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Articles 1 - 30 of 34
Full-Text Articles in Nursing Midwifery
The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson
The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson
Graduate Theses, Dissertations, and Capstones
Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …
Intimate Partner Violence Experience, Support Seeking And Coping Strategies Among Pregnant Women In Southwestern Uganda, Eve Katushabe, John Baptist Asiimwe, John Bosco Ndinawe, Editor Abeneitwe, Agnes Katusiime, Gladys Nakidde, Vincent Batwala
Intimate Partner Violence Experience, Support Seeking And Coping Strategies Among Pregnant Women In Southwestern Uganda, Eve Katushabe, John Baptist Asiimwe, John Bosco Ndinawe, Editor Abeneitwe, Agnes Katusiime, Gladys Nakidde, Vincent Batwala
School of Nursing & Midwifery, East Africa
Intimate partner violence (IPV) during pregnancy remains a global health challenge. This study aimed to explore pregnant women’s experiences of IPV, support seeking, and coping strategies in Southwestern Uganda. Pregnant women who had experienced IPV during pregnancy were purposively selected and completed in-depth interviews, with data saturation reached after 25 participants. Guided by the feminist theory, data were analyzed deductively and inductively using thematic analysis. Participating pregnant women were exposed to physical violence (e.g., the gravid abdomen being stepped on), psychological violence (e.g., verbal abuse), sexual violence (e.g., being forced into uncomfortable sexual positions), and financial control and manipulation (e.g., …
Benefits To Swaddle Bathing, Brenna Dotson, Kori Redden, Cassidy Payne
Benefits To Swaddle Bathing, Brenna Dotson, Kori Redden, Cassidy Payne
Scholars Week
Swaddle bathing is a technique that entails bathing an infant while they are comforted in a swaddle. This technique is rarely seen in everyday hospital practice, even though there is ample evidence of its benefits and advantages. Our project aimed to combine research proving the effectiveness of swaddle bathing through scoring methods that consider pain, vital signs, temperature, crying duration, and more. The research is combined to support the impact that swaddle bathing can have on not only infants but parents as well. Parents implementing the swaddle bath enjoy improved confidence and attachment, along with decreased stress. The evidence was …
E-Gaming: An Active Learning Pedagogy For Engaging Learners In A Private University In Karachi, Pakistan, Laila Akber Cassum, Syeda Sadia Fatima
E-Gaming: An Active Learning Pedagogy For Engaging Learners In A Private University In Karachi, Pakistan, Laila Akber Cassum, Syeda Sadia Fatima
School of Nursing & Midwifery
There is a radical shift in teaching and learning pedagogies to engage the learners in healthcare profession. It was a tough challenge for Pakistani educators of an esteemed university to motivate and assess the learners for concept absorption and critical reasoning using creative approaches. Teaching and learning styles have changed fundamentally from conventional teacher centred to inquiry-based student-centred approach. Classroom teaching in recognised nursing and medical institutes in Pakistan have transformed to blended and entirely online methodologies with the integration of diverse active learning strategies. The educators grapple to engage the millennials and to encounter this, gaming technological platform was …
Evaluation Of The Feasibility Of A Midwifery Educator Continuous Professional Development (Cpd) Programme In Kenya And Nigeria: A Mixed Methods Study, Duncan Shikuku, Hauwa Mohammed, Lydia Mwanzia, Alice Ladur, Peter Nandikove, Eunice Ndirangu, Alphonce Uyara, Catherine Waigwe, Lucy Nyaga, Issak Bashir
Evaluation Of The Feasibility Of A Midwifery Educator Continuous Professional Development (Cpd) Programme In Kenya And Nigeria: A Mixed Methods Study, Duncan Shikuku, Hauwa Mohammed, Lydia Mwanzia, Alice Ladur, Peter Nandikove, Eunice Ndirangu, Alphonce Uyara, Catherine Waigwe, Lucy Nyaga, Issak Bashir
School of Nursing & Midwifery, East Africa
Background Midwifery education is under-invested in developing countries with limited opportunities for midwifery educators to improve/maintain their core professional competencies. To improve the quality of midwifery education and capacity for educators to update their competencies, a blended midwifery educator-specific continuous professional development (CPD) programme was designed with key stakeholders. This study evaluated the feasibility of this programme in Kenya and Nigeria.
