Impact of delayed development in premature infants on mother-infant interaction: a prospective investigation

When an Infant Has a Feeding Problem

This study explored possible consequences of gastroesophageal reflux (GER) in the infant on the mother-infant subsystem within the family system. A total of 36 mother-infant pairs contributed information. A group of mother-infant dyads where the infant had GER (n = 20) was compared with a control group (n = 16). Infants with GER were more likely than infants in the control group to be a source of stress, and care giving issues beyond feeding were more of a problem for the mothers in the GER group than for mothers in the control group. In comparison to the control group of mothers, there were no higher levels of maternal separation anxiety or greater amounts of help the mother received in daily tasks when the infant had GER. Videotapes made of the mother playing with the infant were scored by a research assistant blind to the diagnosis of the baby. Subtle differences in the infant's behavior during the first play session were observed when the infant had GER. No group differences were found in a second videotaped play session several weeks later. The study provides insight into early parenting experiences when there are problems feeding the baby.

The Impact of Low-risk Prematurity on Maternal Behaviour and Toddler Outcomes

This short-term longitudinal research project was designed to compare the maternal behaviour of mothers whose toddlers had been born preterm with the maternal behaviour of mothers whose toddlers had been born at term; the outcomes for the toddlers were also assessed. Twenty-one toddlers who had been born preterm with low medical risk (1460-2420 grams) were compared with 21 term toddlers who were matched in terms of social class. The heightened maternal responsiveness that had been observed during the first year with preterm infants had disappeared by 12 months, and by 20 months it was the mothers whose infants had been born at term who were more vocally responsive. During the second year, the mothers of preterm toddlers were characterised by more maternal control behaviour than were the mothers of term toddlers. Assessments of cognitive and language performance at the gestationally corrected ages of 12 and 20 months did not differentiate the toddlers who had been born preterm and term. In terms of play skills, reflected during interaction with their mothers at 12 and 20 months, the preterm toddlers were more actively involved than were the term toddlers. Despite the successful adjustment of these low-risk preterm toddlers, maternal behaviour was affected by the circumstances of preterm birth, even after 20 months.

A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects

Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function. Quality of care was also assessed. Multivariate analysis of variance investigated group, site, and interaction effects; correlation analysis identified individual variable contributions to significant effects. The results consistently favored the experimental groups. The following contributed to the group effects: shorter duration of parenteral feeding, transition to full oral feeding, intensive care, and hospitalization; lower incidence of necrotizing enterocolitis; reduced discharge ages and hospital charges; improved weight, length, and head circumferences; enhanced autonomic, motor, state, attention, and self-regulatory functioning; reduced need for facilitation; and lowered family stress and enhanced appreciation of the infant. Quality of care was measurably improved. Very low birth weight infants and their parents, across diverse settings, may benefit from individualized developmental care.

Family dynamics in families with very low birth weight and full-term infants: a pilot study

The purpose of this pilot study was to determine differences in family health across six dimensions of functioning between families with a very low birth weight infant (VLBW) and families with a full-term infant. An epidemiologic model and Barnhill's (1979) system theory of healthy family dynamics provided the organizing framework for the study. Sixteen families with a VLBW infant and 25 families with a full-term infant were assessed for differences in family health across Barnhill's six dimensions. Independent t-tests showed no significant differences on the five dimensions of infant behavioral style. While a 2 x 3 MANOVA showed no significant differences on any of the measures by family, the Turkey HSD post hoc tests for main effect found significant differences related to the mothers' position within the family, Specifically, the position the mother maintains in the family significantly contributes to certain dimensions of family health.

Journal writing as a social support strategy for parents of premature infants: a pilot study

BACKGROUND

Having a premature baby is acknowledged to be stressful to parents. Journal writing combines practical, emotional and informational support that may be useful to these parents.

METHODS

We conducted a study to assess the potential for promoting journal-writing for parents receiving social support in a special care nursery (SCN). Parents were provided with educational material on journal writing, and subsequently surveyed concerning their journal-writing during their child's hospitalization.

