The effects of preterm birth on mother-infant interaction and attachment during the infant's first two years

Early environment and long-term outcomes of preterm infants

Prematurity is associated with an increased risk of long-term health and neurodevelopmental problems. Key perinatal and neonatal factors that affect these outcomes have long been studied. However, more recently, there has been an appreciation of the importance of environmental factors in long-term outcomes of preterm babies, particularly in light of the rapid maturation of the brain during these babies' early days of life. Breastmilk and breastfeeding is the gold standard for infant feeding, including preterm babies. The benefits are well established in regard to protection from serious complications like necrotising enterocolitis. Although theoretically plausible, the benefits for neurodevelopment are less clear. Noise, pain and the environment of the neonatal intensive care can also affect infant neurodevelopment. It is established that noise and pain have deleterious effects. However, the benefits of single-room vs open-bay neonatal units remain under debate. Developmental care practices, of which there are many, are increasingly embraced worldwide. There are benefits both for the parents and the baby, however, the evidence is difficult to pool due to the heterogeneity of studies and study populations. Finally, it is important to remember the importance of the role of parents in shaping long-term neurodevelopment of the high-risk preterm newborn. Increasingly, positive parenting and parents' mental health are shown to have long lasting advantages for preterm infants. A deeper understanding of early environmental factors is key to developing future interventions to optimise outcomes of preterm newborns.

The contribution of maternal executive functions and active coping to dyadic affective dynamics: Children with autism spectrum disorder and their mothers

Parenting is a cognitive, emotional, and behavioral endeavor, where parents' control capacities, including executive functions and active control coping, help parents to guide and regulate interactions with their children; yet limited research investigates how these capacities are associated with parent-child affective regulation processes during parent-child interactions. This study examined whether maternal executive functions (sustained attention, interference inhibitory control, working memory) and active engaged coping were related to dyadic affective flexibility and positive mutual affective interactions between mothers and their young children with autism spectrum disorders (N = 40). Dyadic flexibility and mutual positive affect were measured using dynamic systems-based modeling of second-by-second affective patterns during a mother-child interaction. The results showed that higher levels of maternal sustained attention and inhibitory control were related to increased dyadic affective flexibility. In addition, higher levels of maternal sustained attention and higher use of engaged coping were related to dyadic mutual positive affect. The findings highlight the importance of maternal cognitive control capacity in promoting adaptive parent-child dyadic regulatory processes.

Interactive sequences between fathers and preterm infants in the neonatal intensive care unit

AIMS

The first purpose of the study was to examine fathers' spontaneous communicative behavior with their preterm infants in the neonatal intensive care unit, and how father's and infant's behaviors affected each other. The second purpose was to examine any possible association between the fathers' and/or infants' characteristics and the quality of fathers' behaviors with their infants.

STUDY DESIGN/SUBJECTS/OUTCOME MEASURES

Father-preterm infant dyads (n=20) were assessed at 34-36 weeks postmenstrual age, during a spontaneous face-to-face communication with the infant placed in a heated cot in the NICU, and coded according to the Parent-Preterm Infant Coding System.

RESULTS

The presence of the father's Affiliative Behavior increased the occurrences of infant Gazing at the parent's face. In turn, infant gazing increased the occurrence of paternal Affiliative Behavior. The likelihood of infant's Gazing at the father's face was also significantly elicited by infrequent occurrences of paternal Affectionate Talk, co-occurring with Gazing at infant with Positive Facial Affect (but no Touch). With regard to the predictors of quality in father-infant interactions, we found a significant positive correlation between fathers' level of depressive symptomatology and fathers' Affiliative Behavior.

CONCLUSION

Our results show the of bidirectional sequential patterns of communication between fathers and preterm infants at 35 weeks postmenstrual age, and provide important information about the quality and modalities of paternal communication and their influence on infant behavioral states. From a clinical perspective, these results suggest that father-specific interventions designed to improve and sustain fathers' positive engagement with infants in the NICU should be pursued.

Depressive symptoms and maternal psychological distress during early infancy: A pilot study in preterm as compared with term mother-infant dyads

BACKGROUND

Preterm birth does not only affect infants but also represents an unexpected and traumatic event for parents. There are few reports on parenting stress during early infancy comparing preterm and term mothers, with the results being somewhat inconsistent.

METHODS

As part of a longitudinal study, preterm mother-infant and term mother-infant dyads were enrolled. Dyads were assessed twice: during hospitalisation in the neonatal intensive care unit (NICU) and at 3 months of infant age (corrected age for preterm). Each mother completed a self-report set of psychological questionnaire in both time points. All the children underwent a neurological examination at 40 weeks post conceptional age and at 3 months (corrected age for preterm).

RESULTS

20 preterm and 20 term dyads were included. NICU mothers reported elevated postnatal depressive symptoms and high stress level, even if the preterm infants were with low perinatal risk and normal neurological examination. Comparing preterm infant with low perinatal risk and normal neurological examination with term-born children at 3 months, we found higher parental stress in term mothers than in preterm mothers.

LIMITATIONS

This study was limited by a relatively small sample size; findings are preliminary and warrant further investigation in larger-scale study.

CONCLUSIONS

Findings confirm that becoming a mother of a preterm infant is an event associated with emotional distress. These symptoms may resolve with time, and sometimes are independent of the infant's clinical severity. Assessing parental sources of stress and subsequent follow-up is essential to promote parental support, both for preterm and term mothers.

Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town

BACKGROUND

Most pregnancies run a normal course, ending in a healthy mother-infant relationship, but sometimes, it can also be a life-threatening and stressful condition. The stress levels of mothers are more aggravated when they deliver preterm babies.

OBJECTIVES

To explore the coping strategies of mothers of preterm babies with the stress of preterm delivery and subsequent admission of the preterm neonate to a neonatal care unit.

