"Weathering the storm:" Mothers' and fathers' experiences of parenting a preterm infant

Fathers' experiences of nurses' roles and care practices during their preterm infant's stay in the neonatal intensive care unit

INTRODUCTION

Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents.

AIM

Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU.

DESIGN

Qualitative study using ethnographic data collection techniques.

METHODS

Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis.

RESULTS

Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities.

CONCLUSION

Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial.

RELEVANCE TO CLINICAL PRACTICE

Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities.

REPORTING METHOD

Adherence to the COREQ guidelines.

Maternal Reports of Preterm and Sick Term Infants' Settling, Sleeping and Feeding in the 9 Months after Discharge from Neonatal Nursery: An Observational Study

The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU.

Development and psychometric evaluation of "Caring Ability of Mother with Preterm Infant Scale" (CAMPIS): a sequential exploratory mixed-method study

BACKGROUND

Caring ability is one of the most important indicators regarding care outcomes. A valid and reliable scale for the evaluation of caring ability in mothers with preterm infants is lacking.

OBJECTIVE

The present study was conducted with the aim of designing and psychometric evaluation of the tool for assessing caring ability in mothers with preterm infants.

METHOD

A mixed-method exploratory design was conducted from 2021 to 2023. First the concept of caring ability of mothers with preterm infants was clarified using literature review and comparative content analysis, and a pool of items was created. Then, in the quantitative study, the psychometric properties of the scale were evaluated using validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 401 mothers with the mean age of 31.67 ± 6.14 years to assess the construct validity.

RESULT

Initial caring ability of mother with preterm infant scale (CAMPIS) was developed with 64 items by findings of the literature review, comparative content analysis, and other related questionnaire items, on a 5-point Likert scale to be psychometrically evaluated. Face, content, and construct validity, as well as reliability, were measured to evaluate the psychometric properties of CAMPIS. So, the initial survey yielded 201 valid responses. The three components: 'cognitive ability'; knowledge and skills abilities'; and 'psychological ability'; explained 47.44% of the total observed variance for CAMPIS with 21 items. A subsequent survey garnered 200 valid responses. The confirmatory factor analysis results indicated: χ2/df = 1.972, comparative fit index (CFI) = 0.933, and incremental fit index (IFI) = 0.933. These results demonstrate good structural, convergent, discriminant validity and reliability. OMEGA, average inter-item correlation (AIC), intraclass correlation coefficients (ICC) for the entire scale were at 0.900, 0.27 and 0.91 respectively.

CONCLUSION

Based on the results of the psychometric evaluation of CAMPIS, it was found that the concept of caring ability in the Iranian mothers with preterm infants is a multi-dimensional concept, which mainly focuses on cognitive ability, technical ability, and psychological ability. The designed scale has acceptable validity and reliability characteristics that can be used in future studies to assess this concept in the mothers of preterm infants.

A Concept Analysis of Paternal Bonding With Prematurely Born Infants

BACKGROUND

Maternal bonding in infancy has long been the focus of research and practice. Despite emerging evidence highlighting the importance of paternal bonding, little attention has been focused on fathers. Simultaneously, there is little clarity regarding possible differences between bonding and attachment.

PURPOSE

This article aims to clarify the concept of paternal bonding with infants born prematurely.

METHODS/SEARCH STRATEGY

Using Walker and Avant's approach to concept analysis, we selected databases and searched them for relevant studies published between 2012 and 2022. We identified 28 articles that (1) defined bonding specific to fathers of infants born prematurely, (2) were peer-reviewed, and (3) were in English. From the articles, we extracted and analyzed data specific to concept definitions, antecedents, and consequences.

RESULTS

Regarding paternal bonding with infants born prematurely, our analyses of the 28 studies yielded a conceptual definition of this topic that extends beyond the commonly used definition emphasizing emotional connection. The newly formulated definition covers the cognitive, behavioral, and dynamic, as well as emotional, attributes of bonding. We identify and discuss antecedents and consequences of bonding.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Our findings led to a consistent conceptual definition of the bonding phenomenon in question. The definition should serve as a conceptual basis for future guidelines governing clinical practice and research. Through our findings, nurses can better understand and promote paternal bonding with infants born prematurely. Finally, our findings can improve researchers' exploration of this topic.

Measurement invariance analysis of the Postpartum Specific Anxiety Scale - Research Short Form in mothers of premature and term infants

OBJECTIVE

Mothers of premature infants are more likely to develop anxiety during the first postpartum year than mothers of term infants. However, commonly used measures of anxiety were developed for general adult populations and may produce spurious, over-inflated scores when used in a postpartum context. Although perinatal-specific tools such as the Postpartum Specific Anxiety Scale [PSAS] offer a promising alternative form of measurement, it is not clear whether the measure performs similarly in mothers of premature infants as it does in mothers of term infants. The objective of the current study was to identify whether items on the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) are being interpreted in the same manner in mothers of term infants and mothers of premature infants. Mothers (N = 320) participated in an international on-line survey between February 2022 and March 2023 (n = 160 mothers of premature infants, n = 160 mothers of term infants) where they completed the PSAS-RSF. Data were analysed using a measurement invariance analysis to assess whether constructs of the PSAS-RSF are performing in a similar manner across the two groups.

