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.     

Infant developmental outcomes following prenatal exposure to antidepressants,and maternal depressed mood and positive affect

Background

Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants has been associated with delays in early developmental milestones, but there remains uncertainty. Even among a subset of studies examining the Bayley Scales of Infant Development (BSID), some have reported normal mental and psychomotor development while others have suggested a delay in motor development. Given an increasing number of infants exposed to SRIs, furthering our understanding of the possible developmental implications of SRI exposure in utero is critical.

Aims

To examine the effects of prenatal serotonin reuptake inhibitor exposure and maternal mood on infant developmental outcomes at 10 months of age.

Study design

Prospective study of mothers and their 10-month-old infants.

Subjects

We examined 31 mother–child pairs exposed prenatally to SRIs and 52 mother–child pairs who were nonexposed.

Outcome measure

The Bayley Scales of Infant Development (third edition) scores.

Results

Infants exposed prenatally to SRIs scored significantly lower than nonexposed infants on gross motor (P = 0.03), social–emotional (P = 0.04) and adaptive behavior (P = 0.05) subscales of the BSID-III, controlling for pre- and postnatal maternal depressed mood, smoking and alcohol use during pregnancy. No significant differences in any of the BSID-III subscales were observed between infants exposed and infants nonexposed to pre and postnatal maternal depressed mood (P > 0.05). Increased levels of maternal positive affect at 10 months predicted increased social–emotional scores (P = 0.03).

Conclusions

Infants prenatally exposed to SRIs score significantly lower on the gross motor, social–emotional and adaptive behavior subscales of the BSID-III, and this was not explained by underlying maternal depression.     

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.     

Early relations between language development and the quality of mother–child interaction in very-low-birth-weight children

Background

It is not clearly understood how the quality of early mother–child interaction influences language development in very-low-birth-weight children (VLBW).

Aims

We aim to analyze associations between early language and the quality of mother–child interaction, and, the predictive value of the features of early mother–child interaction on language development at 24 months of corrected age in VLBW children.

Study design

A longitudinal prospective follow-up study design was used.

Methods

The participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24 months of age. The quality of mother–child interaction was assessed using PC-ERA method at 6 and at 12 months of age.

Results

Associations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother–child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2 years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly.

Conclusions

The biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions.     

Maternal interactive behaviour as a predictor of preschoolers' attachment representations among full term and premature samples

Background

Associations between maternal sensitivity and child attachment have been established in many samples, but the strength of the association varies across populations. The sensitivity–attachment link has never been examined at the level of representations nor among premature samples.

Objective

The present study is aimed at exploring associations between maternal interactive behaviour and children's attachment representations in a population of preterm and full-term infants.

Method

Maternal interactive behaviour was assessed at 6 and 18 months (Ainsworth Sensitivity Scale & Care Index) and children's attachment representations were measured at 42 months (Attachment Story Completion Task) in a sample of preterm (N = 48) and full-term (N = 23) infants.

Results

Maternal unresponsiveness at 6 months and sensitivity at 18 months explained 54% of the variance of disorganized attachment representations in the full-term group but was not significantly related to attachment patterns in the preterm group.

Conclusion

These results corroborate previous work on the causes of disorganized attachment and also point to the need to consider the development of attachment differently for children evolving in specific developmental contexts. They especially stress the importance of distinguishing between risk factors associated with the mother as opposed to the child.     

Infant cardiac surgery and the father–infant relationship: Feelings of strength,strain, and caution

Objective

The purpose of this study was to examine the father–infant relationship in infants with congenital heart disease (CHD).

Method

Sixty-three fathers whose infants had cardiac surgery before 3 months of age reported on their attachment relationship with their infant within two months of hospital discharge using both qualitative and quantitative methods.

