Parent-child attachment in children born preterm and at term: A multigroup analysis

Parents' information needs during the first year at home with their very premature born child; a qualitative study

Objective

To obtain insights into parents' information needs during the first year at home with their very preterm (VP) born infant.

Methods

We conducted semi-structured interviews with parents of VP infants participating in a post-discharge responsive parenting intervention (TOP program). Online interviews were audiotaped and transcribed verbatim. Inductive thematic analysis was performed by two independent coders.

Results

Ten participants were interviewed and had various and changing information needs during the developmental trajectory of their infant. Three main themes emerged; (1) Help me understand and cope, (2) Be fully responsible for my baby, and (3) Teach me to do it myself. Available and used sources, such as the Internet, did not meet their information needs. Participants preferred their available and knowledgeable healthcare professionals for reassurance, tailored information, and practical guidance.

Conclusion

This study identified parents' information needs during the first year at home with their VP infant and uncovered underlying re-appearing needs to gain confidence in child-caring abilities and autonomy in decision-making about their infants' care.

Innovation

This study provides valuable information for healthcare professionals and eHealth developers to support parental self-efficacy during the first year after preterm birth.

Evaluation of a new tool - "Step by step with my baby" - to support parental involvement in the care of preterm infants

BACKGROUND AND AIMS

Parental guidance is essential for supporting parental involvement, maintaining the quality and safety of infant care, and limiting parental stress. The efficiency of a new tool to support parental empowerment - "Step by step with my baby" - was evaluated. The perception of this tool by parents and nurses was studied.

METHODS

This was a prospective, observational study conducted from September 2019 to December 2020 at a level-3 neonatal center. A total of 79 newborns (<33 weeks of gestational age or small for gestational age), 84 parents, and 94 nurses were included. The new tool that was evaluated is in the form of a drawing of flowers to be colored according to the parents' ability to care for their newborn. Six domains were explored and given a score (total of 35 points) according to the parents' ability to care for each item: behavior, skin-to-skin contact, carrying, oral and tube feeding, and routine care. The use and relevance of this tool were evaluated by parents and caregivers.

RESULTS

At a mean of 19 days of life, parents required caregiver support regardless of the skill domain (6/35). After 26 days, the mean score increased to 19.4 (p < 0.05). Parents felt autonomous in changing diapers and monitoring temperature but always required help for skin-to-skin contact, carrying, and feeding with or without a tube. The progression was not affected by the presence of siblings, the distance from home, and staying in the parental hospital room. For 67 % of the parents, the tool gave them a better understanding of their newborn and helped them be more confident (69 %) without feeling judged (81 %). These feelings were upheld by nurses.

CONCLUSIONS

This tool was efficient for evaluating parents' autonomy and helped them take ownership of the care provided.

Factors related to a disturbance in the mother-child bond and attachment

INTRODUCTION

Establishing an adequate bond and attachment between a mother and child is essential for preventing pathologies and developing this relationship in the future.

PURPOSE

To identify the factors related to a disturbance of the mother-child bond or attachment.

METHODS

A cross-sectional descriptive study was carried out with women with a biological child between 6 weeks and 18 months of age. The Mother-Child Bond-Attachment Questionnaire (VAMF, for its name in Spanish) was administered to measure the bond and postnatal attachment together with a questionnaire containing sociodemographic, psychosocial, and health variables referring to the mother and the newborn.

RESULTS

1114 women participated. The multivariate analysis showed that skin-to-skin contact (aOR = 0.58; 95% CI: 0.37, 0.90) and breastfeeding (aOR = 0.55; 95% IC: 0.35, 0.86) reduce the probability of presenting a bond disturbance. Anxiety during pregnancy, childbirth, and the puerperium (aOR = 3.95; 95% CI: 2.57, 6.05) and postpartum complications (aOR = 1.60; 95% CI: 1.03, 2.48) increase the chance of having a bond disturbance. Skin-to-skin contact (aOR = 0.61; 95% CI: 0.38, 1.00), breastfeeding (aOR = 0.47; 95% CI: 0.27, 0.80,) and an older age of the infant (months) (aOR = 0.77: 95% CI: 0.72, 0.82) reduces the probability of presenting an attachment disturbance.

