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Li R, Li T, Yan X, Feng J, Yu Z, Chen C. Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:37. [PMID: 38433210 PMCID: PMC10910825 DOI: 10.1186/s13052-024-01613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Home phototherapy (HPT) remains a contentious alternative to inpatient phototherapy (IPT) for neonatal hyperbilirubinemia. To guide evidence-based clinical decision-making, we conducted a meta-analysis of randomized clinical trials (RCTs) and cohort studies and assessed the comparative risks and benefits of HPT and IPT. METHODS PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure Database, Wanfang Database, Chinese Science and Technique Journals Database, ClinicalTrials.gov, and International Clinical Trial Registry Platform trial were searched from inception until June 2, 2023. We included RCTs and cohort studies and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Study quality was assessed with the Cochrane Collaboration Risk of Bias tool and the Newcastle-Ottawa scale. The outcome measures were phototherapy duration, daily bilirubin level reduction, exchange transfusion, hospital readmission, parental stress scale, and complications. We used fixed- or random-effects meta-analysis models, assessed heterogeneity (I2), conducted subgroup analyses, evaluated publication bias, and graded evidence quality. RESULTS Nine studies (998 patients) were included (four RCTs, five cohort studies). HPT was associated with longer phototherapy duration (SMD = 0.55, 95% CI: 0.06-1.04, P = 0.03). Cohort study subgroup analysis yielded consistent results (SMD = 0.90; 95% CI: 0.69 to 1.11, P < 0.001, I2 = 39%); the RCTs were not significantly different (SMD = -0.04; 95% CI: -0.15 to 0.08, P = 0.54, I2 = 0%). Hospital readmission was higher with HPT (RR = 4.61; 95% CI: 1.43-14.86, P = 0.01). Daily bilirubin reduction (WMD = -0.12, 95% CI: -0.68 to 0.44, P = 0.68) or complications were not significantly different (RR = 2.29; 95% CI: 0.31-16.60, P = 0.41). The evidence quality was very low. HPT was associated with lower parental stress (SMD = -0.44, 95% CI: -0.71 to -0.16, P = 0.002). None of three included studies reported exchange transfusion. CONCLUSIONS The current evidence does not strongly support HPT efficacy for neonatal hyperbilirubinemia, as high-quality data on long-term outcomes are scarce. Future research should prioritize well-designed, large-scale, high-quality RCTs to comprehensively assess HPT risks and benefits.
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Affiliation(s)
- Rui Li
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Tingting Li
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Xudong Yan
- Department of Pediatrics Division of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jing Feng
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China
| | - Zhangbin Yu
- Department of Pediatrics Division of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
| | - Cheng Chen
- Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China.
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Pettersson M, Eriksson M, Odlind A, Ohlin A. Home phototherapy of term neonates improves parental bonding and stress: Findings from a randomised controlled trial. Acta Paediatr 2022; 111:760-766. [PMID: 34932853 DOI: 10.1111/apa.16231] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
AIM We aimed to evaluate whether in-home phototherapy for hyperbilirubinaemia could reduce the poorer parent-infant bonding and increased parental stress associated with neonatal hospital treatment. METHODS In this multicentre randomised controlled trial, we allocated families to either home phototherapy or standard hospital care. The primary outcome was parent-infant bonding measured on the Postpartum Bonding Questionnaire directly after therapy and 4 months later. Secondary outcomes were results on four other instruments measuring parental bonding, quality of life and mental health. RESULTS We randomised 78 of 147 newborn infants to intervention and 69 to the control group. No significant differences were detected in length of stay, mean bilirubin, or weight gain. Parents in the intervention group had better scores on bonding both at discharge (p = 0.034) and at 4 months (p = 0.008; effect size r = 0.2) and lower levels of stress at 4 months (p = 0.024) than controls. No statistically significant outcomes were found for the secondary outcomes. CONCLUSION In-home phototherapy improved bonding and reduced parental stress in comparison with usual in-hospital treatment. Caregivers should consider offering home phototherapy to families of non-immunised term infants with hyperbilirubinaemia.