METHOD

A qualitative research approach applying an exploratory and descriptive design was applied to explore the coping strategies of mothers with preterm babies admitted in a neonatal care unit. The study applied a purposive sampling technique to select mothers with preterm babies. The population for this study included women who delivered preterm babies and whose babies were admitted in the neonatal care unit at a public hospital in Cape Town. Semi-structured interviews were conducted until data saturation was reached, and 11 mothers with preterm babies in the selected public hospital participated in the study. Data were analysed manually using thematic content analysis with an inductive approach.

RESULTS

Results were deductively interpreted and supported by the Brief COPE model. The main themes that emerged from data analysis included praying, attachment with baby and acceptance of the situation. Under praying the following subthemes emerged, namely praying for God's strength, God's grace, babies' survival and thanksgiving to God for babies' health and preferred gender. The theme of attachment with the baby emerged with the following subthemes: bonding with the baby and seeing the baby. The last theme that was acceptance of the situation emerged with the following subtheme: perseverance in the situation and mother's awareness of her responsibility.

CONCLUSION

Even though the mothers of preterm babies cope differently after delivery, their coping abilities, which included praying, attachment to baby and acceptance of the situation, were greatly determined by the condition of their babies as well as the support they receive from significant others.

[Differences in Conflict-Based Play Behavior, Socio-Emotional and Cognitive Development of Preterm Children Compared to Full-Term Children at Preschool Age]

Differences in Conflict-Based Play Behavior, Socio-Emotional and Cognitive Development of Preterm Children Compared to Full-Term Children at Preschool Age Preterm children are at increased risk for socio-emotional and cognitive developmental difficulties at preschool age. This study investigates whether preterm children (n = 50) at the age of five years show different socio-emotional competencies in conflict situations and in the corresponding conflict resolution capacity in comparison to full-term children (n = 50). For this purpose, the MacArthur Story Stem Battery was used as the central examination method. In addition, parents completed the Strengths and Difficulties Questionnaire to obtain information about the children's behavior; moreover, the Wechsler Preschool and Primary Scale of Intelligence - Third Edition was applied to examine cognitive development. The parental reports did not reveal any behavioral differences between preterm and term children. However, significant group differences regarding their play behavior were detected. In their narratives, preterm children included content themes of interpersonal conflict and dysregulation more frequently compared to term born controls. Concerning empathic and moral themes and narrative coherence, no group difference could be detected. This could indicate that preterm children show no clinically manifest behavioral disorders at preschool age, but differences concerning intrapsychic experience compared to controls. In addition, preterm children had significantly lower IQ scores than term-born controls. Gestational age was a significant predictor of IQ and hyperactivity and attention problems. The results clarify the need for long term clinical follow up of preterm children and should be used to provide more specific care and support.

Longitudinal Study of music Therapy's Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an international randomised trial

INTRODUCTION

Preterm birth has major medical, psychological and socioeconomic consequences worldwide. Music therapy (MT) has positive effects on physiological measures of preterm infants and maternal anxiety, but rigorous studies including long-term follow-up are missing. Drawing on caregivers' inherent resources, this study emphasises caregiver involvement in MT to promote attuned, developmentally appropriate musical interactions that may be of mutual benefit to infant and parent. This study will determine whether MT, as delivered by a qualified music therapist during neonatal intensive care unit (NICU) hospitalisation and/or in home/municipal settings following discharge, is superior to standard care in improving bonding between primary caregivers and preterm infants, parent well-being and infant development. METHODS AND ANALYSIS: Design: international multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled trial; informed by a completed feasibility study. Participants: 250 preterm infants and their parents. Intervention: MT focusing on parental singing specifically tailored to infant responses, will be delivered during NICU and/or during a postdischarge 6-month period. Primary outcome: changes in mother-infant bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding Questionnaire. Secondary outcomes: mother-infant bonding at discharge and at 12-month CA; child development over 24 months; and parental depression, anxiety and stress, and infant rehospitalisation, all over 12 months.

ETHICS AND DISSEMINATION

The Regional Committees for Medical and Health Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service users were involved in development of the study and will be involved in implementation and dissemination. Dissemination of findings will apply to local, national and international levels.

TRIAL REGISTRATION NUMBER

NCT03564184.

Language in 2-year-old children born preterm and term: a cohort study

PURPOSE

Language skills are critical. Children born very preterm are vulnerable to language problems, but further work is needed to determine characteristics and specific predictors of language problems in this population. We aimed to compare language outcomes between 2-year-old children born <30 weeks and their term-born peers; and to explore risk factors for language difficulties in this cohort.

DESIGN

Language at 2 years was examined in 134 children born <30 weeks and 133 children born at term using the Bayley Scales of Infant and Toddler Development - 3rd Edition (Bayley-3) and the Communication and Symbolic Behaviour Scale: Developmental Profile (Infant Toddler Checklist) (CSBS:DP). Outcomes were compared between groups. Factors hypothesised to predict language outcome were examined in the preterm group: gestational age at birth, birth weight z-score, sex, hearing loss, multilingualism, maternal education, brain abnormality on MRI, medical risk and oromotor concerns at 12 months.

RESULTS

Children born <30 weeks performed more poorly on the CSBS:DP (particularly the social and symbolic composites) and the language scale of the Bayley-3 at 2 years than term-born peers. Lower gestational age at birth, male sex, hearing loss and multilingualism predicted poorer language scores.

CONCLUSIONS

Despite improvements in medical management, children born very preterm exhibit language delays at 2 years of age, with specific deficits in social communication and symbolic skills. Significant predictors of poorer language outcomes were similar to those in the general population (male sex, hearing loss, multilingualism), suggesting that further work is needed to establish which specific factors place preterm-born children at heightened risk.

