Maternal depressive symptoms during pregnancy, and newborn irritability

Maternal depression is associated with a wide range of adverse outcomes for children, including poor mother-infant interactions at 3 months post-partum. The aim of this study is to determine whether maternal depressive symptoms during pregnancy are associated with neonatal neurobehavioral functioning, as measured by the Neurologic and Adaptive Capacity Scale. The study population consists of 1,123 mothers and their term infants who were participants in a larger study of maternal health and infant outcomes. Women were administered the Center for Epidemiologic Studies-Depression (CES-D) questionnaire for depressive symptoms during their pregnancy. Their infants were subsequently assessed by a pediatrician blind to their CES-D scores. The CES-D score was associated with unconsolability and excessive crying (p less than 0.01). The higher the mother's CES-D score, the more likely it was that the infant would be unconsolable or cry excessively. Mothers with CES-D scores at the 90th percentile were 2.6 times more likely to have unconsolable newborns, compared with women with CES-D scores at the 10th percentile (95% C.I. = 1.54, 4.23). When potentially confounding variables, such as cigarette smoking, alcohol, marijuana, and cocaine use, poor weight gain, income, birth weight, and other drug use, were controlled, the relationship between CES-D score and newborn unconsolability and excessive crying remain unchanged. The results of this study suggest that the relationship between early childhood problems and maternal depressive symptoms may be part of a sequence that starts with depressive symptoms during pregnancy.     

Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample

ObjectiveTo examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample.MethodsOur sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24–31 weeks), moderate/late preterm (MLPT, 32–36 weeks) and full term (FT, 37–41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression.ResultsInfant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19–4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40–3.80, and aOR, 1.74; 95% CI, 1.40–2.16, respectively).ConclusionsMothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.     

Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices

OBJECTIVE: To determine whether maternal depressive symptoms, reported when infants are 2 to 4 months old, are associated with mothers' early parenting practices. DESIGN: Secondary data analyses collected from the National Evaluation of Healthy Steps for Young Children. Data sources included newborn enrollment questionnaires and parent interviews when infants were 2 to 4 months old. Maternal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. SETTING: Twenty-four pediatric practices across the United States. PARTICIPANTS: A total of 5565 families enrolled in Healthy Steps; 4874 mothers (88%) completed 2- to 4-month interviews and provided Center for Epidemiologic Studies Depression Scale data; 17.8% of mothers reported having depressive symptoms. MAIN OUTCOME MEASURES: Ten parenting practices assessed in 3 domains: safety (sleep position and lowering water temperature), feeding (cereal, water, or juice; continuing breastfeeding), and practices to promote child development (showing books, playing with infant, talking to infant, and following 2 or more routines). RESULTS: Mothers with and without depressive symptoms reported similar uses of safety and feeding practices. Mothers with depressive symptoms had reduced odds of continuing breastfeeding (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.61-0.88), showing books (AOR, 0.81; 95% CI, 0.68-0.97), playing with the infant (AOR, 0.70; 95% CI, 0.54-0.90), talking to the infant (AOR, 0.74; 95% CI, 0.63-0.86), and following routines (AOR, 0.61; 95% CI, 0.52-0.72). CONCLUSION: Maternal depressive symptoms are common in early infancy and contribute to unfavorable parenting practices.     

The impact of very premature birth on the psychological health of mothers

BACKGROUND: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. STUDY DESIGN: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. SUBJECTS AND METHODS: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. RESULTS: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. CONCLUSIONS: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.     

