Noteworthy Professional News
POSTPARTUM DEPRESSION AND THE NEONATAL INTENSIVE CARE UNIT
Postpartum depression is a medical diagnosis given to a woman within the first year after childbirth. Symptoms are very similar to depression including feelings of sadness, hopelessness, or worthlessness.1 , 2 These symptoms are more severe than common “baby blues” that present more mildly in nature such as tearfulness, frequent worrying, and tiredness. Postpartum depression affects approximately 20% of mothers3 and is estimated to be much higher in those women with a child in the neonatal intensive care unit (NICU).4 There are suggestions that women should be assessed for postpartum depression at time points other than their postpartum follow-up appointments with their obstetrician, including in the emergency department with a fussy child younger than 1 year.1 , 2 Often when the infant is medically cleared, it is the mother who needs medical attention. Although a NICU is the primary unit caring for ill and premature infants, it is the exact place where additional assessing and services for postpartum depression could occur. When the exciting day for that child to be discharged home from the NICU presents itself, it is imperative that we evaluate the entire home situation prior to discharge.3 Many times, NICU staff may not feel that they can control the environment these infants experience when going home. Examining that a mother's health is adequate to take on newborn care tasks and dealing with extensive, medically challenging situations is necessary to safeguard a child's initial entrance to home life. What is your NICU doing today to identify mothers who may present with symptoms of postpartum depression while visiting their infant? Is there sufficient skilled staffing support to add this responsibility within the NICU setting? A topic to consider when the goal is to send infants into the arms of competent and self-sufficient families.
STABLE MICROBUBBLE TEST USING ORAL FLUID SAMPLES TO IDENTIFY RESPIRATORY DISTRESS SYNDROME
For decades, as technology and medicine have allowed premature infants to live beyond the NICU walls, the desire to predict the immaturity of lung development has also increased. Since the late 1900s, tests such as the stable microbubble test have been proposed, analyzed, and tested to be a sensitive and specific predictor for respiratory immaturity in infants from amniotic samples taken during an amniocentesis.5 , 6 Since this time, the use of the stable microbubble test has been an underutilized prenatal laboratory test result in the United States for pregnancies anticipated to end prematurely compared with the lecithin/sphingomyelin ratio test. Not all premature deliveries are expected, not every healthcare facility may have the technology to conduct a lecithin/sphingomyelin ratio test, and for those women, with little to no prenatal care, what is the best way to determine the risk for respiratory distress syndrome when an amniocentesis is no longer an option? Recently, research has shown that the use of the stable microbubble test performed as well as other samples types (ie, amniotic or gastric) in predicting respiratory distress syndrome in premature infants.7 In 64 patients born less than 34 weeks of gestation, a minimum of 0.2 mL of oral secretions was collected by the obstetrician in the delivery room. Test results were available within 5 minutes and at a low cost8 to assist in assessing whether a premature infant needed surfactant. A small microbubble test result less than 25 small microbubble (SM)/mm2 demonstrated a sensitivity of 81.4% and specificity of 85.7% on oral secretion samples in being able to predict surfactant deficiency.8 As a result, the stable microbubble test may be a bedside test to consider for any delivering hospital facility at the time of a premature birth when other sample types or tests are not available.
1. Jarvis LR, Breslin KA, Badolato GM, Chamberlain JM, Goyal MK. Postpartum depression screening and referral in a pediatric emergency department [published online ahead of print May 5, 2018]. Pediatr Emerg Care. doi:10.1097/PEC.0000000000001499.
2. Emerson BL, Bradley ER, Riera A, Mayes L, Bechtel K. Postpartum depression screening in the pediatric emergency department. Pediatr Emerg Care. 2014;30(11):788–792. doi:10.1097/PEC.0000000000000260.
3. Waldrop J, Ledford A, Perry LC, Beeber LS. Developing a postpartum depression screening and referral procedure in pediatric primary care. J Pediatr Health Care. 2018;32(3):e67–e73. doi:10.1016/j.pedhc.2017.11.002.
4. Mounts KO. Screening for maternal depression in the neonatal ICU. Clin Perinatol. 2009;36(1):137–152. doi:10.1016/j.clp.2008.09.014.
5. Chida S, Fujiwara T, Takahashi A, Kanehama S, Kaneko J. Precision and reliability of stable microbubble test as a predictor of respiratory distress syndrome. Acta Paediatr Jpn Overseas Ed. 1991;33(1):15–19.
6. Pattle RE, Kratzing CC, Parkinson CE, et al Maturity of fetal lungs tested by production of stable microbubbles in amniotic fluid. Br J Obstet Gynaecol. 1979;86(8):615–622.
7. Ribeiro MADS, Fiori HH, Luz JH, Garcia PCR, Fiori RM. Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns [published online ahead of print May 30, 2018]. J Pediatr (Rio J). doi:10.1016/j.jped.2018.04.008.
8. Fiori HH, Fiori RM. Why not use a surfactant test for respiratory distress syndrome? Neonatology. 2015;107(4):312. doi:10.1159/000369376.