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12 "Premature Infant"
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Original Articles
Experience of Becoming a Father of a High Risk Premature Infant
Jeong Eon Park, Byoung Sook Lee
J Korean Acad Nurs 2017;47(2):277-288.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.277
AbstractAbstract PDF
Purpose

This study was performed to identify the experience of becoming a father of a high risk premature infant.

Methods

Grounded theory was used for this research. The participants were 12 fathers who had premature infants lighter than 2,500g of birth weight, less than 37 weeks of gestational age and having stayed 2 weeks or longer in a NICU right after birth. Theoretical sampling was done to identify participants and indepth interviews were done for the data collection. For data analysis, the process suggested by Corbin and Strauss was used.

Results

For these participants the core phenomenon of the experience of becoming a father of a high risk premature infant was ‘striving through with belief and patience’. The phenomenon was ‘being frustrated in an unrealistic shock’. Contextual conditions were ‘uncertainty in the health status of the premature baby’ and ‘no one to ask for help’ and intervening conditions were ‘possibility in the health recovery of the premature baby’ and ‘assistance from significant others’. Action/interaction strategies were ‘withstanding with belief in the baby’ and ‘enduring with willpower as head of the family’ and the consequence was ‘becoming a guardian of the family’.

Conclusion

For the participants, the process of becoming the father of a high risk premature infant was striving through the situation with belief in their babies' ability to overcome the crisis and waiting for the babies' recovery with patience.

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Effects of a Sensory Stimulation on Weight Gain, Behavioral State, and Physiological Responses in Premature Infants
Hee Seung Song, Hee Sun Shin
Journal of Korean Academy of Nursing 2001;31(4):703-711.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.4.703
AbstractAbstract PDF

PURPOSE: The purpose of this study was to examine the effects of sensory stimulation on premature infants.
METHOD
Thirty three premature infants admitted to NICU of D University Hospital in C city were randomly assigned in two groups (Experimental group: 16, Control group:17). For the experimental group, tactile and kinesthetic stimulation developed by Dr. Field was applied 2 times a day for 10 days. Behavioral state was measured using the Anderson Behavioral State Scale (ABSS). Heart rate, respiration, and oxygen saturation were obtained for each infant before and after sensory stimulation. Hypothesis testing was done using the X2- test, student t-test, and repeated measures of ANOVA.
Result
Hypothesis 1: There was a significant difference in the daily body weight gain between experimental and control group (F= 40.77, p= .0001). Hypothesis 2: There was a significant difference in the frequency of 'inactive awake state' between two groups (X2= 39.778, p= .001). Hypothesis 3: There were significant differences in the mean of heart rate and O2 saturation between two groups (t= -2.174, p= .037; t= 3.080, p= .005). However, there was no significant difference in the mean of respiration rate between two groups (t= -1.966, p= .581).
CONCLUSION
The effectiveness of a sensory stimulation on weight gain and behavioral state in premature infants was supported. Further study is recommended to develop a sensory stimulation method as an independent nursing intervention for premature infant.

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The Effects of Kangaroo Care on Body Weight, Physiologic Responses and Behavioral States in Premature Infants
Hyun Young Koo
Journal of Korean Academy of Nursing 2000;30(1):171-182.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.1.171
AbstractAbstract PDF

This study was performed to investigate the effect of kangaroo care on body weight, physiological responses and behavioral states in premature infants. The subjects were 32 premature infants, fifteen for the kangaroo care group and seventeen for the control group, who hospitalized in a neonatal intensive care unit at a university-affiliated hospital. The kangaroo care was applied 8 times during the twenty five days with 40 minutes for each session. The kangaroo care provides the skin-to-skin contact during which a premature infant wearing a diaper and a hat is placed on its mother's chest. As for the measures, body weight was measured everyday. The levels of epinephrine, norepinephrine and 17-OHCS were measured twice, before beginning the first intervention and after finishing the last intervention. While each session of the care is undergoing, such physiological responses were measured periodically as heart rate, respiration rate, oxygen saturation, core temperature and skin temperature. The results were as follows : 1. The weight gain was significantly greater in the kangaroo care group than that in the control group during the period of performing the kangaroo care. 2. No significant difference was revealed between the two groups in heart rate, respiration rate, oxygen saturation and core temperature. The kangaroo care group also showed significant increases in the skin temperature. 3. The differences in the levels of epinephrine, norepinephrine and 17-OHCS were not significant between the kangaroo care and the control groups. The level of norepinephrine in the two groups was significantly increased over time. 4. Sleep pattern changed significantly in the kangaroo group from a very restless sleep to a very quiet sleep. These results suggest that kangaroo care is an effective nursing intervention for premature infants in gaining weight, achieving stable physiological responses and facilitating a quiet sleep.