Postnatal depression and SIDS: A prospective study

Abstract This study was carried out in response to reports from nurses to a post-neonatal mortality review committee that a number of mothers of infants dying from sudden infant death syndrome (SIDS) appeared to be depressed before the child's death. The New Zealand Cot Death Study was a 3 year multicentre case-control study for SIDS. There were 485 SIDS cases in the post-neonatal age group in the study regions, and these were compared with 1800 control infants. Infants of mothers with either a self-reported use of medication for psychiatric disorders, a history of hospitalization for psychiatric illness or a family history of postnatal depression had a significantly increased risk of SIDS compared with infants of mothers who were either not using medication (odds ratio (OR) = 1.45; 95% confidence interval (Cl) = 1.03, 2.04) or were without a history of hospitalization for psychiatric illness (OR = 1.80; 95% Cl = 1.03, 3.11) or a family history of postnatal depression (OR = 1.61; 95% Cl = 1.06, 2.43). All mothers of infants born in the study areas over a 1 year period were eligible to complete a questionnaire measuring maternal depression when the infant was 4 weeks of age. Thirty-three infants subsequently died from SIDS, and they were compared with 174 controls. Fifteen (45.5%) of the mothers of cases were depressed, compared with 28 (16.1%) of the mothers of controls. This prospective study found that the infants of those mothers that were depressed were more likely to die from SIDS than those of the non-depressed mothers (OR = 4.35; 95% Cl = 1.82, 10.37) and postnatal depression as a risk factor for SIDS was still significant after controlling for possible confounding variables (OR = 3.37; 95% Cl = 1.24, 9.12). We conclude that postnatal depression is a risk factor for SIDS.     

Parent identification of early emerging child behavior problems: predictors of sharing parental concern with health providers

OBJECTIVES: To better understand the predictors of parental discussions with pediatric care providers (pediatricians, psychologists/psychiatrists, social workers, early intervention providers, or other medical specialists) regarding early child behavior problems and to suggest strategies for eliciting early identification from parents in health care settings. DESIGN: A cross-sectional survey of parents of children from a representative healthy birth cohort. The survey included the Infant-Toddler Social Emotional Assessment, measurement of parental worry regarding problematic behavior, and demographic factors. SETTING: Fifteen urban and suburban towns in the northeastern United States. PARTICIPANTS: The study sample consisted of all parents of 11- to 39-month-olds (n = 269) who exceeded the 90th percentile on 1 or more Infant-Toddler Social Emotional Assessment problem domain scores (representing elevated problematic behavior symptoms) from an original sample of 1278. RESULTS: Few parents (17.7%) who reported elevated problematic behavior spoke to a provider about such problems. In adjusted models, speaking to a provider was associated with reported worry about behavior (odds ratio [OR], 3.47 [95% confidence interval (CI), 1.74-6.92]) and with low reported child social-emotional competence (OR, 2.68 [95% CI, 1.23-5.84]). In adjusted models, worry was most likely among parents who reported low child competence (OR, 2.18 [95% CI, 1.07-4.22]) and disruption in family routines attributed to the child's behavior (OR, 2.38 [95% CI, 1.31-4.33]). CONCLUSIONS: Parental worry is a robust predictor of help seeking among parents of children with behavioral problems. Further, lags in social competence contribute to both parental worry and help seeking. These findings, in conjunction with previous evidence that child behavior problems amenable to early intervention are often unidentified, suggest that systematic inquiry by health care providers about parental concerns is important in the identification of early emerging behavioral health problems.     

早产儿母亲生活方式 疾病因素病例对照研究

目的：对早产儿和足月儿母亲生活方式和疾病因素进行问卷调查，分析早产的相关危险因素，为降低早产发生率提供依据。方法：选取严格配对的病例和对照共600例作为研究对象，对母亲进行生活方式、疾病因素和膳食（Knowledge-Attitude-Practice, KAP）等的问卷调查，对新生儿的一般资料进行收集，用条件logistic回归等进行统计分析。结果：①早产儿母亲身高、孕前体重和孕前体重指数均低于足月儿母亲，早产儿出生身长、体重、Apgar评分总和均低于足月儿(P<0.05)；②早产儿母亲的KAP以及总评分都明显低于足月儿母亲(P<0.05)；尤其是早产儿母亲的膳食行为不合理、不科学尤其突出。③经多因素logistic回归分析发现早产的危险因素有反复流产病史和此次妊娠有胎膜早破；保护因素有母亲膳食KAP总评分和母亲孕前体重(P<0.05)。结论：早产的高危人群为孕前体重低、营养知识态度行为评分低、有反复流产史及此次发生胎膜早破者。应强调定期产前检查，加强营养教育，在孕前和孕期尽量避免或消除以上危险因素。     

Maternal depression is associated with mother-infant interaction in preterm infants.

