34 research outputs found
Midwives’ decision-making process when a non-vigorous neonate is born – a Swedish qualitative interview study
No full textObjective: Midwives are often the first ones to make decisions when a neonate is unexpectedly born non-vigorous. This study aimed to understand how midwives reason and what they experience when deciding what to do when a non-vigorous neonate is born. In present practice, the decision to cut the umbilical cord early is strongly affected bythe decision that the neonate needs resuscitation. To better understand the decisions taken during the first minutes of the non-vigorous neonate's life, this study focused on the midwives' decision to cut the umbilical cord. Design:: A qualitative study with an inductive and descriptive design using the Critical Incident Technique was chosen to gain a more in-depth understanding of the factors influencing the midwife's decision-making process concerning cutting the umbilical cord in a critical situation. Semi-structured interviews were conducted, and thematic analysis, as described by Braun and Clarke, was performed. Setting and participants:: Eligible study participants were midwives currently working in labour wards in Sweden. Findings: In total, 14 midwives were interviewed between November 2019 and March 2020. The interviews rendered an understanding about midwives' decision-making on the timing of cord clamping in the non-vigorous neonates. An overarching theme was generated: "The balancing act of clamping the umbilical cord" which consisted of three themes, "Assessing the neonate in need of resuscitation", "Valuing own knowledge and experience" and "Influencing decision-making", and seven sub-themes. Many factors in addition to clinical reasoning influenced the midwives' decision-making processes. Feelings, intuition, and experience also had an effect to varying degrees
Reorganizando la violencia: la «historia de éxito» colombiana y los límites del discurso del posconflicto
No full textEl punto de partida de este artículo es la «historia de éxito» colombiana, es decir, la afirmación de una transición de un conflicto problemático a un posconflicto exitoso. Considerando que los debates en torno al éxito colombiano operan bajo la lógica de presencia/ausencia de violencia, aquí se propone pensar el posconflicto en términos de la transformación de las reglas del uso de la violencia. Para ello, se analizan los aspectos principales del programa de profesionalización que se aceleró y profundizó a través del Plan Colombia, con el objetivo de comprender los términos bajo los cuales se entiende la expertise de los militares colombianos. Finalmente, se discute la reorganización de la violencia en el posconflicto por medio de un mapeo de los principales rasgos de los programas de entrenamiento militar en el contexto de paz.Cómo citar este artículo: Viana, Manuela Trindade. «Reorganizando la violencia: la “historia de éxito” colombiana y los límites del discurso del posconflicto». Revista CIDOB d’Afers Internacionals, n.º 121 (abril de 2019). DOI: doi.org/10.24241/rcai.2019.121.1.135Traducción del original en inglés: Maria Gené Gi
Midwives’ decision-making process when a non-vigorous neonate is born – a Swedish qualitative interview study [Elektronisk resurs]
No full textObjective: Midwives are often the first ones to make decisions when a neonate is unexpectedly born non-vigorous. This study aimed to understand how midwives reason and what they experience when deciding what to do when a non-vigorous neonate is born. In present practice, the decision to cut the umbilical cord early is strongly affected bythe decision that the neonate needs resuscitation. To better understand the decisions taken during the first minutes of the non-vigorous neonate's life, this study focused on the midwives' decision to cut the umbilical cord. Design:: A qualitative study with an inductive and descriptive design using the Critical Incident Technique was chosen to gain a more in-depth understanding of the factors influencing the midwife's decision-making process concerning cutting the umbilical cord in a critical situation. Semi-structured interviews were conducted, and thematic analysis, as described by Braun and Clarke, was performed. Setting and participants:: Eligible study participants weremidwives currently working in labour wards in Sweden. Findings: In total, 14 midwives were interviewed between November 2019 and March 2020. The interviews rendered an understanding about midwives' decision-making on the timing of cord clamping in the non-vigorous neonates. An overarching theme was generated: "The balancing act of clamping the umbilical cord" which consisted of three themes, "Assessing the neonate in need of resuscitation", "Valuing own knowledge and experience" and "Influencing decision-making", and seven sub-themes. Many factors in addition to clinical reasoning influenced the midwives' decision-making processes. Feelings, intuition, and experience also had an effect to varying degrees
Neurodevelopmental outcomes of a randomised trial of intact cord resuscitation
No full textAIM: It has been suggested that intact cord resuscitation can reduce the risk of brain damage. We investigated the effects on neurodevelopment at two years of age.METHODS: This study was performed in Kathmandu, Nepal. In 2016, 231 late preterm and term infants born vaginally and not breathing were randomised to resuscitation with an intact cord or the standard practice of early cord clamping (CC). At two years of age, the World Health Organization's Infant and Young Child Development tool was used to assess the child's neurodevelopment, during telephone interviews with caregivers.RESULTS: We followed up 138 infants (59.7%) at a mean age of 24.8 ±0.8 months. A significant difference was seen in the development for age Z-score, between the group resuscitated with an intact umbilical cord and the group resuscitated with early CC. The median (range) scores were 1.0 (0.1-2.1) versus. 0.9 (-2.0-1.8), respectively (p=0.04). There were no difference in the motor, language-cognitive and socio-emotional domains.CONCLUSION: Neurodevelopment improvements were observed at two years of age in infants resuscitated with an intact rather than early clamped umbilical cord. No definitive conclusions could be drawn due to protocol violations and a low follow-up rate. More research is needed
Cord clamping beyond 3 minutes : Neonatal short-term outcomes and maternal postpartum hemorrhage
