Parenting style impacts cognitive and behavioural outcomes of former preterm infants: A systematic review

Early Parenting Interventions to Enhance Development in Infants and Children Born Prematurely: A Systematic Review and Meta-Analysis

INTRODUCTION

Parenting interventions have the potential to become effective strategies for improving the developmental trajectories of infants and children born prematurely. However, the effectiveness of parenting interventions is not well understood.

METHODS

A literature search was conducted in five databases. A total of 24 studies involving 3,636 participants were included for review.

RESULTS

The results showed a significant effect in cognition, language, motor development, and behavioral problems of children born prematurely. Parenting stress, anxiety, and interactive behaviors showed significant effect size.

DISCUSSION

This review focuses on interventions that employ scaffolding parenting strategies to enhance the development of children born prematurely. Efforts should continue to empower parents through effective and sustainable parenting interventions to improve the quality of life of preterm children.

Developing the mother-child interaction inventory and uncovering mother-child interaction profiles in Türkiye

BACKGROUND

In this study, we aimed to design a mother-report inventory to comprehensively assess mother-child interaction in the 0-3 age range, focusing on maternal and child interaction behavior and mutual attunement.

METHODS

Our research involved three stages, with 1061 mothers and their 0-3-year-old children: 45 in the pilot study, 498 in exploratory factor analysis and latent profile analysis, and 518 in confirmatory factor analysis.

FINDINGS

The Mother-Child Interaction Inventory emerged as a valid and reliable measurement tool, comprising three distinct scales: 1) Maternal Interaction Behavior Questionnaire with sensitive structuring, hostility, and intrusiveness subscales; 2) Child Interaction Behavior Questionnaire with emotional-behavioral involvement and child characteristics; and 3) Mutual Attunement Questionnaire with reciprocity and problem-solving subscales. Latent profile analysis revealed four mother-child interaction profiles, indicating different characteristics in maternal and child interaction behavior and mutual attunement, categorized as "Excellent interaction quality," "Average interaction quality 1", "Average interaction quality 2," and "Poor interaction quality."

DISCUSSION

The study underscores the significance of maternal and child interaction behavior and mutual attunement in determining the quality of mother-child interaction. The mother-report The Mother-Child Interaction Inventory is a functional measurement tool to evaluate interaction separately and holistically, unveiling mother-child interaction profiles in the Turkish context.

PRACTICE IMPLICATIONS

The practical implications of this research are significant for health professionals, educators, and stakeholders working with children and families. The Mother-Child Interaction Inventory provides a valuable tool for assessing interaction dynamics, offering insights that can be directly applied to improve mother-child interaction.

Factors affecting parental role adaptation in parents of preterm infants after discharge: a cross-sectional study

Background

Parenting a preterm infant can be incredibly challenging and stressful, particularly in the first year after discharge. Desirable parental role adaptation leads to appropriate parenting behaviors and parent-infant interaction, which are essential to child health and development.

Aim

To investigate the level of parental role adaptation and its influencing factors among parents of preterm infants in the first year after hospital discharge according to Belsky's parenting process model among parents of preterm infants in the first year after hospital discharge.

Methods

A cross-sectional study design was adopted using convenience sampling. Data were collected using the Parental Role Adaptation Scale (PRAS) in parents with preterm infants, the Perceived Social Support Scale (PSSS), the Coping Adaptation Processing Scale (CAPS-15), and a sociodemographic questionnaire. Descriptive statistics, non-parametric tests, Spearman correlation analyses, and multivariate linear regression were used to analyze the data.

Results

In total, 300 Chinese parents were included in the analysis. In the multivariate analysis, first-time parent (p = 0.003), master's degree and above (p = 0.042), coping adaptation processing (p = 0.000), residence location (towns: p = 0.019, city: p = 0.028), monthly family income (6000-10,000: p = 0.000, >10,000: p = 0.000), and perceived social support (p = 0.001) were all significant predictors of parental role adaptation and collectively accounted for 56.8% of the variation in parental role adaptation of parents with preterm infants (F = 16.473, p < 0.001). Coping adaptation processing mediated the relationship between perceived social support and parental role adaptation (95% bootstrap CI = 0.022, 0.130).

Conclusion

Chinese parents of preterm infants experience a moderate level of parental role adaptation when their child is discharged from the hospital to home. Parents who are not first-time parents, have master's degrees or above, live in towns or cities, have higher coping and adaptation abilities, have high monthly family income, and greater perceived social support have a higher level of parental role adaptation. Healthcare providers should pay more attention to parents with low socioeconomic status and encourage them to improve their coping and adaptation abilities and to utilize their formal and informal social support networks.

Barriers and Facilitators of Parent Presence in the Neonatal Intensive Care Unit

PURPOSE

The purpose of this study was to describe system-level and personal factors influencing parent presence in the neonatal intensive care unit (NICU) and identify differences in factors by sociodemographic characteristics.

STUDY DESIGN AND METHODS

In a cross-sectional national survey study using social media recruitment, participants rated the frequency of 13 potential barriers and 12 potential facilitators using a 5-point Likert scale. Experiences of discrimination and parent-staff engagement were also measured.

RESULTS

Valid responses were analyzed from 152 participants. Uncomfortable facilities and home responsibilities were the most highly reported system-level and personal barriers, respectively. Encouragement to participate in caregiving and social support were the most highly reported system-level and personal facilitators, respectively. Participants reported low to moderate levels of discrimination and moderate levels of parent-staff engagement. Latent class analysis revealed three sociodemographic clusters. Differences in barriers, facilitators, discrimination, and engagement were found among clusters.

CLINICAL IMPLICATIONS

NICU facilities are uncomfortable and may discourage parent presence. Allowing support persons to accompany parents, providing comfortable facilities, and engaging parents in caregiving may promote greater parent presence and improved parent and child outcomes. Studies of potential bias toward parents with lower education and income and effects on parent presence and infant outcomes are needed.

Associations between parental adherence to healthy lifestyles and cognitive performance in offspring: A prospective cohort study in China

BACKGROUND

Previous studies have reported associations of specific maternal and paternal lifestyle factors with offspring's cognitive development during early childhood. This study aimed to investigate the prospective associations between overall parental lifestyle and offspring's cognitive performance during adolescence and young adulthood in China.

METHODS

We included 2531 adolescents aged 10-15 years at baseline in 2010 from the China Family Panel Studies. A healthy parental lifestyle score (ranged 0-5) was constructed based on the following five modifiable lifestyle factors: Smoking, drinking, exercise, sleep, and diet. Generalized estimating equation models were used to examine the association between baseline parental healthy lifestyle scores and offspring's fluid and crystallized intelligence in subsequent years (2012, 2014, 2016, and 2018).

