Parent and family outcomes following very preterm or very low birth weight birth: a review

Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial

OBJECTIVE

To examine the effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit.

DESIGN

Prospective randomized controlled parallel-group clinical trial.

SETTING

Maternal and Child Health Hospital, Fujian, China.

METHODS

The control group received routine neonatal intensive care unit care, while the intervention group received a web neonatal intensive care unit diary based on routine care. Outcomes, including anxiety, depression, and post-traumatic stress disorder symptoms, quality of life, sleep quality, care ability, and cortisol and melatonin levels, were evaluated at T1 (Time 1, before the intervention), T2 (Time 2, immediately after the intervention), and T3 (Time 3, 1 month after the intervention).

RESULTS

Seventy pairs of parents of preterm infants in the neonatal intensive care unit were randomly allocated to two groups: intervention (n = 35) and control (n = 35). The anxiety scores in the intervention group were significantly lower at T2 and T3 than those in the control group (P < 0.001). The care ability scores in the intervention group were significantly higher at T2 and T3 (P < 0.001). The prevalence of post-traumatic stress disorder at T3 was significantly different between the groups (P = 0.040). No significant differences were observed in the quality of life or sleep quality between the groups at T2 and T3 (P > 0.05). No significant differences were observed in cortisol and melatonin levels between the groups (P > 0.05).

CONCLUSIONS

Web neonatal intensive care unit diaries effectively relieved anxiety symptoms, reduced the prevalence of post-traumatic stress disorder, and enhanced the care abilities of parents of preterm infants in the neonatal intensive care unit.

IMPLICATIONS FOR CLINICAL PRACTICE

Web neonatal intensive care unit diary can be considered in clinical practice as a convenient psychological intervention method, especially among parents of preterm infants in the neonatal intensive care unit.

Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings

BACKGROUND

In recent years, there has been a wide array of research studies published on parental mental health and stress following very preterm birth. This review aims at reviewing the prevalence and risk factors of long-term parental depression, anxiety, post-traumatic stress symptoms and parenting stress following very preterm birth.

METHODS

We searched PubMed, PsychINFO and Web of Science for descriptive, cross-sectional and longitudinal studies published between January 2013 and August 2022.

RESULTS

45 studies met our inclusion criteria. In the first two years, depression, anxiety, post-traumatic stress symptoms and parenting stress were present in ∼20 % of mothers of extreme and very low birth weight (E/VLBW) infants. Long-term psychological distress symptoms could be observed, although few studies have focused on symptoms into school age and longer. Fathers of VLBW infants might experience more psychological distress as well, however, they were only included in ten studies. We found that parental distress is more common when the co-parent is struggling with mental health symptoms. Many risk factors were identified such as social risk, history of mental illness, interpersonal factors (i.e. social support) and child-related factors (i.e. intraventricular hemorrhage, disability, use of medical equipment at home).

LIMITATIONS

Several studies have methodological issues, such as a lack of control of known confounders and there is a large variety of measures employed.

CONCLUSION

Important risk factors for stress and mental health symptoms were identified. More evidence is needed to determine if long-term symptoms persist into school age. Research should focus on taking a family-based approach in order to identify preventive strategies and resilience factors in parents of VLBW infants.

Preterm Birth, Family Income, and Intergenerational Income Mobility

Importance

Preterm birth (PTB) has been associated with lower income in adulthood, but associations with intergenerational income mobility and the role of family socioeconomic status (SES) as modifying factor are unclear.

Objectives

To assess whether the association between PTB and income differs according to family SES at birth and to assess the association between PTB and intergenerational income mobility.

Design, Setting, and Participants

This study comprised a matched cohort of live births in Canada between January 1, 1990, and December 31, 1996, with follow-up until December 31, 2018. Statistical analysis was performed between May 2023 and March 2024.

Exposure

Preterm birth, defined as birth between 24 and 37 weeks' gestational age (with gestational age subcategories of 34-36, 32-33, 28-31, and 24-27 weeks) vs early and full term births (gestational age, 37-41 weeks).

Main Outcomes and Measures

Associations between PTB and annual adulthood income in 2018 Canadian dollars were assessed overall (current exhange rate: $1 = CAD $1.37) and stratified by family income quintiles, using generalized estimating equation regression models. Associations between PTB and percentile rank change (ie, difference between the rank of individuals and their parents in the income distribution within their respective generations) and upward or downward mobility (based on income quintile) were assessed using linear and multinomial logistic regressions, respectively.

Results

Of 1.6 million included births (51.1% boys and 48.9% girls), 6.9% infants were born preterm (5.4% born at 34-36 weeks, 0.7% born at 32-33 weeks, 0.5% born at 28-31 weeks, and 0.2% born at 24-27 weeks). After matching on baseline characteristics (eg, sex, province of birth, and parental demographics) and adjusting for age and period effects, PTB was associated with lower annual income (mean difference, CAD -$687 [95% CI, -$788 to -$586]; 3% lower per year), and the differences were greater among those belonging to families in the lowest family SES quintile (mean difference, CAD -$807 [95% CI, -$998 to -$617]; 5% lower per year). Preterm birth was also associated with lower upward mobility and higher downward mobility, particularly for those born earlier than 31 weeks' gestational age (24-27 weeks: mean difference in percentile rank change, -8.7 percentile points [95% CI, -10.5 to -6.8 percentile points]).

Conclusions and Relevance

In this population-based matched cohort study, PTB was associated with lower adulthood income, lower upward social mobility, and higher downward mobility, with greater differences among those belonging to economically disadvantaged families. Interventions to optimize socioeconomic outcomes of preterm-born individuals would need to define target population considering SES.

The interaction of family functioning and disease- and treatment-related factors on quality of life for children after cancer

PURPOSE

Children with cancer experience low quality of life (QOL), yet heterogeneity underscores a need to understand how risk and resilience factors interact. This study evaluated if family functioning relates to QOL differentially depending on diagnosis and treatment intensity.

METHODS

Participants included children (ages 8-14) who completed treatment within six months for either brain tumor (BT; n = 42) or non-central nervous system solid tumor (ST; n = 29). Caregivers and children rated QOL and family functioning. Treatment intensity was categorized as low, moderate, or high. Cross-informant moderation models tested hypothesized interactions.

RESULTS

Child-reported family functioning significantly interacted with diagnosis and treatment intensity in models of caregiver-reported QOL. More maladaptive family functioning was associated with reduced QOL for children with BT and moderately-intense treatments.

CONCLUSIONS

Children with BT and moderate treatment intensities are sensitive to family functioning, highlighting an at-risk group to target for family-level intervention. Future work should evaluate these associations longitudinally.

Psycho-emotional intervention with parents of very preterm babies during the first year: A single-arm pilot study

Studies of intervention programs that aim to improve the emotional state of parents of children admitted to the neonatal intensive care units (NICU) are scarce in Spain. The aims of this single-arm pilot study are to get to know the emotional profile of parents of high-risk preterm newborns, and to explore parents' patterns of emotional well-being before and after a psychological program called the Parental Empowerment Program, to increase parental readiness levels. The sample was made up of 100 parents (50 couples) who participated in the program. Measurements were taken of post-traumatic stress, depression, and resilience at 1 month and 12 months. Repeated measurements and dyadic data analyses were performed. One month after the birth of the baby and prior to the start of the program, mothers show more symptoms of stress and depression than fathers. After the intervention, both parents experienced improvements in their mood levels. The evidence obtained seems to show that high resilience levels and low post-traumatic stress symptoms are associated with reduced depression levels after implementing the program. However, the heterogeneity of the responses obtained, the observed associations between stress, resilience, and maternal depression, along with the reciprocal influence between maternal and paternal depression 1 year after the intervention, highlight the need for a more in-depth exploration of the interplay between risk and protective factors in this population. Despite the identified potential threats to validity, further work in this direction is recommended, including the implementation of clinical trials to demonstrate intervention efficacy. The adaptation of the parents' mutual emotional adjustment at each stage would allow them to participate more actively in the baby's care.

Parenting stress and health-related quality of life among parents of extremely preterm born early adolescents in England: a cross-sectional study

OBJECTIVE

To determine whether extremely preterm (EP) birth exerts persisting effects on parents in early adolescence.

DESIGN

Cross-sectional survey conducted between March 2017 and October 2018.

