Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying

Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N = 389) of infant carrying (six times a week or daily) and parents reporting low levels (N = 128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.

Psychometric soundness and predictive factors of the NCAST Parent-Child Interaction Teaching Scale in urban Chinese population

BACKGROUND

Quality of parent-child interaction in early childhood functions as a critical indicator of nurturing care and is strongly associated with short-term and long-term development (health, cognition, language, social emotion, well-being, etc.). NCAST PCI Teaching Scale (PCI-TS), a video-based assessment regarded as a gold standard to measure PCI, has been widely used worldwide. However, its psychometric soundness among the urban Chinese population is unclear. This study assesses the PCI-TS's reliability and validity and explores predictive factors among urban Chinese parent-child dyads.

METHODS

PCI-TS was adopted to code mother-child interaction among urban Chinese dyads recruited during the children's regular health checks in local maternal and child health centres. Reliability was evaluated by internal consistency (Cronbach'α coefficient) and test-retest reliability (Pearson correlation) with an average interval of 18 days. Score distribution of each subscale and total scale were compared with NCAST Database and Canadian community sample by single sample t-test. Criteria-related validity was conducted by Infant-Toddler Home Observation Measurement of the Environment (Pearson correlation). Predictive factors was performed by multiple linear regression.

RESULTS

Four hundred and twenty-nine eligible mother-child dyads were included for data analysis among the 466 recruited samples. Four qualified local paediatricians accomplished video coding with an average agreement of 86%. The PCI-TS has strong reliability among the Chinese population with the Cronbach'α coefficients of the Caregiver-Infant total score, Caregiver total and Infant total scores of 0.81, 0.81 and 0.74, respectively; an acceptable test-retest reliability (r = 0.73, p < 0.01); and moderate correlation with IT-HOME, ranging from 0.53 to 0.62. Child age, birth weight, maternal education, full-time housewife, living with grandparent(s) and living space were predictive factors on PCI-TS in the Chinese population.

CONCLUSION

PCI-TS showed good psychometric properties for measuring mother-child interactions among urban Chinese dyads, offering clinicians and researchers a practical tool to evaluate PCI objectively. Child age, maternal education and living space were beneficial factors, while full-time mothers and living with grandparent(s) were risk factors.

Is Birth Method Associated with Sensory Hyperreactivity in Children 3-4 Years in an Upper-Middle-Income Country?

Background

Research has shown that pressure in the vaginal birth process aids the infant's neurophysiological adaption to extrauterine life, including their ability to regulate their responses to diverse sensory stimuli. As pressure is absent in elective caesarean section births, we hypothesised that these children may be at higher risk for developing sensory hyperreactivity (SHR), a sensory modulation difficulty which negatively impacts on the child's engagement in their occupations. This paper reports on a study which investigated associations between birth method and SHR.

Method

In this cross-sectional study, 91 children aged three and four years from various language, cultural, and socioeconomic groups were recruited and categorised based on birth method (caesarean section or vaginal birth). Caregivers of each child completed the Short Sensory Profile-2 and a demographic questionnaire. The prevalence of SHR between the birth method groups was compared.

Results

The prevalence of SHR was greater in the vaginal birth group (29%) than the caesarean section group (9%). Mothers in the vaginal birth group were younger (p ≤ 0.001), of lower-income level (p = 0.003), and more likely to be single (p = 0.037). During data collection with the vaginal birth group, comprehensibility of certain items in the Short Sensory Profile-2 proved challenging for many caregivers.

Conclusion

The statistically significant higher prevalence of SHR in the vaginal birth group supported a null hypothesis. However, the results are questioned due to the challenges related to data collection. Given this, the study supports the need for further investigation of how sociocultural and socioeconomic factors influence the assessment of SHR in the South African context.