RESULTS

Of the 73 parents enrolled, 32% kept a journal; of these, 73% felt it helped considerably in reducing stress, and 68% used it as a means of addressing the most stressful elements of their nursery experience. Journals were used primarily to document involvement in care (45%), record-keeping (36%), and organization of thoughts (27%). All of those who kept a journal recommended it for use by other parents.

CONCLUSIONS

Encouraging parents to keep a journal is a constructive way of dealing with the SCN-related stress.

Creating paths: living with a very-low-birth-weight infant

OBJECTIVE

To describe parents' method of adaptation to the problems of caring for a very-low-birth-weight (VLBW) infant at home.

DESIGN

Exploratory, involving three interview sessions, 1 month, 3 months, and 5 months after hospital discharge of a VLBW infant.

SETTING

A newborn intensive-care unit in a tertiary-care center.

PARTICIPANTS

Fourteen parents of VLBW (< 1,500 g) infants after hospital discharge.

RESULTS

A basic social process, Creating Paths, was identified. It is the continuous process experienced by parents living with a VLBW infant the first 5 months after hospital discharge. The process consists of three stages: gathering, emerging, and affirming.

CONCLUSIONS

This grounded theory systematically tracks and describes the adaptation process of parents with VLBW infants during the first 5 months of living at home. The theory may be used to anticipate concerns and provide guidance and support to parents and their infants.

Maternal distress and perceptions of infant development following extracorporeal membrane oxygenation and conventional ventilation for persistent pulmonary hypertension

Neurodevelopmental outcome and concurrent maternal distress were examined for infants who suffered persistent pulmonary hypertension at birth and were treated with either extracorporeal membrane oxygenation (ECMO) (n = 19) or conventional ventilation (CV) (n = 15). Mothers were asked to complete inventories assessing their infant's (mean age 8.74 months) developmental growth as well as their own psychological health. Relevant sociodemographic and treatment parameters were also entered into the analysis. The results indicated that ECMO and CV infants did not differ on developmental indices and impairment rates were 15-23% respectively, similar to previous reports. In addition, ECMO and CV mothers did not differ in their reports of psychological distress. Correlational analyses revealed that length of treatment for ECMO but not CV infants significantly predicted developmental delay and maternal distress. For CV mothers, maternal distress was associated with the perception of delayed language. The results are discussed in terms of the limited morbidity associated with ECMO and CV interventions and the possible role of a 'vulnerable child syndrome' in understanding the maternal-infant relationship following ECMO therapy.

The relationship between psychosocial factors and developmental outcome for very low and extremely low birthweight infants: a review

Over the last quarter century, the improved survival rate of very low birthweight infants has sharpened questions about their residual disabilities. Longitudinal studies have devoted attention to the cognitive and neurodevelopmental outcome of these infants, but much less is known about their long-term social and emotional development. Psychiatrists consulting to neonatal intensive care units and assessing these infants in their families, will be assisted by a better understanding of the developmental and psychological outcomes of such infants. This paper reviews the state of knowledge in both of these areas. It argues the paramount importance of psychosocial factors to the infants' developmental outcome, and the importance of longitudinal research in further clarifying the predictive value of these factors. In a subsequent paper, we consider the efficacy of interventions with this group.

Infant psychiatry: its relevance for the general psychiatrist

The study of infancy can provide us with new models for the genesis and treatment of psychiatric disorders. It allows us to observe development and can elucidate the contribution the internal and external world make to mental health and disorder. It can also help to define and describe developmental pathways which may be instrumental in creating a resilient or vulnerable adult.

Hyperactive girls and boys: stimulant drug effects on mother-child interactions

Two doses of Ritalin (0.15 mg/kg and 0.35 mg/kg BID) were evaluated for their differential effects on the mother-child interactions of hyperactive girls and boys. The effects of Ritalin on these interactions were similar for both sexes. During task performance, the children increased their duration of compliance to the tasks. Mothers responded with decreased commands and control over compliance, while increasing their level of more general, non-directive interactions and passive observation of their children. The findings are consistent with previous studies of stimulant drug effects on the social interactions of hyperactive children.