Physical and mental health in African American mothers with HIV

This article examines the physical and mental health of African American mothers during a 2-year period following the birth of an infant seropositive for human immunodeficiency virus (HIV). Participants were 34 African American mothers enrolled when the infants were approximately 3 months of age and reinterviewed when the infants were 6, 12, 18, and 24 months. Three self-report questionnaires were used to assess physical health (perception of health, activity limitation, and physical symptoms) and mental health (depressive symptoms and stigma). Health symptoms most often reported were infections, problems thinking and remembering, low energy, and gynecologic problems. Moderate levels of perceived stigma were reported. Depressive symptoms were high; a large number of women at each data point had depressive symptom scores above the cutoff, indicating risk for depression. There were significant correlations between depressive symptoms and health, suggesting a link between mental and physical health. These findings have significance for the health of the mother and the parenting of her infant. Attention should be paid to the mental and physical health of mothers with HIV, especially during the first 2 years after the birth of a child.

Developmental outcomes of infants with bronchopulmonary dysplasia: comparison with other medically fragile infants

The purpose of this study was to compare the developmental outcomes and mother-infant interactions of infants with bronchopulmonary dysplasia (BPD) and those of other medically fragile infants. One-hour behavioral observations were made of the interactions of mothers with two groups of infants (23 with BPD, 39 medically fragile without BPD or neurological problems) at enrollment, every 2 months during hospitalization, 1 month after discharge, and at 6 months' and 12 months' corrected age. Assessment of the home environment also was done at 6 and 12 months. Multiple regressions were calculated separately for child mental, adaptive, language, and motor outcomes. Predictors were: home environment assessment, measures of maternal interactive behaviors (positive attention, expression of negative affect, medicalized caregiving), infant group membership, and presence of intraventricular hemorrhage (IVH) in the infant. There were no significant differences between the two groups in any of the developmental outcomes or interactive variables, and the presence of IVH had no effect on these variables. Maternal positive attention and the home environment were correlated with mental development, and mother negative affect was related to adaptive behavior for both groups. Differences in developmental and interactive behaviors between infants with BPD and other prematurely born infants found in other studies appear to be a result of chronic health problems and, thus, are not unique to infants with BPD.

Perceptions of health and their relationship to symptoms in African American women with type 2 diabetes

Diabetes mellitus is an incurable disease and a major cause of mortality and morbidity. Diabetes disproportionately affects members of minorities who suffer from higher rates of complications and greater disability (Cowie & Eberhardt, 1996). The purpose of this study was to (a) describe the symptoms of African American women with Type 2 diabetes and examine the relationship among diabetes-related symptoms; (b) document complications of diabetes and perceptions of health and functioning; and (c) examine the relationship between duration of diabetes and age at diagnosis and perceived health. A convenience sample of 75 African American women with Type 2 diabetes were interviewed. A 44-item questionnaire measured selected demographic variables, symptoms, documented complications, and their perceived relationship to diabetes. The SF-20 was used to measure perceptions of health status. Data show that African American women with Type 2 diabetes have a wide variety of symptoms and poor perceptions of their general health and physical functioning.

Unsafe caregiving practices experienced by 3-year-old children born prematurely

Unsafe caregiving practices were studied in relation to risk factors for unintentional injuries as reported in the literature. A total of 54 premature children at 3 years of age and their mothers were observed twice in their homes for 2-hour periods, and the HOME Inventory was scored at one of the visits. Field notes from these visits were analyzed for unsafe practices, including hazards in the environment and inadequate parental supervision. Unsafe practices occurred for approximately 30% of the children studied. T-tests indicated that children with no unsafe practices had higher HOME scores than children with unsafe practices. In addition, lower HOME scores and later birth order were correlated with a greater number of unsafe practices. Maternal age and education, family size, child birthweight, and maternal perception of child vulnerability were not related to the presence of unsafe caregiving practices. The findings also suggest that the HOME Inventory may have promise as a useful tool in screening for unsafe caregiving of preschool children.