RESULTS

Offspring in the top tertile of parental healthy lifestyle scores performed better in overall fluid intelligence (multivariable-adjusted β = 0.53, 95% confidence interval [CI]: 0.29-0.77) and overall crystallized intelligence (multivariable-adjusted β = 0.35, 95% CI: 0.16-0.54) than those in the bottom tertile of parental healthy lifestyle scores. The results were similar after further adjustment for the offspring's healthy lifestyle scores and persisted across the subgroups of parental socioeconomic status. Additionally, maternal and paternal healthy lifestyle scores were independently associated with better offspring's cognitive performance, with significant contribution observed for paternal never-smoking, weekly exercise, and diversified diet. When both parents and offspring adhered to a healthier lifestyle, we observed the highest level of the offspring's overall crystallized intelligence.

CONCLUSIONS

Our study indicates that parental adherence to a healthier lifestyle is associated with significantly better offspring's cognitive performance during adolescence and early adulthood, regardless of socioeconomic status. These findings highlight the potential cognitive benefits of promoting healthy lifestyles among parents of adolescents.

Preschool Mathematics and Literacy Skills and Educational Attainment in Adolescents Born Preterm and Full Term

OBJECTIVES

To test whether preschool academic skills were associated with educational attainment in adolescence and whether associations differed between individuals born preterm and at full term.

STUDY DESIGN

This prospective cohort study comprised 6924 individuals, including n = 444 (6.4%) adolescents born preterm (<37 weeks of gestation) from the Avon Longitudinal Study of Parents and Children. Preschool academic (mathematics and literacy) skills were rated by teachers at 4-5 years. Educational attainment at 16 years was informed by attaining a General Certificate of Secondary Education (GCSE) in key subjects mathematics and English. Logistic regressions assessed the association between preterm birth, preschool mathematics, and GCSE Mathematics and between preterm birth, preschool literacy, and GCSE English.

RESULTS

Similar numbers of adolescents born preterm and at term achieved a GCSE in mathematics and English (53.6 % vs 57.4% and 59.5% vs 63.9%, respectively; P values > .05). Higher preschool academic skill scores in mathematics were associated with greater odds of attaining GCSE Mathematics and preschool literacy skills were associated with GCSE English. Adolescents born preterm with higher preschool mathematics (OR: 1.51, CI: 1.14, 2.00) and literacy skills (OR: 1.57, CI: 1.10, 2.25) were more likely to attain GCSEs in the respective subject than their term-born counterparts with equal levels of preschool skills.

CONCLUSIONS

Preschool academic skills in mathematics and literacy are associated with educational attainment of preterm and term-born individuals in adolescence. Children born prematurely may benefit more from preschool mathematics and literacy skills for academic and educational success into adolescence than term-born individuals.

Feasibility and acceptability of an online parenting intervention to address behaviour problems in moderately to extremely preterm pre-school and school-age children

BACKGROUND

Preterm birth is associated with adverse mental health outcomes, including internalizing problems, social difficulties and inattention. Interventions are needed beyond infancy and toddlerhood to support children and their families. We examined the feasibility and acceptability of the I-InTERACT Preterm pilot study, an online parenting intervention for preterm children ages 3-8.

METHOD

Families participated in a weekly intervention comprised of seven sessions with online modules followed by videoconference coaching sessions with a therapist. Following completion of the study, caregivers completed a survey to assess their satisfaction and were asked to participate in a voluntary semi-structured interview to provide feedback. We anticipated greater than a 50% participation rate (enrollment feasibility) and 75% completion rate (adherence feasibility). We also hypothesized that at least 80% of participants would be satisfied with the intervention (acceptability).

RESULTS

Nineteen of 32 families (59%) enrolled in the study, suggesting adequate enrollment feasibility. Feasibility of programme completion (adherence) was lower than anticipated (59%). Regarding satisfaction, all caregivers agreed that the programme's information was relevant to them and their family. Nearly all participants (92%) indicated that they had a better understanding of the effects of preterm birth on behaviour, that they enjoyed the programme, that it met their expectations and that they recommend the programme to others. In qualitative interviews, caregivers expressed satisfaction with the content, skills they learned, and receiving direct coaching. Caregivers suggested improvements to increase intervention feasibility and skill implementation, including offering biweekly sessions and more hands-on coaching.

CONCLUSION

Our largely satisfactory acceptability rates suggest the value of and need for a parenting intervention for children born preterm past the initial period of early development. Future directions include modifying the intervention in response to caregiver feedback to improve recruitment, engagement and adherence.

Effects of an online family-focused parenting support intervention on preterm infants' physical development and parents' sense of competence and care ability: A randomized controlled trial

BACKGROUND

Parenting of preterm infants presents unique challenges, particularly during their transition from hospital to home. Early discharge programs can assist parents during this critical period. However, the feasibility of delivering a family-focused online discharge program remains understudied.

OBJECTIVES

This study was conducted to investigate the impact of a family-focused online parenting support intervention on parents' sense of competence, depression, caregiving, social support, family functioning, and the weight and length of preterm infants.

METHODS

We conducted a single-blind, two-arm randomized controlled trial with a repeated-measures design. Participants were recruited from a specialized tertiary hospital in China between May and December 2022. Forty-five families were randomly assigned to the intervention group and 44 to the control group. The intervention included three components: (1) two one-hour group sessions and three 30-minute individual sessions of online parenting support; (2) two follow-up telephone calls (15-30 min each) post-discharge; and (3) access to online parenting resources. Primary outcomes included parenting sense of competence, parental care ability, and preterm infants' weight and length. Secondary outcomes included depression, social support, and family functioning. Measurements were taken at baseline, preterm infant discharge, one month post-discharge, and three months post-discharge. A generalized estimating equation model was employed based on the intention-to-treat principle for outcome comparison.

RESULTS

Parents in the intervention group showed significant improvements in parenting sense of competence (P < 0.001), parental care ability (P < 0.001), depression (P < 0.001), and social support (P = 0.002). However, no statistically significant differences were observed in preterm infants' weight and length, or in family functioning (P > 0.05).

CONCLUSIONS

Although the intervention did not affect preterm infants' outcomes, the positive enhancements in parenting sense of competence, care ability, depression, and social support indicate that online family-focused parenting support can effectively prepare parents for hospital discharge and the early transition period.

Corrigendum: Longitudinal relations between parenting stress and child internalizing and externalizing behaviors: testing within-person changes, bidirectionality and mediating mechanisms

[This corrects the article DOI: 10.3389/fnbeh.2022.942363.].

Behavioral and neural measures of infant responsivity increase with maternal multisensory input in non-irritable infants

INTRODUCTION

Parents often use sensory stimulation during early-life interactions with infants. These interactions, including gazing, rocking, or singing, scaffold child development. Previous studies have examined infant neural processing during highly controlled sensory stimulus presentation paradigms.

OBJECTIVE

In this study, we investigated infant behavioral and neural responsiveness during a mother-child social interaction during which the mother provided infant stimulation with a progressive increase in the number of sensory modalities.