RESULTS

Whilst the PSAS-RSF achieved configural invariance and so retains its four-factor structure, metric invariance was not reached and so items are being interpreted differently in mothers of premature infants. Items concerning infant-separation, finance, and anxieties surrounding infant health are potentially problematic. Future research must now modify the PSAS-RSF for specific use in mothers of premature infants, to ensure measurement of anxiety in this population is valid.

Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress

Introduction

It is well established that a premature birth increases the likelihood of developing anxiety during the postpartum period, and that the environment of the neonatal intensive care unit (NICU) might be a contributing factor. Mothers of earlier premature infants may experience these anxieties to a higher degree compared to mothers of later premature infants. The aim of this study was to explore the association between prematurity and postpartum-specific anxiety, and the relationship between postpartum-specific anxiety and stress in the NICU.

Materials and methods

Mothers (N = 237) of infants aged between birth and 12 months completed an online survey containing the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). Structural equation modeling was used to analyze the relationship between gestational age and postpartum-specific anxiety, with one-way ANOVAs used to analyze this relationship with respect to categories of gestational age. Hierarchical regression models analyzed the relationship between postpartum-specific anxiety and stress in the NICU.

Results

For the PSAS-RSF, Practical Infant Care Anxieties (p = 0.001), Maternal Competence and Attachment Anxieties (p = 0.033), and Infant Safety and Welfare Anxieties (p = 0.020) were significantly associated with week of gestation. Practical Infant Care and Infant Safety and Welfare Anxieties were significantly higher for mothers of late premature infants, compared to mothers of term infants (p < 0.001; p = 0.019). There were no significant between-group differences with respect to Maternal Competence and Attachment Anxieties. After controlling for potential confounders, Infant Safety and Welfare Anxieties were significantly associated with increased stress in the NICU (p < 0.001) as measured by the PSS:NICU.

Conclusions

Our findings highlight the need for interventions for mothers with premature infants, which specifically target anxieties reflected in the PSAS-RSF, such as routine care and increasing maternal self-efficacy.

Perspectives of extremely prematurely born adults on what to consider in prenatal decision-making: a qualitative focus group study

OBJECTIVE

A shared decision-making (SDM) approach is recommended for prenatal decisions at the limit of viability, with a guiding role for parental values. People born extremely premature experience the consequences of the decision made, but information about their perspectives on prenatal decisions is lacking. Therefore, this study aims to describe their perspectives on what is important in decision-making at the limit of viability.

DESIGN

Semi-structured focus group discussions were conducted, recorded and transcribed verbatim. The data were independently analysed by two researchers in Atlas.ti.

RESULTS

Four focus groups were conducted in the Netherlands, with five to six participants each, born between 240/7 and 300/7 weeks gestation in the period between 1965 and 2002. Considering their personal life experiences and how their extremely premature birth affected their families, the participants reflected on decision-making at the limit of viability. Various considerations were discussed and summarised into the following themes: anticipated parental regret, the wish to look at the baby directly after birth, to give the infant a chance at survival, quality of life, long-term outcomes for the infant and the family, and religious or spiritual considerations.

CONCLUSIONS

Insights into the perspectives of adults born extremely premature deepened our understanding of values considered in decision-making at the limit of viability. Results point out the need for a more individualised prediction of the prognosis and more extensive information on the lifelong impact of an extremely premature birth on both the infant and the family. This could help future parents and healthcare professionals in value-laden decision-making.

Effectiveness of psychosocial interventions on the psychological outcomes of parents with preterm infants: A systematic review and meta-analysis

BACKGROUND

Parents of preterm infants are often thrown unexpectedly into the care of their vulnerable infant, causing them to be stressed and overwhelmed. Social support has been previously highlighted as a crucial factor in helping parents cope with stress. Several psychosocial interventions have thus been developed to support parents of preterm babies, which warrant further investigations.

OBJECTIVES

To evaluate the effectiveness of psychosocial interventions in reducing stress (primary outcome), anxiety, depression, pediatric medical traumatic stress (PMTS) and increasing social support among parents with preterm infants.

METHODS

A systematic-review and meta-analysis were conducted. Eight electronic databases were searched for relevant studies from their respective inception dates till September 2023. Meta-analysis was performed with RevMan, using the random-effects model. Heterogeneity was investigated using Cochran Q and I2 tests, and publication bias was assessed using funnel plots. Subgroup analyses were conducted for follow-up measurement, gender of parent, type of intervention provider, and setting.

FINDINGS

Eighteen studies were included in this review, and all studies were meta-analysed. Participants who received psychosocial interventions reported significantly lower stress and depression in comparison to control group participants. Psychosocial interventions delivered by psychologists and trained researchers were more effective compared to the nurses. The GRADE assessment indicated that the certainty of evidence for all outcomes were very low.

