Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study.
Objectives: To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice.Design: Prospective national cohort study of all births before 32 weeks of gestation.Sett...
| Publicado en: | Pediatric Critical Care Medicine Vol. 17; no. 10; pp. 957 - 968 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Oct2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=118551139&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 118551139 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15297535 N1Y jtl: Pediatric Critical Care Medicine issn: 15297535 maglogo: N pubinfo: dt: Oct2016 vid: 17 iid: 10 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 118551139 118551139 NLM27518584 118551139 10.1097/PCC.0000000000000914 NLM27518584 118551139 ppf: 957 ppct: 11 formats: tig: atl: Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study. aug: au: Pierrat, Veronique Coquelin, Anaëlle Cuttini, Marina Khoshnood, Babak Glorieux, Isabelle Claris, Olivier Durox, Mélanie Kaminski, Monique Ancel, Pierre-Yves Arnaud, Catherine affil: Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France sug: subj: Kangaroo Care Standards Breast Feeding Trends Child Development Infant, Premature, Diseases Prevention and Control Intensive Care, Neonatal Standards Practice Guidelines Intensive Care, Neonatal Trends Prospective Studies Intensive Care Units, Neonatal Trends Infant, Newborn Intensive Care Units, Neonatal Standards Infant, Premature Intensive Care, Neonatal Methods France Kangaroo Care Trends Logistic Regression Human Infant, Newborn: birth-1 month ab: Objectives: To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice.Design: Prospective national cohort study of all births before 32 weeks of gestation.Setting: Twenty-five French regions.Participants: All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005).Interventions: None.Measurements and Main Results: Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p < 0.001). Individual factors associated with kangaroo care initiation were gestational age (odds ratio, 5.79; 95% CI, 4.49-7.48 for babies born at 27-31 wk compared with babies born at 23-26 wk) and, to a lesser extent, single pregnancy, birthweight above the 10th centile, and mother's employment before pregnancy. At unit level, policies and training in neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p < 0.0001).Conclusions: Dissemination of neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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