Use of the parenting stress index in mothers of preterm infants

The Role of Parenting Stress as a Mediator in the Relationship Between Postpartum Depressive Symptoms and Early Childhood Internalizing Behaviour

Parenting stress occurs when demands of the parenting role are perceived as overwhelming and has been proposed as a mechanism through which postpartum mood disturbances may impact child psychopathology. In a prospective longitudinal birth cohort of 111 birthing parent-child dyads, this study examined whether the relationship between birthing parents' mood symptoms in infancy (3 months postpartum) and their child's internalizing behaviour in early childhood (3 and 6 years old) is mediated by parenting stress at 6 months postpartum. The relationship between higher postpartum mood symptoms at 3 months and increased internalizing behaviour at 3 years of age was mediated by increased reports of parenting stress at 6 months (b = .12, 95% CI = .02, .25). This association was not evident at 6 years. Parenting stress in early infancy may provide a treatment target to reduce the impact of perinatal depression on early child behavior.

Evaluation of an e-Learning Breastfeeding Program for Postpartum Mothers of Moderately High-Risk Newborn Infants Admitted to the Special Care Nursery

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding.

Memories of Infant Pain in the Neonatal Intensive Care Unit Influence Posttraumatic Stress Symptoms in Mothers of Infants Born Preterm

OBJECTIVES

The birth of a preterm infant and witnessing ones' infant in pain is remembered by parents as being one of the most stressful aspects of the neonatal intensive care unit (NICU). Elevated posttraumatic stress symptoms (PTSS) are highly prevalent among mothers of preterm infants, however, little is known about mothers' memories of invasive procedures in the NICU and how these memories may contribute to the development of PTSS. We examined the relationships between number of invasive procedures, mothers' memories of these procedures, and their PTSS at discharge from the NICU.

MATERIALS AND METHODS

Participants included 36 mothers of infants born below 37 weeks gestational age recruited from a tertiary-level NICU. Medical chart review was performed between birth and discharge from the NICU. At discharge, a research nurse conducted a structured memory interview with the mothers to assess their memories of their infants' invasive procedures. Mothers also completed a self-report measure of PTSS (Posttraumatic Stress Disorder Checklist for the DSM-5).

RESULTS

Mothers of infants exposed to greater numbers of invasive procedures had more elevated PTSS at discharge (R=0.37). Moreover, mothers who recalled having greater anxiety about their infant's invasive procedures had greater symptoms of reexperiencing (R=0.34) and avoidance (R=0.28) at discharge from the NICU.

DISCUSSION

Greater neonatal exposure to invasive procedures and mothers' recall of these procedures were related to mothers' posttraumatic stress symptomatology at discharge. Invasive procedures in the NICU represent an important target area for neonatal intervention to reduce maternal distress and improve outcomes.

Preparing families to care for ventilated infants at home

Advances in neonatal care have led to increased survival of infants with complex medical needs and technology dependence. Transition of the ventilator-dependent infant from hospital to home is a complex process that requires extensive coordination between the medical team and family. Home caregivers must be prepared to provide routine care for the ventilator-dependent child and respond to life-threatening emergencies. Families should be counseled on the need for home nursing, medical equipment and an adequate home environment to ensure a safe transition to home. Throughout the process, the family may require financial, social and psychological support. A structured education and transition process that is clearly communicated to parents is necessary to have an effective partnership with families.

Late preterm birth is a strong predictor of maternal stress later in life: Retrospective cohort study in school-aged children

AIM

The aim of this study was to compare the level of stress in mothers of school-aged children born late preterm and admitted to the intensive care unit (ICU) with the level of maternal stress if a child was born late preterm and not admitted to the ICU as well as if a full-term child was admitted to the ICU.

METHODS

In this retrospective cohort study the data were gathered via telephone interview with mothers. The Parenting Stress Index/Short Form was used to determine the level of stress in mothers. Background demographic characteristics, medically relevant variables, and the level of stress were tested using the chi-square test and Kruskal-Wallis test. Logistic regression was used in order to identify predictors of significant level of stress.