CONCLUSION

Psychosocial interventions effectively reduce stress and depression levels in parents with preterm infants. Our findings encourage the implementation of psychosocial interventions to improve parental psychological wellbeing. Future higher quality trials are needed to measure psychological outcomes among parents, especially fathers.

Effects of an online family-focused parenting support intervention on preterm infants' physical development and parents' sense of competence and care ability: A randomized controlled trial

BACKGROUND

Parenting of preterm infants presents unique challenges, particularly during their transition from hospital to home. Early discharge programs can assist parents during this critical period. However, the feasibility of delivering a family-focused online discharge program remains understudied.

OBJECTIVES

This study was conducted to investigate the impact of a family-focused online parenting support intervention on parents' sense of competence, depression, caregiving, social support, family functioning, and the weight and length of preterm infants.

METHODS

We conducted a single-blind, two-arm randomized controlled trial with a repeated-measures design. Participants were recruited from a specialized tertiary hospital in China between May and December 2022. Forty-five families were randomly assigned to the intervention group and 44 to the control group. The intervention included three components: (1) two one-hour group sessions and three 30-minute individual sessions of online parenting support; (2) two follow-up telephone calls (15-30 min each) post-discharge; and (3) access to online parenting resources. Primary outcomes included parenting sense of competence, parental care ability, and preterm infants' weight and length. Secondary outcomes included depression, social support, and family functioning. Measurements were taken at baseline, preterm infant discharge, one month post-discharge, and three months post-discharge. A generalized estimating equation model was employed based on the intention-to-treat principle for outcome comparison.

RESULTS

Parents in the intervention group showed significant improvements in parenting sense of competence (P < 0.001), parental care ability (P < 0.001), depression (P < 0.001), and social support (P = 0.002). However, no statistically significant differences were observed in preterm infants' weight and length, or in family functioning (P > 0.05).

CONCLUSIONS

Although the intervention did not affect preterm infants' outcomes, the positive enhancements in parenting sense of competence, care ability, depression, and social support indicate that online family-focused parenting support can effectively prepare parents for hospital discharge and the early transition period.

Recalled parental rearing behavior shapes mental health after preterm birth: Evidence from the Gutenberg Prematurity Study

Associations of preterm birth with later-life mental distress are well-established. A research gap concerns the role of psychosocial factors such as the family context. This study investigated associations of recalled parental rearing behavior with both preterm birth characteristics and psychological symptom burden later in life. Based on birth registry data of the Mainz University Hospital in Germany (infants born between 1969 and 2002) and using a selection algorithm, a cohort study comprising four gestational age (GA) strata was conducted (≥ 37 weeks: n = 138; 33-36 weeks: n = 132; 29-32 weeks: n = 106; ≤ 28 weeks: n = 132). Participants underwent a medical examination and completed standardized questionnaires. We investigated differences in dimensions of recalled parental rearing behavior according to GA and tested pre-/perinatal stress indicators and recalled parental rearing behavior as statistical predictors of depression and anxiety symptoms later in life. Lower GA was associated with more recalled emotional warmth and overprotection. Recalled emotional warmth was associated with fewer depression and anxiety symptoms, while recalled overprotection co-occurred with more depression symptoms. The findings indicate the relevance of parental rearing behavior for the offspring's mental health. As preterm birth implicates stress for the whole family requiring adaptive parental behavior, the latter could be an important modifiable risk factor.

Ranking Future Outcomes Most Important to Parents of Children with Bronchopulmonary Dysplasia

OBJECTIVE

To assess which potential future outcomes are most important to parents of children with bronchopulmonary dysplasia, a disease that affects future respiratory, medical, and developmental outcomes for children born preterm.

STUDY DESIGN

We recruited parents from 2 children's hospitals' neonatal follow-up clinics and elicited their importance rating for 20 different potential future outcomes associated with bronchopulmonary dysplasia. These outcomes were identified and selected through a literature review and discussions with panels of parents and clinician stakeholders, via a discrete choice experiment.

RESULTS

One hundred and 5 parents participated. Overall, parents ranked "Will my child be more vulnerable to other problems because of having lung disease?" as the most important outcome, with other respiratory health related outcomes also highly ranked. Outcomes related to child development and effects on the family were among the lowest ranked. Individually, parents rated outcomes differently, resulting in a broad distribution of importance scores for many of the outcomes.

CONCLUSIONS

The overall rankings suggest that parents prioritize future outcomes related to physical health and safety. Notably, for guiding research, some top-rated outcomes are not traditionally measured in outcome studies. For guiding individual counseling, the broad distribution of importance scores for many outcomes highlights the extent to which parents differ in their prioritization of outcomes.

How does stress affect maternal and paternal perceptions of relationship strain after a preterm birth? Results of a retrospective survey study

AIM

Strain on couple relationships is associated with a lower well-being. As premature birth is known to pose stress to parents, this study explores whether interparental relationship strain comes to pass within mothers and fathers during their infant's stay in a neonatal intensive care unit.

