Early psychosocial parent-infant interventions and parent-infant relationships after preterm birth-a scoping review

Objective

Early psychosocial interventions for preterm infants and their parents are diverse. This study aimed to structure the knowledge on psychosocial parent-infant interventions and to identify gaps in the intervention studies.

Methods

We included studies on early (during first year of life) psychosocial parent-infant interventions with parent-infant relationship outcomes after preterm birth (< 37 weeks). We excluded studies that did not focus on preterm infants, failed to indicate the studied intervention and outcomes, were not written in English, were not controlled or peer-reviewed studies, or did not provide essential information for eligibility. The search included studies published between January 2000 and March 2024 in PubMed and PsycINFO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in reporting. Psychosocial parent-infant intervention studies were classified adapting the International Classification of Health Interventions (ICHI) and the Template for Intervention Description and Replication (TIDieR).

Results

The included 22 studies reported data from 18 different interventions with preterm infants (< 37 weeks). Studies excluded preterm infants with health risks (19/22, 86%), with very low gestational age and/or birth weight (7/22, 32%), and/or mothers with psychosocial risks (14/22, 64%). Of the 18 interventions, 12 (67%) were classified as counseling, 3 (17%) as emotional support, 2 (11%) as psychotherapeutic, and 1 (6%) as educational. The parent-child relationship was assessed using 30 different methods and varying time points up to 18 months of age. Most studies (17/22, 77%) reported positive changes in the parent-child relationship favoring the intervention group.

Conclusion

We identified four types of interventions to influence parenting behavior; the most used was counseling. All four intervention types showed positive effects on parent-infant relationships, although the preterm populations studied were selective, the effects were evaluated using different methods, and the follow-up periods were short. These findings indicate a need for studies with standardized methods, longer follow-up, and less-restricted preterm populations to develop guidelines for all families with preterm infants.

Intrusive parenting in early childhood: A review and meta-analysis

This systematic review and meta-analysis examines similarities and differences in intrusive parenting between mothers and fathers and relations between intrusive parenting and early childhood development. The authors integrated 55 studies and differentiated cognitive skills and socio-emotional problems as developmental outcomes. The present study employs three-level meta-analyses to reliably estimate effect sizes and examine a range of moderators. It finds a moderate effect size of similarities in intrusive parenting within a family (r = 0.256, confidence interval [CI] = [0.180, 0.329]). No significant differences were observed in intrusiveness level between mothers and fathers (g = 0.035, CI = [-0.034, 0.103]). Intrusive parenting had a significant positive association with children's socio-emotional problems (r_mother  = 0.098, CI_mother  = [0.051, 0.145]; r_father  = 0.094, CI _father  = [0.032, 0.154]) but was not related to cognitive skills. Moderator analyses suggest that East Asian mothers exhibit higher intrusiveness levels than fathers, whereas Western parents display no significant differences. Overall, these results reveal more similarities than differences in intrusive parenting and that culture likely plays a role in shaping gender-specific parenting behaviors.

Parental perspectives of outcomes following very preterm birth: Seeing the good, not just the bad

AIM

To describe parental perspective on health and developmental outcomes of their preterm child in relation to level of neurodevelopmental impairment (NDI).

METHODS

A parental survey about their children aged 15-36 months corrected age born ˂29 weeks' gestation investigated parental concerns and positive attributes. Parental responses in relation to their child's level of NDI were examined using Kruskal-Wallis and chi-square for trend tests.

RESULTS

One hundred ninety-nine parental responses were obtained for 163 children, including 44% with NDI. Vast majority of parents reported their children were developing well with good physical health. All parents, irrespective of NDI, reported their children were happy and had a positive personality. Appreciation of social interactions was higher for parents of children without versus with NDI (96% vs. 87%, p = 0.039). Parents of children with NDI were more likely to express concerns than those without NDI. Overall, development was the most common area of concern (45%), followed by the child's future (40%) and physical health (35%).

CONCLUSION

Parents of preterm children report many positive points and concerns, some of which are not examined in neonatal follow-up data. These parental perspectives could be used to inform parents of preterm infants, both antenatally and in the neonatal unit.

The Quality of Interactive Behaviors in the Context of Prematurity: Fathers, Mothers, Daughters, and Sons

OBJECTIVE

This study examined the quality of interaction between preterm-born preschoolers and their mothers and fathers, focusing on the role of child and parental sex.

