Newborn Behavior Research Articles

Dissemination of newborn behavior observation skills after Newborn Individualized Developmental Care and Assessment Program (NIDCAP) implementation.

AimTo assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).DesignProspective observational study.MethodsTwelve nurses viewed 20‐min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme.ResultsDespite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.

Neonatal behavior of babies exposed to maternal depressive and anxiety disorders during perinatal period

Perinatal depression and perinatal anxiety can affect up to 20% of women during pregnancy and postpartum. Babies exposed to these pathologies suffer consequences in their development at a cognitive, motor, emotional and social level. Some of these can be observed since birth. In addition, adverse effects have been described in the behavior of the newborn exposed to psychopharmacotherapy during pregnancy. The aims of the study were to observe the neonatal behavior of babies exposed to perinatal depression or anxiety and to compare it between both diagnostic groups of mothers. The cohort included 86 newborns, from 2 to 67 days of chronological age (29 ± 13.4, 48% females), exposed to maternal depression (n = 27) or anxiety (n = 59). The Neonatal Behavior Assessment Scale, 4th edition, (Brazelton and Nugent, 2011) was administered at a maternal mental health unit to register the neonatal behavior. Chi-square and Student t-test analyses were calculated to compare item scores and percentages of suboptimal responses between both groups; Pearson correlations were calculated to analyze the relation of obstetric and psychiatric variables of mothers and the behavior of newborns. Significant differences between groups were found only regarding the change in skin color, with higher percentages of suboptimal responses in the group exposed to anxiety than to depression (24% versus 4%, Chi2 = 3.89; p < .05). Correlation analyses show that, although the birth weight is positively related to the interactive social orientation (tracing face and voice: r = .28, p = .02), the last was affected negatively by the dose of antidepressants during the third trimester of pregnancy (tracing face and voice: r = -.31, p = 0.03), indicating that higher doses of antidepressant was related with lower interactive social orientation. Our findings emphasize the need to detect depression and anxiety in women during the perinatal period in order to intervene at a multidisciplinary level in both, mother and baby, and the relation.

The First Relationship – the Experience of Fundamental Trust as a Foundation for the Development of Faith

The article is an important starting point for reflecting upon the emergence and development of fundamental trust through the first, primary relationship between the newborn and the parent. The birth of the first child signifies establishment of a family system, in which the concepts and mechanisms that Relational Family Therapy is built upon, are reflected on a systemic, interpersonal and intrapsychic level. Relational Family Therapy can find a way to resolve painful psychical contents and bring about a relief of the family system. The starting point for the study of the family described in this paper is the method of observing newborn behavior, the Newborn Behavioral Observations System (hereinafter NBO) with elements of Relational Family Therapy, which significantly helps to build a confident parental role and establishes a closer relationship between parents and children, thus forming the foundation for all further relationships.

Designing dress (Sarbebe) for kangaroo care, the effect of kangaroo care provided with this dress on mother and newborn's comfort†

The aims of the researchers were to design the clothes to be worn by the mothers in kangaroo care (KC) and to determine the effect of the KC provided with these clothes on the comfort of the mother and infant. This study was experimentally carried out as a methodological, randomized controlled trial for the designing of clothes for KC. Data were collected using the “Parent and Newborn Information Form”, “KC Comfort Scale” and “Newborn Comfort Behavior Scale (Comfort-Neo)”. The body temperature, heart rate, oxygen saturation, respiration rate parameters of the newborns were evaluated. The data were transferred to the IBM SPSS Statistics 23 program and evaluated. Our results showed that the KC Comfort Scale total score was 71.1 ± 14.8 in the control group and 84.0 ± 1.5 in the intervention group and “Newborn Comfort Behavior Scale” total scores were found to be 12.47 ± 6.90 in the control group and 8.67 ± 3.46 in the intervention group. It was determined that the KC Comfort Scale (z: −4.785 p: 0.000) in the intervention group were significantly higher compared to the control group (p < 0.05). Pain (z: −4.439 p: 0.000) and distress (z: −4.601 p: 0.000) levels of the control group were found to be significantly higher compared to the intervention group. Sarbebe is recommended to be used in KC practices since it was concluded that maternal comfort and satisfaction was high and the pain and distress scores of the newborn were low after KC provided with Sarbebe.

