Parenting stress in mothers of preterm infants during early infancy

Objective

Mothers of preterm infants during the first year of life may experience stresses greater that those found in mothers of term infants. The aim of the study was to determine the levels of parenting stress and psychological well-being in mothers of very preterm babies in comparison to a control group of term mothers.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were recruited together with 105 mothers who delivered 120 babies at term. At 4 months of age (corrected for prematurity for the preterm babies), the mothers completed the Parenting Stress Index Short Form, the Edinburgh Postnatal Depression Scale (EPDS), the Dyadic Adjustment Scale (DAS) and the Short Temperament Scale for Infants (STSI). The preterm and term groups were compared.

Results

Questionnaires were returned from 86 of the preterm mothers and 97 of the term mothers. The mean Total Stress score for the preterm and term groups was 67.0 and 63.79 respectively (P = 0.32) with 17% of the preterm and 9% of the term group having high scores (P = 0.135). There were no differences of the EPDS and the DAS between the groups. The temperament of the preterm infants was similar to the term infants. For both groups, scores on the EPDS, DAS and the STSI were independent predictors of Total Stress scores on multiple regression analysis.

Conclusion

Parenting stress in mothers of preterm infants during early infancy does not appear to be greater than that in mothers of infants born at term. For both groups of mothers, depression symptoms, marital satisfaction and infant temperament were independent risk factors for high levels of parenting stress.     

Twin birth: An additional risk factor for poorer quality maternal interactions with very preterm infants?

Background

Twin birth can be considered an additional risk factor for poor interactions between mothers and their very preterm (VP; < 32 weeks' gestation) infants.

Aims

To explore if mothers of (VP) twins experience higher levels of stress than mothers of singletons and if mother–twin infant dyads experience poorer quality interactions.

Method

Mothers of VP twin infants (N = 17) were closely matched to mothers of VP singleton infants (N = 17). Mother–infant interaction was assessed before discharge from hospital and during a home visit at three months corrected age using the Nursing Child Assessment Teaching Scale (NCATS). Mothers' responsiveness to their infants was assessed using the Responsivity subscale of the Home Observation for Measurement of the Environment (HOME) and mothers completed the Parenting Stress Index short form (PSI-SF).

Results

Mothers of twins had significantly lower HOME responsiveness scores (median 9 vs. 10) at three months corrected age and were more likely to have total PSI-SF scores in the clinical range (> 90th percentile) compared to mothers of singletons (Fishers exact probability = 0.05). Twin infants had lower mean Total Child Domain NCATS scores than singletons both at discharge (9.07 vs. 11.33) and at three months corrected age (13.18 vs. 15.71) indicating they were less responsive communicators.

Conclusions

VP twins present a greater challenge than singletons as their mothers experience high levels of parenting stress. Although mothers appear to compensate for twin infants' poorer clarity of cues in a structured, one to one task, mothers of twins were less responsive than mothers of singletons in an unstructured setting.     

Declining cognitive development from 8 to 18 months in preterm children predicts persisting higher parenting stress

Background

Higher parenting stress in mothers of children born very preterm may be in part a response to poorer neurobehavioral development, reflecting realistic concerns in addition to adaptation to the trauma of preterm delivery. To our knowledge, there are few longitudinal studies of parenting stress that have addressed child cognitive competence.

Aims

To examine parenting stress in preterm and full-term children at 8 and 18 months corrected chronological age (CCA), in relation to child cognitive development and behavior.

Subjects

Participants were N = 152 children (98 preterm born ≤ 32 weeks gestation, and 54 full-term) seen at 8 and 18 months CCA, and the primary caregiver parent.

Study design/Outcome measures

The Parenting Stress Index questionnaire was completed by a parent, child interactive behavior was videotaped, and the Bayley Scales of Infant Development (BSID II, Mental Development Index; MDI) were administered at both ages.

Results

Total Parenting Stress was higher in preterm than full-term children at 8 and 18 months CCA (p < .02), accounted for primarily by the Child domain. Hierarchical regression showed (after controlling for neonatal risk, number of children in the home, child interactive behavior and maternal education) that decreasing Bayley MDI scores from 8 to 18 months CCA predicted higher parenting stress for preterm children. For full-term children, number of children in the home and child interactive behavior predicted parental stress at 18 months.