The effect of narrative writing on fathers' stress in neonatal intensive care settings

Objective: This study was conducted to examine the effect of narrative writing on fathers' stress in the Neonatal Intensive Care Units (NICUs) during infants' hospitalization.Methods: A quasi-experimental study was conducted among two groups of fathers with preterm infants in the NICUs of two teaching hospitals of Gorgan University of Medical Sciences. Pre- and post-tests were administered to a sample size of 70 during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods.Results: The mean total stress score was 74.05 ± 17.39 in the control and 80.11 ± 15.82 in the intervention group on the 3rd day, suggesting no significant difference. In other words, both groups had a similar stress level before the intervention (p-value = .13, t = 1.52). However, the mean total stress score was 85.45 ± 16.91 in the control group and 48.00 ± 10.49 in the intervention group on the 10th day, suggesting a significant reduction in the stress level in the intervention group following the intervention (p-value = .001, t = -11.01).Conclusion: According to the findings, the narrative writing may be considered as an efficient supportive intervention to reduce the fathers' stress in the NICUs. However, more research is needed to justify its implementation.

Stress and feelings in mothers and fathers in NICU: identifying risk factors for early interventions

AIMS

The aims of this study were to explore parents' stress levels and negative feelings after premature births and to identify the risk factors related to parents' stress and negative feelings during their children's neonatal intensive care unit (NICU) stay.

BACKGROUND

Preterm birth is a multi-problematic event that may put the babies in danger for both their medical and neurophysiological conditions and could have a negative impact on both the mother-father relationship and the parent-child interactions.

METHODS

The study involved 43 mothers and 38 fathers of preterm infants. All participants filled out the Parental Stressor Scale: Neonatal Intensive Care Unit and the Profile of Mood States.

FINDINGS

The results revealed significant differences between mothers' and fathers' responses to preterm births in terms of both stress and negative feelings. We found that, for mothers, their own young age and the baby's need for respiratory support were significant predictors of stress; for fathers, their own young age and the baby's lower gestational age and worse condition at birth were significant predictors of stress and negative feelings. The NICU may be a stressful place both for mothers and fathers. Identifying which mothers and fathers are at risk immediately after their children are born could help to direct specific interventions that can reduce these parents' stress and prevent them from negative feelings.

INTERVENÇÃO MUSICOTERÁPICA PARA MÃE-BEBÊ PRÉ-TERMO: UMA PROPOSTA DE INTERVENÇÃO NA UTI NEONATAL

O presente relato de experiência descreve a Intervenção musicoterápica para mãe-bebê pré-termo – IMUSP, que visa sensibilizar a mãe a cantar para seu bebê pré-termo, durante a internação na Unidade de Terapia Intensiva Neonatal. A IMUSP está prevista para oito sessões, alternadas entre sessões individuais com a mãe e sessões com mãe-bebê. Na implementação da IMUSP, a musicoterapeuta realizou a intervenção na UTINeo de um hospital público com nove mães e bebês prematuros. Foram encontrados vários desafios relativos à disponibilidade das famílias atendidas e às exigências do hospital. Em função disso, foi necessário adaptar a IMUSP, flexibilizando o número de sessões, o tipo de atividades propostas, bem como a alternância entre sessões com a mãe e com mãe-bebê. Evidências sugerem que a IMUSP contribuiu para o ‘empoderamento’ da mãe e do bebê, e para a ‘musicalidade comunicativa’ da díade, fortalecendo a interação mãe-bebê pré-termo. A IMUSP é uma intervenção de baixo custo com grande potencial de impacto a longo prazo, uma vez que, além de oferecer apoio à díade na UTINeo, orienta a mãe para que possa cantar autonomamente para seu bebê durante a internação e após a alta hospitalar. Futuros estudos são necessários para ampliar a aplicação da IMUSP e verificar os seus benefícios a curto e longo prazo para a mãe, o bebê pré-termo e a interação mãe-bebê.

Parent-Infant Interaction during the First Year of Life in Infants at High Risk for Cerebral Palsy: A Systematic Review of the Literature

Introduction

Perinatal adverse events put neonates at high risk for short and long-term disabilities, including cerebral palsy (CP). The most recent guidelines about early intervention in infants with brain damage have emphasized the importance of family involvement from the very first phases of development. Early parent-infant interactions are pivotal in promoting infant cognitive and social developmental trajectories. However, little is known about the extent to which severe adverse perinatal events can affect the quality of early parent-infant interactions.

Patients and Methods

We systematically searched five databases (PubMed, PsycINFO, EMBASE, CINAHL, and Cochrane Library) for the publications assessing parent-infant interactions in infants at high neurological risk within 1 year of age. Articles were selected if they involved direct comparison between high-risk populations and healthy controls or low-risk populations, and if quantitative or semiquantitative tools were used to assess the parent-infant interaction. Measures of parent-infant interaction included infant interactive behaviors, parental interactive behaviors, and dyadic interactive patterns.

Results

The search yielded 18 publications that met the inclusion criteria. The articles represent a high level of heterogeneity in terms of infant neurological risk, infant age, and tools assessing interactive behaviors. Both infant and maternal behaviors within the investigated interactive exchanges were reported to be compromised, leading to subsequent overall impairment of the dyadic patterns.

Conclusion

While the studies reviewed here provide general and important information, the review did not yield a clear picture of early dyadic interactions in high-risk infant populations. Further observational studies are warranted in order to provide a more accurate knowledge of the early dyadic exchanges between infants at high neurological risk and their parents, as they might provide a critical opportunity for early family centered habilitative interventions.

Pain, Parental Involvement, and Oxytocin in the Neonatal Intensive Care Unit

Preterm infants (PTI) typically experience many painful and stressful procedures or events during their first weeks of life in a neonatal intensive care unit, and these can profoundly impact subsequent brain development and function. Several protective interventions during this sensitive period stimulate the oxytocin system, reduce pain and stress, and improve brain development. This review provides an overview of the environmental risk factors experienced by PTI during hospitalization, with a focus on the effects of pain, and early maternal separation. We also describe the long-term adverse effects of the simultaneous experiences of pain and maternal separation, and the potential beneficial effects of maternal vocalizations, parental contact, and several related processes, which appear to be mediated by the oxytocin system.