SETTING

Evaluation of a longitudinal population-based birth cohort in England at 11 years of age (EPICure2@11 Study).

PARTICIPANTS

Parents of EP (<27 weeks of gestation) adolescents and control parents of term born (≥37 weeks of gestation) classmates of similar age and sex.

MAIN OUTCOME MEASURES

The Parenting Stress Index Short Form (PSI-4-SF) and the Short Form Health Survey (SF-12v1).

RESULTS

The 163 EP and 125 comparison respondents were most commonly mothers in their mid-40s. EP parents reported higher total parenting stress scores compared with controls, overall (adjusted difference in means: 14 (95% CI 9 to 20)) and after exclusion of moderate and severe child disability and multiples (9 (95% CI 3 to 15). Average physical and mental health-related quality of life scores were similar in the two groups (adjusted difference in means physical health: -2 (95% CI -4 to 1) and mental health: -1 (95% CI -4 to 1)). Among EP parents, 12% (20/164) reported the combination of high parenting stress and low mental health scores. With increasing child age, parenting stress scores for preterm parents were lower in contrast to controls who reported increasing parenting stress.

CONCLUSIONS

In early adolescence, compared with parents of term-born children, EP parents experience increased levels of parenting stress that are particularly high among a proportion of parents and associated with lower mental health-related quality of life. Practitioner awareness of this continuing risk throughout childhood is important to support parental abilities and well-being.

Predictors of parenting difficulties at the 18-month health checkups: A retrospective study using administrative data from infant health checkups

OBJECTIVE

This study aimed to identify predictors of parenting difficulties at 18 months from the results of the 4-, 6-7-, and 9-10-month infant health checkups among caregivers who had not experienced difficulties at 4 months.

DESIGN AND SAMPLES

This retrospective study used data from infant health checkups conducted in a city in Tokyo from November 2019 to October 2021. The participants were caregiver-child dyads of children who had undergone four checkups. Low birthweight, preterm, and multiple birth infants, and caregivers who experienced difficulties at 4 months were excluded.

MEASUREMENTS

Data included caregiver, child-rearing environment, and child factors at the 4-, 6-7-, and 9-10-month checkups and caregivers' self-reported parenting difficulties at the 18-month checkup.

RESULTS

Of the 555 caregivers, 48 (8.6%) experienced parenting difficulties at 18 months. Logistic regression analyses showed that mothers' physical condition (4 months), children being male, abnormal child growth (4 months), less than 10th percentile for children's height (6-7 and 9-10 months), and abnormal examination results (6-7 months) were significantly associated with parenting difficulties at 18 months.

CONCLUSIONS

To prevent child abuse, public health nurses should consider the identified factors to detect and support caregivers with emerging parenting difficulties.

Effect of adverse perinatal outcomes on postpartum maternal mental health in low-income and middle-income countries: a protocol for systematic review

INTRODUCTION

More than three-fourths of adverse perinatal outcomes (preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death) occur in low-income and middle-income countries. These adverse perinatal outcomes can have both short-term and long-term consequences on maternal mental health. Even though there are few empirical studies on the effect of perinatal loss on maternal mental illness, comprehensive information on the impact of adverse perinatal outcomes in resource-limited settings is scarce. Therefore, we aim to systematically review and synthesise evidence on the effect of adverse perinatal outcomes on maternal mental health.

METHODS AND ANALYSIS

The primary outcome of our review will be postpartum maternal mental illness (anxiety, depression, post-traumatic stress disorder and postpartum psychosis) following adverse perinatal outcomes. All peer-reviewed primary studies published in English will be retrieved from databases: PubMed, MEDLINE, CINAHL Ultimate (EBSCO), PsycINFO, Embase, Scopus and Global Health through the three main searching terms-adverse perinatal outcomes, maternal mental illness and settings, with a variant of subject headings and keywords. We will follow the Joanna Briggs Institute critical appraisal checklist to assess the quality of the studies we are including. The review findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Estimate-based meta-analysis will be performed. We will assess heterogeneity between studies using the I2 statistics and publication bias will be checked using funnel plots and Egger's test. A subgroup analysis will be conducted to explore potential sources of heterogeneity (if available). Finally, the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

Since this systematic review does not involve human participants, ethical approval is not required. The review will be submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023405980.

Parents' life satisfaction prior to and following preterm birth

The current study tested whether the reported lower wellbeing of parents after preterm birth, relative to term birth, is a continuation of a pre-existing difference before pregnancy. Parents from Germany (the German Socio-Economic Panel Study, N = 10,649) and the United Kingdom (British Household Panel Study and Understanding Society, N = 11,012) reported their new-born's birthweight and gestational age, subsequently categorised as very preterm or very low birthweight (VP/VLBW, < 32 weeks or < 1500 g), moderately/late preterm or low birthweight (MLP/LBW, ≥ 32 weeks and < 37 weeks/≥ 1500 g and < 2500 g), or term-born (≥ 37 weeks and ≥ 2500 g). Mixed models were used to analyse life satisfaction, an aspect of wellbeing, at four assessments-two years and six months before birth and six months and two years afterwards. Two years before birth, satisfaction of prospective term-born, MLP/LBW, or VP/VLBW mothers did not significantly differ. However, mothers of VP/VLBWs had lower satisfaction relative to mothers of term-borns at both assessments post-birth. Among fathers, satisfaction levels were similarly equivalent two years before birth. Subsequently, fathers of VP/VLBWs temporarily differed in satisfaction six months post-birth relative to fathers of term-borns. Results indicate that parents' lower life satisfaction after VP/VLBW birth is not a continuation of pre-existing life satisfaction differences.

Implementing Guidelines for NICU Parent Presence: Effects on Parent and Infant Stress

BACKGROUND

Relationships between parents and infants are essential for mitigating stressors encountered in neonatal intensive care units (NICUs) and are supported by parent presence and engagement.

PURPOSE

The purpose of this study was to compare NICU parent and infant outcomes pre- and postimplementation of an intervention aimed at increasing parent presence and engagement in the NICU. This family-centered care intervention consisted of communicating specific guidelines for parent presence.

METHODS

Data related to parent presence, skin-to-skin care, and breastfeeding; parental stress; infant outcomes including weight gain, length of stay, feeding status at discharge, and stress; and unit-level outcomes were collected from a convenience sample of 40 NICU families recruited preimplementation and compared with data for 38 NICU families recruited postimplementation of specific guidelines for parent presence. To establish comparability of groups, infants were assigned scores using the Neonatal Medical Index.

RESULTS

Parent presence, engagement in skin-to-skin care, and breastfeeding rates were not significantly different between groups. Stress-related outcomes were significantly decreased in NICU mothers, fathers, and infants, and infant feeding outcomes were improved in the postintervention group.

CONCLUSIONS

Specific guidelines for parent presence may represent an invitation for parents to engage with their NICU infants and may positively impact parent and infant stress.

Quality of Life of Mothers and Fathers 4 to 6 Months After Birth: The Effect of a Very Preterm Delivery

OBJECTIVES

The sparse literature on the effect of a preterm delivery on parents' quality of life (QoL) yields inconsistent results, restricting their analysis to mothers. The present study aimed to assess the effect of a very preterm delivery on parents' gender-specific perception of QoL, 4 to 6 months after birth.

METHODS

A total of 117 parents of very preterm infants hospitalized at birth in a level III Neonatal Intensive Care Unit, and 214 parents of never hospitalized full-term infants born in a public maternity, both located in the North of Portugal, participated in the study, 4 to 6 months after delivery (November 2013-June 2015). The Portuguese version of the World Health Organization Quality of Life - BREF Inventory was applied and scores were transformed to reflect a 0 to 100 scale.

RESULTS

The mean [standard deviation (SD)] of overall QoL ranged between 72.1 (13.3) among mothers of full-term infants and 74.6 (12.5) among mothers of very preterm infants. The perception of QoL was not significantly different among parents of very preterm and full-term infants, according to gender. The highest scores were observed in the psychological and physical dimensions, for both mothers and fathers.

CONCLUSIONS FOR PRACTICE

The lack of differences on the perception of QoL among mothers and fathers of very preterm and full-term infants, highlights the need to deeply understand and explore the influence of accommodation mechanisms, the extended family/community and health policies on parental QoL trajectories.