METHODS

We prospectively collected and analyzed video-coded behavioral interactions and electroencephalogram (EEG) frontal asymmetry (FAS) from infants (n = 60) at 2-4 months born at ≥ 34 weeks gestation. As the number of sensory modalities progressively increased during the interaction, infant behaviors of emotional connection in facial expressiveness, sensitivity to mother, and vocal communication increased significantly. Conversely, infant FAS for the entire cohort did not change significantly. However, when we accounted for infant irritability, both video-coded behaviors and EEG FAS markers of infant responsiveness increased across the interaction in the non-irritable infants. The non-irritable infants (49%) demonstrated positive FAS, indicating readiness to engage with, rather than to withdraw from, multisensory but not unisensory interactions with their mothers.

RESULTS

These results suggest that multisensory input from mothers is associated with greater infant neural approach state and highlight the importance of infant behavioral state during neural measures of infant responsiveness.

Parental cognitive stimulation in preterm-born children's neurocognitive functioning during the preschool years: a systematic review

In the United States, survival rates for preterm neonates (<37 weeks of gestation) have tripled in recent years. In parallel, preterm-born children show poorer performance in neurocognitive functioning compared to their full-term peers (≥39 weeks of gestation), and biological models predicting preterm-born children's neurocognitive performance have been met with limited success, highlighting a need to focus on environmental factors. Thus, this systematic review examines the literature on parental cognitive stimulation in relation to preterm-born children's neurocognitive outcomes. Studies were considered for inclusion if they included a sample of preterm-born children, included a measure of parental cognitive stimulation, and included a measure of child neurocognitive performance. The databases searched were PubMed, PsychINFO, CINAHL, ProQuest, and Scopus. Eight studies were included (44 unique associations). Findings suggest that preterm-born children's language skills might be open to a wide range of qualitative and quantitative features of parental cognitive stimulation. Our findings suggest that parental cognitive stimulation matters for preterm-born children's neurocognitive performance. Future experiential models should examine the mechanistic roles of cognitive stimulation in relation to narrowed neurocognitive outcomes to better inform possible prevention and intervention efforts. IMPACT: This systematic review examines the literature on parental cognitive stimulation in relation to preterm-born children's neurocognitive outcomes. Our review demonstrates that preterm-born children's language skills might be open to a wide range of qualitative and quantitative features of parental cognitive stimulation. The emphasis on environmental factors might ultimately better inform possible prevention and intervention efforts for children at risk as they transition to formal schooling.

Digital Parenting Interventions for Fathers of Infants From Conception to the Age of 12 Months: Systematic Review of Mixed Methods Studies

BACKGROUND

Digital interventions help address barriers to traditional health care services. Fathers play an important parenting role in their families, and their involvement is beneficial for family well-being. Although digital interventions are a promising avenue to facilitate father involvement during the perinatal period, most are oriented toward maternal needs and do not address the unique needs of fathers.

OBJECTIVE

This systematic review describes the digital interventions that exist or are currently being developed for fathers of infants from conception to 12 months postpartum.

METHODS

A systematic search of the MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Embase (using Ovid), and CINAHL (using EBSCO) databases was conducted to identify articles from database inception to June 2022, of which 39 met the inclusion criteria. Articles were included if they were peer-reviewed and described a digital intervention that targeted fathers of fetuses or infants aged ≤12 months. Systematic reviews, meta-analyses, and opinion pieces were excluded. Data from these studies were extracted and themed using a narrative synthesis approach. Quality appraisal of the articles was conducted using the Mixed Methods Appraisal Tool.

RESULTS

A total of 2816 articles were retrieved, of which 39 (1.38%) met the inclusion criteria for eligibility after removing duplicates and screening. Eligible articles included 29 different interventions across 13 countries. Most articles (22/29, 76%) described interventions that were exclusively digital. There were a variety of digital modalities, but interventions were most commonly designed to be delivered via a website or web-based portal (14/29, 48%). Just over half (21/39, 54%) of the articles described interventions designed to be delivered from pregnancy through the postpartum period. Only 26% (10/39) of the studies targeted fathers exclusively. A wide range of outcomes were included, with 54% (21/39) of the studies including a primary outcome related to intervention feasibility. Qualitative and mixed methods studies reported generally positive experiences with digital interventions and qualitative themes of the importance of providing support to partners, improving parenting confidence, and normalization of stress were identified. Of the 18 studies primarily examining efficacy outcomes, 13 (72%) reported a statistically significant intervention effect. The studies exhibited a moderate quality level overall.

CONCLUSIONS

New and expecting fathers use digital technologies, which could be used to help address father-specific barriers to traditional health care services. However, in contrast to the current state of digital interventions for mothers, father-focused interventions lack evaluation and evidence. Among the existing studies on digital interventions for fathers, there seem to be mixed findings regarding their feasibility, acceptability, and efficacy. There is a need for more development and standardized evaluation of interventions that target father-identified priorities. This review was limited by not assessing equity-oriented outcomes (eg, race and socioeconomic status), which should also be considered in future intervention development.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

Objective

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

Methods

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

Results

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

Conclusion

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

Longitudinal neonatal brain development and socio-demographic correlates of infant outcomes following preterm birth

Preterm birth results in premature exposure of the brain to the extrauterine environment during a critical period of neurodevelopment. Consequently, infants born preterm are at a heightened risk of adverse behavioural outcomes in later life. We characterise longitudinal development of neonatal regional brain volume and functional connectivity in the first weeks following preterm birth, sociodemographic factors, and their respective relationships to psychomotor outcomes and psychopathology in toddlerhood. We study 121 infants born preterm who underwent magnetic resonance imaging shortly after birth, at term-equivalent age, or both. Longitudinal regional brain volume and functional connectivity were modelled as a function of psychopathology and psychomotor outcomes at 18 months. Better psychomotor functioning in toddlerhood was associated with greater relative right cerebellar volume and a more rapid decrease over time of sensorimotor degree centrality in the neonatal period. In contrast, increased 18-month psychopathology was associated with a more rapid decrease in relative regional subcortical volume. Furthermore, while socio-economic deprivation was related to both psychopathology and psychomotor outcomes, cognitively stimulating parenting predicted psychopathology only. Our study highlights the importance of longitudinal imaging to better predict toddler outcomes following preterm birth, as well as disparate environmental influences on separable facets of behavioural development in this population.

Parenting sense of competence among chinese parents of premature infants: a cross-sectional study

BACKGROUND

Parenting sense of competence is not only indispensable to the wellbeing of the parents of premature infants, but is also pivotal to the overall development of these infants. This study examined the level of parenting sense of competence and its associated factors in Chinese parents of preterm infants.