Reflective functioning in fathers with young children born preterm and at term

The present study assessed 322 parents of 173 children aged between 12 and 20 months (74 children born preterm) with the Parent Development Interview (PDI) to capture parents' Reflective Functioning (RF). RF scores were obtained, and topics were disclosed, for which modeling with Latent Dirichlet Allocation (LDA) was applied. The study addressed (a) whether RF scores differed between fathers of children born preterm and at term, and diverged from the mothers' RF and, (b) whether topics on fathers' minds differed regarding parenting preterm or at-term children, and diverged from topics on parenting raised by mothers. Results indicated that parents of at-term children revealed similar RF scores, though fathers of children born preterm scored lower than mothers of children born preterm. Whereas fathers' RF scores were associated with topics about the paternal role, interests and activities, mothers' RF was related to concerns about how to meet the child's needs.

Recommendations on the environment for hospitalised newborn infants from the French neonatal society: rationale, methods and first recommendation on neonatal intensive care unit design

AIM

Hospitalised newborn infants may be stressed due to inappropriate sensory stimuli and early separation from their families, that can negatively impact their neurodevelopment. The French Group of Reflection and Evaluation of the Environment of Newborns (GREEN) issues guidelines based on environmental neonatology and family-centred care. The first recommendation focuses on private family rooms versus large shared rooms.

METHODS

These guidelines are based on a systematic evaluation of the literature providing different grades of evidence. Internal and external reviews by multidisciplinary experts examined the scientific evidence of all recommendations. The literature search was performed for the period January 1, 2000 to January 1, 2016 with the keywords 'single room' or 'private room' and 'neonatal intensive care unit'.

RESULTS

A total of 25 studies were retained. Most studies reported a positive impact of private rooms on the health of newborn infants and satisfaction of families. Private rooms could lead to sensory deprivation if there is low parental involvement with limited presence and to reduced interaction among caregivers.

CONCLUSION

We recommend that neonatal units should mostly have private rooms. With this architectural design, we recommend supporting the staff's needs for changes in the organisation and philosophy of care and to provide improved family support.

Maternal sensitivity is associated with configural processing of infant's cues in preterm and full-term mothers

BACKGROUND

Prematurity may affect mother-infant bonding and alter maternal sensitivity to infant's cues. Efficient perception of infants' facial and bodily cues is a crucial aspect of maternal sensitivity and may be challenged by prematurity, as infants' signals may not be easily intelligible. However, it is still unexplored how premature birth impacts the maternal ability to perceive infants' signals.

AIMS

To investigate whether prematurity influences the perceptual sensitivity of mothers to infants' cues and, in particular, the configural processing of the faces and bodies of familiar and unfamiliar infants.

STUDY DESIGN

The inversion effect paradigm was used to evaluate the configural vs. detail-based processing of the face and body of own or others' infants. Preterm mothers were compared to full-term mothers with either low or high maternal sensitivity.

PARTICIPANTS

Forty-three healthy full-term and twenty-one preterm mothers of infants aged about six months.

OUTCOME MEASURES

Maternal sensitivity during dyadic interaction, gestational age, accuracy and reaction time in a delayed matching-to-sample task of upright vs. inverted body and face stimuli (i.e., inversion effect).

RESULTS

Preterm mothers were found to be less sensitive than the full-term ones. Higher maternal sensitivity during dyadic interaction was associated with lower inversion effect for unfamiliar as compared to own infants' bodies. However, preterm mothers and full-term mothers with low sensitivity showed comparable inversion effect in perceiving unfamiliar infants' faces or bodies.

CONCLUSIONS

Preterm birth per se does not directly affect body configural processing, but it may be associated to reduced maternal sensitivity, ultimately leading to a less refined perception of own infant's cues.

Risk factors for maltreatment-related infant hospitalizations in New York City, 1995-2004

BACKGROUND

Child maltreatment is a major public health problem, but population-based surveillance and research is hindered by limitations of official child welfare data. The present study used a promising complementary data source, hospital discharge data, to investigate risk factors for infant injuries suggestive of maltreatment.

METHODS

Discharge data from all hospital births to New York City residents from 1995 to 2004 were linked to birth certificates and to subsequent infant hospitalizations within 12 months after delivery. Probable maltreatment of infants was identified with 33 injury diagnosis codes highly correlated with maltreatment. Modified Poisson regression estimated the association of sociodemographic factors and pregnancy/birth characteristics with subsequent infant admission for probable maltreatment.

RESULTS

Risk factors for maltreatment included neonatal intensive care unit stays of more than 11 days (adjusted risk ratio [aRR] = 1.8; 95% confidence interval [CI]: 1.1-2.8), preterm birth (aRR = 1.6; 95% CI: 1.2-2.1), maternal age less than 20 years (aRR = 1.5; 95% CI: 1.2-1.9), and public insurance (aRR = 1.5; 95% CI: 1.2-1.9). Factors associated with reduced maltreatment risk included mother born outside the United States (aRR = 0.7; 95% CI: 0.6-0.8) and female infant (aRR = 0.7; 95% CI: 0.6-0.9).

CONCLUSIONS

Sociodemographic factors and challenges at birth (preterm, neonatal intensive care unit stays) are important risk factors for subsequent maltreatment-related hospitalization, with potential implications for prevention targeting.

Parent-child attachment in children born preterm and at term: A multigroup analysis

OBJECTIVE

While ample research exists about mother-child attachment, so far little focus has been on specifics of father-child attachment. Even less research is available on the nature of the father-child relationship for children born preterm. The objective of this study was to determine whether children born preterm (23 to 37 weeks gestation) differ in their attachment to their fathers and mothers from their term peers (> 37 weeks gestation), and whether specific child characteristics, such as gender, twin status, and developmental status, have an influence on the parent-child relationship.

METHODS

The sample consisted of 290 children (n = 140 girls, 48.28%), 190 born before term (including 45 twin pairs) between 12 and 36 months of age (M = 19.5, SD = 5.7) and 100 term children of the same age (M = 18.8, SD = 6.1) with their 245 fathers and mothers. Attachment of the children with their mothers and fathers was assessed using the Attachment Q-sort during two home visits. Children's developmental status was measured with the Bayley Scales of Infant and Toddler Development.