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Affiliation(s)
- Miriam Pettersson
- Department of Paediatrics Faculty of Medicine and Health Örebro University Örebro Sweden
- Faculty of Medicine and Health School of Medical Sciences Örebro University Örebro Sweden
| | - Mats Eriksson
- Department of Paediatrics Faculty of Medicine and Health Örebro University Örebro Sweden
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | | | - Andreas Ohlin
- Department of Paediatrics Faculty of Medicine and Health Örebro University Örebro Sweden
- Faculty of Medicine and Health School of Medical Sciences Örebro University Örebro Sweden
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Gordo L, Oliver-Roig A, Martínez-Pampliega A, Iriarte Elejalde L, Fernández-Alcantara M, Richart-Martínez M. Parental perception of child vulnerability and parental competence: The role of postnatal depression and parental stress in fathers and mothers. PLoS One 2018; 13:e0202894. [PMID: 30148877 PMCID: PMC6110487 DOI: 10.1371/journal.pone.0202894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 08/10/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Parents' perception that their child may be vulnerable to serious life-threatening illnesses can have negative effects on how they exercise their parenting. No studies have yet been carried out on parent´s perception of their child’s vulnerability, when the child has not suffered a severe illness. This study tries to analyze the relationship between parent´s perception of their children´s vulnerability and parental competence, and analyzes the mediating role of postnatal depression and parental stress. Method The study was carried out on mothers and fathers of full-term infants who did not have any serious illnesses. A total of 965 people (385 fathers and 580 mothers) participated in the study. Results The results revealed an association between parental perception of their child’s vulnerability and parent’s perception of parental competence through depression and parental stress. However, this association was different for fathers and mothers. Conclusion The variable of perception of child’s vulnerability was a relevant factor to understand parental competence.
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Affiliation(s)
- Leire Gordo
- Department of Social and Developmental Psychology, University of Deusto, Bilbao, Spain
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Matvienko-Sikar K, Murphy G, Murphy M. The role of prenatal, obstetric, and post-partum factors in the parenting stress of mothers and fathers of 9-month old infants. J Psychosom Obstet Gynaecol 2018. [PMID: 28635525 DOI: 10.1080/0167482x.2017.1286641] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The aim of this paper was to examine the role of perinatal, obstetric and post partum factors on maternal and paternal stress. It will present the first examination of the role of prenatal, obstetric, post-partum, and demographic variables in parenting stress for mothers and fathers at 9 months. METHODS Data from 6821 parental dyads of 9-month-old infants were extracted from the Growing Up in Ireland National Longitudinal Study of Children. Participants completed the Parental Stress Scale, the Dyadic Adjustment Scale, the Quality of Attachment Sub-scale from the Maternal and Paternal Postnatal Attachment Scales, and a single item health status question from the Short Form 12 Health Survey. Information on prenatal care, pregnancy complications, obstetric outcomes, infant health, and participant demographics were also collected. Separate hierarchical linear regressions were conducted for mothers and fathers Results: Mothers reported higher levels of parenting stress than fathers (p < 0.001). Maternal parenting stress was predicted by attachment, own health status, average sleep, occupation, household income, and having a very rapid labor. Paternal parenting stress was predicted by attachment and own health status. DISCUSSION A range of perinatal factors was associated with an increased risk of higher parenting stress at 9 months post-partum and the roles of these factors differ between mothers and fathers. These findings are important for predicting and reducing risk of parenting stress in both genders.