AIM: The purpose of this study was to assess the prevalence and the background factors of maternal depressive symptoms and their relation to the quality of mother-infant interaction in a group of preterm infants and their mothers. METHODS: The signs of maternal depression were evaluated in 125 mothers of very preterm infants (birth weight < or = 1500 g or < 32 gestational weeks) at 6 months of infant's corrected age using Edinburgh Postnatal Depression Scale (EPDS). The association between maternal depressive symptoms and the quality of mother-infant interaction as assessed by the parent child early relational assessment method (PCERA) method was studied at 6 and 12 months of corrected age in 32 preterm infants who were their mothers' firstborn infants and singletons. RESULTS: The prevalence of depression assessed by EPDS in mothers of very preterm infants was 12.6%. Most interestingly, the number of postnatal signs of depression associated negatively with the quality of the maternal interaction behaviour with their preterm infants. CONCLUSIONS: This study suggests that maternal depression may be a risk factor in the development of the mother-infant relationship between preterm infants and their mothers. Therefore, it would be important to identify signs of depression in mothers of preterm infants to offer early support.     

Correlates of mothers' persistent depressive symptoms: a national study.

PURPOSE: The purpose of this study was to examine the prevalence, persistence, and correlates of mothers' depressive symptoms over a 5-year period in a nationally representative sample of the United States population. METHOD: Data from 2235 mothers in the National Survey of Families and Households, Wave I, 1987-1988, and Wave II, 1992-1994, were analyzed. Outcome measures were scores on the Center for Epidemiological Studies Depression Scale (CES-D, 12-item version) and a validated three-item depression screen. RESULTS: One fifth of study mothers had positive CES-D scores and almost half (48%) had negative CES-D scores in both waves. Wave I risk factors for persistent "positive" CES-D scores were maternal age less than 30 years (24%), African-American (33%), never married (26%) or divorced (32%), education less than high school (35%), and indigent (32%). Adjusted odds ratios (AOR) and 95% confidence intervals for persistent "positive" versus persistent "negative" CES-D scores were: age less than 30 years (Wave I), AOR = 1.64, (1.22-2.21); unmarried (Wave II), AOR = 2.60, (1.89-3.56); education less than high school (Wave II), AOR = 2.18, (1.41-3.38); and indigent (Wave II), AOR = 2.09 (1.36-3.21). DISCUSSION: About one fifth of the study sample reported high depressive symptoms twice over a 5-year period. Depression in women, especially mothers, is an urgent public health problem.     

A case-control study to determine risk factors for hospitalization for rotavirus gastroenteritis in U.S. children

OBJECTIVE: The objective of this case-control study nested within a surveillance study conducted at 3 hospitals (Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's Hospital of New Orleans, New Orleans, LA; and Hasbro Children's Hospital, Providence, RI) was to identify risk factors for rotavirus gastroenteritis requiring hospitalization. PATIENTS: Cases were children < or =59 months of age who were admitted with acute gastroenteritis (AGE) and found to have rotavirus infection. Controls were selected from a birth certificate registry (Cincinnati and Providence) or a registry of patients from a large practice consortium in 11 locations (New Orleans). RESULTS: Three hundred forty-nine rotavirus-infected cases and 1242 control subjects were enrolled. Breast feeding was protective against hospitalization for rotavirus AGE for infants <6 months of age. (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2-13.2). Low-birth-weight (<2500 g) infants had increased risk for hospitalization even beyond the first few months of life (OR, 2.8; 95% CI, 1.6-5.0). Children in child care were more likely to be hospitalized for rotavirus AGE than those cared for at home, particularly those > or =24 months of age (OR, 3.0; 95% CI, 1.8-5.3). Other characteristics associated with rotavirus AGE hospitalization were children <24 months of age covered by Medicaid or without insurance (OR, 2.1; 95% CI, 1.4-3.2) and having another child in the house <24 months of age (OR, 1.6; 95% CI, 1.1-2.3). The data suggest that maternal age <25 years (OR, 1.4; 95% CI, 1.0-2.0) and a mother with less than a high school education (OR, 1.5; 95% CI, 1.0-2.3) may also increase risk of rotavirus hospitalization. CONCLUSION: There are socioeconomic and environmental factors and aspects of the child's medical and dietary history that identify children at risk for hospitalization with rotavirus AGE.     

