101
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Burnett AC, Cheong JLY, Doyle LW. Biological and Social Influences on the Neurodevelopmental Outcomes of Preterm Infants. Clin Perinatol 2018; 45:485-500. [PMID: 30144851 DOI: 10.1016/j.clp.2018.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although very preterm birth and very low birthweight are recognized risk factors for longer term developmental difficulties, there is a wide spectrum of outcomes for children and adolescents born preterm. Biological and social variables have the potential to explain this variability. Although current understanding of these influences and how they interact is incomplete, perinatal factors are related to permanent neurosensory impairments such as cerebral palsy, blindness, and deafness. Cognitive and academic outcomes are variably associated with biological and social variables across development, and the most robust correlates of behavior and mental health difficulties include early behavioral problems and family influences.
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Affiliation(s)
- Alice C Burnett
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria 3010, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Jeanie L Y Cheong
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3010, Australia; Neonatal Services, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, Level 7, 20 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Lex W Doyle
- Premature Infant Follow-Up Program, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria 3010, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3010, Australia; Newborn Research, The Royal Women's Hospital, Level 7, 20 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
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102
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Yaari M, Rotzak NL, Mankuta D, Harel-Gadassi A, Friedlander E, Eventov-Friedman S, Bar-Oz B, Zucker D, Shinar O, Yirmiya N. Preterm-infant emotion regulation during the still-face interaction. Infant Behav Dev 2018; 52:56-65. [PMID: 29864604 DOI: 10.1016/j.infbeh.2018.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 11/18/2022]
Abstract
Very-preterm (VPT), moderately-preterm (MPT), and full-term (FT) infants' emotion-regulation behaviors were assessed via the Still-Face procedure at a corrected age of four months. As a developmental task during the first year of life, emotion regulation is important for social and cognitive development. Although substantial evidence indicates that VPT infants exhibit emotion-regulation difficulties, little is known about MPT infants' emotion regulation capabilities, this group also possibly being at risk. The participants included 135 parent-infant dyads: 46 VPT (gestational age 24-32 weeks), 51 MPT (gestational age 32-34 weeks), and 38 FT (gestational age 37-41 weeks). The infants' affect, gaze-aversion, and self-comforting behaviors were coded. Preterm infants responded to parental still face in similar fashion to FT infants, displaying robust still-face and recovery effects. The preterm infants exhibited less developed emotion-regulation behaviors, however, manifested in less positive affect and more gaze aversion in the face-to-face and reunion episodes compared to FT infants. With respect to self-comforting behaviors, each group displayed a significantly different pattern of behaviors throughout the procedure, suggesting better emotion regulation skills among MPT infants compared to the VPT infants. The findings on gaze aversion and self-comforting behaviors could have implications for strategies to incorporate into intervention programs supporting development of emotion regulation skills.
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Affiliation(s)
- Maya Yaari
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | | | - David Mankuta
- Department of Neonatology, Hadassah University Hospital, Israel
| | | | - Edwa Friedlander
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | | | - Benjamin Bar-Oz
- Department of Obstetrics & Gynecology, Hadassah University Hospital, Israel
| | - David Zucker
- Department of Statistics, The Hebrew University of Jerusalem, Israel
| | - Oren Shinar
- Department of Statistics, The Hebrew University of Jerusalem, Israel
| | - Nurit Yirmiya
- Department of Psychology, The Hebrew University of Jerusalem, Israel.
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103
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Lapcharoensap W, Lee HC, Nyberg A, Dukhovny D. Health Care and Societal Costs of Bronchopulmonary Dysplasia. Neoreviews 2018; 19:e211-e223. [PMID: 33384574 DOI: 10.1542/neo.19-4-e211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite significant technological advances and increasing survival of premature infants, bronchopulmonary dysplasia (BPD) continues to be the most prevalent major morbidity in surviving very low-birthweight infants. Infants with BPD are often sicker, require longer stays in the NICU, and accumulate greater hospital costs. However, care of the infant with BPD extends beyond the time spent in the NICU. This article reviews the costs of BPD in the health-care setting, during the initial hospitalization and beyond, and the long-term neurodevelopmental impact of BPD, as well as the impact on a family caring for a child with BPD.
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Affiliation(s)
| | - Henry C Lee
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Amy Nyberg
- March of Dimes NICU Family Support Coordinator, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
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104
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Barkmann C, Helle N, Bindt C. Is very low infant birth weight a predictor for a five-year course of depression in parents? A latent growth curve model. J Affect Disord 2018; 229:415-420. [PMID: 29331702 DOI: 10.1016/j.jad.2017.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 11/20/2017] [Accepted: 12/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND A very low birth weight (VLBW) is considered as a significant risk factor for early-onset developmental problems in infants, but is also discussed as a potential risk factor for the development of depressive symptoms in affected parents. METHODS In this study, the 5-year courses of maternal and paternal depression with VLBW and term born infants (n = 250 families) are modeled and predicted by factors existing at the time of birth. RESULTS The dyadic trajectories of depression could be best described by five classes (I no depression, II minor maternal depression, III increasing dyadic depression, IV significant maternal depression, V highly depressed mothers). VLBW was a significant predictor for the course of parental depression - even under control of preexisting psychiatric disorders and other confounders. Interaction effects and a dose-response relationship were not existent. LIMITATIONS Class IV and V had to be merged for the prediction analysis, a missing bias could not be ruled out, and families with a low birth weight (between 2500 and 1500g) were not included. CONCLUSIONS The results are well in line with what is known from studies so far, suggesting that maternal and paternal trajectories of depression show distinctable patterns which are associated with a VLBW. An early screening of mothers and fathers of a VLBW infant seems reasonable to prevent the development of a depression in parents and further difficulties for the child.
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Affiliation(s)
- Claus Barkmann
- Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Nadine Helle
- Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Germany
| | - Carola Bindt
- Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Germany
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105
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Abstract
Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14-2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07-2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.
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Affiliation(s)
- Nancy E Reichman
- Department of Pediatrics and Child Health Institute of New Jersey, Rutgers University-Robert Wood Johnson Medical School, 89 French St., Room 3272, New Brunswick, NJ, 08903, USA.