Effects of skin-to-skin contact on full-term infants' stress reactivity and quality of mother-infant interactions

Skin-to-skin contact (SSC) between mothers and their infants has beneficial effects in both preterm and full-term infants. Underlying mechanisms are largely unknown. This randomized controlled trial assessed whether daily SSC in full-term mother-infant dyads: (1) decreases infants' cortisol and behavioral reactivity to a mild naturalistic stressor, and (2) facilitates interaction quality between infants and mothers (i.e., improved maternal caregiving behavior and mother-infant adrenocortical synchrony). Pregnant Dutch women (N = 116) were recruited and randomly allocated to an SSC or care-as-usual condition. The SSC condition performed 1 h of SSC daily, from birth until postnatal week 5. In week 5, mothers bathed the infant (known mild stressor). Infant and maternal cortisol was sampled at baseline, 25 and 40 min after bathing, and infant and maternal behavior was rated. Results did not indicate effects of SSC on infant behavioral and cortisol reactivity to the bathing session. Similarly, no effect of SSC was found on maternal caregiving behavior and mother-infant adrenocortical synchrony. In conclusion, the findings provide no evidence that daily mother-infant SSC is associated with full-term infants' behavioral and adrenocortical stress reactivity or mother-infant interaction quality. Future studies should replicate these findings and unveil other potential mechanisms underlying beneficial effects of SSC.

Still-face redux: Infant responses to a classic and modified still-face paradigm in proximal and distal care cultures

Literature on infant emotion is dominated by research conducted in Western, industrialized societies where early socialization is characterized by face-to-face, vocal communication with caregivers. There is a dearth of knowledge of infant emotion in the context of social interaction outside of the visual and vocal modalities. In a three-population cross-cultural comparison, we used the still-face task to measure variation in behavior among infants from proximal care (practicing high levels of physical contact) communities in Bolivia and distal care (emphasizing vocal and visual interaction) communities in the U.S. and Fiji. In a modified version of the face-to-face still-face (FFSF), Study 1, infants in the U.S. and Fiji displayed the typical behavioral response to the still-face episode: increased negative affect and decreased social engagement, whereas infants in Bolivia showed no change. For tactile behavior, infants in Bolivia showed an increase in tactile self-stimulation from the interaction episode to the still-face episode, whereas U.S. infants showed no change. In Study 2, we created a novel body-to-body version of the still-face paradigm ("still-body") with infants in US and Bolivia, to mimic the near-constant physical contact Bolivian infants experience. The U.S. and Bolivian infant response was similar to Study 1: US infants showed decreased positive affect and increased negative affect and decreased social engagement from the interaction to the still-body episode and Bolivian infants showed no change. Notably, there were overall differences in infant behaviors between the two paradigms (FFSF and Still-Body). Infants in Bolivia and the U.S. showed increased positive facial affect during the FFSF paradigm in comparison with the Still-Body paradigm. Our results demonstrate the need for more globally representative developmental research and a broader approach to infant emotion and communication.

A Comparison of Non-verbal Maternal Care of Male and Female Infants in India and the United Kingdom: The Parent-Infant Caregiving Touch Scale in Two Cultures

Differences in infant caregiving behavior between cultures have long been noted, although the quantified comparison of touch-based caregiving using uniform standardized methodology has been much more limited. The Parent-Infant Caregiving Touch scale (PICTS) was developed for this purpose and programming effects of early parental tactile stimulation (stroking) on infant hypothalamic-pituitary adrenal (HPA)-axis functioning (stress-response system), cardiovascular regulation and behavioral outcomes, similar to that reported in animals, have now been demonstrated. In order to inform future studies examining such programming effects in India, we first aimed to describe and examine, using parametric and non-parametric item-response methods, the item-response frequencies and characteristics of responses on the PICTS, and evidence for cross-cultural differential item functioning (DIF) in the United Kingdom (UK) and India. Second, in the context of a cultural favoring of male children in India, we also aimed to test the association between the sex of the infant and infant "stroking" in both cultural settings. The PICTS was administered at 8-12 weeks postpartum to mothers in two-cohort studies: The Wirral Child Health and Development Study, United Kingdom (n = 874) and the Bangalore Child Health and Development Study, India (n = 395). Mokken scale analysis, parametric item-response analysis, and structural equation modeling for categorical items were used. Items for two dimensions, one for stroking behavior and one for holding behavior, could be identified as meeting many of the criteria required for Mokken scales in the United Kingdom, only the stroking scale met these criteria in the sample from India. Thus, while a comparison between the two cultures was possible for the stroking construct, comparisons for the other non-verbal parenting constructs within PICTS were not. Analyses revealed higher rates of early stroking being reported for the United Kingdom than India, but no sex differences in rates in either country and no differential sex difference by culture. We conclude that PICTS items can be used reliably in both countries to conduct further research on the role of early tactile stimulation in shaping important child development outcomes.

