Ornithine transcarbamylase deficiency is the most common urea cycle disorder. If left untreated, pathogenic variants in the OTC gene can cause hyperammonemia leading to neurotoxicity, coma, and death. A comprehensive ove...Ornithine transcarbamylase deficiency is the most common urea cycle disorder. If left untreated, pathogenic variants in the OTC gene can cause hyperammonemia leading to neurotoxicity, coma, and death. A comprehensive overview of ornithine transcarbamylase deficiency is presented including the genetic cause; varied age of onset, clinical presentation, and severity; diagnostic testing; and lifelong and anticipated future treatments. More specifically, there is a focus on the prenatal, natal, and postpartum course and treatment recommendations for genetic heterozygous (carrier) females and hemizygous male newborns with ornithine transcarbamylase deficiency.
PURPOSE: The purpose of this review is to investigate the current landscape of evidence-based mHealth resources designed to support pregnant patients with fetal anomalies, with a focus on enhancing maternal wellbeing, di...PURPOSE: The purpose of this review is to investigate the current landscape of evidence-based mHealth resources designed to support pregnant patients with fetal anomalies, with a focus on enhancing maternal wellbeing, disseminating relevant information, and facilitating communication with nurses, physicians, and other health care professionals. STUDY DESIGN: Using the JBI (formerly known as the Joanna Briggs Institute) scoping review protocol and the PRISMA-ScR framework, we conducted a comprehensive search across databases including CINAHL, Medline, Web of Science, and Google Scholar. METHODS: A keyword search was conducted, resulting in 227 unique records. Articles discussing mobile apps for pregnancies with a fetal diagnosis or fetal risk for anomaly were included, including hospital-affiliated or telehealth apps that were adapted for use with this specific population. RESULTS: Ten articles were selected for inclusion. Our analysis identified several predominant themes. The surge of mHealth, influenced in part by the COVID-19 pandemic, has provided critical access to care for pregnant patients with fetal anomalies through mobile platforms. Comprehensive resource tools integrating informational components via mHealth are needed to offer flexibility to patients as well as nurses, physicians, and other health care professionals. Adopting a patient-driven approach in developing mHealth resources is important in meeting the needs of patients, their families, and their health care team. CLINICAL IMPLICATIONS: A framework for the development and implementation of high-fidelity mHealth resources tailored to this vulnerable population is needed. Emphasizing a patient-centered approach in the creation of mHealth resources is paramount to ensuring their effectiveness and usefulness for pregnant women experiencing fetal anomalies, their families, and the perinatal health care team.
PURPOSE: The purpose of this study was to inform perinatal loss care by expanding upon the five processes of Swanson's Theory of Caring through a holistic lens. STUDY DESIGN AND METHODS: This study was a qualitative cont...PURPOSE: The purpose of this study was to inform perinatal loss care by expanding upon the five processes of Swanson's Theory of Caring through a holistic lens. STUDY DESIGN AND METHODS: This study was a qualitative content analysis of 34 interview transcripts of parents' experiences with perinatal loss. A priori codes were identified using a holistic model which guided the integration of parents' holistic needs into Swanson's Theory. RESULTS: Nurses can address parents' physical, psychological, social, spiritual, and cultural needs using Swanson's Theory to provide high-quality, holistic care that may foster healing. Parents were appreciative of nurses who were transparent, did not avoid talking about their baby, facilitated memorialization, and fostered bonding. Anticipating parents' needs, being emotionally present, and recognizing the meaning of the perinatal loss experienced helped parents to have a more positive loss experience. CLINICAL IMPLICATIONS: By incorporating holistic interventions into care guided by Swanson's Theory, nurses can empower parents within their loss experience. Interventions to create memories, foster bonding and connection, promote autonomy, and celebrate personhood may facilitate healing. It is necessary to ensure nurses have the support and resources to attend to parents' holistic needs, including education and sufficient time for care interactions. Providing education in perinatal loss and grief, particularly to new nurse graduates, is necessary to ensure nurses are equipped to provide holistic care to families experiencing perinatal loss.