Results

Mean scores on the Paternal Postnatal Attachment Scale and scores for patience and tolerance were not different from previously published community norms, ps > .05. Scores for pleasure and interaction (t[50] = − 2.383, p = .021, CI: − 2.93, − .25) and affection and pride subscale (t[56] = − 2.935, p = .005, CI: − 1.20, − .23) were significantly lower than community norms. Additionally, 37% of fathers described feeling a strong relationship with their infant whereas 17% reported initial apprehension or condition-specific worry. Fathers with infants who spent fewer days at home prior to admission reported feelings of relationship strain as well as lower pleasure in interaction, affection and pride, patience and tolerance, and overall attachment quality.

Conclusion

Having an infant with CHD affects some father–infant relationships differently than others with some fathers feeling closer to their infant and other fathers feeling reservation about getting too close. One explanation for these differences may be that spending a great deal of time in hospital restricts the number and quality of interactions infants have with their fathers. Opportunities for intervention include clinical psychosocial services encouraging fathers to interact with and provide physical care of their infant, especially if fathers perceive their infant as medically fragile.     

Neonatal neurobehavioral abnormalities and MRI brain injury in encephalopathic newborns treated with hypothermia

Background

Neonatal Encephalopathy (NE) is a prominent cause of infant mortality and neurodevelopmental disability. Hypothermia is an effective neuroprotective therapy for newborns with encephalopathy. Post-hypothermia functional–anatomical correlation between neonatal neurobehavioral abnormalities and brain injury findings on MRI in encephalopathic newborns has not been previously described.

Aim

To evaluate the relationship between neonatal neurobehavioral abnormalities and brain injury on magnetic resonance imaging (MRI) in encephalopathic newborns treated with therapeutic hypothermia.

Study design

Neonates with hypoxic ischemic encephalopathy (HIE) referred for therapeutic hypothermia were prospectively enrolled in this observational study. Neurobehavioral functioning was assessed with the NICU network neurobehavioral scale (NNNS) performed at target age 14 days. Brain injury was assessed by MRI at target age 7–10 days. NNNS scores were compared between infants with and without severe MRI injury.

Subjects & outcome measures

Sixty-eight term newborns (62% males) with moderate to severe encephalopathy underwent MRI at median 8 days (range 5–16) and NNNS at median 12 days of life (range 5–20). Fifteen (22%) had severe injury on MRI.

Results

Overall Total Motor Abnormality Score and individual summary scores for Non-optimal Reflexes and Asymmetry were higher, while Total NNNS Z-score across cognitive/behavioral domains was lower (reflecting poorer performance) in infants with severe MRI injury compared to those without (p < 0.05).

Conclusions

Neonatal neurobehavioral abnormalities identified by the NNNS are associated with MRI brain injury in encephalopathic newborns post-hypothermia. The NNNS can provide an early functional assessment of structural brain injury in newborns, which may guide rehabilitative therapies in infants after perinatal brain injury.     

Development of the Preverbal Visual Assessment (PreViAs) questionnaire

Background

Visual cognitive functions of preverbal infants are evaluated by means of a behavioral assessment. Parents or primary caregivers may be appropriate to certify the acquisition of certain abilities.

Aims

To develop the PreViAs (Preverbal Visual Assessment) questionnaire to assess visual behavior of infants under 24 months of age and to assess the normative outcomes for each item at each age.

Study design

The process was divided into three phases: scale development (items and domains generation), pilot testing, and exploratory analysis.

Results

The final version of the PreViAs questionnaire consisted of 30 items, each related to one or more of four domains (visual attention, visual communication, visual–motor coordination, and visual processing). For the exploratory analysis, 298 children (159 boys and 139 girls) were recruited. Their ages ranged from 0.1 to 24 months (mean, 11.2 months). Internal consistency of the questionnaire was high for all domains (Cronbach's α coefficients of 0.85–0.94).

Conclusions

The PreViAs questionnaire is a useful scale for assessing visual cognitive abilities of infants under 24 months of age. It is easy and feasible to complete by primary caregivers.     

