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Rilling JK, Lee M, Zhou C, Gonzalez A, Lindo J. Grandmotherhood is associated with reduced OXTR DNA methylation. Psychoneuroendocrinology 2024; 168:107122. [PMID: 39002451 DOI: 10.1016/j.psyneuen.2024.107122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
In mammals, both parental and alloparental care are associated with increased brain oxytocin signaling. Grandmothers are important alloparents in many human families. Based on animal model research showing that peripheral Oxtr methylation is associated with Oxtr expression in the nucleus accumbens, we investigated whether grandmaternal caregiving is associated with lower peripheral OXTR methylation. Results reveal several regions within OXTR where grandmothers have lower DNA methylation compared with non-grandmother controls, and no regions where grandmothers have higher OXTR DNA methylation. Among grandmothers, OXTR methylation was most strongly correlated with the grandmother's assessment of the degree of positive feelings between her and the grandchild, which in turn predicted caregiving engagement. Although there was little evidence that grandmaternal OXTR methylation modulated grandmaternal neural responses to viewing photos of the grandchild within brain regions involved in caregiving motivation, it was negatively correlated with the neural response to an unknown grandchild. Thus, while OT signaling may not be essential for activating grandmaternal brain reward systems in our low-stress experimental context, it may support caregiving motivation towards unrelated children. Future longitudinal research should determine whether the transition to grandmotherhood is associated with a reduction in OXTR methylation.
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Affiliation(s)
- James K Rilling
- Department of Psychology, Emory University, United States; Department of Psychiatry and Behavioral Sciences, Emory University, United States; Center for Behavioral Neuroscience, Emory University, United States; Emory National Primate Research Center, Emory University, United States; Center for Translational Social Neuroscience, Emory University, United States.
| | - Minwoo Lee
- Department of Anthropology, Emory University, United States
| | - Carolyn Zhou
- Department of Anthropology, Emory University, United States
| | - Amber Gonzalez
- Department of Anthropology, Emory University, United States
| | - John Lindo
- Department of Anthropology, Emory University, United States
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Kingsbury MA. The intertwining of oxytocin's effects on social affiliation and inflammation. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100239. [PMID: 38784104 PMCID: PMC11112266 DOI: 10.1016/j.cpnec.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
•Oxytocin is an ancient adaptive hormone that promotes social affiliation to maximize fitness and longevity.•Oxytocin is a multifaceted hormone that regulates stress responses at all levels of cellular organization within individuals.•Oxytocin's dual actions on sociability and inflammation highlight its powerful capacity as a modulator of human health.
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Affiliation(s)
- Marcy A. Kingsbury
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, 02129, USA
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3
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Pados BF, Camp L. Physiology of Human Lactation and Strategies to Support Milk Supply for Breastfeeding. Nurs Womens Health 2024; 28:303-314. [PMID: 38972331 DOI: 10.1016/j.nwh.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/21/2024] [Indexed: 07/09/2024]
Abstract
Despite advances across the globe in breastfeeding initiation rates, many families continue to report they are not meeting their breastfeeding goals. Concerns about milk supply, infant nutritional intake, and infant weight gain are among the most commonly cited reasons for early breastfeeding cessation. Nurses working with individuals during the perinatal period are uniquely positioned to educate families and offer evidence-based interventions to promote optimal milk supply, infant growth, and maternal mental and physical health. Such interventions include early and frequent skin-to-skin care, emptying of the breast, and professional lactation support. By implementing such evidence-based practices in the first hours after birth and connecting families to lactation support in the first 14 days, nurses can begin to help families achieve their breastfeeding goals.
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Girma D, Abita Z. Rural versus urban variations of factors associated with early initiation of breastfeeding in Ethiopia. Heliyon 2024; 10:e33427. [PMID: 39027529 PMCID: PMC467058 DOI: 10.1016/j.heliyon.2024.e33427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
Background Early initiation of breastfeeding is an important strategy to reduce under-five mortality. Nevertheless, it remains under-practiced in developing countries. In Ethiopia, there were studies done to identify determinants of early initiation of breastfeeding. However, the variation of factors among rural versus urban residents has not been investigated. Therefore, the main objective of this study is to investigate the variation of factors associated with early initiation of breastfeeding among rural versus urban residences. Methods The 2016 Ethiopian Demographic and Health Survey data was used to conduct the study. Mothers whose index child aged less than 24 months have participated in the study. We excluded mothers who had fetal death during birth and who didn't live with their child. Accordingly, a total of 3396 weighted samples of mothers from rural residences and 478 weighted samples of mothers from urban residences were included in the final analysis. A multivariable logistic regression analysis has been used to explore determinants of early initiation of breastfeeding. Finally, statistically significant associations have been declared by using AOR with a 95%CI at a p-value of <0.05. Results In rural residences, age of mothers 15-24 years (AOR: 1.39, 95 % CI: 1.08, 1.79), mothers who are not currently working (AOR: 1.45, 95 % CI: 1.19, 1.78), large birth size (AOR: 1.49, 95 % CI: 1.17, 1.92), and giving birth at health facility (AOR: 1.25, 95 % CI: 1.01, 1.53) were factors associated with a higher odds of early initiation of breastfeeding. Whereas, in urban residences, being second to third birth order (AOR: 1.94, 95 % CI: 1.01, 3.75), skin-to-skin contact care (AOR: 2.58, 95 % CI: 1.44, 4.63) and antenatal care visit were factors associated with early initiation of breastfeeding. Regardless of residences, vaginal delivery (Rural AOR: 4.06, 95 % CI: 1.75, 9.44; Urban AOR: 2.52, 95 % CI: 1.15, 5.54) and involvement of mothers in health care decisions (Rural AOR: 1.52, 95 % CI: 1.25, 1.85; Urban AOR: 2.62, 95 % CI: 1.33, 5.17) were common determinants of early initiation of breastfeeding. Conclusions This study concludes that the factors associated with early initiation of breastfeeding are different among rural versus urban residences. Accordingly, maternal ages, maternal current working status, birth sizes, and place of delivery are identified as factors associated with early initiation of breastfeeding among rural residences. Whereas, antenatal care visits, skin-to-skin contact care, and birth order are identified as factors associated with early initiation of breastfeeding among urban residences. Regardless of residence, mode of delivery, and involvement of mothers in health care decisions are common determinants of early initiation of breastfeeding. Therefore, irrespective of the residence, special emphasis has to be given to newborns delivered by cesarean section to increase the rate of early initiation of breastfeeding.
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Affiliation(s)
- Desalegn Girma
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Zinie Abita
- School of Public Health, College of Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia
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Zhou H, Zhu R, Xia Y, Zhang X, Wang Z, Lorimer GH, Ghiladi RA, Bayram H, Wang J. Neuropeptides affecting social behavior in mammals: Oxytocin. Peptides 2024; 177:171223. [PMID: 38626843 DOI: 10.1016/j.peptides.2024.171223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/24/2024] [Accepted: 04/13/2024] [Indexed: 04/30/2024]
Abstract
Oxytocin (OXT), a neuropeptide consisting of only nine amino acids, is synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Although OXT is best known for its role in lactation and parturition, recent research has shown that it also has a significant impact on social behaviors in mammals. However, a comprehensive review of this topic is still lacking. In this paper, we systematically reviewed the effects of OXT on social behavior in mammals. These effects of OXT from the perspective of five key behavioral dimensions were summarized: parental behavior, anxiety, aggression, attachment, and empathy. To date, researchers have agreed that OXT plays a positive regulatory role in a wide range of social behaviors, but there have been controversially reported results. In this review, we have provided a detailed panorama of the role of OXT in social behavior and, for the first time, delved into the underlying regulatory mechanisms, which may help better understand the multifaceted role of OXT. Levels of OXT in previous human studies were also summarized to provide insights for diagnosis of mental disorders.
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Affiliation(s)
- Hong Zhou
- Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Hubei University of Technology, Wuhan, Hubei 430068, China; International Center for Redox Biology & Precision Medicine of Hubei Province, Hubei University of Technology, Wuhan, Hubei 430068, China; National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan, Hubei 430068, China
| | - Rui Zhu
- Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Hubei University of Technology, Wuhan, Hubei 430068, China; International Center for Redox Biology & Precision Medicine of Hubei Province, Hubei University of Technology, Wuhan, Hubei 430068, China; National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan, Hubei 430068, China
| | - Yuqing Xia
- Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Hubei University of Technology, Wuhan, Hubei 430068, China; International Center for Redox Biology & Precision Medicine of Hubei Province, Hubei University of Technology, Wuhan, Hubei 430068, China; National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan, Hubei 430068, China
| | - Xinming Zhang
- Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Hubei University of Technology, Wuhan, Hubei 430068, China; International Center for Redox Biology & Precision Medicine of Hubei Province, Hubei University of Technology, Wuhan, Hubei 430068, China; National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan, Hubei 430068, China
| | - Zixu Wang
- National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan, Hubei 430068, China
| | | | - Reza A Ghiladi
- Department of Chemistry, North Carolina State University, Raleigh, NC 27695, USA
| | - Hasan Bayram
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey
| | - Jun Wang
- Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Hubei University of Technology, Wuhan, Hubei 430068, China; International Center for Redox Biology & Precision Medicine of Hubei Province, Hubei University of Technology, Wuhan, Hubei 430068, China; National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan, Hubei 430068, China.
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Zeng G, Leung TS, Maylott SE, Malik A, Adornato AA, Lebowitz M, Messinger DS, Szeto A, Feldman R, Simpson EA. Infants' salivary oxytocin and positive affective reactions to people. Horm Behav 2024; 164:105579. [PMID: 38905820 DOI: 10.1016/j.yhbeh.2024.105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/30/2024] [Accepted: 06/06/2024] [Indexed: 06/23/2024]
Abstract
Oxytocin is a neuropeptide positively associated with prosociality in adults. Here, we studied whether infants' salivary oxytocin can be reliably measured, is developmentally stable, and is linked to social behavior. We longitudinally collected saliva from 62 U.S. infants (44 % female, 56 % Hispanic/Latino, 24 % Black, 18 % non-Hispanic White, 11 % multiracial) at 4, 8, and 14 months of age and offline-video-coded the valence of their facial affect in response to a video of a smiling woman. We also captured infants' affective reactions in terms of excitement/joyfulness during a live, structured interaction with a singing woman in the Early Social Communication Scales at 14 months. We detected stable individual differences in infants' oxytocin levels over time (over minutes and months) and in infants' positive affect over months and across contexts (video-based and in live interactions). We detected no statistically significant changes in oxytocin levels between 4 and 8 months but found an increase from 8 to 14 months. Infants with higher oxytocin levels showed more positive facial affect to a smiling person video at 4 months; however, this association disappeared at 8 months, and reversed at 14 months (i.e., higher oxytocin was associated with less positive facial affect). Infant salivary oxytocin may be a reliable physiological measure of individual differences related to socio-emotional development.
