婴儿母亲育儿压力及相关影响因素分析

目的调查南京市主城区6个月婴儿母亲的育儿压力,并分析相关的影响因素。方法采用简式育儿压力问卷（中文版）（parenting stress index-short form,PSI-SF）和自编基本情况调查表对随机抽取的420组南京市的6个月婴儿及其母亲进行调查并比较分析。结果母亲的文化程度与育儿压力呈负相关;婴儿的性别、家庭收入及母亲年龄与母亲的育儿压力差异无统计学意义。结论在婴幼儿期,母亲的受教育程度是影响其育儿压力的重要因素之一。     

Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit

Objective: This study aims to determine maternal stress and anxiety as perceived by mothers whose premature infants were admitted to the neonatal intensive care unit (NICU) and to identify maternal stress and its relationship with maternal and infant characteristics and anxiety.

Background: Vulnerable premature infants commonly require special care in the NICUs. In most cases, prolonged hospitalization results in stress and anxiety for the mothers.

Methods: A non-probability convenience survey was used in a public hospital, with 180 mothers completing the 26-item Perceived Stress Scale (PSS) and a 40-item State-Trait Anxiety Inventory (STAI).

Results: 56.5% of mothers had high levels of stress, 85.5% of mothers had a high level of state-anxiety and 67.8% of mothers had a high level of trait-anxiety. The stress experienced by these mothers had a significant relationship with anxiety, and was found to be associated with state and trait anxiety levels, but not with maternal and infant characteristics.

Conclusion: Mothers in this setting revealed high levels of stress and anxiety during their premature infants’ NICU admission. An immediate interventional programme focusing on relieving mothers’ anxiety and stress is needed to prevent maternal stress and anxiety at an early stage.     

Antenatal corticosteroid therapy in premature infants

Objective The objective was to examine the effect of antenatal corticosteroid treatment on premature infants, with special attention to any possible adverse effects on neonatal outcome.Methods A retrospective chart review of all singleton and multiple pregnancies delivered in our perinatal center between 1991 and 1999, who had a birth weight of 1,500 g and who were subsequently admitted to our neonatal intensive care unit. Three hundred and sixty-five infants were included in the study and divided into two groups. One group had a gestational age below 28 weeks (196 days) and one group was 28 weeks (>196 days) onward.Results Antenatal corticosteroid therapy reduced the duration of mechanical ventilation, the need for supplementary oxygen, and the need for exogenous surfactant in neonates born at >196 dayss gestation (p<0.05). Corticosteroid treatment seemed to benefit the respiratory distress syndrome (RDS; p=0.051) in this group. There were less cases of necrotizing enterocolitis and neonatal death in the group with corticosteroid treatment (p<0.05). Before 28 weeks gestation, all parameters that were examined (e.g., duration of mechanical ventilation, need for supplemental oxygen, need for exogenous surfactant, RDS) showed no significant differences between those pregnancies pre-treated with corticosteroids or those not treated with corticosteroids. There was no adverse effect of corticosteroids on chorioamnionitis and early onset sepsis in pregnancies with a premature rupture of the membranes. Repeated corticosteroid treatment had no effect on birth weight, but did not improve neonatal outcome either. The interval between last corticosteroid treatment and delivery had no influence on RDS. There was no effect of corticosteroids on periventricular leukomalacia and intraventricular hemorrhage. Regression analysis showed a higher risk of severe RDS in multiple gestations.Conclusion Antenatal betamethasone treatment reduces perinatal morbidity and mortality after 28 weeks gestation. We found no adverse effects and also no benefit of repetitive corticosteroid treatment. The interval between last corticosteroid treatment and delivery did not influence the incidence of RDS. Dose, timing, and rate of antenatal corticosteroids should be reconsidered in multiple gestations.     

Incubators versus mothers' arms: body temperature conservation in very-low-birth-weight premature infants

OBJECTIVE: To determine whether there is a significant difference between the temperatures of very-low-birth-weight (VLBW) premature infants in the incubator and in the mothers' arms. DESIGN: Repeated measures, with random assignment to treatment order and the infants serving as their own controls. SETTING: A 40-bed tertiary-level nursery in a university teaching hospital. PARTICIPANTS: A convenience sample of 20 preterm infants weighing 1,095 to 1,500 g and from 30 to 37 weeks postconceptional age. The infants were screened for factors that would interfere with temperature maintenance. MAIN OUTCOME MEASURES: Axillary temperatures were measured with an electronic thermometer for equal periods of time in incubators and mothers' arms. The mean temperature differences between the two study conditions were compared using two-tailed t tests and repeated analysis of variance (ANOVA). Weight was monitored and analyzed for evidence of increased metabolic activity. RESULTS: No significant variations were found in the infants' mean temperatures in the incubator, but the infants were significantly warmer while in their mothers' arms. CONCLUSION: VLBW premature infants can maintain a stable temperature in their mothers' arms without evidence of increased metabolic activity. Nurses can encourage mothers to hold their infants without fear of cold stress or weight loss.     