Developmental problems and interactions between mothers and prematurely born children

This study explored how the developmental status of 49 3-year-old prematurely born children related to the interactions between these children and their mothers. Two 2-hour observations of mother-child interactions, the Home Observation for Measurement of the Environment (HOME) inventory, a developmental assessment, and Nursing Child Assessment Teaching Scale (NCATS) were scored when the child was 3 years corrected age. The effects of specific developmental problems (cognitive, language, and attention) were examined by comparing subgroups with and without these problems. Children with normal IQs spent less time not playing and scored higher on the NCATS than children with low IQs. Mothers of children with normal IQs scored higher on provision of play materials on the HOME. The mothers of children with language concerns interacted less, talked less, were more negative, and scored lower on the HOME and NCATS than mothers of the children with normal language abilities. Children with attention problems were more active than children with normal attention spans. These findings suggest that mother-child interactions might be useful for identifying children at risk for developmental delay and that interventions with preschool children with developmental delays will probably be more effective if their mothers are helped to provide a more appropriate social environment.

Feeding and non-feeding interactions of mothers and prematures

The interactions between mothers and premature infants during feeding and nonfeeding periods were explored. Twenty-nine premature infants and their mothers were observed interacting for 1 hour in their homes at 6 months corrected for prematurity. Mothers were more likely to engage in the following behaviors involving close contact during feeding: looking at the infant, holding the infant, having body contact, and rocking their infants. They interacted with their infants 96% of feeding time. During nonfeeding periods, they were more likely to engage in more distal behaviors (e.g., gesturing, touching, and playing with the infant) and spent only 67% of the time interacting with the infant. Infants were more likely to be alert, vocalize, play with objects, express negative affect, and locomote during nonfeeding, and they were more likely to be drowsy or asleep during feeding. Therefore, a complete understanding of interactions between mothers and prematures can only come from examining both feeding and nonfeeding periods.

Mothers' stories about their experiences in the neonatal intensive care unit

The purpose of this article is to let mothers tell the stories of their neonatal intensive care unit (NICU) experiences and to determine how well these experiences fit the Preterm Parental Distress Model. Interviews were conducted with 31 mothers when their infants were six months of age corrected for prematurity and were analyzed using the conceptual model as a framework. The analysis verified the presence in the data of the six major sources of stress indicated in the Preterm Parental Distress Model: (1) pre-existing and concurrent personal and family factors, (2) prenatal and perinatal experiences, (3) infant illness, treatments, and appearance in the NICU, (4) concerns about the infant's outcomes, (5) loss of the parental role, and (6) health care providers. The study indicates that health care providers, and especially nurses, can have a major role in reducing parental distress by maintaining ongoing communication with parents and providing competent care for their infants.

The usefulness of an assessment of emotional involvement of HIV-positive mothers and their infants

INTRODUCTION

A positive mother-infant relationship is crucial for optimal child development; however, many factors may interfere with the development of a such a relationship. One group at risk for compromised mother-infant interactions is women with HIV infection. The purposes of this study were (a) to examine the usefulness of the Attachment During Stress scale (ADS) for measuring the emotional involvement of HIV-positive mothers with their infants during a clinic visit and (b) to explore the effects of maternal health status, age, parity, and educational level on mother-infant involvement.

METHOD

A descriptive, longitudinal study was conducted with 57 primarily African American HIV-positive mothers and their infants who were patients at 1 of 2 regional referral centers. The ADS was completed during the child's physical examination at 3, 6, and 12 months of age, and mothers completed questionnaires during these visits.

RESULTS

Maternal age, education level, health status, and parity were not related to maternal emotional involvement. However, the emotional involvement of the mother and infant were correlated (r = 0.73, P < .001).

DISCUSSION

These findings suggest that the ADS may be a useful screening tool to supplement the nurse's clinical judgment in a pediatric outpatient setting. The ADS provides some useful information about the emotional involvement of the mother and infant, although it does not provide a comprehensive assessment of their relationship.