Conclusion

Higher parenting stress persisting to 18 months CCA in preterm children may partly reflect realistic parental concerns with their child's development.     

Family functioning, burden and parenting stress 2 years after very preterm birth

Background

Examining rates of difficulties in family functioning following very preterm birth has been a relatively neglected area of research.

Aims

To examine family functioning, burden and parenting stress in families with very preterm compared with term born children, and investigate influences of parental mental health problems and child neurodevelopmental disability on family outcomes in families with preterm children.

Study design

Participants were 184 very preterm and 71 term children and their parents. Parents completed the Family Assessment Device, Parenting Stress Index and Impact on Family questionnaires when their children were 2 years old (corrected for prematurity). Parental mental health and social risk information were also collected. Children were assessed for neurodevelopmental disability.

Results

Families with very preterm children reported poorer family functioning (p = .03) compared with families with term born children, with less evidence for differences between families with very preterm and term born children in parenting stress and family burden. Within very preterm families, parental mental health problems were associated with higher levels of parenting stress (p = .001), and parents of children with a neurodevelopmental disability were more likely to report higher family burden (p = .04).

Conclusions

For families with very preterm children, parental mental health symptoms and child neurodevelopmental disability may identify families at risk of greater stress and burden who may benefit from additional support.     

Arousal from sleep pathways are affected by the prone sleeping position and preterm birth: Preterm birth,prone sleeping and arousal from sleep

Objectives

Preterm infants exhibit depressed arousability from sleep when compared with term infants. As the final cortical element of the arousal process may be the most critical for survival, we hypothesized that the increased vulnerability of preterm infants to the Sudden Infant Death Syndrome (SIDS) could be explained by depressed cortical arousal (CA) responses. We evaluated the effects of preterm birth on stimulus-induced arousal processes in both the prone and supine sleeping positions.

Study design

10 healthy preterm infants were studied with daytime polysomnography, in both supine and prone sleeping positions, at 36 weeks gestational age, 2–4 weeks, 2–3 months and 5–6 months post-term corrected age. Sub-cortical activations and cortical arousals (CA) were expressed as proportions of total arousal responses. Preterm data were compared with data from 13 healthy term infants studied at the same corrected ages.

Results

In preterm infants increased CAs were observed in the prone position at all ages studied. Compared to term infants, preterm infants had significantly fewer CAs in QS when prone at 2–3 months of age and more CAs when prone at 2–4 weeks in AS. There were no differences in either sleep state when infants slept supine.

Conclusions

Prone sleeping promoted CA responses in healthy preterm infants throughout the first six months of post-term age. We have previously suggested that in term infants enhanced CA represents a critical protection against a potentially harmful situation; we speculate that for preterm-born infants the need for this protection is greater than in term infants.     

The development of autonomic cardiovascular control is altered by preterm birth

Objectives

Autonomic dysfunction, either sympathetic or parasympathetic, may explain the increased incidence of Sudden Infant Death Syndrome (SIDS) among preterm infants, as well as their subsequent heightened risk of hypertension in adulthood. As little is known about the development of autonomic function in preterm infants, we contrasted autonomic cardiovascular control across the first 6 months after term-corrected age (CA) in preterm and term infants.

Study design

Preterm (n = 25) and age matched term infants (n = 31) were studied at 2–4 weeks, 2–3 months and 5–6 months CA using daytime polysomnography. Blood pressure and heart rate were measured during quiet (QS) and active (AS) sleep. Autonomic control was assessed using spectral indices of blood pressure and heart rate variability (BPV and HRV) in ranges of low frequency (LF, reflecting sympathetic + parasympathetic activity), high frequency (HF, respiratory-mediated changes + parasympathetic activity), and LF/HF ratio (sympatho-vagal balance).

Results

In preterm infants, HF HRV increased, LF/HF HRV decreased and LF BPV decreased with age (p < 0.05); these changes were most evident in AS. Compared to term infants, preterm infants in QS exhibited lower LF, HF and total HRV at 5–6 months; higher HF BPV at all ages; and lower LF BPV at 2–4 weeks (p < 0.05).