Early psychomotor therapy in very preterm infants does not improve Bayley-III scales at 2 years

AIM

To assess the efficacy of post-hospital psychomotor therapy in the development of very preterm infants at nine and 24 months.

METHODS

We conducted a randomised controlled study at Toulouse Children's Hospital between 2008 and 2014 among preterm infants aged under 30 weeks. All infants in both groups could benefitt from physiotherapy to prevent motor disorders. The intervention group received 20 early post-hospital psychomotor therapy sessions. The development was assessed by the Bayley Scale Infant Development at nine and 24 months.

RESULTS

The intervention and control group contained 77 and 84 infants, respectively, with 57 infants in each group undergoing assessment at 24 months. Boys accounted for 56% of the population. Median gestational age was 28 weeks, range 25-29. The development scores at 24 months did not significantly differ between the randomisation groups. At 9 months, we observed improvements in global motricity (mean difference 0.9 point, p = 0.04) and fine motricity for the subgroup containing educationally underserved mothers (mean difference 1.6 point, p = 0.008). There was no significant difference in neuromotor functioning between the two groups.

CONCLUSION

The benefits of psychomotor therapy were short-lived and did not persist post-intervention. Our results and this organisational model encouraged us to persevere towards similar multi-professional care.

The neonatal perspective of paid family medical leave (PFML)

Paid family medical leave (PFML) offers infants, parents, and society at large numerous health and economic benefits. It has been shown to improve neonatal and maternal outcomes, breastfeeding rates, familial relationships, and decrease gender inequalities in the workplace. Though the economic feasibility of PFML has been well established in many countries, the USA lacks a cohesive and comprehensive federal PFML policy. Neonatal healthcare providers play a critical role in impacting neonatal health and should actively advocate for the development and promotion of a federal PFML policy, particularly one that is inclusive of both mothers and fathers and is at least 12 weeks in duration.

Socioeconomic disadvantage and parental mood/affective problems links negative parenting and executive dysfunction in children born very preterm

Poverty increases the risk of poorer executive function (EF) in children born full-term (FT). Stressors associated with poverty, including variability in parenting behavior, may explain links between poverty and poorer EF, but this remains unclear for children born very preterm (VPT). We examine socioeconomic and parental psychosocial adversity on parenting behavior, and whether these factors independently or jointly influence EF in children born VPT. At age five years, 154 children (VPT = 88, FT = 66) completed parent-child interaction and EF tasks. Parental sensitivity, intrusiveness, cognitive stimulation, and positive and negative regard were coded with the Parent-Child Interaction Rating Scale. Socioeconomic adversity spanned maternal demographic stressors, Income-to-Needs ratio, and Area Deprivation Index. Parents completed measures of depression, anxiety, inattention/hyperactivity, parenting stress, and social-communication interaction (SCI) problems. Parental SCI problems were associated with parenting behavior in parents of children born VPT, whereas socioeconomic adversity was significant in parents of FT children. Negative parenting behaviors, but not positive parenting behaviors, were related to child EF. This association was explained by parental depression/anxiety symptoms and socioeconomic adversity. Results persisted after adjustment for parent and child IQ. Findings may inform research on dyadic interventions that embed treatment for parental mood/affective symptoms and SCI problems to improve childhood EF.

A systematic synthesis of qualitative studies on parents' experiences of participating in early intervention programs with their infant born preterm

Early intervention programs involving both the parent and the infant born preterm have demonstrated positive effects on developmental outcomes for the children. However, studies have also shown that parental engagement and adherence when implementing intervention programs can be challenging. The aim of this review was to provide a comprehensive description and new insights into key messages gleaned from the parent reports on participating in early intervention with their infant born preterm; knowledge vital to facilitate implementation of early interventions into clinical practice when using a model of direct parent involvement. Early intervention is broadly defined as a multi-interdisciplinary field provided to children from birth to five years of age to foster child health, wellbeing, development, adapting parenting and family function. For this systematic synthesis we define early intervention as programs with specific activities completed with the infant during the first year after birth. We assembled qualitative interview studies on parents' experiences with participation in early intervention and applied Malterud's qualitative systematic meta-synthesis to synthesize and translate the original findings across studies. In the analysis we applied enactive concepts of embodiment, autonomy, participatory sensemaking, and agency. 10 qualitative studies were identified and included. The systematic synthesis reveals how parents' successful and meaningful participation in early intervention programs were facilitated by their "active embodied doing." The "embodied doing" appeared as the basis for the parents' sense-making processes, development of confidence, and the ability for parents to see new possibilities for actions within themselves, with and in the child. In that respect, a perception of mutuality in the interaction between parent, infant and interventionist was central. Consequently, an important consideration when implementing early intervention into clinical practice is to promote embodied parent-infant interactions as well as trust between the parent and the interventionist.

Examining the impact of premature birth on parental mental health and family functioning in the years following hospital discharge: A review

BACKGROUND

This review provides an update of the current research related to the impact of extreme and very premature birth on parental mental health and family functioning following discharge from hospital.

METHODS

Full-text peer reviewed articles in English, describing parents' and families' health and wellbeing after the discharge from hospital of their baby using validated questionnaires, were evaluated. Results of included studies are presented in a summarized format. Embase, Medline and PsycINFO databases were accessed in January 2021.

RESULTS

38 studies were included. Nine manuscripts reported on parental mental health and 13 on stress, which are a concern after the birth of a premature infant, especially in the first year. Depression, anxiety, and stress are known to measure higher compared to parents of infants born at term. Over several years, these measures of mental health decrease significantly. Four reported on quality of life for parents of premature infants, which is reduced immediately after discharge, but then improves over time. The impact of premature birth on the family functioning was described in ten included studies and was described to have positive and negative consequences.

CONCLUSION

The negative impact of the premature birth and hospital journey on parental mental health lessens significantly with time.

Quality of Social Relationships with Parents and Peers in Adolescents Born Extremely Preterm

OBJECTIVE

Adolescents born extremely preterm (EPT, gestational age [GA] <28 weeks) are at higher risk for problems in peer socialization than those born full-term (FT, GA >36 weeks). This study was designed to examine the possibility that adolescents born EPT may also have difficulty in transitioning from parents to peers for socialization, a process referred to as "social reorienting." A secondary aim was to investigate associations of social reorienting with other neurodevelopmental characteristics.

METHODS

The Network of Relationships Inventory, Relationship Quality Version was administered to 24 adolescents (ages 11-16 years) born EPT and 29 born FT to obtain self-ratings of closeness and discord with parents and peers. Measures of other neurodevelopmental characteristics included tests of cognitive and social skills, adolescent self-ratings of adjustment and victimization, and parent ratings of youth behavior and adaptive skills. Mixed model analyses controlling for sex, socioeconomic status, and race were conducted to examine group differences in measures of relationship quality and their associations with other neurodevelopmental characteristics.

RESULTS

The EPT group had higher ratings of closeness with parents than the FT group. For adolescents from lower socioeconomic backgrounds, those born EPT had lower closeness with peers. Higher closeness with parents was associated with lower test scores. Lower closeness and more discord with peers were associated with more behavior problems.

CONCLUSION

Findings suggest that adolescents born EPT have difficulties in social reorientation toward peers and identify factors related to these difficulties. Results imply a need for interventions to improve peer socialization in youth born EPT.

Implementing modified family integrated care in a U.S. neonatal intensive care unit: nursing perspectives and effects on parents

OBJECTIVES

(1) Assess effects of a modified Family Integrated Care (FICare) model on U.S. Neonatal Intensive Care Unit (NICU) parents; (2) Evaluate NICU nurses' perspectives.

DESIGN

Case -control design with parental stress assessed before and after NICU-wide FICare implementation using Parent Stressor Scale: NICU (PSS:NICU) questionnaire. In addition, stratification by degree of participation evaluated associations with parental stress, parental-staff communication and discharge readiness. Questionnaires captured nursing perspectives on FICare.

RESULTS

79 parents (88%) participated prior to FICare; 90 (90%) after. Parent stress was lower (p < 0.001) with FICare. Parents learning 5-15 infant-care skills had lower stress compared to those learning <5 (p = 0.008). Parent utilization of an educational app was associated with improved communication frequency (p = 0.007) and quality (p = 0.012). Bedside NICU nurses reported multiple positive associations of FICare for parents and staff.