METHODS

Participants included 88 preterm-born children (<37 wk gestational age) and 44 full-term-born children (≥37 wk gestational age) aged 3 1/2 years and their parents. Mother-child and father-child dyads were observed during a structured interactive task. Children's cooperation-compliance and negativity-hostility behaviors were coded using the Coding System for Mother-Child Interactions, and parents' sensitive behavior was coded using the Ainsworth Sensitivity Scale.

RESULTS

There was no association between preterm birth and the quality of child and parents' interactive behaviors. In the full-term group, fathers exhibited lower levels of sensitive behavior than mothers, but in the preterm group, both parents exhibited similar levels of sensitive behavior. Preterm boys exhibited more interactive difficulties than preterm girls, but there was no significant effect of child sex on full-term children's interactive behaviors. Children exhibited more compliance-cooperation and less negativity-hostility toward fathers than toward mothers.

CONCLUSION

The findings suggest that prematurity in itself does not affect the quality of parent-preterm child interactive behaviors as the children enter the preschool period. Preterm boys seem to be at higher risk for interactive difficulties than girls, and thus, child sex should be considered when monitoring and examining the development of preterm children.

Döhmann I, Bretthauer S, Krankenkasse T, Wobbe‐Ribinski S. Trust in medical professionals and its influence on the stress experience of parents of premature infants

AIM

To examine parents' perceptions of stress and their trust in physicians and nursing staff and to investigate whether trust influences the parental perceptions of potential stressors resulting from their infant's hospitalisation in a neonatal intensive care unit.

METHODS

Parents of very and extremely low birth weight infants were surveyed in a nationwide retrospective cross-sectional study 6-18 months after their child's birth. Parental stress was measured utilising the PSS:NICU_German/2-scales, and trust was measured by the scales Trust in Physicians and Trust in Nursing Staff. In addition to descriptive analyses, multiple linear regression models were conducted.

RESULTS

The change in parents' anticipated roles was assessed as more stressful than their infant's appearance and behaviour. Trust in nursing staff significantly influenced the parental stress level. Although the level of trust in physicians was rated higher than trust in nursing staff, trust in physicians did not yield a significant effect on the parental stress experience.

CONCLUSION

Efforts to foster parental trust in nursing staff may reduce the parental stress level and hence enable parents to better cope with the situation. The parental resources unleashed in this way can be employed to enhance parenting.

Parenting and Neurobehavioral Outcomes in Children Born Moderate-to-Late Preterm and at Term

OBJECTIVES

To compare the parenting environment and the relationships between parenting behaviors and concurrent child neurobehavioral outcomes at 2 years of corrected age between children born moderate-to-late preterm (MLP; 32-36 weeks of gestation) and at term (≥37 weeks of gestation).

STUDY DESIGN

Participants were 129 children born MLP and 110 children born at term and their mothers. Mothers' parenting behaviors (sensitivity, structuring, nonintrusiveness, nonhostility) were assessed at 2 years of corrected age using the Emotional Availability Scales. Child cognitive and language development were assessed using the Bayley Scales of Infant and Toddler Development, and social-emotional competence using the Infant Toddler Social and Emotional Assessment.

RESULTS

Mothers of children born MLP and at term displayed similar parenting behaviors overall, with slightly lower nonintrusiveness in mothers of children born MLP (adjusted mean difference -0.32 [-0.60, -0.04]; P = .03). In both groups of children, greater maternal sensitivity was associated with better cognitive development (P < .001 MLP; P = .02 term), increased maternal structuring was associated with better social-emotional competence (P = .02 MLP; P = .03 term), and higher maternal nonintrusiveness was associated with better cognitive, language, and social-emotional outcomes (all P < .04). Greater maternal sensitivity and structuring were associated with better language development in children born MLP but not in children born at term.

CONCLUSIONS

Parenting behaviors are important for neurobehavioral outcomes in children born MLP and at term. Language development may be more strongly influenced by select parenting behaviors in children born MLP compared with children born at term.

