Infants with bronchopulmonary dysplasia: a developmental perspective

Sleep quality, stress, caregiver burden, and quality of life in maternal caregivers of young children with bronchopulmonary dysplasia

Little is known about the influence of sleep quality, stress, and caregiver burden on quality of life in maternal caregivers of young children with bronchopulmonary dysplasia (BPD). In 61 maternal caregivers (mean age 29.59 years) of young children with BPD (mean age 13.93 months), caregivers reported sleeping a mean of 5.8 hours, and significant correlations were found between sleep quality and depressive symptoms and stress, as well as an inverse correlation with quality of life. Sleep quality was found to be the most significant predictor of quality of life in maternal caregivers.

Mother-infant interactions of medically fragile infants and non-chronically ill premature infants

At 6 months corrected for prematurity, 41 medically fragile prematures, 20 medically fragile full-terms, and 28 prematures without chronic illnesses were observed interacting with their mothers for 1 hr. Mothers of non-chronically ill prematures gestured to and touched their infants less, were uninvolved with them for a longer time, and spent less time interacting and looking at their infants than did mothers of medically fragile infants. Medically fragile full-terms slept more than the non-chronically ill prematures. The non-chronically ill premature group played with objects more and exhibited more locomotion. Thus, the non-chronically ill prematures had more mature behaviors but less frequent interactions than did the medically fragile infants. These disparities reflect differences both in the infants' functional maturity and in maternal compensation for infant vulnerability.

Developmental outcomes of infants with bronchopulmonary dysplasia: comparison with other medically fragile infants

The purpose of this study was to compare the developmental outcomes and mother-infant interactions of infants with bronchopulmonary dysplasia (BPD) and those of other medically fragile infants. One-hour behavioral observations were made of the interactions of mothers with two groups of infants (23 with BPD, 39 medically fragile without BPD or neurological problems) at enrollment, every 2 months during hospitalization, 1 month after discharge, and at 6 months' and 12 months' corrected age. Assessment of the home environment also was done at 6 and 12 months. Multiple regressions were calculated separately for child mental, adaptive, language, and motor outcomes. Predictors were: home environment assessment, measures of maternal interactive behaviors (positive attention, expression of negative affect, medicalized caregiving), infant group membership, and presence of intraventricular hemorrhage (IVH) in the infant. There were no significant differences between the two groups in any of the developmental outcomes or interactive variables, and the presence of IVH had no effect on these variables. Maternal positive attention and the home environment were correlated with mental development, and mother negative affect was related to adaptive behavior for both groups. Differences in developmental and interactive behaviors between infants with BPD and other prematurely born infants found in other studies appear to be a result of chronic health problems and, thus, are not unique to infants with BPD.

Guided participation and development of care-giving competencies for families of low birth-weight infants

The concept of guided participation is central to theory for supporting families in developing competencies for care of their low birth-weight infants. Guided participation is a process through which an experienced person helps another person who has less experience to become competent in practices that are personally and socially meaningful practices of everyday life. A practice is made up of socially formed activities directed to accomplishing a recurring goal. For a parent, infant care-giving encompasses protecting, comforting and nurturing activities, including feeding. For premature infants, a mother's care-giving begins during the neonatal intensive care unit stay and continues, after the infant's discharge from hospital, in the home. Care-giving competencies are addressed through guided participation of a mother in her care-giving practice. In this process, her working model of herself as parent, her infant, and feeding is constructed and revised through the guided participation process. In this paper, a general theory of guided participation that could be used to promote care-giving competencies is described. Two cases from a pilot study are presented to illustrate the application of the theory to a mother's feeding practice with infants who were born prematurely and who developed problems with feeding during the first year of life. These cases indicate that guided participation offers a means of precisely tailoring support for care-giving to the mother's needs and goals for development of competencies. Further research on how guided participation is best introduced to families of varying resources and life circumstances, how it is best implemented across settings as the infant moves from hospital to home, and how nurses can apply its principles with available resources and opportunities is needed.