CONCLUSIONS

Any degree of FICare participation decreases parental stress; increased participation has multiple positive associations.

A biopsychosocial model of NICU family adjustment and child development

BACKGROUND

Although infants in Neonatal Intensive Care Units (NICU) are at risk for developmental impairments and parents are at risk for emotional distress, factors that explain outcomes remain unknown. Here, we developed the first biopsychosocial model to explain family adjustment after NICU discharge.

METHODS

Participants included 101 families at The Children's Hospital of Philadelphia Neonatal Follow-Up Program who had been discharged 1.5-2.5 years prior. We gathered data using validated assessments, standardized assessments, and electronic medical records.

RESULTS

Our structural equation model, informed by the Double ABC-X Model, captured the dynamic relationships among infant, parent, couple, and family factors. Infant medical severity, posttraumatic stress, couple functioning, and family resources (e.g., time, money) were key for family adjustment and child development.

CONCLUSIONS

Interventions that target parental posttraumatic stress, couple dynamics, parental perception of time for themselves, and access to financial support could be key for improving NICU family outcomes.

The Role of Family Function and Triadic Interaction on Preterm Child Development-A Systematic Review

Preterm infants are at high risk of developmental disability/delay and are more dependent on their caregiving environment for regulation due to their neurological immaturity. A premature birth is also a major stressor to the family system that constitutes the infant's caregiving environment. The following systematic review investigates whether families with preterm children differ from families with full-term children in their interactions, and what impact the quality of family interaction has on child development. Using the Cochrane model, we conducted a systematic review of quantitative studies published in psycINFO, socINDEX, and PubMed, concerning family quality in triadic interactions in families with premature infants and children, and at least one child development outcome variable. The quality of these studies was assessed using the Newcastle-Ottawa scale assessment form for cohort studies (NOS). Eleven studies were included in the review. Quality of family interactions is either equal to or poorer in families with preterm children, compared with families with full-term children. Importantly, the link between quality of family interactions and child development outcome is stronger in preterm children compared with full-term children, regarding both positive and negative influence. Our results highlight the importance of strengthening family interactions in order to promote development in preterm children. Notably, this review provides the first systematic overview of family function and the quality of triadic interactions in preterm families. The limited number of studies with a family-system focus makes it difficult for us to draw any definitive conclusions, while underscoring the need for more observational studies, particularly post-infancy, to be able to identify specific aspects of family interactions that may be critical for preterm child development.

Impact of current Australian paid parental leave on families of preterm and sick infants

AIM

Parents of preterm or sick infants are at increased risk of mental health problems. The financial stress associated with an infant's prolonged hospital stay can have an additional negative effect on families' wellbeing and child development. This study explores parent use of Australian paid parental leave (PPL) and the financial impact of having an infant requiring neonatal care.

METHODS

Retrospective, cross-sectional, online survey study conducted from November 2020 to February 2021. Participants were parents of babies born from 1 January 2013, admitted to a neonatal intensive care unit or special care nursery in Australia. The survey explored use of Australian Government and private sector PPL, and financial stress. Parent-reported anxiety and depression were measured using the EuroQol Group 5D-5L Anxiety and Stress Subscale.

RESULTS

Two hundred and thirty-one parents responded of which 93% had a preterm infant. Seventy-three percent of infants were hospitalised for more than 1 month, and 34% were readmitted to hospital within the first year following discharge home. Eighty-three percent of parents reported moderate, severe or extreme levels of anxiety or depression. Seventy-six percent reported that having a child in hospital had a moderate-very large financial impact on their family. Parents identified main costs to be travel, food, inability to work and direct medical costs.

CONCLUSIONS

Having an infant born preterm or sick has significant emotional and financial implications for families. The current Australian Government PPL scheme does not adequately support parents of preterm or sick infants, and a change is urgently needed to improve outcomes for this vulnerable population.

How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study

PURPOSE

The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals.

DESIGN AND METHODS

We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model.

RESULTS

On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family.

CONCLUSIONS

Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family.

PRACTICE IMPLICATIONS

Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways.

Preterm Infant Outcomes at 24 Months After Clinician-Supported Web-Based Intervention

The authors of this study evaluated infant and parent outcomes at 12 and 24 months after a clinician-supported, web-based early intervention for preterm infants.

OBJECTIVE

To examine the efficacy of a clinician-supported, web-based intervention delivered over the first year after birth compared with standard care in children born after <34 weeks' gestation, on child development at 24 months corrected age (CA), parental mental health, and the parent-child relationship at 24 months.

METHODS

We randomly allocated 103 preterm infants to clinician-supported, web-based intervention (n = 50) or standard care control (n = 53) groups. At 24 months CA, child cognitive, language, motor, social-emotional development, and the parent-child relationship were assessed. Parental mental health and quality of life were assessed at 12 and 24 months CA.

RESULTS

At 24 months, child development, maternal mental health, and maternal quality of life were similar for the intervention and control groups. There was some evidence that mothers in the intervention group had lower odds of being in the elevated category for depression at 12 months (odds ratio: 0.19; 95% confidence interval [CI]: 0.04-0.90; P = .04). Scores were higher in the intervention group for child responsiveness (mean difference: 0.57; 95% CI: 0.03-1.11; P = .04), child involvement (mean difference: 0.61; 95% CI: 0.09-1.13; P = .02), and maternal structuring (mean difference: 0.72; 95% CI: 0.22-1.21; P = .01) during the parent-infant interaction at 24 months.

CONCLUSIONS

This study provides preliminary evidence that a clinician-supported, web-based early intervention program for preterm infants had a positive effect on the parent-child relationship and maternal mental health immediately after the intervention but potentially little effect on child development.

Micro-preemie Parents' Perceptions of Trauma-Informed Developmental Neuroprotective Care and Nursing Support

BACKGROUND

Preterm birth is traumatic for both the infant and parents. Trauma-informed developmental neuroprotective care (TIDNC) may positively influence the outcomes for micro-preemie infants (infants born before 26 weeks' gestation) as well as support parents in crisis.

PURPOSE

To explore how TIDNC influences micro-preemie parents' perceptions of nursing care and support.

METHODS

A descriptive cross-sectional study was conducted at a 56-bed level III neonatal intensive care unit (NICU). A convenience sample of micro-preemie parents (n = 16, 46%) completed the Nurse Parent Support Tool (NPST) questionnaire, which included 2 open-ended questions.

RESULTS

These parents scored high scores on the NPST (mean = 4.62 ± 0.24), indicating most parents felt support from the nursing staff and perceived individualized family-centered high-quality nursing care. Subscale scores were higher than all previous studies. Parents perceived high levels of support most of the time to almost always. Although 4 themes were closely associated with the subscales, the fifth theme, Praise has not been previously documented. Parents were grateful for nurses who provided compassionate care and support during one of the most difficult times of their lives.

IMPLICATIONS FOR PRACTICE

TIDNC encourages robust nurse-parent authentic caring relationships, which are foundational to the parents' perceptions of nursing care and support. These relationships, built on mutual trust, respect, and genuine listening, appear to foster an exceptionally high degree of support.

IMPLICATIONS FOR RESEARCH

More research is needed to examine how unit culture, characteristics of nurses, parents, and infants as well as infant outcomes influence micro-preemie parents' perception of care and further explore the nature of support.

Effective stress intervention programs for parents of premature children: A systematic review

The birth of a child alters family dynamics and can be stressful for parents, especially in the case of prematurity. This article carried out a systematic review on interventions in parents to reduce the stress experienced by the birth of a premature infant. The aims were to describe and classify the different interventions and to have an overview of their effectiveness. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide and the PICO model. For searching the bibliography, we used Web of Science, Science Direct, PubMed and PsycINFO databases. From a total of 450 articles identified, this review finally included 46 studies with empirical evidence. The articles clustered into different types of interventions, such as psychoeducational and parental or maternal support programs, relaxation techniques, expressive writing, art therapy, music therapy and interventions related to interaction and tactile stimulation. There is a wide range of effectiveness in reducing parental stress to a greater or lesser degree. There is a great heterogeneity of interventions. Despite that, they all have a parental educational component that needs to be studied in greater depth.