Conclusions

With maturation, in preterm infants, parasympathetic modulation of the heart increases while sympathetic modulation of blood pressure decreases. Compared to term infants, preterm infants exhibit lesser parasympathetic modulation of the heart along with greater respiratory-mediated changes and lower sympathetic modulation of blood pressure. Impaired autonomic control in preterm infants may increase their risk of cardiovascular dysfunction later in life.     

Increased rate of parental postpartum depression and traumatization in moderate and late preterm infants is independent of the infant's motor repertoire

Background

Moderately and late preterm infants represent a considerable and increasing proportion of infants cared for in neonatal departments worldwide. Parents of preterm infants are at risk of postpartal depression (PPD) and posttraumatic stress disorder (PTSD), and preterm infants are at risk of developmental impairment.

Aim

This study aimed to assess (1) the incidence of parental PPD and PTSD in moderate to late preterm infants in comparison to full-term infants and (2) the influence of infants' motor repertoire assessed by Prechtl's general movements and illness severity on parental PPD and PTSD.

Subjects

We studied 60 mothers and 56 fathers of 69 preterm infants (born at 32 to 37 weeks of gestation) and 32 mothers and 29 fathers of 34 full-term infants.

Outcome measures

We assessed the incidence of parental PPD, PTSD and perceived social support as well as infants' illness severity and motor repertoire at birth, term and 3 months corrected age.

Results

Preterm mothers and fathers had significant higher depression scores after birth compared to full-term parents (p = 0.033 and 0.021). Preterm fathers also had higher traumatization scores compared to full-term fathers (p = 0.007). Probable or possible PPD/PTSD was not associated with infant's illness severity or quality of motor repertoire. No differences in motor development were found between preterm and full-term infants.

Conclusion

Moderate to late preterm infants' parents are at increased risk for PPD irrespective of infants' motor repertoire or illness severity.     

Early communication in preterm infants following intervention in the NICU

Background

Despite ongoing improvements in clinical care, preterm infants experience a variety of stressors in the first weeks of life, including necessary medical procedures, which may affect development. Some stress-reduction programmes based in the Neonatal Intensive Care Unit (NICU) have reported a positive impact on development. In particular, trials of the Mother–Infant Transaction Program (MITP) have shown positive short and longer term effects, and are based on training parents to recognise and minimise stress responses in preterm infants.

Aims

To evaluate the impact on early developmental milestones of an enhanced MITP (PremieStart) delivered over an extended period in the NICU.

Study design

This was a parallel 2-group randomised controlled trial involving 109 women with 123 infants born at < 30 weeks gestation assessed initially at term-equivalent age and then at 6 months' corrected-age.

Results

Intervention mothers were more sensitive in providing infant care, stressed their infants less, showed greater awareness of, and responded more appropriately to, negative infant cues (p < 0.05 in each case). Intervention infants displayed significantly lower stress when being bathed by mothers at term-equivalent age (p < 0.05). At 6 months corrected-age, intervention infants showed higher mean scores on the Communication and Symbolic Behavior Scales Developmental Profile Infant–Toddler Checklist. The strongest effects appeared in Symbolic behaviour (p = 0.05) and this was reflected in the Total score (p < 0.05).

Conclusions

As significant cognitive and language deficits are reported in longitudinal studies of preterm children, an intervention that improves early infant communication abilities is promising, especially since previous research suggests that the strongest benefits may emerge at later ages.     

Myocardial function in term and preterm infants. Influence of heart size,gestational age and postnatal maturation

Background

Sparse knowledge exists on the differences in cardiac function between term and preterm infants. This study examines the impact of heart size, gestational age and postnatal maturation on myocardial function.

Aim

To assess and compare serial echocardiographic indices of myocardial function in term and moderately preterm infants.

Methods

Longitudinal, prospective, observational echocardiographic cohort study of 45 healthy term infants examined at day three and at 12–20 weeks postnatal age and 53 moderately preterm infants (gestational age 31–35 weeks) examined at day three and at term equivalent (4–10 weeks postnatal age).

Outcomes

Primary: Systolic mitral and tricuspid annular plane excursions and annular peak systolic pulsed wave tissue Doppler (pwTDI) velocities.Secondary: Indices normalized for heart size.

