A Study of Maternal Competence in Preterm Birth Condition, during the Transition from Hospital to Home: An Early Intervention Program's Proposal

Understanding the experience of the mothers' ability to take care of their preterm infants related to in-hospital and post-discharge: a qualitative content analysis

BACKGROUND

Preterm infants may experience many health and developmental issues, which continue even after discharge from the neonatal intensive care unit. Once home, the mother, as a non-professional and the primary caregiver will be responsible for the essential care of her preterm infant.

PURPOSE

Understanding the take care ability in mothers with preterm infants.

METHODS

The content analysis method was used. The data were collected using in-depth and semi-structured interviews from April 2021 to February 2022. Eleven mothers, two fathers, two grandmothers, one neonatal nurse, and two neonatologists with a mean age of 36.05 ± 10.88 years were selected using purposeful and snowballing sampling in Tehran, Iran. Allocating adequate time for data collection, gathering data through different methods, peer checking by two qualitative researchers, long interaction with the settings, maximum variation sampling, appropriate quotations, and showing the range of facts fairly and honestly were considered to ensure the trustworthiness of this study. The data were analyzed through Lindgren et al.'s approach using MAXQDA software.

RESULTS

Based on the findings and participants' experiences in 18 deep interviews, the mothers with desirable care ability have adequate ability as described by 17 subcategories and are categorized into five dimensions. The care ability of the mothers of preterm infants upon neonatal intensive care unit discharge consisted of five categories including maternal identity, infant's needs, cognitive ability, technical ability, and psychological ability.

IMPLICATIONS FOR PRACTICE AND RESEARCH

In the mothers of preterm infants, maternal identity and the infant's needs are antecedents of the care ability concept. The care ability of the mothers with preterm infants is distinct from those of other caregivers. This is a multi-dimensional concept and trait related to maternal cognitive ability, technical ability, and maternal psychological ability. Professional neonatal nurses should assess their care ability from multiple perspectives: cognitive, technical, and psychological abilities. They should be considered in designing empowerment and engagement programs for the improvement of the care ability of the mothers of preterm infants. Both mothers and professional neonatal nurses should take responsibility for improving the mothers' ability to take care of their preterm infants.

Personality Traits and Sociodemographic Variables' Effects on Parental Burnout During the Second and Fourth COVID-19 Waves in Italian Parents

(1) Background: Since the COVID-19 pandemic was a source of stress for families, this study aimed to investigate the influence of dispositional factors, such as personality traits and sociodemographic variables, on parental burnout among Italian parents during two waves of the COVID-19 pandemic. Therefore, the study assessed personality traits and sociodemographic variables as protective or risk factors for parental burnout levels. (2) Methods: The study consisted of two cross-sectional samples collected during the second and fourth waves of the Italian pandemic. The participants included 600 Italian parents: 245 from the second wave (average age = 37.12, SD = 2.78) and 355 from the fourth wave (average age = 36.89, SD = 3.14). The measures used were the Balance between Risks and Resources, the Personality Inventory, and a sociodemographic questionnaire. (3) Results: The t-test showed that parents in the fourth wave had lower parental burnout levels. Moreover, stepwise multiple linear regression revealed that sociodemographic variables did not have an effect, while significant effects of personality traits were found. Specifically, neuroticism was identified as a risk factor for parental burnout, while agreeableness and openness were identified as protective factors. (4) Conclusions: The findings indicated that similar stress levels were reported between the two waves of parents and that personality traits play a crucial role in facilitating or limiting the management of parental competencies during a risk condition.

Relational "Dance" Between Mother and Moderately Preterm Infant at 6 and 9 Months of Correct Age: Possible Risk and Protective Factors

BACKGROUND/OBJECTIVES

This study explores the characteristics of the early mother-infant relationship in a sample of 30 mother-preterm infant dyads between 6 and 9 months, using a phenomenological observational tool called "Dance Steps". This tool examines the configuration and reciprocity of mother-infant interactions. The study also investigates how sociodemographic factors and maternal functioning variables, such as postnatal depression and perceived social support, may serve as risk or protective factors in the development of these interaction "Steps".

METHODS

Observations were conducted through video recordings of face-to-face caregiver-infant interactions during unstructured play sessions at neonatal follow-up visits. The data focused on identifying specific characteristics of reciprocity in the "dance steps".

RESULTS

The results reveal certain features of reciprocity are stable over time, demonstrating synchronicity and attunement in many of the "dance steps". Other "steps" evolve in response to the child's developing competence. Sociodemographic factors, particularly the mother's educational level and the infant's sex, significantly influence the "Dance". Postnatal depression negatively affected reciprocity in several steps, especially impacting the infant, whereas perceived social support had a lesser effect.

CONCLUSIONS

The findings emphasize the importance of supporting mothers of preterm infants to adjust their interactions in ways that promote the child's developmental competence. This support is essential for fostering physical and emotional closeness during critical developmental transitions.