Methods This was a mixed methods intervention study using a concurrent nested design. 120 randomly selected midwifery educators from 81 pre-service training institutions were recruited. Educators completed four self-directed online learning (SDL) modules and three-day practical training of the …
Perceptions And Experiences Of Nursing Students And Faculty Members Regarding Implementation Of The Bs-Nursing Program, Abdul Karim, Yasmin Amarsi, Yasmin Parpio, Laila Akber Cassum, Munira Amirali, Shakir Rehman
Perceptions And Experiences Of Nursing Students And Faculty Members Regarding Implementation Of The Bs-Nursing Program, Abdul Karim, Yasmin Amarsi, Yasmin Parpio, Laila Akber Cassum, Munira Amirali, Shakir Rehman
School of Nursing & Midwifery
Objective: To explore the perceptions and experiences of nursing students and faculty members regarding the implementation of the baccalaureate nursing programme in public-sector setting.
Methods: The descriptive, exploratory, qualitative study was conducted at the Khyber Medical University, Peshawar, Pakistan, from April 15, 2020 to April 15, 2021, and comprised undergraduate nursing students and faculty members. Because of the coronavirus disease-2019 pandemic, the subjects were interviewed through telephonic call using a semi-structured interview guide. Data was analysed using the Creswell's analysis approach.
Results: Of the 15 subjects, 10(66.6%) were students aged 21-24 years; 7(70%) males and 3(30%) females. The remaining 5(33.3%) …
Implementation Of Staff Education To Standardize The Use Of Positions During The First Stage Of Labor, Minh Chau T. Phan
Implementation Of Staff Education To Standardize The Use Of Positions During The First Stage Of Labor, Minh Chau T. Phan
Master's Projects and Capstones
This project aims to educate labor and delivery (L&D) nurses on effective laboring positions that can aid fetal descent during the first stage of labor. In an L&D unit of a south Bay Area County hospital, there is a lack of standardization of knowledge and practices on laboring positions among the nursing staff. Evidence shows that upright positions and frequent mobility are effective in shortening the duration of labor and minimizing unnecessary cesarean deliveries. Based on the evidence, a project was implemented using verbal education of evidence-based laboring positions. An educational handout was also provided along with a recorded video …
Effects And Outcomes Of Different Laboring Positions And The Influence From Societal Norms, Amberlyn Heskett
Effects And Outcomes Of Different Laboring Positions And The Influence From Societal Norms, Amberlyn Heskett
Nursing | Senior Theses
Background
Within labor and delivery, every birth is different. Alarmingly, the U.S. has the highest maternal mortality rate, including death during labor, among developed countries (World Health Organization, 2022). Many maternal deaths may be preventable.
In the U.S., the use of forceps, vacuum-assisted birth, episiotomies, and emergency C-sections are common for women during childbirth. Even though some laboring positions may assist birthing more than others, there often is resistance to allowing various positions due to outside influences, including societal norms, hospital management, and healthcare professional training. Women in labor are vulnerable and look to their nurses for support during the …
No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson
No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson
Master's Projects and Capstones
Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …
Prenatal Education For Black Mothers And Their Support Persons As An Intervention For Improving Initiation Of Breastfeeding, Sandra King
Doctor of Nursing Practice Projects
Background: The benefits of breastfeeding are commonly known; however, the rates of exclusive breastfeeding among the Black community are less than those of other ethnic groups. Providing breastmilk or formula to an infant is an individual decision. Influential factors such as cultural background, employment status, socioeconomic status, level of education, and availability of support from family members and health care providers correlate with the method a mother chooses to feed her infant. Increasing breastfeeding initiation immediately after birth is a necessary precedent for uptake in the exclusivity of breastfeeding.