A narrative review of the effect of parent-child shared reading in preterm infants

The benefits of book-reading interventions on language development in full-term infants have been well investigated. Because children born preterm face a greater risk of cognitive, language and emotional impairments, this narrative review examines the theoretical evidence, empirical findings, and practical challenges for introducing such intervention to this population. The effect of shared book interventions on typically developing infants is mediated by three components: a linguistic aspect (i.e., exposure to enriched linguistic input), an interactive aspect (i.e., eliciting more synchronous and contingent communication), and a parental aspect (i.e., reducing parental stress and increasing sense of control). Parental shared book reading in a neonatal intensive care unit (NICU) was found to be feasible and well accepted. It provides concrete support for positive parenting in a highly stressful context. Preliminary evidence supports a positive effect of shared reading sessions in physiological parameters of preterm infants in NICU. One study showed that parental shared book reading in an NICU is associated with lower decline in language development during the first 24 months compared to a historical control group. Findings from a community-based birth cohort confirm the positive effect of this intervention on cognitive development with a 2-year-follow up. More structured clinical trials are now needed to confirm these preliminary findings. Questions remain about possible moderators of these interventions, in particular cultural features.

Parent-Infant Interactions Among Infants With High Risk of Cerebral Palsy: A Protocol for an Observational Study of Infant and Parental Factors for Dyadic Reciprocity

Background: An early diagnosis of chronic disability, such as risk of Cerebral Palsy (CP), is likely to affect the quality of parent-infant interactions by affecting both infant and parental factors. Due to adverse perinatal events, infants at high risk of CP may exhibit less engagement in interactions, while parents may experience increased mental health problems and disrupted parental representations that can have a negative effect on parental sensitivity. Recent clinical guidelines on early intervention among families with infants at risk of CP recommends supporting parental sensitivity and mutual enjoyable interactions more research is needed to inform such interventions. This includes understanding how infant and parental risk as well as resilience factors impact parent-infant interactions and how existing parenting programs developed among typical developing infants should be adapted to families with infants at risk of CP. In addition, as majority of research on infant neurohabilitation focus on improving motor and cognitive outcomes research on infant emotional development is needed. The study aim is to assess the quality of early parent-infant interactions in families with high-risk infants, compared to families with low-risk infants, and to explore how interaction quality is affected by infant and parental factors. Three potential mediating factors explaining the association between CP risk and less optimal parent-infant interactions will be explored: infant interactional capacities, parental mental health and well-being, and parents' representations of their child. Methods: The prospective, longitudinal design will follow infants at high risk for CP and their parents and a control group at three time points from 15 weeks to 15 months corrected infant age (CA). Measures comprise infant developmental assessments, questionnaires and interviews with both parents, and global ratings of video-recorded parent-infant interactions. Discussion: Study results will enhance our understanding of how parent-infant interactions may be affected by perinatal neurological risk and identify potential important mechanisms for observed associations. This knowledge could assist in planning future early screening and intervention programs and identifying families who should be offered targeted psychological interventions in addition to neurohabilitation programs.

The Effect of Supportive Nursing Interventions on Reducing Stress Levels of Mothers of Infants in the Neonatal Intensive Care Unit: A Randomized Controlled Trial

The purpose of this study was to determine the effects of supportive interventions on the stress levels of mothers with infants hospitalized in the Neonatal Intensive Care Unit (NICU). This study was a prospective, pre-and post-test randomized controlled trial. The research was completed with 85 mothers in two groups of 45 subjects and 40 controls selected at random. Data collection used the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), NICU Parent Belief Scale (NICU:PBS), State-Trait Anxiety Inventory (STAI TX-2) and saliva cortisol analysis. There were statistically significant differences in favor of the experiment group for the PSS:NICU images and sounds subscale and PBS total points after supportive interventions (p < .05). Supportive nursing interventions were effective in reducing stress related to the intensive care environment, anxiety levels and saliva cortisol levels and increasing parental belief among mothers.

Self-reinforcement: Coping strategies of Iranian mothers with preterm neonate during maternal role attainment in NICU; A qualitative study

INTRODUCTION

Having a preterm neonate in the neonatal intensive care unit (NICU) is one of the most stressful experience for parents. In facing these stressors, mothers need to find ways to adapt and control resources to maintain stability. The aim of this paper is to report coping strategies of mothers with preterm neonate during maternal role attainment in NICU.