METHODS

This cross-sectional study was performed at a university teaching hospital in Fuzhou (China) from December 2021 to April 2022. Data were collected using the Parenting Sense of Competence Scale, Edinburgh Postnatal Depression Scale, Social Support Rating Scale, Parenting Care Knowledge Subscale, Parenting Care Skill Subscale, and a sociodemographic questionnaire.

RESULTS

A total of 401 Chinese parents were included in the analysis. The average parenting sense of competence scale score was 70.93 ± 13.06. After controlling for demographic characteristics, parenting knowledge (β = 0.149, P = 0.013), parenting skills (β = 0.241, P < 0.001), social support (β = 0.184, P < 0.001) and depression (β = -0.272, P < 0.001), were significantly associated with the parenting sense of competence score, and explained 43.60% of the variance in this score.

CONCLUSIONS

Chinese parents of preterm infants were found to have a moderate parenting sense of competence. This could be further improved through efforts aimed at reducing depressive symptoms and increasing parenting knowledge, parenting skills, and social support.

Five-Factor Personality Dimensions Mediated the Relationship between Parents' Parenting Style Differences and Mental Health among Medical University Students

BACKGROUND

Previous studies have identified the relationships between parental parenting style, personality, and mental health. However, the interactive influences between mother's and father's parenting styles on personality have been examined less often. To fill the gaps, the first aim of this study was to build the relationships between parental parenting style differences (PDs) and five-factor personality dimensions. The second aim was to test the mediating effect of five-factor personality dimensions on the relationships between parental parenting style differences and mental health.

METHODS

This is a cross-sectional study conducted among medical university students, and 2583 valid participants were analyzed. Mental health was measured by the Kessler-10 scale. The Chinese Big Five Personality Inventory brief version (CBF-PI-B) was used to access five-factor personality dimensions. PD was calculated by the short form of Egna Minnen av Barndoms Uppfostran. Linear regressions were conducted to analyze the associations between PD and five-factor personality dimensions. The SPSS macros program (PROCESS v3.3) was performed to test the mediating effect of five-factor personality dimensions on the associations between PD and mental health.

RESULTS

Linear regressions found that worse mental health was positively associated with PD (β = 0.15, p < 0.001), higher neuroticism (β = 0.61, p < 0.001), lower conscientiousness (β = -0.11, p < 0.001), lower agreeableness (β = -0.10, p < 0.01), and lower openness (β = -0.05, p < 0.05). The results also supported that PD was positively associated with lower conscientiousness (β = -0.15, p < 0.01), lower agreeableness (β = -0.09, p < 0.001), lower openness (β = -0.15, p < 0.001), and lower extraversion (β = -0.08, p < 0.001), respectively. The mediating effect of agreeableness or openness was supported for the relationships between PD and mental health.

CONCLUSION

These findings remind us of the importance of consistent parenting styles between mother and father, and they also can be translated into practices to improve mental health among medical university students.

Neurodevelopmental Outcomes at Two Years' Corrected Age of Very Preterm Infants After Implementation of a Post-discharge Responsive Parenting Intervention Program (TOP program)

OBJECTIVE

To compare neurodevelopmental outcomes at two years corrected age (CA) between infants born very preterm (VP) who did or did not receive a post-discharge responsive parenting intervention (TOP program) between discharge home and 12 months CA.

STUDY DESIGN

The Systemic Hydrocortisone to Prevent Bronchopulmonary Dysplasia (SToP-BPD) study showed no differences between treatment groups in motor and cognitive development using the Dutch Bayley Scales of Infant Development, and behavior using the Child Behavior Check List at two years CA. During its study period, the TOP program was gradually scaled up nationwide in the same population, providing an opportunity to evaluate the effect of this program on neurodevelopmental outcome, after adjusting for baseline differences.

RESULTS

Among 262 surviving VP infants in the SToP-BPD study, 35% received the TOP program. Infants in the TOP group had a significantly lower incidence of a cognitive score <85 (20.3% vs. 35.2%; adjusted absolute risk reduction -14.1% [95% CI -27.2 to -1.1]; p=0.03), and a significantly higher mean cognitive score (96.7 ±13.8), compared with the non-TOP group (92.0 ±17.5; crude mean difference 4.7 [95% CI 0.3 to 9.2]; p=0.03). No significant differences were found on motor scores. For behavior problems, a small but statistically significant effect for anxious/depressive problems was found in the TOP group (50.5 vs. 51.2; p=0.02).

CONCLUSIONS

VP infants supported by the TOP program from discharge until 12 months CA had better cognitive function at two years CA. This study demonstrates a sustained positive effect of the TOP program in VP infants.

A Comparison of the Clinical Presentation of Preterm Birth and Autism Spectrum Disorder: Commonalities and Distinctions in Children Under 3

Premature infants and infants later diagnosed with autism spectrum disorder (ASD) share many commonalities in clinical presentations. However, prematurity and ASD also have differences in clinical presentation. These overlapping phenotypes can lead to misdiagnoses of ASD or missing a diagnosis of ASD in preterm infants. We document these commonalities and differences in various developmental domains with the hope of aiding in the accurate early detection of ASD and timely intervention implementation in children born premature. Given the degree of similarities in presentation, evidence-based interventions designed specifically for preterm toddlers or toddlers with ASD may ultimately aid both populations.

Parenting Style Interventions in Parents of Preterm and High-Risk Infants: Controversies, Cost, and Future Directions

This review highlights the current state of evidence on interventions whose primary purpose is to change parenting style in parents of preterm, and other-high risk, infants. To date, interventions for parents of preterm infants are heterogeneous with variability in intervention timing, measured outcomes, program components, and cost. Most interventions target parental responsivity/sensitivity. Most reported outcomes are short-term, measured at age less than 2 years. The few studies that report later child outcomes in prekindergarten/school-aged children are encouraging, overall indicating improved cognition and behavior in the children of parents who received a parenting style intervention.

Positive Parenting and Early Childhood Cognition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This review examines the effectiveness of positive parenting interventions aimed at improving sensitivity, responsiveness, and/or non-harsh discipline on children's early cognitive skills, in four meta-analyses addressing general mental abilities, language, executive functioning, and pre-academics. The objectives are to assess the magnitude of intervention effectiveness and identify moderators of effectiveness. We include randomized controlled trials of interventions targeting positive parenting to improve cognition in children < 6 years. Studies that include children with neurodevelopmental and/or hearing disorders were excluded. MEDLINE, PsycINFO, ERIC, and ProQuest Dissertations & Theses (October 2021) and citation chaining identified relevant records. Five reviewers completed screening/assessments, extraction, and risk of bias. Pooled analysis in Comprehensive Meta-Analysis (Version 3) used random effects modeling, with moderation via Q-statistics and meta-regression. Positive parenting interventions led to significant improvements in mental abilities (g = 0.46, N = 5746; k = 33) and language (g = 0.25, N = 6428; k = 30). Effect sizes were smaller and nonsignificant for executive functioning (g = 0.07, N = 3628; k = 14) and pre-academics (g = 0.16, N = 2365; k = 7). Robust moderators emerged for language and cognition. For cognition, studies with higher risk of bias scores yielded larger intervention effects. For language, studies with younger children had larger effect sizes. Studies mitigated selection and detection bias, though greater transparency of reporting is needed. Interventions that promote parental sensitivity, responsiveness, and non-harsh discipline improve early mental abilities and language. Studies examining executive functioning and pre-academics are needed to examine moderators of intervention effectiveness. Trial registration Systematic review PROSPERO registration. CRD42020222143.