Purpose: This Doctor of Nursing Practice project aims to improve prenatal …
Examining Predictors Of Attitudes And Knowledge Of Registered Nurses And Nursing Students In Tennessee Toward Pregnant And Perinatal Women With A Substance Use Disorder, Jessica Patrylo
Electronic Theses and Dissertations
Substance use disorders (SUDs) among pregnant and perinatal women continue to be a national public health crisis. Furthermore, nursing students and perinatal nurses have historically negative and punitive attitudes toward this vulnerable population of women. As nurses are primary care providers for pregnant and perinatal women, this is troublesome as perinatal patients express feeling stigmatized by nurses whom they should be able to trust. This contributes to the reluctance of women to seek needed medical and prenatal care. Tennessee was the first state to criminalize drug use in pregnancy and has higher neonatal abstinence syndrome (NAS) rates, which were more …
The Ways In Which Women’S Suffrage Affected Healthcare, Madison M. Weber
The Ways In Which Women’S Suffrage Affected Healthcare, Madison M. Weber
The Review: A Journal of Undergraduate Student Research
The 19th Amendment had and continues to have a major impact on women’s healthcare in the United States. Prior to suffrage, women had little to no ability to voice their thoughts on and change policies that regarded their own health. This essay addresses the way in which the vote both directly and indirectly impacted healthcare; including workplace conditions, maternal and reproductive rights, racial disparities, political advocacy and healthcare, the different waves of feminism, and how this has all affected modern healthcare for women. From progressive articles being published in women's magazines, to the establishment of marital rape, to the availability …
Barriers To Healthy Births At Nigerian Hospitals, Caroline Johnston
Barriers To Healthy Births At Nigerian Hospitals, Caroline Johnston
Senior Theses
Maternal mortality is a problem everywhere, but it is especially dangerous in Nigeria where the average woman experiences pregnancy six times during her lifetime (Population Reference Bureau, 2001). Many researchers focus on the medical complications associated with labor, such as hemorrhage, eclampsia, or infection. Although these birth complications are the direct sources of maternal death, it is also important to recognize how maternal mortality is a multifaceted issue influenced by local cultural groups, religions, politics, poverty level and the absence of basic infrastructures. Although maternal mortality is interconnected with social and geographical elements, my paper concentrates on Nigerian hospitals and …
Evidence-Based Practice: Delaying Infant Bathing, Gabrielle Wadle, Grace Frankland
Evidence-Based Practice: Delaying Infant Bathing, Gabrielle Wadle, Grace Frankland
Scholars Week
A hospital's policy regarding infant bathing is currently not congruent with best nursing practice. The hospital’s current policy is to bathe an infant once they are stable and their rectal temperature is at or above 98.6 °F. Although the infant may become stable within the first 24-hours of birth, the World Health Organization recommends that, “Bathing should be delayed until 24 hours after birth.” (2013, p. 4). Research has been completed to support delaying infant bathing until 24 hours post-delivery, suggesting potential modifications to current policy.
Journeying Through Uncharted Territory: The Role Of Humour In Adaption Of Undergraduate Nursing Students In Their First Year Of Study, Marie-Josée Boulianne
Journeying Through Uncharted Territory: The Role Of Humour In Adaption Of Undergraduate Nursing Students In Their First Year Of Study, Marie-Josée Boulianne
Theses
Newly graduated nurses adapting to their professional role have been studied, mainly in their first year of practice. The development of coping strategies, acculturation and other adaptations to the nursing world begin at the onset of the educational journey. Understanding how these manifest early in the formative years can enable educators to tailor nursing programs to assist the future nurse to develop positive coping mechanisms and help pave the way to a successful transition into practice. This research aimed to identify elements conducive to positive adaptation and wellbeing of nursing students during their first year of nursing studies, including the …
Nursing Education Amidst Covid-19: Obstacles And Way Forward, Farida Bibi Mughal, Nasreen Rafiq, Bibi Hajira Irshad Ali
Nursing Education Amidst Covid-19: Obstacles And Way Forward, Farida Bibi Mughal, Nasreen Rafiq, Bibi Hajira Irshad Ali
School of Nursing & Midwifery
No abstract provided.