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Affiliation(s)
| | - Gillian Murphy
- b School of Applied Psychology, University College Cork , Ireland
| | - Mike Murphy
- b School of Applied Psychology, University College Cork , Ireland
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Candelori C, Trumello C, Babore A, Keren M, Romanelli R. The experience of premature birth for fathers: the application of the Clinical Interview for Parents of High-Risk Infants (CLIP) to an Italian sample. Front Psychol 2015; 6:1444. [PMID: 26483712 PMCID: PMC4586417 DOI: 10.3389/fpsyg.2015.01444] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/09/2015] [Indexed: 11/25/2022] Open
Abstract
Aim: The study explored fathers’ experience of premature birth during the hospitalization of their infants, analyzing levels of depressive and anxiety symptoms as compared with mothers. Moreover the Italian version of the Clinical Interview for Parents of High-Risk Infant (CLIP) was tested through confirmatory factor analysis. Methods: Couples of parents (N = 64) of preterm infants (gestational age < 37 weeks) were administered a socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the CLIP after the admission to the Neonatal Intensive Care Unit (NICU). Results: Significant levels of anxiety and depressive symptoms and high percentages of subjects above the corresponding risk thresholds were found among fathers and mothers with higher scores among the latters. Confirmatory factor analysis of the CLIP showed an adequate structure, with better fit for mothers than for fathers. Conclusion: Results highlighted the importance for nurses and clinicians working in the NICU to consider not only the maternal difficulties but also the paternal ones, even if these are often more hidden and silent. In addition the CLIP may be considered an useful interview for research and clinical purposes to be used with parents of high-risk infants.
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Affiliation(s)
- Carla Candelori
- Laboratory of Dynamic Psychology, Department of Psychological Sciences, Health and Territory, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
| | - Carmen Trumello
- Laboratory of Dynamic Psychology, Department of Psychological Sciences, Health and Territory, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
| | - Alessandra Babore
- Laboratory of Dynamic Psychology, Department of Psychological Sciences, Health and Territory, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
| | - Miri Keren
- Infant Mental Health Unit, Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv, Israel
| | - Roberta Romanelli
- Laboratory of Psychometrics, Department of Psychological Sciences, Health and Territory, Università degli Studi "G. d'Annunzio" Chieti-Pescara Chieti, Italy
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Kong LP, Cui Y, Qiu YF, Han SP, Yu ZB, Guo XR. Anxiety and depression in parents of sick neonates: a hospital-based study. J Clin Nurs 2013; 22:1163-72. [PMID: 23480505 DOI: 10.1111/jocn.12090] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 01/07/2023]
Abstract
AIMS AND OBJECTIVES To investigate the prevalence of anxiety and depression in parents of hospitalised neonates and to analyse their relationship with other factors such as stress and social support, to provide evidence for targeted clinical interventions. BACKGROUND The perinatal period, a special susceptibility to negative emotions, is a period that women and their spouses have to face. In this time, the fact that the neonates have to be hospitalised is no doubt a huge psychological stress to their parents. Little understanding of the hospitalisation environment, lacking awareness of neonatal diseases as well as concerns about the neonates' safety, can easily lead to negative emotions in parents. Under the influence of negative mood, parents could become irritable and vulnerable, which may do harm to their physical and mental health, impact family harmony and even result in ineffective communication with doctors, affecting the care of neonates. DESIGN This study applied a cross-sectional study design. METHODS The psychological status of 600 parents (400 fathers and 200 mothers) was assessed in the first week of the hospitalisation of neonates, using the Self-Rating Anxiety Scale, Self-Rating Depressive Scale, Social Support Rating Scale and Perceived Stress Scale. RESULTS The results of the cross-sectional survey showed that 20% of fathers and 24% of mothers had symptoms of anxiety, while 30.8% of fathers and 35% of mothers had depressive symptoms. The total scores for anxiety and depression in these parents were significantly higher than the normal population (p<0.01). The level of social support and perceived stress were the most important factors relating to parental anxiety and depression. CONCLUSION Parents of hospitalised neonates are more prone to suffer from negative emotions than normal population. Anxiety and depression are common emotions in these parents. However, the social support they receive is far from satisfactory, so timely and effective nursing interventions are essential. RELEVANCE TO CLINICAL PRACTICE Health professionals should understand the mental health of parents with hospitalised neonates and take measures to reduce their psychological pressure so as to improve their care of the neonates, and help to maintain the harmony and stability of families and the whole society.