Early parenting behaviour is associated with complex attention outcomes in middle to late childhood in children born very preterm

Attention deficits are common in children born very preterm (VP), especially for children with higher social risk. The aim of this study was to examine the association between parenting behavior and attention in children born VP, and whether this association is influenced by familial social risk. Two hundred and twenty-four children born <30 weeks' gestation and/or with a birth weight <1250 g were recruited at birth. At 2 years, social risk was calculated and parenting behaviors were observed during a parent-child interaction task, with children's attention skills assessed at 7 and 13 years using standardized assessments. Higher levels of sensitive parenting at 2 years were positively associated with divided attention at age 7 years, and higher levels of intrusive parenting were negatively associated with divided attention at 13 years. Children born VP with higher social risk were more positively influenced by sensitive parenting behavior for sustained attention at 7 years, selective attention at 13 years, and divided attention at 7 and 13 years than children born VP with lower social risk. Additionally, children born VP with higher social risk were more negatively influenced by intrusive parenting for sustained attention outcomes at 7 years than those with lower social risk. In summary, the evidence for a contribution of early parenting to attention outcomes in children born VP was stronger for more complex attention (divided attention) compared with basic attention domains. Our findings also suggest that early parenting behavior has a particular influence on children born VP from socially disadvantaged environments for attention outcomes.

Longitudinal relations between parenting stress and child internalizing and externalizing behaviors: Testing within-person changes, bidirectionality and mediating mechanisms

Introduction

Parenthood can be experienced as a pleasant but challenging period for parents, possibly accompanied by parenting stress. Early parenthood in particular is a vulnerable period as many parents experience biological and psychosocial changes related to new parenthood. Previous studies have shown that parenting stress is related to child behavior problems, but few studies have investigated the transactional relations across time between parenting stress and child internalizing and externalizing outcomes separately, examining within-person changes. The first aim of this study was to examine the transactional within-person associations of parenting stress and child internalizing and externalizing behavior problems across childhood from age 9 months to 9 years. As a second aim, we examined parenting as a possible underlying mechanism of the transactional associations by testing whether parental warmth and hostility mediate within-person associations of parenting stress and child behavior across time.

Method

Data were analyzed from the Growing Up in Ireland longitudinal child cohort study including 7,208 caregiver-child dyads at wave 1 (child's age 9 months), who were followed at child's age three (wave 2), five (wave 3), and 9 years (wave 5). Primary caregiver's and child's age and gender, household income, occupational status, educational status, partner status, and cultural background were covariates assessed at all waves. Data were analyzed using a random intercept cross-lagged panel model (CLPM) in R-lavaan.

Results

Bidirectional relations between parenting stress and child behavior were found for both internalizing and externalizing behavior from age 5 to 9, but not for earlier time points.

Discussion

Our results did not indicate mediating effects of parental warmth or parental hostility in the associations between parenting stress and child behavior problems. Therefore, we conclude that parenting stress and child internalizing as well as parenting stress and child externalizing behaviors have transactional associations from child's age 5 to 9 years. Future research examining transactional associations of parenting stress and child behaviors should investigate possible other mediations taking a within-person approach by utilizing the RI-CLPM.

Parental priorities in the home care of preterm and full term newborns

BACKGROUND

The initial weeks after hospital discharge is a period of adaptation when parents assume great responsibility for the care of their child. Preterm birth may impact their demands of care.

AIMS

To compare parental priorities in the care of preterm and full-term newborns in the first two months after hospital discharge and to identify changes in priorities over time.

METHODS

Parents of 22 full-term and 19 preterm infants were followed for two months after hospital discharge, with three timepoint evaluations of the parental priorities. They reported on infant care demands in a semi-structured interview.

RESULTS

Despite prematurity, demands were similar between groups. Within-group changes occurred over time. Priorities related to bathing and caring for the navel showed significant reduction (p < 0.01); demands related to children's health care increased in the groups (p < 0.01). Feeding and sleep priorities were reduced in the full-term group (p < 0.02). Children's adaptation to routine increased significantly in the preterm group (p = 0.04).

CONCLUSION

Knowledge of parents' priorities in caring for preterm or full-term newborns at home helps health care teams develop appropriate support strategies and improve specialized assistance to the families.

Revealing Differences in Brand Loyalty and Brand Engagement of Single or no Parented Young Adults

The present study reveals differences in brand engagement, brand loyalty and brand evangelism among single or no parented young adults. It was found that persons who were raised without one or both parents for at least three years show higher emotional connectivity to brands compared to their counterparts from a control group. A widely recognized structural equation modelling technique—partial least squares method—has been applied in order to test the research hypotheses. Two Baltic States, namely, Lithuania and Latvia, served as an empirical basis of the study. The results of the research are relevant not only to business related disciplines, such as marketing and management, but also to other social sciences fields presuming the existence of more psychology-related differences among single or no parented persons.

Parent-infant interaction quality is related to preterm status and sensory processing

BACKGROUND

Parent-infant interactions provide the foundation for the development of infant socioemotional wellbeing. Preterm birth can have a substantial, and often detrimental, impact on the quality of early parent-infant interactions. Sensory processing difficulties, common in preterm infants, are further associated with poorer interaction quality. There is a paucity of research, however, examining the links between the quality of parent-infant interaction, preterm birth, and sensory processing difficulties. This study aimed to characterise the quality of interactions of parent-infant dyads involving preterm infants who may display sensory processing differences and examine the associations between parent-infant interaction quality, preterm status and infant sensory processing.

METHOD

67 parent-infant dyads (12-months infant age, 22 preterm, 45 full-term) participated in a recorded, semi-structured 15-minute play interaction. Parents also filled out questionnaires on demographics, and infant sensory processing (Infant and Toddler Sensory Profile-2; ITSP-2). Interaction quality was rated using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO).