METHODS

A retrospective cross-sectional survey was conducted with parents who experienced a preterm birth (September to December 2020). Linear regression was used to analyse associations between stress and relationship strain.

RESULTS

The study included 437 mothers and 301 fathers. Fathers experienced lower relationship strain (M = 2.49, SD = 1.00) than mothers (M = 3.37, SD = 1.04). Overall, a significant association between relationship strain and stress due to the infant's behaviour and appearance was found for mothers (β = 0.16, p = 0.02) and fathers, with a significantly higher association for fathers (β = 0.27, p ≤ 0.002). With regard to parental role alterations, only mothers showed a significant association (β = 0.21, p ≤ 0.001).

CONCLUSION

Although mothers showed higher levels of stress and relationship strain, stress may also have an impact on fathers. Therefore, research should focus on stress prevention measures to meet both maternal and paternal needs.

Prevalence of mental health problems in mothers of preterm infants admitted to NICU: A cross-sectional study

OBJECTIVE

To study the prevalence of mental health problems among mothers of preterm infants admitted to the neonatal intensive care unit (NICU).

METHODS

In this cross-sectional two-arm study, 130 mothers in each group, with either term infants not in NICU or preterm infants admitted to NICU, underwent mental health assessment using the Generalized Anxiety Disorder Scale, Centre for Epidemiologic Studies-Depression Scale, Stanford Acute Stress Reaction Questionnaire and Modified Parental Stress Scale-NICU. Their coping styles and quality of life were also assessed. Data were analyzed using SPSS IBM 25.0.

RESULTS

Anxiety (66.2% versus 46.9%) and depression (45.4% versus 23.1%) were more common among NICU mothers. Regarding subdomains of acute stress reaction, a higher number of NICU mothers showed symptoms of anxiety, re-experience and functional impairment. For mothers with infants in NICU, sight, sound, and parental role alterations were stressful. They had reduced quality of life scores in domains of physical health, psychological health, and social relationships. Also, a higher number of these mothers exhibited problem-solving and emotion-focused coping.

CONCLUSION

Preterm birth with NICU admission of the infant is more stressful for a mother than the term birth of a healthy neonate. It affects her mental health and quality of life. Both the obstetrician and the pediatrician should be mindful of this.

Prevalence of and factors associated with postnatal depression and anxiety among parents of preterm infants: A systematic review and meta-analysis

BACKGROUND

This study aimed to determine the prevalence of and factors associated with postpartum depression and anxiety among mothers and fathers of preterm infants and to examine the relationships between maternal and paternal symptoms.

METHODS

Six electronic databases were searched to identify eligible studies reporting parental depression and anxiety within 1 year postpartum. Data were extracted for a random-effects meta-analysis to estimate the prevalence with 95 % confidence intervals (CIs). Subgroup and meta-regression analyses were conducted to analyze associations between study characteristics and prevalence estimates.

RESULTS

In total, 79 studies were included. The meta-analysis of studies on mothers generated estimates of prevalence for depression (29.2 %, 95 % CI, 21.8 %-37.9 %) and anxiety (37.7 %, 95 % CI, 24.1 %-53.6 %). The meta-analysis of fathers indicated a pooled depression prevalence of 17.4 % (95 % CI, 12.5 %-23.8 %) and an anxiety estimate of 18.3 % (95 % CI, 8.1 %-36.3 %). Assessment time points and methods as well as the geographic continent in which the study was conducted were significant moderators of depression and anxiety. Significant inter-correlations were found between mothers' and fathers' depression and anxiety symptoms (p < 0.05).

LIMITATIONS

Limited data from specific geographic continents, including Africa and Asia.

CONCLUSIONS

Prevalence of depression and anxiety among preterm infants' parents was high, highlighting the need for early psychological screening and assessment. Further research is required to improve services that focus on parents' postpartum psychological needs in the family context.

Not being able to hug our baby before the cables: Early experiences of parents with premature babies

BACKGROUND

The nursing care provided after the intensive care period and discharge can contribute to the optimal growth and development of the baby while protecting the mental health of the parents.

OBJECTIVE

The aim of this study is to examine in detail the experiences of parents with premature babies about having a premature baby and their experiences with the hospitalization process of their babies in the neonatal intensive care unit (NICU).

DESIGN

The methodological approach was informed by Van Manen's hermeneutic phenomenological methodology. The sample consisted of 15 parents who had a preterm baby in the NICU of a state hospital in Turkey.

RESULTS

The data obtained from this study were categorized under four themes: having a preterm baby, perception of intensive care, feelings toward nurses, emotions about discharge and home care.

CONCLUSIONS

Health professionals should know what the parents' perception of being a parent and having a premature baby is.

Caregivers' perception of the role of the socio-environment on their extremely preterm child's well-being

PURPOSE

The purpose of this qualitative descriptive study was to explore primary caregivers' perception of how social-environmental characteristics, and their own role as primary caregivers, affected their extremely preterm adolescent's well-being.

