Parent Engagement Correlates With Parent and Preterm Infant Oxytocin Release During Skin-to-Skin Contact

Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation

AIM

To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care.

DESIGN

The concepts' uses in the literature were analysed to determine attributes, influences, and relationships.

METHODS

Delineations of each concept are established and conceptual definitions are proposed following Morses' methods.

DATA SOURCES

MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023.

RESULTS

Multinational publications dated 1991-2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family-integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf.

CONCLUSION

These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers.

IMPLICATIONS

Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family-integrated care delivery.

IMPACT

Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family-integrated care delivery.

FINDINGS

Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another.

IMPACT

Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family-integrated care delivery.

Impact of discharge criteria on the length of stay in preterm infants: A retrospective study in Japan and Finland

BACKGROUND

To shorten the hospital stay in preterm infants, it is important to understand the factors extending the length of stay.

AIMS

To understand how different discharge criteria affect the length of stay in preterm infants.

STUDY DESIGN

A retrospective comparison study.

SUBJECTS

Preterm infants born at 28 to 31 gestational weeks in 2020-2021 in a Level IV NICU in Japan (n = 22) and a Level III NICU in Finland (n = 49).

OUTCOME MEASURES

We compared the most common last discharge criteria and the postmenstrual age (PMA) between the two NICUs. The potential extending effects of each discharge criterion on the length of stay were also evaluated. The discharge criteria were classified into six categories: temperature, respiration, feeding, examination, weight limit, and family readiness.

RESULTS

The PMA at discharge was significantly higher in Japan than in Finland: median 40.7 (interquartile range 39.9-41.3) vs. 37.9 (36.9-39.0) weeks; r = 0.58; p < 0.001. The most common last discharge criterion was the family criterion in Japan (n = 19; 86 %) and the respiration criterion in Finland (n = 43; 88 %). In Japan, the length of stay was extended by 7.9 (standard deviation [SD] 7.0) days due to a lack of family readiness for discharge and 8.7 (SD 8.7) days due to not having discharged home with a feeding tube as a common practice.

CONCLUSIONS

The length of stay of preterm infants in Japan could be notably reduced by supporting the parents' earlier readiness for discharge and allowing tube feeding at home.

Associations between Parental Engagement in the Neonatal Intensive Care Unit and Neighborhood-Level Socioeconomic Status

OBJECTIVE

 This study aimed to (1) determine the effect of neighborhood-level socioeconomic status (SES), which considers the social and physical environment where a person lives, on parental engagement in the Neonatal Intensive Care Unit (NICU) and (2) compare the relationships between parental engagement and individual versus neighborhood-level measures of SES.

STUDY DESIGN

 In this cohort study, parents (n = 45) of premature neonates ≤34 weeks' gestation were assessed at 2 and 6 weeks after birth from December 2017 to October 2019. Neighborhood-level SES was determined using census data per the Association of Maternal and Child Health Programs' methodology, and parents self-reported their education level as an individual-level measure of SES. Data on frequency of engagement in NICU activities, including telephone updates, visitation, providing expressed breastmilk, and participating in kangaroo care, were collected from the electronic medical record. Parent psychosocial factors were assessed using validated surveys. Statistical analysis was performed using Fisher's exact test, t-test, and logistic regression.

RESULTS

 In multivariate regression analysis, disadvantaged neighborhood-level SES was associated with decreased odds of kangaroo care (OR = 0.16, 95% CI: [0.03-0.89]) and visitation (OR = 0.14, 95% CI: [0.02-0.87]), while lower individual-level SES was not significantly associated with kangaroo care, visiting, calling, or pumping (p > 0.05).

CONCLUSION

 Parental engagement was more consistently and significantly associated with neighborhood-level SES than with individual-level SES. Therefore, neighborhood-level SES measures may be more explanatory than individual-level SES measures. Further studies and targeted interventions are needed to address disparities in the frequency of kangaroo care and visitation according to SES.

KEY POINTS

· Parents from disadvantaged neighborhoods are less likely to do kangaroo care and visit the NICU.. · Parent engagement was more significantly associated with neighborhood than with parent education.. · Neighborhood-level SES measures may be more explanatory than individual-level SES measures.. · Interventions are needed to address SES-related disparities in NICU kangaroo care and visitation..

In need of a specific antibody against the oxytocin receptor for neuropsychiatric research: A KO validation study

Antibodies are one of the most utilized tools in biomedical research. However, few of them are rigorously evaluated, as there are no accepted guidelines or standardized methods for determining their validity before commercialization. Often, an antibody is considered validated if it detects a band by Western blot of the expected molecular weight and, in some cases, if blocking peptides result in loss of staining. Neither of these approaches are unquestionable proof of target specificity. Since the oxytocin receptor has recently become a popular target in neuropsychiatric research, the need for specific antibodies to be used in brain has arisen. In this work, we have tested the specificity of six commercially available oxytocin receptor antibodies, indicated by the manufacturers to be suitable for Western blot and with an available image showing the correct size band (45-55 KDa). Antibodies were first tested by Western blot in brain lysates of wild-type and oxytocin receptor knockout mice. Uterus tissue was also tested as control for putative differential tissue specificity. In brain, the six tested antibodies lacked target specificity, as both wild-type and receptor knockout samples resulted in a similar staining pattern, including the expected 45-55 KDa band. Five of the six antibodies detected a selective band in uterus (which disappeared in knockout tissue). These five specific antibodies were also tested for immunohistochemistry in uterus, where only one was specific. However, when the uterine-specific antibody was tested in brain tissue, it lacked specificity. In conclusion, none of the six tested commercial antibodies are suitable to detect oxytocin receptor in brain by either Western blot or immunohistochemistry, although some do specifically detect it in uterus. The present work highlights the need to develop standardized antibody validation methods, including a proper negative control, in order to grant quality and reproducibility of the generated data.