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Effects of a Sensory Stimulation on Weight, Stress Hormone and Behavioral State in Premature Infants
Kun Ja Lee
Journal of Korean Academy of Nursing 1999;29(2):445-455.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.2.445
AbstractAbstract PDF

This study has been conducted on the nonequivalent control group pretest-posttest design in quasi experimental basis and newly born premature infants from intensive care unit of G Medical University Hospital in Inchon Metropolitan were selected in two groups of 21 infants each. The first group for experimental and the other for control. Data has been collected form October 30, 1997 to August 29, 1998. For the experimental group tactile and kinesthetic stimulation was applied 2 times a day for 10 days(10:00~11:00 hours in the morning and 17:00~18:00 in the afternoon). As a weight weighing instrument, electronic indicator scale(Cas Co, Korea) was used. To determine urine cortisol concentration level in stress hormone, radio immuno assay method was used. And high performance liquid chlomatogarphy was used to determine urine norepinephrine, concentration level. To determine behavior status, tools developed by anderson et al(1990) and remodeled by Kim Hee-Sook(1996) were used. Collected data were analyzed with the SAS program using x2-test, student t-test, repeated measures ANOVA and paired t-test. The result were as follow. 1. As for the daily weight gain, the experimental group showed first change in weight and this group also showed higher weight in the average weight than the control group. Statistically, however, there was no significant factor between the two groups. 2. The cortisol concentration in urine showed decrease in the experimental group norepinephrine concentration in urine showed increase in both experimental and control groups. No statistical significance was shown between the two groups. 3. In the aspect of behavior status, the experimental group showed statistical significance by showing inactive in the state of alert and conversion to a positive state than the control group. In conclusion, the sensory stimulation in this study showed a positive aspect through there was no statistical significance n the weight gain and urine stress hormone concentration. In the behavior status, there was statistical significance in the frequency of staying inactive in the state of alert and conversion to a positive state.

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The Effects of Open Endotracheal Suctioning(ETS) and Close ETS on Oxygen Saturation and Heart Rate in Premature Infants with Respiratory Distress Syndrome
Mi Soon Kim, Young Mee Ahn, In Ok Park, Sook Ja Choi, Mi Young Yoo
Journal of Korean Academy of Nursing 1998;28(3):529-539.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1998.28.3.529
AbstractAbstract PDF

Prematurity is the main cause for respiratory distress syndrome(RDS) in neonates. The goal in the treatment of RDS is to maintain respiration with adequate oxygenation. ETS needs to be performed to remove lung secretions in the ventilated premature infants with RDS. Oxygen saturation(SpO2) and heart rate(HR) were compared in 22 premature infants with RDS using two types of ETS: open ETS versus close ETS. The results showed there was no significant difference in the SpO2 and HR returned to the baseline within 1 minute after suctioning. But in some case, there was a significantly greater incidence in the decrease of SpO2 below 90% occurred in the open ETS than in the close ETS. It implies that closed ETS may be beneficial to premature infants who tend to develop desaturation easily.

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Assessment of Hydration on the Stratum Corneum and the Influencing Factors in Neonates
Youngmee Ahn, Eunjin Shin
Journal of Korean Academy of Nursing 2007;37(5):781-789.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2007.37.5.781
AbstractAbstract PDF
Purpose

The study was conducted to investigate the skin hydration level in various body sites and identify the influencing factors in neonates.

Methods

An exploratory comparison study was designed to measure the stratum corneum hydration, using a National DM-R2 on the forehead, abdomen, buttocks, and the back of the hands and feet of 198 neonates including 92 premature infants.