PURPOSE: The purpose of this study was to understand the lived experiences of postpartum women on medication-assisted therapy for opioid use disorder. STUDY DESIGN AND METHODS: van Manen's interpretive hermeneutic phenom...PURPOSE: The purpose of this study was to understand the lived experiences of postpartum women on medication-assisted therapy for opioid use disorder. STUDY DESIGN AND METHODS: van Manen's interpretive hermeneutic phenomenological design was used. Recruitment and data collection from seven participants occurred at an outpatient office offering care for perinatal patients on medication-assisted therapy for opioid use disorder. Data collection occurred between September 2021 and March 2022 via in-person interviews using a demographic data sheet, interview guide, speech recognition software, and digital recordings. Demographic data were analyzed using descriptive statistics. Qualitative data were analyzed using precoding, coding, and thematic analysis via van Manen's interpretive hermeneutic phenomenological method. RESULTS: Seven themes were identified: troubled origins, used opioids to deal with life issues, needed to be self-reliant, opioid use disorder overtook their life, the baby was a motivator to seek treatment, the need for combined medication-assisted therapy and collaborative care, and hope for a better life. CLINICAL NURSING IMPLICATIONS: Nurses can provide trauma-informed care, support the importance of medication-assisted therapy in recovery, incorporate a collaborative care team with expertise in postpartum opioid use disorder, continue the collaborative care team for a minimum of 1 year, and advocate for the patient's role as parent.
PURPOSE: To explore the influence of maternal nutrition factors, including body mass index, nutritional supplementation, and dietary intake during the breastfeeding period, on macro and micronutrient composition in human...PURPOSE: To explore the influence of maternal nutrition factors, including body mass index, nutritional supplementation, and dietary intake during the breastfeeding period, on macro and micronutrient composition in human milk. STUDY DESIGN AND METHODS: We conducted a scoping review using the PRISMA-ScR checklist, initially identifying 5,984 original studies published in the English language from PubMed, Scopus, and Web of Science that presented findings on the association of maternal nutritional factors on human milk nutrient composition. After screening the title and abstract, we selected 69 studies for full review, including 3 studies found through checking reference lists. After full review, we included 23 studies in this scoping review. RESULTS: Most studies found maternal body mass index and supplement consumption affected human milk macro and micronutrient composition, whereas inconsistent results were found on the relationship between maternal diet and human milk nutrients. Methodologies varied substantially across studies, especially for milk sample collection methods and maternal nutrition assessments. CLINICAL IMPLICATIONS: Maternal nutrition factors may affect levels of human milk nutrients, requiring maternal nutrition monitoring during breastfeeding. However, given the considerable variability in the results between studies and methodological approaches, further studies should use standardized and validated procedures to strengthen the findings on this topic.
BACKGROUND: Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services...BACKGROUND: Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes. METHODS: This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024. Eligible articles were published in English, peer-reviewed, and focused on subjective accounts of accessing prenatal care in rural areas of the United States. Seven articles met inclusion criteria and were assessed for quality using the Joanna Briggs Institute checklists. RESULTS: Three major categories influencing access to prenatal care in rural areas were developed. Individual factors included transportation, family support, motivation, and work commitments. Socioeconomic factors encompass health insurance, rurality, income, and housing. System factors involved the qualities of nurses, midwives, physicians, the clinic environment, and collaboration within the health care system. The findings emphasized the complexity of rural prenatal care access. CONCLUSIONS: Understanding patient and care giver perspectives on accessing prenatal care in rural areas is crucial for addressing the factors influencing maternal outcomes. Rural pregnant women face unique challenges, contributing to an increased risk of maternal morbidity and mortality. Further research is needed to explore their experiences and develop interventions to improve access and outcomes in rural areas.
Approximately two-thirds of pregnancy-related deaths in the United States occur during the postpartum period, yet there is minimal research focusing on the postpartum hospital stay, a critical point of contact between wo...Approximately two-thirds of pregnancy-related deaths in the United States occur during the postpartum period, yet there is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. A new approach to postpartum care is needed. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. Using Walker & Avant's method of concept analysis, we identified four defining attributes of woman-centered care in the literature: 1) choice, control, and involvement in decision-making ; 2) communication and collaboration in the caregiver-woman relationship ; 3) individualized and holistic care ; and 4) continuity of care . Using these findings, we offer a conceptual definition of woman-centered care and apply the attributes to the postpartum hospitalization in the model and contrary cases. We discuss the potential of the concept to improve maternal health care during this critical period.