Lactation support in neonatal intensive care units in Germany from the mothers' perspective - a mixed-method study of the current status and needs

BACKGROUND

Establishing successful lactation in mothers of very low birth weight (VLBW, <1500g) infants requires structured lactation support. Little is known about mothers' perspectives on lactation support in German neonatal intensive care units (NICUs).

METHODS

This paper features a convergent mixed-method approach that includes a retrospective, cross-sectional questionnaire and interview data to showcase mothers' perceptions of lactation support in NICUs. Content analysis of the interviews (n = 12) and a descriptive analysis of quantitative data (n = 533) were performed to illustrate the current status and need for lactation support in German NICUs.

RESULTS

The results show that lactation support in German NICUs is often inadequate and does not comply with recommendations based on the existing literature to encourage pumping and breastfeeding in mothers. The data imply that even if lactation is successfully initiated in most cases, it is often not maintained over time, which may be due to a lack of personal support and consistent information.

CONCLUSION

The overall structures and institutional guidelines for lactation support should be encouraged to promote nutrition with mother´s own milk in German NICUs.

Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge

OBJECTIVE

This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood.

STUDY DESIGN

This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic.

RESULTS

At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = -1.1 (-1.6, -0.7)], poorer language outcome [p = 0.049, β = -0.5 (-0.9, -0.003)], and poorer motor outcome [p <0.001, β = -1.0 (-1.5, -0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment.

CONCLUSION

Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU.

KEY POINTS

· There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.. · The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.. · These findings provide increased motivation for optimizing the early NICU environment..

Application of the Adverse Childhood Experiences Framework to the NICU

BACKGROUND

Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families.

PURPOSE

Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment.

METHODS

An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed.

RESULTS

NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

Infant and Parent Outcomes Related to NICU-Based Co-occupational Engagement

Neonatal intensive care unit (NICU) co-occupations may impact parent-infant outcomes. The main objective of this study was to explore relationships between parent and infant outcomes based on whether sensory-based interventions (co-occupations) occurred most often between parent-infant dyads or provider/volunteer-infant dyads. Thirty-five families received the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, which includes education defining specific amounts of sensory exposures for infants to receive each day of NICU hospitalization (with a preference for parent delivery). Infant sensory experiences in the NICU were logged, and dyads were grouped based on who conducted most of the sensory interventions with the infant in the NICU into a Parent-Infant Co-occupation group or Other Administered group. The Parent-Infant Co-occupation group had infants with less lethargy on the NICU Network Neurobehavioral Scale (p = .04), and parents with lower scores on the Parental Stress Scale (p = .003) and State-Trait Anxiety Inventory-state (p = .047). Parent-infant engagement in co-occupations was related to parental mental health and infant neurobehavior.

Effects of family-centered care on bonding: A systematic review

Most critically ill neonates require constant monitoring, continuous care, and supervision. However, distance created by admission and prolonged stay in a neonatal intensive care unit (NICU) may contribute to a delay in parent-infant bonding. This review aimed to determine how family-centered care (FCC) in the NICU affects parental bonding with critically ill infants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform a systematic search of the literature within the following four electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, and Web of Science. The search was conducted through July/August 2020. Research quality was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Grading Scale. Out of 816 articles identified through literature search, 16 of the studies met our inclusion criteria. The majority of the studies (n = 14) found FCC interventions resulted in a significant increase in parental bonding. Results showed evidence practicing FCC in the NICU setting supports early parent-infant bonding. Nurses should consider implementing evidence-based FCC strategies into practice, such as allowing parents unrestricted access to their infants. More rigorous research with larger samples is recommended. More studies are also needed focusing on father-infant dyads and mother-father-infant triads.

Maternal Voice and Tactile Stimulation Modulate Oxytocin in Mothers of Hospitalized Preterm Infants: A Randomized Crossover Trial

Prematurity is a major risk factor for perinatal stress and neonatal complications leading to systemic inflammation and abnormal mother-infant interactions. Oxytocin (OT) is a neuropeptide regulating the inflammatory response and promoting mother-infant bonding. The release of this hormone might be influenced by either vocal or tactile stimulation. The main objective of the current randomized, crossover, clinical trial was to assess the salivary OT/cortisol balance in mothers following the exposure of their baby born preterm to two types of sensorial interventions: maternal voice without or with contingent tactile stimulation provided by the mother to her infant. Among the 26 mothers enrolled, maternal voice intervention alone had no effect on OT and cortisol levels in the mothers, but when associated with tactile stimulation, it induced a significant increase in maternal saliva oxytocin (38.26 ± 30.26 pg/mL before vs 53.91 ± 48.84 pg/mL after, p = 0.02), particularly in the mothers who delivered a female neonate. Maternal voice intervention induced a significant reduction in cortisol and an increase in OT levels in mothers when the maternal voice with a tactile stimulation intervention was performed first. In conclusion, exposure to the maternal voice with a contingent tactile stimulation was associated with subtle changes in the maternal hormonal balance between OT and cortisol. These findings need to be confirmed in a larger sample size and may ultimately guide caregivers in providing the best intervention to reduce parental stress following preterm delivery.