METHODS

Participants were 20 mothers who identified as the primary caregiver of an adolescent born extremely prematurely (<28 weeks gestation) enrolled in the ELGAN cohort study. Data was collected through individual interviews and was analyzed using inductive content analysis.

RESULTS

A total of three themes, and five subthemes, were identified. The two main themes were "familial impact to health and well-being," and "contributors and barriers at the community level." This study described specific familial and community contributors to child and caregiver well-being, including: the importance of advocacy, participating in community activities, and social and familial support networks.

CONCLUSIONS

Overall, while there are individual level characteristics that contribute to well-being, a support structure at the family and community level is essential to children born extremely prematurely, and their mother's, well-being.

PRACTICE IMPLICATIONS

Healthcare providers caring for these families should understand that not only are extremely preterm youth affected by prematurity, but caregivers are also deeply impacted. Therefore, it is essential that maternal and family care is emphasized by nurses and healthcare providers.

Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study

BACKGROUND

Postpartum contraception counseling and method use vary widely among patients who had a preterm birth. We performed this study to explore what issues and concerns individuals with preterm infants requiring intensive care describe as influencing their postpartum contraceptive choices.

METHODS

We conducted a qualitative study using semi-structured interviews with participants who gave birth to a singleton preterm infant admitted to the neonatal intensive care unit (NICU). We explored pregnancy, childbirth, postpartum care, and NICU experiences, as well as future reproductive plans and postpartum contraceptive choices. Two coders used a constant-comparative approach to code transcripts and identify themes.

RESULTS

We interviewed 26 participants: 4 (15%) gave birth at less than 26, 6 (23%) at 26 to 27 6/7, 8 (31%) at 28 to 31 6/7, and 8 (31%) at 32 to 36 6/7 weeks of gestation. We identified three main themes related to future pregnancy plans and contraception choice. First, participants frequently described their preterm birth and their infants' NICU hospitalization as traumatic experiences that affected plans for future pregnancies. The loss of control in predicting or preventing a future preterm birth and uncertainty about their premature child's future medical needs resulted in participants wanting to avoid going through the same experience with another child. Second, participants chose contraception based on previous personal experiences, desired method features, and advice from others. Last, having a preterm birth did not result in any ambivalence among those who desired permanent contraception.

CONCLUSIONS

Preterm birth influences future pregnancy plans. When discussing reproductive goals with patients, clinicians should be aware of potential trauma associated with a premature birth, assess for whether patients want to discuss contraception, and center the conversation around individual needs if patients do desire contraceptive counseling.

Family caregivers' experiences of caring for neonates undergoing enterostomy in China: A qualitative study

AIM

To describe the nursing experiences and care needs of family caregivers caring for neonates with enterostomies in China.

DESIGN

A qualitative study.

METHODS

We conducted semi-structured interviews with family caregivers who care for neonates undergoing enterostomy. Family caregivers were selected using a purposive sampling method from three children's hospitals until no new data were generated (N = 26). Data analysis applied the thematic analysis method. The caregivers' experiences were described using qualitative content analysis.

RESULTS

The experience of family caregivers was described as growing in adaptation, where five main themes emerged: (1) complex emotional responses; (2) uncertainty about everything; (3) lack of confidence, anxiety and helplessness; (4) eagerness for professional support; (5) active adaptation, gain-harvest and gain-growth. These findings increased understanding and added knowledge on this topic that is rarely studied in China. Healthcare authorities and professionals should recognize and understand the lives and situations of family caregivers (whose neonates undergo enterostomy) to better identify their difficulties and needs.

Assessing the psycholinguistic and psychometric properties of the Turkish version of the Transition Questionnaire grounded on the Hospital-to-Home Transition Model

PURPOSE

The aim of this study was to assess the psycholinguistic and psychometric properties of the Turkish version of the Transition Questionnaire, which is grounded on the Hospital-to-Home Transition Model.

DESIGN AND METHODS

This cross-sectional methodological study was conducted with the participation of 380 parents in the neonatal intensive care clinic in a tertiary hospital between February 2020 and January 2021. A data assessment, number and percentage analysis, and language validity, content validity, and construct validity analyses were applied. In addition, a cluster analysis was performed on the sub-dimensions obtained from the questionnaire, and one-way analysis of variance was used to test the difference between the clusters.

RESULTS

The content validity index was determined to be 0.89. It was determined that the sample size was adequate for the factor analysis (with a KMO value of 0.779 and Bartlett's test of sphericity value of χ2(276)=4026.181; p<0.05). As a result of the exploratory factor analysis, 12 items were omitted from the questionnaire. Fit indices of the new three-factor questionnaire structure that was formed upon removal of the items were evaluated by confirmatory factor analysis (χ2/df=4.783, RMSEA = 0.076, GFI = 0.776, AGFI = 0.726, CFI = 0.707, SRMR = 0.097). The reliability coefficient was found to be 0.871-0.716 for the sub-dimensions of the questionnaire and 0.795 for the overall questionnaire.

CONCLUSIONS

It was determined that the Turkish version of the Transition Questionnaire is valid and reliable for making post-discharge evaluations of parents with preterm infants in Turkish society.