CONCLUSIONS

Skin-to-skin contact and breastfeeding are associated with a lower probability of impaired bonding and attachment. Anxiety states during pregnancy, childbirth, and the puerperium, and complications after childbirth increase the probability of developing a bond disorder. The older the age of the infant, the lower the frequency of having an impaired attachment.

IMPLICATIONS TO PRACTICE

Identifying the factors associated with the establishment of the mother-child bond and attachment is essential for the development of prevention strategies and early identification of cases that may present alterations and avoid their consequences on the health of the mother and child.

Neurodevelopmental, Mental Health, and Parenting Issues in Preterm Infants

The World Health Organization in its recommendations for the care of preterm infants has drawn attention to the need to address issues related to family involvement and support, including education, counseling, discharge preparation, and peer support. A failure to address these issues may translate into poor outcomes that extend across the lifespan. In this paper, we review the often far-reaching impact of preterm birth on the health and wellbeing of the parents and highlight the ways in which psychological stress may have a negative long-term impact on the parent-child interaction, attachment, and the styles of parenting. This paper addresses the following topics: (1) neurodevelopmental outcomes in preterm infants, including cognitive, sensory, and motor difficulties, (2) long-term mental health issues in premature infants that include elevated rates of anxiety and depressive disorders, autism, and somatization, which may affect social relationships and quality of life, (3) adverse mental health outcomes for parents that include elevated rates of depression, anxiety, and symptoms of post-traumatic stress, as well as increased rates of substance abuse, and relationship strain, (4) negative impacts on the parent-infant relationship, potentially mediated by maternal sensitivity, parent child-interactions, and attachment, and (5) impact on the parenting behaviors, including patterns of overprotective parenting, and development of Vulnerable Child Syndrome. Greater awareness of these issues has led to the development of programs in neonatal mental health and developmental care with some data suggesting benefits in terms of shorter lengths of stay and decreased health care costs.

Musical and vocal interventions to improve neurodevelopmental outcomes for preterm infants

BACKGROUND

Preterm birth interferes with brain maturation, and subsequent clinical events and interventions may have additional deleterious effects. Music as therapy is offered increasingly in neonatal intensive care units aiming to improve health outcomes and quality of life for both preterm infants and the well-being of their parents. Systematic reviews of mixed methodological quality have demonstrated ambiguous results for the efficacy of various types of auditory stimulation of preterm infants. A more comprehensive and rigorous systematic review is needed to address controversies arising from apparently conflicting studies and reviews.

OBJECTIVES

We assessed the overall efficacy of music and vocal interventions for physiological and neurodevelopmental outcomes in preterm infants (< 37 weeks' gestation) compared to standard care. In addition, we aimed to determine specific effects of various interventions for physiological, anthropometric, social-emotional, neurodevelopmental short- and long-term outcomes in the infants, parental well-being, and bonding.

SEARCH METHODS

We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, RILM Abstracts, and ERIC in November 2021; and Proquest Dissertations in February 2019. We searched the reference lists of related systematic reviews, and of studies selected for inclusion and clinical trial registries.

SELECTION CRITERIA

We included parallel, and cluster-randomised controlled trials with preterm infants < 37 weeks` gestation during hospitalisation, and parents when they were involved in the intervention. Interventions were any music or vocal stimulation provided live or via a recording by a music therapist, a parent, or a healthcare professional compared to standard care. The intervention duration was greater than five minutes and needed to occur more than three times.