Posttraumatic stress symptoms following pregnancy complicated by hyperemesis gravidarum

Abstract

Objective.?Hyperemesis gravidarum (HG) can be accompanied by severe physical and emotional distress. Most studies have focused on the physical and psychological stress associated with this condition during the affected pregnancy. This study explores posttraumatic stress symptoms (PTSS) and negative life outcomes following HG pregnancies.

Methods.?A total of 610 women (HG?=?377 and control?=?233) were recruited and completed an online survey. χ-square analyses were used to compare the HG and control groups on various life outcome variables.

Results.?Eighteen percent of women with HG reported full criteria PTSS (n?=?68). Negative life outcomes regarding financial and marital status, career, as well as psychological and physical well-being differed significantly for the HG groups compared to the control group (0.001?<?p?<?0.05).

Conclusions.?PTSS is common following HG pregnancies and is associated with negative life outcomes including inability to breastfeed, marital problems, financial problems, and inability of self care.     

Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence

Objective

To evaluate posttraumatic stress disorder (PTSD), depression, and hopelessness in women 1 and 6 months after they experienced sexual violence.

Methods

This prospective study, in which the clinician-administered PTSD scale, the Beck depression inventory, and the Beck hopelessness scale were used, included 67 women at 1 month and 52 women at 6 months after they experienced sexual violence.

Results

Overall, 77.6% of the women were ≤ 24 years of age, and 52% were adolescents; 15% had a history of drug abuse, and 13.5% had a history of previous sexual violence. The aggressor was unknown in 76% of cases, and there was more than 1 aggressor in 9% of cases. In the first month, 43% of the women had moderate or very severe PTSD; 52.2% had moderate or severe depression; and 22.4% had moderate or severe hopelessness, which decreased to 21%, 20% and 10%, respectively, at 6 months. In the first month, severity of PTSD was associated with moderate or severe depression, and at 6 months severity of PTSD was associated with multiple aggressors and previous psychiatric disorders. All scores decreased in the sixth month.

Conclusion

Severe mental health disorders were still present 6 months after women had experienced sexual violence.     

Exploring posttraumatic stress disorder symptom profile among pregnant women

Posttraumatic stress disorder (PTSD) is more prevalent in perinatal than general samples of women (6–8% vs. 4–5%). To explore potential causes, we examined the symptom profiles of women belonging to two separate samples: a perinatal clinic sample (n?=?1581) and a subsample of women in a similar age range from the U. S. National Women's Study (NWS) (n?=?2000). Within the perinatal sample, risk ratios were higher for all 17 PTSD symptoms among women with current PTSD compared with unaffected women, suggesting that higher rates are not likely due to measurement error. The younger age and greater social disadvantage in the perinatal clinic sample contributed only a small proportion of variance in symptom levels compared with extent of trauma exposure and pre-existing PTSD. Compared with the national study sample's symptom profile, the perinatal sample had higher rates of occurrence of five symptoms: detachment, loss of interest, anger and irritability, trouble sleeping, and nightmares. This analysis confirms that PTSD rates are higher in perinatal samples, which is likely due to exacerbation of pre-existing PTSD among women of a younger age and greater social disadvantage. Further elucidation is warranted, including identifying triggers and determining if there are needs for pregnancy-specific interventions.     

Breastfeeding practices in mothers of high-respiratory-risk NICU infants: impact of depressive symptoms and smoking

Abstract

Aim: Mothers of infants in the neonatal intensive care unit (NICU) have very low breastfeeding rates and these high-respiratory-risk (HRR) NICU infants may benefit from breastfeeding through decreased risk for respiratory illnesses. This population’s increased risk for maternal depression and high rates (22%) of maternal smoking may negatively affect breastfeeding.

Objective: This exploratory study investigated associations of breastfeeding with depressive symptoms and maternal smoking in mothers of HRR NICU infants (i.e. presence of one household smoker and birth weight <1500?g or mechanical ventilation ≥12?h).