RESULTS

Mothers of late preterm born children who were admitted to the ICU, as well as mothers of late preterm children who were not admitted had higher level of stress compared to mothers of full-term children. Namely, mothers of late preterm born children admitted to the ICU had 18-fold increase in risk for significant level of total stress (OR = 18.09; 95% CI 8.55 to 38.26) while 24-fold greater risk was observed in mothers of late preterm children who were not admitted to the ICU (OR = 24.05; 95% CI 10.66 to 54.26) in comparison to mothers of full-term born children.

CONCLUSION

Results indicate that preterm birth and its complications are associated with a higher level of stress in mothers, that persists to school age.

Transition From Hospital to Home in Parents of Preterm Infants: A Literature Review

Transition from hospital to home is a complex and multidimensional phenomenon for parents of prematurely born infants (<37 weeks of gestation). The absence of a clear conceptualization of this particular transition coupled with the challenges parents have when they return home and higher costs of healthcare service usage postdischarge dictates the need for a better understanding of this phenomenon. A literature review was undertaken using Whittemore and Knafl's theoretical framework for integrative review as a guide. A systematic search of the electronic databases (PsycINFO, PubMed, Medline, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Cochrane Database for Systematic Reviews, and EBSCO) was performed. Fifty selected reports of research conducted on parents of preterm infants during 1980-2014 are included in this article. Five themes emerged from the review-disruption of parental role development, distorted development of parent-infant relationships, psychological consequences of a preterm birth and infant hospitalization, learning caregiving and parenting, and need for social and professional supports-which appear to reflect parental challenges during transition from hospital to home after discharge. Several inconsistencies in results of the studies dictate the need for further research in this vulnerable population; the better conceptualization and measurement of transitional challenges are warranted.

Psychometric properties of the Parenting Stress Index-Short Form (PSI-SF) in a high-risk sample of mothers and their infants

The goal of the present study was to evaluate the psychometric properties of the English and Spanish versions of the Parenting Stress Index-Short Form (PSI-SF) with mothers of 12- to 15-month-old infants with elevated levels of behavior problems and from predominately Hispanic, low-income backgrounds. Mothers of 58 infants were assessed as part of a larger study examining a brief home-based intervention for infants with elevated behavior problems. Internal consistency was good for all 3 subscales (i.e., Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child) and the Total Stress scale. Convergent validity of subscales was supported by correlations with measures of theoretically related constructs, including maternal depressive symptoms, maternal parenting practices, and infant behavior. Furthermore, examination of the optimal clinical cutoff by examining sensitivity and specificity suggested that for this high-risk sample lower percentile scores (73rd-77th), relative to the published 85th percentile cutoff, were sufficient for identifying mothers with clinically elevated depressive symptoms and infants with clinically elevated behavioral and emotional difficulties. The current results provide psychometric support for the PSI-SF as an effective and appropriate measure for use with high-risk families that have been underrepresented in previous research, including mothers of very young children with behavior problems, Hispanic and Spanish-speaking populations, and low-income families. (PsycINFO Database Record

Predictors of parenting stress trajectories in premature infant-mother dyads

This prospective longitudinal study examined predictors of parenting stress trajectories over time in a sample of 125 mothers and their preterm infants. Infant (multiple birth, gestational age, days hospitalized, and neonatal health risks) and maternal (socioeconomic, education, depressive symptoms, social support, and quality of interaction during infant feeding) characteristics were collected just prior to infant hospital discharge. Parenting stress and maternal interaction quality during play were measured at 4, 24, and 36 months corrected age. Hierarchical linear modeling was used to analyze infant and maternal characteristics as predictors of parenting stress scores and change over time. Results indicated significant variability across individuals in parenting stress at 4 months and in change trajectories. Mothers of multiples and infants with more medical risks and shorter hospitalization, and mothers with lower education and more depressive symptoms, reported more parenting stress at 4 months of age. Parenting stress decreased over time for mothers of multiples and for mothers with lower education more than for mothers of singletons or for mothers with higher educational levels. Changes in parenting stress scores over time were negatively associated with maternal behaviors during mother-infant interactions. Results are interpreted for their implications for preventive interventions.