DATA COLLECTION AND ANALYSIS

Three review authors independently extracted data. We analysed the treatment effects of the individual trials using RevMan Web using a fixed-effects model to combine the data. Where possible, we presented results in meta-analyses using mean differences with 95% CI. We performed heterogeneity tests. When the I2 statistic was higher than 50%, we assessed the source of the heterogeneity by sensitivity and subgroup analyses. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We included 25 trials recruiting 1532 infants and 691 parents (21 parallel-group RCTs, four cross-over RCTs). The infants gestational age at birth varied from 23 to 36 weeks, taking place in NICUs (level 1 to 3) around the world. Within the trials, the intervention varied widely in type, delivery, frequency, and duration. Music and voice were mainly characterised by calm, soft, musical parameters in lullaby style, often integrating the sung mother's voice live or recorded, defined as music therapy or music medicine. The general risk of bias in the included studies varied from low to high risk of bias. Music and vocal interventions compared to standard care Music/vocal interventions do not increase oxygen saturation in the infants during the intervention (mean difference (MD) 0.13, 95% CI -0.33 to 0.59; P = 0.59; 958 infants, 10 studies; high-certainty evidence). Music and voice probably do not increase oxygen saturation post-intervention either (MD 0.63, 95% CI -0.01 to 1.26; P = 0.05; 800 infants, 7 studies; moderate-certainty evidence). The intervention may not increase infant development (Bayley Scales of Infant and Toddler Development (BSID)) with the cognitive composition score (MD 0.35, 95% CI -4.85 to 5.55; P = 0.90; 69 infants, 2 studies; low-certainty evidence); the motor composition score (MD -0.17, 95% CI -5.45 to 5.11; P = 0.95; 69 infants, 2 studies; low-certainty evidence); and the language composition score (MD 0.38, 95% CI -5.45 to 6.21; P = 0.90; 69 infants, 2 studies; low-certainty evidence). Music therapy may not reduce parental state-trait anxiety (MD -1.12, 95% CI -3.20 to 0.96; P = 0.29; 97 parents, 4 studies; low-certainty evidence). The intervention probably does not reduce respiratory rate during the intervention (MD 0.42, 95% CI -1.05 to 1.90; P = 0.57; 750 infants; 7 studies; moderate-certainty evidence) and post-intervention (MD 0.51, 95% CI -1.57 to 2.58; P = 0.63; 636 infants, 5 studies; moderate-certainty evidence). However, music/vocal interventions probably reduce heart rates in preterm infants during the intervention (MD -1.38, 95% CI -2.63 to -0.12; P = 0.03; 1014 infants; 11 studies; moderate-certainty evidence). This beneficial effect was even stronger after the intervention. Music/vocal interventions reduce heart rate post-intervention (MD -3.80, 95% CI -5.05 to -2.55; P < 0.00001; 903 infants, 9 studies; high-certainty evidence) with wide CIs ranging from medium to large beneficial effects. Music therapy may not reduce postnatal depression (MD 0.50, 95% CI -1.80 to 2.81; P = 0.67; 67 participants; 2 studies; low-certainty evidence). The evidence is very uncertain about the effect of music therapy on parental state anxiety (MD -0.15, 95% CI -2.72 to 2.41; P = 0.91; 87 parents, 3 studies; very low-certainty evidence). We are uncertain about any further effects regarding all other secondary short- and long-term outcomes on the infants, parental well-being, and bonding/attachment. Two studies evaluated adverse effects as an explicit outcome of interest and reported no adverse effects from music and voice.

AUTHORS' CONCLUSIONS

Music/vocal interventions do not increase oxygen saturation during and probably not after the intervention compared to standard care. The evidence suggests that music and voice do not increase infant development (BSID) or reduce parental state-trait anxiety. The intervention probably does not reduce respiratory rate in preterm infants. However, music/vocal interventions probably reduce heart rates in preterm infants during the intervention, and this beneficial effect is even stronger after the intervention, demonstrating that music/vocal interventions reduce heart rates in preterm infants post-intervention. We found no reports of adverse effects from music and voice. Due to low-certainty evidence for all other outcomes, we could not draw any further conclusions regarding overall efficacy nor the possible impact of different intervention types, frequencies, or durations. Further research with more power, fewer risks of bias, and more sensitive and clinically relevant outcomes are needed.