Early parental interactions with and perceptions of multiple birth infants

The perceptions and interactions of mothers and fathers of seven sets of twins and one set of triplets were compared to those of parents of 49 singleton infants. Couples were typically interviewed together three times during the pregnancy and at 1 week and 3 months post-partum. Two-weekly observations of mother-father-infant interactions were conducted after the first postnatal interview. Three major themes were apparent in the interviews--the positive and negative specialness for multiple births, difficulties involved in managing more than one infant, and attachment issues--that were also evident during the observations. Although there were few differences in care-giving and interactive behaviours between the multiple birth and singleton parents, the logistics of caring for more than one infant dictated that multiple birth infants were left alone more and looked at, talked to and held less often. Couples used different strategies to care for their infants, varying in both the extent to which they interacted preferentially with the infants and in the relative involvement of the mother, father and others.

Nursing care and the development of sleeping and waking behaviors in preterm infants

The relationship between nursing care and the development of sleep-wake behaviors of 71 medically high-risk preterms was examined. The development of preterm infants' sleep-wake states, jitteriness, and negative facial expressions were influenced not only by the presence of the nurse, but also by the type of caregiving the nurse provided. The infant was awake more often when with caregivers than when alone. Waking states increased over time only when the infant was with caregivers, whereas quiet sleep increased only when the infant was alone. Infant behaviors and sleep-wake development were related to the intrusiveness of care. For example, negative facial expressions and sleep-wake transitions increased over time during the most intrusive caregiving. The development of sleeping and waking in preterm infants appears to depend not only on biological maturation but also nursing stimulation. As long-term developmental effects of nurse caregiving are unknown, additional research is needed.

Distress and growth outcomes in mothers of medically fragile infants

BACKGROUND

With recent advances in medical and nursing care, many high-risk infants are surviving the neonatal period with severe, life-threatening chronic illnesses, resulting in extended hospitalizations and/or frequent rehospitalizations and long periods of dependence on technology for survival.

OBJECTIVE

To describe the factors predicting maternal adjustment in mothers caring for medically fragile infants.

METHOD

Subjects were mothers (n = 67) whose infants had a serious life-threatening illness requiring hospitalization and technology for survival. Data for this longitudinal study were collected at enrollment and hospital discharge, and at 6, 12, and 16 months after birth. Distress was measured as depressive symptoms using the Center for Epidemiologic Studies Depression Scale, and growth was assessed using a personal developmental impact rating scale. Data about personal characteristics, parental role attainment, infant-illness characteristics, and maternal illness distress were collected.

RESULTS

Mothers of medically fragile infants experience distress and growth as a result of their child's illness. Mean scores on the depression scale at both time points were moderately high and a high percentage of mothers scored at risk for depressive symptoms. Maternal developmental impact ratings at 6 months were neutral to slightly negative and at 16 months were between neutral and positive. While the mean depressive symptom scores and maternal developmental ratings were lower at the later time points, these differences were not significant. Maternal depressive symptoms and developmental impact ratings were moderately but negatively correlated at 6 and 16 months, indicating that higher depressive symptoms were related to more negative developmental impact ratings. Distress was influenced by maternal characteristics, hospital environmental stress, and worry about the child's health. Growth was influenced by characteristics of the child's illness, hospital environmental stress, concern about the child's health, and level of maternal role attainment.

CONCLUSIONS

Nurses should consider personal characteristics and level of parental role attainment as well as characteristics of the child and illness-related distress in their approaches to intervention with mothers of critically ill infants.

Temporal organization of sleep-wake states in preterm infants

The development of temporal organization of sleep-wake states during the preterm period was examined. Seventy-one high-risk preterms from two cohorts were observed from 7 to 11 p.m. weekly from the time they were no longer critical until discharge. Mixed general linear model analyses found that with increasing postconceptional age, quiet waking, active waking, and sleep-wake transition bouts occurred more frequently, quiet sleep bouts occurred less frequently, and active waking and quiet sleep bouts increased in length. However, these developmental patterns were not stable over cohorts. On the other hand, the transitional probabilities between states were similar in both cohorts, providing evidence for biological bases for some aspects of temporal organization. Active sleep was pivotal in state transitions. Younger infants showed fewer transitions that did not involve active sleep. Thus, temporal organization is an early characteristic of sleep-wake states but is not a unitary phenomenon. Transitional probabilities remain relatively invariant, whereas bouts lengths and frequencies may be altered in different populations or by differing environmental conditions.