The Role of Oxytocin in Early-Life-Stress-Related Neuropsychiatric Disorders

Early-life stress during critical periods of brain development can have long-term effects on physical and mental health. Oxytocin is a critical social regulator and anti-inflammatory hormone that modulates stress-related functions and social behaviors and alleviates diseases. Oxytocin-related neural systems show high plasticity in early postpartum and adolescent periods. Early-life stress can influence the oxytocin system long term by altering the expression and signaling of oxytocin receptors. Deficits in social behavior, emotional control, and stress responses may result, thus increasing the risk of anxiety, depression, and other stress-related neuropsychiatric diseases. Oxytocin is regarded as an important target for the treatment of stress-related neuropsychiatric disorders. Here, we describe the history of oxytocin and its role in neural circuits and related behaviors. We then review abnormalities in the oxytocin system in early-life stress and the functions of oxytocin in treating stress-related neuropsychiatric disorders.

Release of Oxytocin and Cortisol Is Associated With Neurobehavioral Patterns in Premature Infants

OBJECTIVE

To examine relationships among salivary oxytocin and cortisol levels in parents and preterm infants and neurobehavioral functioning in preterm infants after skin-to-skin contact.

DESIGN

A secondary analysis of a randomized crossover study.

SETTING

NICU.

PARTICIPANTS

Twenty-eight stable premature infants and their mothers and fathers.

METHODS

Participating infants contributed 108 saliva samples that we collected 45 minutes after skin-to-skin contact and tested for oxytocin and cortisol. We randomized data collection by whether the infant was held first by the mother or by the father. We conducted linear regression to test if summary scores on the NICU Network Neurobehavioral Scale were associated with salivary oxytocin and cortisol levels.

RESULTS

We found a significant negative relationship between infant oxytocin levels and the Stress scores (b = -0.07, p < .01) and the Excitability scores (b = -1.12, p = .04) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant oxytocin levels and the Self-Regulatory scores (b = 0.38, p = .05) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant cortisol level and the Stress scores (b = 0.05, p = .04), Excitability scores (b = 1.06, p = 0.05), and Asymmetrical Reflexes scores (b = 1.21, p = .03) among infants held skin-to-skin with their mothers. We only found a negative significant relationship between infant cortisol levels and the Stress scores (b = -0.03, p = .04) among infants held skin-to-skin with their fathers.

CONCLUSION

We found that oxytocin is an important biomarker that may improve infant neurobehavioral functioning. The data showed a difference in oxytocin responses after skin-to-skin contact with mothers compared to fathers.

Influence of oxytocin on parenting behaviors and parent-child bonding: A systematic review

Oxytocin (OT) plays a pivotal role in early parent-child relationship formation and bonding that is critical for the social, cognitive, and emotional development of the child. Therefore, this systematic review aims to consolidate all available evidence regarding the associations of parental OT concentration levels with parenting behavior and bonding within the past 20 years. A systematic search was conducted in five databases from 2002 to May 2022, and 33 studies were finalized and included. Due to the heterogeneity of the data, findings were presented narratively based on the type of OT and parenting outcomes. Current evidence strongly suggests that parental OT levels are positively related to parental touch and parental gaze and affect synchrony and observer-coded parent-infant bonding. No gender difference in OT levels was observed between fathers and mothers, but OT strengthens affectionate parenting in mothers and stimulatory parenting in fathers. Child OT levels were also positively associated with parental OT levels. Family and healthcare providers could encourage more positive touch and interactive play between parent and child to strengthen parent-child relationships.

The Role of Oxytocin in Abnormal Brain Development: Effect on Glial Cells and Neuroinflammation

The neonatal period is critical for brain development and determinant for long-term brain trajectory. Yet, this time concurs with a sensitivity and risk for numerous brain injuries following perinatal complications such as preterm birth. Brain injury in premature infants leads to a complex amalgam of primary destructive diseases and secondary maturational and trophic disturbances and, as a consequence, to long-term neurocognitive and behavioral problems. Neuroinflammation is an important common factor in these complications, which contributes to the adverse effects on brain development. Mediating this inflammatory response forms a key therapeutic target in protecting the vulnerable developing brain when complications arise. The neuropeptide oxytocin (OT) plays an important role in the perinatal period, and its importance for lactation and social bonding in early life are well-recognized. Yet, novel functions of OT for the developing brain are increasingly emerging. In particular, OT seems able to modulate glial activity in neuroinflammatory states, but the exact mechanisms underlying this connection are largely unknown. The current review provides an overview of the oxytocinergic system and its early life development across rodent and human. Moreover, we cover the most up-to-date understanding of the role of OT in neonatal brain development and the potential neuroprotective effects it holds when adverse neural events arise in association with neuroinflammation. A detailed assessment of the underlying mechanisms between OT treatment and astrocyte and microglia reactivity is given, as well as a focus on the amygdala, a brain region of crucial importance for socio-emotional behavior, particularly in infants born preterm.