Parental Perception of Vocal Contact with Preterm Infants: Communicative Musicality in the Neonatal Intensive Care Unit

In this study, we evaluate mothers’ subjective experience of speaking and singing to their infants while they are in their incubators. We also discuss the relevance of the theoretical framework of Communicative Musicality for identifying the underlying mechanisms that may help explain its beneficial effects, both for parents and infants. Nineteen mothers talked and sung to their stable preterm infants in the incubators, for 5 min each, in three sessions over a period of 6 days. After each session, mothers were asked to assess in a self-report questionnaire the ease and the effectiveness of addressing their infants by speaking and singing and their prior musical experience. Perceived ease and effectiveness in communication were found to increase progressively from one session to the next. Mothers rated the speech to be increasingly more effective. This intuitive mean of interaction between parents and infants could be encouraged and supported by the nurses and the medical staff. Furthermore, individual musical experience affects perceived ease of communicating vocally with infants after a premature birth and should thus be encouraged during pregnancy.

Implementing a Skin-to-Skin Care and Parent Touch Initiative in a Tertiary Cardiac and Surgical Neonatal Intensive Care Unit

BACKGROUND

Skin-to-skin care (SSC) has been integrated as an essential component of developmental care for preterm infants. Despite documented benefits, SSC is not routinely practiced in the cardiac and surgical neonatal intensive care unit, with a predominantly term population, due to staff apprehension, patient factors and acuity, and environmental constraints.

PURPOSE

The purpose of this quality improvement project was to increase SSC, parental holds, and parent touch events for infants in our cardiac and surgical neonatal intensive care unit. When traditional SSC was not possible, alternative holds and alternative parent touch (APT) methods were encouraged.

METHODS

Quality improvement and qualitative descriptive methodology were utilized to assess baseline, develop education and practice changes, and evaluate the use of SSC, holds, and APT methods at 12 and 18 months postintervention. Implementation included educational tools and resource development, simulations, peer champions, in-class teaching, and team huddles. Decisions around the type of hold and parent touch were fluid and reflected complex infant, family, staff, and physical space needs.

FINDINGS

Given its initial scarcity, there was an increased frequency of SSC and variety of holds or APT events. Staff survey results indicated support for the practice and outlined persistent barriers.

IMPLICATIONS FOR PRACTICE

Skin-to-skin care, holds, and APT practices are feasible and safe for term and preterm infants receiving highly instrumented and complex cardiac and surgical care.

IMPLICATIONS FOR RESEARCH

Future research regarding the intervention's impact on neurodevelopmental outcomes of infants and on parent resilience in the surgical and cardiac neonatal intensive care unit is warranted.

Mother-Infant Skin-to-Skin Contact: Short- and Long-Term Effects for Mothers and Their Children Born Full-Term

This brief report reviews findings from a longitudinal study of skin-to-skin contact (SSC) with mothers and full-term infants and a follow-up study of these dyads when the children were 9 years. Findings infer the positive influence of SSC on mother-child interactions in infancy and into children's middle childhood. Mothers and infants in SSC and control groups were seen when infants were 1 week, 1 month, 2 months, and 3 months. SSC group mothers reported fewer depressive symptoms in infants' early weeks and had a greater reduction in salivary cortisol, a physiological stress indicator, in infants' first month (Bigelow et al., 2012). SSC group mothers who initially chose to breastfeed continued to breastfeed their infants throughout the 3 months, whereas breastfeeding mothers in the control group declined over the visits (Bigelow et al., 2014). When engaged in the Still Face Task with their mothers, SSC group infants showed the still face effect with their affect at 1 month, a month before the control group infants did so (Bigelow and Power, 2012). At 3 months, SSC group infants were social bidding to their mothers during the still face phase. When the children were 9 years, the mother-child dyads engaged in conversations about the children's remembered emotional events (Bigelow et al., 2018). Mother-child dyads who had been in the SSC group showed more engagement and reciprocity in the conversations than mother-child dyads who had been in the control group. Oxytocin, which is induced by SSC, is hypothesized to be an underlying factor that helped the mother-infant relationship have a positive trajectory with long-term benefits.