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.     

Making up is hard to do, especially for mothers with high levels of depressive symptoms and their infant sons

BACKGROUND: The goal of this study was to evaluate the interactions of mothers with normative or high levels of depressive symptomatology on the Center for Epidemiologic Studies-Depression Scale (CES-D) and their 3-month-old infants. Although successful mutual regulation of affect is critical to children's socio-emotional development, little is known about the factors that influence dyadic processes such as synchrony, matching, mismatching, and bi-directionality during early infancy. Therefore, this study evaluated the effects of maternal depressive symptom status, infant gender, and interactional context on mother-infant affective expressiveness and the dyadic features of their interactions. METHODS: Participants were 133 mothers and their healthy full-term infants. Mothers were classified into three groups on the basis of their total score on the CES-D at 2 months of infant age: a high symptom group (CES-D score > or = 16), a mid symptom control group (CES-D score = 2-12), and a low symptom group (CES-D score = 0-1). Mothers and infants were then videotaped in the Face-to-Face Still-Face paradigm at 3 months of infant age. The mothers' and infants' affect during the interactions prior to (first play) and following the still-face (reunion play) were coded microanalytically using Izard's AFFEX system. RESULTS: Results indicated that male as compared to female infants were more vulnerable to high levels of maternal depressive symptoms and that high symptom mothers and their sons had more difficult interactions in the challenging reunion episode. CONCLUSIONS: The findings suggest that a cycle of mutual regulatory problems may become established between high symptom mothers and their sons, particularly in challenging social contexts. The long-term consequences of this early social interactive vulnerability in terms of later development need to be further investigated.     

Physical and emotional health of mothers of youth with functional abdominal pain

OBJECTIVE: To determine if mothers of youth with functional abdominal pain (FAP) experience more anxiety, depressive, and somatic symptoms and disorders than mothers of unaffected children. DESIGN: Case-control study. SETTING: Four primary care pediatric practices in western Pennsylvania. PARTICIPANTS: Mothers of 8- to 15-year-old children and adolescents presenting with FAP (59 cases) or for routine care in the absence of recurrent pain (76 controls). OUTCOME MEASURES: Questionnaires and blinded interviews assessing anxiety, depressive, and somatic symptoms and disorders; quality of life; and service use. RESULTS: On univariate analyses, mothers of FAP cases were significantly more likely than mothers of controls to have a lifetime history of irritable bowel syndrome (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.5-10.3), migraine (OR, 2.4; 95% CI, 1.1-5.3), and anxiety (OR, 4.8; 95% CI, 2.2-10.6), depressive (OR, 4.9; 95% CI, 2.2-11.0), and somatoform (OR, 16.1; 95% CI, 2.0-129.8) disorders than mothers of controls, and current anxiety, depressive, and somatic symptoms, poorer overall quality of life, and greater use of ambulatory health, but not mental health, services. Multivariate logistic regression found pediatric FAP to be most closely associated with maternal history of anxiety and depression (adjusted OR, 6.1; 95% CI, 1.8-20.8). CONCLUSIONS: Functional abdominal pain may be better conceptualized as a disorder of emotion than a narrowly defined disorder of gastrointestinal function. Low rates of mental health service use by mothers of youth with FAP suggest that family health and illness attitudes deserve study.     