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Hope Corman
- Department of Finance and Economics, Rider University, 2083 Lawrenceville Rd., Lawrenceville, NJ, 08648, USA
- National Bureau of Economic Research, New York, NY, USA
| | - Kelly Noonan
- Department of Finance and Economics, Rider University, 2083 Lawrenceville Rd., Lawrenceville, NJ, 08648, USA
- National Bureau of Economic Research, New York, NY, USA
- Department of Economics, Princeton University, 222 Julis Romo Rabinowitz Building, Princeton, NJ, 08544, USA
| | - Manuel E Jiménez
- Department of Pediatrics, Boggs Center for Developmental Disabilities, Child Health Institute of New Jersey, and Department of Family Medicine, Rutgers University-Robert Wood Johnson Medical School, 89 French St., Room 3271, New Brunswick, NJ, 08903, USA
- Children's Specialized Hospital, New Brunswick, NJ, USA
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106
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Spittle AJ, Treyvaud K, Lee KJ, Anderson PJ, Doyle LW. The role of social risk in an early preventative care programme for infants born very preterm: a randomized controlled trial. Dev Med Child Neurol 2018; 60:54-62. [PMID: 29058313 DOI: 10.1111/dmcn.13594] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 12/01/2022]
Abstract
AIM To examine the differential effects of an early intervention programme for infants born preterm on neurodevelopment and parental mental health according to family social risk. METHOD One hundred and twenty infants born earlier than 30 weeks' gestation were randomized to early intervention (n=61) or control groups (n=59). Cognitive, language, and motor outcomes were assessed by blinded assessors at 2 years, 4 years, and 8 years, and primary caregivers completed questionnaires on their anxiety and depression. Outcomes at each time point were compared between groups using linear regression with an interaction term for social risk (higher/lower). RESULTS There was evidence of interactions between intervention group and social risk for cognition at 2 years and 4 years, motor function at 4 years, and language at 8 years, with a greater intervention effect in children from higher social risk environments. In contrast, the impact of early intervention on parental depressive symptoms was greater for parents of lower social risk than for those of higher social risk. INTERPRETATION Effects of early intervention on outcomes for children born preterm and their caregivers varied according to family social risk. Family social risk should be considered when implementing early intervention programmes for children born preterm and their families. WHAT THIS PAPER ADDS Intervention is associated with better early cognitive functioning for children in higher social risk families. Positive effects of intervention for the high risk group were not sustained at school-age. Intervention has a greater effect on primary caregiver mental health in the lower social risk group compared with higher social risk.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Karli Treyvaud
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia.,Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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107
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Gray PH, Edwards DM, Gibbons K. Parenting stress trajectories in mothers of very preterm infants to 2 years. Arch Dis Child Fetal Neonatal Ed 2018; 103:F43-F48. [PMID: 28659361 DOI: 10.1136/archdischild-2016-312141] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine levels of parenting stress in mothers of preterm and term infants when the children were 2 years old; to determine the trajectory of stress over three time periods and to examine the association of maternal and neonatal factors and developmental outcomes with parenting stress. DESIGN It is a prospective longitudinal study to determine parenting stress in mothers of preterm and term infants with outcomes having been previously obtained at 4 and 12 months. At 2 years, 79 preterm mothers (96 babies) and 64 term mothers (77 babies) participated. The mothers completed the Parenting Stress Index-Short Form (PSI-SF), the Depression, Anxiety, Stress Scale (DASS) and the Child Behaviour Checklist (CBCL). The infants had a neurological examination and the Bayley-III scales were administered. RESULTS The mean total PSI-SF at 2 years was significantly higher for the preterm group compared with the term group of mothers (p=0.007). There was a significant increase in the mean total PSI over time for the preterm mothers (p<0.001). For mothers at 2 years, there was an association with high levels of parenting stress and abnormal scores on the DASS (p<0.001) and high total T-scores on the CBCL (internalising p<0.001; externalising p=0.006). There was no association between parenting stress and maternal demographics, neonatal factors or Bayley-III results. CONCLUSIONS Parenting stress in mothers of preterm infants continues to be high at 2 years having increased over time. Maternal mental health problems and infant behavioural issues contribute to the stress.
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Affiliation(s)
- Peter H Gray
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.,Mothers, Babies and Women's Health Programme, Mater Research Institute-University of Queensland, South Brisbane, Queensland, Australia
| | - Dawn M Edwards
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
| | - Kristen Gibbons
- Mothers, Babies and Women's Health Programme, Mater Research Institute-University of Queensland, South Brisbane, Queensland, Australia
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108
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Amorim M, Silva S, Kelly-Irving M, Alves E. Quality of life among parents of preterm infants: a scoping review. Qual Life Res 2017; 27:1119-1131. [PMID: 29248997 DOI: 10.1007/s11136-017-1771-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To synthesize the body of knowledge on the factors influencing the QoL of mothers and fathers of preterm infants. METHODS A scoping review was performed. Publications indexed in PubMed®, Web of Science™, CINAHL® and PsycINFO® were searched, targeting studies presenting original empirical data that examined parental perception on QoL after a preterm delivery. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized and qualitative data were explored by content analysis. RESULTS The studies, 11 quantitative and 1 mixed methods, were derived mainly from the USA (n = 6). Heterogeneity across the studies was observed regarding the operationalization of QoL and the use of units of analysis (mothers, parents, families and caregivers). In a context where 40 out of 45 covariates were analysed by only one or two studies, results suggested that parental QoL after a preterm delivery is influenced by factors related with mother's characteristics, family issues and health care environment rather than infants' variables. Factors regarding fathers' characteristics and structural levels were not addressed. CONCLUSIONS Standardizing the operationalization of the QoL when analysing mothers and fathers of preterm infants calls for a structured questionnaire adapted to their specific needs. Further research should include both mothers and fathers, invest in mixed methods approaches and be performed in different countries and settings for allowing integration and comparison of findings.
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Affiliation(s)
- Mariana Amorim
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Global Public Health Doctoral Programme, Porto, Portugal.
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Michelle Kelly-Irving
- INSERM UMR1027, 31000, Toulouse, France.,Université Toulouse III Paul Sabatier, UMR1027, 31000, Toulouse, France
| | - Elisabete Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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109
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Cambonie G, Muller JB, Ehlinger V, Roy J, Guédeney A, Lebeaux C, Kaminski M, Alberge C, Denizot S, Ancel PY, Arnaud C. Mother-infant interaction assessment at discharge and at 6 months in a French cohort of infants born very preterm: The OLIMPE study. PLoS One 2017; 12:e0188942. [PMID: 29216238 PMCID: PMC5720768 DOI: 10.1371/journal.pone.0188942] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 11/15/2017] [Indexed: 01/18/2023] Open
Abstract
Objectives The principal aim was to investigate the feasibility of assessing mother-infant interactions at discharge and at 6 months infant corrected age in singletons born before 32 weeks of gestation. The secondary aims were to describe these interactions and their disorders, explore the association between maternal emotional state and the interactions, and assess the relationship between disordered interactions and infant social withdrawal behaviour. Methods OLIMPE is an ancillary study of the population-based study EPIPAGE 2, which recruited preterm neonates in France in 2011. 163 dyads participated at discharge and 148 at 6 months. Interactions were observed with the Attachment During Stress (ADS) scale, which includes two behavioural subscales, for the mother (m-ADS) and her infant (i-ADS). Two professionals independently completed the ADS scales for one third of the observations. Maternal emotional state was assessed using self-administered questionnaires of depression, anxiety, and stress. Infant’s social withdrawal behaviour at 6 months was measured by the Alarm Distress Baby scale. Results At discharge, 15.3% of the m-ADS scales and 43.3% of the i-ADS scales had at least one unobserved component. At 6 months, all items on both scales were noticeable in >90% of the dyads. Reliability, estimated by the kappa coefficient, ranged between 0.39 and 0.76 at discharge, and between 0.21 and 0.69 at 6 months. Disordered interactions were indicated on 48.6% of the m-ADS scales and 36.5% of the i-ADS scales at discharge. At 6 months, these rates were 32.6% and 26.0%. Disordered interactions at 6 months were associated with identified disorder at discharge. Insecure infant attachment was not influenced by maternal mental health but was strongly associated with infant social withdrawal behaviour. Conclusions The ADS scale can be used to screen for early interaction disorders after premature birth and may help to target dyads that would most benefit from early intervention.