Results

On day three, all indices were higher in the term than in the preterm infants whereas normalized systolic pwTDI velocities were lower in the term infants and normalized excursions showed no difference. All indices increased with advanced postnatal age. The indices in term infants on day three were lower than in preterm infants at term equivalent, with and without normalization. After postnatal maturation in both groups, all indices were higher in the term group (except left pwTDI), whereas normalized indices showed no consistent pattern.

Conclusions

Myocardial function indices increased with gestational age at birth and more profoundly with postnatal maturation. Serial examinations of non-normalized and normalized myocardial function indices showed no sustained differences between the preterm and the term infants.Normalization by heart size may be of value when assessing myocardial function in infants.     

Postural complexity differs between infant born full term and preterm during the development of early behaviors

Background and aims

Postural control differs between infants born preterm and full term at 1–3 weeks of age. It is unclear if differences persist or alter the development of early behaviors. The aim of this longitudinal study was to compare changes in postural control variability during development of head control and reaching in infants born preterm and full term.

Methods

Eighteen infants born preterm (mean gestational age 28.3 ± 3.1 weeks) were included in this study and compared to existing data from 22 infants born full term. Postural variability was assessed longitudinally using root mean squared displacement and approximate entropy of the center of pressure displacement from birth to 6 months as measures of the magnitude of the variability and complexity of postural control. Behavioral coding was used to quantify development of head control and reaching.

Results

Group differences were identified in postural complexity during the development of head control and reaching. Infants born preterm used more repetitive and less adaptive postural control strategies than infants born full term. Both groups changed their postural complexity utilized during the development of head control and reaching.

Discussion

Early postural complexity was decreased in infants born preterm, compared to infants born full term. Commonly used clinical assessments did not identify these early differences in postural control. Altered postural control in infants born preterm influenced ongoing skill development in the first six months of life.     

Sex and gestational age effects on auditory brainstem responses in preterm and term infants

Background

Some studies find delayed development of the auditory brainstem in preterm infants, but others do not.

Aim

To compare auditory brainstem responses (ABRs) in healthy preterm and term infants depending on sex and gestational age (GA).

Methods

Participants were 111 preterm (27–36 weeks GA) and 92 term (37–41 weeks GA) infants. ABR tests were conducted at 6 weeks (corrected age if preterm).

Results

There were no overall differences between term and preterm groups in ABRs. However, males showed longer latencies for waves III, V, and I–III, III–V, and I–V intervals and smaller amplitudes for wave III and V than females in both preterm and term groups (all p values ≤ .01). A 3-way interaction between group, sex, and GA (p < .05) showed that preterm males with later GA had longer wave I–V interval, whereas term females with later GA showed shorter wave I-V interval. Growth velocity predicted wave I–V interval in preterm infants, controlling for other factors (male: p = .07, female: p < .05).

Conclusion

ABRs in preterm and term infants were similar at 6 weeks (corrected age if preterm), but males had less advanced ABRs than females. More rapid growth predicted less mature ABR in later GA preterm infants in this setting where they were unlikely to receive extra iron. The roles of GA, growth, and iron balance in ABR development warrant further study.     

Pain evaluation after a non-nociceptive stimulus in preterm infants during the first 28 days of life

Background

Protective mechanisms that modulate and lead to habituation to pain are immature in preterm newborn infants.

Aims

To evaluate if a routine non-painful handling will be perceived as painful throughout the neonatal period in newborn infants with 28–32 weeks of gestational age.

Study design

Prospective cohort study.

Subjects

36 preterm infants without malformations evaluated for pain during a diaper change.

Outcome measures

Patients were studied at three times (5 min prior, during, and 3 min after the diaper change) during five moments (72 h, 7, 14, 21 and 28 days of life) by evaluation of heart rate, oxygen saturation and 3 validated pain assessment tools: the Neonatal Infant Pain Scale (NIPS), the Behavioral Indicators of Infant Pain (BIIP) and Premature Infant Pain Profile (PIPP). Results were analyzed by repeated measures ANOVA adjusted for gender, gestational age at birth, number of painful procedures and use of opioids.

Results

Patients had, at birth, mean gestational age of 30.2 ± 1.4 weeks, birthweight of 1257 ± 238 g, with 50% males. Analysis of pain assessment tools did not show increase of pain presence or pain scores at the five sequential evaluation moments. The variation of oxygen saturation during the three study times was similar at the different post-natal ages, but heart rate variation increased significantly from 72 h until the 28th day of life.