Relationship between health literacy and maternal bonding: A prospective cross-sectional study

Background

Maternal bonding has an effect on the baby throughout its life. The effective and complete occurrence of the mother-baby bond depends on many factors which can be individual or environmental. Health literacy plays an important role in the health behaviors of individuals, the prevention of diseases, and the improvement of health. Health literacy is a key determinant of medical-related issues.

Objectives

This study was conducted to examine the relationship between health literacy and mother-infant attachment in infancy. It was aimed to predict the biopsychosocial impact of the mother's health literacy level on the baby's life indirectly.

Materials and Methods

The sample of this descriptive and cross-sectional study included 202 mothers. Data were collected using the Personal Information Form, Health Literacy Scale-Short Form (HLS-SF), and Maternal Attachment Inventory (MAI).

Results

There were no statistical correlations between HLS-SF scores and MAI scores. In addition, the mothers with a statistically significant higher MAI score were those whose partners had a higher education level, had a planned pregnancy, worked in the prenatal period, never breastfed, and had earlier skin-to-skin contact with their baby. (P < 0.05).

Conclusion

Factors that may affect maternal bonding, which affects a baby's entire life, should be addressed by the authorities and necessary improvements would be useful. We believe that this previously unexplored study will pave the way for multicenter similar studies.

Cross-modal coherence and incoherence of early infant interactive behavior: links to attachment in infants born very preterm or full-term

Infants exhibit flexibly organized configurations of facial, vocal, affective, and motor behavior during caregiver-infant interactions that convey convergent messages about their internal states and desires. Prior work documents that greater cross-modal discrepancy at 4 months predicts disorganized attachment. Here, we evaluated whether: very preterm (VPT) or full-term (FT) status predicts cross-modal coherence or incoherence in infants' behavior with the caregiver at 3 months; and, regardless of prematurity, whether cross-modal interactive coherence or incoherence predicts 12-month attachment. Participants included 155 infants (85 FT; 70 VPT), and their mothers followed from birth to 12 months (corrected age). Infants' cross-modal coherent and incoherent responses were scored microanalytically from videotaped en-face interactions. Infants' attachment security was evaluated during Ainsworth's Strange Situation. Infants born VPT exhibited more incoherent cross-modal responses and insecure attachment than infants born FT. Regardless of prematurity, infants' coherent and incoherent cross-modal interactive behaviors at 3 months predicted different attachment patterns at 12 months.

Analyzing the relationship between feelings about pregnancy and mother-infant bonding with the onset of maternal psychological distress after childbirth: The Japan Environment and Children's Study

BACKGROUND

Strengthening maternal mental health from early pregnancy is essential. This study investigated the factors affecting the onset of maternal psychological distress at 12 months after childbirth in women who had not experienced it during pregnancy.

METHODS

Feelings about pregnancy were assessed using a questionnaire in the first trimester, and maternal mental health was assessed using the 6-Item Kessler Psychological Distress Scale (K6) in the first and second/third trimesters and at 12 months after childbirth. Mother-infant bonding was assessed using the Japanese version of Mother-to-Infant Bonding Scale (MIBS-J) in the first, sixth, and twelfth months after childbirth. This study comprised 46,053 mothers without psychological distress (K6 ≤ 4) during pregnancy from the 97,415 mothers enrolled in the Japan Environment and Children's Study.

RESULTS

The onset of psychological distress at 12 months after childbirth was associated with negative maternal feelings about pregnancy, a history of infertility treatment before the current pregnancy, and poor mother-infant bonding after childbirth. Abortion history was not associated with psychological distress. The strongest factor affecting the onset of psychological distress was mother-infant bonding (β = 0.28), and the indirect effect of feelings about pregnancy was also observed (β = 0.10).