Obstetric fractures in caesarean delivery and risk factors as evaluated by paediatric surgeons

Introduction

Obstetric fractures usually occur after complicated births and are sent to paediatric orthopaedics for treatment and follow-up. Clavicle fractures represent the most common orthopaedic birth injury, involving approximately 0.2 to 3.5% of births.

Hypotheses

Caesarean delivery, elective or necessary, along with the type of presentation, may play a determinant role in the aetiology of obstetric fractures.

Materials and methods

We chose to do a retrospective study to determine possible risk factors for this type of injury that may manifest in either delivery. Our aim was to deepen our knowledge in order to have a better prediction and a better management of this condition. Data gathered included parity, gestity, type of delivery, presentation, shoulder dystocia, type of fracture, birth weight, and APGAR score.

Results

We followed 136 patients that were diagnosed with Allman type I clavicle fracture, 32 of them also having brachial plexus birth palsy (BPBP) type 1 (Duchenne-Erb). Natural birth with a pelvic presentation imposes a relative risk of 6.2 of associated pathology compared to cranial presentation. Caesarean delivery and cranial presentation increase the risk of related pathology by 5.04 compared to natural birth. Statistically, pelvic presentation is 5.54 times more likely to develop related pathology than cranial presentation. Type of delivery and presentation correlate with associated pathology of clavicle fractures.

Discussion and conclusion

Caesarean delivery brings risks for the newborn and should be practiced only when necessary. Predictive modeling in obstetrics in third-trimester evaluations may statistically predict risks of birth complications like fracture and BPBP.

Thirteen-Year Outcomes of a Randomized Clinical Trial of Early Preventive Care for Very Preterm Infants and Their Parents

OBJECTIVE

To evaluate 13-year outcomes of a randomized controlled trial of preventive care (VIBeS Plus) for infants born very preterm and their parents and examine whether possible effects of intervention varied by family social risk.

STUDY DESIGN

Families were randomized to an intervention arm (n = 61) or a standard care arm (n = 59). The intervention was delivered at home by psychologists and physiotherapists over the infants' first year, focusing on infant development and parental mental health. At 13 years corrected age, cognitive, motor, and behavioral outcomes, and parental mental health were assessed. Primary estimands were between-group mean differences, estimated using multiple imputed regression models.

RESULTS

Follow-up included 81 surviving children (69%). There was little evidence of benefits of the intervention for IQ, attention, executive functioning, working memory, and academic skills regardless of level of social risk. Specifically, mean differences in adolescent cognitive outcomes ranged from -2.0 units (95% CI, -9.9 to 5.9) in favor of standard treatment to 5.1 units (95% CI, -2.3 to 12.5) favoring the intervention. A group-by-social risk interaction was observed only for adolescent motor outcomes, with mean differences favoring the intervention for those at higher social risk (balance, 4.9; 95% CI, 1.3-8.5; total motor, 3.2; 95% CI, 0.3-6.2), but not those at lower social risk (balance, -0.3; 95% CI, -2.4 to 1.9; total motor, 0.03; 95% CI, -1.9 to 2.0). Mean differences in adolescent behavior and parental mental health ranged from -6.6 (95% CI -13.8, 0.5) to -0.2 (95% CI, -1.9 to 1.4) and -1.8 (95% CI, -4.1 to 0.6) to -1.7 (95% CI, -4.3 to 1.0), respectively, indicating a pattern of fewer symptoms in the intervention group.

CONCLUSIONS

Benefits of the intervention persisted for adolescent behavior, with better motor outcomes observed in those from socially disadvantaged families. Replication with larger samples, multiple informant reports, and assessment of quality of life-related outcomes is warranted.

TRIAL REGISTRATION

http://www.anzctr.org.au/: ACTRN12605000492651.

Association of Single Nucleotide Polymorphisms from Angiogenesis-Related Genes, ANGPT2, TLR2 and TLR9, with Spontaneous Preterm Labor

In this study, we hypothesized that the changes localized at angiopoietin-2 (ANGPT2), granulocyte-macrophage colony-stimulating factor (CSF2), fms-related tyrosine kinase 1 (FLT1) and toll-like receptor (TLR) 2, TLR6 and TLR9 genes were associated with spontaneous preterm labor (PTL), as well as with possible genetic alterations on PTL-related coagulation. This case-control genetic association study aimed to identify single nucleotide polymorphisms (SNPs) for the aforementioned genes, which are correlated with genetic risk or protection against PTL in Polish women. The study was conducted in 320 patients treated between 2016 and 2020, including 160 women with PTL and 160 term controls in labor. We found that ANGPT2 rs3020221 AA homozygotes were significantly less common in PTL cases than in controls, especially after adjusting for activated partial thromboplastin time (APTT) and platelet (PLT) parameters. TC heterozygotes for TLR2 rs3804099 were associated with PTL after correcting for anemia, vaginal bleeding, and history of threatened miscarriage or PTL. TC and CC genotypes in TLR9 rs187084 were significantly less common in women with PTL, compared to the controls, after adjusting for bleeding and gestational diabetes. For the first time, it was shown that three polymorphisms-ANGPT2 rs3020221, TLR2 rs3804099 and TLR9 rs187084 -were significantly associated with PTL, adjusted by pregnancy development influencing factors.

The AIMS home-video method: parental experiences and appraisal for use in neonatal follow-up clinics

Background

In The Netherlands, prematurely born infants and their parents are offered regular developmental check-ups in a hospital setting. In line with providing healthcare at distance, the use of video footage showing the infant’s behavior and movements, taken by parents at home and assessed by professionals online, might be a fruitful future practice. The focus of this study was to gain insight into parental experiences with the Alberta Infant Motor Scale home-video method and their appraisal of its applicability for use in an outpatient neonatal follow-up clinic.

Method

A qualitative descriptive study among parents of healthy extremely or very premature infants (GA 26.2–31.5 weeks) participating in a longitudinal study of motor development between 3–18 months corrected age. Ten semi-structured interviews were conducted and transcribed verbatim. Data was analyzed independently. Inductive content analysis was performed following the process of the AIMS home-video method.

Results

Parents appraised the AIMS home-video method as manageable and fun to do. Instructions, instruction film, and checklists were clear. Transferring the video footage from their phone to their computer and uploading it to the web portal was sometimes time-consuming. Parents gained a better awareness of their infant’s motor development and found the provided feedback a confirmation of what they already thought about their infant’s development and was reassuring that their child was doing well. First-time parents seemed more uncertain and had a greater need for information about (motor) development, but on the other hand, also had confidence in their child.

All parents thought that home-videos can be an addition to follow-up visits, but cannot replace (all) visits. It may be an opportunity to reduce the frequency of hospital visits, while still having their infant monitored.

Conclusion

Parents appraised the AIMS home-video method positively and are of the opinion that home-videos can be of added value in monitoring infants at risk in neonatal follow-up additional to hospital visits. In future research a user-friendly application and/or platform to exchange video footage safely between parents and professionals should be developed with all possible stakeholders involved and implementation should be explored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03398-9.

Incidence and Risk Factors for Postpartum Depression among Women with Preterm Prelabor Rupture of Membranes

OBJECTIVE

Patients admitted for preterm prelabor rupture of membranes are more likely to have risk factors for postpartum depression, including preterm delivery, low-birthweight infants, and a stressful life event. However, there is a paucity of data characterizing the development of postpartum depression in this population. We aim to evaluate the incidence of and describe risk factors for postpartum depression among patients admitted with preterm prelabor rupture of membranes.

STUDY DESIGN

This is a retrospective cohort study of patients admitted for preterm prelabor rupture of membranes in a single health system between 2013 and 2019. Patients who developed depression were compared with patients who did not develop depression. Demographic, antepartum/intrapartum/postpartum, and neonatal characteristics were compared. Bivariate statistics were used to compare outcomes and logistic regression was used to estimate adjusted odds ratios.

RESULTS

Of 132 included patients with preterm prelabor rupture of membranes, 25 (18.9%) had postpartum depression. Factors significantly (p < 0.05) associated with postpartum depression included history of depression, anxiety, or any prior mental health condition. Earlier admission gestational age, rupture of membranes < 28 weeks, earlier delivery gestational age, neonatal morbidity, and neonatal necrotizing enterocolitis also were significantly associated with postpartum depression. Latency, maternal postpartum length of stay, and neonatal intensive care unit length of stay were not significantly associated. In regression models, only a history of depression (odds ratio [OR], 11.89; 95% confidence interval [CI], 2.78-50.95) and neonatal morbidity (OR, 5.01; 95% CI, 1.15-21.89) remained associated with postpartum depression.