Relation between sleep status of preterm infants aged 1-2 years and mothers' parenting stress

BACKGROUND

The aim of this study was to compare infants' sleep measures through an actigraph and maternal parenting stress among preterm and full-term mothers, and to explore the factors affecting maternal parenting stress in relation to infants' sleep.

METHODS

The subjects were 44 pairs of mothers and children. Twenty-one were in the preterm group, and 23 were in the full-term group. Inclusion criteria for preterm infants were born at less than 36 weeks and birthweight of less than 2500 g. The Parenting Stress Index (PSI) Short Form assesses maternal perception of the degree of parenting stress: the children's domain, and the parent's domain. An actigraph was applied to assess the infants' sleep measures.

RESULTS

The PSI showed significant differences, with high scores in parenting stress in the preterm group. Also, the number of mothers who complained about their infant's sleep issues was significantly higher in the preterm group. Most of the sleep measures showed improvement by their age in both preterm and full-term infants. Multiple linear regression analysis showed that sleep efficiency, longest sleep duration at nighttime accounted for 71% of stress in the children's domain of the PSI of the preterm group.

CONCLUSION

The parenting stress among mothers of preterm infants was significantly higher than that of mothers of full-term infants. The mothers of preterm infants were concerned about their infant's nocturnal sleep quality.

Parent behaviors moderate the relationship between neonatal pain and internalizing behaviors at 18 months corrected age in children born very prematurely

Children born very preterm (≤ 32 weeks gestation) exhibit greater internalizing (anxious/depressed) behaviors compared to term-born peers as early as 2 years corrected age (CA); however, the role of early stress in the etiology of internalizing problems in preterm children remains unknown. Therefore, we examined the relationship between neonatal pain and internalizing behavior at 18 months CA in children born very preterm and examined whether parent behavior and stress moderated this relationship. Participants were 145 children (96 very preterm, 49 full term) assessed at 18 months CA. Neonatal data were obtained from medical and nursing chart review. Neonatal pain was defined as the number of skin-breaking procedures. Cognitive ability was measured with the Bayley Scales of Infant Development II. Parents completed the Parenting Stress Index III, Child Behavior Checklist 1.5-5, and participated in a videotaped play session with their child, which was coded using the Emotional Availability Scale IV. Very preterm children displayed greater Internalizing behaviors compared to full-term control children (P=.02). Parent Sensitivity and Nonhostility moderated the relationship between neonatal pain and Internalizing behavior (all P<.05); higher parent education (P<.03), lower Parenting Stress (P=.001), and fewer children in the home (P<.01) were associated with lower Internalizing behavior in very preterm children, after adjusting for neonatal medical confounders, gender, and child cognitive ability (all P>.05). Parent Emotional Availability and stress were not associated with Internalizing behaviors in full-term control children. Positive parent interaction and lower stress appears to ameliorate negative effects of neonatal pain on stress-sensitive behaviors in this vulnerable population.

Mothers' stressor as the day of discharge from the NICU approaches

The purpose of this study was to determine the occurrence of stress and the areas of stress experienced by mothers as they prepare for their infants' transition from the neonatal intensive care unit to the home setting. A descriptive survey study was used to study mothers of infants anticipating discharge to home within 5 days. The author used a descriptive survey research design using the Parental Stressor Scale: Infant Hospitalization tool and a global measure of stress. The highest area of stress was parental role alterations. All mothers in the study reported experiencing stress related to their infants' anticipated discharge, with extremely high levels of stress reported by 34% of participants. These findings support the position that nurses are to provide guidance to mothers that strengthens their parenting role and relationship with their infants.