RESULTS

Preterm and full-term infants differed in sensory processing and parent-infant interaction. Infant prematurity was associated with the sensory domains of; visual (r = - 0.37, p = .005), touch (r = - 0.39, p = .002), and movement (r_s = - .32, p = .01), as well as the interaction domains of; responsivity (r_s;= - .43, p = .001), teaching (r_s = - .31, p = .02), and interaction total score (r = - 0.34, p = .01). Interaction quality was related to sensory registration (r_s = - .38, p = .008), auditory (r_s = - .34, p = .02), seeking (r_s = .29, p = .05) and sensory behavioural scores (r_s = - .52, p < .001). Overall, interaction quality was best predicted by infant prematurity and auditory scores, R² = .15, F(1, 47) = 4.01, p = .02.

DISCUSSION

Preterm infants differed from their full-term peers in both their sensory processing and in their dyadic interactions with parents. Preterm status was associated with less responsivity and teaching and was found to predict overall interaction quality. Poorer infant sensory processing was associated with less parental teaching, affection and responsivity during interactions. Our results suggest that preterm birth is related to sensory processing difficulties, and that prematurity and sensory processing are differentially associated with aspects of interaction quality. These findings support the further examination of the interplay between preterm birth, sensory processing, and parent-infant interaction quality.

Mothers' experiences of a new early collaborative intervention, the EACI, in the neonatal period: A qualitative study

AIM

To explore mothers' experiences of the EArly Collaborative Intervention.

BACKGROUND

Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers' experiences of the new intervention were explored.

DESIGN

A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript.

RESULTS

Two main overarching themes were constructed. The first theme, 'mothers' feelings evoked from the EArly Collaborative Intervention' describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm baby's behaviour increased, and the intervention helped the parents to communicate around their baby's needs. The second theme, 'based on the preterm baby's behavior', describes experiences of the provision and the learning process about their preterm baby's needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby.

CONCLUSIONS

Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their baby's well-being. Furthermore, the intervention felt strengthening for their relationship with the other parent.

RELEVANCE TO CLINICAL PRACTICE

The EArly Collaborative Intervention can support parents' abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well-being.

Exceeding expectations after perinatal risks for poor development: associations in term- and preterm-born preschoolers

OBJECTIVE

To define parenting/social characteristics associated with better-than-expected cognitive and motor outcomes in preschoolers at similar perinatal biological risk-level including various gestational ages at birth (GA) and perinatal complications.

STUDY DESIGN

Prospective cohort study (n = 87) of children at four years, median GA 29 weeks (IQR 26, 38). Assessments included Differential Ability Scales, Movement Assessment Battery, parenting styles, and social risk scores. Perinatal risk factors were weighted based on regression models for each outcome; individual calculated risk scores became predictors to extract standardized residuals from the mean (>1 SD above mean = better-than-expected). Mixed-effect regressions examined associations between positive adaptation and parenting/social factors.

RESULT

Perinatal risk scores explained 21-53% outcome variability. Children across all GA displayed positive adaptation. Children of parents with higher authoritarian scores had higher odds of better-than-expected outcomes (OR 1.17, p = 0.0002).

CONCLUSION

Parental structure may promote positive adaptation at preschool age in children with perinatal risk factors for poor development, including extreme prematurity.

Association Between Parental Parenting Style Disparities and Mental Health: An Evidence From Chinese Medical College Students

Background

The associations between parental parenting styles and adolescents' development and health problems were also identified in a series of studies. However, the interactive impact of mother's and father's parenting style was less reported, which was implied in previous studies. In this study, we aim to analyze the associations between parental parenting style disparities and mental health among medical college students.

Method

A cross-sectional study was conducted among medical college students in Shandong province, China, and 2,598 medical college students with parents were analyzed in this study. Items in a short form of Egna Minnen av Barndoms Uppfostran (EMBU) were used to calculate the parental parenting style disparities. Mental health was evaluated by the Kessler 10 scale.

Results

The results of linear regressions showed that parental nurture reject disparities (RDs, β = 0.50, p < 0.001), parental emotional warmth disparities (WDs, β = 0.33, p < 0.001), parental overprotective disparities (ODs, β = 0.25, p < 0.001), and total disparities in parenting styles (TDs, β = 0.15, p < 0.001) were associated with mental health among medical college students, respectively. The other associated factors were age, ethnicity, chronic disease, above average family economic status, and good parental relationship.

Conclusion

Our findings supported the positive association between parental parenting style disparities and mental health problems. Further studies can test the mechanism and intervention of the findings about the importance of parental parenting style consistence on mental health.

Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries - a scoping review

BACKGROUND

By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children's health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries.

METHODS

This review followed the methodology of "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". To identify German and English scientific peer-reviewed literature published from January 1^st, 2000, to December 19^th, 2019, the following search term blocks were linked with the logical operator "AND": (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus.

RESULTS

The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent-child conflicts) are identified to have mediating or moderating effects. While families' living conditions (i.e., TVs in children's bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities.

CONCLUSION

Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children's health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.

Analysis of the supportive care needs of the parents of preterm children in South Korea using big data text-mining: Topic modeling

Purpose

The purpose of this study was to identify the supportive care needs of parents of preterm children in South Korea using text data from a portal site.

Methods

In total, 628 online newspaper articles and 1,966 social network service posts published between January 1 and December 31, 2019 were analyzed. The procedures in this study were conducted in the following order: keyword selection, data collection, morpheme analysis, keyword analysis, and topic modeling.

Results

The term “yirundung-yi”, which is a native Korean word referring to premature infants, was confirmed to be a useful term for parents. The following four topics were identified as the supportive care needs of parents of preterm children: 1) a vague fear of caring for a baby upon imminent neonatal intensive care unit discharge, 2) real-world difficulties encountered while caring for preterm children, 3) concerns about growth and development problems, and 4) anxiety about possible complications.

Conclusion

Supportive care interventions for parents of preterm children should include general parenting methods for babies. A team composed of multidisciplinary experts must support the individual growth and development of preterm children and manage the complications of prematurity using highly accessible media.

Associations Between Neonatal Brain Structure, the Home Environment, and Childhood Outcomes Following Very Preterm Birth

Background

Very preterm birth is associated with an increased risk of childhood psychopathology and cognitive deficits. However, the extent to which these developmental problems associated with preterm birth are amenable to environmental factors or determined by neurobiology at birth remains unclear.

Methods

We derived neonatal brain structural covariance networks using non-negative matrix factorization in 384 very preterm infants (median gestational age [range], 30.29 [23.57–32.86] weeks) who underwent magnetic resonance imaging at term-equivalent age (median postmenstrual age, 42.57 [37.86–44.86] weeks). Principal component analysis was performed on 32 behavioral and cognitive measures assessed at preschool age (n = 206; median age, 4.65 [4.19–7.17] years) to identify components of childhood psychopathology and cognition. The Cognitively Stimulating Parenting Scale assessed the level of cognitively stimulating experiences available to the child at home.

Results

Cognitively stimulating parenting was associated with reduced expression of a component reflecting developmental psychopathology and executive dysfunction consistent with the preterm phenotype (inattention-hyperactivity, autism spectrum behaviors, and lower executive function scores). In contrast, a component reflecting better general cognitive abilities was associated with larger neonatal gray matter volume in regions centered on key nodes of the salience network, but not with cognitively stimulating parenting.