CONCLUSION

Postpartum depression occurred in nearly one in five patients with preterm prelabor rupture of membranes. Pre-existing depression and adverse neonatal outcomes strongly predicted postpartum depression. There is an urgent need to prioritize maternal mental health among patients with preterm prelabor rupture of membranes in the peripartum period. Further research is needed to identify optimal resources for mitigating the risk of postpartum depression in this cohort.

KEY POINTS

· After PPROM, postpartum depression is common.. · Maternal depression and neonatal morbidity are risk factors for PPD.. · Hospital admission permits intervention for PPD..

Personalized support of parents of extremely preterm infants before, during and after birth

The emotional turmoil associated with extremely preterm birth is inescapable parents. How each parent handles the unexpected, makes sense of the unknown and learns to parent their child is uniquely personal. A rigid standardized approach to support families through their journey before and during neonatal intensive care disregards this individuality. This article reviews general concepts and practices that can be learned and applied by clinicians to promote resiliency and help parents cope adaptively. This review will describe how to personalize parenting support during the antenatal consultation and hospitalization for parents of extremely premature infants. To facilitate this, mindsets and care delivery models need to shift from inflexible standardized protocols to flexible guidelines that enable personalized communications, support structures and care delivery models tailored to each person's characteristics, preferences, and values.

Emotion Recognition in Preterm and Full-Term School-Age Children

Children born preterm (<37 weeks’ gestation) show a specific vulnerability for socio-emotional difficulties, which may lead to an increased likelihood of developing behavioral and psychiatric problems in adolescence and adulthood. The accurate decoding of emotional signals from faces represents a fundamental prerequisite for early social interactions, allowing children to derive information about others’ feelings and intentions. The present study aims to explore possible differences between preterm and full-term children in the ability to detect emotional expressions, as well as possible relationships between this ability and socio-emotional skills and problem behaviors during everyday activities. We assessed 55 school-age children (n = 34 preterm and n = 21 full-term) with a cognitive battery that ensured comparable cognitive abilities between the two groups. Moreover, children were asked to identify emotional expressions from pictures of peers’ faces (Emotion Recognition Task). Finally, children’s emotional, social and behavioral outcomes were assessed with parent-reported questionnaires. The results revealed that preterm children were less accurate than full-term children in detecting positive emotional expressions and they showed poorer social and behavioral outcomes. Notably, correlational analyses showed a relationship between the ability to recognize emotional expressions and socio-emotional functioning. The present study highlights that early difficulties in decoding emotional signals from faces may be critically linked to emotional and behavioral regulation problems, with important implications for the development of social skills and effective interpersonal interactions.

Enhancing Parents' Well-Being after Preterm Birth-A Qualitative Evaluation of the "Transition to Home" Model of Care

There are few programs available aimed at preventing short- and long-term negative consequences after preterm birth and covering the entire care continuum. The “Transition to Home (TtH)” model is such a program, offering structured, individual support for families with preterm infants before and after hospital discharge. This study gathers and examines the parents’ views of receiving support from an interprofessional team under the TtH model of care during hospitalization and after discharge. Using a qualitative explorative design, 39 semi-structured interviews with parents were analyzed thematically. From this analysis, three main themes were identified: (1) TtH and the relevance of continuity of care; (2) Enhancement of parents’ autonomy and self-confidence; (3) Perception of interprofessional collaboration. Within these themes, the most relevant aspects identified were continuity of care and the appointment of a designated health care professional to anchor the entire care continuum. Emotional support complemented by non-medical approaches, along with strength-based and family resource-oriented communication, also emerged as key aspects. Continuous, family-centered care and well-organized interprofessional collaboration promote the well-being of the family after a premature birth. If the aspects identified in this study are applied, the transition from hospital to home will be smoothened for the benefit of affected families.

PreEMPT (Preterm infant Early intervention for Movement and Participation Trial): Feasibility outcomes of a randomised controlled trial

PURPOSE

Investigate feasibility of PreEMPT: a novel participation-focused, early physiotherapy intervention for preterm infants in regional Australia.

MATERIALS AND METHODS

Participants were infants born <35 weeks, residing in regional Australia. Sixteen infants were recruited then randomised to usual physiotherapy care (UPC: n = 8) or PreEMPT (n = 8). PreEMPT involved 14-weeks of alternating clinic- or telehealth-based, participation-focused intervention. Feasibility was evaluated by: demand, practicality, acceptability, implementation and limited efficacy testing for infants (motor, participation) and parents (mental well-being, self-efficacy).

RESULTS

Demand was lower than expected (45% recruitment rate). For practicality, attrition was high in the PreEMPT group (mean assessment attendance 3.8/5 sessions, range 2-5) compared to UPC (4.8/5 sessions, range 4-5). In addition, mean PreEMPT treatment dose received was approximately half intended (overall: 7.3/14 sessions, range 0-12; equivalent for face-to-face: 3.9/7, range 0-6, versus telehealth 3.4/7, range 0-6). The most common reason cited for treatment non-attendance was maternal mental health (22 sessions). Treatment acceptability for parents was high, with PreEMPT parents reporting they were offered choices in sessions (p = .02), and increased their knowledge (p = .01) and confidence (p = .009). There was a large effect size in favour of PreEMPT for increased parental self-efficacy (p = .021, ES = 1.34).

CONCLUSION

Early post-discharge physiotherapy for preterm infants in regional Australia is beneficial according to families but logistically challenging.

Increased Risk of Parental Instability for Children Born Very Preterm and Impacts on Neurodevelopmental Outcomes at Age 12

Caring for a child born preterm places significant emotional and financial burdens on family relationships. This paper examines (a) the extent to which children born very and extremely preterm are more likely to experience parental change/caregiver instability than children born full term, (b) predictors of parental change/s for preterm infants, and (c) whether exposure to parental change/caregiver instability increases child neurodevelopmental risk. Data were collected as part of a prospective longitudinal study of 110 very preterm and 113 full-term born infants and their parents studied from birth to corrected age 12 years. At ages 2, 4, 6, 9 and 12 years, detailed information was collected about the frequency and nature of all parent/caregiver changes for 3-6 monthly intervals of each child's life. At age 12, all children completed a comprehensive neurodevelopmental evaluation of their emotional and behavioural adjustment, cognition, and educational achievement. Results showed that children born very preterm were at increased risk of experiencing parental/caregiver changes, with this risk being greatest for those born extremely preterm. Neonatal medical complexity, family socioeconomic disadvantage, maternal psychological wellbeing, and child neurodevelopmental impairment were associated with a higher risk of parental change. Preterm birth and exposure to parental change/instability contributed additively to poorer child outcomes. Findings support the need for family-focused neonatal and postnatal care strategies for high-risk infants, to support parents as well as their infants to optimize child health and developmental outcomes.

Maternal Mood and Perception of Infant Temperament at Three Months Predict Depressive Symptoms Scores in Mothers of Preterm Infants at Six Months

Postpartum depression is more prevalent in mothers and fathers of preterm infants compared to parents of full-term infants and may have long-term detrimental consequences for parental mental health and child development. The temperamental profile of an infant has been postulated as one of the important factors associated with parental depressiveness in the first months postpartum. This study aimed to examine the longitudinal relationship between depressive symptoms and perceived infant temperament at 3 months corrected age, and depressive symptoms at 6 months corrected age among mothers and fathers of infants born preterm. We assessed 59 families with infants born before the 34th gestational week using the Edinburgh Postnatal Depression Scale (EDPS) and the Infant Behavior Questionnaire-Revised. We found that mothers’ scores on EPDS and infants’ Orienting/regulation at 3 months corrected age predicted mothers’ EPDS scores at 6 months corrected age. In particular, higher depressive scores were related to higher depressive symptoms at 6 months corrected age, whereas higher infant Orienting/regulation was related to lower depressive symptoms at 6 months corrected age. Due to the low internal consistency of EPDS at 6 months for fathers, we were unable to conduct similar analyses for fathers. Our results point to the importance of considering both early indices of maternal mood as well as mother-reported measures of preterm infant temperament in the attempts to predict levels of maternal depressiveness in later months of an infant’s life. Further studies are urgently needed in order to better understand the associations between depressiveness and infant temperament in fathers, and with more consideration for the severity of the effects of infant prematurity.