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Affiliation(s)
- Guangyu Zeng
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China; Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | - Tiffany S Leung
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Arushi Malik
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alexis A Adornato
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mendel Lebowitz
- School of Medicine, Emory University, Atlanta, GA, USA; Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | | | - Angela Szeto
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Ruth Feldman
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel; Child Study Center, Yale University, New Haven, CT, USA
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Clarke-Sather AR, Compton C, Roberts K, Brearley A, Wang SG. Systematic Review of Kangaroo Care Duration's Impact in Neonatal Intensive Care Units on Infant-Maternal Health. Am J Perinatol 2024; 41:975-987. [PMID: 36577443 DOI: 10.1055/a-2003-3935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Kangaroo care (KC), skin-to-skin contact between infants and caregivers, is encouraged in neonatal intensive care units (NICUs) to support health through improved weight, growth, and infant-maternal attachment while reducing the incidence of sepsis and infant pain. However, the optimal duration and frequency of KC to maximize health outcomes is unknown. Given parents' time stressors, identifying optimal KC time is critical. A literature review was undertaken on May 28, 2021 via querying the PubMed database from January 1, 1995, to May 28, 2021, regarding KC and NICUs with 442 results. Eleven studies met the eligibility criteria of (1) comparative KC between infants and adult caregivers in NICUs as a randomized controlled trial, (2) peer-reviewed articles in English, (3) study subjects ≥5, (4) health outcomes, and (5) KC sessions >1. Infant physical growth parameters, infant neurodevelopment, infant stress via salivary cortisol levels, and breastfeeding outcomes appear to increase with KC as compared with standard care (SC) without KC. Improvements were observed with longer KC duration, 2 h/d as compared with 1 h/d, for neurodevelopment and breastfeeding outcomes, but no greater improvement with longer KC duration was shown for reducing infant stress through salivary cortisol levels. Regarding maternal stress, the influence of KC duration showed mixed Parental Stressor Score: NICU scores. Further study on the impact of KC duration and frequency on health outcomes and dose-response relationship would help determine how much and how frequent KC is needed to improve specific health outcomes for infants and their mothers. KEY POINTS: · Data on kangaroo care duration's health impacts is lacking.. · Establishing dose-response for kangaroo care is needed.. · Kangaroo care for longer improves some but not all outcomes..
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Affiliation(s)
- Abigail R Clarke-Sather
- Department of Mechanical and Industrial Engineering, University of Minnesota Duluth, Duluth, Minnesota
| | - Crystal Compton
- Department of Design, Housing, and Apparel, University of Minnesota, St. Paul, Minnesota
| | - Kari Roberts
- Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Ann Brearley
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Sonya G Wang
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
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Feng X, Zhang Y. Effects of mother-infant skin-to-skin contact on mother-infant relationship and maternal psychology feelings: A qualitative study. Nurs Open 2024; 11:e2181. [PMID: 39031733 PMCID: PMC11191751 DOI: 10.1002/nop2.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/16/2024] [Accepted: 04/24/2024] [Indexed: 07/22/2024] Open
Abstract
AIMS To explore the effects of mother-infant skin-to-skin contact on mother-infant relationship and maternal psychology feelings. DESIGN An exploratory qualitative research design using semi-structured interviews. METHODS A total of 64 mother-infant pairs who met the inclusion criteria were selected as the experimental subjects to receive early and continuous intervention of mother-infant skin-to-skin contact (SSC). On this basis, the qualitative research method of procedural grounded theory was used to conduct semi-structured interviews with 18 puerperas before discharge from the hospital; the three-level coding method of procedural grounded theory and Graneheim & Lundman qualitative content analysis method were combined to conductinterview content analysis in Nvivo 12 software, so as to extractcore categories and condense the theme. RESULTS (1) The data were coded to extract five core categories, namely, birth experience, role transition, contact perception, mother-infant connection and parental efficacy; (2) there were statistically significant differences in the number of coding reference points in five nodes before and after SSC, that is, mothers' positive feelings, newborns' physical characteristics noticed by their mothers, mother-infant connection, role transition and birth experience. The number of coding reference points after SSC was statistically significant greater than before SSC; (3) The coding interview results showed that SSC could promote the sense of happiness in nurturing.
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Affiliation(s)
- Xiaoyan Feng
- Department of ObstetricsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Nursing DepartmentThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yuqing Zhang
- Research Center for Adolescent Personality and Health, Institute of PsychologyChinese Academy of SciencesBeijingChina
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Bushroe K, Lloyd B, McDaneld C, Mathur A, Rao R. Feasibility and Impact of a Pilot Neonatal Cuddler Program on Preterm Infants in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e870-e878. [PMID: 36451624 DOI: 10.1055/s-0042-1758726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Preterm infants experience daily stress in the neonatal intensive care unit (NICU). Positive sensory experiences mitigate stress responses, but parental participation can be limited by external pressures. This study aimed to describe the impact of a neonatal cuddler program (NCP) on preterm infants' growth. STUDY DESIGN A multidisciplinary program trained volunteers to interact with NICU infants when family was not at bedside. Infants were followed prospectively throughout admission. Intervention data included frequency, type, and duration of activity throughout the study period. Student t-test and chi-square test were used to analyze the impact of volunteer interaction on anthropometric measures at discharge. RESULTS Forty-five infants interacted with a volunteer (intervention group, n = 45) compared with the control group (n = 56) following coronavirus disease 2019 restrictions. The median (range) time of interaction with a volunteer in the intervention group was 90.0 (5.0-705.0) minutes per infant. Infants in the two groups had similar gestational ages, birth weights, lengths, and occipitofrontal circumferences (OFC). Infants in the intervention group had higher rates of spontaneous intestinal perforation, bronchopulmonary dysplasia, and reached full enteral feeds later. However, rates of severe intraventricular hemorrhage, retinopathy of prematurity, and duration of mechanical ventilation were similar. Infants in the two groups did not differ in the NICU length of stay. At discharge, infants in the intervention group weighed more (p = 0.04) and had higher OFC's (p = 0.01) and OFC z-scores (p = 0.03). The change in z-scores from birth to discharge was significant for the weight (p = 0.02) but not length or OFC. In regression analyses, only group allocation was identified as a significant factor for OFC z-scores at discharge (β= 0.279, p = 0.011) and for change in weight z-scores from birth to discharge (β = 0.226, p = 0.041). CONCLUSION Growth is positively impacted by an NCP despite limited interaction. Additional work is needed to demonstrate the impact on neurobehavioral and developmental outcomes. KEY POINTS · Establishing and implementing a neonatal cuddler program in a large, level IV NICU is feasible.. · Neonatal cuddler programs can provide positive sensory experiences when parents are not at bedside.. · Even limited exposure to these positive sensory experiences can positively impact growth parameters for preterm infants..
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Affiliation(s)
- Kylie Bushroe
- Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Brieann Lloyd
- Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Chonita McDaneld
- Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Amit Mathur
- Division of Newborn Medicine, Department of Pediatrics, Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, Missouri
| | - Rakesh Rao
- Division of Newborn Medicine, Department of Pediatrics, St. Louis Children's Hospital and Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Uvnäs-Moberg K, Gross MM, Calleja-Agius J, Turner JD. The Yin and Yang of the oxytocin and stress systems: opposites, yet interdependent and intertwined determinants of lifelong health trajectories. Front Endocrinol (Lausanne) 2024; 15:1272270. [PMID: 38689729 PMCID: PMC11058227 DOI: 10.3389/fendo.2024.1272270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
During parturition and the immediate post-partum period there are two opposite, yet interdependent and intertwined systems that are highly active and play a role in determining lifelong health and behaviour in both the mother and her infant: the stress and the anti-stress (oxytocin) system. Before attempting to understand how the environment around birth determines long-term health trajectories, it is essential to understand how these two systems operate and how they interact. Here, we discuss together the hormonal and neuronal arms of both the hypothalamic-pituitary-adrenal (HPA) axis and the oxytocinergic systems and how they interact. Although the HPA axis and glucocorticoid stress axis are well studied, the role of oxytocin as an extremely powerful anti-stress hormone deserves more attention. It is clear that these anti-stress effects depend on oxytocinergic nerves emanating from the supraoptic nucleus (SON) and paraventricular nucleus (PVN), and project to multiple sites at which the stress system is regulated. These, include projections to corticotropin releasing hormone (CRH) neurons within the PVN, to the anterior pituitary, to areas involved in sympathetic and parasympathetic nervous control, to NA neurons in the locus coeruleus (LC), and to CRH neurons in the amygdala. In the context of the interaction between the HPA axis and the oxytocin system birth is a particularly interesting period as, for both the mother and the infant, both systems are very strongly activated within the same narrow time window. Data suggest that the HPA axis and the oxytocin system appear to interact in this early-life period, with effects lasting many years. If mother-child skin-to-skin contact occurs almost immediately postpartum, the effects of the anti-stress (oxytocin) system become more prominent, moderating lifelong health trajectories. There is clear evidence that HPA axis activity during this time is dependent on the balance between the HPA axis and the oxytocin system, the latter being reinforced by specific somatosensory inputs, and this has long-term consequences for stress reactivity.
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Affiliation(s)
- Kerstin Uvnäs-Moberg
- Department of Animal Environment and Health, Section of Anthrozoology and Applied Ethology, Swedish University of Agricultural Sciences, Skara, Sweden
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jonathan D. Turner
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
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11
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Horner S. Impact of Parent Presence and Engagement on Stress in NICU Infants. Adv Neonatal Care 2024; 24:132-140. [PMID: 38547480 DOI: 10.1097/anc.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Infants in neonatal intensive care units (NICUs) are exposed to frequent stressors that impact their neurodevelopmental outcomes. Parent presence and engagement are considered critical to improving infant outcomes, yet associations between cumulative NICU parent presence, engagement, and infant stress are infrequently examined. PURPOSE To examine associations between NICU infant stress and the amount (hours per week) or frequency (days per week) of parent presence and skin-to-skin care (SSC). METHODS A secondary analysis of a data set representing 78 NICU families was conducted. Infant acuity was measured using Neonatal Medical Index (NMI) scores. Parent presence and SSC data were collected from electronic medical records. Infant stress was measured using resting salivary cortisol levels collected at NICU discharge (median = 33 days of life). RESULTS More cumulative SSC was associated with lower discharge cortisol in NICU infants for SSC measured in hours per week (P = .03) or days per week (P = .05). Cumulative parent presence was not significantly associated with infant cortisol at discharge. Hierarchical regression analyses examining timing of parent presence supported a model including admission cortisol, NMI score, and parent presence during weeks 1 to 4 of life for explaining infant stress at discharge (R2 = 0.44, P = .004). Analyses examining timing of SSC supported a model including admission cortisol, NMI score, and frequency of SSC during week 1 for explaining infant stress at discharge (R2 = 0.21, P = .04). IMPLICATIONS FOR PRACTICE AND RESEARCH Early, frequent SSC to mitigate stress in NICU infants was supported. Results suggested that timing of parent presence impacts NICU infant stress; however, additional study is recommended.