Conclusions

Our results suggest that while neonatal brain structure likely influences cognitive abilities in very preterm children, the severity of behavioral symptoms that are typically observed in these children is sensitive to a cognitively stimulating home environment. Very preterm children may derive meaningful mental health benefits from access to cognitively stimulating experiences during childhood.

The causal influence of responsive parenting behaviour on academic readiness: a protocol for a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Children's academic readiness has important implications for subsequent achievement and psychosocial functioning. A growing number of studies are utilizing randomized controlled trials (RCT) to examine whether responsive parenting interventions lead to positive gains in children's academic readiness. A synthesis of the extant literature is warranted to gain a precise estimate of the causal influence of responsive parenting on academic readiness, as well as to examine moderators that may serve to strengthen or weaken this effect. The main objective of this study will be to conduct a systematic review and meta-analysis of RCTs evaluating the use of responsive parenting interventions to target academic readiness: problem-solving/reasoning, language proficiency, executive functioning, and pre-academic skills (e.g., numeracy/literacy).

METHODS

Studies that took place in the early childhood period (< 6 years at baseline), targeted responsive parenting behaviours using an RCT (with control group, waitlist, or treatment as usual as a comparator), and included an outcome assessment of academic readiness will be considered for eligibility. Children and/or parents with special needs and/or disabilities will be excluded. The primary outcome is the effect of responsive parenting interventions on academic readiness. Secondary outcomes include substantive and methodological moderators and parent-mediated effects on outcomes. We will search MEDLINE, PsycINFO, ERIC, and ProQuest Dissertations & Theses Global databases from their inception onwards and we will also conduct backward/forward searching of eligible studies. Published and unpublished works will be considered. Screening, full-text assessments, and data extraction will be completed by two independent reviewers. Risk of bias will be assessed using the CLARITY tool for RCTs. Effect sizes will be calculated based on study-level standardized differences between experimental and control groups and entered into random effects models to obtain a pooled effect (meta-analysis). Moderation will be examined through Q-statistics and meta-regression to study sources of between-study variation in effect sizes. A pooled path model of mediation will be used to study parent-mediated effects.

DISCUSSION

Findings will illuminate causal relations between responsive parenting and academic readiness, with implications for developmental science. Findings will also guide decision making in policy and practice for supporting early childhood development and reducing social disparities in children prior to school-entry.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020222143 .

Spatial Thinking in Term and Preterm-Born Preschoolers: Relations to Parent-Child Speech and Gesture

Spatial skills predict important life outcomes, such as mathematical achievement or entrance into Science, Technology, Engineering, and Mathematics (STEM) disciplines. Children significantly vary in their spatial performance even before they enter formal schooling. One correlate of children's spatial performance is the spatial language they produce and hear from others, such as their parents. Because the emphasis has been on spatial language, less is known about the role of hand gestures in children's spatial development. Some children are more likely to fall behind in their spatial skills than others. Children born premature (gestational age <37 weeks) constitute such a risk group. Here, we compared performance of term and preterm-born children on two non-verbal spatial tasks-mental transformation and block design. We also examined relations of children's performance on these tasks to parental spatial language and gesture input and their own production of spatial language and gesture during an independent puzzle play interaction. We found that while term and preterm-born children (n = 40) as a group did not differ in the mental transformation or block design performance, children varied widely in their performance within each group. The variability in mental transformation scores was predicted by both a subset of spatial words (what aspects of spatial information) and all spatial gestures children produced. Children's spatial language and gesture were in turn related to their parents' spatial language and gesture. Parental spatial language and gesture had an indirect relation on children's mental transformation, but not block design, scores via children's spatial language, and gesture use. Overall, results highlight the unique contributions of speech and gesture in communicating spatial information and predicting children's spatial performance.

Impact of Home Parenting Environment on Cognitive and Psychomotor Development in Children Under 5 Years Old: A Meta-Analysis

This study aims to evaluate the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old by using meta-analysis. A systematic search of the Chinese and English databases including Pubmed, Embase, the Cochrane Library, CNKI, Weipu, Wanfang, and CBMdisc databases from January 1, 1990, to July 31, 2021, was performed. Articles concerning the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old were included. Review Manager 5.4 was used for meta-analysis. Subgroup analysis in terms of age and region were performed. A total of 12 articles were included, including 11 in English and 1 in Chinese. Meta-analysis showed that there was significant relationship between home parenting environment and the cognitive and psychomotor development of children (r = 0.31; r = 0.21). Subgroup analysis showed that correlation between home parenting environment and the cognitive and psychomotor development of children was stronger in children over 18 months compared to those under 17 months [(r = 0.33, r = 0.21) vs. (r = 0.28, r = 0.17)]. The converted summary r value between home parenting environment and cognitive development in developing and developed countries was both 0.32. Conclusively, there is a positive correlation between the home parenting environment and the cognitive and psychomotor development of children under 5 years old. Improving the home parenting environment of children is beneficial to promote their early development.

Supporting parenting during infant hospitalisation for CHD

OBJECTIVE

To characterise the parenting priorities of mothers and fathers of infants hospitalised with CHD and generate recommendations to support parenting during infant hospitalisation.

STUDY DESIGN

Through online crowdsourcing, an innovative research methodology to create an online community to serve as a research sample, 79 parents of young children with CHD responded to questions about parenting during hospitalisation via private social networking site. Responses were analysed using qualitative research methods.

RESULTS

Three broad themes were identified: (1) establishing a bond with my baby, (2) asserting the parental role, and (3) coping with fear and uncertainty. Parents value provider support in restoring normalcy to the parenting experience during infant hospitalisation.

CONCLUSIONS

Care teams can support parenting during infant hospitalisation by promoting parents' roles as primary caretakers and decision-makers and attending to the emotional impact of infant hospitalisation on the family.

A Randomized Trial of Continuous Versus Intermittent Skin-to-Skin Contact After Premature Birth and the Effects on Mother-Infant Interaction

BACKGROUND

Premature birth affects opportunities for interaction between infants and mothers. Skin-to-skin contact (SSC) is standard care in neonatal care but has not been sufficiently studied regarding the effects on interaction between preterm infant and mothers.

PURPOSE

The purpose of this study was to compare interaction between preterm infants and their mothers after continuous versus intermittent SSC from birth to discharge. A secondary aim was to study a potential dose-response effect between time in SSC and quality of interaction.

METHODS

Families were randomly assigned to either continuous (n = 17) or intermittent (n = 14) SSC before delivery. Interaction was measured from videotapes of a Still-Face Paradigm collected at 4 months' corrected age. Face-to-face interaction was coded according to Ainsworth's Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scales-R. Dose-response correlations were calculated between mean time spent in SSC and each of the interaction scales.