Mothers' experiences of a new early collaborative intervention, the EACI, in the neonatal period: A qualitative study

AIM

To explore mothers' experiences of the EArly Collaborative Intervention.

BACKGROUND

Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers' experiences of the new intervention were explored.

DESIGN

A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript.

RESULTS

Two main overarching themes were constructed. The first theme, 'mothers' feelings evoked from the EArly Collaborative Intervention' describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm baby's behaviour increased, and the intervention helped the parents to communicate around their baby's needs. The second theme, 'based on the preterm baby's behavior', describes experiences of the provision and the learning process about their preterm baby's needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby.

CONCLUSIONS

Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their baby's well-being. Furthermore, the intervention felt strengthening for their relationship with the other parent.

RELEVANCE TO CLINICAL PRACTICE

The EArly Collaborative Intervention can support parents' abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well-being.

The Impact of Preterm Birth on Sleep through Infancy, Childhood and Adolescence and Its Implications

There is emergent literature on the relationship between the development of sleep-wake cycles, sleep architecture, and sleep duration during the neonatal period on neurodevelopmental outcomes among children born preterm. There is also a growing literature on techniques to assess sleep staging in preterm neonates using either EEG methods or heart and respiration rate. Upon discharge from hospital, sleep in children born preterm has been assessed using parent report, actigraphy, and polysomnography. This review describes the ontogeny and measurement of sleep in the neonatal period, the current evidence on the impact of preterm birth on sleep both in the NICU and in childhood and adolescence, and the interaction between sleep, cognition, and social-emotional outcomes in this population.

Cognitive Function, Mental Health, and Quality of Life in Siblings of Preterm Born Children: Protocol for a Systematic Review

Background

Children and adults born preterm are at increased risk of cognitive impairments, mental health disorders, and poorer quality of life. Epidemiological studies have shown that the impact of preterm birth extends to the immediate family members; however, existing research have focused on parents, and little attention has been given to siblings.

Objective

The aim of the systematic review described in this protocol is to synthesize currently available evidence on the impact of exposure to preterm birth (ie, having a sibling born preterm) on cognition, mental health, and quality of life of term born siblings (index child) of preterm born children, and to critically appraise the evidence.

Methods

This protocol outlines a systematic review designed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist. We will include all studies that assess outcomes in siblings of children born preterm. Quantitative and qualitative studies will be eligible for the systematic review, and only studies in English will be included. Firstly, search will be conducted electronically on PubMed, Scopus, Embase, Mednar, and opengrey.eu databases and, secondly, manually in Google Scholar and reference lists. The search strategy will include keywords and synonyms, Boolean operators, and text words (ie, within title and abstract). The team of reviewers will screen the search results, extract data from eligible studies, and critically appraise the studies. Analysis will involve both descriptive and quantitative approaches. Meta-analysis will be conducted if appropriate.

Results

This systematic review was registered on PROSPERO (International Prospective Register of Systematic Reviews) on December 18, 2020, and it is currently in progress. The findings will be synthesized to determine the effect of preterm birth on full-term siblings and the quality of the available evidence.

Conclusions

The evidence derived from this study will shed light on gaps and limitations in the field of preterm birth, more specifically, the effect of preterm birth on full-term siblings. In addition, we hope that understanding the impact of preterm birth on family members will inform targeted interventions and policies for those identified at high risk and how to mitigate health risks.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42021222887; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222887

International Registered Report Identifier (IRRID)

DERR1-10.2196/34987

Alberta Family Integrated Care™ and Standard Care: A Qualitative Study of Mothers' Experiences of their Journeying to Home from the Neonatal Intensive Care Unit

Globally, one in ten infants is born preterm. Most preterm infants require care in a level II Neonatal Intensive Care Unit (NICU), which are highly technological critical care environments that can be overwhelming for parents. Alberta Family Integrated Care (AB-FICare™) is an approach to care that provides strategies to integrate parents into their infant’s care team. This sub-study is the first to compare mothers’ experiences in the context of AB-FICare™ and standard care. Semi-structured interviews with mothers from AB-FICare™ (n = 14) and standard care (n = 12) NICUs were analyzed using interpretive description informed by grounded theory methods. We identified a major theme of Journeying to Home with six categories: Recovering from Birth, Adapting to the NICU, Caring for Baby, Coping with Daily Disruption, Seeing Progress, and Supporting Parenting. Mothers in the AB-FICare™ group identified an enhancement to standard care related to building reciprocal trust with healthcare providers that accelerated Journeying to Home.

