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Parenting Confidence and Needs for Parents of Newborns in Taiwan
Ching-Pyng Kuo,Hsiao-Ling Chuang,Shu-Hsin Lee,Wen-Chun Liao
Iranian Journal of Pediatrics , 2012,
Abstract: Objective: Parenting confidence with regards to caring for their infants is crucial for the healthy adaptation to parenthood and the development of positive parent-infant relationships. The postpartum period is a tremendous transitional time for parents, so their unique needs should be considered. This study explored parenting confidence and needs in parents when their newborns are discharged from hospital, and explored the best predictors of parenting confidence and needs.Methods: A cross-sectional design with a questionnaire survey was used in this study. The questionnaire included three parts: Demographic, Parenting Needs and Parenting Confidence Questionnaire. We survey a convenience sample of 96 parents from a postnatal ward and a neonatal intermediate care unit of the medical central hospital in Taichung, Taiwan.Findings: The mean age of the subjects was 32 years and 67.7% of the subjects’ education level was college or above. Approximately one half of the subjects was multiparous, vaginal delivery and had planned pregnancy.The mean gestational age and birth weight of the newborns was 37.7 weeks and 2902 g, respectively. Parentswho had a planned pregnancy (t=2.1, P=0.04) or preterm infants (t=2.0, P=0.046) and those whose infants were delivered by cesarean section (t=2.2, P=0.03) had higher parenting needs. In addition, parents of low birth weight infants had higher parenting needs (r=-0.23, P=0.02). Regarding parenting confidence, multiparaparents perceived higher confidence than primipara parents (t=2.9, P=0.005). Needs in psychosocial support were significantly correlated with parenting confidence (r=0.21, P<0.05). The stepwise multiple regression analysis showed that parity and needs in psychosocial support predict parenting confidence of 13.8%variance.Conclusion: The findings of this study help care providers to identify parents with low parenting confidence at an early postpartum stage. Health care teams should provide appropriate psychosocial support and health education based on parents needs.
Rethinking Stress in Parents of Preterm Infants: A Meta-Analysis  [PDF]
Renske Schappin, Lex Wijnroks, Monica M. A. T. Uniken Venema, Marian J. Jongmans
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0054992
Abstract: Background With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress. Methods and Findings A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants. Conclusions Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself.
Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis  [cached]
Benzies Karen M,Magill-Evans Joyce E,Hayden K,Ballantyne Marilyn
BMC Pregnancy and Childbirth , 2013, DOI: 10.1186/1471-2393-13-s1-s10
Abstract: Background Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant’s environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants. Methods MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies. Results Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04). Conclusions Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. Implications of key findings Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.
Parents’ lived experience of providing kangaroo care to their preterm infants
Angela Leonard,Pat Mayers
Health SA Gesondheid , 2008, DOI: 10.4102/hsag.v13i4.401
Abstract: Premature and low birthweight infants pose particular challenges to health services in South Africa. While there is good evidence to demonstrate the benefits of kangaroo care in low birthweight infants, limited research has been conducted locally on the experiences of parents who provide kangaroo care to their preterm infants. This phenomenological study explores the lived experience of parents who provided their preterm infants with kangaroo care at a tertiary-level maternity centre in the Western Cape. In-depth interviews were conducted with six parents: four mothers and two fathers. Data was analysed using an adaptation of the approaches described by Colaizzi (1978:48-71) and Hycner (1985:280-294). To ensure trustworthiness, the trustworthiness criteria described by Guba and Lincoln (1989:242-243) were applied. Kangaroo care is a phased process, each phase bringing a unique set of experiences. The eight themes that emerged are described: unforeseen, unprepared and uncertain - the experience of birth; anxiety and barriers; an intimate connection; adjustments, roles and responsibilities; measuring success; a network of encouragement and support; living-in challenges; and living with the infant outside of hospital. Challenges facing health care providers are described and recommendations for