Results

The results showed 32.7%-36.5% of stratum corneum hydration for all sites. Premature infants revealed a higher hydration level on the peripheral sites (dorsal hand and feet) than those of the full-term infants, possibly resulting from therapeutic regimens including an incubator or radiant warmer. Infants in an incubator showed a higher hydration level than those in radiant warmers, suggesting more attention to fluid management for infants in the open environment. In addition, all stratum corneum hydration measurements except one, from the forehead, showed a positive correlation with postnatal age in full-term infants while showing no relation to any measurements in premature infants.

Conclusion

The study demonstrated the very low skin hydration levels in hospitalized neonates, particularly in premature neonates with more susceptible skin hydration instability despite therapeutic interventions for fluid balance. More vigilant fluid management is imperative in neonates, particularly those in the open environment.

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The Effects of a Home-Visiting Discharge Education on Maternal Self-esteem, Maternal Attachment, Postpartum Depression and Family Function in the Mothers of NICU Infants
Young Mee Ahn, Mi Ran Kim
Journal of Korean Academy of Nursing 2004;34(8):1468-1476.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.8.1468
AbstractAbstract PDF
Purpose

A quasi-experimental study was performed to investigate the effects of a home visiting discharge education program on the maternal self-esteem, attachment, postpartum depression and family function in 35 mothers of neonatal intensive care unit (NICU) infants.

Methods

Twenty-three mothers in the intervention group received the home visiting discharge education while 12 mothers in the control group received the routine, hospital discharge education. Baseline data was collected in both groups one day after delivery. The intervention group received the home visiting discharge education while the control group did the routine hospital-based discharge education. The questionnaire including the data on maternal self-esteem, attachment, postpartum depression and family function were collected within 1week after the discharge by mail.

Results

The scores of maternal self-esteem, and attachment were significantly increased, and the postpartum depression and the family function score were decreased after the home visiting discharge education in intervention group. There were no changes in these variables before and after the routine hospital-based discharge education in control group.

Conclusion

These results support the beneficial effects of home visiting discharge education on the maternal role adaptation and family function of the mothers of NICU infants.

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The Effects of the Systemic Follow up Health Care Program on the Health Promotion and the Risk Reduction in Premature Infants and Their Mothers
Young Mee Ahn
Journal of Korean Academy of Nursing 2004;34(6):1129-1142.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.6.1129
AbstractAbstract PDF
Purpose

This research was conducted to evaluate the effects of asystemic follow-up care program on health promotion and risk reduction in 64 high-risk infants(HRI) including premature infants and their mothers.

Method

The intervention consisted of systemic NICU education, tele-counseling and 3 home visits in 6 months. The subjects were divided into either the intervention group or the control group receiving the conventional education without the tele-counseling and home visiting. Infant health promotion was measured using physical assessment, types of health problems, reflexes, OPD visiting history, DDST, immunization, feeding assessment, Infant death rate, etc. Maternal self-esteem, postpartum depression and family function were measured using the maternal self-report inventory(MRI), EPDS, and family apgar score(Fapgar), retrospectively.

Result

All premature infants in the intervention group were in the normal range of growth and development, and the regular vaccination schedule. The health problems in the intervention group were addressed early so not to develop into adverse effects. The follow-up program for 6 months showed beneficial effects on MRI, EPDS, and Fapgar.

Conclusion

A systemic follow-up health care program is beneficial on health promotion and risk reduction in 64 HRI including premature infants and their mothers.

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Development of the Developmental Support Competency Scale for Nurses Caring for Preterm Infants
Jeong Soon Kim, Hee Sun Shin
J Korean Acad Nurs 2016;46(6):793-803.   Published online December 30, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.6.793
AbstractAbstract PDF
Purpose

Developmental care has been recognized as a very important component for the development and health promotion of preterm infants. However, research on how to assess developmental nursing competency has not been studied as expected. This study was done to develop and evaluate a new scale to measure nursing competency for developmental support of preterm infants.

Methods

Concept analysis was done with using the Hybrid model of Schwartz-Barcott and Kim (2000), from which a preliminary new scale (30 items) was developed. To test the validity and reliability of the new scale being developed, data were collected from 122 NICU nurses at 4 hospitals in 3 cities in the Republic of Korea, from December, 2014 to March, 2015.