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.     

Assessment of motor behaviour in high-risk-infants at 3 months predicts motor and cognitive outcomes in 10 years old children

Background

The general movement assessment has mainly been used to identify children with cerebral palsy (CP). A detailed assessment of quality of infant motor repertoire using parts of the “Assessment of Motor Repertoire — 3 to 5 Months” which is based on Prechtl's general movement assessment can possibly identify later motor and cognitive problems in children without CP.

Aims

This study aims to determine whether analysis of quality of infant motor repertoire has predictive value for motor and cognitive outcomes at age 10 in children at risk for later neurological impairment.

Study design

A longitudinal study design was used.

Subjects

Video-recordings of 40 “neurologically high-risk” infants at 14 weeks post-term age were analysed with respect to motor repertoire.

Outcome measures

Fidgety movements were classified as present or absent. Quality of concurrent motor repertoire was classified as normal if smooth and fluent and abnormal if jerky, monotonous or stiff. Poor motor outcome was defined as a score ≤ 5th centile on the Movement-Assessment-Battery-2, while poor cognitive outcome as total IQ < 85 on Wechsler Intelligence Scale-III.

Results

Among the high-risk children with presence of fidgety movements, poor motor and/or cognitive outcome at 10 years was identified by abnormal concurrent motor repertoire at 14 weeks post-term age in 86% (95% CI: 0.60–0.96) of the children. On the other hand, 71% (95% CI: 0.47–0.87) of those with normal motor and cognitive outcomes were identified by presence of fidgety movements and normal motor repertoire.

Conclusions

Assessment of quality of infant motor repertoire may be a valuable early clinical marker for later impaired motor and cognitive outcomes in high-risk children who do not develop CP.     

Study of mother-infant attachment patterns and influence factors in Shanghai

Background

In contrast to the considerable volume of international research on infant attachment development, significantly less research has been conducted in China.

Aim

The present study was designed to identify the patterns of mother–infant attachment in Shanghai and to explore the influence factors.

Study design and subjects

The subjects included 160 healthy infant–mother dyads. Infant attachment and temperament were assessed with the Strange Situation Procedure and Carey's temperament questionnaire, respectively; the mother's personality, maternal sensitivity and marital satisfaction were assessed with Eysenck's personality questionnaire, Maternal Behavior Q-sort Manual Version 3.1 and Olson's marital questionnaire, respectively. A self-formulated questionnaire of family environment factors was completed by the infant's mother.

Results

Of the 160 infants, 68.2% were rated as securely attached (B) and 31.8% as insecurely attached. Of those infants rated as insecurely attached, 7.5% were characterized as avoidant (A), 21.8% as resistant (C) and 2.5% as disorganized (D). Maternal sensitivity and marital satisfaction as well as the approachability dimension of infant temperament, were significantly different between securely attached infants and insecurely attached infants. From a temperament perspective, resistant infants showed higher-level intensity of reaction than avoidant infants. Moreover, multiple caregivers in the family and infant's sleeping with other caregivers at night were more likely to be associated with insecure mother–infant attachment.

Conclusion

There exist certain cultural characteristics in mother–infant attachment patterns in Shanghai. The influence factors are related with the high involvement of non-mother caregivers as well as maternal sensitivity, marital satisfaction and infant's temperament characteristics.     

Fetal exposure to synthetic oxytocin and the relationship with prefeeding cues within one hour postbirth

Background

Prefeeding cues are oral-motor neurobehaviors that communicate feeding readiness, and the ability to self-comfort and regulate behavioral state. Intrapartum and newborn procedures have been associated with altered frequency and emergence of prefeeding cues soon after birth. Intrapartum synthetic oxytocin is commonly used for labor induction/augmentation in the US, yet there is little research on potential effects on infant neurobehavioral cues.

Aims

To explore whether fetal exposure to synthetic oxytocin was associated with the infant's level of prefeeding organization shortly after birth.