Infertility and early parent-infant interactions

Approximately 50% of infertile couples will become parents through pregnancy or adoption, but they experience major difficulties while working towards this goal. Infertility treatments are associated with physical pain and psychological distress, and adoption procedures are prolonged and emotionally stressful. The extent to which these stressors alter the parenting of these couples is not known. The purpose of this study, therefore, was to examine the early parent-infant interactions in infertile couples who become parents through pregnancy or adoption. Two groups of infertile couples (30 who achieved pregnancy and 21 who adopted) and a group of 19 couples without fertility problems were observed interacting with their infants twice, 7 to 21 days after the infant's arrival and a week later, at a time when both parents were at home. Their babies were between 9 days and 5 months of age. Behaviours of the mother, father and infant were recorded every 10 seconds, beginning when the baby was picked up and ending when the baby was put down asleep or 1 1/2 hours had passed. Repeated measures ANOVAs were used to compare the three groups over the observations. There were no differences between fertile and infertile biological parents. Adopted infants showed more alertness, less sleeping, more smiles, and more looking than biological infants. Adoptive mothers spent less time as the sole interactor. Adoptive parents spent more time in playing with their infants and held and touched them less than did biological parents. Infertility, therefore, does not appear to affect early parenting. In general, the amounts of behaviours exhibited by infertile biological parents were very close to those of fertile parents. Differences in the behaviours of adoptive as compared to biological parents can best be explained as responses to the behaviours of their older infants, rather than as evidence of different parenting styles.

Modeling development of sleep-wake behaviors: I. Using the mixed general linear model

The purpose of this paper is to demonstrate the use of the mixed general linear model (MixMod) for modeling development of sleep-wake behaviors in preterm infants. The mixed general linear model allows the concurrent identification of both group and individual developmental patterns in longitudinal data sets with inconsistently timed data, irregularly timed data, and randomly missing values. This statistical technique is well suited to data from preterm infants because these infants enter and leave longitudinal studies at varying times depending on their health status. One sleep organizational variable--the regularity of respiration in quiet sleep--obtained from a study of 37 preterm infants was used as an example. Seven infant characteristics were used as covariates. The various steps involved in conducting a mixed model analysis of this variable are illustrated. The strengths and limitations of this technique are discussed.

Modeling development of sleep-wake behaviors. II. Results of two cohorts of preterms

A mixed general linear model analysis of the development of sleep-wake states was conducted on 37 high-risk preterm infants and replicated with a second cohort of 34 infants. Most dependent variables showed significant development over the preterm period: active sleep decreased, and active waking, quiet waking, and the organization of active sleep and quiet sleep increased over the preterm period in both cohorts. The amount of quiet sleep also increased over age, but this change was significant only for Cohort 1. Seven infant characteristics used as covariates had only minor effects. There were no significant differences in the developmental trajectories (slopes) of the two cohorts. The amounts of four variables differed between cohorts: Cohort 2 infants had less sleep-wake transition, more active sleep, less active sleep without REM, and more regular quiet sleep. These findings suggest that developmental patterns of sleep wake states are stable enough in the preterm period that deviant individual patterns might be used to identify infants with neurological problems.

Pediatric nurses' use of behaviors to make medication administration decisions in infants recovering from surgery

Although behavioral observation is recommended as the primary pain assessment for the nonverbal postsurgical child, little is known about clinicians' use of observation in their medication administration decisions. Eight infants were videotaped after surgery and segments of the videotapes were categorized as medication inactive or medication active (assumed to relieve pain) based on the usual duration of infants' analgesics. Nurses (N=50) viewed these segments and mean percent agreement with the pharmacologic categorization was 54%. Agreement was high for medication active segments and low for medication inactive ones. Nurses reported using the pain behaviors described in the literature as well as other infant characteristics in their decision making. Infant behaviors observed in the medication inactive snippets were not suggestive enough of the presence of pain to result in the nurses choosing to medicate.