Impact of an mHealth intervention on parents' emotional health and on the neurodevelopment of high-risk infants

We assess the prenatal and postnatal effect of the High-Risk Pregnancy and Baby Parenting programme, which is complemented with two mHealth (app-based) resources. The GLM Repeated Measures Model technique was used to explore differences in the emotional health of the participants and in their infants' neurodevelopment, comparing programme versus usual care groups, composed of 150 and 195 participants, respectively. The mothers presented lower levels of depression (mean difference 1.74, p = 0.04, 95% CI 0.07, 3.40) and higher levels of resilience (mean difference 4.09, p = 0.004, 95% CI 1.40, 6.78). For the fathers, positive effects on resilience were recorded (p < 0.001). A positive treatment effect was perceived in the infants' cognitive (p = 0.014), language (p < 0.001) and motor (p = 0.006) development. These findings suggest application of the programme can benefit maternal emotional health and infant neurodevelopment. M-Health technology could make this programme more accessible.

Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress

Introduction

It is well established that a premature birth increases the likelihood of developing anxiety during the postpartum period, and that the environment of the neonatal intensive care unit (NICU) might be a contributing factor. Mothers of earlier premature infants may experience these anxieties to a higher degree compared to mothers of later premature infants. The aim of this study was to explore the association between prematurity and postpartum-specific anxiety, and the relationship between postpartum-specific anxiety and stress in the NICU.

Materials and methods

Mothers (N = 237) of infants aged between birth and 12 months completed an online survey containing the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). Structural equation modeling was used to analyze the relationship between gestational age and postpartum-specific anxiety, with one-way ANOVAs used to analyze this relationship with respect to categories of gestational age. Hierarchical regression models analyzed the relationship between postpartum-specific anxiety and stress in the NICU.

Results

For the PSAS-RSF, Practical Infant Care Anxieties (p = 0.001), Maternal Competence and Attachment Anxieties (p = 0.033), and Infant Safety and Welfare Anxieties (p = 0.020) were significantly associated with week of gestation. Practical Infant Care and Infant Safety and Welfare Anxieties were significantly higher for mothers of late premature infants, compared to mothers of term infants (p < 0.001; p = 0.019). There were no significant between-group differences with respect to Maternal Competence and Attachment Anxieties. After controlling for potential confounders, Infant Safety and Welfare Anxieties were significantly associated with increased stress in the NICU (p < 0.001) as measured by the PSS:NICU.

Conclusions

Our findings highlight the need for interventions for mothers with premature infants, which specifically target anxieties reflected in the PSAS-RSF, such as routine care and increasing maternal self-efficacy.

Maternal Concerns in Home Care for the Premature Newborn: An Integrative Review

OBJECTIVE

To identify and analyze the scientific literature, both national and international, concerning the primary maternal concerns about caring for premature newborns at home.

METHODS

This integrative review is based on the guiding question: "What scientific publications from 2012 to 2021 address maternal concerns about the care of premature newborns at home?". Searches were conducted in the electronic databases: Embase, Medline, Web of Science, Lilacs, Scielo, and Cochrane Library.

RESULTS

A total of 21 articles were identified. The qualitative analysis showed that maternal concerns pertained to breastfeeding, hygiene, sunbathing practices, managing infant colic, identifying signs, symptoms, and clinical changes, temperature control, and the third phase of the kangaroo method.

CONCLUSIONS

Maternal uncertainties underscore the importance of enhancing strategies focused on supporting families and ensuring continued care for neonates at home.

Development and validation of a maternal anxiety for neonatal jaundice scale in China

BACKGROUND

Maternal anxiety induced by neonatal jaundice has adverse effects on maternal and infant health, but there was no specific tool to identify the anxiety level of mothers. This study aims to develop a Maternal Anxiety for Neonatal Jaundice Scale (MANJS) and to validate it in the target population.

METHODS

An initial 11-items MANJS was developed through literature review, expert panel consultation, and a pilot-test. Subsequently, mothers of neonates with jaundice were recruited from the Maternal and Child Health Hospital of Hainan Province, China, from June to December 2018, for a formal questionnaire survey. Based on the data collected, the scale was validated for construct validity, convergent validity, discriminant validity, content validity, and internal consistency reliability after the items screening.

RESULTS

The reliability and validity of MANJS were validated in 1127 mothers of jaundiced neonates. After the item with cross-loadings was removed using exploratory factor analysis, MANJS consisted of two dimensions and 10 items, with a cumulative variance contribution of 74.36% and factor loadings above 0.6 for all items. The confirmatory factor analysis identified three items with cross-factor loading or error correlation and then they were removed orderly. The further confirmatory factor analysis showed a good construct validity for the 7-item MANJS, with standardized root mean square residual (SRMR) = 0.029, root mean square error of approximation (RMSEA) = 0.068, comparative fit index (CFI) = 0.961, Tucker-Lewis index (TLI) = 0.937, incremental fit index (IFI) = 0.961, normed fit index (NFI) = 0.954, goodness of fit index (GFI) = 0.998, adjusted goodness of fit index (AGFI) = 0.996, respectively. The average variance extracted values (AVE) of the two factors were 0.80 and 0.72, and the combined reliability (CR) were 0.94 and 0.88, respectively. Cronbach's alpha was 0.90 for the MANJS, and split-half reliability was 0.72.

CONCLUSIONS

MANJS was demonstrated to have satisfactory reliability and validity in evaluating maternal anxiety caused by neonatal jaundice among Chinese postpartum women.