Parents’ Perspectives on Counseling for Fetal Heart Disease: What Matters Most?

After diagnosis of congenital heart disease (CHD) in the fetus, effective counseling is considered mandatory. We sought to investigate which factors, including parental social variables, significantly affect counseling outcome. A total of n = 226 parents were recruited prospectively from four national tertiary medical care centers. A validated questionnaire was used to measure counseling success and the effects of modifiers. Multiple linear regression was used to assess the data. Parental perception of interpersonal support by the physician (β = 0.616 ***, p = 0.000), counseling in easy-to-understand terms (β = 0.249 ***, p = 0.000), and a short period of time between suspicion of fetal CHD, seeing a specialist and subsequent counseling (β = 0.135 **, p = 0.006) significantly improve “overall counseling success”. Additional modifiers (e.g., parental native language and age) influence certain subdimensions of counseling such as “trust in medical staff” (language effect: β = 0.131 *, p = 0.011) or “perceived situational control” (age effect: β = 0.166 *, p = 0.010). This study identifies independent factors that significantly affect counseling outcome overall and its subdimensions. In combination with existing recommendations our findings may contribute to more effective parental counseling. We further conclude that implementing communication skills training for specialists should be considered essential.

Case Report: Treatment of Extremely Preterm Infants With Birthweight Below 300 g: Case Series

Reports on the birth of infants weighing <300 g are quite rare and little is known about the best practices in treating such micropreemies. Therefore, we report here on three cases of low birthweight infants weighing <300 g, of whom two infants survived. The birthweights and gestational ages were ranging 279–293 g and 22 + 6/7 – 23 + 6/7 weeks, respectively. All the infants had severe fetal growth restriction and prematurity. The infant in case 1 died of hepatic rupture, perhaps due to birth trauma, which emphasized the need for less invasive obstetric procedures including en caul delivery. The infant in case 2 managed to survive through severe prematurity secondary to hydrops fetalis. However, complications followed soon as tracheal granulation tissue was formed with neurodevelopmental impairment. The infant in case 3 was born recently and her clinical course was less remarkable without severe complications, despite having the least gestational age and birthweight among the three patients. The improved care protocols for extremely low birthweight infants over these years through experiential learning including that with cases 1 and 2 may have ensured the better outcome of case 3. Accumulating evidence and recording the experience of such cases with continuous constructive discussion can contribute to better outcomes and appropriate parental counseling for extremely small babies in the future.

Antenatal Diagnosis of Parapagus Conjoined Twins: 3D Virtual and 3D Physical Models

Conjoined twins (CTs) are a rare complication from monochorionic and monoamniotic twin pregnancies. We describe the use of 3D technologies, including 3D virtual and 3D physical models on prenatal evaluation of one parapagus CT. A 16-year-old G1P0 woman was referred for fetal magnetic resonance imaging (MRI) anatomical evaluation of a CT at 28 weeks of gestation. 3D images of the fetal surface were generated by the software during the examination for spatial comprehension of the relationship between the fetal parts. The pair of CTs died at the 32nd week of gestation, a few hours after cesarean section. 3D technologies are an important tool for parental counseling and preparation of the multidisciplinary care team for delivery and neonatal assistance and possible surgical planning for postnatal separation in CTs cases.

Fetal Cardiac Services during the COVID-19 Pandemic: How Does It Affect Parental Counseling?

The COVID-19 pandemic impacts health care providers in multiple ways, even specialties that do not seem to be affected primarily, such as fetal cardiac services. We aimed to assess the effects on parental counseling for fetal congenital heart disease (CHD). In this multicenter study, we used a validated questionnaire. Parents were recruited from four national tertiary medical care centers (n = 226); n = 169 had been counseled before and n = 57 during the pandemic. Overall counseling success including its dimensions did not differ between the two groups (p = n.s.). However, by applying the sorrow scale, we could demonstrate that parents counseled during the pandemic were significantly more concerned (p = 0.025) and unsure (p = 0.044) about their child’s diagnosis, therapy and outcome. Furthermore, parents expressed a significantly increased need for written and/or online information on fetal heart disease (p = 0.034). Other modifiers did not affect counseling success (p = n.s.). We demonstrate that the COVID-19 pandemic impacts effectiveness of parental counseling for fetal CHD, possibly by altering parental perceptions. This needs to be taken into consideration when counseling. Implementing alternative and innovative approaches (e.g., online conference or virtual reality tools) may aid in facilitating high-quality services in critical times such as in the present pandemic.