Effect of standard rest periods on apnea and weight gain in preterm infants

This study determined the effect of modifying a single aspect of the intermediate care environment on the incidence of apnea and rate of weight gain in convalescent preterm infants. Twenty-two preterm infants were assigned to experimental and control groups using a randomized, matched-pair design. Over a three-week period, infants in the experimental group were provided a 1 1/2-hour nap period four times a day during which their beds were covered and they were left undisturbed. Control infants received standard nursing care. The infants in the experimental group had more apnea at the start of the study than the control infants but showed a significantly more rapid decline in the incidence of apnea. These infants also gained significantly more weight per day than the control infants. Thus, a simple modification of nursing care that involved minimal increases in nursing time had a beneficial effect on preterm infants.

HOME inventory and NCATS: relation to mother and child behaviors during naturalistic observations. Home Observation for Measurement of the Environment. Nursing Child Assessment Teaching Scale

The purpose of this study was to determine the relationships among the Nursing Child Assessment Teaching Scale (NCATS), the Home Observation for Measurement of the Environment (HOME) inventory, and interactive behaviors observed in the home for fifty-three 3-year-old, prematurely born children and their mothers. The total HOME score showed high internal consistency, with moderate subscale levels. NCATS total score showed high internal consistency, but low to moderate subscale consistency. Combining NCATS subscales into a mother subscale and child subscale improved internal consistency. The HOME and the NCATS mother subscale correlated with observed maternal behaviors, but the NCATS child subscale was unrelated to child behaviors. Relationships between observed behaviors and HOME scores did not differ for high- and low-education mothers or for Caucasians and African Americans, but only low-education mothers and African Americans exhibited correlations between NCATS scores and observed behaviors. These results show the HOME, NCATS, and naturalistic observations measure related, but not overlapping, aspects of the mother's contribution to her relationship with her child, but the NCATS child subscale should be used with caution with 3-year-olds.

Maternal recall of the neonatal intensive care unit

This study examined how mothers of prematurely born three-year-old children retrospectively recall their responses to their infant's hospitalization in the neonatal intensive care unit (NICU). Forty-four mothers of three-year-old prematurely born children were interviewed as part of a longitudinal study. Data from maternal interviews were analyzed using the analytic inductive method. Findings support the hypotheses that were based on the Parental Stress in the ICU model. Three years after the birth of their premature infants, mothers reported vivid memories of stress related to the appearance and behavior of their infants, the pain and procedures the infants endured, alterations in their role as parents, and stress related to the infant's illness severity and uncertainty about infant outcomes. Prenatal problems, such as high-risk pregnancy or birth, infant loss, and disturbances in family support, were also recalled as sources of stress. Findings have implications for family-centered nursing care in NICUs.

Parenting the prematurely born child: pathways of influence

Recognizing the importance of parents in the lives of preterm infants, investigators and clinicians have increasingly focused on the needs of parents during the period when their infant is hospitalized in a neonatal intensive care unit and the impact of this experience on their subsequent parenting. The purpose of this report is to summarize research findings from over two decades of research, present a framework for understanding the various influences on parents of prematurely-born children, and suggest clinical interventions that are important in helping parents both in the hospital and after discharge.

Parents as passengers during pediatric transport

INTRODUCTION

The transport environment presents a unique setting in which the feasibility, advantages, and disadvantages of passengers accompanying a patient must be assessed carefully. The purpose of this study was to describe the current practice of including parents as passengers during pediatric interfacility transport.

METHODS

One-hundred-eighty-eight critical care transport programs in the United States responded to a voluntary mail survey, providing information about current policies, practices, and crew perceptions of the advantages and disadvantages of carrying parents as passengers.

RESULTS

Extra seating for passengers was available in 96% of ambulances, 86% of fixed-wing aircraft, and 54% of helicopters used for pediatric transport. Parents traveled as passengers in all types of vehicles; most frequently in ambulances and fixed-wing aircraft. Twenty percent of helicopter programs allowed parent passengers on more than half of their pediatric transports in this vehicle. Advantages of parent passengers included emotional benefit for the parent and child, availability of parents for history and consent, good public relations, and having the parent present if the child dies. Disadvantages included potential parent anxiety, crew distraction, and space limitations.