Methods: Breastfeeding, depression and smoking data were collected from 104 mothers in the NICU following delivery.

Results: Fifty-five (52.9%) mothers reported breastfeeding, 39 (37.5%) had a Center for Epidemiological Studies Depression Scale (CES-D) score (≥16) suggestive of depression, and 36 (34.6%) reported smoking. Mothers with CES-D scores ≥16 were less likely to breastfeed compared to those with scores <16 (38.5% versus 61.5%; p?=?0.02). Breastfeeding and smoking were not significantly associated (p?<?0.10). Mothers of HRR infants with significant depressive symptoms who smoke have significantly lower breastfeeding rates (21%) than mothers who are not depressed and do not smoke (65%).

Conclusions: Interventions to improve breastfeeding initiation and continuation that target depression and smoking are necessary.     

Respiratory distress syndrome in twin infants compared with singletons

OBJECTIVE: The purpose of this study was to determine gestational age-specific incidence and risk factors of respiratory distress syndrome (RDS) in twins compared with singletons. STUDY DESIGN: An analysis of 850,406 singleton and 23,278 twin infants born alive in Finland between 1987 and 2000 was performed. A number of antenatal and perinatal/intranatal factors were evaluated. RESULTS: At less than 28 weeks of gestation, the incidence of RDS was higher in both first- and second-born twins compared with singletons. At more advanced gestation, first-born twins had a significantly lower incidence of RDS compared with the others. There was no difference in the concordance of RDS between same-sex and opposite-sex twin pairs. Vaginal delivery, female sex, being born first, and being the lighter of the twins protected from RDS. CONCLUSION: After taking into account gestation, twins are not at higher risk of RDS compared with singletons except at very early gestation. Environmental factors predominate over genetic ones in the predisposition to RDS in twins.     

A comparative study of HHHFNC and NCPAP in preventing reintubation in extreme preterm infants born at less than 30-week gestation

Introduction: Despite recent advances in respiratory support, the wide use of antenatal steroids and surfactant-replacement therapy, respiratory problems continue to represent the leading cause of mortality in premature infants during the neonatal period. In the last few years, HHHFNC has been widely adopted as a mode of noninvasive respiratory support for infants with respiratory difficulties. However, data of the safety and efficacy of HHHFNC use in extremely premature infants are scarce. This study will aid in bridging the knowledge gap and sheds light on the efficacy and, more importantly, the safety of HHHFNC as noninvasive respiratory support for extremely premature infants.

Methods: This is a retrospective comparative study conducted at neonatal intensive care unit (NICU), Norfolk and Norwich University Hospital between 1 October 2010 and 31 December 2014. Data were collected from the medical notes and electronic records of the eligible patients. Participants’ total number was 26, 9 patients in nCPAP group while HHHFNC group consisted of 17 patients. The participants’ gestational age was ranging between 24 to 29?+?9 weeks who were supported by either nCPAP or HHHFNC after first extubation. Primary outcome was defined as the need for reintubation within 72-hour immediately postextubation, i.e. failure of noninvasive respiratory support.

Results: Study showed no statistically significant differences in either primary (nCPAP (9/2 [22%]), HHHFNC (17/2 [12%]; p?=?.59)) or secondary outcomes (Constant need for O₂ in the first 4 weeks of life (p?=?.62), pneumothorax (p?=?1.0), nasal injury (p?=?.35)). p Value for spontaneous bowel perforation was not computed, as there were no affected patients.

Conclusions: The study demonstrates that HHHFNC is similarly safe and efficacious in comparison to nCPAP as noninvasive respiratory support for extremely premature infants’ postextubation.     

汶川大地震妇女创伤后应激障碍的抽样调查研究

目的:调查地震灾害对灾区妇女特别是孕产妇的心理影响,以及社会支持对灾区妇女心理健康的保护作用。方法:于地震发生后第3个月,采用PTSD检查量表平民版(PCL-C)和社会支持量表(MSPSS)对绵阳地区孕妇和育龄期非孕妇女进行问卷调查,并进行相关分析。结果:孕妇组和对照组中各有7例(15.2%)和18例(33.3%)预测发生创伤后应激障碍(PTSD),两组PTSD发生率差异有统计学意义(P<0.05)。对照组PCL-C与MSPSS测量结果之间明显负相关(r=-0.414,P=0.002),孕妇组则无相关性(P>0.05)。结论:地震给妇女的心理健康造成影响,较高的社会支持对于降低孕妇的应激反应程度可能起到一定的保护性作用。     