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Affiliation(s)
- Gilles Cambonie
- Department of Neonatal Medicine, Arnaud de Villeneuve University Hospital, Montpellier, France
- * E-mail:
| | - Jean-Baptiste Muller
- Department of Neonatal Medicine, Women’s and Children’s University Hospital, Nantes, France
| | - Virginie Ehlinger
- UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
| | - Joël Roy
- Child and Adolescent Psychiatry Unit, Nîmes University Hospital, Nîmes, France
| | - Antoine Guédeney
- Child and Adolescent Psychiatry Unit, Bichat-Claude Bernard University Hospital, Paris, France
| | - Cécile Lebeaux
- Inserm UMR 1153 Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Monique Kaminski
- Inserm UMR 1153 Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Corine Alberge
- Department of Neonatal Medicine, Children's University Hospital, Toulouse, France
| | - Sophie Denizot
- Department of Neonatal Medicine, Women’s and Children’s University Hospital, Nantes, France
| | - Pierre-Yves Ancel
- Inserm UMR 1153 Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Catherine Arnaud
- UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
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110
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Baud O. [Prematurity, progress and challenges]. SOINS. PÉDIATRIE, PUÉRICULTURE 2017; 38:10-14. [PMID: 29162252 DOI: 10.1016/j.spp.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prematurity is one of the main causes of neonatal mortality and comorbidities, and longer term sequalae. The survival rate and quality of life of premature babies has however progressed significantly and infants benefit from improved monitoring and long-term follow-up. Notable advances have been made in the area of developmental care, although their implementation in units needs to be improved. Innovations in perinatology should emerge in the years ahead.
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Affiliation(s)
- Olivier Baud
- Inserm U1141,Université Paris-Diderot, Sorbonne Paris Cité,Service de réanimation et pédiatrie néonatales, Hôpital universitaire Robert-Debré, AP-HP, 48 boulevard Sérurier, 75019, Paris, France.
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111
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Bagge SR, Westgate B, Few K, Clarke P, Adlam A, Walsh J, O'Brien M. Acceptability and feasibility of collecting psychosocial data from fathers of very low birth weight infants. J Child Health Care 2017; 21:283-291. [PMID: 29119814 DOI: 10.1177/1367493517715147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the feasibility and acceptability of collecting outcome data from parents of very low birth weight (VLBW) infants and to explore the psychological and social adaptation of fathers. Questionnaires were distributed to 38 parents of VLBW infants and 36 parents of term infants within a hospital Neonatal Intensive Care Unit. Field notes were also taken. Parents indicated collecting outcome data in this population was feasible and acceptable, but barriers and difficulties in data collection were identified, particularly for fathers. Furthermore, parents highlighted a lack of emotional support for fathers. In conclusion, research with parents of VLBW infants should happen with consultation, flexibility and measures designed specifically for this population.
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Affiliation(s)
- S R Bagge
- 1 School of Psychology, University of East Anglia, Norwich, Norfolk, UK
| | - B Westgate
- 2 Department of Psychological Sciences, Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - K Few
- 3 Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - P Clarke
- 3 Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - A Adlam
- 4 College of Life and Environmental Sciences, University of Exeter, Devon, UK
| | - J Walsh
- 1 School of Psychology, University of East Anglia, Norwich, Norfolk, UK
| | - M O'Brien
- 5 Thomas Coram Research Unit, University College London, Institute of Education, London, UK
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112
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Mughal MK, Ginn CS, Magill-Evans J, Benzies KM. Parenting stress and development of late preterm infants at 4 months corrected age. Res Nurs Health 2017; 40:414-423. [DOI: 10.1002/nur.21809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/06/2017] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Joyce Magill-Evans
- Department of Occupational Therapy; University of Alberta; Edmonton Alberta Canada
| | - Karen M. Benzies
- Faculty of Nursing, Department of Paediatrics; University of Calgary; Calgary Alberta Canada
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113
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Hadfield K, O'Brien F, Gerow A. Is level of prematurity a risk/plasticity factor at three years of age? Infant Behav Dev 2017; 47:27-39. [PMID: 28324848 DOI: 10.1016/j.infbeh.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
Children born preterm have poorer outcomes than children born full-term, but the caregiving environment can ameliorate some of these differences. Recent research has proposed that preterm birth may be a plasticity factor, leading to better outcomes for preterm than full-term infants in higher quality environments. This analysis uses data from two waves of an Irish study of children (at 9 months and 3 years of age, n=11,134 children) and their caregivers (n=11,132 mothers, n=9998 fathers) to investigate differences in how caregiving affects social, cognitive, and motor skills between full-term, late preterm, and very preterm children. Results indicate that parental emotional distress and quality of attachment are important for child outcomes. Both being born very preterm and late preterm continue to be risk factors for poorer outcomes at 3 years of age. Only fathers' emotional distress significantly moderated the effect of prematurity on infants' cognitive and social outcomes-no other interactions between prematurity and environment were significant. These interactions were somewhat in line with diathesis stress, but the effect sizes were too small to provide strong support for this model. There is no evidence that preterm birth is a plasticity factor.
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Affiliation(s)
- Kristin Hadfield
- Resilience Research Centre, Dalhousie University, Halifax, NS, Canada.
| | - Fearghal O'Brien
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, United States
| | - Aaron Gerow
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
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114
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Steinberg Z, Patterson C. Giving Voice to the Psychological in the NICU: A Relational Model. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/15289168.2016.1267539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G. Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:322-329. [PMID: 27997053 DOI: 10.1002/uog.17388] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/26/2016] [Accepted: 12/13/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Cervical length screening by transvaginal sonography (TVS) has been shown to be a good predictive test for spontaneous preterm birth (PTB) in symptomatic singleton pregnancy with threatened preterm labor (PTL). The aim of this review and meta-analysis of individual participant data was to evaluate the effect of knowledge of the TVS cervical length (CL) in preventing PTB in singleton pregnancies presenting with threatened PTL. METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and the Cochrane Complementary Medicine Field's Trials Register (May 2016) and reference lists of retrieved studies. Selection criteria included randomized controlled trials of singleton gestations with threatened PTL randomized to management based mainly on CL screening (intervention group), or CL screening with no knowledge of results or no CL screening (control group). Participants included women with singleton gestations at 23 + 0 to 36 + 6 weeks with threatened PTL. We contacted corresponding authors of included trials to request access to the data and perform a meta-analysis of individual participant data. Data provided by the investigators were merged into a master database constructed specifically for the review. The primary outcome was PTB < 37 weeks. Summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% CI. RESULTS Three trials including a total of 287 singleton gestations with threatened PTL between 24 + 0 and 35 + 6 weeks were included in the meta-analysis, of which 145 were randomized to CL screening with knowledge of results and 142 to no knowledge of CL. Compared with the control group, women who were randomized to the known CL group had a significantly lower rate of PTB < 37 weeks (22.1% vs 34.5%; RR, 0.64 (95% CI, 0.44-0.94); three trials; 287 participants) and a later gestational age at delivery (MD, 0.64 (95% CI, 0.03-1.25) weeks; MD, 4.48 (95% CI, 1.18-8.98) days; three trials; 287 participants). All other outcomes for which there were available data were similar in the two groups. CONCLUSIONS There is a significant association between knowledge of TVS CL and lower incidence of PTB and later gestational age at delivery in symptomatic singleton gestations with threatened PTL. Given that in the meta-analysis we found a significant 36% reduction in the primary outcome, but other outcomes were mostly statistically similar, further study needs to be undertaken to understand better whether the predictive characteristics of CL screening by TVS can be translated into better clinical management and therefore better outcomes and under what circumstances. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. CRIBADO MEDIANTE LA LONGITUD CERVICAL PARA LA PREVENCIÓN DEL PARTO PRETÉRMINO EN EMBARAZOS CON FETO ÚNICO Y RIESGO DE PARTO PREMATURO: REVISIÓN SISTEMÁTICA Y METAANÁLISIS DE ENSAYOS CONTROLADOS ALEATORIZADOS HACIENDO USO DE LOS DATOS INDIVIDUALES DE LAS PACIENTES: RESUMEN OBJETIVO: El cribado mediante la longitud cervical obtenida con ecografía transvaginal (ETV) ha demostrado ser una buena prueba para la predicción del parto pretérmino espontáneo (PPTE) en embarazos con feto único sintomáticos debido a la amenaza de parto pretérmino (PPT). El objetivo de esta revisión y metaanálisis de los datos de participantes individuales fue evaluar el efecto de medir la longitud cervical (LC) mediante ETV con el fin de prevenir el parto prematuro en embarazos únicos con amenaza de PPT. MÉTODOS: Se realizaron búsquedas en los ficheros de ensayos de Cochrane Pregnancy and Childbirth Group y Complementary Medicine Field (mayo de 2016), y en las listas de referencias de los estudios encontrados. Los criterios de selección incluyeron ensayos controlados aleatorizados de embarazos con feto único y riesgo de PPT con aleatorización de la paciente basada principalmente en el cribado mediante la LC (grupo de intervención), el cribado mediante la LC sin conocimiento de los resultados, o sin cribado de LC (grupo de control). Las participantes fueron mujeres embarazadas con feto único desde las 23 + 0 hasta las 36 + 6 semanas y con riesgo de PPT. Se estableció contacto con los autores de los ensayos incluidos para solicitar el acceso a los datos y llevar a cabo un metaanálisis de los datos de las participantes individualmente. Los datos proporcionados por los investigadores se agregaron a una base de datos maestra creada específicamente para esta revisión. El resultado primario fue el PPTE < 37 semanas. Las medidas resumen se reportaron como riesgo relativo (RR) o como diferencia de medias (DM) con IC del 95%. RESULTADOS En el metaanálisis se incluyeron tres ensayos con un total de 287 embarazos con feto único y riesgo de PPT entre 24 + 0 y 35 + 6 semanas, de los cuales 145 fueron asignados al azar a un cribado mediante la LC con conocimiento de los resultados y 142 a aquellos para los que se desconocía la LC. En comparación con el grupo control, las mujeres que fueron asignadas aleatoriamente al grupo en el que se conocía la LC tuvieron una tasa de parto prematuro a < 37 semanas significativamente menor (22,1% vs. 34,5%; RR 0,64 (IC 95%, 0,44-0,94); 3 ensayos; 287 participantes ) y una edad gestacional al momento del parto más tardía (DM 0,64 (IC 95%, 0.03-1.25) semanas; DM 4,48 (IC 95%, 1,18-8,98) días; 3 ensayos; 287 participantes). El resto de los resultados para los cuales había datos disponibles fueron similares en ambos grupos. CONCLUSIONES Existe una asociación significativa entre el conocimiento de la LC obtenida mediante ETV y una menor incidencia de PPTE y edad gestacional más tardía en el momento del parto en embarazos con feto único sintomáticos debido al riesgo de parto pretérmino (PPT). Teniendo en cuenta que en el metaanálisis se encontró una reducción significativa del 36% en el resultado primario, pero que los otros resultados fueron estadísticamente similares en su mayoría, serán necesarios más estudios para entender mejor si las propiedades predictivas del cribado mediante la LC obtenida con ETV se pueden traducir en una mejor atención clínica y por lo tanto mejores resultados dependiendo de las circunstancias. :META: : ,(preterm labor,PTL),(transvaginal sonography,TVS)(spontaneous preterm birth,PTB)。metaPTL,TVS(cervical length,CL)PTB。 : CochraneCochrane(20165)。PTL,CL()CLCL()。23 + 036+6PTL。,,meta。。37PTB。(relative risk,RR)95%CI(mean difference,MD)。 : meta3,28724 + 035+6PTL,145CL,142CL。,CL37PTB[22.1%34.5%;RR,0.64(95% CI,0.44 ~ 0.94);3;287],[MD,0.64(95% CI,0.03 ~ 1.25);MD,4.48(95% CI,1.18 ~ 8.98);3;287]。2,。 : PTL,TVS CLPTB。meta36%,,,TVSCL,。.
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Affiliation(s)
- V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - M Palacio
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - A Ness
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA, USA
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool and Liverpool Women's Hospital, Liverpool, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Kings College Hospital, London, UK
| | - G Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Barton K, Redshaw M, Quigley MA, Carson C. Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role of relationship quality and wider social support. BMC Pregnancy Childbirth 2017; 17:44. [PMID: 28122585 PMCID: PMC5267424 DOI: 10.1186/s12884-017-1223-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/10/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Research into the impact of unintended pregnancy on the wellbeing of women tends to focus on pregnancies ending in either termination or lone motherhood. Unintended pregnancy is common in partnered women, but little is known about the association between unintended pregnancy and postpartum affective disorders, such as depression and anxiety in this group. Poor relationship quality and lack of social support are considered risk factors for psychological distress (PD). We examined the association between unplanned motherhood and subsequent PD in partnered women, for whom evidence is sparse, accounting for the role of relationship quality and social support. METHODS Data for 12,462 partnered mothers were drawn from the first survey of Millennium Cohort Study, completed at 9 months postpartum. Women reported whether their baby was planned, and how they felt when they discovered that they were pregnant. Pregnancy intention is categorised as "planned", "unplanned/happy", "unplanned/ambivalent" and "unplanned/unhappy". PD was assessed using the modified 9-item Rutter Malaise Inventory. Social support was measured by a composite score for perceived support, and a measure of actual support from friends and family. Relationship quality was assessed using a modified Golombok-Rust Inventory of Marital State. The effect of pregnancy intention on the odds of PD at 9 months was estimated, adjusting for potential confounding factors. All analyses were weighted for response and design effects. RESULTS In total 32.8%(weighted) (4343/12462) of mothers reported an unplanned pregnancy: 23.3 wt% (3087) of mothers felt happy, 3.5 wt% (475) ambivalent, and 6.0 wt% (781) unhappy upon discovery. Unplanned pregnancy was associated with a significantly increased odds of PD compared to planned (OR 1.73 (95%CI: 1.53, 1.95)). This was more pronounced among women who reported negative or ambivalent feelings in early pregnancy (OR 2.72 (95%CI:2.17, 3.41) and 2.56 (95%CI:1.95, 3.34), respectively), than those who reported positive feelings (OR 1.39 (95%CI:1.21, 1.60)). Adjustment for relationship quality, in particular, reduced odds of PD after unplanned pregnancy (e.g. from 2.19 (95%C: 1.74, 2.74) to 1.63 (95% CI: 1.29, 2.07 in the unplanned, unhappy group compared to the planned). CONCLUSIONS A third of partnered mothers reported that their pregnancy was unintended, yet this group is under-researched. Unplanned motherhood was associated with increased risk of PD at 9 months postpartum, particularly among women who felt unhappy or ambivalent at the start. The roles of relationship quality and social support require further investigation, as possible means to intervene and improve maternal wellbeing.