DISCUSSION

This study reflects the widely diverse policies, practices, and opinions relevant to this topic and confirms a need for further study.

Parenting the prematurely born child

The purpose of this chapter is to summarize the findings of the nursing research on parenting the prematurely born child. This research focused on eight general areas: impact of the home environment on infant development status, the relationship between premature infants and their mothers during the first 2 years, parenting during hospitalization, maternal concerns about infant discharge, fathering, subpopulations of premature infants, parenting after the first 2 years, and interventions to improve parenting. There is a need to strengthen the design and conceptualization of these studies, to move toward more intervention research, and to do research that is more culturally sensitive, especially toward fathers, ethnic and cultural minority groups, and the poor.

Fertility status and symptoms in childbearing couples

The symptoms of 58 pregnant couples--37 with a history of infertility and 21 without a history of infertility--were compared. The Symptomatology Inventory, a checklist of 42 common physical and psychological symptoms of pregnancy, was completed by each spouse from months 4 to 9 of pregnancy. For purposes of analysis, the individual symptoms were grouped into three categories: physical symptoms, negative affective symptoms, and positive affective symptoms. Although the infertile pregnant couples did not experience more symptoms than fertile couples, their pattern of reporting pregnancy-related symptoms was quite different. In terms of both number and type of symptoms, infertile spouses' symptoms tended to be positively related. Compared to fertile couples, the infertile couples experienced symptoms globally and were more consistent in the number of symptoms reported by each spouse. Additional research is needed to confirm these findings and to determine the implications of these differences for childbearing and the martial relationship.

Behaviors of preterm infants with and without chronic lung disease when alone and when with nurses

Many clinicians believe that infants with chronic lung disease display more irritability and react more negatively to care than other preterm infants. Therefore, the sleep-wake states and behaviors displayed by 31 high-risk preterm infants without chronic lung disease and 20 infants with chronic lung disease during four-hour observations conducted in intermediate care between 32 and 36 weeks postconceptional age were compared. Separate analyses were conducted for times when infants were alone and when they were with nurses to determine whether behavioral differences might be greater during handling. There were very few differences between the groups in either situation. Sleep-wake states did not differ. The infants with chronic lung disease exhibited more jitters at every age, but only when they were alone. Infants with and without chronic lung disease showed isolated differences in five behaviors when they were alone but in only two behaviors when they were with nurses. Thus, there is no evidence that 32- to 36-week preterm infants with chronic lung disease are more irritable or react more negatively to care than other preterm infants.

Comparison of pregnancy symptoms of infertile and fertile couples

This study was undertaken to describe the most common symptoms experienced during pregnancy by couples with a history of infertility and to compare them with symptoms of expectant couples without a history of reproductive problems. The Symptomatology Inventory, a 42-item checklist of common pregnancy symptoms, was used. The 10 most frequent symptoms reported and their rank order were very similar for the women from both groups. Men from the two groups frequently reported similar symptoms, but differed on their rank order. This research provides evidence that in terms of pregnancy symptoms infertile and fertile couples are more alike than they are different.

Compensatory parenting: how mothers describe parenting their 3-year-old, prematurely born children

Premature infants and their mothers experience difficulties in establishing their relationships. The effect of these early problems on later parenting is not known. This study explored whether mothers' recollections surrounding the birth and hospitalization of a preterm infant affected their perceptions and their parenting of these children at 3 years of age. Twenty-seven primary caregivers of 30 prematurely born children completed three questionnaires on their perceptions of their children and were interviewed about parenting experiences. The core concept identified in analysis was compensatory parenting, a parenting style in which mothers provided special experiences and avoided others in an attempt to compensate the children for their neonatal experiences. Compensatory parenting was influenced by the view of these prematurely born children as both special and normal and by salient prenatal, labor, and delivery experiences; memories of the neonatal intensive care unit experience; the sequelae of emotional responses to these experiences; and subsequent health problems after discharge. Prospective research is needed to further study compensatory parenting and to develop interventions.

Effect of standard rest periods on convalescent preterm infants

OBJECTIVE

To examine the effects of standardized rest periods on the sleep-wake states of preterm infants who were convalescing.