新生儿重症监护病房早产儿细菌定植的临床研究

目的了解NICU中住院早产儿的细菌定植状况及定植菌的耐药性。方法对2002年5月至2003年4月间在北京协医院NICU住院治疗的早产儿进行细菌学监测，于入院时和入院后每周常规做咽拭子及直肠拭子培养。收集每位早产儿的临床及实验室资料，对结果进行统计学分析。结果147例早产儿共培养出183株定植菌。入院当天即有细菌定植者11例，入院后发生细菌定植者52例。定植菌以革兰阴性杆菌为主(占62.8%)。早产儿获得细菌定植与胎龄小、出生体重低、住院时间长、应用机械通气、胃肠外营养、长时间使用抗生素等因素有关。美罗培南在目前所用抗生素中对革兰阴性杆菌敏感性最高，但与耐甲氧西林凝固酶阴性葡萄球菌(MRScoN)定植之间具有相关性。败血症以革兰阴性杆菌为主，细菌定植1周左右为败血症高发期。结论应对在NICU住院的早产儿进行细菌学监测，根据监测结果判断细菌定植状态和采取保护措施。控制抗生素使用、缩短住院时间和胃肠外营养的时间，对控制早产儿细菌定植将起到重要作用。     

Childbirth Narratives of Women With Posttraumatic Stress Symptoms in the Postpartum Period

Objective

To examine cognitive, emotional, and perceptual differences in the childbirth narratives of women with high levels of posttraumatic stress symptoms (PTSS) compared with women with low levels of PTSS in the postpartum period.

Longitudinal study of perinatal maternal stress,depressive symptoms and anxiety

Objectives

to understand the trends in, and relationships between, maternal stress, depressive symptoms and anxiety in pregnancy and post partum.

Design

a prospective longitudinal survey study was undertaken to explore maternal psychological distress throughout the perinatal period. The participants were recruited after 24 completed weeks of gestation, and were followed-up monthly until one month post partum (four surveys in total).

Setting

participants were recruited from a single hospital in southern Taiwan, and asked to complete questionnaires in the hospital waiting area.

Participants

inclusion criteria were: age ≥18 years, able to read and write Chinese, ≥24 weeks of gestation, singleton pregnancy and no pregnancy complications (including a diagnosis of antenatal depression or anxiety disorder). In total, 197 women completed all four surveys (response rate 74.62%).

Measurements and findings

stress was measured with the 10-item Perceived Stress Scale, depressive symptoms were measured with the Center for Epidemiologic Studies' Depression scale, and anxiety was measured with the Zung Self-reported Anxiety Scale. Participants were followed-up at four time points: T1 (25–29 gestational weeks), T2 (30–34 gestational weeks), T3 (>34 gestational weeks) and T4 (4–6 weeks post partum). Appointments for data collection were made in accordance with the participants' antenatal and postnatal check-ups. The three types of maternal distress had different courses of change throughout the perinatal period, as levels of depressive symptoms remained unchanged, anxiety levels increased as gestation advanced but declined after birth, and stress decreased gradually during pregnancy but returned to the T1 level after birth. There was a low to high degree of correlation in maternal stress, depressive symptoms and anxiety in pregnancy and post partum.

Key conclusions

around one-quarter of the study participants had depressive symptoms during pregnancy and post partum. Stress and anxiety showed opposing courses during the perinatal period. Regardless of the trend, maternal mental distress returned to the T1 level after birth.

Implications for practice

effective survey questionnaires are suggested for use as primary screening for possible psychological distress among pregnant and post partum women. It is suggested that health care professionals involved in obstetrics and midwifery should pay attention to the psychological needs of pre- and postnatal women, provide women with sufficient information about their mental well-being, and make appropriate and timely referrals to psychiatric or psychological care.     

Review of literature for the striking clinic picture seen in two infants of mothers with systemic lupus erythematosus

Fertility and maintanence of pregnancy is impaired in patients with SLE, which is an autoimmune disease commonly seen in women of childbearing age, due to disease-causing autoantibodies. The auto-antibodies transplacentally passing to the fetus may destroy the specific fetal tissues according to their types. These harmful effects may also continue in postnatal life.

Here, we report two neonates born to mothers with SLE, and presented with clinically different pictures. The first case, who was born to a mother with asymptomatic SLE, had fetal arrhythmias in prenatal period, and developed complete AV block shortly after birth. Specific auto-antibodies of the mother and infant were positive. Permanent pacemaker was inserted into the infant.