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Affiliation(s)
- Katherine Barton
- MSc student, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Maggie Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
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Fotiou C, Vlastarakos PV, Bakoula C, Papagaroufalis K, Bakoyannis G, Darviri C, Chrousos G. Parental stress management using relaxation techniques in a neonatal intensive care unit: A randomised controlled trial. Intensive Crit Care Nurs 2017; 32:20-8. [PMID: 26520208 DOI: 10.1016/j.iccn.2015.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/19/2015] [Accepted: 08/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of relaxation techniques on the stress/anxiety of parents with hospitalised premature infants, three months following discharge from the neonatal intensive care unit. STUDY DESIGN A randomised controlled trial was conducted in the neonatal intensive care unit of a tertiary maternity hospital including 59 parents, who were randomised into two groups: 31 in the intervention group and 28 in the control group. Parents in the intervention group practiced three different relaxation techniques, in addition to undergoing the same information-based training courses as did the parents of the control group. DATA COLLECTION Data were collected 10-15 days post delivery and three months post discharge. The assessment measures included the Perceived Stress Scale, the State and Trait Anxiety Inventory 1 and 2 and salivary cortisol levels. RESULTS The psychometric assessment at baseline was comparable between the two groups. The intervention group showed a significant reduction in trait anxiety (p=0.02) compared with the control group three months post discharge. The perceived stress decreased in both groups (p=0.699). No difference in salivary cortisol levels was detected. The multivariate analysis revealed that higher initial stress levels (p<0.001) and university/college education (p=0.003) were associated with higher parental stress, whereas moderate-to-high income satisfaction was associated with lower parental stress (p=0.003). CONCLUSION Further long-term follow-up of families with a neonatal intensive care unit experience could assess more delayed effects of stress management by relaxation techniques.
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Affiliation(s)
- Catherine Fotiou
- Postgraduate Program in Stress Management and Health Promotion, University of Athens, Athens, Greece
| | | | - Chrysa Bakoula
- Second Department of Pediatrics, University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - George Bakoyannis
- Department of Biostatistics, "Richard M. Fairbanks" School of Public Health, University of Indiana, Indianapolis, IN, USA
| | - Christine Darviri
- Postgraduate Program in Stress Management and Health Promotion, University of Athens, Athens, Greece
| | - George Chrousos
- First Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
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Spittle A, Treyvaud K. The role of early developmental intervention to influence neurobehavioral outcomes of children born preterm. Semin Perinatol 2016; 40:542-548. [PMID: 27817913 DOI: 10.1053/j.semperi.2016.09.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Children who are born preterm are at risk of adverse long-term neurobehavioral outcomes, including cognitive, motor, and behavioral impairments. Early developmental interventions that commence within the first year after preterm birth have a preventative focus, with the aim to positively influence the developmental trajectory. While there is a great deal of heterogeneity in the research trials to date, there is evidence that early developmental interventions have a moderate effect on cognitive and behavioral outcomes up to preschool age, with some evidence for improved motor outcomes. This review discusses key components of early developmental interventions including commencing the intervention as early as possible, ideally in the neonatal intensive care unit, and promoting developmental skills overtime with an appropriate enriched environment. The importance of involving and supporting parents in early intervention is also highlighted, particularly given the influence of the parent-infant relationship on developmental outcomes and higher rates of mental health problems in parents after preterm birth.
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Affiliation(s)
- Alicia Spittle
- Department of Physiotherapy, University of Melbourne, Level 7 Alan Gilbert Building, 161 Barry St, Parkville 3010, Victoria, Australia; Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia; Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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119
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Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Executive function (EF) refers to the set of cognitive processes involved in the self-regulation of emotion and goal-directed behavior. These skills and the brain systems that support them develop throughout childhood and are frequently compromised in preterm children, even in those with broadly average global cognitive ability. Risks for deficits in EF in preterm children and attendant problems in learning and psychosocial functioning are higher in those with more extreme prematurity, neonatal complications, and related brain abnormalities. Associations of higher levels of EF with more supportive home and school environments suggest a potential for attenuating these risks, especially with early identification. Further research is needed to understand how deficits in EF evolve in preterm children, refine assessment methods, and develop interventions that either promote the development of EF in this population or help children to compensate for these weaknesses.
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Affiliation(s)
- H. Gerry Taylor
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Caron A.C. Clark
- Department of Education, University of Nebraska-Lincoln, Lincoln, NE, USA
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121
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Spittle AJ, Barton S, Treyvaud K, Molloy CS, Doyle LW, Anderson PJ. School-Age Outcomes of Early Intervention for Preterm Infants and Their Parents: A Randomized Trial. Pediatrics 2016; 138:peds.2016-1363. [PMID: 27940686 DOI: 10.1542/peds.2016-1363] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the child and parental outcomes at school age of a randomized controlled trial of a home-based early preventative care program for infants born very preterm and their caregivers. METHODS At term-equivalent age, 120 infants born at a gestational age of <30 weeks were randomly allocated to intervention (n = 61) or standard care (n = 59) groups. The intervention included 9 home visits over the first year of life focusing on infant development, parental mental health, and the parent-infant relationship. At 8 years' corrected age, children's cognitive, behavioral, and motor functioning and parental mental health were assessed. Analysis was by intention to treat. RESULTS One hundred children, including 13 sets of twins, attended follow-up (85% follow-up of survivors). Children in the intervention group were less likely to have mathematics difficulties (odds ratio, 0.42; 95% confidence interval [CI], 0.18 to 0.98; P = .045) than children in the standard care group, but there was no evidence of an effect on other developmental outcomes. Parents in the intervention group reported fewer symptoms of depression (mean difference, -2.7; 95% CI, -4.0 to -1.4; P < .001) and had reduced odds for mild to severe depression (odds ratio, 0.14; 95% CI, 0.03 to 0.68; P = .0152) than parents in the standard care group. CONCLUSIONS An early preventive care program for very preterm infants and their parents had minimal long-term effects on child neurodevelopmental outcomes at the 8-year follow-up, whereas primary caregivers in the intervention group reported less depression.