Determining Racial And Ethnic Disparities In Breastfeeding In The United States, Summer Coker
Determining Racial And Ethnic Disparities In Breastfeeding In The United States, Summer Coker
The Eleanor Mann School of Nursing Undergraduate Honors Theses
The benefits of breastfeeding have been thoroughly studied and researched, with the majority of healthcare providers, health organizations and policies, and professionals in health all recommending the practice. Breastfeeding has protective factors for the newborn against infection and mortality. Other benefits for breastfed children include reduced risk of obesity, asthma, and ear infections; enhanced chance of having a higher income; and a stronger immune system that can follow them throughout adulthood (World Health Organization [WHO] 2020). For mothers who breastfeed, there is a reduced risk of developing ovarian and breast cancer, high blood pressure, and type 2 diabetes (Centers for …
Exploration Of The Experiences And Viewpoints Of Faculty Members On Continuing Education Webinars: A Qualitative Study, Fatemeh Jafarzadeh-Kenarsari, Kobra Abouzari-Gazafroodi, Fatemeh Zaersabet
Exploration Of The Experiences And Viewpoints Of Faculty Members On Continuing Education Webinars: A Qualitative Study, Fatemeh Jafarzadeh-Kenarsari, Kobra Abouzari-Gazafroodi, Fatemeh Zaersabet
The Qualitative Report
Continuing education is necessary to improve the professional knowledge and skills of graduates of medical sciences, which may be implemented via e-learning. This qualitative study aimed to explore the experiences and viewpoints of faculty members participating in continuing education webinars. The participants consisted of 15 faculty members selected purposefully and with maximal variation regarding their sex, age, the field of specialization, academic rank, and work experience. Data were collected through semi-structured individual face-to-face interviews. Data analysis of these transcripts using a qualitative content analysis approach revealed 3 themes and 9 sub-themes. The main themes included “Moving across the boundaries of …
Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney
Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney
Publications and Research
Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …
La Adherencia A Las Recomendaciones De Sueño Seguro Por Parte De Las Enfermeras En Unidades De Cuidado Intensiva Neonatal (Ucin) De Hospitales Públicos Y Privados En El Gran Buenos Aires / The Adherence To Safe Sleep Recommendations By Nurses In Neonatal Intensive Care Units (Nicus) Of Public And Private Hospitals In Grand Buenos Aires, Joelle M. Schauer
Independent Study Project (ISP) Collection
El Síndrome de Muerte Súbita de Lactante (SMSL) es “la muerte de un niño menor de 1 año que ocurre, aparentemente, durante el sueño y no puede ser explicada luego de una investigación exhaustiva, que incluye una autopsia completa, la investigación de las circunstancias de la muerte y la revisión de la historia clínica" (Jenik et al., 2015, p. 2). La Academia Americana de Pediatría (AAP) tiene recomendaciones sobre las prácticas del sueño seguro que pueden disminuir el riesgo de SMSL y otras Muertes Súbitas Inesperadas Infantiles (MSII).
El objetivo de esta investigación es analizar la adherencia a estas recomendaciones …
Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson
Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson
Williams Honors College, Honors Research Projects
Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …
Comparison Of Undergraduate Educational Environment In Medical And Nursing Program Using The Dreem Tool, Salima Farooq, Rehana Rehman, Mehwish Hussain, Jacqueline Maria Dias
Comparison Of Undergraduate Educational Environment In Medical And Nursing Program Using The Dreem Tool, Salima Farooq, Rehana Rehman, Mehwish Hussain, Jacqueline Maria Dias
School of Nursing & Midwifery
Introduction: Educational environment (EE) in a health educational institute can bring about an enduring impact on the students' motivation, knowledge, critical thinking along with their social life. Therefore, identifying strengths and the need for change in the education environment is vital for the enhancement of the students' learning.
Objective: This study aimed to compare the perceptions of nursing and medical students about their EE in a private university, Karachi Pakistan.
Methodology: Data from two cross-sectional studies of 884 students from both medical and nursing schools of Aga Khan University was acquired and analyzed. EE was measured by …
Journey Interrupted: A Phenomenological Exploration Of Miscarriage, Marit A. Watson, Vanessa D. Jewell, Sarah L. Smith
Journey Interrupted: A Phenomenological Exploration Of Miscarriage, Marit A. Watson, Vanessa D. Jewell, Sarah L. Smith
The Open Journal of Occupational Therapy
Background: Miscarriage is a significant life event that impacts occupational performance, identity, and competence and that influences perceptions of motherhood. Because of the lack of social rituals often attributed to the death of a loved one, miscarriages may result in disenfranchised grief, which impedes coping.
Methods: This phenomenological study explored the impact of miscarriage on relationships, perceptions of motherhood, and the meaning of occupation in the context of grief. Data was collected through semi-structured interviews (N = 4) and completion of a brief demographic questionnaire. The interviews were digitally recorded, transcribed verbatim, and reviewed to ensure accuracy. Using inductive thematic …
Book Review: Surrogacy: A Human Rights Violation By Renate Klein, Sheela Saravanan
Book Review: Surrogacy: A Human Rights Violation By Renate Klein, Sheela Saravanan
Dignity: A Journal of Analysis of Exploitation and Violence
No abstract provided.