Optimism as a mediator of the association between social support and peripartum depression among mothers of neonatal intensive care unit hospitalized preterm infants

The birth of a preterm infant and the hospitalization in a neonatal intensive care unit (NICU) add extra functional and emotional demands to the typical transition to motherhood. Therefore, the prevalence of peripartum depression (PPD) among preterm mothers is especially high. As optimism was found to be a mediator of the association between social support and depression, the current study aimed to test this mediation in the population of NICU mothers. A sample of 128 Israeli mothers of 214 NICU hospitalized infants filled out self-report questionnaires regarding background variables, social support, optimism, and PPD symptoms. As hypothesized, optimism was found to partially mediate the association between social support and PPD symptoms among mother of preterm infants. The higher the perceived social support reported, the higher maternal optimism reported, and in turn, the lower PPD symptoms reported. In accordance with the Transactional Stress Theory, social support and optimism reflect maternal secondary appraisals that impact the way mothers of preterm infants cope with the challenging situation of a preterm birth and NICU hospitalization. Healthcare professionals should encourage preterm mothers' use of social support to increase optimism and reduce the risk of developing PPD.

"What are you carrying?" Experiences of mothers with preterm babies in low-resource setting neonatal intensive care unit: a qualitative study

INTRODUCTION

Babies born preterm often have challenges in feeding, temperature control and breathing difficulty and are prone to infection during the neonatal period. These usually necessitate admission to the neonatal intensive care unit (NICU). Admission to NICU disrupts the mother-baby bonding.

OBJECTIVE

This study explored the lived experiences of mothers with preterm babies admitted to NICU in a low-resource setting.

STUDY DESIGN

This was a qualitative study where 16 participants took part in indepth interviews and 35 in focus group discussions. We included mothers who delivered and were caring for preterm babies at the NICU of Mulago National Referral Hospital.

STUDY SETTING

Data were collected from a public hospital, which works as a district and national referral hospital located in the capital of Uganda.

PARTICIPANTS

Fifty-one mothers with preterm babies in the NICU were sampled and recruited after informed consent. Data were analysed using manual thematic analysis.

RESULTS

There were six themes on the experiences of mothers of preterm babies in NICU: constant worry and uncertainty about the survival of their babies, baby feeding challenges, worries of discharge, communication gaps between mothers and nurses, community acceptability and disdain for preterm babies, and financial challenges.

CONCLUSIONS AND RECOMMENDATIONS

Mothers of preterm babies admitted to NICU in a low-resource setting still need a lot of support other than the medical care given to their babies. Support groups in the hospital and community are recommended to help in dealing with these challenges.

Impacts of Neonatal Hospitalization on Families during the 2019 Coronavirus Pandemic

OBJECTIVE

Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19.

STUDY DESIGN

Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The primary outcomes were impact on family life and financial stability, as measured by the Impact on Family scale, an instrument that evaluates changes to family life as a result of infant or childhood illness.

RESULTS

Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. Parents reported significant family impact and greater financial difficulty. Extremely premature infants, lower household income, parent mental health, and lower parental confidence were predictive of greater impacts on family life.

CONCLUSION

Parents reported significant family and financial impacts during their infant's hospitalization amid COVID-19. Further studies are needed to guide clinical practice and inform family-supportive resources that can mitigate consequences to family well-being.

KEY POINTS

· Impact of infant hospitalization in the context of COVID-19 is largely unknown.. · In a cohort of NICU parents during COVID-19, they reported changes to family life and finances.. · Greater impacts were reported by parents with lower income, confidence, and very premature infants..

The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents' Experience

Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.

Father involvement in the care of children born small and sick in Rwanda: Association with children's nutrition and development

BACKGROUND

Little is known about father's involvement in the care of children born with perinatal risk factors. This study aimed to understand father's involvement in the care of children born preterm, low birth weight (LBW) and/or with hypoxic ischemic encephalopathy (HIE) in rural Rwanda and assess child and home environment factors associated with father involvement.

METHODS

A cross-sectional study of children born preterm, LBW or with HIE who were discharged from Kirehe District Hospital neonatal unit from May 2015 to April 2016 and those enrolled in a neonatal unit follow-up programme from May 2016 to November 2017. Interviews were conducted when the children were ages 24-47 months in the child's home. Primary caregivers reported on father involvement in parenting, home environment, child disability, and child development outcomes. Children's nutritional status were directly measured. Only children whose fathers were living in the home were included in the sample. Bivariate analyses were conducted using Fisher's exact test and Wilcoxon Rank Sum test.

RESULTS

A total of 236 children aged 24-47 months were included in this study, 66.4% were born preterm or LBW with a mean age of 33.3 months. 73.5% of children were at risk of disability and 77.7% had potential delay in overall child development. 15.5% of fathers reported engaging in four or more activities with their child in the last 3 days. Factors associated with father involvement included smaller household size (p = 0.004), mother engaged in decision-making (p = 0.027), being on-track in developmental milestones for problem solving (p = 0.042) and mother's involvement in learning activities (p = 0.043); the number of activities a father engaged in was significantly associated with the child's overall development (p = 0.032).

CONCLUSION

We found that father involvement in activities to support learning was low amongst children born preterm/LBW and/or with HIE. Programme interventions should encourage fathers to engage with their children given the benefits for children's development.

Transitional care experiences of caregivers of preterm infants hospitalized in a neonatal intensive care unit: A qualitative descriptive study

Aim

To describe the transitional care experiences and nursing needs of caregivers of preterm infants hospitalized in neonatal intensive care units (NICUs).