Culture, carrying, and communication: Beliefs and behavior associated with babywearing

Ethnographic research suggests mother-infant physical contact predicts high levels of maternal responsiveness to infant cues, yet it is unclear whether this responsiveness is driven by the act of physical contact or by underlying beliefs about responsiveness. We examine beliefs and behavior associated with infant carrying (i.e., babywearing) among U.S. mothers and experimentally test the effect of mother-infant physical contact on maternal responsiveness. In Study 1 (N = 23 dyads), babywearing mothers were more likely to interact contingently in response to infant cues than non-babywearing mothers during an in-lab play session. In Study 2 (N = 492 mothers), babywearing predicted maternal beliefs emphasizing responsiveness to infant cues. In Study 3 (N = 20 dyads), we experimentally manipulated mother-infant physical contact in the lab using a within-subjects design and found that babywearing increased maternal tactile interaction, decreased maternal and infant object contact, and increased maternal responsiveness to infant vocalizations. Our results motivate further research examining how culturally-mediated infant carrying practices shape the infant's early social environment and subsequent development.

The effect of mother-infant skin-to-skin contact on Ghanaian infants' response to the Still Face Task: Comparison between Ghanaian and Canadian mother-infant dyads

The effect of mother-infant skin-to-skin contact on Ghanaian infants' developing social expectations for maternal behavior was investigated. Infants with high and low mother-infant skin-to-skin contact experience in the infants' first month engaged with their mothers in a Still Face Task at 6 weeks of age. Infants with high skin-to-skin contact experience, but not those with low skin-to-skin contact experience, demonstrated the still face effect with their smiles. Infants with both high and low skin-to-skin contact experience demonstrated the still face effect with their visual attention. The behaviors of the Ghanaian infants and their mothers during the task were compared to archival evidence of Canadian mother-infant dyads' behaviors in skin-to-skin and control groups who engaged in the Still Face Task at the infant ages of 1 and 2 months. Similarities and differences between the behaviors of the mother-infant dyads in the two cultures were assessed.

Historical background to maternal-neonate separation and neonatal care

Maternal-neonate separation after birth is standard practice in the modern obstetric care. This is however a relatively new phenomenon, and its origins are described. Around 1890, two obstetricians in France expanded on a newly invented egg hatchery as a method of caring for preterm newborns. Mothers provided basic care, until incubators became part of commercial exhibitions that excluded them. After some 40 years hospitals accepted incubators, and adopted the strict separation of mothers from babies observed at the exhibitions. The introduction of artificial infant formula made the separation practical, and this also became normal practice rather than breastfeeding. Incubators and formula were unquestioned standard practices before randomized controlled trials were introduced, and therefore never subjected to such trials. The introduction of Kangaroo Care began 40 years ago in Colombia, now as a novel intervention. Recent trials do in fact show that maternal-neonate separation is detrimental to mothers and babies. Recent scientific discoveries such as the microbiome, epigenetics, and neuroimaging provide the scientific explanations that have not been available before, suggesting that skin-to-skin contact and breastfeeding are defining for the basic reproductive biology of human beings.

Effects of a short video feedback intervention on enhancing maternal sensitivity and infant development in low-income families

This study evaluated the effects of a short video feedback intervention aimed at enhancing maternal sensitivity and the development of infants from low-income families in a randomized controlled trial. Forty-four mother-infant dyads living in low-income communities from Salvador, Brazil were randomly assigned between intervention and control groups. Maternal sensitivity was assessed during free-play and infant development was evaluated with a standardized scale. Intervention took place in eight home visits between the infant's third and tenth month. Results showed mothers in the intervention group interpreted the meaning of their infants' behavior more often (r = 0.33), asked babies more questions (r = 0.39), and were less intrusive (r = 0.47) when compared to controls on posttest. The absence of significant intervention effects on infant development suggests the need for additional intervention strategies and a greater time lag between maternal sensitivity and infant development assessments to detect possible delayed effects.

Sucrose vs. skin to skin care for preterm neonatal pain control-a randomized control trial

OBJECTIVE

To compare the efficacy of SSC with oral Sucrose for pain management in preterm neonates.