information about kangaroo care and support for parents are made. Opsomming Vroeggebore babas en babas met ’n lae geboortegewig stel besondere uitdagings vir Suid-Afrikaanse gesondhiedsdienste. Daar bestaan goeie bewyse dat die kangaroesorgmetode voordelig is vir babas met ’n laegeboortegewig, dog is minimale plaaslike navorsing gedoen oor die ondervindinge van ouers wat hierdie metode gebruik om vir hul vroeggebore babas te sorg. Hierdie fenomenologiese studie verken die geleefde ervaringe van ouers wat vir hulle vroeggebore babas deur middel van die kangaroesorgmetode in ’n tersiêre kraamsentrum in die Weskaap gesorg het. Data is ingesamel deur in-diepte onderhoude met ses ouers te voer: vier moeders and twee vaders van vroeggebore babas. Data is ontleed volgens ’n verwerking van die metodes soos deur Colaizzi (1978:48-71) en Hycner (1985:280-294) beskryf. Om betroubaarheid te verseker, is die betroubaarheidskriteria van Guba en Lincoln (1989:242-243) toegepas. Kangaroesorg is ’n geleidelike proses; elke fase lei tot ‘n unieke stel ondervindinge. Agt temas is uit die data ge dentifiseer: Onverwags, onvoorbereid en onseker - die geboorte-ervaring; angstigheid and hindernisse; ’n intieme verband; aanpassings, rolle en verantwoordelikhede; die meting van sukses; ’n n
Impact on parents of bronchiolitis hospitalization of full-term, preterm and congenital heart disease infants
Alexandre Lapillonne, Antoine Regnault, Véronique Gournay, Jean-Bernard Gouyon, Hélène Gilet, Daniela Anghelescu, Tatiana Miloradovich, Benoit Arnould, Guy Moriette
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-171
Abstract: Four hundred sixty-three infants aged less than 1 year and hospitalized for bronchiolitis were included in a French observational study during the 2008–2009 season. Parents were asked to complete the IBHQ at hospital discharge and 3 months later. IBHQ scores, ranging from 0 (no impact) to 100 (highest impact), were compared according to gestational age (full-term, 33–36 wGA, ≤ 32 wGA) and the presence of congenital heart disease (CHD). The potential drivers of impact were explored using multivariate linear regressions.The study included 332 full-terms, 71 infants born at 33–36 wGA, and 60 at ≤ 32 wGA; 28 infants had a CHD. At hospital discharge, 9 of the 12 IBHQ mean scores were above 40, indicating a marked impact on parents. Three months later, all mean scores were lower but 5 were still greater than 40. At discharge, the length of hospitalization had a significant effect on IBHQ worries and distress, fear for future, guilt and impact on daily organization scores (p<0.01); the parents’ educational level had a significant effect on IBHQ worries and distress, fear for future, impact on daily organization and financial impact scores (p<0.05). The only statistically significant difference found between the parents of preterm and full-term infants was for the physical impact score at discharge (p=0.004).Bronchiolitis hospitalization has conspicuous emotional, physical and organizational consequences on parents and siblings, which persist 3 months after hospital discharge. The main drivers of the impact were length of hospital stay and parents’ educational level, while infants’ gestational age or the presence of a CHD had little influence.Bronchiolitis is a viral obstructive bronchial disease occurring in epidemics in infants aged 1–24 months, and manifesting as dyspnoea with tachypnoea, restricted expiration, chest hyperinflation and respiratory distress potentially interfering with feeding; auscultation is dominated by crepitant or subcrepitant rales, rapidly followed
Preterm Birth a Risk Factor for Postpartum Depression in Pakistani Women  [PDF]
Salima Sulaiman Gulamani, Shahirose Sadrudin Premji, Syed Iqbal Azam, Zeenatkhanu Kanji
Open Journal of Depression (OJD) , 2013, DOI: 10.4236/ojd.2013.24013
Abstract: A Pakistani cohort of 170 mothers of full-term infants and 34 mothers of preterm infants were screened at 6 weeks after delivery to compare the rate of PPD, and examine the contribution of parenting stress and mother-infant interaction to PPD among mothers of preterm infants. Mothers completed the Edinburgh postnatal depression scale, and a general questionnaire. Mothers of preterm infants also completed the parental stress scale and parental bonding questionnaire. The rate of PPD was significantly higher with the adjusted odds increasing by 2.68 (95% Confidence Interval 1.16 - 6.17, p = .015) in mothers of preterm in- fants. Significantly more depressed mothers of preterm infants did not receive some level of support from their husbands (p = .014), and had some level of difficulty feeding (p = .03) or identifying the amount to feed their infant (p = .02). A large proportion of mothers reported no support from friends in rearing children.