LIMITATIONS

We used the full version of MIBS-J consisting of 10 items at 12 months after childbirth but included only five items in the first and sixth months.

CONCLUSIONS

Inadequate mother-infant bonding was associated with the onset of maternal psychological distress after childbirth. Supporting mother-infant bonding is critical throughout the perinatal period, considering maternal feelings about pregnancy.

The Association between Prematurity, Antibiotic Consumption, and Mother-Infant Attachment in the First Year of Life

Antibiotics have individual and public-health drawbacks. Nevertheless, mother-infant attachment quality and maternal sensitivity are associated with antibiotic use. Ambivalent-attached infants are more likely to consume antibiotics than other infants. Conceivably, the emotional over-externalization of ambivalent-attached infants and maternal anxiety when infants are ill raise concerns in healthcare professionals, leading to antibiotic over-prescriptions. However, because infants prematurely born, particularly those with less than 32 weeks of gestation, are under more accurate health vigilance, the impact of infant and maternal behavior on antibiotic prescription may vanish in this sample. To test this hypothesis, we performed a longitudinal study to compare antibiotic use and the quality of mother-infant attachment in three groups: 86 infants born at full-term, 44 moderate-to-late preterm infants (32-36 gestation weeks), and 58 very-to-extreme preterm infants (<32 gestation weeks). Infants' attachment was observed with the Ainsworth Strange Situation's experimental paradigm at 12 months of corrected age. Findings indicate that infant attachment strategy is associated with antibiotics uptake, but results vary across samples. The proportion of infants that used antibiotics is highest among ambivalent-attached infants in the full-term sample but highest among avoidant-attached infants in the very-to-extreme premature sample. Moreover, higher infant gestational age and lower maternal sensitivity determine higher antibiotic use.

[Fathers in Early Parenting Programs. Impulses from the European and International Fatherhood Research]

Prevention and intervention programs (early parenting programs) which are provided by regional multi-professional networks for families with infants are still addressed to mothers, primarily. The question is whether the European and international fatherhood research can supply valuable suggestions for a better involvement of fathers. We discuss determinants of lived fatherhoods that range from educated fathers of national middle class over fathers with migrant backgrounds up to educationally and economically disadvantaged fathers. We elucidate barriers which stand in the way of father involvement in the current parenting programs, and exemplary describe how the resistance could be successfully overcome.

The impact of low birthweight in infant patterns of regulatory behavior, mother-infant quality of interaction, and attachment

It remains unclear whether infants born preterm are more likely to develop an insecure attachment with their mothers. In this study, instead of using gestational age criteria, we observe attachment in infants born with very low birthweight. Although the collinearity between gestational age and birthweight is high, infants born with very low birthweight for their gestational age tend to stay more days in NICU and to have more comorbidities than other infants with the same gestational age. Thus, we wonder about the impact of low gestational birth (per se) in infants' regulatory behavior, the quality of mother-infant interactions, and attachment security. The participants are 71 infants' weight lower than 1599 g of gestational weight (varying between 23 and 34 weeks of gestational) and their mothers. Dyads were observed in free play and during Face to Face Still-Face paradigm with infants at 3 months of corrected age. At 12 months of corrected age, mother-infant attachment was observed during Strange Situation. Results indicate that infants with low/very low gestational birthweight have high levels of insecure attachment (70 %) and non-positive patterns of regulatory behavior (64 %). Maternal and infant interactive behavior is highly associated with infant attachment. In turn, maternal interactive behavior is associated with gestational age, birthweight, and number of days in NICU.

Assessment of factors and father-infant attachment levels among Turkish's fathers of preterm infants

PURPOSE

Identify the factors affecting father-infant attachment among Turkishs fathers of preterm infants.