Is paternal oxytocin an oxymoron? Oxytocin, vasopressin, testosterone, oestradiol and cortisol in emerging fatherhood

How do hormonal levels in men change from pregnancy to after the birth of their firstborn child, and what is the role of oxytocin, alone or in interplay with other hormones, in explaining variance in their parenting quality? We explored in 73 first-time fathers the development of five hormones that have been suggested to play a role in parenting: oxytocin (OT), vasopressin (AVP), testosterone (T), oestradiol (E2) and cortisol (Cort). In an extended group of fathers (N = 152) we examined associations with fathers’ behaviour with their 2-month-old infants. OT and E2 showed stability from the prenatal to the postnatal assessments, whereas AVP and T decreased significantly, and Cort decreased marginally. OT on its own or in interplay with other hormones was not related to paternal sensitivity. Using an exploratory approach, the interaction between T and E2 emerged as relevant for fathers’ sensitive parenting. Among fathers with high E2, high T was associated with lower sensitivity. Although we did not find evidence for the importance of OT as stand-alone hormone or in interplay with other hormones in this important phase in men's lives, the interaction between T and E2 in explaining variation in paternal behaviour is a promising hypothesis for further research.

This article is part of the theme issue ‘Interplays between oxytocin and other neuromodulators in shaping complex social behaviours’.

Association between salivary oxytocin levels and the amygdala and hippocampal volumes

Salivary oxytocin levels have been widely measured and studied in relation to social behavior because of procedural simplicity and noninvasiveness. Although the relationship between oxytocin levels in the blood and the hippocampus and amygdala is now becoming clear with reliable blood oxytocin studies, few studies have examined the relationship between salivary oxytocin and the brain function and structure. This study aimed to investigate whether the salivary oxytocin level is associated with the volume of the amygdala and hippocampus in 178 adults (92 women and 86 men) in their third to seventh decade of life. We performed volumetric analysis of the amygdala and hippocampus using FreeSurfer and measured salivary oxytocin levels using enzyme-linked immunosorbent assay. The results showed contradictory effects of the salivary oxytocin level on the amygdala volume by sex and no significant effect on the hippocampal volume. Specifically, men showed a positive correlation between the salivary oxytocin level and amygdala volume, whereas women showed a negative correlation between the salivary oxytocin level and amygdala volume. The present study's finding of sex differences in the association between salivary oxytocin and brain structure supports previous findings that there are sex differences in the oxytocin system.

Parent-infant closeness after preterm birth and depressive symptoms: A longitudinal study

Background

Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents.

Methods

This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents’ presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14  days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4  months corrected age of the infant.

Results

The study included 684 mothers and 574 fathers. The median presence was 469   min (Q1 258 and Q3 1,087) per 24   h for the mothers and 259   min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4  months, respectively. Parents’ presence and depressive symptoms varied greatly between the units. Parents’ presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted).

Conclusion

No association was found between the duration of parent-infant closeness in the neonatal unit and parents’ depressive symptoms. The beneficial effects of family-centered care on parents’ depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents’ depression after NICU stay.

Peripheral oxytocin concentrations in psychiatric disorders - A systematic review and methanalysis: Further evidence

Increased interest in understanding how changes in the oxytocinergic system are associated with the etiology and progression of psychiatric disorders has currently boosted the publication of studies. We present a systematic literature review followed by meta-analyses assessing whether peripheral oxytocin (OXT) levels among psychiatric patients differ from healthy controls, considering the moderating role of methodological aspects and samples' characteristics. The following electronic databases were searched: PubMed, Web of Science, PsycINFO, SciELO, LILACS, and Scopus. Fifty-five papers were included in the analysis, and nine independent meta-analyses were performed according to the different diagnoses. Lower OXT concentrations were found in groups of specific disorders (i.e., schizophrenia, restricting and binge-eating/purging subtypes of anorexia nervosa, and borderline personality disorder) with medium to large effect sizes. Great heterogeneity was found among the studies, so that caution is needed to interpret the results. High OXT levels with an effect size of the same magnitude were found for bipolar disorder - type I and obsessive disorder. In contrast, no differences were found for bulimia, autism spectrum, depression, or social anxiety. No meta-analyses were performed for body dysmorphic disorder, post-traumatic stress disorder, or trichotillomania because only one study was identified for each of these disorders. Altered endogenous OXT concentrations are found in several disorders addressed and must be analyzed according to each disorder's specificities.