Rethinking stress in parents of preterm infants: a meta-analysis

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.

Symptoms of acute stress disorder in mothers of premature infants

PURPOSE

: To determine whether significant symptoms of acute stress disorder (ASD) are present in mothers of premature infants in the neonatal intensive care unit (NICU).

SUBJECTS

: Forty mothers of premature infants born less than 33 weeks and admitted into NICU.

DESIGN

: Prospective, cohort, within-subjects.

METHODS

: Mothers completed the Stanford Acute Stress Reaction Questionnaire, Edinburgh Postnatal Depression Scale, and the Acute Stress Disorder Interview to explore the number and severity of stress-related symptoms at 2 separate time periods, 7 to 10 days after birth, and 1 month after birth.

RESULTS

: Twenty-eight percent of the mothers met diagnostic criteria of ASD at 7 to 10 days after birth, and at 1 month after birth ASD symptoms persisted. The majority of the mothers described premature birth as a traumatic stressor. The most commonly met criteria were dissociation and anxiety. Significant symptoms of depression were found in 43% of mothers and persisted 1 month after birth. Rates of depression and moderate to severe symptoms of ASD were significantly related in mothers at 1 week and at 1 month after birth.

CONCLUSIONS

: The premature birth experience is traumatic for mothers and may lead to various emotional responses including stress-related symptoms such as depression and/or ASD. Mothers with significant symptoms of depression and those with symptoms of stress seem to be more at risk for developing symptoms of ASD.

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 ≤30weeks gestation were recruited together with 105 mothers who delivered 120 babies at term. At 4months 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.

Transition from hospital to home for parents of preterm infants

Research on the phenomenon of transition spans several decades. This article discusses the transition from hospital to home and the challenges parents of preterm infants experience during a neonatal intensive care unit stay and after discharge. The article explores the link between parental problems and rehospitalizations and the need for accurate measures of transitional concerns. An example of a theoretical model and instrument is described.

Parental psychological well-being and cognitive development of very low birth weight infants at 2 years

AIM

To assess the associations between cognitive development of very low birth weight (VLBW) infants and measures of parental psychological well-being.

METHODS

In this prospective cohort study, 182 VLBW infants born 1/2001-12/2006 at the Turku University Hospital, Finland, were followed up. At 2 years corrected age, cognitive development of the child was assessed using the Mental Development Index of Bayley Scales, and both parents filled in validated questionnaires defining parental psychological well-being (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale).

RESULTS

The cognitive delay of the infant was associated with paternal symptoms of depression (p = 0.007) and parenting stress (p = 0.03). Mothers of the infants with cognitive delay reported increased parenting stress related to the difficulty to accept the child (p = 0.001). Weak sense of coherence predicted depressive symptoms in both parents (p < 0.0001).

CONCLUSION

Even if the fathers of VLBW infants experienced depressive symptoms less often than the mothers, the ability of the fathers to cope was significantly associated with the cognitive development of the infant. In addition, the fathers reported more parenting stress if the infant had a cognitive delay. The mothers reported more parenting stress related to accepting the VLBW infant with cognitive delay.

Declining cognitive development from 8 to 18 months in preterm children predicts persisting higher parenting stress

BACKGROUND

Higher parenting stress in mothers of children born very preterm may be in part a response to poorer neurobehavioral development, reflecting realistic concerns in addition to adaptation to the trauma of preterm delivery. To our knowledge, there are few longitudinal studies of parenting stress that have addressed child cognitive competence.

AIMS

To examine parenting stress in preterm and full-term children at 8 and 18 months corrected chronological age (CCA), in relation to child cognitive development and behavior.

SUBJECTS

Participants were N=152 children (98 preterm born ≤32 weeks gestation, and 54 full-term) seen at 8 and 18 months CCA, and the primary caregiver parent. STUDY DESIGN/OUTCOME MEASURES: The Parenting Stress Index questionnaire was completed by a parent, child interactive behavior was videotaped, and the Bayley Scales of Infant Development (BSID II, Mental Development Index; MDI) were administered at both ages.