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Affiliation(s)
- Alicia J Spittle
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; .,Departments of Physiotherapy.,Women's Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia; and
| | - Sarah Barton
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Women's Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia; and.,Paediatrics, and.,Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia
| | - Carly S Molloy
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Women's Newborn Research Centre, The Royal Women's Hospital, Victoria, Australia; and.,Paediatrics, and.,Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Anderson
- Victorian Infant Brain Study, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.,Paediatrics, and
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Henderson J, Carson C, Redshaw M. Impact of preterm birth on maternal well-being and women's perceptions of their baby: a population-based survey. BMJ Open 2016; 6:e012676. [PMID: 27855105 PMCID: PMC5073632 DOI: 10.1136/bmjopen-2016-012676] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Approximately 15 million babies were born preterm worldwide in 2010 and in England in 2014 there were 52 249 preterm births. Preterm babies are at increased risk of poor outcomes and this can put enormous strain on the family. OBJECTIVE This study aimed to test the hypothesis that giving birth preterm affects maternal health, mood and well-being, and alters women's feelings and perceptions about their baby. METHODS Data collected in a population-based survey of maternity care in England in 2014 were used. Women were randomly selected and asked about their pregnancy, birth and postnatal experience when their babies were about 3 months of age. Descriptive statistics were produced, and logistic regression used to estimate ORs, adjusted for key confounders.Main outcome measures-Women's self-reported postnatal health, Edinburgh Postnatal Depression Scale, women's perceptions of their baby. RESULTS 4578 women returned completed questionnaires. Of these, 42 (0.9%) had babies born before 32 weeks' gestation and 243 (5.5%) at 32-36 weeks. Comparing the three gestational age groups, no statistically significant differences in rates of depressive symptoms measured on the Edinburgh Postnatal Depression Scale were found. However, using a health problems checklist, anxiety, fatigue and flash-backs were more common in mothers of preterm babies. Overall, mothers of preterm babies had less early contact with their baby, more postnatal health problems, substantially less positive feelings towards their baby and made less use of the support options available. CONCLUSIONS Women with preterm births are at increased risk of ill-health and negative feelings about their baby in the early months after birth. They make less use of postnatal services and support than other women and this may be an area where the use of specialist services would be appropriate.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Berghella V, Saccone G. Fetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2016; 215:431-8. [PMID: 27133012 DOI: 10.1016/j.ajog.2016.04.038] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE DATA Fetal fibronectin is an extracellular matrix glycoprotein that is produced by amniocytes and cytotrophoblasts and has been shown to predict spontaneous preterm birth. STUDY The aim of this systematic review and metaanalysis of randomized clinical trials was to evaluate the effect of the use of fetal fibronectin in the prevention of preterm birth in singleton pregnancies with threatened preterm labor. STUDY APPRAISAL AND SYNTHESIS METHODS The research was conducted with the use of MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library as electronic databases from the inception of each database to February 2016. Selection criteria included randomized clinical trials of singleton gestations with threatened preterm labor that were assigned randomly to management based on fetal fibronectin results (ie, intervention group) or not (ie, comparison group). Types of participants included women with singleton gestations at 23 0/7 to 34 6/7 weeks with threatened preterm labor. Studies that included management that was also based on the use of sonographic cervical length were excluded. The primary outcome was preterm birth at <37 weeks of gestation. The summary measures were reported as relative risk or as mean differences with 95% confidence interval. RESULTS Six trials that included 546 singleton gestations with symptoms of preterm labor were included in the metaanalysis. The overall risk of bias of the included trials was low. Women were eligible for the random assignment in case of symptoms that suggested preterm labor at 23-34 weeks of gestation. During admission, before digital examination, a Dacron swab was rotated in the posterior fornix for 10 seconds to absorb cervicovaginal secretions that were then analyzed for the fetal fibronectin qualitative method, with results reported as either positive or negative. Women who were assigned randomly to the fetal fibronectin group had a similar incidence of preterm birth at <37 weeks of gestation (20.7% vs 29.2%; relative risk, 0.72; 95% confidence interval, 0.52-1.01), at <34 weeks of gestation (8.3% vs 7.9%; relative risk, 1.09; 95% confidence interval, 0.54-2.18), at <32 weeks of gestation (3.3% vs 5.6%; relative risk, 0.64; 95% confidence interval, 0.24-1.74), and at <28 weeks of gestation (1.1% vs 1.7%; relative risk, 0.74; 95% confidence interval, 0.15-3.67) compared with the control group. No differences were found in the number of women who delivered within 7 days (12.8% vs 14.5%; relative risk, 0.76; 95% confidence interval, 0.47-1.21), in the mean of gestational age at delivery (mean difference, 0.20 week; 95% confidence interval, -0.26 to 0.67), in the rate of maternal hospitalization (27.4% vs 26.9%; relative risk, 1.07; 95% confidence interval, 0.80-1.44), in the use of tocolysis (25.3% vs 28.2%; relative risk, 0.97; 95% confidence interval, 0.75-1.24), antenatal steroids (29.2% vs 29.2%; relative risk, 1.05; 95% confidence interval, 0.79-1.39), in the mean time in the triage unit (mean difference, 0.60 hour; 95% confidence interval, -0.03 to 1.23) and in neonatal outcomes that included respiratory distress syndrome (1.3% vs 1.5%; relative risk, 0.91; 95% confidence interval, 0.06-14.06), and admission to the neonatal intensive care unit (19.4% vs 8.1%; relative risk, 2.48; 95% confidence interval, 0.96-6.46). Management based on the fetal fibronectin test required higher hospitalization charges (mean difference, $153; 95% confidence interval, 24.01-281.99). CONCLUSION Fetal fibronectin testing in singleton gestations with threatened preterm labor is not associated with the prevention of preterm birth or improvement in perinatal outcome but is associated with higher costs.
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Treyvaud K, Aldana AC, Scratch SE, Ure AM, Pace CC, Doyle LW, Anderson PJ. The influence of multiple birth and bereavement on maternal and family outcomes 2 and 7years after very preterm birth. Early Hum Dev 2016; 100:1-5. [PMID: 27399608 DOI: 10.1016/j.earlhumdev.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Psychological distress has been reported by mothers of infants born very preterm (VPT) and by mothers of multiples (twins and triplets). This study examined the influence of i) multiple birth and ii) bereavement associated with a multifetal pregnancy, on mental health, parenting stress and family functioning for mothers of children born VPT across early childhood. METHODS Participants were 162 mothers of 194 infants (129 singletons, 65 multiples) born at <30weeks' gestation or with a birth weight<1250g who completed questionnaires when their children were two and seven years corrected age. Fifteen mothers (9%) experienced bereavement associated with a multifetal pregnancy. Maternal mental health was assessed using the General Health Questionnaire at two years and Hospital Anxiety and Depression Scale at seven years. Parenting stress and family functioning were assessed using the Parenting Stress Index and Family Assessment Device. RESULTS Maternal mental health, stress and family functioning were similar in mothers of VPT singletons and multiples. However compared with mothers who had not experienced bereavement, mothers who had were 3.6 times [95% confidence interval (95% CI) 1.05, 12.5] more likely to report elevated anxiety symptoms and 3.6 times [95% CI 1.05, 12.3] more likely to report elevated depressive symptoms when their VPT child was seven years old. CONCLUSIONS The results of this study highlight the need for monitoring and offering ongoing support to bereaved mothers with surviving VPT children. However, within the context of VPT birth, multiple birth does not increase the risk for maternal psychological distress in early childhood.
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Affiliation(s)
- Karli Treyvaud
- LaTrobe University, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia; Royal Women's Hospital, Victoria, Australia.
| | | | | | | | - Carmen C Pace
- Murdoch Childrens Research Institute, Victoria, Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia
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125
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Weis J, Lundqvist P. Parent experiences of communication with healthcare professionals in neonatal intensive care units: a qualitative systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:12-18. [PMID: 27635740 DOI: 10.11124/jbisrir-2016-003053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The objectives of this review are to explore parents' experiences of communication with healthcare professionals and to identify the meaningfulness of communication to parents in the neonatal intensive care unit (NICU).More specifically, the objectives are to identify.
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Affiliation(s)
- Janne Weis
- 1Neonatal Department, Copenhagen University Hospital, Copenhagen, Denmark 2Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence 3Department of Health Sciences, Lund University, Lund, Sweden
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126
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Håkstad RB, Obstfelder A, Øberg GK. Parents' Perceptions of Primary Health Care Physiotherapy With Preterm Infants: Normalization, Clarity, and Trust. QUALITATIVE HEALTH RESEARCH 2016; 26:1341-1350. [PMID: 26449495 DOI: 10.1177/1049732315608137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Having a preterm infant is a life-altering event for parents. The use of interventions intended to support the parents is recommended. In this study, we investigated how parents' perceptions of physiotherapy in primary health care influenced their adaptation to caring for a preterm child. We conducted 17 interviews involving parents of seven infants, at infants' corrected age (CA) 3, 6, and 12 months. The analysis was a systematic text condensation, connecting to theory of participatory sense-making. The parents described a progression toward a new normalcy in the setting of persistent uncertainty. Physiotherapists can ameliorate this uncertainty and support the parents' progression toward normalization, by providing knowledge and acknowledging both the child as subject and the parent-child relationship. Via embodied interaction and the exploration of their child's capacity, the parents learn about their children's individuality and gain the confidence necessary to support and care for their children in everyday life.
