Purpose-To determine the safety of oropharyngeal administration of own mother's colostrum to ELBW infants in first days of life. A secondary purpose was to investigate the feasibility of (1) delivering this intervention to ELBW infants in the first days of life, and (2) measuring concentrations of secretory immunoglobulin A (sIgA) and lactoferrin in tracheal aspirate secretions and urine of these infants.Subjects-Five ELBW infants (mean BW and gestational age = 657 grams and 25.5 weeks, respectively).Design-Quasi experimental, one group, pretest-posttest design.Methods-Subjects received 0.2 mL of OMC administered oropharyngeally every two hours for 48 consecutive hours, beginning at 48 hours of life. Concentrations of sIgA and lactoferrin were measured in tracheal aspirates and urine of each subject at baseline, at the completion of the intervention and again 2 weeks later.Results-All infants completed the entire treatment protocol, each receiving 24 treatments. A total of 15 urine specimens were collected and 14 were sufficient in volume for analysis. A total of 15 tracheal aspirates were collected, but only 7 specimens (47%) were sufficient in volume for analysis. There was wide variation in concentrations of sIgA and lactoferrin in urine and tracheal aspirates among the five infants; however several results were outside the limits of assay detection. All infants began to suck on the endotracheal tube during the administration of colostrum drops. Oxygen saturation measures remained stable or increased slightly during each of the treatment sessions. There were no episodes of apnea, bradycardia, hypotension or other adverse effects associated with the administration of colostrum.Conclusions-Oropharyngeal administration of OMC is easy, inexpensive, and well-tolerated by even the smallest and sickest ELBW infants. Future research should continue to examine the optimal procedure for measuring the direct immune effects of this therapy, as well as the clinical outcomes such as infections, particularly ventilator-associated pneumonia (VAP). of infants born at 24 weeks of gestation will survive to discharge, compared to 50% just 15 years ago. 1 However, the survival of these infants is associated with significant short and long-term morbidity, including nosocomial infection, 2, 3 necrotizing enterocolitis, 4 intraventricular hemorrhage, 4,5 periventricular leukomalacia 6 and adverse long-term neurodevelopmental sequelae including cognitive and motor disabilities, visual and/or hearing impairment, and cerebral palsy. [7][8][9] Nosocomial infection, an acquired infection after 48 hours of hospital admission, is particularly important because of its high prevalence and its association with other morbidities including poor growth, 10, 11 adverse long-term neurological sequelae, 10 increased length of hospital stay, 12 and a substantial cost 12 to families, hospitals, and society. The risk of acquiring a nosocomial infection is inversely related to birth weight and gestational age, and directly related to the severi...
The present study tested cognitive-behavioral therapy (CBT) for insomnia in older adults with osteoarthritis, coronary artery disease, or pulmonary disease. Ninety-two participants (mean age = 69 years) were randomly assigned to classroom CBT or stress management and wellness (SMW) training, which served as a placebo condition. Compared with SMW, CBT participants had larger improvements on 8 out of 10 self-report measures of sleep. The type of chronic disease had no impact on these outcomes. The hypothesis that CBT would improve daytime functioning more than SMW was only supported by a global rating measure. These results add to findings that challenge the dichotomy between primary and secondary insomnia and suggest that psychological factors are likely involved in insomnias that are presumed to be secondary to medical conditions.
The effectiveness of a behavioral parent training (BPT) intervention for improving maternal self-efficacy, maternal stress, and the quality of mother-toddler interactions has been demonstrated (Gross, Fogg, & Tucker, 1995). The 1-year follow-up of the 46 parents of toddlers (assigned to an intervention or comparison group) who participated in that study is reported. It was hypothesized that (a) BPT would lead to enduring positive changes in parenting self-efficacy, parenting stress, and parent-toddler interactions; and (b) the amount of parent participation in the intervention would be correlated with greater gains in parent-child outcomes at 1 year. All the families were retained and significant gains in maternal self-efficacy, maternal stress, and mother-child interactions were maintained. Minimal BPT effects were found for fathers. BPT dosage was related to reductions in mother critical statements and negative physical behaviors at 1-year postintervention. The findings are consistent with self-efficacy theory and support parenting self-efficacy as a target for BPT in families of young children.
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