MCN Am J Matern Child Nurs
· 2024 Nov-Dec 01 · PMID 38976790
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Stillbirth affects 1 in 175 pregnancies in the United States. There are significant racial and ethnic disparities in rates of stillbirth. Rates of stillbirth are highest among non-Hispanic Native Hawaiian or Other Pacifi...Stillbirth affects 1 in 175 pregnancies in the United States. There are significant racial and ethnic disparities in rates of stillbirth. Rates of stillbirth are highest among non-Hispanic Native Hawaiian or Other Pacific Islander and non-Hispanic Black women, more than twice the rate of non-Hispanic White women. Stillbirth is a public health crisis that warrants attention as it has significant physical, psychosocial, and economic effects on women and their family. Many stillbirths occur due to placental insufficiency, causing a lack of oxygenation of the fetus, which can result in decreased movement. Pregnant patients who experience stillbirth often observe decreased fetal movement days before birth. Daily fetal movement monitoring has the potential to identify pregnancies at risk so providers can intervene. Count the Kicks is a fetal movement monitoring program that provides standardized education and resources for expectant parents. Increased awareness of providers and childbearing families about the importance of fetal movement monitoring, standardized provision of education on fetal movement counting, and what to do if a baby's normal movement patterns change can be helpful in promoting healthy pregnancy outcomes.
OBJECTIVE: The purpose of this study was to explore maternity care experiences of African immigrant women during the perinatal period including factors affecting access to and use of care. METHODS: We used Sandelowski's...OBJECTIVE: The purpose of this study was to explore maternity care experiences of African immigrant women during the perinatal period including factors affecting access to and use of care. METHODS: We used Sandelowski's (2010) qualitative descriptive approach to examine how African immigrant women from various countries of origin and with diverse ethnic backgrounds experienced and navigated the maternity care system in the United States during pregnancy and childbirth. We conducted semi-structured interviews with 15 African immigrant women living in the Columbus, Ohio area. Participants were recruited using purposive and snowball sampling between February 2021 and May 2021. Interviews were recorded, transcribed, and analyzed using a reflexive thematic analysis approach. FINDINGS: Four major themes defined the experiences of our study participants: access to information, patient-clinician relationships, experiences of discrimination , and costs of maternity care . CLINICAL IMPLICATIONS: Findings highlight key barriers to providing quality and acceptable maternity care to African immigrant women at multiple levels. This group's unique barriers underlie the importance of incorporating their diverse experiences into maternity care models and clinical practice. Further research is needed to evaluate and improve maternity care for African immigrant women.
PURPOSE: The purpose of this study was to determine age-based reference values for the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. STUDY DESIGN AND METHODS: GIGER data from health...PURPOSE: The purpose of this study was to determine age-based reference values for the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. STUDY DESIGN AND METHODS: GIGER data from healthy, full-term born children under 2 years of age were used to determine reference values. For each age group, median, interquartile range, 90 th , and 95 th percentile scores were calculated for each subscale and the total score. 90 th percentile scores were also calculated for each of the 36 items based on the full sample. RESULTS: Data from 625 children were used to determine reference values for children 0-2, 2-4, 4-6, 6-8, 8-10, 10-12, and 12-24 months. In healthy, full-term infants, gastrointestinal and gastroesophageal reflux symptoms improved over the first 24 months of life, with the most improvement occurring over the first 2 months. CLINICAL IMPLICATIONS: The GIGER is a 36-item measure of gastrointestinal and gastroesophageal reflux symptoms for children under 2 years old that has evidence of adequate psychometrics for clinical practice and research. The age-based reference values established in this study can be used to guide score interpretation and determine when a child's symptoms warrant further investigation. This may help identify infants and toddlers with significant symptoms earlier so that they can obtain the care they need.