The effects of oxytocin and vasopressin administration on fathers' neural responses to infant crying: A randomized controlled within-subject study

In a randomized double-blind within-subject control study we investigated the effects of oxytocin and vasopressin administration on neural reactivity to infant cry sounds in 70 first-time fathers in the first year of fatherhood. Additionally, we examined whether effects of oxytocin and vasopressin administration on neural reactivity were moderated by fathers' early childhood experiences. Neural reactivity to infant cry sounds (versus control sounds) was measured using functional magnetic resonance imaging (fMRI). Furthermore, participants reported on their childhood experiences of parental harsh discipline and parental love withdrawal. Whole brain analyses revealed no significant effect of vasopressin or oxytocin administration on neural activation in response to infant cry sounds. Region of interest analyses showed decreased amygdala activation in both the oxytocin condition and the vasopressin condition as compared to placebo. We found no moderating effects of fathers' early childhood experiences. Our findings suggest that oxytocin administration may decrease feelings of anxiety or aversion to a crying infant. Whether decreased amygdala activation after vasopressin administration might be explained by contextual factors (e.g., absence of high levels of threat, unfamiliarity of the infant) or represents an affiliative response to infant distress warrants further investigation. Findings of the present study showed that oxytocin and vasopressin are important hormones implicated in neural models of infant cry perception in fatherhood.

Barriers to Kangaroo Care in the NICU: A Qualitative Study Analyzing Parent Survey Responses

BACKGROUND

Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored.

PURPOSE

To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC.

METHODS

This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services.

RESULTS

Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.

Ten Years of Neonatal Intensive Care Adaption to the Infants' Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway

Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support. Our paper describes how we managed to systematically reorganize the nurse's workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants' needs by providing neonatal intensive care with parents as equal partners.

Factors That Influence NICU Health Care Professionals' Decision Making to Implement Family-Centered Care

BACKGROUND

Neonatal intensive care unit (NICU) is a multifaceted, technology-driven high stress environment for professionals, infants and families.

PURPOSE

Examine healthcare professionals' beliefs and perceptions regarding providing FCC within the context of NICU.

METHODS

This exploratory descriptive study used an online-survey format. The survey comprised several instruments including the Perceived Stress Scale, symptoms of burnout subscale from the Professional Quality of Life scale, and the Family Nurse Caring Belief Scale (FNCBS). Demographic and open-ended items were also included.

RESULTS

Sample consisted of 115 multidisciplinary participants working in a level IV neonatal intensive care unit. Participants report strong levels of FCC beliefs. Participants strongly agreed (82%) or agreed (18%) that no matter how sick the infant is, he or she needs to be treated as an individual. A significant correlation (r=-0.343, P < .001) exists between participant's stress composite score and FNCBS composite score. There were significant relationships between participant's years of experience (F = 5.35, P < .002) and education levels (F = 2.60, P < .05) and higher FNCBS composite scores. There were also significant relationships between participant's years of experience (F = 4.77, P < .004) and education (F = 2.89, P < .039) with higher Perceived Stress Scale composite scores.

IMPLICATIONS FOR PRACTICE

Results suggest that while participants agreed that FCC is important, they also believed that inadequate staffing and inappropriate assignments may lead to rationing of care.

IMPLICATIONS FOR RESEARCH

Further research is needed to explore factors that lead to rationing of FCC.

Association of a Family Integrated Care Model With Paternal Mental Health Outcomes During Neonatal Hospitalization

IMPORTANCE

During newborn hospitalization in the neonatal unit, fathers often feel anxious and excluded from their child's caregiving and decision-making. Few studies and interventions have focused on fathers' mental health and their participation in neonatal care.

OBJECTIVE

To study the association of a family integrated care (FICare) model (in single family rooms with complete couplet-care for the mother-newborn dyad) vs standard neonatal care (SNC) in open bay units with separate maternity care with mental health outcomes in fathers at hospital discharge of their preterm newborn and to study whether parent participation was a mediator of the association of the FICare model on outcomes.

DESIGN, SETTING, AND PARTICIPANTS

This prospective, multicenter cohort study was conducted from May 2017 to January 2020 as part of the fAMily Integrated Care in the Neonatal Ward Study, at level-2 neonatal units in the Netherlands (1 using the FICare model and 2 control sites using SNC). Participants included fathers of preterm newborns admitted to participating units. Data analysis was performed from January to April 2021.

EXPOSURE

FICare model in single family rooms with complete couplet-care for the mother-newborn dyad during maternity and/or neonatal care.

MAIN OUTCOMES AND MEASURES

Paternal mental health was measured using the Parental Stress Scale: NICU, Hospital Anxiety and Depression Scale, Post-partum Bonding Questionnaire, Perceived (Maternal) Parenting Self-efficacy Scale, and satisfaction with care (EMpowerment of PArents in THe Intensive Care-Neonatology). Parent participation (CO-PARTNER tool) was assessed as a potential mediator of the association of the FICare model with outcomes with mediation analyses (prespecified).

RESULTS

Of 309 families included in the fAMily Integrated Care in the Neonatal Ward Study, 263 fathers (85%) agreed to participate; 126 fathers were enrolled in FICare and 137 were enrolled in SNC. In FICare, 89 fathers (71%; mean [SD] age, 35.1 [4.8] years) responded to questionnaires and were analyzed. In SNC, 93 fathers (68%; mean [SD] age, 36.4 [5.5] years) responded to questionnaires and were analyzed. Fathers in FICare experienced less stress (adjusted β, -10.02; 95% CI, -15.91 to -4.13; P = .001) and had higher participation scores (adjusted odds ratio, 3.424; 95% CI, 0.860 to 5.988; P = .009) compared with those in SNC. Participation mediated the beneficial association of the FICare model with fathers' depressive symptoms (indirect effect, -0.051; 95% CI, -0.133 to -0.003) and bonding with their newborns (indirect effect, -0.082; 95% CI, -0.177 to -0.015).