METHODS

This paper reports a part of the findings of a grounded theory study that investigated how the mothers of preterm neonates go through maternal role attainment. The data were collected through in-depth semi-structured interviews with 12 mothers with preterm neonate admitted to the NICU and 5 nurses working in NICU. Data were analyzed according to Corbin and Strauss's (2015) approach using constant comparative analysis technique.

FINDINGS

Four themes, emerged from experiences of the participants, formed the concept of "Self-reinforcement" as the prominent strategy of mothers: "support seeking", "Spiritual getting in the mood", "Hope creation" and "Getting energy from the baby".

CONCLUSION

These findings showed that mothers use strategies to calm and support themselves and their neonates, and recognize that their lives had changed and need to adjust to their new circumstances.

Father's Bonding With an Infant Born Prematurely: A Qualitative Meta-synthesis

There is no current theory that explains the process of a fathers' bonding with their infants born prematurely. Through meta-synthesis of 19 qualitative studies, we developed a conceptual framework to illustrate how fathers perceive the relationship with their premature infant formed over the first 18 months of life. It details the contextual factors that contribute to that process. Findings reveal a complex process comprised of five stages, derived from five core themes and related subthemes. Fathers progress through five sequential stages to establish their role as fathers and form emotional connections with their child. Stages include: (a) feeling alien and lacking emotional connection to the infant, (b) caregiving engagement and claiming the role as a father, (c) claiming the infant as their own, (d) adjusting to having the infant home, and (5) normalizing family life. This conceptual framework can inform future research and clinical interventions designed to foster father-infant bonding.

Fathers' lived experiences of caring for their preterm infant at the neonatal unit and in neonatal home care after the introduction of a parental support programme: A phenomenological study

Aim

To describe fathers’ lived experiences of caring for their preterm infant at the neonatal unit and in hospital‐based neonatal home care after the introduction of an individualised parental support programme.

Method

Seven fathers from a larger study were included due to their rich narrative interviews about the phenomenon under study. The interviews took place after discharge from neonatal home care. The theoretical perspective was descriptive phenomenology. Giorgi’s outlines for phenomenological analysis were used. Findings The general structure of the phenomenon was described by the following four themes: The partner was constantly present in the fathers’ minds; The fathers’ were occupied by worries and concerns; The fathers felt that they were an active partner to the professionals and Getting the opportunity to take responsibility. The fathers were satisfied with the support and treatment during their infant’s hospitalisation. However, there were times when they felt excluded and not fully responsible for their infant. The fathers prioritised the mother, thus ignoring their own needs. Furthermore, they worried about their infant’s health and the alteration of their parental role. Neonatal home care was experienced as a possibility to regain control over family life.

Conclusion

The general structure of fathers’ experiences highlights the importance of professionals becoming more responsive to fathers’ needs and to tailoring support to fathers by focusing on their individual experiences and needs.

Trajectories of Overprotective Parenting and Hyperactivity-Impulsivity and Inattention Among Moderate-Late Preterm Children: A Population-Based Study

Parents of preterm children are more likely to adopt non-optimal parenting behaviors than parents of full-term (FT) children. However, there is a lack of studies on parents of children born moderate to late preterm (MLP; 32-36 gestational weeks). In this study, we aimed to examine: (1) the association between MLP birth status and the trajectory of parental overprotection throughout preschool years, and (2) the role of parental overprotection, MLP birth status, and their interaction in the prediction of the trajectories of hyperactivity-impulsivity and inattention throughout childhood. Data comes from a Canadian representative population-based cohort including 2028 FT, 100 MLP children, and their parents. Overprotective parenting was measured when children were 5, 17, and 29 months old. Hyperactivity-impulsivity and inattention symptoms were measured repeatedly from 4 to 8 years of age. Trajectories of parents' overprotectiveness and children's hyperactivity-impulsivity and inattention were modeled. MLP birth status was associated with an increase in parental overprotectiveness across the preschool period. MLP birth status and parental overprotection were both found to be associated with higher levels of hyperactivity-impulsivity symptoms across childhood. No interaction was found between birth status and parental overprotection. The results suggest that parents of MLP children become more overprotective across time compared to parents of FT children and that children born MLP and/or exposed to higher levels of parental overprotection demonstrated higher levels of hyperactivity-impulsivity symptoms across childhood.

