neonates and term neonates differ significantly?

Methodology
Design- Non-experimental, longitudinal, descriptive
Sample- Well infants born at altitude
Setting- Hospital nurseries in Utah, Colorado, and California
Instruments- SpO2 levels using a Masimo Radical SET Monitor were collected at 3 times (12-24, 36-48, and 60-72 hours old) and demographic information from patient charts.

Analysis/Results
Measures of central tendency for various altitudes were compared with ANOVA. SpO2 readings at sites at or above 6800ft were significantly lower than those at 4498ft. No significant differences were noted for sleep state or season. Significant differences were also noted between the pre-term and term neonates.

Implications for Practice and Research
The findings fill the gap in knowledge regarding SpO2 levels for neonates born at altitudes ranging from 4498-8150ft. These findings may guide the practitioner in initiation of supplement oxygen and may assist in idenfitying CCHD through routine screening of neonates. Further research is needed for additional altitudes.

Learning Objectives
1. Describe the background and significance of SpO2 levels for infants born at high altitude.
2. Discuss study finding and implications.

Bibliography
Beebe SA, Heery LB. Pulse oximetry at moderate altitude. Clinical Pediatrics 1994; 33(6):329-332.

Comer DM. Pulse oximtery Implications for practice. JOGNN 1992; 21(1):35-41.

Duster MC. Effects of altitude. EMedicine Journal 2001; 2: section 2-7.

Gamponia MF, Babaali H, Yugar F, Gilman RH. Reference values for pulse oximetry at high altitude. Arch Dis Child 1998; 78:461-465.

Hay WW, Brockway JM, Eyzaguirre M. Neonatal pulse oximetry: Accuracy and reliability. Pediatrics 1989; 83(5):717-722.

Longo LD. High altitude and pregnancy. LLU&MC Scope 1997; (internet reference)

Lozano JM, Duque OR, Buitrago T, Behaine S. Pulse oximetry reference values at high altitude. Archives of Disease in childhood 1992; 67; 299-301.

Mahle WT, Newburger JW, Matherne GP, Smith GC, Hoke TR, Koppel R, Gidding SS, Beekman RH, Grosse SD. Role of pulse oximeter in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP. Pediatrics 2009; 124(2): 823-833.

Mok JY, McLaughlin FJ, Pintar M, Hak H, Amaro-Galvez R, Levison H. Transcutaneous monitoring of oxygenation: what is normal? Journal of Pediatrics 1986; 108(3): 365-371.

Nicholas R, Yaron M, Reeves J. Oxygen saturation in children living at moderate altitude. J Am Board Fam Pract 1993; 6(5): 452-456.

Niermeyer, S. Going to high altitude with a newborn infant. High Altitude Medicine & Biology 2007; 8(2): 117-123.

Niermeyer S, Shaffer EM, Thilo E, Corbin C, Moore LG. Arterial oxygenation and pulmonary arterial pressure in healthy neonates and infants at high altitude. J Pediatrics 1993; 123(5): 767-772.

Pollard AJ. Pulse oximetry reference values at high altitude. Archives of Disease in Childhood 1992; 67(11): 1413.

Prechtal, HFR. The behavioral states of the newborn infant. Brain Research 1974; 76: 185-212.

Salas, AA. Pulse oximetry values in healthy term newborns at high altitude. Annals of Tropical Paediatrics 2008, 28(28): 275-278.

Saleu G, Lupiwa S, Javati A, Namuigi P, Lehmann D. Arterial oxygen saturation in healthy young infants in the highlands of Papua New Guinea. P N G Med J 1999; 42(3-4):90-93.

Thilo EH, Park-Moore B, Berman ER, Carson BS. Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? American Journal of Diseases in Childhood 1991; 145(10): 1137-1140.

(171) The Perfect Pouch: A Comprehensive Case for Kangaroo Care
Lisa Cooper, LMSW, March of Dimes, White Plains, NY
Coauthor: Laura Miller, March of Dimes, White Plains, NY


Abstract
In a national evaluation published in 2007 in a peer-reviewed medical journal, NICU parents reported that holding/kangaroo caring their newborn was the most comforting of any opportunity provided to them during their newborn's hopsitalization The study indicated that staff also deemed Kangaroo Care as critical in reducing stress and enhancing bonding. Still, only 8% of staff reported the routine practice of Kangaroo Care in their unit. Interviews with NICU parents throughout the nation has validated these results, demonstrating that despite the multitude of proven benefits of Kangaroo Care, parents are offered this activity late in their baby's hospitalziaiton and at a low frequency. In this presentation, essential for recent nursing grads to those seasoned professionals, the presenter will share the many proven benefits of Kangaroo Care, from the physiological to the psychosocial, and address the reasons for low incidence of practice and provide possible explanations for the normal feelings of parental ambivalence at the initiation of Kangaroo Care. Audience participants will have an opportunity to share their own beliefs about Kangaroo Care and rationales for doing it and for resistance. Finally, the presentation will share the components of a new program that has been developed and implemented to increase the onset and frequency of Kangaroo Care and it positive impact on families and staff.

Learning Objectives
1. Identify at least three benefits of kangaroo care.
2. Cite two reasons that kangaroo care is practiced at low frequency or late in NICU hospitilization.
3. List three ways to enhance the onset and frequency of kangaroo care in the NICU.

Bibliography
Cooper, L.G., Gooding, J.S., Gallagher, J., Sternesky, L., Berns, S.D. (2007). Impact of a family-centered care intitative on NICU care, staff and families. Journal of Perinatology, 27, 32-S37.
Hendricks-Munoz, K.D. & Prendergast, C.C. (2007). Barriers to provision of developmental care in the neonatal intensive care unit: Neonatal nursing perceptions. Am J. Perinatol, 24, 71-78.
Ludington-Hoe, S.M., Ferreira, C.N., Swinth,  J., & Ceccardi, J.J. (2003). Safe criteria and preocedure for kangaroo care with intubated preterm infants. JOGNN, 32, 579-588.