CONCLUSIONS AND RELEVANCE

These findings suggest that the FICare model is associated with decreased paternal stress at discharge and enables fathers to be present and participate more than SNC, thus improving paternal mental health. Supporting fathers to actively participate in all aspects of newborn care should be encouraged regardless of architectural design of the neonatal unit.

Parents' Experiences of Immediate Skin-to-Skin Contact After the Birth of Their Very Preterm Neonates

OBJECTIVE

To explore parents' experiences of immediate skin-to-skin contact after the birth of their very preterm neonates and their perceptions regarding care and support from staff.

DESIGN

A descriptive qualitative study.

SETTING

Birth and neonatal units within a university hospital in Sweden.

PARTICIPANTS

Six parent couples who co-cared for their very preterm neonates with skin-to-skin contact throughout the first 6 hours after birth.

METHODS

We analyzed individual interviews using reflexive thematic analysis as described by Braun and Clarke.

RESULTS

The parents' experiences of immediate skin-to-skin contact with their very preterm neonates were represented by the following three themes: A Pathway to Connectedness, Just Being in a Vulnerable State, and Creating a Safe Haven in an Unknown Terrain. Skin-to-skin contact helped the parents attain their roles as essential caregivers and provided a calming physical sensation that promoted parents' feelings of connectedness with their newborns. When parents provide skin-to-skin contact at birth, staff members need to recognize and address their vulnerability. A good relationship with nursing staff, which was mediated through staff behaviors and availability, facilitated skin-to-skin contact.

CONCLUSION

Skin-to-skin contact initiated at birth with very preterm neonates was a valuable and empowering experience for parents and enhanced early bonding between parents and their newborns. Staff members should recognize that skin-to-skin contact between parents and neonates is an interactive process that has challenges. Future research is warranted to understand the needs of nursing staff who provide initial care in the postpartum period. Furthermore, we recommend the implementation of maternal-neonatal couplet care.

Breastfeeding Promotion and Nursing Care for Infants with Cleft Palate and/or Cleft Lip in Northeastern Craniofacial Center, Thailand

Background:

The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process.

Objective:

To evaluate the treatment and breastfeeding rate in infants with CP and CLP.

Methods:

A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected.

Results:

A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively.

Conclusion:

Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.

Intranasal oxytocin administration but not peripheral oxytocin regulates behaviors of attachment insecurity: A meta-analysis

In light of the roles of oxytocin (OT) in social bonding and interpersonal relationship, studies have examined the roles of OT in human attachment, but by and large previous findings are inconsistent. Here, we conducted - meta-analyses to estimate the associations between peripheral OT level (e.g., blood and salivary OT) and attachment (i.e., attachment dimensions and behaviors of attachment insecurity) and examine the effects of intranasal OT administration on behaviors of attachment insecurity. The analyses indicated that: (1) Peripheral OT level was not significantly associated with attachment dimensions (e.g., attachment anxiety and attachment avoidance) and behaviors of attachment insecurity; (2) intranasal OT administration significantly reduced behaviors of attachment insecurity of neutral contexts, particularly behaviors of attachment avoidance. The findings suggest that intranasal OT administration is an available approach for reducing behaviors of attachment insecurity of interpersonal situations with ambiguous social cues, which implicates suggestions for therapeutic treatments of attachment-related dysfunctions.

Systematic review shows the benefits of involving the fathers of preterm infants in early interventions in neonatal intensive care units

Aim

This review identifies interventions involving the fathers of preterm infants that have been tested in neonatal intensive care units (NICU). It examines their effects on the fathers and infants and highlights any differences between fathers and mothers who took part in the same interventions.

Methods

A systematic search was performed in English from 1995 to 1 September 2020, using the CINAHL, Cochrane Central Register of Controlled Trials, Embase, PubMed and PsycINFO databases. We examined 14 peer‐reviewed studies that investigated NICU interventions involving 478 fathers, whose 511 infants were born before 37 weeks of gestation. These included empirical studies with clinical outcomes.

Results

Studies on fathers' interventions in NICUs were limited and mainly restricted to basic skin‐to‐skin contact or tactile interventions. The interventions had similar general positive effects on mothers and fathers when it came to infant physiological and behavioural reactions. There was also evidence of a positive effect on the fathers, including their mental health.

Conclusion

Including fathers as active partners in the care of their preterm newborn infants produced good outcomes for both of them. Further research is needed to develop new, multimodal and interactive interventions that provide fathers with positive contact with their preterm infants.

Development and psychometric evaluation of the CO-PARTNER tool for collaboration and parent participation in neonatal care

BACKGROUND

Active parent participation in neonatal care and collaboration between parents and professionals during infant hospitalization in the neonatal intensive care unit (NICU) is beneficial for infants and their parents. A tool is needed to support parents and to study the effects and implementation of parent-partnered models of neonatal care.