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Affiliation(s)
- Li-Ping Kong
- School of Nursing, Nanjing Medical University, Nanjing, China
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Hildingsson I, Thomas J. Parental stress in mothers and fathers one year after birth. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.840882] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants. SEXUAL & REPRODUCTIVE HEALTHCARE 2013; 4:107-12. [PMID: 24041731 DOI: 10.1016/j.srhc.2013.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/23/2013] [Accepted: 06/18/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the influence of co-care facilities and amount of skin-to-skin contact during Neonatal Intensive Care Unit (NICU) stay on maternal stress in mothers of preterm infants at two months corrected age. METHODS A prospective cohort study that involved 300 mothers of pre-term infants was conducted in four NICUs (two with co-care facilities and two with non co-care) in Sweden. Data on duration of skin-to-skin contact per day for all days admitted to the NICU were collected using self-reports. Maternal stress was measured by the Swedish Parental Stress Questionnaire (SPSQ) at two months of infant's corrected age. RESULTS Mothers whose infants were cared for in a NICU with co-care facilities reported significantly lower levels of stress in the dimension of 'incompetence' compared to mothers whose infants had been cared for in non co-care NICUs. The amount of skin-to-skin experienced during the neonatal stay was not significantly associated with levels of maternal stress at two months corrected age. CONCLUSION The finding that mothers who do not experience co-care facilities experience greater levels of stress in relation to feelings of incompetence is of concern. Improvements to NICU environments are needed to ensure that mother-infant dyads are not separated.
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Widarsson M, Engström G, Rosenblad A, Kerstis B, Edlund B, Lundberg P. Parental stress in early parenthood among mothers and fathers in Sweden. Scand J Caring Sci 2012; 27:839-47. [PMID: 23067055 DOI: 10.1111/j.1471-6712.2012.01088.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/04/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parental stress affects parenting behaviour and the quality of dyadic parent-child interactions. Mothers generally show higher parental stress than fathers. AIMS Our aims were to assess the perceived level of parental stress in early parenthood and examine the differences between mothers and fathers within couples in relation to their levels of education, parental experience, existence of a parental role model and sense of coherence. METHODS In total, 307 mothers and 301 fathers of 18-month-old children answered the Swedish Parenthood Stress Questionnaire (SPSQ); and 318 mothers and 311 fathers answered the Sense of Coherence (SOC-3) scale; 283 couples answered both the SPSQ and SOC-3. RESULTS Mothers perceived higher levels of stress than fathers in the sub-areas incompetence (p < 0.001), role restriction (p < 0.001), spouse relationship problems (p = 0.004) and health problems (p = 0.027), and in total (p = 0.001). In contrast, fathers perceived higher stress than mothers in the sub-area social isolation (p < 0.001). When the data were stratified with respect to education, parental experience, existence of a parental role model and sense of coherence, significant results were observed in some of these sub-areas. CONCLUSIONS Mothers and fathers experience stress in different areas during their early parenthood. Healthcare professionals should be aware of the differences in stress that exist between mothers and fathers, so that parents can be adequately prepared for parenthood and avoid parental stress.
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Affiliation(s)
- Margareta Widarsson
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Brummelte S, Grunau RE, Synnes AR, Whitfield MF, Petrie-Thomas J. Declining cognitive development from 8 to 18 months in preterm children predicts persisting higher parenting stress. Early Hum Dev 2011; 87:273-80. [PMID: 21334150 DOI: 10.1016/j.earlhumdev.2011.01.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/31/2010] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Susanne Brummelte
- Developmental Neurosciences & Child Health, Child and Family Research Institute, Vancouver, BC, Canada
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