Awareness of typical speech-language development among parents of children with hearing impairment

<p class="abstract"><strong>Background:</strong> Parents of children with hearing impairment who are aware of normal speech-language development play an effective and active role in the early detection, diagnosis, and habilitation of these children. Hence this study was aimed to explore the level of awareness about normal speech and language milestones in parents of children with hearing impairment.</p><p class="abstract"><strong>Methods:</strong> Questionnaire assessing the parents’ awareness of speech-language development in children from birth to 3 years was administered on 80 parents of children (birth to 5 years) with hearing impairment. These included 40 parents of children recently diagnosed with hearing impairment (group 1 HI-R) and 40 parents of children with hearing impairment who were fitted with appropriate hearing devices and enrolled in a speech and language habilitation program (group II HI-T). </p><p class="abstract"><strong>Results:</strong> Results indicated that the level of awareness was moderate for both the groups for semantic and morphosyntax domains as well as total scores, but was low to moderate for the pragmatic domain. There was no statistically significant difference in the level of awareness between the two groups.</p><p class="abstract"><strong>Conclusions:</strong> Moderate awareness levels indicates that parents of children with hearing impairment need to be made aware about the normal speech and language development so that it can guide them in the habilitation process. This information although important does not appear to have been provided to the parents of children already undergoing habilitation. Thus, there is need of including this as a goal in parental counseling.</p>

Improvement in appetite among stunted children receiving nutritional intervention in Bangladesh: results from a community-based study

Background/objectives Stunted children often have poor appetite, which may limit their response to nutritional interventions. We investigated the effect of a nutritional intervention on the appetite status of stunted children. Methods A longitudinal prospective intervention study was conducted with 50 stunted (length for age; LAZ < −2) (age and sex matched) aged 12–18 months and their mothers in Bauniabadh slum of Dhaka city. The stunted children received the following intervention package: one boiled egg and 150 ml milk daily 6 days a week for 3 months; psychosocial stimulation including structured play activities and parental counseling for 6 months; routine clinical care. Appetite status was measured using an interview-based tool “Early Childhood Appetite and Satiety Tool.” Results Over the period of nutritional intervention, the mean appetite score increased from 49 to 60 in the stunted children and was associated with increased food consumption. Over the intervention period, both egg and milk consumption increased (40.3–49.6 g and 83.8–138.5 ml, respectively). Conclusions Assessment of appetite status using EACST appears to be a useful tool for monitoring a nutritional intervention in stunted children. This tool may be useful for programs in managing child stunting in low-income countries and an important way to assess the efficacy of a nutritional intervention in these children.

Parental Counseling and Its Effects on the Formation of the Child's Personality

Raising children is a challenge, as children grow, change, go through a series of evolutionary phases with different tasks and goals, which the parent often does not know. The child starts from the stage where his primary need is care until he has to detach from his parents to explore the world. Parental counseling is of fundamental importance regarding the physical, cognitive and psychosocial development of the child in the first years of life. The socio-economic status and the cultural context influence the way parents raise and educate their children. Many of the parents living in poverty and social exclusion, concerned about the conditions in which they live do not realize their parental style and its influence on the development of children, do not problematize the parent-child relationship and the importance of the first years of life for the formation of the child's personality. The article illustrates how through different sessions of parental counseling 50 Romani families from different marginalized communities in Alba Iulia were supported, in their educational role and in activating resources and skills for raising children. Families who have been parental counselors have become aware of the importance of children's education, the need to go to school, the value of attachment in building the parent-child relationship, and the future relationships that the child will have in the future, etc. Parental counseling offered parents a path through which to deepen, clarify, improve their educational style and family communication.

Laparoscopic Ureteroureterostomy vs. Common Sheath Ureteral Reimplantation in Children With Duplex Kidney Anomalies

Purpose: Laparoscopic ureteroureterostomy (LUU) has been proposed as an alternative to common sheath ureteral reimplantation (CSUR) in children with symptomatic duplex kidneys. However, data is limited for LUU in the pediatric population. The aim of this study was to analyze our experience with LUU and to compare the results with those after CSUR to assess whether a less invasive surgical approach could be a valid alternative.Patients and methods: The data of all children with duplex kidneys who underwent either LUU or CSUR at our center from 2006 to 2018 were reviewed retrospectively. After parental counseling, the option of LUU was provided as an alternative to CSUR for unilateral procedures and in the absence of vesicoureteral reflux to the receiving ureter. Baseline characteristics, indication for surgery, hospitalization and operative times, and intraoperative, post-operative, and late complications were analyzed. Preoperative and 1-year post-operative sonographies were reviewed by a pediatric radiologist. Increasing renal pelvic diameter (Δ &gt;5 mm) was regarded as a sign of ureteral obstruction.Results: Forty children were included in this study, with 16 children receiving LUU and 24 children receiving CSUR. The children had a mean age of 2.7 years (7 months−9.8 years) and were followed up in our outpatient clinic for an average of 3.9 years (3 months−10.6 years) after surgery. The median hospital stay was 2 days shorter after LUU. Initially, a considerably longer time was needed for LUU, but after more experience was gained, similar operative times were observed for both procedures. Complications were encountered in both groups. After LUU, two patients developed anastomotic leakage: one was managed conservatively, and one required temporary nephrostomy. In the CSUR group, one patient developed vesicoureteral obstruction during follow-up and required reoperation with LUU. The occurrence of post-operative urinary tract infections was similar in both groups. No complications related to the ureteral stump after LUU arose.Conclusion: LUU is a safe and efficacious treatment option for children with duplex kidney anomalies and can be used as an alternative to CSUR. All children receiving LUU showed a non-obstructive, patent anastomosis and no signs for stenotic compromise of the receiving ureter.