METHODOLOGY

Parallel-group, assessor-blinded randomized control trial conducted from February-June 2017 at a level 3B-NICU. Hundred preterm neonates (29-0/7 to 36-6/7 weeks gestational age) requiring heel-stick were randomly assigned (1:1), to SSC (50, Group-A) and Sucrose (50, Group-B). In Group-A, SSC was provided at least 10 min before the procedure. In Group-B, 0.2 ml of oral Sucrose was provided 2 min before the procedure. Blinded assessment of Premature Infant Pain Profile (PIPP) score was done 30 s post-procedure using recorded videos.

RESULTS

Baseline variables were [Mean(SD)] gestational age [32.79(2.34) weeks], age [14.04(11.10) days] and birth weight [1.62(0.35) kilograms]. PIPP score was less in group- A vs. B but could not achieve statistical significance [Mean(SD): 7.74(2.43) vs. 8.1(2.82), p = 0.50 CI of the difference: (-1.40,0.68)].

CONCLUSIONS

SSC and Sucrose have comparable efficacy in managing pain in premature neonates.

An Observational Cohort Study Examining the Effect of the Duration of Skin-to-Skin Contact on the Physiological Parameters of the Neonate in a Neonatal Intensive Special Care Unit

BACKGROUND

Focus on skin-to-skin contact (SSC) as a family-centered care intervention in Neonatal Intensive Special Care (NISC) Units continues to increase. Previously, SSC has been shown to improve neonatal physiological stability, support brain development, and promote bonding and attachment. Limited research exists investigating SSC duration and neonatal physiological responses.

PURPOSE

This study examined the relationship between SSC duration and the neonate's oxygen saturation, heart rate (HR), respiratory rate (RR), and temperature.

METHOD

An observational cohort study was conducted at The Royal Women's Hospital NISC Unit in Melbourne, Australia. For each neonate participant, 1 SSC with their parent was studied (parent convenience) and neonatal physiological parameters recorded, with a bivariate correlation used to explore the relationship between the duration of SSC and the percentage of time during SSC that the neonate's physiological variables remained within a target range.

FINDINGS

No correlation existed between the duration of SSC and the neonatal physiological variables of oxygen saturation, HR, RR, and temperature. However, neonatal oxygen requirement was more often reduced across the duration of SSC.

IMPLICATIONS FOR PRACTICE AND FUTURE RESEARCH

Due to previously documented benefits to neonates physiologically from SSC, and our supportive finding that SSC reduces neonatal oxygen requirement, we believe that this study adds to the evidence to support promotion of SSC in NISC Units. The duration of SSC does not appear to negatively impact the physiological effects to the neonate. Thus, SSC should be encouraged in all NISC Units to be conducted for the length of time the parent is able. This study should be repeated with a larger sample size.

Physiological benefits to parents from undertaking skin-to-skin contact with their neonate, in a neonatal intensive special care unit

There has been increased focus on the use of family-centred care interventions, such as skin-to-skin contact (SSC) in Neonatal Intensive Special Care (NISC) Units over the past two decades. SSC between a parent and their neonate has previously shown to promote positive mental and emotional health in parents and assist in bonding and attachment between parent and neonate. The purpose of this study was to investigate the effect that SSC between parent and their neonate has on the parent's heart rate (HR) and blood pressure (BP). There has been a lack of prior research investigating the physiological responses from SSC on parents, hence the need to conduct this study. The study was conducted as an observational cohort study at The Royal Women's Hospital NISC Unit in Melbourne, Australia. One SSC between parent and neonate was recorded, and three repeated measures analysis of variance (anova) were conducted to investigate the relationship between SSC and the parent's HR, systolic BP and diastolic BP. The study found statistically significant differences between the parent's initial HR and BP, to measurements taken during the SSC (p < 0.05). This may suggest that parents' find SSC with their neonate to be a stress-reducing intervention, whilst they are in a NISC Unit. This may in turn promote associated benefits, such as a decrease in parental depression and anxiety, whilst they are in the NISC Unit, physical health benefits, as well as increased feelings of bonding between parent and their neonate. Based on the findings, it is suggested that SSC should be promoted in NISC Units as a family-centred care intervention that lowers parent's HR and BP and may provide associated health benefits.

Early skin-to-skin contact for mothers and their healthy newborn infants

BACKGROUND

Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.

OBJECTIVES

To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies.

SELECTION CRITERIA

Randomized controlled trials that compared immediate or early SSC with usual hospital care.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach.