RESULTS

Total Parenting Stress was higher in preterm than full-term children at 8 and 18 months CCA (p<.02), accounted for primarily by the Child domain. Hierarchical regression showed (after controlling for neonatal risk, number of children in the home, child interactive behavior and maternal education) that decreasing Bayley MDI scores from 8 to 18 months CCA predicted higher parenting stress for preterm children. For full-term children, number of children in the home and child interactive behavior predicted parental stress at 18 months.

CONCLUSION

Higher parenting stress persisting to 18 months CCA in preterm children may partly reflect realistic parental concerns with their child's development.

A multicentric study of disease-related stress, and perceived vulnerability, in parents of children with congenital cardiac disease

Parents of children with congenitally malformed hearts can suffer from stress as a result of the medical condition of their child. In this cross-sectional study, we aimed to describe levels of parental stress, and perceived vulnerability, in parents of children who underwent major cardiac surgery, by using both generic and disease-related measures for assessment. We included parents of children who underwent open-heart surgery over the period 2002 through 2007 in the Center for congenital Anomalies Heart Amsterdam/Leiden, abbreviated to provide the acronym CAHAL. In total, we assessed 114 mothers and 82 fathers of 131 children, using the Pediatric Inventory for Parents, short form, General Health Questionnaire, Parental Stress Index-Short Form, State-Trait Anxiety Index and the Child Vulnerability Scale. Compared to the reference groups of the instruments used, parents of children with congenitally malformed hearts did not report higher generic nor disease-related stress scores, and parenting levels of stress were also comparable to reference groups. State anxiety levels, however, were higher in mothers of children with congenitally malformed hearts. Both fathers and mothers reported significantly higher rates of perceived vulnerability than did parents of healthy children. Risk factors for increased anxiety and perceived vulnerability were found in the number of surgical procedures, the time past since the last procedure, and ethnicity. Severity of the lesion did not influence parental levels of stress, but parents of children with hypoplastic left heart syndrome did report higher levels of stress than other parents. Psychosocial screening of parents of children with congenitally malformed hearts is important in order to provide appropriate counselling to those parents most in need.

Maternal stress and depression and the lateralisation of infant cradling

BACKGROUND

Studies show that 65-85% of mothers cradle their infants to the left side of their body, but that this bias changes with maternal mood and stress. The present study examines the hypothesis that maternal stress and depression status will influence the cradling bias differentially.

METHOD

As part of a larger study on mother-infant interaction, mothers (N = 79) were asked to pick up and briefly hold their children in their arms (44 boys, 35 girls; mean age 7.2 months, range 3 to 14 months).

RESULTS

Results indicated that 86% of mothers who were neither stressed nor depressed cradled to the left and 14% to the right. Comparing the cradling side of stressed mothers with those who were neither stressed nor depressed, more in the former group showed right-sided cradling. In contrast, mothers who were just depressed preferred to cradle to the left.

CONCLUSION

The lack of a left-sided cradling bias might be due to stress rather than depression experienced by mothers. Furthermore, this study provides evidence that the state of maternal mental health might be indicated by the side on which they cradle their child preferentially.

Child and parental adaptation to pediatric stem cell transplantation

GOALS OF WORK

Allogeneic pediatric stem cell transplantation (SCT) is a very intensive treatment with a high mortality and morbidity. The objectives of this study were to assess the (1) self- and proxy-reported health-related quality of life (HRQoL) compared to a norm group, (2) levels of parenting stress compared to a norm group, (3) differences in HRQoL and parenting stress pre- and post-SCT, and (4) effect of child age and parenting stress on self- and proxy-reported HRQoL pre- and post-SCT.

MATERIALS AND METHODS

Pre- and on average 10 months post-SCT, 21 children and adolescents and their parent(s) completed questionnaires on HRQoL and the mothers completed a measure of parenting stress.

