INSERTION OF THE FATHER IN THE CARE OF THE HOSPITALIZED PRETERM INFANT: PERCEPTION OF THE MULTIPROFESSIONAL TEAM

The effect of paternal anxiety on mother-infant bonding in neonatal intensive care

BACKGROUND

The hospitalization of a preterm infant in the NICU can lead to mental health difficulties in parents, but not much is known how paternal anxiety might affect the mother-infant relationship.

METHODS

This prospective cohort study is a secondary analysis investigating how paternal anxiety levels might affect maternal bonding in the NICU using the dataset of the multinational pragmatic randomized controlled trial LongSTEP. A linear mixed-effects model was used for correlations of paternal anxiety (GAD-7) and maternal bonding (PBQ) at NICU discharge, and at 6 and 12 months infant corrected age. Secondary analyses examined effects on paternal anxiety related to: site (Argentina, Colombia, Israel, Norway, and Poland), maternal depression (EPDS), infant gestational age at birth, paternal age, and type of pregnancy.

RESULTS

Paternal anxiety did not predict maternal bonding at NICU discharge (p = 0.096), at 6 months (p = 0.316), or at 12 months infant corrected age (p = 0.473). Secondary outcomes showed a statistically significant site effect, with higher paternal anxiety levels at the two Colombian sites at baseline (p = 0.014 and p = 0.020) and for one site at discharge (p = 0.012), but not for paternal age (p = 0.925 and p = 0.793), infant gestational age at birth (p = 0.974 and p = 0.686 and p = 0.340), or type of pregnancy (p = 0.381). Maternal depression predicted paternal anxiety at baseline (p < 0.001) and at discharge (p = 0.003).

CONCLUSIONS

In this study, paternal anxiety did not predict maternal bonding. Paternal anxiety varied by site, indicating a need for research on potential cultural differences in manifestation of paternal anxiety. Maternal depression predicted paternal anxiety, confirming a previously reported correlation. Further research on variations in paternal mental health in the neonatal period is warranted, as well as exploration of the social contagion of mental health in preterm parents.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03564184.

Factors influencing fathers' involvement in the care of hospitalized preterm newborns in Balaka, Malawi

BACKGROUND

Malawi has one of the highest incidences of premature birth, with twice the mortality compared to full-term. Excluding fathers from preterm newborn care has negative consequences, including father feeling powerless, missed bonding opportunities with the newborn, additional strain on the mother, and negative family dynamics such as breakdown in communication, reduced trust, and strained relationships. In Malawi, there is no deliberate policy to have fathers involved in preterm care despite having high incidence of preterm birth and neonatal mortality. There is also limited literature on the factors that influence fathers' involvement in the care. The aim of the study was to explore factors influencing fathers' involvement in the care of hospitalized preterm newborns.

METHODS

A descriptive qualitative study design was used, guided by Theory of planned behaviour and the model proposed by Lamb on male involvement. Sixteen in-depth interviews were conducted with fathers of preterm infants purposively and conveniently sampled in June 2021. Interviews were digitally recorded and transcribed verbatim. Data were organized and analyzed using Nvivo software and thematic analysis approach was used because the approach allows deeper understanding of the data, identification of patterns and themes, and provides rich insights into participants' experiences and perspectives.

RESULTS

The barriers and facilitators that influence a father's involvement in the care of preterm newborn babies include: perceived difficulty with care activities and benefits of involvement, gender roles and socio-cultural beliefs, work and other family responsibilities, social support, baby's physical appearance/nature and health status, feedback from the baby, multiple births, and hospital's physical environment and provision of basic needs.

CONCLUSION

The study found that fathers value their involvement in caring for hospitalized preterm newborns but face barriers. Evidence-based interventions like education programs, training sessions, and support groups can help fathers overcome barriers and promote better outcomes for infants and families.

The Current Concept of Paternal Bonding: A Systematic Scoping Review

Bonding is crucial to perinatal mental health. Despite an extensive body of literature on maternal bonding, few studies have focused on paternal bonding. This scoping review aimed to clarify the current state of the concept of paternal-infant/fetus bonding. The eligibility criteria were drawn from the population concept and context elements to answer the following questions: "what is paternal bonding?" and "what are the constructs of the concept of paternal bonding?" The review comprised 39 studies. Paternal bonding was associated with both positive and negative paternal behavior and thought and may be determined based on fathers' beliefs and rearing history. Most studies showed that father-child interaction is one of the factors promoting paternal bonding. However, fathers generally felt more distant from their babies post-delivery than mothers. Only a few studies originally defined paternal bonding; most relied on the definitions of maternal bonding. We found different descriptions lacking consensus. Few studies examined the differences between paternal and maternal bonding. No consensus exists on the concept, constructs, and assessment of paternal bonding. The causal relationship between paternal bonding and other variables is unexplored. Future studies should explore fathers' perspectives and experiences, focusing on the unknown aspects of paternal bonding identified in this review.

Percepção materna sobre a participação do pai na hospitalização do filho em unidade intensiva pediátrica

Objetivo: compreender a percepção materna sobre a participação do pai durante a hospitalização do filho em Unidade de Terapia Intensiva Pediátrica. Métodos: pesquisa qualitativa de inspiração fenomenológica, cujo referencial metodológico para análise dos discursos, advindos de 12 entrevistas com mães de crianças hospitalizadas no interior do estado de São Paulo, foi a análise da estrutura do fenômeno situado. Resultados: emergiram três categorias temáticas: Participando do processo de adoecimento do filho - a essencialidade da presença do pai; Sofrendo pelo filho - o pai sendo afetado pela hospitalização; Não podendo estar com o filho - o pai sendo impedido de ser acompanhante durante a hospitalização. As mães reconhecem a participação dos pais durante hospitalização do filho por meio de apoio, compartilhamento de atividades e na importância para a recuperação da criança. Contudo, o sofrimento advindo do adoecimento e da hospitalização, a necessidade de se dedicar ao trabalho, questões organizacionais do hospital e a ausência de legislações trabalhistas impedem a permanência dos pais no serviço de saúde. Conclusão: as unidades pediátricas precisam modificar as normas institucionais, acolhendo mãe e pai, oferecendo condições de permanência e apoiando-os durante a hospitalização do filho. É mister que a área de Enfermagem familiar discuta a participação do pai na vida do filho, em especial no ambiente hospitalar e de cuidados intensivos, de modo a impulsionar a elaboração de leis que garantam a manutenção do emprego em caso de acompanhamento do filho durante a hospitalização.