Clinical-epidemiological characterization of neonatal necrotizing enterocolitis of seven public hospitals

Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. To describe the clinical/epidemiological behavior of newborns who underwent NEC. Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria.

Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12-13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.

The nine stages of skin-to-skin: practical guidelines and insights from four countries.

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin‐to‐skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research. Although the evidence for positive outcomes through skin‐to‐skin contact are robust, there is a dearth of research specifically focused on clinical practice. The methodology considers the four available data sets that used Widström's 9 stages, which consists of studies from Japan, Sweden, Italy and the United States, examining the parameters of each stage across settings from around the world. This research provides an expanded understanding of the timing of the newborn's progression through Widström's 9 observable stages. We found that newborns in all four data sets began with a birth cry and continued through the remaining stages of relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping during the first hours after birth and consolidated the data into a Sign of the Stages chart to assist in further research. The evidence supports making a safe space and time for this important newborn behaviour. Clinical practices should encourage and protect this sensitive period.

Barriers to practice of critical newborn care behaviours: findings from a qualitative assessment in rural Madhya Pradesh, India

Background: In India, the state of Madhya Pradesh has one of the highest infant mortality rates (IMR) as compared to the national average. About two out of every three infant deaths in Madhya Pradesh, are of neonates. Given the high neonatal mortality rate in the state, this study aimed to explore the perceptions, practices, barriers and enablers related to critical newborn care behaviors, such as cord-care, thermal care, skin-to-skin care, and early initiation of breastfeeding, in the first 24 hours of life.Methods: In-depth interviews and focus group discussions were conducted with 53 respondents including mothers and fathers of the newborn, mothers-in-law, elected community and tribal leaders, local NGO representatives, and frontline health workers, in two districts of Madhya Pradesh.Results: Few mothers knew about the benefits of cord care, thermal care and early initiation of breastfeeding. Fathers lacked knowledge and perceived newborn care as the mother’s responsibility. Skin-to-skin care was rarely practiced; and was perceived across respondent groups as necessary only for weak infants. Older women, influential in decision making in the household, held misconceptions about thermal care and breastfeeding practices. Traditions and social norms emerged as major barriers while institutional delivery served as an enabling factor for the practice of correct newborn-care behaviors.Conclusions: To increase adoption of critical newborn behaviours, health care providers will have to move beyond mere interpersonal communication with individual mothers at facility or household levels towards a community and societal approach. A strategic behaviour change communication program that addresses deep-rooted traditional and social norms is required to help the state reduce infant deaths.

Impact of a novel smartphone application on low-income, first-time mothers’ breastfeeding rates: a randomized controlled trial