MAIN RESULTS

Post-SCT, home functioning, physical functioning, and total HRQoL scores were lower than the norm group. We found stable HRQoL scores over time with the exception of the domain home functioning, which was rated lower post-SCT than pre-SCT. Parents reported lower HRQoL scores than the children pre- and post-SCT and younger children experienced better HRQoL than older children. Parenting stress was higher post-SCT than pre-SCT and high levels of parenting stress were predictive of poor parental ratings of child HRQoL post-SCT.

CONCLUSIONS

Ongoing psychosocial assessment post-SCT is necessary to target children with a lowered HRQoL and parents who experience elevated parenting stress who may be in greater need of more supportive care.

Fathers' experiences in the neonatal intensive care unit: a search for control

OBJECTIVE

This qualitative study aimed at understanding the experiences of fathers of very ill neonates in the NICU.

METHODS

Sixteen fathers of very ill and/or very preterm infants who had been in the NICU for >30 days were interviewed by a male physician. Fathers were asked about their level of comfort with or concerns about staff communication regarding their infant, about accessing information, and about more general perceptions of their experience in the neonatal intensive care unit. Interviews were audiotaped and transcribed for analysis. Coding used content analysis with construction of themes by 3 researchers.

RESULTS

The overarching theme for fathers was a sense of lack of control. Their world view, as a "backdrop" theme, provided context for all of the themes. Four other interrelated subthemes were identified, including information; communication, particularly with the health care team; fathers' various roles; and external activities. Fathers reported that relationships with friends/family/health care team, receiving information consistently, and receiving short written materials on common conditions were ways of giving them support. The fathers said that speaking to a male physician was a positive and useful experience.

CONCLUSIONS

Fathers experience a sense of lack of control when they have an extremely ill infant in the NICU. Specific activities help fathers regain a sense of control and help them fulfill their various roles of protectors, fathers, partners, and breadwinners. Understanding these experiences helps the health care team offer targeted supports for fathers in the NICU.

Randomised trial of a parenting intervention during neonatal intensive care

OBJECTIVE

To evaluate the influence of parenting intervention on maternal responsiveness and infant neurobehavioural development following a very premature birth.

DESIGN

Cluster-randomised controlled trial, with a crossover design and three-month washout period.

SETTING

Six neonatal intensive care units.

PATIENTS

Infants born <32 weeks' gestation.

INTERVENTION

The Parent Baby Interaction Programme (PBIP) is a supportive, educational intervention delivered by research nurses in the neonatal intensive care unit, with optional home follow-up for up to six weeks after discharge.

MAIN OUTCOME MEASURES

Parenting stress at 3 months adjusted age, as measured by the Parenting Stress Index (PSI). Other outcomes included the Neurobehavioural Assessment of the Preterm Infant (NAPI) and maternal interaction as assessed by the Nursing Child Assessment Teaching Scale (NCATS) and the responsivity subscale for Home Observation for Measurement of the Environment (HOME).

RESULTS

112 infants were recruited in the intervention phases and 121 in the control phases. Mean standardised NAPI scores at 35 weeks did not differ between the PBIP and control groups. Both groups had low but similar NCATS caregiver scores before discharge (36.6 in the PBIP group and 37.4 in control, adjusted mean difference -0.7, 95% CI -2.7 to 1.4). At three months, adjusted age mean PSI scores for the PBIP group were 71.9 compared with 67.1 for controls (adjusted mean difference 3.8, 95% CI -4.7 to 12.4). NCATS scores and HOME responsivity scores were similarly distributed between the groups.

CONCLUSION

This early, nurse-delivered, parent-focused interaction programme intervention had no measurable effects on short-term infant neurobehavioural function, mother-child interaction or parenting stresses.

Maternal psychological reaction to newborn genetic screening for type 1 diabetes

OBJECTIVE

The purpose of this work was to describe levels of maternal anxiety, depressive symptoms, and perceptions of infant vulnerability associated with newborn genetic screening for susceptibility to type 1 diabetes.