DESIGN

A randomized experimental study conducted from time of infants' entry into intermediate care until their discharge from the hospital. Because subjects' time in this study varied, data were analyzed cross-sectionally using the observation made between 5-11 days of the study and longitudinally over 3 weeks using a subset of subjects.

SETTING

The intermediate care nursery of a tertiary care hospital.

SUBJECTS

Forty-six preterm infants (23 matched pairs). A subset of 12 pairs, in which infants in the experimental and the control groups were in the study for 3 weeks, was analyzed longitudinally.

INTERVENTIONS

Four standardized rest periods each day.

MAIN OUTCOME MEASURES

Infants were observed once a week between noon and 8 p.m. Three sleep-wake states--quiet awake, active, and sleep--were measured as percentages of the naps and total observation.

RESULTS

Within 5 days, infants in the experimental group exhibited more sleep (F[1,44] = 2.37, p < 0.05) and less active states (F[1,44] = 3.06, p < 0.01) during nap time. Infants receiving the intervention for 3 weeks had more sleep (F[1,22] = 4.63, p < 0.05) and less quiet waking states (F[1,22] = 13.85, p < 0.01) during naps. State patterns over the entire observation did not differ between the groups at 5 days, but by 3 weeks, infants in the experimental group had less quiet waking (F[1,22] = 17.44, p < 0.001) and longer uninterrupted sleep bouts (F[1,22] = 5.19, p < 0.05).

CONCLUSIONS

A simple modification of nursing care had an impact on the sleeping and waking states of preterm infants.

Beyond couvade: pregnancy symptoms in couples with a history of infertility

Thirty-six couples with a history of infertility reported their physical, positive emotional, and negative emotional symptoms during pregnancy. The women experienced more physical symptoms than did the men. Both the men and women experienced second-trimester decreases in negative emotional symptoms and third-trimester increases in negative emotional symptoms. The women's physical symptoms also showed a second-trimester dip. Each symptom type was correlated for husbands and wives, but only 6 husbands showed evidence of couvade syndrome by exhibiting exact correspondence with their wives' symptoms. Symptom attunement appears to be a better term than couvade for most infertile men's experiences of pregnancy.

Pathologic apnea and brief respiratory pauses in preterm infants: relation to sleep state

The development of pathologic apnea, respiratory pauses, and periodic respiration was examined in 71 high-risk preterm infants, observed weekly. Respiration was recorded every 10 seconds; apnea length and periodic respiration were scored from a tape. All subjects had respiratory pauses, and 36 had pathologic apnea. The mean length of respiratory pauses was longer in quiet sleep, and the frequency of respiratory pauses was greater in active sleep. The mean length of respiratory pauses and probability of pathologic apnea in both sleep states and frequency of pauses in quiet sleep decreased with age. Sex, theophylline treatment, race, and length of mechanical ventilation affected the developmental trajectories of some apnea variables. Apnea in preterm infants cannot be considered a unitary phenomenon.

Postoperative pain management in preverbal children: the prescription and administration of analgesics with and without caudal analgesia

A retrospective chart review was conducted to examine the prescription and administration of analgesics with and without caudal analgesia to inpatient preverbal children within the first 48 hours after surgery. The 75 subjects were between birth and 24 months of age and had undergone various operative procedures. Seventy (93%) of these subjects were prescribed analgesics, but 8 of them had only acetaminophen prescribed. Of the 70 subjects who had a medication prescribed, 64 (91%) patients received analgesics. Morphine was the most frequently administered analgesic. The prescribed and administered mean dosages were less than the minimum recommended dosage for morphine. The mean prescribed and administered dosage for other analgesics exceeded the minimum recommended dosage. Preverbal children who had caudal analgesia during surgery were more likely to receive fewer dosages of analgesics and to receive lower dosages of narcotics even after 24 hours postoperatively than children who had not had caudal analgesia.