Conclusions

In preterm infants, the non-nociceptive handling does not trigger pain responses even after 28 days of neonatal care, which includes the experience of repetitive procedural pain.     

The effect of socioeconomic status on the language outcome of preterm infants at toddler age

Background

Independently, both prematurity and low socioeconomic status (SES) compromise language outcome but less is known regarding the effects of low SES on outcome of prior preterm infants at toddler age.

Aim

To assess SES effects on the language outcome of prior preterm infants at toddler age.

Study design

Retrospective chart review of infants born at ≤ 32 weeks, matched for gestational age (GA), birth weight (BW), chronic lung disease (CLD), periventricular leukomalacia (PVL), right and left intraventricular hemorrhage (IVH-R, L), and age at Bayley Scales of Infant Development III (BSID-III) testing.

Subjects

Using insurance status as a proxy for SES, 65 children with private insurance (P-Ins) were matched with 65 children with Medicaid-type insurance (M-Ins).

Outcome measures

Bayley Scales of Infant Development-III Language Composite.

Results

M-Ins vs. P-Ins were similar in GA, BW, and age at BSID-III testing (mean 22.6 months adjusted), as well as other matched characteristics (all p ≥ 0.16). BSID-III Language Composite scores were lower in M-Ins than P-Ins (87.9 ± 11.3 vs. 101.9 ± 13.6) with a clinically significant effect size of 0.93 (p < 0.001). Overall, 45% of M-Ins exhibited mild to moderate language delay compared to 8% of P-Ins. Receptive and Expressive subscale scores also were lower in M-Ins than in P-Ins (both p < 0.001).

Conclusions

In this preterm cohort, by toddler age, M-Ins was associated with lower scores on measures of overall language as well as receptive and expressive language skills. Our findings, showing such an early influence of SES on language outcome in a cohort matched for biomedical risk, suggest that very early language interventions may be especially important for low SES preterm toddlers.     

Maternal emotional availability at bedtime and infant cortisol at 1 and 3 months

Background

Previous work has shown that early experience influences infant cortisol secretion. Few studies, however, have examined associations between parenting quality and cortisol levels and patterning in very young infants.

Aims

This study examined linkages between maternal emotional availability (EA) during a routine caregiving task, bedtime, and infant cortisol in the first 3 months of life. Concurrent and longitudinal associations between maternal EA and infant cortisol were examined.

Study design

Families were visited when their infants were 1 and 3 months old. Video equipment was set up in order to record the infant's bedtime routine. Parents were provided with materials with which to take saliva samples from their infants at late afternoon, bedtime, and the following morning.

Subjects

At 1 month, participants were 96 mothers and infants living in a rural U.S. state. Data were available for 88 mothers and infants at 3 months.

Outcome measures

Maternal EA was scored from videotapes of bedtime at each age point. Infant cortisol was assessed from the saliva samples taken by parents.

Results

Regression analyses indicated that at 1 and 3 months of age, infants of more emotionally available mothers showed lower levels of cortisol secretion across the night than infants of less emotionally available mothers. Additionally, multilevel model analyses indicated that infants of more emotionally available mothers showed greater evidence of a decline in their cortisol levels across the evening, followed by an increase across the nighttime into the morning in their cortisol at 3 months.

Conclusions

Findings suggest that maternal care in the context of a routine caregiving task is associated with lower stress reactivity and with earlier circadian patterning in very young infants.     

Parenting self-efficacy: Links with maternal depression,infant behaviour and adult attachment

Background

This study examined predictors of parenting self-efficacy (PSE) in a sample of first-time mothers during the first year after childbirth and evaluated the effect of a brief, intensive, mother–infant residential intervention on PSE and infant behaviour.

Methods

83 primiparous women with infants aged 0–12 months admitted to a residential parent–infant program participated in a structured clinical interview for DSM-IV diagnosis of depressive and anxiety disorders and completed questionnaires assessing psychological distress, adult attachment and childhood parenting experiences. During their residential stay, nurses recorded infant behaviour using 24-hour charts.