PATIENTS AND METHODS

Mothers of infants tested at birth for genetic susceptibility to type 1 diabetes as part of a prospective study investigating potential environmental triggers of autoimmunity were recruited to this study. Three mother-infant cohorts were studied: 38 infants at increased genetic risk, 73 at low risk, and 76 who had not undergone testing. The Vulnerable Baby Scale, Edinburgh Postnatal Depression Scale, and state subscale of the State Trait Anxiety Inventory were administered at the 9-week, 4-month, and 1-year postnatal ages. Genetic-risk notification occurred at the 10-week postnatal age. Mothers whose infants had undergone genetic testing were also asked to subjectively rate how much they thought and worried about their child's genetic test result. Statistical analyses were conducted to test for differences in questionnaire scores among the 3 groups.

RESULTS

No difference among the groups was detected in Vulnerable Baby Scale or Edinburgh Postnatal Depression Scale scores using linear mixed-effects model analysis. Maternal anxiety was paradoxically slightly lower in the increased-risk group shortly after notification of results, but there were no significant differences among the groups by 1 year. Mothers of infants in the high-risk group reported thinking and worrying about their child's test result significantly more than mothers of low-risk infants at both time points after notification of results.

CONCLUSIONS

Newborn genetic screening to identify infants at risk for type 1 diabetes is not associated with elevated levels of maternal anxiety, depressive symptoms, or heightened perceptions of infant vulnerability. However, responses to subjective assessment questions suggest that it is possible that more subtle effects on mothers do occur, and this requires further investigation.

The applicability of Webster-Stratton Parenting Programmes to deaf children with emotional and behavioural problems, and autism, and their families: annotation and case report of a child with autistic spectrum disorder

This article describes a pilot project whose objective was to explore whether the Webster-Stratton Parenting Programme may be effective for hearing parents and their deaf children who present with conduct disorders and other emotional, behavioural and developmental problems. Outcome measures aimed at overall impact in decreasing behavioural problems and improving overall family function were used. Participants were hearing parents of deaf children referred to our specialist service whose assessment had recommended a parenting skills group as treatment of choice. The children had been diagnosed with behavioural problems with or without additional comorbidity. This pilot phase focused deliberately on one participant, in order to explore whether the approach justified further, more comprehensive evaluative research. Outcome was positive, suggesting that modified Webster-Stratton approaches may well be of use in deaf children of hearing parents.

Reducing parenting stress in families with irritable infants

BACKGROUND

Caring for an infant with unexplained, persistent crying is one of the most stressful events for new parents. Infant irritability, also referred to as infantile colic, occurs in 10-25% of all infants and is the most common parental concern reported in the first year of life.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a home-based nursing intervention in reducing parenting stress in three groups of families with irritable infants, using data from a larger evaluation study.

METHODS

A two-site, randomized clinical trial was conducted with 121 infants and their parents. Infants were randomized to a treatment or a control group. A third group of infants (n = 43) was added as a posttest-only comparison. The level of parenting stress was measured by the Parenting Stress Index (PSI) at baseline, after the 4-week intervention, and at the 8-week follow-up visit.

RESULTS

A repeated measures analysis of variance (ANOVA) was used to compare the two groups across the three time points (baseline, immediately after the 4-week intervention, and at the 8-week follow-up visit). The results revealed a reduction in total parenting stress over time for both the treatment and control groups. Mothers in the treatment group reported reduced parenting stress on the parent-child dysfunctional interaction subscale (p = .04). Total parenting stress scores were found to be significantly higher for mothers in the posttest-only group (p = .009).

CONCLUSION

Initial parenting stress levels were high in all participants. Parent feedback at the exit interview indicated that the nurse visits for data collection were also viewed as helpful in reducing the stress level associated with parenting these irritable infants. This home-based program was perceived as helpful in improving the interactions between parents and their irritable infants.