Maternal perception of illness severity in premature infants

This study examines relationships between the actual severity of the premature infant's medical condition, maternal perception of the severity of the infant's illness, the infant's birth weight, and maternal anxiety levels. Subjects for this study were 44 mothers who were part of a larger study of parental stress in neonatal intensive care units (NICUs). The premature infants of these mothers were hospitalized in the NICU of a large southeastern university medical center at the time of data collection. Mothers completed a severity perception scale and the State-Trait Anxiety Inventory. Data about actual severity of each infant's illness and about the infant's characteristics were collected from the medical chart. The findings indicate that maternal perceptions regarding the severity of their premature infants' illness are complex and are influenced by different factors at different points in time. A significant relationship was not found between the mother's recollection of infant severity at NICU admission and maternal perceptions at the time of the interview, two to five days after admission. Although maternal recall of the severity of the infant's illness on admission is not related to anxiety, perceptions of severity at the time of the interview (two to five days after admission) are related to anxiety scores.

High-risk preterm infants at 3 years of age: parental response to the presence of developmental problems

In this article we describe developmental status at 3 years and family utilization of early intervention services of 24 children who were born prematurely and weighed less than 1,500 g or who required mechanical ventilation at birth. Findings indicated (a) a low rate of major disabling conditions; (b) a high rate of developmental, mild cognitive, and behavioral concerns; and (c) a lack of family follow-through on referrals for early intervention services for potentially responsive children, even though the concerns put the children at risk for school difficulties.

Interactions of parents and nurses with high-risk preterm infants

The interactions of preterm infants with parents were compared with their interactions with nurses. Twenty-nine high-risk preterm infants who were a part of a larger longitudinal study of behavioral development were observed once weekly from 7 p.m. to 11 p.m. A single observation for each infant that contained a minimum of 2 min of parental care and 2 min of nursing care was selected for analysis. Results showed that nurses and parents provided different types of stimulation with nurses more likely to engage in procedural care and parents more likely to hold, talk to, move, and touch the infants affectionately. Infants showed more sleep-wake transition, large body movements, and jitters when with nurses and more active sleep and more smiles when with parents. Similar differences were found when parents and nurses were just holding or touching the infants, but no differences in infant responses were seen during feeding or changing. Thus, the different infant behavioral responses appeared to result primarily from the different stimulation provided by parents and nurses. Implications of these findings for research and clinical practice are discussed.

Amniocentesis in the context of infertility

The encounter with amniocentesis compels infertile couples to experience again the mix of adversity, uncertainty, and hope characterizing both infertility and prenatal testing. Findings from open-ended interviews of 38 couples, 25 infertile and 13 fertile, participating in an ongoing longitudinal field study of infertile childbearing and adopting couples suggest that amniocentesis both reprises elements of the infertility experience and interrupts elements of the pregnancy experience.

Pregnant moments: the process of conception in infertile couples

This report is an explication of the process of conception in infertile couples as illuminated by 24 infertile couples and a comparison group of 6 couples with no fertility impairments. Employing techniques generic to grounded theory research, the investigators found that infertile couples lived conception as a series of biological and phenomenological moments. The process of biomedically-assisted conception consisted of three components including: (a) forcing conception; (b) resolving conceptional ambiguity; and (c) reconciling conception as an idea and as an event. The findings suggest the need for a re-examination of current orientations to pregnancy time and space and appraisal of couples' interpretations of conception. In addition, the convergence of the conception experiences of infertile and fertile couples raises questions about the meaning of normal conception in the current technological context of reproduction.

Mazing: infertile couples and the quest for a child

The overall purpose of the ongoing research project on which this report is based is to explore the transition to parenthood of infertile couples who achieve parenthood through adoption or biotechnical means. Mazing, the process of negotiating the paths to parenthood, was found to be a key component of that transition and the core variable that integrates the experiences of infertile couples after a period of trying but failing to have a child of their own on their own. The theory of mazing is grounded in information obtained from 40 couples who were designated for this study by means of theoretical sampling. Techniques generic to grounded theory research were employed; these included open-ended interviews, constant comparison and subject validation. Mazing, a recursive, iterative and resource-intensive process, includes (a) the construction of a calculus of pursuit, (b) six distinctive patterns of pursuit, and (c) the reframing of desire.