FLIP-2 Study: risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born in Spain at a gestational age of 32 to 35 weeks

BACKGROUND: Ex-premature infants are more predisposed to complicated primary respiratory syncytial virus (RSV) infection. The aim of the present study was to validate the risk factors found in a previous epidemiologic case-control study regarding hospitalization as a result of RSV infection in premature infants born at 32-35 weeks of gestational age (WGA) in Spain. METHODS: A prospective 2-cohort study was conducted during the 2005-2006 (October 2005 to April 2006) and 2006-2007 (October 2006 to April 2007) RSV seasons, respectively. Cases were premature infants hospitalized for RSV infection whereas controls were premature infants of the same age who did not require any hospitalization for respiratory causes. RESULTS: During the study period 5441 children from 37 Spanish hospitals were included in the risk factor analysis. Two hundred two (3.7%) were cases and the rest controls. Of the cases, 17.8% were admitted to the intensive care unit and 7.4% required mechanical ventilation. None of the patients died. Logistic regression analysis demonstrated that the risk of RSV-related respiratory infection requiring hospital admission in preterm infants (32-35 WGA) was associated with the following factors: absolute chronologic age of < or = 10 weeks at the onset of RSV season [odds ratio (OR): 2.99; 95% confidence interval (CI): 2.23-4.01]; presence of school-age siblings or day care attendance (OR: 2.04; 95% CI: 1.53-2.74); and smoking during pregnancy (OR: 1.61; 95% CI: 1.16-2.25). CONCLUSIONS: In premature infants (32-35 WGA), only 3 independent risk factors were found to significantly increase the risk of RSV-related respiratory infection and hospitalization.     

Health and nutritional status of children of adolescent mothers: experience from a diarrhoeal disease hospital in Bangladesh

AIM: The study aimed at assessing clinical and nutritional features and socioeconomic characteristics of the first birth-order children (1-48 months) of adolescent mothers. METHODS: Five hundred and thirty-nine first birth-order children of both sexes, aged 1-48 month(s) were studied. All study children had adolescent mothers aged < or =19 years (when attending hospital), who attended (as a patient) the Dhaka hospital of ICDDR, B during 2000-2005. A similar group of children (n = 540) of mothers aged 25-29 years (when attending hospital) constituted the comparison group. RESULTS: Malnutrition indicated by underweight [OR 2.3, 95% CI 1.7-3.1, p < 0.001], stunting [OR 2.1, 95% CI 1.5-2.8, p < 0.001], wasting [OR 1.8, 95% CI 1.3-2.7, p = 0.001], infancy (<12 months old) [OR 2.8, 95% CI 2.1-3.9, p < 0.001], duration of hospitalization (> or =48 h) [OR 1.6, 95% CI 1.2-2.2, p = 0.001], DPT immunization [OR 1.8, 95% CI 1.3-2.5, p = 0.001] and maternal illiteracy (no formal schooling) [OR 1.5, 95% CI 1.1-2.0, p = 0.007] were significantly associated with children of adolescent mothers, after adjusting for co-variates in the logistic regression analysis. Similar results were also observed when different indices of malnutrition (stunting, underweight or wasting) were added separately to the different models. CONCLUSION: Children of adolescent mothers are likely to be more malnourished, have lesser opportunities for DPT immunization and have longer duration of hospitalization. Adolescent mothers were also more likely to be illiterate. Therefore, the development of preventive and therapeutic strategies will be required to reduce morbidity and improve the health and nutrition status of both children and their adolescent mothers.     

Mothers With Positive or Negative Depression Screens Evaluate a Maternal Resource Guide

IntroductionSocial isolation is common in mothers with high depressive symptoms. This study tested the hypothesis that a maternal resource guide that provided mothers with links to community human service agencies would be deemed more helpful by mothers with positive depression screens (PDS) compared with mothers with negative depression screens (NDS).MethodThis investigation was a cross-sectional survey study of a convenience sample from a primary care practice–based research network, the Southwestern Ohio Ambulatory Research Network (SOAR-Net). English-speaking mothers who took their child(ren) to SOAR-Net practices were eligible to participate in the study. Data were collected between May 2006 and March 2009. A total of 1048 mothers completed the survey, and 234 mothers refused to participate.ResultsMothers were more likely to report that “This guide is helpful to me” if they were single (odds ratio [OR] = 4.05; 95% confidence interval [CI]: 2.77-5.94), their child had public health insurance (OR = 3.59; 95% CI: 2.39-5.40), or they had PDS (OR = 3.57; 95% CI: 2.13-5.98). After adjusting for a number of demographic variables, PDS continued to be significantly associated with “This guide is helpful to me” (adjusted OR = 2.68; 95% CI: 1.58-4.56).DiscussionMothers with PDS were more likely to report that the maternal resource guide would be personally helpful compared with mothers with NDS.     