RESULTS

Within a multigroup analysis of parents with children born preterm and at term more secure attachment was found for both parents in the term sample than in the preterm group. Correlates of attachment specific to fathers of children born preterm accumulated to an explained variance of R2 = .82. For those fathers, less education as well as lower development scores and male gender of the child were associated with lower attachment scores. In the three other parent-child constellations the explained variance did not exceed 20%. Child development proved to be a significant predictor for father-child attachment regardless of the child's birth status. Male gender was associated with lower attachment scores for children born preterm with either parent.

CONCLUSION

The findings highlight the importance of including fathers in research and clinical practice and informing them about preterm birth, possible problems, and developmental consequences as well. Health professionals should be advised to create interventions focusing on both parents to enhance the quality of attachment in parent-child dyads in children born preterm.

Postpartum depression among women in Nagoya indirectly exposed to the Great East Japan Earthquake

This study aimed to assess the situation of postpartum depression and maternal bonding in Nagoya, a city distant from the epicenter of the Great East Japan Earthquake that occurred on March 11, 2011. Among the participants at 1 month after childbirth between March 11, 2010 and March 10, 2013 (n = 188), 152 fully responded to the Edinburgh Postnatal Depression Scale (EPDS) and Mother–Infant Bonding Questionnaire (MIBQ). They were divided into pre-quake (n = 58), and 0–6, 6–12, 12–18, and 18–24 months after the earthquake groups (n = 20, 26, 29, and 19, respectively). The rate of mothers who scored above the cutoff point for the EPDS increased from 12.1% in the pre-quake to 35.0% in the 0–6 months group (p = 0.022). The EPDS total and anxiety subscale scores (mean ± standard error) were also significantly different between the pre-quake and 0–6 months after the earthquake groups (4.45 ± 0.50 vs. 7.95 ± 1.47, p = 0.024; 2.16 ± 0.26 vs. 3.65 ± 0.57, p = 0.021, respectively). The EPDS total and anxiety scores were the highest for the 0–6 months group, followed by the 6–12, 12–18, 18–24 months groups (p = 0.019, p = 0.022). MIBQ scores did not differ between the pre-quake and 0–6 months groups. Depressive symptoms, mainly explained by anxiety, increased after the earthquake with no changes in maternal bonding.

A Comparative Study of the Effects of Skin Contact and Kangaroo Care on Mother's Anxiety

Background:

The aim of the study was to compare of mother and newborns abdominal contact and Kangaroo skin on mother's anxiety.

Materials and Methods:

This study is a single-blind randomized control trial in 2015. Questionnaire about Demographic and Spielberger State-Trait Anxiety Inventory (STAI) was completed for two groups.

Results:

There was no significant difference in maternal anxiety between kangaroo care and abdominal contact by Mann-Whitney test immediately after birth (Z = -1.33, p = 0.42) and after 2 months (Z = -1.47, p = 0.86).

Conclusions:

The effect of kangaroo contact on mother's anxiety was similar to abdominal contact and if the kangaroo care is done for a short period of time, it will not change maternal anxiety.

Parents' views on preparation to care for extremely premature infants at home

AIM

To gain insight into the post-discharge experiences of parents in relation to the adequacy of preparation for caring for extremely premature infants at home.

METHOD

A narrative approach was drawn on to facilitate data collection, through face-to-face semi-structured interviews with 14 parents of extremely premature infants.

FINDINGS

Constant comparative analysis was used to allow the emergence of five key research themes - emotional and mental health of parents, uncertain outcomes, ongoing health needs of the baby, educational needs of health professionals, and parental support and preparation for transition home.

CONCLUSION

Parental experience of being discharged home with a premature baby can be emotionally challenging and necessitates a range of support mechanisms to help them to cope with this period of transition. Health professionals can direct parents to appropriate counselling services, resources and peer support groups. Tailored education is needed for community-based health professionals, such as health visitors, to equip them to support parents practically and emotionally during the transition home and beyond. In addition, health professionals can learn much from parents about what is needed to support them.

What are the effects of supporting early parenting by enhancing parents' understanding of the infant? Study protocol for a cluster-randomized community-based trial of the Newborn Behavioral Observation (NBO) method

Background

Support to strengthen the early parent-infant relationship is recommended to ensure the infant’s future health and development. Little is known about the universal approaches taken by health visitor to support this early relationship. The aim of this study is to investigate the effects of health visitors’ use of the Newborn Behavioral Observation (NBO) method among new parents.

Methods

This is a cluster-randomised community-based study implemented in four Danish municipalities. Health visitors will conduct the trial, and the geographical districts they work in will constitute the clusters as units of randomisation. The participants will be approximately 2800 new families, randomised into an intervention or a comparison group according to their health visitor. The families are recruited at the first postpartum home visit. Parents in both groups receive care as usual: parents in the intervention group also receive the standardised NBO method in home visits performed from 3 weeks to 3 months postpartum. Data consist of self-reported parent questionnaires and video recordings of a selected group of vulnerable first-time mothers recorded 4 months postpartum. The self-reported data are obtained: at baseline 1 week postpartum and then at follow-up 3, 9 and 18 months postpartum. Data will be analysed using the intention-to-treat method and the analyses will include comparison of change in the primary variables across time supplemented by multiple regression analysis. The primary study outcomes are measured by the following factors: parental confidence, infants’ socio-emotional development and mother-infant relationship. Other measures include parental mood and stress, breastfeeding duration and utility of the health visitor services. Data collection among the health visitors in both groups will serve to monitor any change in practice regarding the work with early parent-infant interactions.

Discussion

This protocol describes an evaluation of the NBO method used universally in health visiting practice. The intervention seeks to support early parenting by increasing parents’ understanding of their infants’ cues. The NBO is currently implemented in Denmark even though an evaluation of the NBO has yet to be made in a community setting in Denmark and internationally. The study may contribute to building an increasingly evidence-based practice for health visitors.

Trial registration

ClinicalTrials.gov ID: NCT03070652. Registered February 22, 2017.

