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Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study

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: Twent...

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Autores principales: Pierrat, Veronique, Coquelin, Anaëlle, Cuttini, Marina, Khoshnood, Babak, Glorieux, Isabelle, Claris, Olivier, Durox, Mélanie, Kaminski, Monique, Ancel, Pierre-Yves, Arnaud, Catherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049969/
https://www.ncbi.nlm.nih.gov/pubmed/27518584
http://dx.doi.org/10.1097/PCC.0000000000000914
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author Pierrat, Veronique
Coquelin, Anaëlle
Cuttini, Marina
Khoshnood, Babak
Glorieux, Isabelle
Claris, Olivier
Durox, Mélanie
Kaminski, Monique
Ancel, Pierre-Yves
Arnaud, Catherine
author_facet Pierrat, Veronique
Coquelin, Anaëlle
Cuttini, Marina
Khoshnood, Babak
Glorieux, Isabelle
Claris, Olivier
Durox, Mélanie
Kaminski, Monique
Ancel, Pierre-Yves
Arnaud, Catherine
author_sort Pierrat, Veronique
collection PubMed
description 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.
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spelling pubmed-50499692016-11-01 Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study Pierrat, Veronique Coquelin, Anaëlle Cuttini, Marina Khoshnood, Babak Glorieux, Isabelle Claris, Olivier Durox, Mélanie Kaminski, Monique Ancel, Pierre-Yves Arnaud, Catherine Pediatr Crit Care Med Neonatal Intensive Care 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. Lippincott Williams & Wilkins 2016-10 2016-10-03 /pmc/articles/PMC5049969/ /pubmed/27518584 http://dx.doi.org/10.1097/PCC.0000000000000914 Text en Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
spellingShingle Neonatal Intensive Care
Pierrat, Veronique
Coquelin, Anaëlle
Cuttini, Marina
Khoshnood, Babak
Glorieux, Isabelle
Claris, Olivier
Durox, Mélanie
Kaminski, Monique
Ancel, Pierre-Yves
Arnaud, Catherine
Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study
title Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study
title_full Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study
title_fullStr Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study
title_full_unstemmed Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study
title_short Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study
title_sort translating neurodevelopmental care policies into practice: the experience of neonatal icus in france—the epipage-2 cohort study
topic Neonatal Intensive Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049969/
https://www.ncbi.nlm.nih.gov/pubmed/27518584
http://dx.doi.org/10.1097/PCC.0000000000000914
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