Academic Incivility In Modern Generation Of Nursing Students, Laila Akber Cassum
Academic Incivility In Modern Generation Of Nursing Students, Laila Akber Cassum
School of Nursing & Midwifery
Incivility in nursing academia and workplace is one of the emerging and complex issues in recent years, and can have substantial consequences on the organizational benchmark as well as on the teaching and learning milieu of the institution. Growth of academic incivility among the modern and diversified generation of students can have a profound destructive impact on their academic life and professional career. Impolite and discourteous attitude and behavior in a classroom atmosphere can originate from the learners as well the teachers, which can significantly impact the critical thinking and learning outcomes of the learner. This matter needs to be …
The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey
The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey
Senior Theses
Type 1 Diabetics have various ways of managing their diabetes that have been studied for their effectiveness. Pregnancy in the Type 1 Diabetic has been understudied. It is known that Diabetics in general have poorer pregnancy outcomes because of poor glycemic control. This coupled with the fact that the body needs 3-4 times more insulin as pregnancy comes to an end makes managing blood glucose levels challenging for diabetics (Lowdermilk, 2016, p. 689). For the Type 1 Diabetic, there are two main ways to control diabetes: multiple daily injections using at least two type of insulin and continuous subcutaneous insulin …
Why American Parents Circumcise Their Sons: An Integrative Review Of Literature, Lacy Lauber
Why American Parents Circumcise Their Sons: An Integrative Review Of Literature, Lacy Lauber
Grace Peterson Nursing Research Colloquium
Background: Since medical evidence supports both pros and cons of routine neonatal male circumcision, expectant and new parents are left to make the decision to circumcise their sons on their own. There is limited research as to why American parents choose to circumcise their newborn sons.
Objectives: The purpose of this integrative literature review is to identify the reasons behind parental decision making in neonatal male circumcision in the United States. Understanding motivating factors in parental decision-making can highlight areas of prenatal education for expectant parents.
Method: An integrative literature review was conducted utilizing these online databases: PubMed, The Cumulative …
College Students, Experiences On Smart Phone Technology Usage: A Qualitative Content Analysis Study, Fatemeh Jafarzadeh-Kenarsari, Parand Pourghane
College Students, Experiences On Smart Phone Technology Usage: A Qualitative Content Analysis Study, Fatemeh Jafarzadeh-Kenarsari, Parand Pourghane
The Qualitative Report
Besides many benefits of the cell phone technology, numerous arguments are raised on the different and important negative effects of such a technology. This qualitative content analysis study explored the common usages of smart phone technology, its challenges, and benefits among Iranian college students. Participants were 32 bachelor degree students who were recruited using purposive sampling method with maximum variation. Data were collected through 11 individual semi-structured interviews and 3 focus group discussions (5-8 students in each group). Data analysis was done based on a conventional content analysis approach. Data analysis resulted in 3 main themes and 12 sub-themes. The …
I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam
I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam
Master's Projects and Capstones
The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …
Effective Interventions To Reduce The Increase In Elective Cesarean Sections In Low Risk Women, Kimberly Kelsey, Crystal Hunter, Brianna-Kirsten Tan, Sara Shea, Heather Holland, Sasha Riley, Mary Uy, Tenzin Tsomo, Fasha Ruys-Solorzano, Dolma Tso
Effective Interventions To Reduce The Increase In Elective Cesarean Sections In Low Risk Women, Kimberly Kelsey, Crystal Hunter, Brianna-Kirsten Tan, Sara Shea, Heather Holland, Sasha Riley, Mary Uy, Tenzin Tsomo, Fasha Ruys-Solorzano, Dolma Tso
Student Research Posters
According to the Annals of Family Medicine, the amount of babies born via cesarean section has increased from 4.5% in 1965 to 26.1% in 2002 and nearly 40% of all cesarean sections are repeats. After an extensive literature review, results showed that patients need to be educated about the risks and benefits of vaginal delivery and cesarean delivery. It was also found that there needs to be policy changes to decrease the amount of cesarean sections done and increase the labor and delivery support without using interventions. Further study should be focused on morbidity and mortality very low birth weight …