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Affiliation(s)
- Susan Horner
- Author Affiliations: Loyola University Chicago, Chicago, Illinois; and Ann & Robert H. Lurie Children's Hospital, Lombard, Illinois
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12
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Mehler K, Kribs A, Klein R, Heine E, Trautmann-Villalba P. Delivery room skin-to-skin contact for very preterm infants promotes mother-child interaction and bonding. Acta Paediatr 2024. [PMID: 38450809 DOI: 10.1111/apa.17200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Katrin Mehler
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Angela Kribs
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ruth Klein
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Eva Heine
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Mira A, Coo S, Bastías R. Mother's mental health and the interaction with her moderate preterm baby in the NICU. J Reprod Infant Psychol 2024; 42:299-314. [PMID: 35635499 DOI: 10.1080/02646838.2022.2077921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Moderate preterm infants, born between 320/7 and 336/7 weeks, represent a significant number of preterm-born infants; however, they remain a poorly studied group despite their vulnerability. The objective of this correlational study is to describe the impact of having a moderate preterm infant hospitalised in the NICU on the mothers' mental health and how this relates to the interaction between the dyad. METHOD During the hospitalisation period, 85 moderate preterm mother-infant dyads participated in this study. The participants provided self-reports of depression, parental stress, and skin to skin and breastfeeding practices. Also, mother-infant interaction was assessed in the NICU with an observational scale. RESULTS Mothers evidenced high levels of stress and depressive symptoms during the hospitalization. The stress experienced by these women was significant, although weakly, associated with the interaction with their babies; and mothers of small for gestational age babies showed difficulties in this area. CONCLUSIONS The results of this study could represent a contribution to a better understanding of the relation between the characteristics of moderate preterm babies, maternal emotional wellbeing, and the quality of mother-infant interactions in NICU settings.
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Affiliation(s)
- Andrea Mira
- Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Santiago, Chile
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Soledad Coo
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Rodolfo Bastías
- Unidad de Neonatología, Hospital Luis Tisné T., Servicio de Salud Metropolitana Oriente, Santiago, Chile
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Uvnäs-Moberg K. The physiology and pharmacology of oxytocin in labor and in the peripartum period. Am J Obstet Gynecol 2024; 230:S740-S758. [PMID: 38462255 DOI: 10.1016/j.ajog.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 03/12/2024]
Abstract
Oxytocin is a reproductive hormone implicated in the process of parturition and widely used during labor. Oxytocin is produced within the supraoptic nucleus and paraventricular nucleus of the hypothalamus and released from the posterior pituitary lobe into the circulation. Oxytocin is released in pulses with increasing frequency and amplitude in the first and second stages of labor, with a few pulses released in the third stage of labor. During labor, the fetus exerts pressure on the cervix of the uterus, which activates a feedforward reflex-the Ferguson reflex-which releases oxytocin. When myometrial contractions activate sympathetic nerves, it decreases oxytocin release. When oxytocin binds to specific myometrial oxytocin receptors, it induces myometrial contractions. High levels of circulating estrogen at term make the receptors more sensitive. In addition, oxytocin stimulates prostaglandin synthesis and release in the decidua and chorioamniotic membranes by activating a specific type of oxytocin receptor. Prostaglandins contribute to cervical ripening and uterine contractility in labor. The oxytocin system in the brain has been implicated in decreasing maternal levels of fear, pain, and stress, and oxytocin release and function during labor are stimulated by a social support. Moreover, studies suggest, but have not yet proven, that labor may be associated with long-term, behavioral and physiological adaptations in the mother and infant, possibly involving epigenetic modulation of oxytocin production and release and the oxytocin receptor. In addition, infusions of synthetic oxytocin are used to induce and augment labor. Oxytocin may be administered according to different dose regimens at increasing rates from 1 to 3 mIU/min to a maximal rate of 36 mIU/min at 15- to 40-minute intervals. The total amount of synthetic oxytocin given during labor can be 5 to 10 IU, but lower and higher amounts of oxytocin may also be given. High-dose infusions of oxytocin may shorten the duration of labor by up to 2 hours compared with no infusion of oxytocin; however, it does not lower the frequency of cesarean delivery. When synthetic oxytocin is administered, the plasma concentration of oxytocin increases in a dose-dependent way: at infusion rates of 20 to 30 mIU/min, plasma oxytocin concentration increases approximately 2- to 3-fold above the basal level. Synthetic oxytocin administered at recommended dose levels is not likely to cross the placenta or maternal blood-brain barrier. Synthetic oxytocin should be administered with caution as high levels may induce tachystole and uterine overstimulation, with potentially negative consequences for the fetus and possibly the mother. Of note, 5 to 10 IU of synthetic oxytocin is often routinely given as an intravenous or intramuscular bolus administration after delivery to induce uterine contractility, which, in turn, induces uterine separation of the placenta and prevents postpartum hemorrhage. Furthermore, it promotes the expulsion of the placenta.
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Affiliation(s)
- Kerstin Uvnäs-Moberg
- Department of Animal Environment and Health, Swedish University of Agriculture, Uppsala, Sweden.
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Manzar S. Kangaroo mother care and its effects on the digestive system of preterm infants. J Trop Pediatr 2024; 70:fmae006. [PMID: 38515250 DOI: 10.1093/tropej/fmae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Shabih Manzar
- Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
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Zagoory-Sharon O, Yirmiya K, Peleg I, Shimon-Raz O, Sanderlin R, Feldman R. Breast milk oxytocin and s-IgA modulate infant biomarkers and social engagement; The role of maternal anxiety. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 17:100219. [PMID: 38187086 PMCID: PMC10765300 DOI: 10.1016/j.cpnec.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Breastfeeding has long been known to improve infants' health and mental development and to enhance the mother-infant bond, but much less research focused on the biological composition of breast milk and its associations with the infant's biomarkers and social development. In this exploratory study, we measured oxytocin (OT) and secretory immunoglobulin-A (s-IgA), the most abundant antibody in breast milk, and evaluated their associations with the same biomarkers in infant saliva and, consequently, with infant social engagement behavior. Fifty-five mother-infant dyads were home-visit and OT and s-IgA were assessed from breast milk and from infant saliva before and after a free-play interaction. Infant social behavior was coded offline using the Coding Interactive Behavior (CIB) and maternal anxiety self-reported. A path model revealed that mother's breast milk s-IgA impacted child social engagement via its links with child OT. In parallel, maternal breast milk OT was linked with infant social behavior through its association with the infant's immunity. This path was moderated by maternal anxiety; only in cases of high anxiety breast milk OT was positively connected to infant s-IgA. Our study, the first to measure OT and s-IgA in both breast milk and infant saliva in relation to observed social behavior, underscores the need for much further research on the dynamic interplay between breast milk composition, infant biomarkers, maternal mental health, and infant social outcomes. Results may suggest that biological systems in breast milk integrate to prepare infants to function in their social ecology through bio-behavioral feedback loops that signal the degree of stress in the environment.
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Affiliation(s)
| | | | - Itai Peleg
- Center for Developmental Social Neuroscience, Reichman University, Israel
| | - Ortal Shimon-Raz
- Center for Developmental Social Neuroscience, Reichman University, Israel
| | - Rachel Sanderlin
- Center for Developmental Social Neuroscience, Reichman University, Israel
| | - Ruth Feldman
- Center for Developmental Social Neuroscience, Reichman University, Israel
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Freccero A, Scala M, McLeod KA, Donahue B, Webb M, Briggs M, Najm I, Sinha M, Santagata L, Dahlen A, Nasr A. The Safety of Body Wraps on Skin-to-Skin Care in the Neonatal Population: A Pilot Study. Adv Neonatal Care 2024; 24:E11-E19. [PMID: 38127581 DOI: 10.1097/anc.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Despite well-established benefits of skin-to-skin care (SSC) for preterm infants and parents, standardized guidelines for implementation do not exist. Furthermore, the literature offers little evidence-based information to guide best practice. PURPOSE To discover whether SSC using a body wrap to hold preterm infants would increase the duration of SSC, decrease parental stress during SSC, and minimize adverse events to ensure that body wraps are safe and feasible. METHODS Twenty-nine dyads of parents and preterm infants younger than 34 weeks postmenstrual age were enrolled. The first 15 dyads to meet inclusion criteria were assigned to a standard of care group for SSC with no body wrap. The remaining 14 dyads were assigned to an experimental group for SSC with a body wrap. Each dyad performed 2 SSC holds. Parents completed the Parental Stressor Scale and Parent Feedback Form. Adverse events were also documented. RESULTS No statistically significant differences were found between the 2 groups in total SSC time ( P = .33), the number of adverse events ( P = .31 for major events; P = .38 for minor events), average parental stress ( P = .22), and parental confidence performing SSC ( P = .18). IMPLICATIONS FOR PRACTICE AND RESEARCH This study found that SSC with a body wrap is safe for preterm infants in a neonatal intensive care unit (NICU). This is the first study to explore the use, safety, and effectiveness of body wraps during SSC with preterm infants in an NICU. Future research should be conducted with larger sample sizes to further evaluate the safety and efficacy.
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Affiliation(s)
- Allison Freccero
- Departments of Rehabilitation Services (Drs Freccero, McLeod, Donahue, and Webb and Ms Briggs) and Nursing (Mss Najm, Sinha, and Santagata), Lucile Packard Children's Hospital Stanford, Palo Alto, California; Departments of Neonatology (Dr Scala) and Pediatrics (Dr Nasr), School of Medicine, Stanford University, Lucile Packard Children's Hospital Stanford, Palo Alto, California; and Quantitative Sciences Unit, School of Medicine, Stanford University, Palo Alto, California (Dr Dahlen)
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Cordolcini L, Castagna A, Mascheroni E, Montirosso R. Skin-to-Skin Care and Spontaneous Touch by Fathers in Full-Term Infants: A Systematic Review. Behav Sci (Basel) 2024; 14:60. [PMID: 38247712 PMCID: PMC10813587 DOI: 10.3390/bs14010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
A series of studies have shown that mothers' early tactile behaviors have positive effects, both on full-term and preterm infants, and on mothers alike. Regarding fathers, research has focused mostly on paternal skin-to-skin care with preterm infants and has overlooked the tactile behavior effects with full-term newborns on infants' outcomes and on fathers themselves. The current systematic review considered the evidence regarding paternal tactile behaviors with full-term infants, including skin-to-skin care (SSC) and spontaneous touch (ST), during parent-infant interactions, and differentiated biophysiological, behavioral and psychological variables both in fathers and in infants. We also compared fathers' and mothers' tactile behaviors for potential differences. The few available studies suggest that paternal touch-SSC and ST-can have positive effects on fathers and infants alike. They also show that, despite some intrinsic differences, paternal touch is as pleasant as maternal touch. However, given the paucity of studies on the topic, we discuss why this field of research should be further explored.
