Mental health concerns of the premature infant through the lifespan

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.

Pilot Study of Sham Feeding in Postoperative Neonates

OBJECTIVE

Sham feeding may enhance development of oral skills in neonates after bowel surgery and decrease stress levels in mothers. In this pilot study, we test the feasibility of sham feeding, identify safety hazards, and assess maternal satisfaction.

STUDY DESIGN

A convenience sample of 15 postoperative neonates was enrolled. Sham feeding with unfortified human milk was offered following a strict advancement protocol beginning with 5 mL once daily and increasing up to 30 mL, three times daily. Continuous gastric suction was used during sham feeding. Each mother completed a satisfaction survey. Sham-fed gastroschisis patients were compared with a historic cohort.

RESULTS

All 15 patients were able to sham feed. A total of 312 sham feeds were offered with a median of 23 sham events per patient. Four minor complications occurred during sham feeding. No differences were noted between 11 sham-fed gastroschisis patients and 81 historic controls. The mothers reported a decrease in stress after sham feeding using a 5-point score (3.8 ± 1.4 vs. 1.5 ± 0.7, p < 0.005) and 100% satisfaction with sham feeding.

CONCLUSION

Sham feeding is feasible for neonates after bowel surgery and is highly rated by mothers.

KEY POINTS

· Sham-feeding human milk to neonates after bowel surgery is feasible and safe.. · A novel postoperative sham feeding protocol is described.. · Mothers of sham-fed infants report it reduces stress compared with not feeding..

Risk Factors for Parenting Stress in Parents of Children Treated with Laser Surgery for Twin-Twin Transfusion Syndrome 2 Years Postpartum

OBJECTIVE

Twin-twin transfusion syndrome (TTTS) is a rare but serious condition that can occur in monochorionic and diamniotic twin pregnancies. Research indicates almost half of postpartum mothers with TTTS may have clinically significant levels of stress. However, no studies have measured the levels of parenting stress at 2 years postpartum, and little research has been conducted on sources of stress.

STUDY DESIGN

A prospective cohort study was conducted. Data were collected from parents whose children were treated with laser ablation in utero and were 2 years old at the time of screening. The Parenting Stress Index - Short Form (PSI-SF) and its three subscales were used to collect data. Descriptive, bivariate, and multivariate analyses were conducted to determine significant predictors associated with each outcome.

RESULTS

A total of 99 children from 56 families were enrolled. Unmarried status (B = -22.8; p = 0.039) and lower maternal educational level (B = -7.8; p = 0.01) were both significantly associated with higher PSI-SF total score.

CONCLUSION

Subgroups of parents whose pregnancy required laser surgery for TTTS may continue to have clinically significant levels of stress at 2 years postpartum. It is important the health care team is aware of this and the sociodemographic risk factors to provide appropriate support for families.

Follow-Up de Nascidos Prematuros: Uma Revisão Sistemática da Literatura

Resumo Objetivou-se mapear estudos científicos sobre follow-up de prematuros na área da psicologia. Buscou-se no portal BVS artigos empíricos publicados até dezembro de 2017 pelos descritores prematur* AND follow up AND child AND psychology. A partir dos critérios adotados, analisou-se 48 artigos, nas categorias: faixa etária em que os prematuros foram avaliados; objetivos do estudo; tipo de avaliação realizada; e resultados encontrados. Destaca-se que a metade realizou o follow-up entre o nascimento e a adolescência, a maioria investigou o desenvolvimento neuropsicológico e encontrou associações entre a prematuridade, déficits cognitivos e psicológicos. Compreende-se que os estudos priorizam as repercussões no desenvolvimento de habilidades e competências, dando pouca atenção aos aspectos psíquicos e às interações criança-pais-ambiente.

Electronic communication preferences among mothers in the neonatal intensive care unit

OBJECTIVE

Mobile communication with the medical-care team has the potential to decrease stress among parents of infants admitted to the neonatal intensive care unit (NICU). We assessed mobile use and communication preferences in a population of urban minority NICU mothers.

STUDY DESIGN

A 30-question English language survey was administered to mothers of NICU patients.

RESULTS

The survey was completed by 217 mothers, 75% were Black, and 75% reported annual household income below $20 000. Only 56% had a computer with Internet access at home, but 79% used smartphones. Most (79%) have searched the Internet for health information in the past year. Receiving electronic messages about their babies was viewed favorably, and text messaging was the preferred platform. The majority of mothers felt electronic messaging would improve communication but should not replace verbal communication.

CONCLUSION

Mobile communication is used widely in this population of NICU mothers and could potentially improve provider-parent communication and reduce parental stress.

Stability of early risk assessment for autism spectrum disorder in preterm infants

Stability and change in early autism spectrum disorder risk were examined in a cohort of 99 preterm infants (⩽34 weeks of gestation) using the Autism Observation Scale for Infants at 8 and 12 months and the Autism Diagnostic Observation Schedule—Toddler Module at 18 months. A total of 21 infants were identified at risk by the Autism Observation Scale for Infants at 8 months, and 9 were identified at risk at 12 months, including 4 children who were not previously identified. At 18 months, eight children were identified at risk for autism spectrum disorder using the Autism Diagnostic Observation Schedule—Toddler Module, only half of whom had been identified using the original Autism Observation Scale for Infants cutoffs. Results are discussed in relation to early trajectories of autism spectrum disorder risk among preterm infants as well as identifying social-communication deficiencies associated with the early preterm behavioral phenotype.

Growing up after extremely preterm birth: lifespan mental health outcomes

There is growing interest in the long-term mental health sequelae of extremely preterm birth. In this paper we review literature relating to mental health outcomes across the lifespan. Studies conducted in the preschool years, school age and adolescence, and adulthood show continuity in outcomes and point to an increased risk for inattention, socio-communicative problems and emotional difficulties in individuals born extremely preterm. Both behavioural and neuroimaging studies also provide evidence of a neurodevelopmental origin for mental health disorders in this population. Here we summarise contemporary evidence and highlight key methodological considerations for carrying out and interpreting studies in this field.

Early educational and behavioral RCT interventions to reduce maternal symptoms of psychological trauma following preterm birth: a systematic review

Early behavioral and educational interventions have been developed to reduce maternal symptoms of psychological trauma (depression, anxiety, parenting stress, acute stress disorder, and posttraumatic stress disorder) following preterm birth (PTB). Aims of this systematic review were to critically assess study methodology and provide a synthesis of existing randomized control trial (RCT) interventions and to estimate effects of the interventions in reducing the maternal symptoms across studies. Four electronic databases were systematically searched to locate relevant RCTs using preestablished eligibility criteria. Data from 8 qualifying RCTs were synthesized. Two reviewers independently assessed study methodology using appraisal checklists. Considerable heterogeneity precluded calculation of pooled estimates. There is evidence that mothers of very preterm infants of low-birth-weight experience major depression for up to 12 months following PTB. Sound interventions implemented during and following infant hospitalization and grounded in coping and self-regulation had a small to moderate effect in reducing maternal depression and anxiety and parenting stress for up to 2 months and 12 months respectively. Clinicians can use existing evidence to help guide best practices. Future high-quality RCTs and meta-analysis require that researchers improve study methodology and include analysis of data on maternal hormonal stress and history of psychological symptoms including during the pregnancy.