No full textBACKGROUND: Delaying cord clamping (CC) for 3-5 minutes reduces iron deficiency and improves neurodevelopment. Data on the effects of CC beyond 3 minutes in relation to short-term neonatal outcomes and maternal risk of postpartum hemorrhage are scarce.METHODS: This was a prospective observational study performed in two delivery departments. Pregnant women with vaginal deliveries were included. Time to CC, estimated postpartum blood loss, and perinatal data were recorded. Spearman's correlation analysis and comparisons between newborns clamped before and after 3 minutes were performed.RESULTS: In total, 904 dyads were included. The mean gestational age ± standard deviation was 40.1 ± 1.2 weeks. CC was performed at a median time of 6 minutes (range 0-23.5). Apgar scores at 5 and 10 minutes were positively correlated with time to CC (correlation coefficient .140, P < .001 and .161, < .001). There was no correlation between CC time and bilirubin level (correlation coefficient .021, P = .54). The median postpartum blood loss was 300 mL (70-2550 mL), with a negative correlation between CC time and postpartum blood loss (-0.115, P = .001). The postpartum blood loss was larger in the group clamped at ≤3 minutes (median [interquartile range] 400 mL [300-600] vs 300 mL [250-450], [P = .003]].CONCLUSIONS: Umbilical CC times beyond 3 minutes in vaginal deliveries were not associated with negative short-term outcomes in newborns and were associated with a smaller maternal postpartum blood loss. Although CC time as long as 6 minutes could be considered as safe, further research is needed to decide the optimal timing
Neurobehavioral Outcomes at 10 Years of Age following Delayed Umbilical Cord Clamping : A Follow-Up Study after a Randomized Trial
No full textINTRODUCTION: The aim of this study was to explore long-term behavioral consequences of early versus delayed cord clamping (CC) in school-aged children. The hypothesis was that early CC would be associated with an increased risk of symptoms associated with attention deficit hyperactivity disorder (ADHD) due to the lower iron stores following early CC compared with delayed CC.METHODS: Exploratory, long-term follow-up study of a randomized controlled trial in Sweden. Full-term, vaginally born, neonates to healthy mothers were originally included and randomized to either early (≤10 s) or delayed (≥180 s) CC. At 10 years of age, scores from the screening questionnaire Swanson, Nolan and Pelham Scale IV (SNAP-IV), that identifies symptoms suggestive of ADHD (but do not diagnose ADHD), were compared between groups of early and delayed CC.RESULTS: We assessed 139/382 (36.4%) children, 64 early CC and 75 delayed CC. No significance in total score and subgroup scores of SNAP-IV was seen when comparing early and delayed CC. In the primary outcome, total scores, mean (standard deviation) of early CC was 14.64 (13.94) and for delayed CC 13.59 (13.41), p = 0.65.CONCLUSION: Timing of umbilical CC and iron status were not associated with symptoms associated with ADHD in 10-year-old children. Studies with higher follow-up rates and in populations with high prevalence of iron deficiency are needed to verify or discard the findings. Understanding if delayed CC has long-lasting neurobehavioral or neurodevelopmental effects can help develop guidelines and program about neonatal care
Umbilical cord clamping and management of the third stage of labor : A telephone-survey describing Swedish midwives’ clinical practice
No full textIntroduction:The timing of cord clamping impacts children’s short- and longterm well-being. When making clinical decisions, midwives incorporate their tacit and professional knowledge, experience and current evidence. There appears to be a lack of knowledge regarding Swedish midwives’ management of the third stage of labor and cord clamping practice. The aim of this study was to explore Swedish midwives’ clinical practice concerning umbilical cord clamping and the third stage of labor in spontaneous vaginal births.Methods:The study was designed as a cross-sectional telephone survey including 13 questions. Midwives were randomly selected from 48 births units in Sweden. Two midwives from each unit were interviewed. The primary outcome was timing of umbilical cord clamping practice in full-term infants. Secondary outcomes were the management of the third stage of labor including prophylactic use of synthetic oxytocin, the timing of cord clamping in preterm infants, controlled cord traction, uterine massage, and cord milking.Results:Altogether, 95 midwives were interviewed. In full-term infants, all midwives preferred late cord clamping. Considerable heterogeneity was seen regarding the practices of synthetic oxytocin administration postpartum, controlled cord traction, uterine massage or cord milking, and cord clamping in preterm infants.Conclusions:Midwives in Sweden modify recommendations regarding delayed cord clamping in a way they might perceive as more natural and practical in their daily, clinical work. The study revealed a reluctance toward the administration of prophylactic oxytocin due to fear that the drug could pass to the infant. An overall large variation of the management of the third stage of labor was seen
Effect of Delayed Cord Clamping on Neurodevelopment at 3 Years [Elektronisk resurs] : A Randomized Controlled Trial
No full textINTRODUCTION: Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal. OBJECTIVE: The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years. METHODS: In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score >1 standard deviation below the mean was defined as "at risk" for developmental impairment. RESULTS: At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were "at risk" for affected gross motor developmentin the early CC group: 14 (18.9%) versus 6 (6.3%), p = 0.02. CONCLUSION: There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were "at risk" for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age
Effect of Delayed Cord Clamping on Neurodevelopment at 3 Years : A Randomized Controlled Trial
No full textINTRODUCTION: Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal.OBJECTIVE: The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years.METHODS: In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score >1 standard deviation below the mean was defined as "at risk" for developmental impairment.RESULTS: At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were "at risk" for affected gross motor development in the early CC group: 14 (18.9%) versus 6 (6.3%), p = 0.02.CONCLUSION: There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were "at risk" for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age