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Affiliation(s)
| | | | | | - Rosario Montirosso
- 0–3 Center for the at-Risk Infant, Scientific Institute IRCCS “Eugenio Medea”, 22040 Bosisio Parini, Italy; (L.C.); (A.C.); (E.M.)
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19
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McCarty D, Silver R, Quinn L, Dusing S, O’Shea TM. Infant massage as a stress management technique for parents of hospitalized extremely preterm infants. Infant Ment Health J 2024; 45:11-21. [PMID: 38140832 PMCID: PMC10947750 DOI: 10.1002/imhj.22095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/19/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
Mothers of infants born extremely preterm requiring prolonged medical intervention in the Neonatal Intensive Care Unit (NICU) are at high risk of developing stress. Parent-administered infant massage is a well-established, safe intervention for preterm infants with many developmental benefits, but the published literature has mostly examined its impact on infants and parents through self-reported or observational measures of stress. The aim of this study was to measure salivary cortisol, a biomarker for stress, in extremely preterm infants and their mothers immediately pre and post parent-administered infant massage in order to detect potential changes in physiologic stress. Twenty-two mother-infant dyads completed massage education with a physical or occupational therapist. All dyads provided salivary cortisol samples via buccal swab immediately pre- and post-massage at the second session. Of mothers determined to be "cortisol responders" (15/22), salivary cortisol levels were lower after massage (pre-minus post-level: -26.47 ng/dL, [CI = -4.40, -48.53], p = .016, paired t-test). Our primary findings include a clinically significant decrease (as measured by percent change) in maternal cortisol levels immediately post parent-administered massage, indicating decreased physiological stress. Integration of infant massage into NICU clinical practice may support maternal mental health, but further powered studies are necessary to confirm findings.
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Affiliation(s)
- Dana McCarty
- Department of Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Rehabilitation Services, University of North Carolina Children’s Hospital, Chapel Hill, NC
| | - Rachel Silver
- Abilitations Children’s Therapy and Wellness Center, Knightdale, NC
| | - Lauren Quinn
- Department of Rehabilitation Services, University of North Carolina Children’s Hospital, Chapel Hill, NC
| | - Stacey Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
| | - T. Michael O’Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, NC
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20
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Malin KJ, Kruschel K, Gondwe K, Lagatta J, Carter CS, Nazarloo HP, Conley Y, White-Traut R. Feasibility of Stress Research in Premature Infant-Maternal Dyads During and After Neonatal Intensive Care Unit Hospitalization. Adv Neonatal Care 2023; 23:583-595. [PMID: 37948632 PMCID: PMC10786239 DOI: 10.1097/anc.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Stress from preterm infant admission to the neonatal intensive care unit (NICU) is associated with infant and maternal physiologic changes, including endocrine and epigenetic alterations. Little is known about the mechanisms connecting NICU stress to biologic changes, and whether preterm infant and maternal stress are reciprocal. As a preliminary step, feasibility and acceptability of measuring indicators of stress are required. PURPOSE This study evaluated the feasibility and acceptability of research examining perceptions and biologic markers of stress in premature infant-maternal dyads during and after NICU hospitalization. METHODS We evaluated study feasibility using a longitudinal descriptive design. Acceptability was measured via a maternal questionnaire. Exploratory data regarding hospitalization, perceptions of stress, social support and social determinants of health, and biologic markers of stress were collected during the first week of life and again 3 months after NICU. RESULTS Forty-eight mothers were eligible for the study, 36 mothers were approached, 20 mothers consented to participate, and 14 mothers completed data collection. Mothers reported high levels of study acceptability despite also voicing concern about the sharing of genetic data. Exploration of DNA methylation of SLC6A4 in preterm infants was significant for a strong correlation with perception of total chronic stress. IMPLICATIONS FOR PRACTICE AND RESEARCH Clinical practice at the bedside in the NICU should include standardized screening for and early interventions to minimize stress. Complex research of stress is feasible and acceptable. Future research should focus on linking early life stress with epigenetic alterations and evaluation of the dyad for reciprocity.
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Affiliation(s)
- Kathryn J Malin
- Marquette University, College of Nursing, Milwaukee, Wisconsin (Dr Malin); Children's Wisconsin, Milwaukee (Drs Malin and White-Traut); Medical College of Wisconsin, Milwaukee (Ms Kruschel and Dr Lagatta); University of Washington, The Department of Child, Family, and Population Health Nursing, Seattle, Washington (Dr Gondwe); The Kinsey Institute at Indiana University, Bloomington, Indiana (Drs Carter and Nazarloo); and University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania (Dr Conley)
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21
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Lyle ANJ, Shaikh H, Oslin E, Gray MM, Weiss EM. Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials: A Systematic Review. JAMA Netw Open 2023; 6:e2348882. [PMID: 38127349 PMCID: PMC10739112 DOI: 10.1001/jamanetworkopen.2023.48882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Representativeness of populations within neonatal clinical trials is crucial to moving the field forward. Although racial and ethnic disparities in research inclusion are well documented in other fields, they are poorly described within neonatology. Objective To describe the race and ethnicity of infants included in a sample of recent US neonatal clinical trials and the variability in this reporting. Evidence Review A systematic search of US neonatal clinical trials entered into Cochrane CENTRAL 2017 to 2021 was conducted. Two individuals performed inclusion determination, data extraction, and quality assessment independently with discrepancies adjudicated by consensus. Findings Of 120 studies with 14 479 participants that met the inclusion criteria, 75 (62.5%) included any participant race or ethnicity data. In the studies that reported race and ethnicity, the median (IQR) percentage of participants of each background were 0% (0%-1%) Asian, 26% (9%-42%) Black, 3% (0%-12%) Hispanic, 0% (0%-0%) Indigenous (eg, Alaska Native, American Indian, and Native Hawaiian), 0% (0%-0%) multiple races, 57% (30%-68%) White, and 7% (1%-21%) other race or ethnicity. Asian, Black, Hispanic, and Indigenous participants were underrepresented, while White participants were overrepresented compared with a reference sample of the US clinical neonatal intensive care unit (NICU) population from the Vermont Oxford Network. Many participants were labeled as other race or ethnicity without adequate description. There was substantial variability in terms and methods of reporting race and ethnicity data. Geographic representation was heavily skewed toward the Northeast, with nearly one-quarter of states unrepresented. Conclusions and Relevance These findings suggest that neonatal research may perpetuate inequities by underrepresenting Asian, Black, Hispanic, and Indigenous neonates in clinical trials. Studies varied in documentation of race and ethnicity, and there was regional variation in the sites included. Based on these findings, funders and clinical trialists are advised to consider a 3-point targeted approach to address these issues: prioritize identifying ways to increase diversity in neonatal clinical trial participation, agree on a standardized method to report race and ethnicity among neonatal clinical trial participants, and prioritize the inclusion of participants from all regions of the US in neonatal clinical trials.
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Affiliation(s)
- Allison N J Lyle
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Henna Shaikh
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
| | - Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Elliott Mark Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
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Kutahyalioglu NS, Scafide KN. Effects of family-centered care on bonding: A systematic review. J Child Health Care 2023; 27:721-737. [PMID: 35430900 DOI: 10.1177/13674935221085799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Nesibe S Kutahyalioglu
- Fazil Boyner Faculty of Health Sciences, Kastamonu University, Kastamonu, Karabuk, Turkey
| | - Katherine N Scafide
- College of Health and Human Services, George Mason University, Fairfax, VA, USA
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Linnér A, Blomqvist YT, Jonsson K, Lilliesköld S, Norman M. Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence. Neonatology 2023; 121:46-55. [PMID: 37844545 PMCID: PMC10836739 DOI: 10.1159/000533900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Infant- and family-centered developmental care can reduce adverse outcomes in both infants and parents. Parents' experiences of the care and staff treatment remain to be evaluated. METHODS Parents of infants admitted to neonatal units in Sweden from July 2020 to May 2022 responded to a questionnaire with standardized questions about in-hospital care. Exposures were hospital, gestational age, length of hospital stay, unit level, and bed density. The proportions of parents rating aspects of neonatal care as excellent, defined as five on a Likert scale, and the determinants of excellence were described. The results were benchmarked with ratings in adult somatic care. RESULTS A total of 4,475/13,108 (34%) parents responded. The ratings of excellent care varied by question from 65% to 90%. The largest variation in excellence between neonatal units (range 43-80%) was found for "participation and involvement." The proportion of excellence was significantly lower among parents of extremely preterm infants. Confidence in the staff was lower in parents of extremely preterm infants than in parents of term infants (56% vs. 83%). Longer hospital stays affected the experience of neonatal care adversely, whereas level of care and bed density were overall unrelated to the parental experience. Parents in neonatal care rated the care as excellent to a higher extent than patients cared for in adult medicine. CONCLUSION A majority of parents rated neonatal care in Sweden as excellent. The less frequent ratings of excellence among parents of extremely preterm infants indicate that more could be done to optimize parental involvement and support.
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Affiliation(s)
- Agnes Linnér
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kristina Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Siri Lilliesköld
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Kutahyalioglu NS, Mallinson RK, Scafide KN, D'Agata AL. "It Takes a Village" to Implement Family-Centered Care in the Neonatal Intensive Care Unit. Adv Neonatal Care 2023; 23:457-466. [PMID: 37499692 DOI: 10.1097/anc.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Although research has demonstrated positive impacts of family-centered care (FCC), many neonatal intensive care unit (NICU) nurses hesitate to fully engage in its practice. There has been little scientific focus on investigating the challenges of FCC implementation in the NICU setting. PURPOSE The purpose of this study was to generate a grounded theory explaining the process by which neonatal nurses experience facilitators and challenges through engaging in FCC practices in the context of the NICU setting. METHODS This qualitative, grounded theory portion of a mixed-methods study employed individual, semistructured, video-based dyadic interviews with 20 neonatal nurses. RESULTS Successful implementation of FCC by neonatal nurses is affected by various factors. The adage that "it takes a village to raise a child" described this process for the nurse participants. The delivery of FCC involves respectful engagement and participation by multiple internal and external stakeholders. The process of delivering FCC was influenced by factors across 6 categories: equitable relationships, bond of trust, knowledge sharing, empowerment in workplace, environment and culture, and regulations. The findings suggest that FCC implementation is not an individual initiative; rather, it involves a complex set of interrelationships between care team members. NICU nurses may consider these findings when they are proposing a change to a FCC model. IMPLICATIONS FOR PRACTICE AND RESEARCH Flexibility is necessary by multidisciplinary teams to achieve maximum benefits of FCC and minimize potential harm, despite the unit design. Facilities may support nurses with continuing education programs to expand their FCC knowledge and skills.