METHODS

We developed and psychometrically evaluated a tool measuring active parent participation and collaboration in neonatal care within six domains: Daily Care, Medical Care, Acquiring Information, Parent Advocacy, Time Spent with Infant and Closeness and Comforting the Infant. Items were generated in focus group discussions and in-depth interviews with professionals and parents. The tool was completed at NICU-discharge by 306 parents (174 mothers and 132 fathers) of preterm infants. Subsequently, we studied structural validity with confirmatory factor analysis (CFA), construct validity, using the Average Variance Extracted and Heterotrait-Monotrait ratio of correlations, and hypothesis testing with correlations and univariate linear regression. For internal consistency we calculated composite reliability (CR). We performed multiple imputations by chained equations for missing data.

RESULTS

A 31 item tool for parent participation and collaboration in neonatal care was developed. CFA revealed high factor loadings of items within each domain. Internal consistency was 0.558 to 0.938. Convergent validity and discriminant validity were strong. Higher scores correlated with less parent depressive symptoms (r = -0.141, 95%CI -0.240; -0.029, p = 0.0141), less impaired parent-infant bonding (r = -0.196, 95%CI -0.302; -0.056, p<0.0001), higher parent self-efficacy (r = 0.228, 95%CI 0.117; 0.332, p<0.0001), and higher parent satisfaction (r = 0.197, 95%CI 0.090; 0.308, p = 0.001). Parents in a family integrated care model had higher scores than in standard care (beta 6.020, 95%CI 4.144; 7.895, p<0.0001) and mothers scored higher than fathers (beta 2.103,95%CI 0.084; 4.121, p = 0.041).

CONCLUSION

The CO-PARTNER tool explicitly measures parents' participation and collaboration with professionals in neonatal care incorporating their unique roles in care provision, leadership, and connection to their infant. The tool consists of 31 items within six domains with good face, content, construct and structural validity.

Parent-Infant Skin-to-Skin Contact and Stress Regulation: A Systematic Review of the Literature

Several studies have focused on neonatal maternal separation (MS) to investigate behavioural and neuroendocrine reactions to lack of contact, but only a few have focused on early separation in the first days or weeks after birth. This literature review investigates the vital importance of contact and touch by exploring how skin-to-skin contact (SSC) regulates stress in the mother-infant relationship. Various databases such as PubMed, Scopus, and ScienceDirect were searched for literature published between 2015 and 2020. From 1141 articles, 22 were declared eligible. The reviewed articles showed how SSC regulates child stress by biological indicators such as the autonomic nervous system (ANS), heart rate variability (HRV), cortisol, and oxytocin. This research concludes the importance of SSC for stress regulation, especially during the COVID-19 pandemic. With no research to date indicating a possible risk of neonatal COVID-19 transmission following SSC, SSC should continue to be practiced for all women, as recommended by the WHO.

A systematic review of human paternal oxytocin: Insights into the methodology and what we know so far

With the consolidation of fathers' engagement in caregiving, understanding the neuroendocrine and hormonal mechanisms underlying fatherhood becomes a relevant topic. Oxytocin (OT) has been linked with maternal bonding and caregiving, but less is known about the role of OT in human fatherhood and paternal caregiving. A systematic review of methods and findings of previous OT research in human fathers was carried. The literature search on PubMed and Scopus yielded 133 records. Twenty-four studies were included and analyzed. Significant variability emerged in OT methodology, including laboratory tasks, assessment methods, and outcome measures. Fathers' OT levels appear to increase after childbirth. OT was significantly correlated with less hostility and with the quality of paternal physical stimulation in play interactions, but not with paternal sensitivity. Fathers' and children's OT levels were significantly correlated in a limited subset of studies, intriguingly suggesting that cross-generational OT regulation may occur during the early years of life. This study highlights relevant issues and limitations of peripheral OT assessment in human subjects, especially in fathers. Although the study of paternal neuroendocrinology appears promising, coping with these issues requires dedicated efforts and methodological suggestions are provided to guide future advances in this field.

The Role of Affectionate Caregiver Touch in Early Neurodevelopment and Parent-Infant Interactional Synchrony

Though rarely included in studies of parent–infant interactions, affectionate touch plays a unique and vital role in infant development. Previous studies in human and rodent models have established that early and consistent affectionate touch from a caregiver confers wide-ranging and holistic benefits for infant psychosocial and neurophysiological development. We begin with an introduction to the neurophysiological pathways for the positive effects of touch. Then, we provide a brief review of how affectionate touch tunes the development of infant somatosensory, autonomic (stress regulation), and immune systems. Affective touch also plays a foundational role in the establishment of social affiliative bonds and early psychosocial behavior. These touch-related bonding effects are known to be mediated primarily by the oxytocin system, but touch also activates mesocorticolimbic dopamine and endogenous opioid systems which aid the development of social cognitive processes such as social learning and reward processing. We conclude by proposing a unique role for affectionate touch as an essential pathway to establishing and maintaining parent-infant interactional synchrony at behavioral and neural levels. The limitations of the current understanding of affectionate touch in infant development point to fruitful avenues for future research.