Study design

Cohort.

Subjects

A convenience sample of 47 healthy full-term infants (36 exposed and 11 unexposed to intrapartum synthetic oxytocin) was studied.

Exclusion criteria

Fetal distress, vacuum/forceps, cesarean, and low Apgar.

Outcome measures

Videotapes of infants (45–50 min postbirth) were coded for frequency of eight prefeeding cues, and analyzed by level of prefeeding organization.

Results

In general, fewer prefeeding cues were observed in infants exposed versus unexposed to synOT and differences were significant for brief and sustained hand to mouth cues [incidence rate ratio (95% CI) = 0.6 (0.4, 0.9) and 0.5 (0.2, 0.9), respectively]. Forty-four percent of exposed infants demonstrated a low level of prefeeding organization, compared to 0% from the unexposed group. In contrast, 25% of exposed versus 64% of unexposed infants demonstrated high prefeeding organization. After adjusting for covariates, exposed infants were at 11.5 times (95% CI = 1.8–73.3) the odds of demonstrating low/medium versus high levels of prefeeding organization compared to unexposed infants.

Conclusions

Newborn neurobehavioral cues may be sensitive to intrapartum synthetic oxytocin.     

Validation of the Preverbal Visual Assessment (PreViAs) questionnaire

Background

Visual cognitive integrative functions need to be evaluated by a behavioral assessment, which requires an experienced evaluator. The Preverbal Visual Assessment (PreViAs) questionnaire was designed to evaluate these functions, both in general pediatric population or in children with high risk of visual cognitive problems, through primary caregivers' answers.

Aim

We aimed to validate the PreViAs questionnaire by comparing caregiver reports with results from a comprehensive clinical protocol.

Study design

A total of 220 infants (< 2 years old) were divided into two groups according to visual development, as determined by the clinical protocol. Their primary caregivers completed the PreViAs questionnaire, which consists of 30 questions related to one or more visual domains: visual attention, visual communication, visual–motor coordination, and visual processing. Questionnaire answers were compared with results of behavioral assessments performed by three pediatric ophthalmologists.

Results

Results of the clinical protocol classified 128 infants as having normal visual maturation, and 92 as having abnormal visual maturation. The specificity of PreViAs questionnaire was > 80%, and sensitivity was 64%–79%. More than 80% of the infants were correctly classified, and test–retest reliability exceeded 0.9 for all domains.

Conclusions

The PreViAs questionnaire is useful to detect abnormal visual maturation in infants from birth to 24 months of age. It improves the anamnesis process in infants at risk of visual dysfunctions.     

Relationship between duration of crying/fussy behavior and actigraphic sleep measures in early infancy

Objective

The objective of the study is to understand the relationship between sleep development and crying episodes during early infancy more accurately by longitudinal and objective sleep evaluations.

Design

The study is designed as a prospective longitudinal study of infants in the first 4 months of life.

Methods

This study included 31 healthy term infants. At approximately 4- to 6-week intervals, when the infants were aged 4–6 weeks, 8–10 weeks, and 14–16 weeks, their mothers recorded the duration of crying/fussy behavior of infants in a timetable and attached an actigraph to the infants for 3 days. The relationship between 24-h crying/fussy behavior duration and actigraphic sleep measures was examined from both a cross-sectional (age group) and longitudinal (within-infants) perspective. Interactions with diverse covariates were studied by multiple regression analysis.

Results

A significant correlation was found between 24-h crying/fussy behavior duration and proportion of active sleep in infants at 14–16 weeks and in within-infant relationships. Among potential covariates, gestational age and co-sleeping had a significant impact on proportion of active sleep. Results of multiple regression analysis showed that gestational age and co-sleeping were positively associated with proportion of active sleep, whereas 24-h crying/behavior duration was not associated with proportion of active sleep.