Observed Progression of Parents' Understanding of Preterm Infants' Behavioral Signs at 33 to 35 Weeks Corrected Age

BACKGROUND

Interventions aimed at improving parental understanding of preterm infants' behavioral signs have drawn increased attention in recent years. However, there are limited data regarding parents' actual perceptions of infants' behavior during parent-infant interactions while infants are in a light-sleep state.

PURPOSES

(1) To describe parental perceptions of infants' behavior at 33 to 35 weeks' corrected age during light-sleep and (2) to identify changes in parental perceptions of preterm infants' behavior over time.

METHODS

This study used a qualitative, longitudinal design based on observations and interviews. Three sets of parents and their infants born between 29 and 30 weeks' gestational age were observed up to 3 times during light sleep states when the infants were 33 to 35 weeks' corrected age. Parents were interviewed regarding their perceptions of infant behavior/growth once at the time of observation and once more within 2 weeks of the final observation. The findings are based on the observation of parents' perception-driven interactions with infants.

RESULTS

Four themes emerged describing the transition of parental perception that progresses to gain a better understanding of their infant's behavior through repeated interaction.

IMPLICATIONS FOR PRACTICE

The findings of this study inform caregivers in neonatal intensive care units regarding the unique experience of parent-infant dyads. This knowledge can help promote family-centered developmental care efforts in neonatal intensive care units.

IMPLICATIONS FOR RESEARCH

Further research should focus on studying a larger sample group to confirm the findings and refining strategies to incorporate the findings to enhance neonatal intensive care unit care.

Pictures of preterm infants elicit increased affective responses and reduced reward-motivation or perspective taking in the maternal brain

Preterm-birth increases the risk of several physical, cognitive, neuromotor, and psychosocial problems in children, and is also related to difficulties in the parent-child relationship. Research suggests that the development of early parent-child interactions in general is affected by deviations from typical infant facial characteristics, which may also be important in the case of small, preterm born infants. Therefore, we examined mothers' (N = 22, of whom 17 had no direct experience with preterm birth) neural responses to pictures of preterm and full-term infants using functional magnetic resonance imaging (fMRI). We also explored whether neural responses to preterm and full-term infants correlated with mothers' self-reported tendencies to be nurturing and protective with children, and with mothers' ratings of affection or aversion toward pictures of preterm infants. Results revealed that, compared to pictures of full-term infants, those of preterm infants elicited more activity in specific areas of the brain (dmPFC, right insula, left caudate, hippocampi, parahippocampi, and PAG), that have previously been associated with processing of negative emotions and with empathy. In addition, less activity was seen in one area of the brain (vmPFC) known to be associated with reward-motivation or mental state understanding and perspective-taking. Higher self-reported maternal nurturance was associated with increased activity to pictures of preterm infants vs full-term infants in the caudate, which might reflect approach- or reward-related processing. To conclude, neural responses to preterm infants are related to reward-motivation, mentalizing, negative emotions, and empathy. Future studies should examine whether such neural processing of preterm infant stimuli might underlie difficulties in the parent-child relationship of parents with a preterm child.

Parents experiences of feeding their extremely preterm children during the first 2-3 years - A qualitative study

AIM

To describe parents of extremely preterm children experiences regarding feeding of their children during the first 3 years of the child's life.

METHODS

This is a qualitative study involving interviews conducted with 12 parents of nine children who had been cared for at one neonatal intensive care unit in Sweden. The interviews were conducted between May and September 2018; the data were analysed using qualitative content analysis.

RESULTS

All parents experienced some difficulties with their child's eating development and described feeding their child as sometimes both difficult and frustrating. Variation in when these difficulties arose made it hard for the parents to obtain the individual support they wanted and needed. Parents experienced a need for more support - from both staff members and parents with similar experiences - during and after their child's stay at the NICU.

CONCLUSION

All parents participating in the study experienced difficulties during some phase of their child's feeding development. They expressed the need for more specialised support both during and after their child's time at the hospital.

Controlling Parenting Behaviors in Parents of Children Born Preterm: A Meta-Analysis

OBJECTIVE

This meta-analysis tested whether parents of preterm-born children differ from parents of full-term-born children regarding controlling parenting.

METHODS

Databases of PubMed, Scopus, Web of Science, Open Access Theses and Dissertations, and Elton B. Stephens Company were searched for cross-sectional and prospective longitudinal studies examining controlling parenting in preterm-born children.