Developmental Outcomes, Attachment and Parenting: Study of a Sample of Spanish Premature Children

The aim of this study is to provide an overview of the development of premature children, including attachment, child psychological adjustment and parental variables. 130 children < 1,500 g or < 32 weeks at birth from two public hospitals, assessed at two years corrected age, together with their parents. Parental socio-demographic data was collected. Infant development, attachment and child psychological adjustment were evaluated, as was parental stress. The percentage of preterm children with developmental delays ranged from 5% to 21%. Girls tend to show higher levels of development than boys with effect sizes ranging from small, η2p = .02, to medium, η2p = .07. Secure attachment was the most frequent pattern in the sample. No significant differences, p < .05, between preterm children and the normative population were found on children´s behavioral problems and maternal stress levels. Despite the fact prematurity is considered to be a risk factor for a child´s development, a significant proportion of these children do not show problems in terms of developmental levels, attachment pattern and maternal stress. However, socio-emotional and affective domains, as well as psychological support programs for parenthood, should be followed up from a multidisciplinary perspective.

Preterm-infant emotion regulation during the still-face interaction

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.

Music From the Very Beginning-A Neuroscience-Based Framework for Music as Therapy for Preterm Infants and Their Parents

Human and animal studies demonstrate that early auditory experiences influence brain development. The findings are particularly crucial following preterm birth as the plasticity of auditory regions, and cortex development are heavily dependent on the quality of auditory stimulation. Brain maturation in preterm infants may be affected among other things by the overwhelming auditory environment of the neonatal intensive care unit (NICU). Conversely, auditory deprivation, (e.g., the lack of the regular intrauterine rhythms of the maternal heartbeat and the maternal voice) may also have an impact on brain maturation. Therefore, a nurturing enrichment of the auditory environment for preterm infants is warranted. Creative music therapy (CMT) addresses these demands by offering infant-directed singing in lullaby-style that is continually adapted to the neonate’s needs. The therapeutic approach is tailored to the individual developmental stage, entrained to the breathing rhythm, and adapted to the subtle expressions of the newborn. Not only the therapist and the neonate but also the parents play a role in CMT. In this article, we describe how to apply music therapy in a neonatal intensive care environment to support very preterm infants and their families. We speculate that the enriched musical experience may promote brain development and we critically discuss the available evidence in support of our assumption.

Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial

Aim

The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).

Methods

Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.

Results

In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66–1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t = 2.44, 95% CI 0.03–0.23, effect size d = 0.26.

Conclusion

In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.

Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes

OBJECTIVE

To 1) define predictors of parent presence, any holding, holding in arms, and skin-to-skin care in the NICU and 2) investigate the relationships between parent participation and a) early neurobehavior and b) developmental outcomes at age 4 to 5years among preterm infants.

METHODS

Eighty-one preterm infants born ≤32weeks estimated gestational age were prospectively enrolled within one week of life in a level III-IV NICU. Parent (maternal and paternal) presence and holding (including holding in arms and skin-to-skin care) were tracked throughout NICU hospitalization. Neurobehavior at term equivalent age and development at 4 to 5years were determined using standardized assessments.

RESULTS

The median number of days per week parents were documented to be present over NICU hospitalization was 4.0 (IQR=2.4-5.8) days; days held per week 2.8 (IQR=1.4-4.3) days [holding in arms days per week was 2.2 (IQR=1.2-3.2) days and parent skin-to-skin care days per week was 0.2 (IQR=0.0-0.7) days]. More parent presence was observed among mothers who were Caucasian, married, older, or employed and among those who had fewer children, familial support and provided breast milk (p<0.05). More holding was observed in infants with fewer medical interventions (p<0.05) and among those who were Caucasian, had a father who was employed, had fewer children and family support (p<0.05). More parent holding in the NICU was related to better reflex development at term age (p=0.02). More parent skin-to-skin care was related to better infant reflexes (p=0.03) and less asymmetry (p=0.04) at term and better gross motor development (p=0.02) at 4-5years.

DISCUSSION

Social and medical factors appear to impact parent presence, holding, and skin-to-skin care in the NICU. Parent holding is related to better developmental outcomes, which highlights the importance of engaging families in the NICU.

Validating the Psychometric Characteristics of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) in a Chinese Context

BACKGROUND

Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet.

OBJECTIVES

The aims of this study were to develop a translated Chinese version of the (PPQ) and validate the psychometric characteristics of the PPQ in a Chinese context.

METHODS

After translation, back-translation, and expert discussion, 280 mothers at 1 to 18months postpartum filled out the questionnaires through the Internet. Then the reliability and validity of the translated questionnaire were tested.

RESULTS

The Chinese version of PPQ (PPQ-C) was composed of 14 items. Cronbach's α coefficient was 0.84, test-retest reliability was 0.88, and the content validity was 0.99. Exploratory factor analysis extracted three factors (representing "arousal", "avoidance" and "intrusion") accounted for 53.30% of the variance. The established 3 factors model was well fitted with the collected data (χ²=76.40, p<0.05).

IMPLICATIONS FOR PRACTICE

The PPQ-C is a short, reliable, and valid instrument that measures the symptoms of PPTSD, and it is recommend for clinical screening.

IMPLICATIONS FOR RESEARCH

Further research could involve diverse participants, as well as better adapt the PPQ-C to Chinese culture.

Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study

Background

Supporting early mother-infant relationships to ensure infants’ future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities.

Methods

This quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis.

Results

The levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93–10.09) compared with 7.62 (95%CI;7.03–8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96–10.14) compared with 7.83 (95%CI;7.19–8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88–9.99) in the intervention group compared with 7.73 (95%CI;7.13–8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13–33.94) compared with 35.29 (95%CI;34.07–36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22–41.98) compared with 40.10 (95%CI;39.65–40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE.

Conclusion

The findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method.

Trial registration

This study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1568-1) contains supplementary material, which is available to authorized users.