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Affiliation(s)
- Nesibe S Kutahyalioglu
- School of Nursing, Karabuk University, Karabuk, Turkey (Dr Kutahyalioglu); School of Nursing, George Mason University, Fairfax, Virginia (Drs Mallinson and Scafide); and College of Nursing, University of Rhode Island, Kingston (Dr D'Agata)
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25
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Pfaus JG, Safron A, Zakreski E. From distal to proximal to interactive: behavioral and brain synchrony during attraction, courtship, and sexual interaction-implications for clinical assessments of relationship style and quality. Sex Med Rev 2023; 11:312-322. [PMID: 37544764 DOI: 10.1093/sxmrev/qead034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Synchronous behaviors between individuals are nonverbal signs of closeness and common purpose. In the flow from initial attraction to intimate sexual interaction, attention and synchrony move from distal to proximal to interactive and are mediated by sensitized activation of neural systems for sexual motivation, arousal, and desire and those that recognize and mimic common facial and body movements between individuals. When reinforced by sexual pleasure and other relationship rewards, this results in the strengthening of attraction and bonding and the display of more common motor patterns. As relationships falter, nonverbal behaviors likely become asynchronous. OBJECTIVES To define behavioral, romantic, and sexual synchrony during phases of attraction and how their disruption can be observed and utilized by clinicians to assess individual relationship styles and quality. METHODS We review the literature on behavioral and attentional synchrony in humans and animals in an effort to understand experiential and innate mechanisms of synchrony and asynchrony and how they develop, as well as implications for attraction, relationship initiation, maintenance of romantic and sexual closeness, and relationship disintegration. RESULTS Evidence is presented that behavioral synchrony and the neural mechanisms that underlie it are vital to relationship formation and satisfaction. CONCLUSION Behavioral synchrony helps to create feelings of sexual and romantic synergy, cohesion, and arousal among individuals. Asynchrony is aversive and can spark feelings of discontent, aversion, and jealousy. Thus, observing patterns of nonverbal sexual and romantic synchrony between individuals offers insights into the potential quality of their relationships.
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Affiliation(s)
- James G Pfaus
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Prague, 18200, Czech Republic
- Center for Sexual Health and Intervention, Czech National Institute of Mental Health, Klecany, 25067, Czech Republic
| | - Adam Safron
- Center for Psychedelic and Consciousness Research, Johns Hopkins Bayview Medical Center, Baltimore, MD, 21224, United States
| | - Ellen Zakreski
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Prague, 18200, Czech Republic
- Center for Sexual Health and Intervention, Czech National Institute of Mental Health, Klecany, 25067, Czech Republic
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McCaffery H, Zaituna J, Busch S, Kaciroti N, Miller AL, Lumeng JC, Rosenblum KL, Gearhardt A, Pesch MH. Developmental trajectories of eating behaviors and cross-lagged associations with weight across infancy. Appetite 2023; 188:106978. [PMID: 37495177 PMCID: PMC10844930 DOI: 10.1016/j.appet.2023.106978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/01/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
Examining typical developmental trajectories of infant eating behaviors, correlates of those trajectories, and cross-lagged associations between eating behaviors and anthropometry, is important to understand the etiology of these behaviors and their relevance to growth early in the lifespan. Mothers (N = 276) completed the Baby Eating Behavior Questionnaire (BEBQ) and infant anthropometrics were measured at ages 1, 2, 4, 6, and 10 months. Infant and maternal characteristics were collected by maternal report. Trajectories of eating behaviors were identified using latent class growth modeling and bivariate analyses examined associations of infant eating behavior trajectory membership with infant and maternal characteristics. Cross-lagged analyses examined associations between BEBQ subscales and infant weight-for-length z-score. Infant eating behavior trajectories included: Consistently High (62%) and Consistently Moderate (38%) Enjoyment of Food; Consistently High (9%), Moderate & Decreasing (43%), and Low & Decreasing (48%) Food Responsiveness; and Consistently High (62%) and Moderate & Decreasing (38%) General Appetite. Trajectory group membership was not associated with infant sex, gestational age, birthweight, or having been exclusively fed breastmilk at 2 months. Consistently High trajectories for Enjoyment of Food, Food Responsiveness, and General Appetite were associated with maternal demographic markers of psychosocial risk (e.g., lower maternal age and educational attainment). Food Responsiveness and General Appetite tracked strongly across infancy within individuals. Cross-lagged associations of Enjoyment of Food, Food Responsiveness, and General Appetite with weight-for-length z-score across infancy were generally null. Much additional work is needed to understand eating behaviors in infancy, their development, and their etiology. Further understanding of infant eating behaviors will provide the basis for future interventions to improve life course nutrition, growth, and health.
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Affiliation(s)
- Harlan McCaffery
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Julie Zaituna
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Sophie Busch
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Niko Kaciroti
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Alison L Miller
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie C Lumeng
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
| | | | - Ashley Gearhardt
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Megan H Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Hirschel J, Carlhan-Ledermann A, Ferraz C, Brand LA, Filippa M, Gentaz E, Lejeune F, Baud O. Maternal Voice and Tactile Stimulation Modulate Oxytocin in Mothers of Hospitalized Preterm Infants: A Randomized Crossover Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1469. [PMID: 37761430 PMCID: PMC10528509 DOI: 10.3390/children10091469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023]
Abstract
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.
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Affiliation(s)
- Jessica Hirschel
- Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital of Geneva, University of Geneva, 1205 Geneva, Switzerland; (J.H.); (A.C.-L.); (C.F.); (L.-A.B.)
| | - Audrey Carlhan-Ledermann
- Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital of Geneva, University of Geneva, 1205 Geneva, Switzerland; (J.H.); (A.C.-L.); (C.F.); (L.-A.B.)
| | - Céline Ferraz
- Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital of Geneva, University of Geneva, 1205 Geneva, Switzerland; (J.H.); (A.C.-L.); (C.F.); (L.-A.B.)
| | - Laure-Anne Brand
- Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital of Geneva, University of Geneva, 1205 Geneva, Switzerland; (J.H.); (A.C.-L.); (C.F.); (L.-A.B.)
| | - Manuela Filippa
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, 1205 Geneva, Switzerland;
- Department of Psychology and Educational Sciences, University of Geneva, 1211 Geneva, Switzerland
| | - Edouard Gentaz
- Sensorimotor, Affective and Social Development Unit, Faculty of Psychology, University of Geneva, 1211 Geneva, Switzerland; (E.G.); (F.L.)
| | - Fleur Lejeune
- Sensorimotor, Affective and Social Development Unit, Faculty of Psychology, University of Geneva, 1211 Geneva, Switzerland; (E.G.); (F.L.)
| | - Olivier Baud
- Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital of Geneva, University of Geneva, 1205 Geneva, Switzerland; (J.H.); (A.C.-L.); (C.F.); (L.-A.B.)
- Inserm U1141, University of Paris, Paris 75019, France
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Pineda R, Kellner P, Guth R, Gronemeyer A, Smith J. NICU sensory experiences associated with positive outcomes: an integrative review of evidence from 2015-2020. J Perinatol 2023; 43:837-848. [PMID: 37029165 PMCID: PMC10325947 DOI: 10.1038/s41372-023-01655-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
To inform changes to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, studies investigating sensory-based interventions in the NICU with preterm infants born ≤32 weeks were identified. Studies published between October 2015 to December 2020, and with outcomes related to infant development or parent well-being, were included in this integrative review. The systematic search used databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar. Fifty-seven articles (15 tactile, 9 auditory, 5 visual, 1 gustatory/olfactory, 5 kinesthetic, and 22 multimodal) were identified. The majority of the sensory interventions that were identified within the articles were reported in a previous integrative review (1995-2015) and already included in the SENSE program. New evidence has led to refinements of the SENSE program, notably the addition of position changes across postmenstrual age (PMA) and visual tracking starting at 34 weeks PMA.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
- Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA.
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Rebecca Guth
- Center for Clinical Excellence, BJC HealthCare, St. Louis, MO, USA
| | | | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
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Wijenayake S, Martz J, Lapp HE, Storm JA, Champagne FA, Kentner AC. The contributions of parental lactation on offspring development: It's not udder nonsense! Horm Behav 2023; 153:105375. [PMID: 37269591 PMCID: PMC10351876 DOI: 10.1016/j.yhbeh.2023.105375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
The Developmental Origins of Health and Disease (DOHaD) hypothesis describes how maternal stress exposures experienced during critical periods of perinatal life are linked to altered developmental trajectories in offspring. Perinatal stress also induces changes in lactogenesis, milk volume, maternal care, and the nutritive and non-nutritive components of milk, affecting short and long-term developmental outcomes in offspring. For instance, selective early life stressors shape the contents of milk, including macro/micronutrients, immune components, microbiota, enzymes, hormones, milk-derived extracellular vesicles, and milk microRNAs. In this review, we highlight the contributions of parental lactation to offspring development by examining changes in the composition of breast milk in response to three well-characterized maternal stressors: nutritive stress, immune stress, and psychological stress. We discuss recent findings in human, animal, and in vitro models, their clinical relevance, study limitations, and potential therapeutic significance to improving human health and infant survival. We also discuss the benefits of enrichment methods and support tools that can be used to improve milk quality and volume as well as related developmental outcomes in offspring. Lastly, we use evidence-based primary literature to convey that even though select maternal stressors may modulate lactation biology (by influencing milk composition) depending on the severity and length of exposure, exclusive and/or prolonged milk feeding may attenuate the negative in utero effects of early life stressors and promote healthy developmental trajectories. Overall, scientific evidence supports lactation to be protective against nutritive and immune stressors, but the benefits of lactation in response to psychological stressors need further investigation.
