The impact of traumatic delivery on the mother–infant relationship

Abstract

This paper considers the effect of traumatic delivery on the mother's state of mind and on her relationship with her new baby. Thought is also given to the parental couple's relationship when they have experienced a traumatic delivery. Research associated with traumatic birth experience, post-traumatic stress disorder and the effect on the developing foetus of high levels of anxiety during pregnancy are further discussed. Clinical material is used to illustrate the distress experienced by two mothers when they have felt traumatised by a difficult labour and birth.     

Graduating Pediatric Residents Entering the Hospital Medicine Workforce, 2006–2015

Objective

In October 2016, the American Board of Medical Specialties approved the petition for pediatric hospital medicine (PHM) to become the newest pediatric subspecialty. Knowledge about residents entering the PHM workforce is needed to inform certification and fellowship accreditation. This study describes the characteristics of graduating pediatric residents with PHM positions and identifies factors associated with postresidency position choices.

From the father's point of view: How father's representations of the infant impact on father–infant interaction and infant development

Despite the knowledge that fathers uniquely contribute to the development of their infants, relatively few studies have focused on the father–infant relationship during early infancy. In the present longitudinal study we included 189 fathers and examined whether their early attachment representations of the infant predicted future quality of father–infant interaction. We also investigated whether these representations were related to the infant's development. Paternal attachment representations were assessed by the Working Model of Child Interview (WMCI) at 6 months post-partum and classified fathers' representations as ‘balanced’ or ‘unbalanced’ (disengaged or distorted). At 24 months, father–infant interaction was videotaped and analyzed by the NICHD coding scales. Further, the Peabody Picture Vocabulary Test (PPVT-III) was administered to evaluate the infant's verbal development. Results revealed that fathers' early attachment representations of the infant predict the quality of future father–infant interaction, with balanced representations more strongly associated with more favorable behaviors in fathers and infants. In addition, paternal interactive behavior appears an important mechanism through which paternal representations influence the development of the infant. These results underline the importance of early identification of fathers with unbalanced attachment representations, and we therefore recommend that more attention should be directed to the quality of the early father–infant relationship in clinical settings.     

Long-term follow-up of male patients after reconstruction of the bladder–exstrophy–epispadias complex: Psychosocial status,continence, renal and genital function

ObjectiveThere is a paucity of knowledge about long-term outcome issues in the bladder–exstrophy–epispadias complex (BEEC). Adult male BEEC patients were investigated in respect of bladder and renal function, fertility, genital function and psychosocial facts.Patients and methodsIn a cross-sectional study, 17 adult male BEEC patients (mean age 23.4 years) from a single centre were evaluated with a questionnaire, renal and bladder ultrasound, blood tests, hormonal profile and semen analysis.ResultsPhenotypically one patient had complete epispadias and 16 had classical bladder exstrophy. Five patients underwent a one-stage functional reconstruction as a primary and 12 as a redo procedure. After a mean follow-up of 19.4 years, 15 bladders were preserved with 12 voiding per urethram and 3 performing intermittent catheterization; 2 were secondarily diverted. Significant residual urine was present in 10; kidneys were normal in 14 patients. Sixteen patients proved ejaculations, 3 had normospermia, 7 oligoasthenospermia and 6 azospermia. In patients with only one single bladder neck procedure normospermia was statistically significant.ConclusionAfter functional BEEC reconstruction, long-term bladder function is preserved with mostly normal renal function. The number of bladder neck attempts has a significant influence on andrologic outcome. Detailed analysis may detect multifactorial pathogenesis from the impaired sperm quality in the BEEC.     

Implementation of neonatal phototherapy with the BiliCocoon Bag® device in the maternity ward and impact on mother–infant separation