Impact of psychological distress and psychophysical wellbeing on posttraumatic symptoms in parents of preterm infants after NICU discharge

Backgorund

Parents after Neonatal Intensive Care Unit (NICU) hospitalization of preterm infant may develop psychopathological symptoms.

The aim of the study was to determine how parental stress and psychophysical wellbeing affect posttraumatic symptoms (PTTS) in parents during the first year after NICU discharge. Moreover, this study aimed to explore any gender-specific difference in psychological distress among mothers and fathers.

Methods

Prospective study design from September 2018 to September 2019. 20 pairs of parents of preterm infants admitted to a tertiary-level NICU were enrolled. Primary outcome was evaluation of PTTS in parents of preterm infants at one year after NICU discharge through Impact of Event Scale- Revised. Secondary outcomes were: impact of parental stress, psychophysical wellbeing, anxiety and depression respectively through Parental Stressor Scale: NICU, Short Form Health Survey-36(SF-36), Self-rating Anxiety Scale and Self-rating Depression Scale.

Results

Mothers experienced higher rates of PTTS than fathers across the first year after NICU discharge (55% vs 20%). Maternal avoidance symptoms were associated with perception of their own infant look. Emotional aspects linked to maternal role predicted 36,8% of their hyperarousal symptoms. Maternal PTTS severity was predicted by their social functioning. Paternal mental health was associated both with maternal and paternal intrusive symptoms.. Maternal stress was associated with paternal avoidance symptoms. Paternal mental health predicted their hyperarousal symptoms (40%) and PTSD severity (52%).

Conclusions

Parents who experienced NICU hospitalization of their own infant are at heightened risk to develop psychopathological symptoms. According to our initial hypothesis, investigating parental psychophysical wellbeing, through SF-36, originally provides a valuable support to detect parents at higher risk to develop posttraumatic outcomes across the first year after NICU discharge. In addition, paternal depression deserves to be taken into account since hospitalization as it could impact paternal PTSD development. Finally, these findings provide an initial evidence of gender-related patterns in PTSD development and psychological distress among mothers and fathers across the first year of their infant.

Play & Grow: prospective observational cohort of toddlers to inform obesity prevention, Columbus, Ohio, USA

PURPOSE

Obesity prevention is increasingly focused on early childhood, but toddlers have not been well-studied, and children born preterm are frequently excluded. The Play & Grow Cohort was established to investigate child growth in relation to parent-child interactions in mealtime and non-mealtime settings.

PARTICIPANTS

Between December 2017 and May 2019, 300 toddlers and primary caregivers were recruited from records of a large paediatric care provider in Columbus, Ohio, USA. This report describes recruitment of the cohort and outlines the data collection protocols for two toddler and two preschool-age visits. The first study visit coincided with enrolment and occurred when children (57% boys) were a mean (SD) calendar age of 18.2 (0.7) months.

FINDINGS TO DATE

Children in the cohort are diverse relative to gestational age at birth (16%, 28-31 completed weeks' gestation; 21%, 32-36 weeks' gestation; 63%, ≥37 weeks' gestation) and race/ethnicity (8%, Hispanic; 35%, non-Hispanic black; 46%, non-Hispanic white). Caregivers enrolled in the cohort are primarily the child's biological mother (93%) and are diverse in age (range 18-54 years), education (23%, high school or less; 20% graduate degree) and annual household income (27%, <US$20 000 24%, ≥US$90 000). Parent-child interactions were video-recorded during play in the laboratory at 18 months (n=299) and during play, reading and mealtime in the home (n=284) at 24 months. The preschool phase of the study was impacted by COVID-19. Parent-child interactions were video-recorded during play and mealtime at home at 36 months (n=141) and during a standardised buffet meal in the laboratory at 42 months (n=50). Caregivers unable to participate in face-to-face visits due to COVID-19 completed questionnaires.

FUTURE PLANS

Assessment during middle childhood is being planned. Future visits will include anthropometric measurements and parent-child interactions at mealtime. School-based outcomes are additionally being considered.

Fathers' experiences of supporting their partners during their preterm infant's stay in the neonatal intensive care unit: a multi-method study

OBJECTIVE

To explore how the fathers experience their role as a support for their partner and the relationship with them during their preterm infant's stay in the NICU.

STUDY DESIGN

Multi-method longitudinal study involving ethnographic observation, semi-structured interviews, self-report questionnaires, and clinical information. Twenty fathers of preterm infants hospitalized in a level-III-NICU were included. Data were analyzed using thematic continent analysis.

RESULTS

Three main themes were identified: support for mother (subthemes: putting mother's and infant's needs first; hiding worries and negative emotions; counteracting the sense of guilt; fear that the mother would reject the child), mother's care for the infant (subthemes: observing mother engaged in caregiving; mother has "something extra"), and couple relationship (subthemes: collaboration; bond).

CONCLUSION

Fathers supporting their partners during the stay in the NICU experience emotional distress and the need for being supported that often are hidden. This demands a great deal of emotional and physical energy.

Different maternal age patterns of preterm birth: Interplay of race/ethnicity, chronic stress, and marital status

The aim of this study was to examine whether the preterm birth (PTB) risks according to maternal age is altered by a woman's marital status and chronic stress among non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women. This researcher analyzed the Pregnancy Risk Assessment Monitoring System data for New York City and Washington State linked with the birth certificates for 2004-2007. The sample included 6344 singleton live births without birth defects to women aged 18 years or older identified as N-H White, N-H Black, Hispanic, or Asian. The outcome was PTB. Maternal age-specific PTB rates were calculated according to race/ethnicity, marital status, and chronic stress. Linear trends of PTB rates with maternal age were evaluated by the Mantel-Haenszel χ² test. Marriage had a protective effect against PTB at advancing maternal age across racial/ethnic groups. The health benefit of marriage was strong, particularly among the married N-H Black and Asian women, manifested as a maternal age-related decrease in the PTB rate (reverse-weathering). In contrast, women not married showed a maternal age-related increase in the PTB rate (weathering) across the racial/ethnic groups. Under higher chronic stress, married women generally experienced less weathering about PTB. These patterns were observed with noticeable racial/ethnic variations. Acknowledging the different dynamics among maternal age, marital status, and chronic stress by race/ethnicity could help shed light on the psychosocial mechanisms underlying the racial/ethnic inequalities in PTB in the United States. To that end, future studies should use more nuanced measurements of paternal support and chronic stress.

Identifying research priorities in newborn medicine: a Delphi study of parents' views

OBJECTIVE

Neonatal conditions can have lifelong implications for the health and well-being of children and families. Traditionally, parents and patients have not been included in shaping the agenda for research and yet they are profoundly affected by the neonatal experience and its consequences. This study aimed to identify consensus research priorities among parents/patients of newborn medicine in Australia and New Zealand.

DESIGN

Parents/patients with experience of neonatal care in Australia and New Zealand completed an online Delphi study to identify research priorities across four epochs (neonatal admission, early childhood, childhood/adolescence and adulthood). Parents/patients first generated key challenges in each of these epochs. Through inductive thematic analysis, recurring topics were identified and research questions generated. Parents/patients rated these questions in terms of priorities and a list of questions consistently rated as high priority was identified.

PARTICIPANTS

393 individuals participated, 388 parents whose children had received neonatal care and 5 adults who had received neonatal care themselves.

RESULTS

Many research questions were identified as high-priority across the lifespan. These included how to best support parental mental health, relationships between parents and neonatal clinical staff (including involvement in care and communication), bonding and the parent-child relationship, improving neonatal medical care and addressing long-term impacts on child health and neurodevelopment.

CONCLUSIONS

Parents with experience of newborn medicine have strong, clear and recurring research priorities spanning neonatal care practices, psychological and other impacts on families, and impacts on child development. These findings should guide neonatal research efforts. In addition to generating new knowledge, improved translation of existing evidence to parents is also needed.

Gestational age on trajectories of social competence difficulties into adolescence

OBJECTIVES

To examine if gestational age groups predict the development of social competence difficulties (SCDs) from childhood into mid-adolescence and to assess the mediation by maternal psychological distress during infancy on these trajectories.