RESULTS

There were no statistically significant differences between groups in maternal interactive behavior toward their infants regarding sensitivity, interference, availability, acceptance, withdrawal, or intrusivity. There was no correlation between mean time in SSC and quality of interaction.

IMPLICATIONS FOR PRACTICE

Continuous SSC from birth to discharge was not superior to intermittent SSC concerning mother-infant interaction between preterm infants and their mothers at 4 months' corrected age. However, compared with other studies, mean time in SSC was also high in the intermittent group.

IMPLICATIONS FOR RESEARCH

Further studies are needed to find out how interaction between parents and preterm infants can be improved, supported, and facilitated in the neonatal intensive care unit (NICU) and whether there is an optimal dose for SSC.

Temperamental Development among Preterm Born Children. An RCT Follow-Up Study

A randomized controlled trial study recruited 146 preterm born children, either to participate in a modified version of the Mother–Infant Transaction Program (MITP-m) or to receive the usual follow-up services, before and after discharge from a neonatal intensive care unit. This follow-up study investigates whether MITP participation is associated with parental perceptions of child temperament from two to seven years. Children’s temperament was reported by mothers and fathers separately at children’s ages of 2, 3, 5, and 7 years. Parents in the MITP-m group reported lower levels of negative emotionality in their children compared to the control group. In maternal reports, a group effect (F(1, 121) = 9.7, p = 0.002) revealed a stable difference in children’s negative emotionality from two to seven years, while a group-by-time interaction related to an increasing difference was detected in reports from fathers (F(1, 94) = 4.8, p = 0.03). Another group difference appeared in fathers’ reports of children’s soothability (F(1, 100) = 14.2, p < 0.0005). MITP-m fathers seemed to perceive their children as easier to soothe at all ages as no interaction with time appeared. Parental reports on children’s sociality, shyness, and activity did not differ between the groups.

Parenting Styles of Parents Who Had Children With and Without High Risk at Birth: A Cross-sectional Comparative Study

Introduction

Parenting style plays a major role in child development by influencing cognitive, social-emotional development, academic performance, and behavioral problems. These characteristics are fairly stable right into adulthood. The influence of risk factors in children on the parenting style of mothers and fathers has not been studied in developing countries.

Aims and methods

The aim of this study is to determine the parenting style of mothers and fathers of children (3-12 years) born with and without high risk and to analyze the influence of this on parenting style. This is an analytical, cross-sectional, comparative study. Sixty-four out of 90 parents of children who have been newborn intensive care unit (NICU) graduates, with moderate to severe risk factors at birth as per the National Neonatology Forum guidelines of India, and 73 parents of children without risk factors at birth were enrolled. A parenting style and dimension questionnaire was used. The commonest parenting style in mothers and fathers and a correlation between parenting style and risk factors in children at birth were identified.

Results

Baseline characteristics were comparable between the high-risk and non-high-risk groups. Eighty percent of mothers and 70% of fathers followed the authoritative parenting style. There was no significant correlation between risk factors and gender, family type or socioeconomic status and the parenting style. Lack of follow-through was the only factor that was significantly present in fathers of children born without risk factors.

Conclusion

Authoritative was the most common parenting style, with no significant difference between parenting in the high-risk and non-high-risk groups. Adopting the appropriate parenting style will optimize developmental outcomes. Further studies are required to look at the influence of proactive positive parenting practices.

Stockholm preterm interaction-based intervention (SPIBI) - study protocol for an RCT of a 12-month parallel-group post-discharge program for extremely preterm infants and their parents

BACKGROUND

Improved neonatal care has resulted in increased survival rates among infants born after only 22 gestational weeks, but extremely preterm children still have an increased risk of neurodevelopmental delays, learning disabilities and reduced cognitive capacity, particularly executive function deficits. Parent-child interaction and parental mental health are associated with infant development, regardless of preterm birth. There is a need for further early interventions directed towards extremely preterm (EPT) children as well as their parents. The purpose of this paper is to describe the Stockholm Preterm Interaction-Based Intervention (SPIBI), the arrangements of the SPIBI trial and the chosen outcome measurements.

METHODS

The SPIBI is a randomized clinical trial that includes EPT infants and their parents upon discharge from four neonatal units in Stockholm, Sweden. Inclusion criteria are EPT infants soon to be discharged from a neonatal intensive care unit (NICU), with parents speaking Swedish or English. Both groups receive three initial visits at the neonatal unit before discharge during the recruitment process, with a strengths-based and development-supportive approach. The intervention group receives ten home visits and two telephone calls during the first year from a trained interventionist from a multi-professional team. The SPIBI intervention is a strengths-based early intervention programme focusing on parental sensitivity to infant cues, enhancing positive parent-child interaction, improving self-regulating skills and supporting the infant's next small developmental step through a scaffolding process and parent-infant co-regulation. The control group receives standard follow-up and care plus extended assessment. The outcomes of interest are parent-child interaction, child development, parental mental health and preschool teacher evaluation of child participation, with assessments at 3, 12, 24 and 36 months corrected age (CA). The primary outcome is emotional availability at 12 months CA.

DISCUSSION

If the SPIBI shows positive results, it could be considered for clinical implementation for child-support, ethical and health-economic purposes. Regardless of the outcome, the trial will provide valuable information about extremely preterm children and their parents during infancy and toddlerhood after regional hospital care in Sweden.

TRIAL REGISTRATION

The study was registered in ClinicalTrials.gov in October 2018 (NCT03714633).

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.

Parenting style associations with sensory threshold and behaviour: a prospective cohort study in term/preterm infants

AIM

Early-life atypical sensory functioning and behavioural profiles are often associated with long-term developmental problems, especially in former preterm infants. We tested whether parenting style is associated with atypical sensory threshold or behavioural outcomes in preterm and term infants assessed during early childhood.

METHODS

We prospectively evaluated parenting style for a cohort of term and preterm infants who had previous assessments of sensory development and behaviour. We used standardised tools to evaluate parenting style, sensory neurological threshold at one year, and internalising and externalising behavioural tendencies at two years. Covariates included gestational age, sex and maternal education.

RESULTS

For the entire cohort (n = 82), children of more permissive parents were 2.7 times more likely to demonstrate abnormal sensory neurological thresholds compared to children of parents with less permissive styles (CI: 1.4-4.9). More permissive parenting scores were also associated with 2.4 times increased internalising (CI: 1.3-4.2) and 3.0 times increased externalising (CI: 1.6-5.6) tendencies. In the preterm group only, higher authoritative parenting scores were associated with fewer behavioural problems.

CONCLUSION

Permissive parenting is associated with worse infant sensory and behavioural outcomes. Authoritative parenting is associated with fewer behavioural problems in preterm children. Modification of parenting style may improve sensory development and behavioural outcomes.