MAIN RESULTS

We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact).

AUTHORS' CONCLUSIONS

Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.

Looking for cues - infant communication of hunger and satiation during milk feeding

It is known that duration of breastfeeding and responsive feeding are associated with decreased risk of obesity. It is however, not clear whether breastfed infants signal more to mothers to facilitate responsive feeding, compared to formula fed, nor what communication cues are important during the feeding interaction. The present study aimed to explore feeding cues in milk-fed infants and to examine if such cues vary by mode of feeding. Twenty-seven mothers and infants were filmed while breastfeeding or formula feeding. Infants' age ranged from 3 to 22 weeks. Feeding cues were identified using a validated list of communication cues (NCAST). The frequency of each cue during the beginning, middle, and end of the meal was recorded. There were 22 feeding cues identified during the feeds, with significantly more frequent disengagement cues expressed than engagement cues. Significantly more frequent feeding cues were observed at the beginning than at the end of the meal showing that cue frequency changes with satiation. Breastfeeding infants exhibited more engagement and disengagement cues than formula fed infants. Supporting mothers to identify engagement and disengagement cues during a milk feed may promote more responsive feeding-strategies that can be acquired by mothers using different modes of feeding.

Hypothesis on supine sleep, sudden infant death syndrome reduction and association with increasing autism incidence

AIM: To identify a hypothesis on: Supine sleep, sudden infant death syndrome (SIDS) reduction and association with increasing autism incidence.

METHODS: Literature was searched for autism spectrum disorder incidence time trends, with correlation of change-points matching supine sleep campaigns. A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.

RESULTS: In five countries (Denmark, United Kingdom, Australia, Israel, United States) with published time trends of autism, change-points coinciding with supine sleep campaigns were identified. The model proposes that supine sleep does not directly cause autism, but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility, thereby specifically increasing the incidence of autism without intellectual disability.

CONCLUSION: Supine sleep is likely a physiological stressor, that does reduce SIDS, but at the cost of impact on emotional and social development in the population, a portion of which will be susceptible to, and consequently express autism. A re-evaluation of all benefits and harms of supine sleep is warranted. If the SIDS mechanism proposed and autism model presented can be verified, the research agenda may be better directed, in order to further decrease SIDS, and reduce autism incidence.

Interactional pattern analysis of mother–baby pairs: Kangaroo mother care versus incubator care

Within the field of neonatal care, two approaches have gained prominence – incubator care and kangaroo mother care. Each contributes to a baby’s physiological well-being. The aim of this study was to conduct an investigation into the effects of incubator care and kangaroo mother care from a psychological perspective – specifically an interactional approach – by undertaking interactional pattern analyses of mother–baby pairs receiving incubator care and kangaroo mother care, respectively. Person-centred interviews were conducted and audio recorded with 17 mothers whose babies were receiving either incubator care or kangaroo mother care at the Dr George Mukhari Academic Hospital in Ga-Rankuwa, South Africa. Each interview was studied by an independent clinical psychologist trained in observation and, in particular, the interactional pattern analysis and who then completed an adapted interactional pattern analysis questionnaire. The procedure yielded standardised interactional pattern analyses for the mother–baby pairs. Mann–Whitney U tests revealed that, in relation to their babies, the mothers in the kangaroo mother care group yielded significantly more effective interactional patterns than those in the incubator care group, highlighting that, in terms of the interactional approach, kangaroo mother care may be the preferred method of neonatal care.

Increased rate of parental postpartum depression and traumatization in moderate and late preterm infants is independent of the infant's motor repertoire

BACKGROUND

Moderately and late preterm infants represent a considerable and increasing proportion of infants cared for in neonatal departments worldwide. Parents of preterm infants are at risk of postpartal depression (PPD) and posttraumatic stress disorder (PTSD), and preterm infants are at risk of developmental impairment.

AIM

This study aimed to assess (1) the incidence of parental PPD and PTSD in moderate to late preterm infants in comparison to full-term infants and (2) the influence of infants' motor repertoire assessed by Prechtl's general movements and illness severity on parental PPD and PTSD.

SUBJECTS

We studied 60 mothers and 56 fathers of 69 preterm infants (born at 32 to 37 weeks of gestation) and 32 mothers and 29 fathers of 34 full-term infants.