Care of hospitalized infants and their families during the COVID-19 pandemic: an international survey

This research study explored changes in family-centered care practices for hospitalized infants and families due to the COVID-19 pandemic. This exploratory descriptive study used a 49-item online survey, distributed to health care professionals working with hospitalized infants and families. The sample consisted of 96 participants from 22 countries. Prior to the COVID-19 pandemic, 87% of units welcomed families and 92% encouraged skin-to-skin care. During the pandemic, family presence was restricted in 83% of units, while participation in infant care was restricted in 32%. Medium-sized (20-40 beds) units applied less restriction than small (<20 beds) units (p = 0.03). Units with single-family rooms that did not restrict parental presence, implemented fewer restrictions regarding parents' active participation in care (p = 0.02). Restrictions to families were not affected by geographic infection rates or developmental care education of health care professionals. Restrictions during the pandemic increased separation between the infant and family.

"Babywearing" in the NICU: An Intervention for Infants With Neonatal Abstinence Syndrome

BACKGROUND

The US opioid epidemic has resulted in an increase of infants at risk for developing neonatal abstinence syndrome (NAS). Traditionally, treatment has consisted of pharmacological interventions to reduce symptoms of withdrawal. However, nonpharmacological interventions (eg, skin-to-skin contact, holding) can also be effective in managing the distress associated with NAS.

PURPOSE

The purpose of this study was to examine whether infant carrying or "babywearing" (ie, holding an infant on one's body using cloth) can reduce distress associated with NAS among infants and caregivers.

METHODS

Heart rate was measured in infants and adults (parents vs other adults) in a neonatal intensive care unit (NICU) pre- (no touching), mid- (20 minutes into being worn in a carrier), and post-babywearing (5 minutes later).

RESULTS

Using a 3-level hierarchical linear model at 3 time points (pre, mid, and post), we found that babywearing decreased infant and caregiver heart rates. Across a 30-minute period, heart rates of infants worn by parents decreased by 15 beats per minute (bpm) compared with 5.5 bpm for infants worn by an unfamiliar adult, and those of adults decreased by 7 bpm (parents) and nearly 3 bpm (unfamiliar adult).

IMPLICATIONS FOR PRACTICE

Results from this study suggest that babywearing is a noninvasive and accessible intervention that can provide comfort for infants diagnosed with NAS. Babywearing can be inexpensive, support parenting, and be done by nonparent caregivers (eg, nurses, volunteers).

IMPLICATIONS FOR RESEARCH

Close physical contact, by way of babywearing, may improve outcomes in infants with NAS in NICUs and possibly reduce the need for pharmacological treatment.See the video abstract for a digital summary of the study. VIDEO ABSTRACT AVAILABLE AT:.

Skin-to-Skin Care is Associated with Reduced Stress, Anxiety, and Salivary Cortisol and Improved Attachment for Mothers of Infants With Critical Congenital Heart Disease

OBJECTIVE

To estimate the effect of skin-to-skin care (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants' neonatal cardiac surgery.

DESIGN

A prospective interventional, baseline response-paired pilot study.

SETTING

Cardiac center of a large, metropolitan, freestanding children's hospital.

PARTICIPANTS

Thirty women whose infants were hospitalized for neonatal cardiac surgery.

METHODS

Participants acted as their own controls before, during, and after SSC at two time points: once before and once after surgery. We measured the stress response of mothers, as indicated by self-reported scores of anxiety and maternal salivary cortisol, and maternal-infant attachment, as indicated by self-reported scores and maternal salivary oxytocin.

RESULTS

Significant reductions in self-reported scores of anxiety and salivary cortisol were found as a result of SSC at each time point, as well as increased self-reported attachment. No significant differences were found in oxytocin.

CONCLUSION

Our findings provide initial evidence of the benefits of SSC as a nurse-led intervention to support maternal attachment and reduce physiologic and psychological stress responses in mothers of infants with critical congenital heart disease before and after neonatal cardiac surgery.

Impact of Skin-to-Skin Parent-Infant Care on Preterm Circulatory Physiology

OBJECTIVES

To ascertain the impact of skin-to-skin care between parents and infants on cardiac function and cerebral blood flow in preterm infants.

STUDY DESIGN

We undertook a prospective study of 40 self-ventilating preterm infants at a quaternary center and assessed cardiac performance and cerebral blood flow. Assessments were carried out two hours before skin-to-skin care and then 60 minutes after skin-to-skin care (with the infant still on parent and turned supine).

RESULTS

Infants were 30.5 ± 0.6 weeks' gestational age and 1378 ± 133 g birthweight. Axillary temperature noted a nonsignificant increase during skin-to-skin care from 36.7 ± 0.07°C to 36.9 ± 0.07°C (P = .07). Cardiac contractility (right ventricular fractional area change [26.5% ± 0.3% vs 27.8% ± 0.4; P < .001] and tricuspid annular plane systolic excursion [0.73 ± 0.03 cm vs 0.77 ± 0.03 cm; P = .02]) increased significantly, coincident with decreased measures of pulmonary vascular resistance. An increase in systemic cardiac output was associated with increased cerebral blood flow and reduced middle cerebral artery resistive index (0.81 ± 0.02 vs 0.74 ± 0.02; P = .0001).

CONCLUSIONS

We documented a significant circulatory beneficial adaptation to a common neonatal practice. These findings align with previously documented physiologic benefits in cardiorespiratory stability and cardiac rhythm in preterm infants, and may be mediated through modulation of the autonomic nervous system.