BackgroundFree bilirubin jaundice is a frequent pathology in the neonatal period. The major complication is neurological toxicity, the most severe form of which is kernicterus. Overall, 5%–10% of jaundiced neonates require treatment. The first-line treatment is phototherapy, with intensive phototherapy being the gold standard. Other equipment is also available, including the BiliCocoon Bag®. It is a safe and controlled therapy that can be performed in the mother's room in the maternity ward, thereby avoiding separation and allowing for breast- or bottle-feeding during treatment. It is easy to install and does not require protective glasses, thus no scope or hospitalization. In our maternity ward, all neonates requiring intensive phototherapy are hospitalized in the neonatology ward.ObjectiveThe objective of our study was to evaluate the number of avoided hospitalizations in neonatology for free bilirubin jaundice since the introduction, according to a strict protocol, of the BiliCocoon Bag® device.Material and MethodThis was a single-center retrospective cohort study using data of newborns usually collected as part of standard care. Children born in our maternity ward during an 18-month period (August 1, 2020 to January 31, 2022) were included. Causes of jaundice, age at the beginning and mode of treatment, number of sessions for each device, and length of stay were compared. Results are presented as number and percentage with median (25th–75th) or mean (extremes) values for categorical and continuous variables, respectively. A t-test was used to compare the means of the independent groups.ResultsA total of 316 newborns were included. Physiological jaundice was the main cause of jaundice. The median age for the first phototherapy treatment was 54.5 h (30–68). The 316 neonates needed 438 phototherapy sessions: 235 (74%) neonates required only one phototherapy session, 85 (36%) of them were treated with the BiliCocoon Bag®. For the 81 children who needed two or more phototherapy sessions, 19 children (23.5%) were treated by tunnel phototherapy and then the BiliCocoon Bag®, and eight children (10%) by BiliCocoon Bag® alone. The BiliCocoon Bag® enabled a relative reduction in the hospitalization rate of 38% and avoided hospitalization for approximately one third of the newborns treated. The BiliCocoon Bag® failure rate was 3.6% and the average length of stay was comparable between the two types of treatment.ConclusionFollowing a strict protocol of use, the BiliCocoon Bag® is a reliable method and a good alternative to intensive phototherapy for newborns in the maternity ward, as it avoids hospitalization and mother–infant separation.     

Pattern of injury mortality by age-group in children aged 0–14 years in Scotland, 2002–2006, and its implications for prevention

Background  

Knowledge of the epidemiology of injuries in children is essential for the planning, implementation and evaluation of preventive measures but recent epidemiological information on injuries in children both in general and by age-group in Scotland is scarce. This study examines the recent pattern of childhood mortality from injury by age-group in Scotland and considers its implications for prevention.     

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015–2016

ObjectivesTo describe aspects of the microcephaly epidemic in the state of Piauí.MethodsAll cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n = 100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n = 63) were used as a comparison group.ResultsIn October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p < 0.001); 33 confirmed cases (35.9%) had a head circumference z-score between ?2 and ?3, 23 (25%) between ?3 and ?4, and 8 (8.7%) had a z-score of less than ?4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group.ConclusionsThe state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.     

Annual Report on Health Care for Children and Youth in the United States: Trends in Racial/Ethnic,Income, and Insurance Disparities Over Time, 2002–2009

ObjectiveTo examine trends in children's health access, utilization, and expenditures over time (2002–2009) by race/ethnicity, income, and insurance status/expected payer.MethodsData include a nationally representative random sample of children in the United States in 2002–2009 from the Medical Expenditure Panel Survey (MEPS) and a nationwide sample of pediatric hospitalizations in 2005 and 2009 from the Healthcare Cost and Utilization Project (HCUP).ResultsThe percentage of children with private insurance coverage declined from 65.3% in 2002 to 60.6% in 2009. At the same time, the percentage of publicly insured children increased from 27.0% in 2002 to 33.1% in 2009. Fewer children reported being uninsured in 2009 (6.3%) compared to 2002 (7.7%). The most significant progress was for Hispanic children, for whom the percentage of uninsured dropped from 15.0% in 2002 to 10.3% in 2009. The uninsured were consistently the least likely to have access to a usual source of care, and this disparity remained unchanged in 2009. Non-Hispanic whites were most likely to report a usual source of care in both 2002 and 2009. The percentage of children with a doctor visit improved for whites and Hispanics (2009 vs 2002). In contrast, black children saw no improvement during this time period. Between 2002 and 2009, children's average total health care expenditures increased from $1294 to $1914. Average total expenditures nearly doubled between 2002 and 2009 for white children with private health insurance. Among infants, hospitalizations for pneumonia decreased in absolute number (41,000 to 34,000) and as a share of discharges (0.8% to 0.7%). Fluid and electrolyte disorders also decreased over time. Influenza appeared only in 2009 in the list of top 15 diagnoses with 11,000 hospitalization cases. For children aged 1 to 17, asthma hospitalization increased in absolute number (from 119,000 to 134,000) and share of discharges (6.6% to 7.6%). Skin infections appeared in the top 15 categories in 2009, with 57,000 cases (3.3% of total).ConclusionsDespite significant improvement in insurance coverage, disparities by race/ethnicity and income persist in access to and use of care. Hispanic children experienced progress in a number of measures, while black children did not. Because racial/ethnic and socioeconomic disparities are often reported as single cross-sectional studies, our approach is innovative and improves on prior studies by examining population trends during the time period 2002–2009. Our study sheds light on children's disparities during the most recent economic crisis.