COVID-19 ; Critical Care ; Humans ; Intensive Care Units ; SARS-CoV-2

Introduction: Initiating and sustaining breastfeeding are influence by many factors including involvement, attitude and support from the partner. Research on breastfeeding mostly investigate maternal factors, although the father’s behaviour and role may influence the success of breastfeeding. Hence, this study aimed to determine the associations of father’s attitude and support with the duration of exclusive breastfeeding new parents. Methods: The study involved 104 new parents in Kuala Lumpur, Malaysia, recruited at three randomly selected antenatal clinics using purposive sampling. Fathers’ breastfeeding attitude was measured using Iowa-Infant-Feeding-Attitude-Scale, whereas paternal support using Subjective Norms and Paternal-Breastfeeding-Influence-Scale questionnaires. Mothers were asked about breastfeeding practice. Results: Exclusive breastfeeding duration rates at six months was 27.9%. The average score for paternal attitude on breastfeeding was 61.0 ±6.3, indicating father’s positive attitude towards breastfeeding. The mean score of paternal breastfeeding supports for subjective norms surrounding breastfeeding and overall support score were 4.3+0.6 and 4.06+0.6, respectively, demonstrating frequent paternal engaging and support in breastfeeding. Duration of exclusive breastfeeding were positively associated with the paternal attitude (β=0.235, p=0.027) and overall mean score for breastfeeding support (β=2.166, p=0.028), but negatively associated with support strategies score (β= -2.203, p=0.026). Conclusion: Overall, paternal support and positive attitude were associated with breastfeeding duration. It is important to increase public awareness on the important roles of fathers during the breastfeeding process such as emphasizing the husband’s role in supporting their wives to breastfeed, as well as the importance of paternal role in caring the baby, especially among new couples.

INTRODUCTION: Despite adhering to criteria for extubation, up to 20% of intensive care patients require re-intubation, even with use of post-extubation high-flow nasal cannula (HFNC). This study aims to identify independent predictors and outcomes of extubation failure in patients who failed post-extubation HFNC. METHODS: We conducted a multicentre observational study involving 9 adult intensive care units (ICUs) across 5 public hospitals in Singapore. We included patients extubated to HFNC following spontaneous breathing trials. We compared patients who were successfully weaned off HFNC with those who failed HFNC (defined as re-intubation ≤7 days following extubation). Generalised additive logistic regression analysis was used to identify independent risk factors for failed HFNC. RESULTS: Among 244 patients (mean age: 63.92±15.51 years, 65.2% male, median APACHE II score 23.55±7.35), 41 (16.8%) failed HFNC; hypoxia, hypercapnia and excessive secretions were primary reasons. Stroke was an independent predictor of HFNC failure (odds ratio 2.48, 95% confidence interval 1.83-3.37). Failed HFNC, as compared to successful HFNC, was associated with increased median ICU length of stay (14 versus 7 days, CONCLUSION Post-extubation HFNC failure, especially in patients with stroke as a comorbidity, remains a clinical challenge and predicts poorer clinical outcomes. Our observational study highlights the need for future prospective trials to better identify patients at high risk of post-extubation HFNC failure.
Adult ; Airway Extubation ; Cannula ; Critical Care ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiratory Insufficiency/therapy* ; Singapore/epidemiology*