RESULTS

The meta-analysis included 27 independent data sets, derived from 34 studies, with a total of 8053 participants-3265 preterm and 4788 full-term children. Parents of children born preterm were more controlling than parents of children born full-term (Hedges' g = 0.29; 95% confidence interval: 0.19-0.39; z = 5.48; p < 0.001). Heterogeneity analysis indicated significant variation in effects between studies (Q = 148.46, p < 0.001), but the effects were not moderated by gestational age, birth weight, child age, child gender, parental education, type of parenting assessment method (observational vs parental self-report), parenting dimension measured (behaviors vs attitudes), type of controlling parenting (intrusiveness vs others), study design (cross-sectional vs longitudinal), year of publication, or geographical setting of the studies (America vs Europe).

CONCLUSION

Findings suggest that parents of children born preterm are at higher risk for engaging in controlling parenting strategies, stressing the importance of psychosocial follow-up support for these parents.

Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision

OBJECTIVE

To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision.

STUDY DESIGN

For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18- to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital.

RESULTS

Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or antenatal steroids. Despite similar birth weight and medical morbidities, the CPS group had longer hospital stays compared with the non-CPS group. In adjusted analysis, cognitive scores were points lower (B = -1.94; 95% CI, -3.88 to -0.08; P = .04) in the CPS at discharge group compared with the non-CPS group. In children who entered CPS supervision after hospital discharge (an additional 106 infants), cognitive scores were 4 points lower (β = -4.76; 95% CI, -7.47 to -2.05; P < .001) and language scores were 5 points lower (β = -4.93; 95% CI, -8.00 to -1.86; P = .002).

CONCLUSION

Extremely preterm infants discharged from the hospital with CPS supervision or entering CPS postdischarge are at increased risk for cognitive delay at 2 years of age. Opportunities exist to intervene and potentially improve outcomes in this vulnerable group of children.

Stress and feelings in mothers and fathers in NICU: identifying risk factors for early interventions

AIMS

The aims of this study were to explore parents' stress levels and negative feelings after premature births and to identify the risk factors related to parents' stress and negative feelings during their children's neonatal intensive care unit (NICU) stay.

BACKGROUND

Preterm birth is a multi-problematic event that may put the babies in danger for both their medical and neurophysiological conditions and could have a negative impact on both the mother-father relationship and the parent-child interactions.

METHODS

The study involved 43 mothers and 38 fathers of preterm infants. All participants filled out the Parental Stressor Scale: Neonatal Intensive Care Unit and the Profile of Mood States.

FINDINGS

The results revealed significant differences between mothers' and fathers' responses to preterm births in terms of both stress and negative feelings. We found that, for mothers, their own young age and the baby's need for respiratory support were significant predictors of stress; for fathers, their own young age and the baby's lower gestational age and worse condition at birth were significant predictors of stress and negative feelings. The NICU may be a stressful place both for mothers and fathers. Identifying which mothers and fathers are at risk immediately after their children are born could help to direct specific interventions that can reduce these parents' stress and prevent them from negative feelings.

Influence of Fathers' Early Parenting on the Development of Children Born Very Preterm and Full Term

OBJECTIVES

To examine factors associated with fathers' early parenting behaviors (including very preterm [VPT] birth, familial social risk, child sex, and child medical risk), and the relationship between fathers' early parenting behaviors and later child development.

STUDY DESIGN

Participants were 81 VPT (born <30 weeks of gestation) and 39 full-term father-child dyads. Parenting behaviors (sensitivity, structuring, nonintrusiveness, nonhostility) were assessed at 12 months of corrected age using the Emotional Availability Scales, with scores ranging from 1 (low) to 7 (high). At 24 months of corrected age, child cognitive, language, motor, and social-emotional development were assessed. Results are presented as (regression coefficients; 95% CIs).

RESULTS

There was little evidence that VPT birth, familial social risk, or child medical risk were associated with fathers' parenting behaviors. Fathers of girls tended to be more sensitive (0.42; 0.18, 0.65), less intrusive (0.36; 0.04, 0.70), and less hostile (0.26; 0.01, 0.50) compared with fathers of boys. Higher structuring was associated with more optimal cognitive (3.29; 1.25, 5.34), and language development (4.69; 2.26, 7.14). Higher sensitivity was associated with more optimal language development 3.35 (0.95, 5.75), and more intrusive behavior was associated with more externalizing symptoms (-1.68; -3.06, -0.31).