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Affiliation(s)
- Sanoji Wijenayake
- Department of Biology, The University of Winnipeg, Winnipeg, Manitoba, Canada.
| | - Julia Martz
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Hannah E Lapp
- Deparment of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Jasmyne A Storm
- Department of Biology, The University of Winnipeg, Winnipeg, Manitoba, Canada
| | | | - Amanda C Kentner
- School of Arts & Sciences, Health Psychology Program, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
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Jin Y, Song D, Yan Y, Quan Z, Qing H. The Role of Oxytocin in Early-Life-Stress-Related Neuropsychiatric Disorders. Int J Mol Sci 2023; 24:10430. [PMID: 37445607 DOI: 10.3390/ijms241310430] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
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.
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Affiliation(s)
- Yue Jin
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Da Song
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Yan Yan
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Zhenzhen Quan
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Hong Qing
- Key Laboratory of Molecular Medicine and Biotherapy, School of Life Science, Beijing Institute of Technology, Beijing 100081, China
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31
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Ulmer-Yaniv A, Yirmiya K, Peleg I, Zagoory-Sharon O, Feldman R. Developmental Cascades Link Maternal-Newborn Skin-to-Skin Contact with Young Adults' Psychological Symptoms, Oxytocin, and Immunity; Charting Mechanisms of Developmental Continuity from Birth to Adulthood. BIOLOGY 2023; 12:847. [PMID: 37372132 DOI: 10.3390/biology12060847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
Premature birth disrupts the continuity of maternal-newborn bodily contact, which underpins the development of physiological and behavioral support systems. Utilizing a unique cohort of mother-preterm dyads who received skin-to-skin contact (Kangaroo Care, KC) versus controls, and following them to adulthood, we examined how a touch-based neonatal intervention impacts three adult outcomes; anxiety/depressive symptoms, oxytocin, and secretory immunoglobulin A (s-IgA), a biomarker of the immune system. Consistent with dynamic systems' theory, we found that links from KC to adult outcomes were indirect, mediated by its effects on maternal mood, child attention and executive functions, and mother-child synchrony across development. These improvements shaped adult outcomes via three mechanisms; (a) "sensitive periods", where the infancy improvement directly links with an outcome, for instance, infant attention linked with higher oxytocin and lower s-IgA; (b) "step-by-step continuity", where the infancy improvement triggers iterative changes across development, gradually shaping an outcome; for instance, mother-infant synchrony was stable across development and predicted lower anxiety/depressive symptoms; and (c) "inclusive mutual-influences", describing cross-time associations between maternal, child, and dyadic factors; for instance, from maternal mood to child executive functions and back. Findings highlight the long-term impact of a birth intervention across development and provide valuable insights on the mechanisms of "developmental continuity", among the key topics in developmental research.
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Affiliation(s)
- Adi Ulmer-Yaniv
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Karen Yirmiya
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Itai Peleg
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Orna Zagoory-Sharon
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
| | - Ruth Feldman
- Center for Developmental Social Neuroscience, Reichman University, Herzliya 4610101, Israel
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32
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Daniels F, Sawangkum A, Kumar A, Coombs K, Louis-Jacques A, Ho TT. Skin to Skin Contact Correlated with Improved Production and Consumption of Mother's Own Milk. Breastfeed Med 2023; 18:483-488. [PMID: 37335327 PMCID: PMC10282785 DOI: 10.1089/bfm.2022.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background: Human milk diet, preferably mother's own milk (MOM) over donor milk (DM), is recommended for preterm infants. Expression of MOM in proximity to preterm infants, especially during or immediately after skin-to-skin contact (SSC), is associated with greater milk production. However, the correlation between SSC and MOM production during hospital admission in preterm infants has not yet been studied. Our study investigated the relationship between SSC and MOM production and consumption in preterm infants during the first postnatal month of life. Materials and Methods: This was a prospective cohort study. Mothers and their preterm infants born at <35 weeks by gestational age (GA) and eligible for SSC within the first 5 postnatal days were eligible for the study. Mothers were given a binder to document pumped breast milk volumes and SSC sessions. Pumped breast milk volumes, enteral feeding type and volume, and SSC duration and frequency were collected daily over the first 28 days of life, along with demographic, perinatal, and feeding data from electronic medical records (EMR). Results: Mean birth GA and weight were 30 ± 3 weeks and 1,443 ± 576 g, respectively. SSC duration was inversely correlated with GA and weight. The SSC duration was positively correlated with ingested MOM volume after correcting for birth GA. The SSC duration was predictive of increased volumes of pumped MOM. Conclusion: Our findings suggest that SSC duration is associated with improved MOM production and consumption. SSC can be a useful tool to increase MOM exposure and improve long-term health outcomes in preterm infants.
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Affiliation(s)
- Felicia Daniels
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Amornrat Sawangkum
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ambuj Kumar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Kelsey Coombs
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Thao T.B. Ho
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Ball MK, Seabrook RB, Corbitt R, Stiver C, Nardell K, Medoro AK, Beer L, Brown A, Mollica J, Bapat R, Cosgrove T, Texter KT. Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates. Pediatr Cardiol 2023; 44:1023-1031. [PMID: 36971793 PMCID: PMC10040310 DOI: 10.1007/s00246-023-03149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/12/2023] [Indexed: 03/28/2023]
Abstract
Early skin-to-skin contact (SSC), beginning in the delivery room, provides myriad health benefits for mother and baby. Early SSC in the delivery room is the standard of care for healthy neonates following both vaginal and cesarean delivery. However, there is little published evidence on the safety of this practice in infants with congenital anomalies requiring immediate postnatal evaluation, including critical congenital heart disease (CCHD). Currently, the standard practice following delivery of infants with CCHD in many delivery centers has been immediate separation of mother and baby for neonatal stabilization and transfer to a different hospital unit or a different hospital altogether. However, most neonates with prenatally diagnosed congenital heart disease, even those with ductal-dependent lesions, are clinically stable in the immediate newborn period. Therefore, we sought to increase the percentage of newborns with prenatally diagnosed CCHD who are born in our regional level II-III delivery hospitals who receive mother-baby SSC in the delivery room. Using quality improvement methodology, through a series of Plan-Do-Study-Act cycles we successfully increased mother-baby skin-to-skin contact in the delivery room for eligible cardiac patients born across our city-wide delivery hospitals from a baseline 15% to greater than 50%.
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Affiliation(s)
- Molly K Ball
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA.
| | - R B Seabrook
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - R Corbitt
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - C Stiver
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - K Nardell
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - A K Medoro
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
| | - L Beer
- Pediatrix Medical Group, Columbus, OH, USA
| | - A Brown
- Phoenix Children's Medical Group, Neonatology, Phoenix, AZ, USA
| | - J Mollica
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - R Bapat
- Division of Neonatology, The Ohio State University Wexner Medical Center, 700 Children's Drive - FOB Suite 6.4A, Columbus, OH, 43205, USA
| | - T Cosgrove
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - K T Texter
- The Fetal Center at Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
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Brekke SM, Halvorsen ST, Bjørkvoll J, Thorsby PM, Rønnestad A, Zykova SN, Bakke LH, Dahl SR, Haaland K, Eger SHW, Solberg MT, Solevåg AL. The association between infant salivary cortisol and parental presence in the neonatal intensive care unit during and after COVID-19 visitation restrictions: A cross-sectional study. Early Hum Dev 2023; 182:105788. [PMID: 37224589 DOI: 10.1016/j.earlhumdev.2023.105788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Parent-infant interaction in the neonatal intensive care unit (NICU) promotes health and reduces infant stress. During the COVID-19 pandemic, however, NICUs restricted parent-infant interaction to reduce viral transmission. This study examined the potential relationship between pandemic visitation restrictions, parental presence and infant stress as measured by salivary cortisol. METHODS A two-NICU cross-sectional study of infants with gestational age (GA) 23-41 weeks, both during (n = 34) and after (n = 38) visitation restrictions. We analysed parental presence with and without visitation restrictions. The relationship between infant salivary cortisol and self-reported parental NICU presence in hours per day was analysed using Pearson's r. A linear regression analysis included potential confounders, including GA and proxies for infant morbidity. The unstandardised B coefficient described the expected change in log-transformed salivary cortisol per unit change in each predictor variable. RESULTS Included infants had a mean (standard deviation) GA of 31(5) weeks. Both maternal and paternal NICU presence was lower with versus without visitation restrictions (both p ≤0.05). Log-transformed infant salivary cortisol correlated negatively with hours of parental presence (r = -0.40, p = .01). In the linear regression, GA (B = -0.03, p = .02) and central venous lines (B = 0.23, p = .04) contributed to the variance in salivary cortisol in addition to parental presence (B = -0.04 p = .04). CONCLUSION COVID-19-related visitation restrictions reduced NICU parent-infant interaction and may have increased infant stress. Low GA and central venous lines were associated with higher salivary cortisol. The interaction between immaturity, morbidity and parental presence was not within the scope of this study and merits further investigation.
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Affiliation(s)
- Stine Marie Brekke
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway; The Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
| | - Silje Torp Halvorsen
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway; The Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Julie Bjørkvoll
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway; The Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Per Medbøe Thorsby
- Hormone laboratory, Department of Medical Biochemistry and Biochemical endocrinology and metabolism research group, Oslo University Hospital, Oslo, Norway
| | - Arild Rønnestad
- The Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute for clinical medicine, Faulty of medicine, University of Oslo, Oslo, Norway
| | - Svetlana N Zykova
- Hormone laboratory, Department of Medical Biochemistry and Biochemical endocrinology and metabolism research group, Oslo University Hospital, Oslo, Norway
| | - Liv Hanne Bakke
- Hormone laboratory, Department of Medical Biochemistry and Biochemical endocrinology and metabolism research group, Oslo University Hospital, Oslo, Norway
| | - Sandra Rinne Dahl
- Hormone laboratory, Department of Medical Biochemistry and Biochemical endocrinology and metabolism research group, Oslo University Hospital, Oslo, Norway
| | - Kirsti Haaland
- The Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Siw Helen Westby Eger
- The Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Marianne Trygg Solberg
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Anne Lee Solevåg
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway; The Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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McCarty DB, Willett S, Kimmel M, Dusing SC. Benefits of maternally-administered infant massage for mothers of hospitalized preterm infants: a scoping review. Matern Health Neonatol Perinatol 2023; 9:6. [PMID: 37131260 PMCID: PMC10155384 DOI: 10.1186/s40748-023-00151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/07/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Infant massage (IM) is a well-studied, safe intervention known to benefit infants born preterm. Less is known about the benefits of maternally-administrated infant massage for mothers of preterm infants who often experience increased rates of anxiety and depression in their infants' first year of life. This scoping review summarizes the extent, nature, and type of evidence linking IM and parent-centered outcomes. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for scoping reviews (PRISMA-ScR) protocol was followed using three databases: PubMed, Embase, and CINAHL. Thirteen manuscripts evaluating 11 separate study cohorts met pre-specified inclusion criteria. RESULTS Six primary topics related to the influence of infant massage on parent outcomes emerged: 1) anxiety, 2) perceived stress, 3) depressive symptoms, 4) maternal-infant interaction, 5) maternal satisfaction, and 6) maternal competence. Emerging evidence supports that infant massage, when administered by mothers, benefits mothers of preterm infants by reducing anxiety, stress, and depressive symptoms and improving maternal-infant interactions in the short-term, but there is limited evidence to support its effectiveness on these outcomes in longer periods of follow-up. Based on effect size calculations in small study cohorts, maternally-administered IM may have a moderate to large effect size on maternal perceived stress and depressive symptoms. CONCLUSIONS Maternally-administered IM may benefit mothers of preterm infants by reducing anxiety, stress, depressive symptoms, and by improving maternal-infant interactions in the short-term. Additional research with larger cohorts and robust design is needed to understand the potential relationship between IM and parental outcomes.