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127
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Treyvaud K, Doyle LW, Lee KJ, Ure A, Inder TE, Hunt RW, Anderson PJ. Parenting behavior at 2 years predicts school-age performance at 7 years in very preterm children. J Child Psychol Psychiatry 2016; 57:814-21. [PMID: 26616792 DOI: 10.1111/jcpp.12489] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parenting influences child development, but it is unclear whether early parenting behavior can influence school-age outcomes in very preterm (VPT) children, and/or if certain groups of VPT children may be more affected by early parenting behavior. These research questions were examined. METHODS Participants were 147 children born <30 weeks' gestation or birth weight <1250 g and their primary caregiver. At term corrected age (CA), magnetic resonance imaging (MRI) was used to determine presence and severity of brain abnormality and medical data collected. High medical risk was defined as the presence of at least one of sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, moderate to severe white matter abnormality on MRI, or postnatal corticosteroids. At 2 years CA, parent-child interaction was assessed, and at 7 years CA, general intelligence (IQ), language, executive function, academic skills, and social-emotional functioning were assessed. RESULTS Higher levels of parent-child synchrony, and parent facilitation, sensitivity and positive affect at 2 years were associated with better child outcomes at 7 years, while higher levels of intrusiveness and negative affect were associated with poorer outcomes. Many of these relationships remained after controlling for early child cognitive development. Interactions between child medical risk (higher/lower) and parenting were limited to child reading, math, and executive functioning outcomes, with stronger relationships for lower medical risk children. CONCLUSIONS The contribution of early parenting to VPT children's school-age performance is significant, with stronger effects for lower medical risk children in some outcomes. These findings support the premise that parenting strategies should be included in the NICU and early interventions programs for VPT infants.
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Affiliation(s)
- Karli Treyvaud
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Lex W Doyle
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Royal Women's Hospital, Melbourne, Vic., Australia
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Alexandra Ure
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | | | - Rod W Hunt
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Royal Women's Hospital, Melbourne, Vic., Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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128
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Helle N, Barkmann C, Ehrhardt S, von der Wense A, Nestoriuc Y, Bindt C. Postpartum anxiety and adjustment disorders in parents of infants with very low birth weight: Cross-sectional results from a controlled multicentre cohort study. J Affect Disord 2016; 194:128-34. [PMID: 26820762 DOI: 10.1016/j.jad.2016.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/06/2016] [Accepted: 01/10/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Both preterm delivery and survival rates of very low birth weight (VLBW: <1500 g) infants are increasing. To date, the focus on studies about postpartum mental health after preterm birth has been on depression and on women. There is a paucity of research regarding prevalence, risks, and predictors of postpartum anxiety in parents after VLBW birth. METHODS Parents with VLBW infants and parents with term infants were recruited into the longitudinal HaFEn-study at the three largest centers of perinatal care in Hamburg, Germany. State anxiety was assessed with the State-Trait-Anxiety Inventory and anxiety and adjustment disorders with a clinical interview one month postpartum. Psychiatric lifetime diagnoses, social support, trait anxiety, stress during birth, socioeconomic status, risks during pregnancy, and mode of delivery were also evaluated. To examine predictors of postpartum state anxiety in both parents simultaneously a multiple random coefficient model was used. RESULTS 230 mothers and 173 fathers were included. The risk for minor/major anxiety symptoms and adjustment disorders was higher in parents with VLBW infants compared to the term group. The risk for anxiety disorders was not higher in parents with VLBW infants. The most important predictors for postpartum state anxiety were high trait anxiety, the birth of a VLBW infant, high stress during birth, and low social support. LIMITATIONS Data reported here are cross-sectional. Thus, temporal relationships cannot be established. CONCLUSIONS Our results emphasize the importance of early screening for postpartum anxiety in both parents with VLBW infants.
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Affiliation(s)
- Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Axel von der Wense
- Department of Neonatology and Paediatric Critical Care, Neonatal Intensive Care Unit, Altona Children's Hospital, Hamburg, Germany
| | - Yvonne Nestoriuc
- Institute of Psychology, Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
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129
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Prolonged Distress of Parents After Early Preterm Birth. J Obstet Gynecol Neonatal Nurs 2016; 45:196-209. [DOI: 10.1016/j.jogn.2015.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 11/22/2022] Open
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130
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Montagna A, Nosarti C. Socio-Emotional Development Following Very Preterm Birth: Pathways to Psychopathology. Front Psychol 2016; 7:80. [PMID: 26903895 PMCID: PMC4751757 DOI: 10.3389/fpsyg.2016.00080] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/14/2016] [Indexed: 01/07/2023] Open
Abstract
Very preterm birth (VPT; < 32 weeks of gestation) has been associated with an increased risk to develop cognitive and socio-emotional problems, as well as with increased vulnerability to psychiatric disorder, both with childhood and adult onset. Socio-emotional impairments that have been described in VPT individuals include diminished social competence and self-esteem, emotional dysregulation, shyness and timidity. However, the etiology of socio-emotional problems in VPT samples and their underlying mechanisms are far from understood. To date, research has focused on the investigation of both biological and environmental risk factors associated with socio-emotional problems, including structural and functional alterations in brain areas involved in processing emotions and social stimuli, perinatal stress and pain and parenting strategies. Considering the complex interplay of the aforementioned variables, the review attempts to elucidate the mechanisms underlying the association between very preterm birth, socio-emotional vulnerability and psychopathology. After a comprehensive overview of the socio-emotional impairments associated with VPT birth, three main models of socio-emotional development are presented and discussed. These focus on biological vulnerability, early life adversities and parenting, respectively. To conclude, a developmental framework is used to consider different pathways linking VPT birth to psychopathology, taking into account the interaction between medical, biological, and psychosocial factors.
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Affiliation(s)
- Anita Montagna
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, St. Thomas' Hospital, King's College LondonLondon, UK
| | - Chiara Nosarti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondon, UK
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131
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Escartí A, Boronat N, Llopis R, Torres R, Vento M. Pilot study on stress and resilience in families with premature newborns. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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132
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Carson C, Redshaw M, Gray R, Quigley MA. Risk of psychological distress in parents of preterm children in the first year: evidence from the UK Millennium Cohort Study. BMJ Open 2015; 5:e007942. [PMID: 26685019 PMCID: PMC4691710 DOI: 10.1136/bmjopen-2015-007942] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess whether the parents of babies born preterm (PT; <37 weeks completed gestation) are at excess risk of psychological distress (PD) at 9 months postpartum, and to explore the influence of the degree of prematurity. DESIGN AND PARTICIPANTS Data were drawn from the UK Millennium Cohort Study, a nationally representative prospective cohort of babies born in 2000-2002. 12,100 families with complete data available for both parents at recruitment (9 months postpartum) are included. EXPOSURE AND OUTCOME Mothers report of gestational age at birth (in weeks) was grouped into: very PT (<32 weeks), moderately PT (32-33 weeks), late PT (34-36 weeks), early term (37-38 weeks), full-term (39-41 weeks), post-term (42 weeks). PD was assessed using a modified Rutter Malaise Inventory, a validated instrument that has been used in both men and women to assess levels of anxiety and distress. RESULTS Overall, 7% of families reported a PT birth; 12.1% of mothers and 8.9% of fathers showed signs of PD at 9 months postpartum. The mothers of very PT infants had an increased risk of PD, compared with the mothers of full-term babies (unadjusted OR 2.10 (1.30 to 3.39; adjusted OR 1.66 (1.02 to 2.69)). Mothers of moderate or late PT babies had no apparent increased risk of PD. However, mothers of early term babies also showed a small excess risk of PD (adjusted OR 1.16 (0.99 to 1.36)). Unadjusted analysis suggested a doubling in the risk of PD in fathers of very and moderately PT babies, compared with fathers of full-term babies, which remains statistically significant after adjustment in the moderately PT group (adjusted OR1.98 (1.20 to 3.29)). CONCLUSIONS The parents of very PT children are at an increased risk of PD at 9 months postpartum, and mothers of children born at early term also see an elevated risk compared with mothers of full-term babies.