胎龄≤32周早产儿低血糖的危险因素分析

目的 探讨胎龄≤32周早产儿出生后发生低血糖的危险因素。方法 回顾性纳入2017年1月至2020年6月入住新生儿重症监护病房的86例胎龄≤32周低血糖早产儿作为低血糖组,随机选取同期住院监测血糖正常的早产儿172例为对照组。采用单因素分析与多因素logistic回归分析筛选早产儿低血糖的危险因素。结果 研究期间早产儿共计515例,其中低血糖86例（16.7%）。低血糖组小于胎龄儿（SGA）、剖宫产出生、孕母高血压、产前使用激素的比例均高于对照组（P < 0.05）,而出生体重及血糖检测前已静脉使用葡萄糖的比例均低于对照组（P < 0.05）。SGA（OR=4.311,95% CI：1.285~14.462）、孕母高血压（OR=2.469,95% CI：1.310~4.652）和产前使用激素（OR=6.337,95% CI：1.430~28.095）为早产儿低血糖的危险因素（P < 0.05）,静脉使用葡萄糖（OR=0.318,95% CI：0.171~0.591）为早产儿低血糖的保护因素（P < 0.05）。结论 SGA、孕母高血压和产前使用激素可增加胎龄≤32周早产儿早期发生低血糖的风险;对胎龄≤32周早产儿,建议生后尽早静脉使用葡萄糖,以减少低血糖的发生。     

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.     

早产儿晚发型败血症危险因素及病原学分析

目的探讨早产儿晚发型败血症的危险因素及病原学特点。方法选择2012年1~12月入住我院新生儿科确诊或临床诊断晚发型败血症的早产儿为观察组,同期入住未并发败血症的早产儿为对照组。回顾性分析比较两组患儿的临床资料,以及血培养检出的病原菌分布情况和药敏情况。结果观察组60例,对照组290例。单因素分析显示出生胎龄≤32周、体重〈1500 g、小于胎龄儿（SGA）、胎膜早破、胃管留置时间〉14天、经外周中心静脉置管（PICC）、胃肠外营养时间〉14天、并发坏死性小肠结肠炎（NEC）、并发巨细胞病毒（CMV）感染、新生儿重症监护室（NICU）住院时间〉5天与早产儿晚发型败血症的发生有关（P〈0.05）。Logistic回归分析显示,出生胎龄≤32周（OR=2.710,95%CI：1.200~6.121）、SGA（OR=4.114,95%CI：1.635~10.354）、PICC置管（OR=2.485,95%CI：1.178~5.239）、并发NEC（OR=15.270,95%CI：5.058~46.100）、CMV感染（OR=20.130,95%CI：5.279~76.754）为早产儿晚发型败血症的独立危险因素。观察组中20例血培养阳性,培养出革兰阴性菌13株（65%）,其中肺炎克雷伯菌10株（50%）、大肠埃希菌2株（10%）、产酸克雷伯菌1株（5%）;革兰阳性菌2株（10%）,均为表皮葡萄球菌;真菌5株（25%）,其中近平滑假丝酵母菌4株（20%）,白色念珠菌1株（5%）。13株革兰阴性菌有10株为产超广谱β内酰胺酶（ESBLS）菌株,其中8株为肺炎克雷伯菌。结论出生胎龄≤32周、SGA、PICC置管、并发NEC、CMV感染为早产儿晚发型败血症的危险因素,肺炎克雷伯菌是最主要的致病菌,耐药性强,其次是近平滑假丝酵母菌。