Design

A qualitative descriptive study.

Methods

We conducted semi‐structured interviews with the 24 caregivers of preterm infants admitted to Children's Hospital, Soochow University. All data were collected by a trained and experienced interviewer. The caregivers' experiences were described using qualitative content analysis.

Results

Six Five themes emerged from the analysis: (a) uncertainty about the disease; (b) anxiety due to restricted visitation; (c) exhaustion from overwork; (d) emotional depression; (e) low care ability; (f) a variety of channels for help and a positive response. This study provides a basis for understanding the needs of their caregivers so that effective coping strategies can be implemented. Nurses' education and practice should focus on understanding the real experiences of the parents of preterm infants during transitional nursing.

Mind-Mindedness and Parenting Stress: A Cross-Sectional Study in a Cohort of Mothers of 3-Month-Old Full-Term and Preterm Infants

The preterm birth of a child is a sudden event that can disturb the overall family system and its functioning. Many studies have been conducted with the aim of exploring how and the degree to which this event affects the early mother–infant dyadic relationship and maternal well-being, with often mixed findings. The present study investigates the combined effect of preterm birth and parenting stress on mind-mindedness, a parenting dimension that captures how parents represent and treat their children as separate individuals with their own mental states and activities. A hundred and ten mothers and their three-month-old infants (preterm = 54; full-term = 56) participated in the study. Mind-mindedness was assessed by coding mothers’ comments about infant’s mental states during dyadic face-to-face interaction. Parenting stress was evaluated with the Parenting Stress Index Short Form questionnaire. Mothers of preterm infants reported similar levels of appropriate and non-attuned mind-related comments to mothers of full-term infants. The reported parenting stress levels were also comparable. Interestingly, only mothers of preterm infants who reported higher stress in parenting showed more non-attuned comments during the interaction. The results underline the need to address preterm birth as a complex event, going beyond group differences and considering its interplay with other risk or protective factors in shaping children’s and parents’ adjustments and well-being.

Mind-mindedness and parenting stress in mothers of preterm and full-term infants: The moderating role of perceived social support

The goal of this study was to examine the effects of preterm birth and maternal childbirth-related posttraumatic stress and parenting stress on maternal mind-mindedness (MM). The study also investigated the effects of perceived social support on parenting stress and MM. Sixty-five preterm (N = 32) and full-term (N = 33) mother-infant dyads were observed at 6 months. Measures of maternal MM were obtained from observations of mother-infant interaction. Mothers also provided ratings of their posttraumatic stress disorder (PTSD) symptoms, parenting stress, and perceived social support via an online survey. Experiencing a preterm birth did not affect mothers' use of mental state descriptors during mother-infant interaction. Neither childbirth-related posttraumatic stress nor parenting stress directly affected maternal ability to comment on the child's mental states appropriately. However, at medium and high levels of perceived social support, a negative association between parenting stress and MM was observed. Maternal perception of being emotionally supported by significant others promoted MM in mothers showing low or mild levels of parenting stress, but not in mothers experiencing high stress in parenting their infants. Results suggest that a proclivity to MM might be affected by the interaction between parenting stress and social support, rather than by childbirth-related variables, such as prematurity.

The risk of low risk: First time motherhood, prematurity and dyadic well-being

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth-relatively unexplored in the literature-is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers' meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.

Reciprocal Influence of Depressive Symptoms Between Mothers and Fathers During the First Postpartum Year: A Comparison Among Full-Term, Very Low, and Extremely Low Birth Weight Infants

Background: Perinatal depression (PND) in mothers and fathers of very low and extremely low birth weight (VLBW and ELBW) infants has not been studied extensively. In particular, no studies investigated the reciprocal influence of depressive symptoms during the first 12 months postpartum. This study aimed at exploring the impact of the severity of prematurity on maternal and paternal PND during the first postpartum year; specifically, we used an Actor-Partner Interdependence Model (APIM) to test the interdependence of both partners on depressive symptoms. Methods: A total of 177 mothers and 177 fathers were recruited, divided into 38 couples with ELBW infants, 56 with VLBW, and 83 of full-term (FT) infants. PND was evaluated by the Edinburgh Postnatal Depression Scale (EPDS) at 3, 9, and 12 months postpartum (corrected age for preterm infants). Results: Maternal depressive symptoms at 3 months were positively related to those at 9 and 12 months in the 3 groups. Conversely, paternal depressive symptoms assessed at 3 months were positively related to those measured at 9 months for the ELBW group, 12 months for the VLBW group, 9 and 12 months for FT condition. Furthermore, a significantly positive partner effect was observed regarding the influence of 3 month maternal depressive symptoms on paternal depressive symptoms at 9 months, but only in the case of the VLBW group. Conclusion: Prematurity represents a very specific scenario in the transition to parenthood, leading to specific reactions in mothers and fathers, especially in high-risk conditions. Results should be deepened given the relevance of their clinical implications.