Results

Results showed PSE to be inversely correlated with maternal depression, maternal anxiety and attachment insecurity. Low levels of parental abuse during childhood, avoidant attachment, male infant gender and depressive symptom severity were found to predict low PSE. Major depression mediated the relation between attachment insecurity and PSE, but there were no links between PSE and infant behaviour. After the intervention, there was a significant improvement in PSE, with abusive parenting during childhood and depressive symptom severity being predictive of change.

Conclusions

This study highlights the links between maternal psychopathology and maternal background factors such as childhood parenting experiences and attachment style in the development of postnatal PSE. Directions for future research are discussed.     

Accumulation of subcutaneous fat,but not visceral fat,is a predictor of adiponectin levels in preterm infants at term-equivalent age

Background

Preterm infants have altered fat tissue development, including a higher percentage of fat mass and increased volume of visceral fat. They also have altered adiponectin levels, including a lower ratio of high-molecular-weight adiponectin (HMW-Ad) to total adiponectin (T-Ad) at term-equivalent age, compared with term infants.

Aims

The objective of this study was to investigate the association between adiponectin levels and fat tissue accumulation or distribution in preterm infants at term-equivalent age.

Study design

Cross-sectional clinical study.

Subjects

Study subjects were 53 preterm infants born at ≤ 34 weeks gestation with a mean birth weight of 1592 g.

Outcome measures

Serum levels of T-Ad and HMW-Ad were measured and a computed tomography (CT) scan was performed at the level of the umbilicus at term-equivalent age to analyze how fat tissue accumulation or distribution was correlated with adiponectin levels.

Results

T-Ad (r = 0.315, p = 0.022) and HMW-Ad levels (r = 0.338, p = 0.013) were positively associated with subcutaneous fat area evaluated by performing CT scan at term-equivalent age, but were not associated with visceral fat area in simple regression analyses. In addition, T-Ad (β = 0.487, p = 0.003) and HMW-Ad levels (β = 0.602, p < 0.001) were positively associated with subcutaneous fat tissue area, but they were not associated with visceral fat area also in multiple regression analyses.

Conclusion

Subcutaneous fat accumulation contributes to increased levels of T-Ad and HMW-Ad, while visceral fat accumulation does not influence adiponectin levels in preterm infants at term-equivalent age.     

The effect of in-hospital developmental care on neonatal morbidity,growth and development of preterm Taiwanese infants: A randomized controlled trial

Introduction

Intervention studies of developmental care for preterm infants in Western societies have shown early but unsustainable effects on child outcomes, however only a limited of studies have examined if developmental care interventions produce similar effects in Eastern cultural contexts.

Aims

To examine the effectiveness of in-hospital developmental care on neonatal morbidity, growth and development of preterm infants with very low birth weight (VLBW; birth weight < 1500 g) in Taiwan.

Methods

One hundred and seventy-eight VLBW preterm infants were randomly assigned to the clinical trial during hospitalization at three hospitals in Taiwan; the control group received five sessions of standard child-focused developmental care and the intervention group received five sessions of child- and parent-focused developmental care. Sixty-two normal term infants were also included as a comparison group. Infants were examined for morbidity, growth and developmental outcomes at term age.

Results

At study entry, more infants in the intervention group were twins or multiples than those in the control group (29% vs. 16%, p = 0.05). After adjusting for birth set, the intervention group had lower incidences of stage II–III retinopathy (odds ratio [OR] = 0.34 [95% confidence interval (CI): 0.15–0.79]; p = 0.01) and feeding desaturation (OR = 0.32 [95% CI: 0.10–1.00]; p = 0.05) and had greater daily weight gains (difference = 2.0 g/day [95% CI: 0–4.0 g/day]; p = 0.05) as compared with the control group. However, the intervention and control groups did not differ in any of the neurodevelopmental measures.

Conclusions

In-hospital developmental care has short-term benefits for Taiwanese VLBW preterm infants in reducing the risk of retinopathy and feeding desaturation as well as in enhancing weight gains at term age.     

Effect of holding on co-regulation in preterm infants: A randomized controlled trial

Objective

To determine whether kangaroo holding of healthy preterm infants over the first eight weeks of an infant's life facilitates co-regulation of salivary cortisol between mother and infant.