Results

The final version of the Developmental Support Competency Scale for Nurses (DSCS-N) caring for premature infants was a 4-point Likert type scale, consisting of 19 items, and categorized as 6 factors, explaining 62.5% of the total variance. Each of the factors were named as follows; ‘environmental support’ (4 items), ‘parental support’ (3 items), ‘interaction’ (3 items), ‘critical thinking’ (3 items), ‘professional development’ (3 items), and ‘partnership’ (3 items). The Cronbach's α coefficient for the scale was .83 and the reliability of the subscales ranged from .60~.76.

Conclusion

The psychometric evaluation of the new scale demonstrated an acceptable validity and reliability. Findings indicate that the DSCS-N can be used as the tool to test the effect of educational programs for nurses and contribute to advance developmental care for preterm infants.

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Mothers' Parenting Experience of Premature Infants: Q Methodological Approach
Mi-Young Chon, Eun Sun Ji, Shin-Hwa Lee
J Korean Acad Nurs 2013;43(6):704-713.   Published online December 31, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.6.704
AbstractAbstract PDF
Purpose

This study was done to identify the parenting experience of mothers of premature infants in order to provide basic data for educational solutions and desirable directions.

Methods

Q-methodology was used as it provides a method of analyzing the subjectivity of each item. The participants were 33 mothers of premature infants who sorted 34 selected Q-statements which were then classified into the shape of a normal distribution using a 9-point scale. Subjectivity on parenting experience among the mothers was analyzed using the pc-QUANAL program.

Results

Four types of parenting experience were identified. Type I was named 'struggling', type II, 'self blame', type III, 'information collecting', and type IV, 'self-introspection'.

Conclusion

The results of this study indicate that different approaches to educational programs are needed for mothers of premature infants based on the four types of parenting experience.

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Breast Feeding Rates and Factors Influencing Breast Feeding Practice in Late Preterm Infants: Comparison with Preterm Born at Less than 34 Weeks of Gestational Age
Gun Ja Jang, Sang Lak Lee, Hyeon Mi Kim
J Korean Acad Nurs 2012;42(2):181-189.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.181
AbstractAbstract PDF
Purpose

This study was done to compare breast feeding rates and factors influencing feeding practice between late preterm (34≤GA<37) and preterm infants (GA<34).

Methods

A survey was done of 207 late preterm and 117 preterm infants in neonatal intensive care units (NICU) of 4 university hospitals in D city. Data were collected from July 2009 to June 2010 from 324 medical records in the NICU. Breast-feeding at home was checked either by telephone survey or questioning during hospital visits.

Results

Rate of breast feeding for late preterm infants was significantly lower than for preterm infants. There was no significant difference in breast-feeding at home. We found differences in factors influencing breast feeding between the two groups. Factors influencing feeding for late preterm infants were type of delivery, mothers' occupation, feeding type during hospitalization, time elapse from hospital discharge, total admission days, infant's body weight at first feeding and length of NPO (nothing by mouth). Factors influencing feeding for preterm infants were birth order, maternal disease and obstetric complications, and one-minute Apgar score.

Conclusion

Results of the study show low rates of breast-feeding for late preterm infants indicating a need for breast-feeding education for mothers of these infants.

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Growth Patterns of Premature Infants Up to 40th Term Week of Corrected Age
Youngmee Ahn, Min Sohn, Sangmi Lee
J Korean Acad Nurs 2011;41(5):613-622.   Published online October 31, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.5.613
AbstractAbstract PDF
Purpose

Study purpose were to describe growth patterns of premature infants in weight, length and head circumference from birth to 40th week of corrected ages (CA) and to explore factors affecting patterns.

Methods

A longitudinal descriptive study was conducted with 267 premature infants. They were categorized into 2 groups; GA group with measurements at birth and the CA group with measurements at CA, which was categorized into 3 groups (group 1-3) by WHO guideline for gestational age (GA) at birth.

Results

GA group presented greater measures in all than CA group at same week of life. Among CA groups, group 3 showed the highest measurements, up to 37 weeks of life, though this disappeared at 38-40 weeks. Reversely, group 1 revealed the highest growth rates in all measures, followed by group 2 and group 3. Significant interaction was observed in all measures between week of life and any type of groups.

Conclusion

Higher measures in GA group, as well group 3 among CA groups, supported the superiority of intra-uterine environment overriding quality of regimen from NICU. Regardless of growth acceleration, smaller infants remain smaller, indicating that intra-uterine thrifty phenotype may continue at least up to the 40th week of CA.

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