The second case was a completely healthy preterm infant who was born to a mother who had pre-eclampsia in pregnancy and diagnosed with SLE and class I lupus nephritis for 12 years.

Severely affected infants may be born to asymptomatic mothers with SLE while the symptomatic mothers may have healthy babies. These contrasting clinical features of infants of mothers with SLE are associated with the type of disease-causing autoantibodies.     

Resveratrol suppresses hyperoxia-induced nucleocytoplasmic shuttling of SIRT1 and ROS production in PBMC from preterm infants in vitro

Objective: By assessing silent mating-type information regulation 2 homolog 1 (SIRT1) nucleocytoplasmic shuttling and reactive oxygen species (ROS) levels in peripheral blood mononuclear cells (PBMCs), this study aimed to explore the role of SIRT1 in premature infants after exposure to hyperoxia and assess the protective effects of resveratrol (Res).

Methods: Firstly, ROS levels as well as SIRT1 translocation and expression in PBMCs samples were evaluated from 40 premature infants with different oxygen amounts received at birth. Then, PBMCs, from additional 40 premature infants administered no oxygen at birth, were used to establish an in vitro model of hyperoxia.

Results: In infants that received O₂ at birth, ROS and MDA levels, and SIRT1 translocation rates gradually increased in a concentration-dependent manner, while SIRT1 gradually decreased. In agreement, PBMCs cultured in vitro showed increased ROS levels after exposed to hyperoxia, SIRT1 translocation increased as well. However, treatment with Res resulted in opposite effects.

Conclusion: Res inhibits ROS release in PBMCs from preterm infants exposed to hyperoxia, likely by preventing SIRT1 nucleocytoplasmic shuttling and increasing SIRT1 expression.     

Neonatal outcomes of premature infants born to preeclamptic mothers

Objective.?Only limited studies with conflicting results are available on neonatal morbidity and mortality in infants born to preeclamptic mothers. The objective of this study was to evaluate neonatal morbidity and mortality in premature infants born to preeclamptic mothers.

Methods.?Premature infants who were admitted to Uludag University, School of Medicine, Neonatal Intensive Care Unit between June 2006 and December 2007 were included in this study. The infants were evaluated according to their demographic characteristics and neonatal morbidities.

Results.?Fifty-one infants born to preeclamptic mothers (study group) and 33 gestational age- and gender-matched infants born to normotensive mothers (control group) were included in this study. No statistical difference was found between the two groups in terms of demographic characteristics. However, frequency of neutropenia, duration of mechanical ventilation, and neonatal sepsis rates were found to be significantly higher in the study group compared with those of the control group. Although the rates of other neonatal morbidities such as bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage and necrotising enterocolitis were found to be higher in the study group, the difference was not statistically significant. Mortality rates were also found to be similar in both groups.

Conclusions.?The infants born to preeclamptic mothers had significantly higher rates of neutropenia and sepsis. There were no significant difference in terms of other neonatal morbidities and neonatal mortality between the study and the control group.     

Neonatal morbidities among full-term infants born to obese mothers

Introduction: Impact of maternal obesity on full-term neonates is not known.

Objective: We hypothesized increased incidence of neonatal morbidities requiring NICU admission in full-term neonates of obese women compared to neonates of normal-weight women.

Methods: Data from full-term pregnancies collected in the Consortium of Safe Labor study were analyzed. Maternal BMI was classified using the WHO criteria. Incidence of neonatal outcomes including sepsis, PDA, NEC, respiratory distress, or their combination were compared between newborns of obese and normal-weight women.

Results: Of the 109?488 women included in the study, 17.7% were obese. Maternal co-morbidities (diabetes, gestational diabetes, hypertension, and preeclampsia) increased with increasing maternal BMI. Both maternal obesity and its related co-morbidities were associated with higher incidence of neonatal morbidities. After adjusting for maternal comorbidities, there was a higher incidence of sepsis (AOR 1.91(1.45–2.50)), and combination of any of the neonatal outcomes (AOR 1.66(1.32–2.09)) among newborns of obese women than those of normal-weight women, along with an increased trend for incidence of PDA (Cochran-Armitage Test (CA)?=?23.1, p?<?0.0001) and NEC (CA?=?7.2, p?=?0.007).

Conclusion: Maternal obesity is independently associated with increased incidence of neonatal sepsis and a combination of neonatal morbidities in full-term newborns with an increased trend for PDA and NEC.