OUTCOME MEASURES

We assessed the incidence of parental PPD, PTSD and perceived social support as well as infants' illness severity and motor repertoire at birth, term and 3 months corrected age.

RESULTS

Preterm mothers and fathers had significant higher depression scores after birth compared to full-term parents (p=0.033 and 0.021). Preterm fathers also had higher traumatization scores compared to full-term fathers (p=0.007). Probable or possible PPD/PTSD was not associated with infant's illness severity or quality of motor repertoire. No differences in motor development were found between preterm and full-term infants.

CONCLUSION

Moderate to late preterm infants' parents are at increased risk for PPD irrespective of infants' motor repertoire or illness severity.

Maternal attention and preterm infant feeding

PURPOSE

The purpose of this study was to explore the relationships among the mother's internal working model of feeding, attentional process, feeding behaviors, and responsiveness accounting for maternal psychological distress, which may contribute to preterm infants' feeding difficulties.

DESIGN AND METHODS

In this descriptive study, 21 mother-preterm infant dyads were videotaped during feeding.

RESULTS

Surprisingly, the internal working model of feeding was a significant negative predictor of maternal feeding behaviors and maternal attention. All other correlations were non-significant.

CONCLUSIONS

Given the early timing of the data collection, it is possible that mothers had not developed a frame of reference of their infant as a person. Research to help further understand factors and timing affecting maternal feeding behaviors is needed.

NICU nurses' ambivalent attitudes in skin-to-skin care practice

This article illuminates the essence of Neonatal Intensive Care Unit (NICU) nurses' attitudes in skin-to-skin care (SSC) practice for preterm infants and their parents. Health care providers are in a unique position to influence the dynamic between infants and parents, and SSC affects both partners in the dyad. The design is descriptively phenomenological in terms of reflective lifeworld approach. Eighteen Swedish, Danish, and Norwegian nurses from NICUs offering varied possibilities and extents of SSC participated. NICU nurses' attitudes in SSC practice are ambivalent. The nurses consider the sensory, wellness, and mutuality experiences to be primary and vital and enact SSC as much as possible. But "as much as possible" is a broad and varied concept, and their attitudes are ambivalent in terms of not always facilitating what they consider to be the optimal caring conditions. The source of NICU nurses' ambivalent attitudes in SSC practice is a complex interplay of beliefs, norms, and evidence, which have a multidisciplinary basis. The ambivalent attitudes are, to a great extent, the result of the need to balance these multidisciplinary concerns. This needs to be acknowledged in considering SSC practice, as well as acknowledging that clinical judgments concerning optimal SSC depend on parents and infants unlimited access to each other, which NICU nurses can influence.

Early skin-to-skin contact for mothers and their healthy newborn infants

BACKGROUND

Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future physiology and behavior.

OBJECTIVES

To assess the effects of early SSC on breastfeeding, physiological adaptation, and behavior in healthy mother-newborn dyads.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), made personal contact with trialists, and consulted the bibliography on kangaroo mother care (KMC) maintained by Dr. Susan Ludington.

SELECTION CRITERIA

Randomized controlled trials comparing early SSC with usual hospital care.

DATA COLLECTION AND ANALYSIS

We independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Thirty-four randomized controlled trials were included involving 2177 participants (mother-infant dyads). Data from more than two trials were available for only eight outcome measures. For primary outcomes, we found a statistically significant positive effect of early SSC on breastfeeding at one to four months postbirth (13 trials; 702 participants) (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.06 to 1.53, and SSC increased breastfeeding duration (seven trials; 324 participants) (mean difference (MD) 42.55 days, 95% CI -1.69 to 86.79) but the results did not quite reach statistical significance (P = 0.06). Late preterm infants had better cardio-respiratory stability with early SSC (one trial; 31 participants) (MD 2.88, 95% CI 0.53 to 5.23). Blood glucose 75 to 90 minutes following the birth was significantly higher in SSC infants (two trials, 94 infants) (MD 10.56 mg/dL, 95% CI 8.40 to 12.72).The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes.

AUTHORS' CONCLUSIONS

Limitations included methodological quality, variations in intervention implementation, and outcomes. The intervention appears to benefit breastfeeding outcomes, and cardio-respiratory stability and decrease infant crying, and has no apparent short- or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations and exact probability values.