DESIGN AND METHODS

This cross-sectional study included 63 fathers of preterm infants between the ages of 6-12 months. Data were collected using the Father-Infant Descriptive Information Form and the Paternal-Infant Attachment Scale (PIAS). Descriptive statistics, independent sample t-tests, mann-whitney test, the kruskal wallis test, the tamhane test, spearman correlation analysis, and linear stepwise regression were used to evaluate the data.

RESULTS

The average PIAS scores of the fathers in the study was 62.97 ± 8.94. A statistically significant difference was found between the birth weight, clinical picture, and length of stay in the Neonatal Intensive Care Unit (NICU) and PIAS total score of preterm infants (p < 0.01). There was a significant difference between the unplanned hospitalization of the baby after discharge and the father's changing the baby's clothes and the PIAS score (p < 0.05). Birth weight and unplanned hospitalization explained 31% of PIAS total score.

CONCLUSIONS

According to the results, father-infant attachment levels of fathers of preterm infants were low. Father's involvement in changing the baby's clothes, preterm birth weight, clinical picture, and length of stay in the NICU were found to be associated with PIAS.

PRACTICAL IMPLICATIONS

It should be remembered that babies can be attached to their fathers as much as they are to their mothers. NICU nurses should initiate father-infant interaction early and ensure fathers' involvement in infant care in the NICU.

Feelings about pregnancy and mother-infant bonding as predictors of persistent psychological distress in the perinatal period: The Japan Environment and Children's Study

Feelings about pregnancy and mother-infant bonding are associated with maternal mental health before and after childbirth. The current study examined factors associated with persistent distress at 12 months after childbirth among mothers with psychological distress in the first trimester, using data from the Japan Environment and Children's Study (JECS). Feelings about pregnancy were assessed using a questionnaire in the first trimester, and maternal mental health was assessed using the Kessler 6 (K6) in the first trimester and at 12 months after childbirth. In addition, mother-infant bonding was assessed using the Mother-to-Infant Bonding Scale Japanese version (MIBS-J) at 12 months after childbirth, and 5 items from the MIBS-J at one and six months after childbirth. Among the 97,415 mothers registered in the JECS, 24,324 mothers with psychological distress (K6 ≥ 5) in the first trimester were included in this analysis. The relationships between persistence of psychological distress at 12 months after childbirth with feelings about pregnancy and mother-infant bonding were analyzed. Both maternal negative feelings about pregnancy in the first trimester and mother-infant bonding after childbirth were significantly associated with persistent psychological distress at 12 months after childbirth (β = 0.02, p = 0.001 and β = 0.35, p < 0.001, respectively). The indirect effect of feelings about pregnancy on persistent distress through mother-infant bonding was also observed (β = 0.06, p < 0.001). These findings indicate that mother-infant bonding after childbirth may be important for improving the mental health of mothers with prenatal psychological distress.

The association of infant temperament and maternal sensitivity in preterm and full-term infants

Infants who experience sensitive caregiving are at lower risk for numerous adverse outcomes. This is especially true for infants born preterm, leading them to be more susceptible to risks associated with poorer quality caregiving. Some research suggests that preterm and full-term infants differ on temperament, which may contribute to these findings. This study aimed to investigate associations between infant temperament (negative emotionality, positive affectivity/surgency, and orienting/regulatory capacity) and maternal sensitivity among infants born preterm (M = 30.2 weeks) and full term. It was hypothesized that mothers of infants born preterm and mothers of infants with more difficult temperaments would display lower sensitivity, indicated by lower responsiveness to nondistress, lower positive regard, and higher intrusiveness. Videotaped play interactions and a measure of temperament (Infant Behavior Questionnaire) were coded for 18 preterm and 44 full-term infants at 9 months (corrected) age. Results suggest that mothers of preterm and full-term infants differed significantly in responding to their infants, but these results cannot be explained by infant temperament. Preterm status and sociodemographic risk emerged as correlates of maternal behavior, such that mothers of infants born preterm and mothers with greater sociodemographic risk displayed lower levels of maternal sensitivity.