CONCLUSIONS

Early parenting did not differ between fathers with VPT and full-term children, but fathers' parenting did vary according to child sex. Fathers' early parenting was associated with future neurodevelopment, reinforcing the need to support fathers' parenting, and include fathers in early intervention programs.

Predictors of length of stay for initial hospitalization in infants with bronchopulmonary dysplasia

OBJECTIVE

Longer initial hospitalizations for preterm infants with bronchopulmonary dysplasia (BPD) can delay family bonding and attainment of developmental milestones, increase the risk for hospital acquired complications, and increase healthcare costs. The goal of the study was to identify the characteristics associated with longer lengths of hospitalization in this high-risk population.

STUDY DESIGN

A retrospective analysis was performed on 660 children (born ≤32 weeks gestation) discharged from 13 Maryland NICUs recruited into an outpatient BPD registry.

RESULT

The mean age of discharge was 4.3 ± 2.9 months (median: 3.7 months). Subjects born with lower birthweights and covered by public insurance had longer lengths of hospitalization. Clinical characteristics at discharge associated with longer initial hospitalizations included gastrostomy tube, mechanical ventilation, tracheostomy, pulmonary hypertension, and supplemental oxygen.

CONCLUSION

Identifying the risk factors associated with longer lengths of stay could prompt the implementation of personalized in-hospital interventions to improve outcomes and minimize length of stay in infants with BPD.

Hope in Parents of Very-Low Birth Weight Infants and its Association with Parenting Stress and Quality of Life

PURPOSE

Being a parent of a very-low-birth-weight (VLBW) infant can be stressful. We aimed to describe parental hope 42months after the birth of a VLBW infant and determine whether there is an association between hope and parenting stress with quality of life (QoL), respectively.

DESIGN AND METHODS

Fifty-nine parents of VLBW infants completed questionnaires about hope, parenting stress and QoL. Pearson correlation coefficients (r) and linear regression models were used to examine the relationship between the selected variables. To compare groups, t-test was used and Cohen's d for effect size was calculated.

RESULTS

Parents of VLBW infants were more hopeful than the general population (p<0.001). Parenting stress and hope were both independently associated with QoL (p<0.001). The subgroup of parents of infants with birth weight <1000g had less hope (p=0.041) and higher parenting stress (p=0.041) than parents of infants with birth weight 1000-1500g.

CONCLUSIONS

Hope and parenting stress were both independent determinants of QoL. Parents of the presumably sickest infants had less hope and higher parenting stress than parents of VLBW infants with a birth weight over 1000g. Hope should be further explored as a coping mechanism in parents of VLBW infants.

PRACTICE IMPLICATIONS

The clinical implications of the strong association between hope, parenting stress and QoL remain to be determined, but reducing stress and strengthening hope seem to be important. This should be taken into account both at hospital discharge and at follow-up, especially for lower-birth-weight infants.

"You Can Only Give Warmth to Your Baby When It's Too Late": Parents' Bonding With Their Extremely Preterm and Dying Child

This study on end-of-life decisions in extremely preterm babies shows that the parents under study experience a multitude of stressors due to the immediate separation after birth, the alienating setting of the neonatal intensive care unit (NICU), the physical distance to the child, medical uncertainties, and upcoming decisions. Even though they are considered to be parents (assigned parenthood), they cannot act as primary caregivers. Instead, they depend on professional instructions for access and care. Embodied parenthood can be experienced only at the end-of-life, that is, during the dying trajectory and after the child's death. Professionally supporting parents during this compressed process (from assigned and distant to embodied parenthood) contributes fundamentally to their perception of being a family and supports their mourning. This calls for the further establishment of palliative and bereavement care concepts in neonatology.

Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress

Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85) and 19 fathers (age = 34.92 ± 4.58) of preterm infants (GA = 30.96 ± 2.97) and 20 mothers (age = 40.08 ± 4.76) and 20 fathers (age = 40.32 ± 6.77) of full-term infants (GA = 39.19 ± 1.42) were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers’ responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay) and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.