DESIGN

Nationally representative population-based birth cohort (UK Millennium Cohort Study).

PARTICIPANTS

15 821 children born in 2000-2002.

OUTCOME MEASURES

SCDs (derived from peer and prosocial subscales of Strengths and Difficulties Questionnaire) were assessed by parent report when the participants were aged 3, 5, 7, 11 and 14 years. Maternal psychological distress was self-rated using Rutter Malaise Inventory when the children were 9 months of age. Data were modelled using latent growth curve analysis.

RESULTS

Developmental trajectories of SCDs were U-shaped in all groups. Very preterm (VP) children (<32 weeks, n=173) showed pronounced difficulties throughout, with the coefficient difference from the full term at age 14 being 0.94 (95% CI 0.23 to 1.66, equivalent to 0.32 SD of the population average SCDs). Moderate-to-late preterm children (32-36 weeks, n=1130) and early-term children (37-38 weeks, n=3232) showed greater difficulties compared with the full-term peers around age 7 years, which resolved by age 14 years (b=0.20, 95% CI -0.05 to 0.44; b=0.03, 95% CI -0.12 to 0.17, respectively). Maternal psychological distress during infancy mediated 20% of the aforementioned association at age 14 years for the VP.

CONCLUSION

There was a dose-response association between gestational age and the trajectories of SCDs. Monitoring and providing support on social development throughout childhood and adolescence and treating early maternal psychological distress may help children who were born earlier than ideal, particularly those born VP.

Mental health monitoring in parents after very preterm birth

AIM

To evaluate parental mental health monitoring during follow-up care for very preterm (VPT) infants, describe symptoms of anxiety and depression and risk factors for mothers and fathers at 1 and 12 months of corrected age.

METHODS

Parents completed the Hospital Anxiety and Depression Scale (HADS). Psychological symptoms and risk factors were analysed within and between mothers and fathers.

RESULTS

In 4 years, the monitoring reached 1260 (48%) families. Of these, 693 mothers and 340 fathers (300 couples) completed the HADS twice. At 1 month, 22% and 15% of the mothers and 10% and 9% of the fathers, respectively, reported elevated symptoms of anxiety and depression. At 12 months, these rates were significantly reduced to 14% and 9% for mothers and 5% and 4% for fathers respectively. Within couples, anxiety and depression were positively associated. At 12 months, in 20% of the couples, one or both parents reported elevated symptoms. Risk factors were length of hospital stay, migration background, educational level and employment status.

CONCLUSION

The mental health of parents of VPT infants improved, but elevated symptoms were still observed in 17% of included families after one year. Acknowledging and remediating parental mental health remain essential during follow-up care.

[Preterm birth: a risk for mental health?]

One in 12 children is born before 37 completed weeks of gestation and during the last decades survival rates and developmental outcomes of even very premature children have significantly improved. As a result, mental health sequelae of preterm birth are more frequently addressed. The manifestation of a distinct psychopathological profile with co-occurrence of symptoms associated with attention deficit/hyperactivity, autism spectrum and anxiety disorders has been recognized and discussed as "preterm behavioral phenotype", mainly affecting high-risk children with very low birth weights. Current research findings on parental psychological distress and early childhood developmental conditions after preterm birth indicate contextual factors that are of relevance, also for clinicians in psychotherapeutic practice.

Peer Relationship Trajectories in Very Preterm and Term Individuals from Childhood to Early Adulthood

OBJECTIVE

To identify trajectories of peer relationships in very preterm and term-born individuals from 6 to 26 years of age and test early-life predictors of these trajectories.

METHOD

As part of the Bavarian Longitudinal Study, 218 very preterm/very low birth weight (VP/VLBW; <32 weeks' gestation/<1500 grams) and 220 healthy term-born (37-42 weeks' gestation) individuals were followed prospectively from birth to adulthood. Parent and self-reports at 6, 8, 13, and 26 years were combined into comprehensive developmentally appropriate scores across 3 domains: peer acceptance, friendships, and peer problems. Latent profile analyses were used to identify trajectories across these 3 domains. Binary and multinomial logistic regressions were used to test the following potential predictors of trajectories: VP/VLBW status, sex, socioeconomic status, neonatal medical risk, parent-infant relationship at 5 months, child inhibitory control at 20 months, and child cognitive abilities at 20 months.

RESULTS

Three trajectories were identified for peer acceptance and friendships, and 2 trajectories were identified for peer problems. Higher cognitive abilities predicted more optimal trajectories in peer acceptance (odds ratio: 1.03 [95% confidence interval = 1.01-1.05]), friendships (1.03 [1.00-1.05]), and peer problems (1.06 [1.04-1.09]). In addition, good parent-infant relationships predicted lower peer problem trajectories (1.61 [1.03-2.50]).

CONCLUSION

Early cognitive deficits may underlie persistent peer relationship difficulties in VP/VLBW samples. Positive parent-infant relationships may help reduce preterm children's risk for long-term peer problems.

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.

Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants

INTRODUCTION

Having an infant admitted to the neonatal intensive care unit (NICU) is associated with increased parental stress, anxiety and depression. Enhanced support for parents may decrease parental stress and improve subsequent parent and child outcomes. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) programme is a novel bundled intervention of psychosocial support delivered by a nurse navigator that includes Acceptance and Commitment Therapy-based coaching, care coordination and anticipatory education for parents of high-risk infants in the NICU through the first year at home. The primary objective is to evaluate the impact of the intervention on parent stress at 12 months.

METHODS AND ANALYSIS

This is a multicentre pragmatic randomised controlled superiority trial with 1:1 allocation to the CCENT model versus control (standard neonatal follow-up). Parents of high-risk infants (n=236) will be recruited from seven NICUs across three Canadian provinces. Intervention participants are assigned a nurse navigator who will provide the intervention for 12 months. Outcomes are measured at baseline, 6 weeks, 4, 12 and 18 months. The primary outcome measure is the total score of the Parenting Stress Index Fourth Edition Short Form at 12 months. Secondary outcomes include parental mental health, empowerment and health-related quality of life for calculation of quality-adjusted life years (QALYs). A cost-effectiveness analysis will examine the incremental cost of CCENT versus usual care per QALY gained. Qualitative interviews will explore parent and healthcare provider experiences with the intervention.

ETHICS AND DISSEMINATION

Research ethics approval was obtained from Clinical Trials Ontario, Children's Hospital of Eastern Ontario Research Ethics Board (REB), The Hospital for Sick Children REB, UBC Children's and Women's REB and McGill University Health Centre REB. Results will be shared with Canadian level III NICUs, neonatal follow-up programmes and academic forums.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT03350243).

Interprofessional Collaboration in a New Model of Transitional Care for Families with Preterm Infants - The Health Care Professional's Perspective

Background

Families with preterm infants find life after hospital discharge challenging and need tailored support to thrive. The “Transition to Home (TtH)”-model offers structured, individual support for families with preterm infants before and after hospital discharge. TtH improves parental mental health and competence, promotes child development and fosters interprofessional collaboration (IPC).

Aim

Evaluate the TtH-models’ structure and implementation process and its associated interprofessional collaboration from the healthcare professional’s (HCP) perspective.

Methods

This qualitative explorative study thematically analyzed four focus group interviews (n=28 HCP) and an open-ended questionnaire with general pediatricians (n=8).

Results

The main themes of the thematic analysis were the benefits of the TtH-model, tailored parental support, the challenges of changing interprofessional collaboration, facilitators and barriers to successfully implementing the model, and feasibility and health economic limits. HCP acknowledge that continuous family-centered care led by an advanced practice nurse (APN) supports, strengthens, and relieves families with preterm infants in the transition from hospital to home. Families in complex situations benefit most. The TtH-model incorporates key aspects of integrated care like shared decision-making, considering family preferences, and defining the APN as the family’s main contact. HCP want network collaboration but found communication, cooperation, and reorganization challenging in the new IPC process. IPC challenges and involving many HCP in family care can create parental oversupply, negatively affect treatment outcomes, and raise health care costs.

Conclusion

These challenges need to be addressed to ensure sustainable implementation of the model. The roles and tasks of HCP should be clearly distinguished from each other, and HCP must have time to learn this new form of IPC. Learning requires time, effective communication strategies, and leadership support. Political action is also required to implement new models of care, including regulating advanced practice roles and developing new financing models.