Study Design

Randomized control trial. Infants were assigned to receive 1 h of daily kangaroo (skin-to-skin contact on the chest of mother) or blanket holding (dressed and held in mother's arms). A registered nurse visited mothers weekly for eight weeks to encourage holding and provide information about infant development. A control group had no holding restrictions and received weekly brief social visits.

Subjects

The study included 79 preterm infants, born between 32 and 35 weeks gestational age and were a mean of 15 days (± 5.7) at enrollment.

Outcome Measures

Co-regulation was conceptualized as progressive reduction in the absolute difference between mother and infant cortisol levels across 60 min of holding at each holding session. Mother and infant cortisol levels were measured before holding and at 30 and 60 min after holding began during three holding sessions (baseline and at two and eight weeks after study initiation). Primary analyses were conducted using hierarchical linear models.

Results

There was much variability in cortisol levels. Levels of mother and infant cortisol decreased during holding. No significant co-regulation occurred in any group at any holding session or over time.

Conclusions

Decreasing level of cortisol in both mothers and infants suggests that holding promoted the expected decline in stress hormone levels. However, supported holding methods did not differentially affect co-regulation compared to controls. Holding is pleasurable and stress may need to be present in order for mothers and infants to demonstrate co-regulation in cortisol levels.     

Extensively hydrolyzed protein formula reduces acid gastro-esophageal reflux in symptomatic preterm infants

Background

Gastro-esophageal reflux (GER) is diagnosed frequently in preterm infants. Pharmacological treatment of GER has some potential side effects. Conservative treatment of GER should be the first-line approach and should include body positioning and diet modifications.Formula-fed preterm infants experience frequently symptoms of feeding intolerance. Hydrolyzed protein formula (HPF) is often used in these infants due to their effects on gastrointestinal motility.

Aims

To investigate the role of an extensively HPF (eHPF) on GER indexes in formula-fed preterm infants with symptoms of both GER and feeding intolerance.

Study design

Randomized crossover trial

Subjects

Preterm infants (gestational age ≤ 33 weeks) with symptoms of feeding intolerance (large gastric residuals, abdominal distension and constipation) and GER (frequent regurgitations and/or postprandial desaturations).

Outcome measures

GER indexes detected by 24-h combined multichannel intraluminal impedance and pH monitoring. GER indexes detected after 4 feeds of an eHPF were compared to those detected after 4 feeds of a standard preterm formula (SPF) by Wilcoxon signed ranks test. A p < 0.05 was considered statistically significant.

Results

eHPF significantly reduced the number of GERs detected by pH monitoring (p = 0.036) and also the reflux index (p = 0.044) compared to SPF. No differences in impedance bolus exposure indexes nor in GER height were detected.

Conclusions

The use of an eHPF should be evaluated for reducing esophageal acid exposure in preterm infants with feeding intolerance and symptoms of GER. Future research should focus on the evaluation of an eHPF adequate for preterm infants in improving clinical symptoms of GER.     

Intra-uterine exposure to maternal opiate abuse and HIV: The impact on the developing nervous system

Background

Both intra-uterine exposure to maternal drugs and HIV are known to adversely affect the developing central nervous system.

Aims

(1) To describe the quality of GMs in infants who were intra-uterinely exposed to maternal opiate abuse and HIV; and (2) to analyze to what extent (a) perinatal events, (b) status of HIV-infection, and (c) the quality of GMs are associated with the neurodevelopmental outcome at 2 to 3 years of age.

Patients and method

Seventy-seven children intra-uterinely exposed to both maternal opiate abuse and HIV in utero (41 boys and 36 girls; 39 born preterm) were videoed twice: first during the first 2 months after term (writhing GMs) and again at 3–5 months (fidgety GMs). Neurodevelopmental outcome was assessed at 2–3 years of age.

Results

Thirty-eight infants showed abnormal writhing GMs; 25 infants had abnormal or absent fidgety movements; 22 children had an adverse neurodevelopmental outcome. The association between GM trajectories and outcome revealed a Cramer-V = 0.75 (p < 0.001). Those infants with active HIV-infection (n = 10) did not differ from the 67 infants who were HIV-exposed but uninfected with respect to their GM quality or outcome.

Conclusions

Serial assessment of GMs in infants who were intra-uterinely exposed to maternal opiates and to HIV can be utilized for early identification of infants at a higher risk for later deficits and needing early intervention.