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Affiliation(s)
- Dana B McCarty
- Department of Health Sciences, University of North Carolina at Chapel Hill, 3024 Bondurant Hall, CB#7135, Chapel Hill, NC, 27599-7135, USA.
| | - Sandra Willett
- Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, USA
| | - Mary Kimmel
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
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Management of Newborns With In Utero Substance Exposure: AWHONN Practice Brief Number 18. Nurs Womens Health 2023; 27:e8-e11. [PMID: 36907796 DOI: 10.1016/j.nwh.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Vittner D, D'Agata A, Choi BY, McGrath J. Release of Oxytocin and Cortisol Is Associated With Neurobehavioral Patterns in Premature Infants. J Obstet Gynecol Neonatal Nurs 2023; 52:248-256. [PMID: 36965512 DOI: 10.1016/j.jogn.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
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.
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Shen G, Moua KTY, Perkins K, Johnson D, Li A, Curtin P, Gao W, McCune JS. Precision sirolimus dosing in children: The potential for model-informed dosing and novel drug monitoring. Front Pharmacol 2023; 14:1126981. [PMID: 37021042 PMCID: PMC10069443 DOI: 10.3389/fphar.2023.1126981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/14/2023] [Indexed: 04/07/2023] Open
Abstract
The mTOR inhibitor sirolimus is prescribed to treat children with varying diseases, ranging from vascular anomalies to sporadic lymphangioleiomyomatosis to transplantation (solid organ or hematopoietic cell). Precision dosing of sirolimus using therapeutic drug monitoring (TDM) of sirolimus concentrations in whole blood drawn at the trough (before the next dose) time-point is the current standard of care. For sirolimus, trough concentrations are only modestly correlated with the area under the curve, with R 2 values ranging from 0.52 to 0.84. Thus, it should not be surprising, even with the use of sirolimus TDM, that patients treated with sirolimus have variable pharmacokinetics, toxicity, and effectiveness. Model-informed precision dosing (MIPD) will be beneficial and should be implemented. The data do not suggest dried blood spots point-of-care sampling of sirolimus concentrations for precision dosing of sirolimus. Future research on precision dosing of sirolimus should focus on pharmacogenomic and pharmacometabolomic tools to predict sirolimus pharmacokinetics and wearables for point-of-care quantitation and MIPD.
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Affiliation(s)
- Guofang Shen
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, United States
| | - Kao Tang Ying Moua
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, United States
| | - Kathryn Perkins
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, United States
| | - Deron Johnson
- Clinical Informatics, City of Hope Medical Center, Duarte, CA, United States
| | - Arthur Li
- Division of Biostatistics, City of Hope, Duarte, CA, United States
| | - Peter Curtin
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, United States
| | - Wei Gao
- Division of Engineering and Applied Science, Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, United States
| | - Jeannine S. McCune
- Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, United States
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Management of Newborns With In Utero Substance Exposure: AWHONN Practice Brief Number 18. J Obstet Gynecol Neonatal Nurs 2023; 52:e1-e4. [PMID: 36907797 DOI: 10.1016/j.jogn.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Shorey S, Asurlekar AR, Chua JS, Lim LHK. Influence of oxytocin on parenting behaviors and parent-child bonding: A systematic review. Dev Psychobiol 2023; 65:e22359. [PMID: 36811366 DOI: 10.1002/dev.22359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alpana Rajesh Asurlekar
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jing Shi Chua
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lina Hsiu Kim Lim
- Immunology Translational Research Program and Department of Physiology, National University of Singapore, Singapore
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Huang X, Chen M, Fu R, He W, He Y, Shentu H, Zhu S. Efficacy of kangaroo mother care combined with neonatal phototherapy in newborns with non-pathological jaundice: A meta-analysis. Front Pediatr 2023; 11:1098143. [PMID: 37082708 PMCID: PMC10112003 DOI: 10.3389/fped.2023.1098143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
BackgroundThe kangaroo-mother care method (KMC) is a skin-to-skin contact-centered care approach with numerous benefits for neonates, but its impact on the treatment of jaundiced neonates is unknown. This study aimed to investigate the efficacy of KMC combined with neonatal phototherapy (NNPT) in treating neonates with non-pathological jaundice.MethodsRelevant articles were searched in PubMed, Embase, Web of Science, and Cochrane Library databases from database establishment to April 2022. The outcomes included, without limitation, serum bilirubin levels, and duration of phototherapy.ResultsThis meta-analysis included five studies (4 randomized controlled trials and 1 observational study) involving four hundred eighty-two neonates with non-pathological jaundice. The results showed that the group receiving KMC combined with NNPT had lower serum bilirubin at 72 h after intervention [weighted mean difference (WMD) = −1.51, p = 0.03], shorter duration of phototherapy [standard mean difference (SMD) = −1.45, p < 0.001] and shorter duration of hospitalization (SMD = −1.32, p = 0.002) compared to NNPT group. There was no difference in peak bilirubin in both groups of neonates (WMD = −0.12, p = 0.62).ConclusionsKMC combined with NNPT helped to treat non-pathological jaundice in newborns compared to NNPT alone.
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Affiliation(s)
- Xiang Huang
- Department of Pediatric, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Meiling Chen
- The Public Health College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wei He
- State Key Laboratory Breeding Base of Green Chemistry Synthesis Technology, Zhejiang University of Technology, Hangzhou, China
| | - Yujing He
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Haojie Shentu
- The Medical Imaging College, Hangzhou Medical College, Hangzhou, China
| | - Suping Zhu
- Department of Pediatric, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
- Correspondence: Suping Zhu
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Rheinheimer N, Beijers R, Bruinhof N, Cooijmans KHM, de Weerth C. Effects of daily full-term infant skin-to-skin contact on behavior and cognition at age three - secondary outcomes of a randomized controlled trial. J Child Psychol Psychiatry 2023; 64:136-144. [PMID: 35942886 PMCID: PMC10087794 DOI: 10.1111/jcpp.13679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Daily skin-to-skin contact (SSC) during early infancy fosters the long-term development of children born preterm. This is the first randomized controlled trial assessing the potential beneficial effects of daily SSC on executive functioning and socio-emotional behavior of children born full-term. Whether children of mothers who experienced prenatal stress and anxiety benefitted more from SSC was also explored. METHODS Pregnant women (N = 116) were randomly assigned to a SSC or care-as-usual (CAU) condition. Women in the SSC condition were instructed to perform one hour of SSC daily from birth until postnatal week five. Prenatal stress was measured with questionnaires on general and pregnancy-specific stress and anxiety completed by the mothers in gestational week 37. At child age three, mothers filled in questionnaires on children's executive functioning, and externalizing and internalizing behavior. Analyses were performed in an intention-to-treat (ITT), per-protocol, and dose-response approach. Netherlands Trial Register: NL5591. RESULTS In the ITT approach, fewer internalizing (95% CI = 0.11-1.00, U = 2148.50, r = .24, p = .001) and externalizing (95% CI = 0.04-2.62, t = 2.04, d = 0.38, p = .04) problems were reported in the SSC condition compared to the CAU condition. Multivariate analyses of variance did not show group differences on executive functioning. Additional analyses of covariance showed no moderations by maternal prenatal stress. CONCLUSIONS Current findings indicate that early daily SSC in full-term infants may foster children's behavioral development. Future replications, including behavioral observations of child behavior to complement maternal reports, are warranted.
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Affiliation(s)
- Nicole Rheinheimer
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Nina Bruinhof
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Kelly H M Cooijmans
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Social Development, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Pavlyshyn H, Sarapuk I. Skin-to-skin contact-An effective intervention on pain and stress reduction in preterm infants. Front Pediatr 2023; 11:1148946. [PMID: 37033163 PMCID: PMC10073438 DOI: 10.3389/fped.2023.1148946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction The outcomes of pain and stress in preterm infants in the neonatal intensive care units (NICUs) compel the continued search for pain- and stress-reducing interventions. The objective of the study To investigate how skin-to-skin contact (SSC) influences chronic pain and stress in preterm infants in the NICU. Materials and methods The study included 140 preterm infants in the NICU with gestational age less than 34 weeks. The overall design was a baseline-response design. Urine and saliva were collected before (baseline) and after SSC to measure pain and stress markers by enzyme immunoassay method. The behavioral indicators of chronic pain were assessed using the EDIN (Échelle Douleur Inconfort Nouveau-Né-neonatal pain and discomfort). Results There was a significant decrease in the dopamine level in preterm infants after SSC in comparison with baseline values (85.99 [69.35; 112.20] pg/ml vs. 132.20 [104.80; 183.70] pg/ml), p < 0.001. The β-endorphin and serotonin levels increased after SSC (40.09 [26.81; 70.63] pg/ml vs. 29.87 [20.61; 46.94] pg/ml, p = 0.009 and 25.49 [20.45; 40.08] ng/ml vs. 22.30 [15.13; 31.65] ng/ml, p = 0.011, respectively). A significant decrease in cortisol levels in saliva and urine after SSC in comparison with baseline values (0.125 [0.079; 0.225] μg/dl vs. 0.371 [0.188; 1.002] μg/dl, p = 0.000 and 27.06 [14.59; 35.35] ng/ml vs. 35.25 [19.78; 61.94] ng/ml, p = 0.001, with a simultaneous increase of oxytocin level (57.00 [36.55; 88.49] pg/ml vs. 38.20 [28.78; 56.04] pg/ml, p = 0.009 were revealed. The total pain EDIN score in infants after SSC was below 6 points, significantly decreasing compared to the baseline (p < 0.05). Conclusion Preterm infants in the NICU experience stress and pain, which were confirmed by the EDIN pain scale and laboratory markers. The level of dopamine and cortisol as pain and stress hormones were reliably high, and normalized after regular SSC. Simultaneously, pain-relieving and anti-stress markers of oxytocin, β-endorphin and serotonin reliably increased in preterm infants in response to the SSC.