The effectiveness of video interaction guidance in parents of premature infants: A multicenter randomised controlled trial
Anneke Tooten, Hannah N Hoffenkamp, Ruby AS Hall, Frans Winkel, Marij Eli?ns, Ad JJM Vingerhoets, Hedwig JA van Bakel
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-76
Abstract: This study is a multi-center randomised controlled trial to evaluate the effectiveness of Video Interaction Guidance in parents of premature infants. In this study 210 newborn infants with their parents will be included: n?=?70 healthy term infants (>37?weeks GA), n?=?70 moderate term infants (32–37?weeks GA) which are recruited from maternity wards of 6 general hospitals and n?=?70 extremely preterm infants or very low birth weight infants (<32?weeks GA) recruited by the NICU of 2 specialized hospitals. The participating families will be divided into 3 groups: a reference group (i.e. full term infants and their parents, receiving care as usual), a control group (i.e. premature infants and their parents, receiving care as usual) and an intervention group (i.e. premature infants and their parents, receiving VIG). The data will be collected during the first six months after birth using observations of parent-infant interactions, questionnaires and semi-structured interviews. Primary outcomes are the quality of parental bonding and parent-infant interactive behaviour. Parental secondary outcomes are (posttraumatic) stress symptoms, depression, anxiety and feelings of anger and hostility. Infant secondary outcomes are behavioral aspects such as crying, eating, and sleeping.This is the first prospective study to empirically evaluate the effect of VIG in parents of premature infants. Family recruitment is expected to be completed in January 2012. First results should be available by 2012.NTR3423Each year, 2% to 9% of the newborns require specialised care in neonatal intensive care units (NICU). The majority are premature infants (born before 37?weeks of gestational age) who weigh less than 2500?g at birth. Modern medical technology has forced back the frontiers of viability so that a growing number of babies, even as young as 23 to 24?weeks gestation with weights as low as 500 gram, are currently surviving [1]. With the improved survival chance of preterm infants, there i
Preterm Birth, Age at School Entry and Educational Performance  [PDF]
David Odd, David Evans, Alan Emond
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0076615
Abstract: Objective To investigate if the lack of gestational age correction may explain some of the school failure seen in ex-preterm infants. Design A cohort study based on the Avon Longitudinal Study of Parents and Children (ALSPAC). The primary outcome was a low Key Stage 1 score (KS1) score at age 7 or having special educational needs (SEN). Exposure groups were defined as preterm (<37 weeks gestation, n = 722) or term (37–42 weeks, n = 11,268). Conditional regression models were derived, matching preterm to term infants on date of birth (DOB), expected date of delivery (EDD) or expected date of delivery and year of school entry. Multiple imputation was used to account for missing covariate data. Results When matching for DOB, infants born preterm had an increased odds of a low KS1 score (OR 1.73 (1.45–2.06)) and this association persisted after adjusting for potential confounders (OR 1.57 (1.25–1.97)). The association persisted in the analysis matching for EDD (fully adjusted OR 1.53 (1.21–1.94)) but attenuated substantially after additionally restricting to those infants who entered school at the same time as the control infants (fully adjusted OR 1.25 (0.98–1.60)). A compatible reduction in the population attributable risk fraction was seen from 4.60% to 2.12%, and year of school entry appeared to modify the association between gestational age and the risk of a poor KS1 score (p = 0.029). Conclusions This study provides evidence that the school year placement and assessment of ex-preterm infants based on their actual birthday (rather than their EDD) may increase their risk of learning difficulties with corresponding school failure.