Conclusions

Subsiding of early crying and decreasing of proportion of active sleep are parallel phenomena in some infants. However, this association was thought to be attributable to the influence of covariates, including co-sleeping or gestational age. The underlying mechanisms regulating these developmental processes might overlap with one another, as covariates that affect one process could affect the other.     

Baseline serum magnesium concentrations and neurodevelopmental outcomes of extremely low birth weight premature infants

Aim

To test the hypothesis that, in ELBW infants who did not receive antenatal MgSO₄, lower baseline serum Mg is associated with poorer neurodevelopmental outcomes (NDO).

Study design

The study was conducted in two phases: Phase 1 — retrospective, and Phase 2 — prospective.

Subjects

Extremely low birth weight infants.

Outcome measures

Mortality and adverse NDO were assessed in relation to initial serum Mg measured in the first 12 hours of age.

Results

We studied 156 ELBW infants. In phase 1 (n = 102): initial serum Mg (median [IQ range]) was greater in the infants who died compared to those who survived (1.7 [1.5–2.2] mg/dL vs. 1.6 [1.4–1.7] mg/dL, p = 0.034). In phase 2 (n = 54): initial serum Mg was greater in infants who died or had adverse NDO at 9 months when compared to those who survived with better NDO (1.7 [1.55–2.1] mg/dL vs. 1.5 [1.4–1.68] mg/dL, p = 0.008). Using receiver operating characteristic (ROC) curve, increased Mg concentration in the first 12 hours > 1.6 mg/dL was associated with unfavorable outcomes with sensitivity of 73%, specificity of 67%, and odds ratio of 5.5 (CI = 1.2–24.8, p = 0.037).

Conclusions

In a cohort of preterm infants without antenatal exposure to MgSO₄, initial serum Mg concentrations associated positively with poor outcomes. Further studies are needed in ELBW infants with poor NDO to determine whether they have a dysfunctional transport system that prevents Mg from entering into cells, or they have an active process that excretes Mg extracellularly.     

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.     

Mode of delivery may influence neonatal responsiveness to maternal separation

Introduction

Maternal–infant separation (MIS) is a highly stressful situation for the neonate.

Materials and methods

A study was conducted to observe and describe the reactions of term neonates to brief maternal separation and restoration of skin contact within the first 48 h of life, and to assess whether the mode of delivery influences neonatal responsiveness. A brief maternal–infant separation situation was videotaped to observe the reactions of the newborns within the first 12–48 h of life. Characteristics observed in the newborns were: the Moro reflex, spreading out arms and feet, looking at the mother, presence/lack of crying, and some dichotomous variables (present or lacking); in mothers: adult speech, “motherese” speech, speaking to another adult present in the room, singing, clicking, tapping on the diaper, rocking, kissing the baby, touching toes, touching hands, changing position, making loving comments, calling the newborn by his/her name and touching his/her back. Crying on restoration of contact was measured.

Results

Ten neonates born by planned C-section and 21 neonates born by oxytocin-induced vaginal delivery were included. No behavioral differences were observed according to the mode of delivery. Neonates born by vaginal delivery took longer (64.8 ± 8.6 s) to calm down than those born by C-section (0.9 ± 1.4 s) (p = 0.004). A correlation was observed between cortisol concentrations at birth and the time required to calm the baby down (r = 0.41; p = 0.02).

Conclusion

Neonates born by a planned C-section cried much less on maternal separation, which might indicate an altered attachment behavior and altered response to stress. Further studies are needed to determine the potential long-term implications of variations in mother–infant attachment during the first days of life.     

Parenting stress in mothers of very preterm infants — Influence of development,temperament and maternal depression

Objective

To measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared.

Results

Questionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p = 0.022), with 19% of the preterm group and 9% of the term group having high scores (p = 0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis.

Conclusions

Parenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.     

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.     

Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction

Background

Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown.

Aims

This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction.

Study design and participants

Mothers of infants aged 12 months old (N = 111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device.

Results

Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction.

Conclusions

Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.