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The Role of Oxytocin in Abnormal Brain Development: Effect on Glial Cells and Neuroinflammation. Cells 2022; 11:cells11233899. [PMID: 36497156 PMCID: PMC9740972 DOI: 10.3390/cells11233899] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
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.
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Li Q, Zhao W, Kendrick KM. Affective touch in the context of development, oxytocin signaling, and autism. Front Psychol 2022; 13:967791. [PMID: 36506943 PMCID: PMC9728590 DOI: 10.3389/fpsyg.2022.967791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022] Open
Abstract
Touch represents one of our most important senses throughout life and particularly in the context of our social and emotional experiences. In this review, we draw on research on touch processing from both animal models and humans. Firstly, we briefly describe the cutaneous touch receptors and neural processing of both affective and discriminative touch. We then outline how our sense of touch develops and summarize increasing evidence demonstrating how essential early tactile stimulation is for the development of brain and behavior, with a particular focus on effects of tactile stimulation in infant animals and pediatric massage and Kangaroo care in human infants. Next, the potential mechanisms whereby early tactile stimulation influences both brain and behavioral development are discussed, focusing on its ability to promote neural plasticity changes and brain interhemispheric communication, development of social behavior and bonding, and reward sensitivity through modulation of growth factor, oxytocin, and opioid signaling. Finally, we consider the implications of evidence for atypical responses to touch in neurodevelopmental disorders such as autism spectrum disorder and discuss existing evidence and future priorities for establishing potential beneficial effects of interventions using massage or pharmacological treatments targeting oxytocin or other neurochemical systems.
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Affiliation(s)
- Qin Li
- School of Foreign Language, Chengdu University of Traditional Chinese Medicine, Chengdu, China,Ministry of Education, Key Laboratory for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Weihua Zhao
- Ministry of Education, Key Laboratory for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Keith M. Kendrick
- Ministry of Education, Key Laboratory for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Keith M. Kendrick,
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Di Chiara M, Laccetta G, Gangi S, De Santis B, Spiriti C, Attenni M, Bertolaso L, Boscarino G, De Nardo MC, Ciambra G, Parisi P, Terrin G. Risk factors and preventive strategies for post-traumatic stress disorder in neonatal intensive care unit. Front Psychol 2022; 13:1003566. [PMID: 36438350 PMCID: PMC9683535 DOI: 10.3389/fpsyg.2022.1003566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/20/2022] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Preterm birth and admission to the neonatal intensive care unit (NICU) could induce post-traumatic stress disorder (PTSD). PTSD is an important factor to focus on, as it is associated with parental mental health difficulties and with changes in caregiving quality such as increased intrusiveness, reduced sensitivity, and increased attachment insecurity for the child. AIMS We aimed to study the main risk factors, in the early life of newborns, and preventive measures for PTSD in parents of neonates hospitalized in the NICU. METHODS We included parents of preterm newborns, consecutively admitted to the NICU of the University La Sapienza of Rome. The presence of PTSD following preterm birth and NICU admission was assessed using the Clinician-administered PTSD scale (CAPS) at enrollment and at 28-30 days following NICU admission or the moment of discharge. We also evaluated the Family Environment Scale which measures the social environment of all types of families; the Parental Stressor Scale which measures parental anxiety and stress; the Spielberger State-Trait Anxiety Inventory consisting of two parts measuring the State (response to present situation) and Trait (pre-disposition to be anxious) anxieties separately, and the Beck Depression Inventory Second Edition assessing depressive symptoms. RESULTS We found, in a multivariate analysis, that the gestational age of newborns admitted to NICU significantly (β = 2.678; p = 0.040) influences the occurrence of PTSD. We found that the cases showed significantly (β = 2.443; p = 0.020) more pathological Parental Stressor Scale sights and sounds scores compared to controls. The early Kangaroo-Care (KC) significantly (β = -2.619; p = 0.015) reduces the occurrence of PTSD. CONCLUSION Post-traumatic stress disorder in parents of preterm newborns is a pathological condition that should be properly managed, in the very first days after birth. The NICU environment represents a main risk factor for PTSD, whereas KC has been demonstrated to have a protective role in the occurrence of PTSD.
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Affiliation(s)
- Maria Di Chiara
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianluigi Laccetta
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sara Gangi
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Benedetta De Santis
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Caterina Spiriti
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Martina Attenni
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Laura Bertolaso
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gianluca Ciambra
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Sinisalo H, Bakermans‐Kranenburg MJ, Peltola MJ. Hormonal and behavioral responses to an infant simulator in women with and without children. Dev Psychobiol 2022; 64:e22321. [PMID: 36282748 PMCID: PMC9545496 DOI: 10.1002/dev.22321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/27/2023]
Abstract
We investigated the impact of maternal status on hormonal reactivity and behavioral responses to an infant simulator in 117 women (54 primiparous, 63 nulliparous). The amount of affectionate touch and motherese were analyzed as behavioral measures of caregiving. Saliva was collected before and 10 min after interaction with the infant simulator to analyze oxytocin, testosterone, cortisol, and estradiol levels. Nulliparous women also provided information about their fertility motivation. Linear mixed models indicated that greater use of affectionate touch was associated with lower overall testosterone levels. Cortisol decreased in response to the interaction in both groups. In the primiparous group, the amount of affectionate touch associated inversely with cortisol levels, whereas in the nulliparous group such association was not found. Oxytocin or estradiol reactivity to the simulator did not differ between the groups, nor were these hormones associated with behavior. Higher fertility motivation in nulliparous women was related to more motherese, and lower testosterone levels. Our results indicate that the simulator elicits hormonal reactivity both in mothers and nonmothers, but the patterns of associations between caregiving behavior and hormonal levels may be partially different. These results encourage using the infant simulator to explore hormonal processes related to the transition to parenthood.
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Affiliation(s)
- Hanneli Sinisalo
- Human Information Processing Laboratory, Faculty of Social Sciences, PsychologyTampere UniversityTampereFinland
| | - Marian J. Bakermans‐Kranenburg
- Faculty of Behavioural and Movement Sciences, Educational and Family StudiesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Mikko J. Peltola
- Human Information Processing Laboratory, Faculty of Social Sciences, PsychologyTampere UniversityTampereFinland,Tampere Institute for Advanced StudyTampere UniversityTampereFinland
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Rashidi M, Maier E, Dekel S, Sütterlin M, Wolf RC, Ditzen B, Grinevich V, Herpertz SC. Peripartum effects of synthetic oxytocin: The good, the bad, and the unknown. Neurosci Biobehav Rev 2022; 141:104859. [PMID: 36087759 DOI: 10.1016/j.neubiorev.2022.104859] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
The first clinical applications of oxytocin (OT) were in obstetrics as a hormone to start and speed up labor and to control postpartum hemorrhage. Discoveries in the 1960s and 1970s revealed that the effects of OT are not limited to its peripheral actions around birth and milk ejection. Indeed, OT also acts as a neuromodulator in the brain affecting fear memory, social attachment, and other forms of social behaviors. The peripheral and central effects of OT have been separately subject to extensive scrutiny. However, the effects of peripheral OT-particularly in the form of administration of synthetic OT (synOT) around birth-on the central nervous system are surprisingly understudied. Here, we provide a narrative review of the current evidence, suggest putative mechanisms of synOT action, and provide new directions and hypotheses for future studies to bridge the gaps between neuroscience, obstetrics, and psychiatry.
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Affiliation(s)
- Mahmoud Rashidi
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.
| | - Eduard Maier
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Robert C Wolf
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Valery Grinevich
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
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Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses. Adv Neonatal Care 2022; 22:432-443. [PMID: 34596093 DOI: 10.1097/anc.0000000000000948] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent-infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice. PURPOSE The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses. METHODS This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments. RESULTS Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (β= 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices ( r =-0.199, P < .001). IMPLICATION FOR RESEARCH AND PRACTICE Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.
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Lebel V, Campbell-Yeo M, Feeley N, Axelin A. Understanding factors associated with emotional closeness in parents with a preterm infant in the neonatal intensive care unit. Early Hum Dev 2022; 173:105664. [PMID: 36075153 DOI: 10.1016/j.earlhumdev.2022.105664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is a dearth of knowledge regarding the specific factors associated with emotional closeness in parents with an infant in the NICU. AIM To determine if parental presence, involvement in infant care, holding, skin-to-skin contact (SSC), perceived family-centered care, depression symptoms, and sociodemographic characteristics are associated with the emotional closeness of parents with an infant hospitalized at the NICU. STUDY DESIGN This longitudinal descriptive study was conducted in two Canadian level-three NICUs. A sociodemographic questionnaire was completed by parents at enrolment. A closeness diary was completed by each parent for 14 days to measure parental presence, involvement in infant care, holding, SSC, and emotional closeness. One question from the DigiFCC tool was sent daily via text message to the parents' cellphones to measure their perception of the quality of family-centered care they experienced. Parent depression symptoms were measured using the Edinburgh Postnatal Depression Scale at discharge. RESULTS A total of 60 families were involved in the study. Increased parental presence (B = 0.21, p < 0.001), increased time involved in infant care (B = 0.14, p < 0.001), increased holding time (B = 0.53, p < 0.001), and greater time in SSC (B = 0.27, p = 0.01) were associated with greater parental emotional closeness. CONCLUSION Several factors may enhance parents' emotional closeness when their infant is in the NICU. Care providers need to be aware and adapt their clinical practices accordingly to promote emotional closeness by encouraging parental presence, involvement in infant care, holding, and skin-to-skin contact.
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Affiliation(s)
- Valérie Lebel
- Nursing department, Université du Québec en Outaouais, 5 St-Joseph, St-Jérôme, Québec J7Z 0B7, Canada.
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, 5869 University Avenue PO BOX 15000, Halifax, Nova Scotia B3H 4R2, Canada; Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada; Izaak Walton Killam Health Centre, 5980 University Ave #5850, Halifax, Nova Scotia B3K 6R8, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, 680 Sherbrooke St W, Bureau 1800, Montreal, Québec H3A 2M7, Canada; Jewish General Hospital Centre for Nursing Research & Lady Davis Institute, 3755 Côte-Sainte-Catherine Street, Montréal, Québec H3T 1E2, Canada
| | - Anna Axelin
- Department of Nursing Science, University of Turku, 20014, Finland
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