Preterm birth enhances the contribution of mothers' mind-mindedness to infants' expressive language development: A longitudinal investigation

Maternal mind-mindedness has been shown to be a powerful predictor of many developmental outcomes and to buffer the impact of psychosocial risk conditions, but no study has investigated whether this parental feature might support child development in the presence of biological risk, such as preterm birth. The present study addresses this gap, by investigating whether early maternal mind-mindedness contributes to the growth of a child's linguistic abilities in the following two years of life, and if the contribution of this maternal feature might be stronger in the presence of preterm birth. Forty mother-child dyads (twenty with a preterm infant) were followed longitudinally, with maternal mind-mindedness assessed at 14 months of age and child's expressive linguistic abilities at 24 and 36 months through observational measures. Multilevel models showed that linguistic abilities increased from 24 to 36 months of age, but that this increase was stronger in full-term infants. Maternal mind-mindedness also contributed to this growth, playing a stronger role in preterm infants than in full-term infants. Altogether, these findings contribute more deeply to the understanding of language development in preterm infants and of the joint contribution made by biological risk and environmental factors; from a practical standpoint, they suggest the importance of addressing mother's mind-mindedness in order to support child's language development.

A Psychological Perspective on Preterm Children: The Influence of Contextual Factors on Quality of Family Interactions

Preterm birth has a critical influence on interactive, communicative, and expressive child behaviour, particularly during the first years of life. Few studies have stressed the assessment of mother-father-child interaction in families with preterm children, generating contradictory results. The present study wished to develop these fields: (i) comparing the quality of family interactions between families with preterm children and families with children born at full term; (ii) observing the development of family interactions after six months in the families with children born preterm; (iii) assessing family and contextual factors, as parental stress and social support, in parents of preterm children in order to observe their influence on the quality of family interactions. 78 families are recruited: 39 families with preterm children (M = 19,8 months, SD = 11,05) and 39 families with full-term children (M = 19,66 months; SD = 13,10). Results show that families with preterm children display a low quality of mother-father-child interactions. After six months, family interactions result is generally stable, except for some LTP-scales reflecting a hard adjustment of parenting style to the evolution of the child. In families with preterm children, the parenting stress seemed to be correlated with the quality of mother-father-child interactions.

Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial

Background

Every year, about 15 million of the world’s infants are born preterm (before 37 weeks gestation). In Alberta, the preterm birth rate was 8.7% in 2015, the second highest among Canadian provinces. Approximately 20% of preterm infants are born before 32 weeks gestation (early preterm), and require care in a Level III neonatal intensive care unit (NICU); 80% are born moderate (32 weeks and zero days [32^0/7] to 33^6/7 weeks) and late preterm (34^0/7 to 36^6/7 weeks), and require care in a Level II NICU. Preterm birth and experiences in the NICU disrupt early parent-infant relationships and induce parental psychosocial distress. Family Integrated Care (FICare) shows promise as a model of care in Level III NICUs. The purpose of this study is to evaluate length of stay, infant and maternal clinical outcomes, and costs following adaptation and implementation of FICare in Level II NICUs.

Methods

We will conduct a pragmatic, cluster randomized controlled trial (cRCT) in ten Alberta Level II NICUs allocated to one of two groups: FICare or standard care. The FICare Alberta model involves three theoretically-based, standardized components: information sharing, parenting education, and family support. Our sample size of 181 mother-infant dyads per group is based on the primary outcome of NICU length of stay, 80% participation, and 80% retention at follow-up. Secondary outcomes (e.g., infant clinical outcomes and maternal psychosocial distress) will be assessed shortly after admission to NICU, at discharge and 2 months corrected age. We will conduct economic analysis from two perspectives: the public healthcare payer and society. To understand the utility, acceptability, and impact of FICare, qualitative interviews will be conducted with a subset of mothers at the 2-month follow-up, and with hospital administrators and healthcare providers near the end of the study.

Discussion

Results of this pragmatic cRCT of FICare in Alberta Level II NICUs will inform policy decisions by providing evidence about the clinical effectiveness and costs of FICare.

Trial registration

ClinicalTrials.gov, ID: NCT02879799. Registered on 27 May 2016. Protocol version: 9 June 2016; version 2.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2181-3) contains supplementary material, which is available to authorized users.

Triadic interactions in families with preterm children: a comparative study with children born at term

The relationship between parents and infants born preterm is multifaceted and could present some relational patterns which are believed to predict psychological risk more than others. For example, insensitive parenting behavior has been shown to place very preterm children at greater risk of emotional and behavioral dysregulation. The main objective of this study was to compare the quality of family interactions in a sample of families with preterm children with one of the families with at-term children, exploring possible differences and similarities. The second aim of this research was to consider the associations among family interactions and parental empowerment, the child's temperament, parenting stress, and perceived social support. The sample consisted of 52 children and their families: 25 families, one with two preterm brothers with preterm children (mean 22.3 months, SD 12.17), and 26 families with children born at term (mean 22.2 months, SD 14.97). The Lausanne Trilogue Play procedure was administered to the two groups to assess the quality of their family interactions. The preterm group was also administered the Questionari Italiani del Temperamento, the Family Empowerment Scale, the Multidimensional Scale of Perceived Social Support, and the Parenting Stress Index - Short Form. Differences in the quality of family interactions emerged between the preterm and at-term groups. The preterm group showed significantly lower quality of family interactions than the at-term group. The parenting stress of both parents related to their parental empowerment, and maternal stress was also related to the partner's parental empowerment. Social support had a positive influence on parenting stress, with maternal stress also related to perceived social support from the partner, which underscores the protective role of the father on the dyad.

The role of sociodemographic factors in maternal psychological distress and mother-preterm infant interactions

Preterm birth has been associated with greater psychological distress and less positive mother infant interactions than were experienced by mothers of full-term infants. Maternal and infant sociodemographic factors have also shown a strong association with psychological distress and the mother-infant relationship. However, findings on their effects over time are limited. In this longitudinal analysis, we explored the relationship of maternal and infant sociodemographic variables (maternal age, maternal education, marital status, being on social assistance, maternal race, infant birth weight, and infant gender) to maternal psychological distress (depressive, posttraumatic stress, anxiety, parenting stress symptoms, and maternal worry about child's health) through 12 months corrected age for prematurity, and on the home environment, and mother-infant interactions through 6 months corrected age for prematurity. We also explored differences related to maternal obstetrical characteristics (gestational age at birth, parity, mode of delivery, and multiple birth) and severity of infant conditions (Apgar scores, need for mechanical ventilation, and infant medical complications). Although the relationship of maternal and infant characteristics with these outcomes did not change over time, psychological distress differed based on marital status, maternal education, infant gender, and infant medical complications. Older mothers provided more a positive home environment. Mother-infant interactions differed by maternal age, being on public assistance, maternal race, infant gender, and infant medical complications. More longitudinal research is needed to better understand these effects over time in order to identify and support at-risk mothers.