Longitudinal changes in attachment patterns of preterm infants born in a non-Western country

Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.

Vivido paterno do filho prematuro hospitalizado por meio do registro fotográfico

Resumo Objetivo compreender o mundo vivido do pai que possui um filho pré-termo hospitalizado por meio do registro fotográfico. Método estudo qualitativo fundamentado no referencial teórico-metodológico da Fenomenologia Social de Schütz. Participaram deste estudo nove pais que possuíam filhos internados em uma das duas unidades neonatais (UTIN/UCI), com idade gestacional inferior a 37 semanas, cujo nascimento ocorreu no período de novembro de 2018 a abril de 2019. Resultados após a análise e a interpretação dos dados coletados, emergiram duas unidades temáticas: Vivenciando momentos da hospitalização do filho pré-termo “motivos por que”, que resultou na categoria Privilégio em registrar a evolução do filho pré-termo; O que almejar do registro fotográfico frente ao momento de hospitalização do filho pré-termo “motivos para”, que resultou nas categorias Felicidade: uma alegria em cada registro; Lembranças: o recordar em cada registro. Considerações finais o uso do registro fotográfico mostrou ser um método que oportunizou compreender que o pai deseja estar próximo ao filho e vivenciar o momento de hospitalização. Desse modo, é necessário que os profissionais desenvolvam estratégias que possibilitem, ao pai, o exercício da paternidade e promovam o vínculo com o seu filho na unidade neonatal.

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

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

A guided participation nursing intervention to theraupeutic positioning and care (GP_Posit) for mothers of preterm infants: protocol of a pilot randomized controlled trial

Background

In the NICU, interventions intended to enhance maternal sensitivity are indicated in order to optimize preterm infant development and long-term mother-infant attachment. A novel nursing intervention was developed following a theory-oriented methodology and is based upon the guided participation theory for mothers to participate in their preterm infant's therapeutic POSITioning and care (GP_Posit). The primary objective of this study is to evaluate the feasibility and acceptability of (i) the study design; and (ii) the experimental GP_Posit nursing intervention during NICU hospitalization. The secondary objective is to estimate the preliminary effects of GP_Posit on maternal and preterm infant outcomes.

Methods

A pilot parallel-group randomized clinical trial (RCT) was designed where mother-preterm infant dyads are being recruited and randomized to a control group (usual care) or experimental group (GP_Posit intervention). Data collection includes feasibility and acceptability data as well as preliminary effects on maternal sensitivity and infant neurodevelopment. Ethical approval from the University Hospital ethical board was obtained in January 2018 (2017-1540).

Discussion

Data collection for this pilot study is expected to end in 2020. Results of this pilot study will inform about the feasibility and acceptability of the study design and GP_Posit intervention, a nursing intervention having the potential to favor maternal sensitivity and infant neurodevelopment in the NICU and guide the elaboration of a large-scale RCT.

Trial registration

clinicaltrial.gov, NCT03677752. Registered 19 September 2018.

Reflective functioning in fathers with young children born preterm and at term

The present study assessed 322 parents of 173 children aged between 12 and 20 months (74 children born preterm) with the Parent Development Interview (PDI) to capture parents' Reflective Functioning (RF). RF scores were obtained, and topics were disclosed, for which modeling with Latent Dirichlet Allocation (LDA) was applied. The study addressed (a) whether RF scores differed between fathers of children born preterm and at term, and diverged from the mothers' RF and, (b) whether topics on fathers' minds differed regarding parenting preterm or at-term children, and diverged from topics on parenting raised by mothers. Results indicated that parents of at-term children revealed similar RF scores, though fathers of children born preterm scored lower than mothers of children born preterm. Whereas fathers' RF scores were associated with topics about the paternal role, interests and activities, mothers' RF was related to concerns about how to meet the child's needs.