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Affiliation(s)
- Claire Carson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Ron Gray
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maria A Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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133
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Anderson SE, McNamara K, Andridge R, Keim SA. Executive function and mealtime behavior among preschool-aged children born very preterm. Eat Behav 2015; 19:110-4. [PMID: 26276709 DOI: 10.1016/j.eatbeh.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/26/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether executive function in preschool-aged children born very preterm was associated with problematic mealtime behavior. STUDY DESIGN Executive function of 41 preschool-aged children (mean age=47 months) born at <30 weeks' gestation was assessed using a standardized protocol (gift bag) and by parent-report (Behavior Rating Inventory of Executive Function-Preschool). The gift bag assessment was video-recorded and good executive function defined as the child not touching the gift bag and remaining seated for >2 min. Parent-reported frequency and severity of child mealtime behavior problems was assessed with a 20-item index (Meals in Our Household, α=0.94). Multivariable regression was used to model associations between executive function and mealtime behavior problems. RESULTS BRIEF-P global executive composite t-scores [mean (standard deviation [SD])=53.5 (15.7)] and mealtime behavior problems scores [mean (SD) =18.5 (13.6)] were correlated (r=0.57, P<0.0001). Adjusted for child sex, age, birth weight, weeks' gestation, parent education, and neonatal intensive care unit length of stay, a 10-unit difference in BRIEF-P t-score was associated with a 7.2-unit difference in mealtime behavior problems score (P<0.0001). Ten children (24%) demonstrated good executive function during the gift bag assessment. Parents reported these children displayed better executive function on the BRIEF-P and had fewer mealtime behavior problems (mean 11.2 vs. 20.8, P=0.02). Adjusted for covariates, good performance on the gift bag task was associated with 14.1 unit lower mealtime behavior problems score (P=0.03). CONCLUSION Among preschool-aged children born very preterm, difficulties with executive function may manifest as mealtime behavior problems. Larger studies are needed to help parents anticipate and manage these behaviors.
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Affiliation(s)
- Sarah E Anderson
- Division of Epidemiology, The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA.
| | - Kelly McNamara
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Rebecca Andridge
- Division of Biostatistics, The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA
| | - Sarah A Keim
- Division of Epidemiology, The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
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134
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Helle N, Barkmann C, Bartz-Seel J, Diehl T, Ehrhardt S, Hendel A, Nestoriuc Y, Schulte-Markwort M, von der Wense A, Bindt C. Very low birth-weight as a risk factor for postpartum depression four to six weeks postbirth in mothers and fathers: Cross-sectional results from a controlled multicentre cohort study. J Affect Disord 2015; 180:154-61. [PMID: 25911131 DOI: 10.1016/j.jad.2015.04.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preterm birth and survival rates of very low birth-weight (VLBW: <1.500g) infants have increased. Although new parents are frequently affected by depressive symptoms, little is known about prevalence, risk, and predictors of parental postpartum depression (PPD) following VLBW birth. Furthermore, most studies assessing PPD in parents of preterm children relied on self-report only. METHODS As part of the HaFEn cohort-study, data from the index groups of parents with VLBW infants and the control group of parents with term infants were cross-sectionally analysed. Families were recruited at the three largest centres of perinatal medical care in Hamburg, Germany. PPD was evaluated one month postpartum using standardized questionnaires and clinical interviews. Socioeconomic status, social support, risks during pregnancy, and psychiatric lifetime diagnoses were also assessed. A multiple random coefficient model was used to examine predictors of PPD in both parents simultaneously. RESULTS 230 mothers and 173 fathers were included. Depending on the measure, the risk of being postnatally depressed was 4 to 18 times higher in mothers and 3 to 9 times higher in fathers from the index group. The most relevant risk factor for PPD was the birth of a VLBW infant, followed by female sex, lifetime psychiatric disorder, and low social support. LIMITATIONS Results presented here, are based on cross sectional data. Therefore no temporal relationships can be established. CONCLUSIONS Our findings highlight the importance of early screening for PPD in both parents of VLBW infants. Factors contributing to developing depression should also be considered in neonatal care.
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Affiliation(s)
- Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Jutta Bartz-Seel
- Department of Neonatology and Paediatric Critical Care, Neonatal Intensive Care Unit, Altona Children׳s Hospital, Hamburg, Germany
| | - Thilo Diehl
- Department of Paediatrics, Neonatal Intensive Care Unit, University Medical Center Hamburg-Eppendorf, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Astrid Hendel
- Department of Neonatology, Neonatal Intensive Care Unit, Asklepios Medical Center Barmbek, Hamburg, Germany
| | - Yvonne Nestoriuc
- Institute of Psychology, Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
| | - Axel von der Wense
- Department of Neonatology and Paediatric Critical Care, Neonatal Intensive Care Unit, Altona Children׳s Hospital, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Germany
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135
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Escartí A, Boronat N, Llopis R, Torres R, Vento M. [Pilot study on stress and resilience in families with premature newborns]. An Pediatr (Barc) 2015; 84:3-9. [PMID: 25865220 DOI: 10.1016/j.anpedi.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/17/2015] [Accepted: 03/03/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Prematurity is associated with severe clinical conditions, long hospital stays, and uncertainty about patient outcomes. These circumstances lead to a stressful situation that may affect family functioning. The aim of this study was to study risk and protection factors affecting family functioning in preterm as compared to healthy term infants. POPULATION AND METHODS Preterm infants with and without pathological conditions (n=40) were recruited at 24 months post-conception age, together with a control group of healthy term newborn infants (n=31). Parents or usual caregivers responded to the Inventory of Family Protection Factors and Parental Stress scales. The results were compared using the Student t test, unidirectional analysis of variance and the Tukey test. RESULTS Parents of the control group attained higher scores than those of the preterm group for all the items studied; however, parents of preterm infants with pathological conditions perceived significantly less family resilience and more stress related to the upbringing of their child. CONCLUSIONS Prematurity itself is a risk factor for family dysfunction because it causes an elevated degree of parental stress and difficulties in the development of protection factors such as resilience.
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Affiliation(s)
- A Escartí
- Departamento de Psicología Social, Facultat de Psicología, Universitat de Valencia, Valencia, España
| | - N Boronat
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - R Llopis
- Departamento de Sociología y Antropología Social, Facultat de Ciencias Sociales, Universitat de Valencia, Valencia, España
| | - R Torres
- Departamento de Psicología Social, Facultat de Psicología, Universitat de Valencia, Valencia, España
| | - M Vento
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Red de Salud Materno Infantil y del Desarrollo SAMID (RD12/0026/0012), Instituto de Investigación Sanitaria La Fe , Valencia, España.
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