Vancomycin pharmacokinetics in preterm infants
Machado, Jose Kleber Kobol;Feferbaum, Rubens;Kobayashi, Celia Etsuco;Sanches, Cristina;Santos, Silvia Regina Cavani Jorge;
Clinics , 2007, DOI: 10.1590/S1807-59322007000400006
Abstract: objetive: the objective of the present study was to evaluate the kinetic disposition of vancomycin in preterm infants with emphasis on the apparent volume of distribution, biological half-life, and total body clearance as well as whether their variations cause significant modification of the trough plasma concentration of the drug, depending on the postconceptional age (pca) and the postnatal age (pna). material and method: twenty-five selected patients were distributed into 2 groups which differed significantly in terms of mean pca (31.2-32.3 weeks in group 1, n = 13; 33.5-34.1 weeks in group 2, n = 12: ci95%, p < .001) and pna (group 1, 12.0-18.5 days; group 2, 18.0-34.0 days, ci95%, p < .05). the parents were informed and signed a written consent for participation of the infants in the protocol that had been previously approved by the ethics committee of the hospital. results: apparent volume of distribution was significantly increased in group 1 compared with patients of group 2 (0.85 vs. 0.56 l/kg, respectively; p = .01,). additionally multiple linear regression revealed a good linear correlation (r = 0.85) of trough plasma concentration of vancomycin with the apparent volume of distribution and also with the biological half-life in patients of group 1, while a good correlation (r = 0.91) was obtained for the trough plasma concentration with total body clearance in infants of group 2. the influence of these kinetic parameters on the trough concentration of vancomycin in preterm infants seems to vary according to pca and pna. conclusion: in conclusion, the trough plasma concentration of vancomycin depends on the pharmacokinetics, and multiple linear correlation indicates that it varies according to the postconceptional and postnatal age of preterm infants.
Association of lipid peroxidation with hepatocellular injury in preterm infants
Barry Weinberger, Kazimierz Watorek, Richard Strauss, Gisela Witz, Mark Hiatt, Thomas Hegyi
Critical Care , 2002, DOI: 10.1186/cc1547
Abstract: Preterm infants (<35 weeks' gestation) admitted to the neonatal intensive care unit were enrolled (with their parents' informed consent) in either the 'cholestasis' group (if their direct bilirubin was >2 mg/dl [34.2 μmol/l] and duration of TPN was ≥ 10 days [n = 27]) or in the control group. Urine samples for measurement of TBARS (proportionate to lipid peroxidation) and blood specimens for analysis of serum bilirubin, ALT, AST, and alkaline phosphatase were obtained within 24 hours of enrollment.The cholestasis and control groups were comparable with respect to gestational age, birth weight, Apgar score, maximum FiO2, and duration of supplemental oxygen administration. Median serum direct bilirubin concentrations in the cholestasis and control groups were, respectively, 3.3 mg/dl (56.4 μmol/l) and 1.7 mg/dl (29.1 μmol/l) (P < 0.001). Serum ALT and AST levels were also elevated in the cholestasis group, but alkaline phosphatase levels did not differ significantly between the groups. Urinary levels of TBARS in all the infants were correlated with ALT and AST but did not differ significantly between cholestatic and control infants.Our findings suggest that oxidant stress is associated with hepatocellular injury in preterm infants. This effect is not correlated with the degree of cholestasis.The incidence of cholestasis related to total parenteral nutrition (TPN) among preterm infants has been estimated to be between 7% and 85%, depending on the population examined and the definition of cholestasis used [1]. In infants with necrotizing enterocolitis or short bowel syndrome, the prevalence of TPN-related cholestasis is 60–90% [2]. Although cholestasis is reversible in most patients after the successful advancement of enteral feeding, progressive liver fibrosis and cirrhosis occur in some patients even after complete enteral nutrition has been established [3]. Some studies have suggested that excessive amino acids, hepatotoxic bile acids, bacterial overgrowth, sepsis, m
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