Mother- and father-infant interactions at 3 months of corrected age: The effect of severity of preterm birth

Early interactions of 92 preterm infants with their mothers (n=54) and fathers (n=38) were explored at 3 months using CARE-Index. Results showed differences in interactions based on parent's gender, with higher control in mothers and unresponsiveness in fathers, while no effect of severity of birth weight emerged.

Greater brain response to emotional expressions of their own children in mothers of preterm infants: an fMRI study

OBJECTIVE

The birth of a preterm infant and Neonatal Intensive Care Unit hospitalization constitute a potentially traumatic experience for mothers. Although behavioral studies investigated the parenting stress in preterm mothers, no study focused on the underlying neural mechanisms. We examined the effect of preterm births in mothers, by comparing brain activation in mothers of preterm and full-term infants.

STUDY DESIGN

We used functional magnetic resonance imaging to measure the cerebral response of 10 first-time mothers of preterm infants (gestational age <32 weeks and/or birth weight <1500) and 11 mothers of full-term infants, viewing happy-, neutral- and distress-face images of their own infant, along with a matched unknown infant.

RESULTS

While viewing own infant's face preterm mothers showed increased activation in emotional processing area (i.e., inferior frontal gyrus) and social cognition (i.e., supramarginal gyrus) and affiliative behavior (i.e., insula).

CONCLUSION

Differential brain activation patterns in mothers appears to be a function of the atypical parenthood transition related to prematurity.

Is level of prematurity a risk/plasticity factor at three years of age?

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.

Preterm infant development, maternal distress and sensitivity: The influence of severity of birth weight

OBJECTIVE

To evaluate the influence of the severity of prematurity based on birth weight on maternal distress and sensitivity and on infant development.

METHODS

Sixty-eight mothers and their preterm babies (30 babies classified into Extremely-Low-Birth Weight-ELBW and 38 into Very-Low-Birth Weight-VLBW) were assessed at 9months of infant corrected age, using: Griffiths Scales for infant development, CARE-Index for maternal sensitivity during 5-minute of mother-infant interaction, and Parenting Stress Index-Short Form (PSI-SF) for maternal distress. Sixty-six healthy full-term infants (FT) and their mothers were assessed with the same procedure.

RESULTS

ELBW, VLBW and FT groups showed similar levels at CARE-Index and PSI-SF. Nevertheless, considering infant development as outcome, a significant interaction between birth weight and maternal distress emerged, with higher Hearing & Language mean quotients in association with Non-Distressed mothers, but only in VLBW infants, compared to FT ones. Also the interaction between birth weight and maternal sensitivity influenced infant development: higher quotients (Eye-hand coordination, Hearing & Language, Locomotor) were significantly associated with sensitive mothers but only in ELBW infants.

CONCLUSION

The severity of prematurity, in interaction with the degree of maternal distress and sensitivity, influenced the level of infant development.

PRACTICAL IMPLICATIONS

Taken together, these results suggest the relevance of considering severity of prematurity and maternal variables in order to implement appropriate interventions for supporting parenting role after a preterm birth and promoting an adequate infant development.

Parental engagement and early interactions with preterm infants during the stay in the neonatal intensive care unit: protocol of a mixed-method and longitudinal study

INTRODUCTION

The preterm infants' developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/father-infant interactions and the parents' ability to respond to the trauma of premature birth. In the case of premature birth, the father's ability to take an active part in the care of the infant from the start is essential. The parents' emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent-infant affective relationship and the parents' confidence in their ability to provide care for their baby.

METHODS AND ANALYSIS

This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother-infant and father-infant interaction in the NICU; (3) a semistructured interview with fathers during the infants' hospital stay; (4) 3-minute video recordings of mother-infant and father-infant face-to-face interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother-infant relationship.

Quality of attachment in infants less than 1500g or less than 32weeks. Related factors

BACKGROUND

Prematurity carries a high risk of mortality and sequelae, altering the bonding process and leading to repercussions in terms of attachment.

OBJECTIVE

To assess the type of attachment in children under 32weeks' gestational age (GA) or below 1500g, in hospitals where development-centred care has been implemented and to study the association between various types of attachment and certain neonatal and family characteristics.

METHOD

Children <1500g or <32weeks GA who were born or admitted before 48h of life to one of two hospitals in Madrid between January and December 2012 were candidates for the study. The type of attachment was assessed through the strange situation procedure (SSP). Attachment was classified according to three types: secure (B), avoidant (A), or resistant/ambivalent (C). Insecure attachment was considered to be A+C. Children were assessed at a corrected age of 2years using the Bayley III Scales and SSP. Data on the characteristics of the parents and children were collected.

RESULTS

A total of 59% (117/199) of the children <1500g or <32weeks GA born in 2012 in the two study hospitals were able to be evaluated. Secure attachment was found in 64% (75/117), avoidant attachment in 12.8% (15/117), and resistant/ambivalent in 23.1% (27/117). The children with secure attachment had a score of 107.6±16 in the cognitive area of the Bayley's Scale versus 98.8±18.8 in those with insecure attachment (p 0.007). Frequency of secure attachment at ≤26weeks GA was 23% (3/13) versus 69% (72/104) in children >26weeks GA (p 0.003).

CONCLUSIONS

Nearly two-thirds of the children studied presented secure attachment, which was associated with better cognitive development. The frequency of secure attachment is lower in the children born more preterm.