Low-income women are less likely to exclusively breastfeed at postpartum day 2 compared with high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day 2. Smartphone applications provide on-demand video. This study aimed to determine whether a novel smartphone application-Breastfeeding Friend-increases breastfeeding rates for low-income, first-time mothers. This double-blinded randomized trial recruited low-income, first-time mothers at 36 weeks' gestation. Consenting women received a complimentary Android smartphone and internet service before 1:1 randomization to Breastfeeding Friend or a control smartphone application. Breastfeeding Friend was created by a multidisciplinary team of perinatologists, neonatologists, lactation consultants, and a middle school teacher and was refined by end-user focus groups. Breastfeeding Friend contained on-demand education and videos on breastfeeding and newborn behavior, tailored to a fifth-grade reading level. The control smartphone application contained digital breastfeeding handouts. The primary outcome was exclusive breastfeeding at postpartum day 2; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. Primary statistical analyses compared outcomes between study groups through intention-to-treat analysis; prespecified secondary analyses did so per protocol. A total of 170 women (85 per arm) were needed to determine whether Breastfeeding Friend increased exclusive breastfeeding at postpartum day 2 from 34% (known baseline) to 56%. A total of 253 women were approached; 170 women enrolled. Most participants were black, with more than half reporting annual household incomes of less than $25,000. Exclusive breastfeeding rates at postpartum day 2 were low and similar among Breastfeeding Friend and control smartphone application users (n=30 [36.6%] vs n=30 [35.7%]; relative risk, 1.02; 95% confidence interval, 0.068-1.53). Breastfeeding rates until 6 months postpartum were also similar between study groups: the rate of exclusive breastfeeding was 8.3% (n=5) and 10.4% (n=7) in the Breastfeeding Friend and control smartphone application groups, respectively (relative risk, 0.8; 95% confidence interval, 0.27-2.38). At 6 weeks postpartum, most Breastfeeding Friend smartphone application users (n=34 [52.3%]) rated their smartphone application as providing the best breastfeeding support. Excluding women who did not use their study smartphone application (Breastfeeding Friend, n=18 [21.4%]; control smartphone application, n=9 [10.6%]) did not affect outcomes. Neither of the smartphone applications improved breastfeeding rates among low-income, first-time mothers above the known baseline rates, despite user perception that Breastfeeding Friend was the best breastfeeding resource at 6 weeks postpartum. By demonstrating the feasibility of smartphone application-based interventions within a particularly high-needs population, our research supports efforts in obstetrics to examine whether mobile health improves peripartum health outcomes.

Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

BackgroundChamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors.MethodsWe prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October–December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05.ResultsCompared to controls (n = 115), a significantly higher proportion of Chamas participants (n = 211) delivered in a health facility (84.4% vs. 50.4%, p < 0.001), attended at least four ANC visits (64.0% vs. 37.4%, p < 0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p < 0·001), and received a CHV home visit within 48 h postpartum (75.8% vs. 38.3%, p < 0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12–9.64, p < 0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls.ConclusionsChamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.Trial registrationClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017).

Optimal Care for NAS: Are We Moving in the Wrong Direction?

The growing numbers of infants born to women with opioid use disorder (OUD) and experiencing neonatal abstinence syndrome (NAS), and the increasing costs of their care,1 has led to a reassessment of prevailing approaches to clinical treatment. Emerging protocols that reduce assessment to limited domains of infant functioning are being adopted and advanced, raising several concerns. NAS is a “generalized multisystem disorder”2 causing a dysregulation of the central and autonomic nervous systems that manifests in a variety of physiologic and neurobehavioral signs, unique to each infant, in the domains of sleep-awake control, motor and/or muscle tone, autonomic functioning, and sensory processing and/or modulation.3 Conventional NAS care incorporates nonpharmacologic treatment (ie, the assessment of the variable dysregulation in specific domains of infant functioning particular to each infant, assessment of maternal capacities to understand and address them, and alterations to the environment and handling to minimize dysregulation with maternal support and education)3 as the principal, first-line therapy for any substance-exposed infant.4 Pharmacotherapy is indicated for infants displaying persistently impaired functioning despite maximal, individualized nonpharmacologic treatment. NAS scoring tools, such as the Finnegan tool5 and variants traditionally used to guide the introduction and weaning of pharmacotherapy, have weaknesses such as subjective scoring and scoring of items that can be attributed to typical newborn behaviors or other conditions, potentially leading to overtreatment and lengthy hospitalizations. A new approach, the Eat, Sleep, Console (ESC) assessment tool, combined simultaneously with other interventions, including the “nonpharmacologic care bundle(s),” attention to maternal needs, and alterations in pharmacotherapy, is being recently promoted. The ESC approach forgoes the identification and/or description of NAS-associated signs and symptoms …

Neurobehavior of mexican newborns in conditions of low perinatal risk

INTRODUCTION: The first hours of life are still a window of opportunity to identify at-risk newborns, but there are few studies focusing on early neonatal behavior.OBJECTIVE: Describe in a cross section the behavior of newborns born in conditions of low perinatal risk under 48 hours of extrauterine life and compare it with historical referents.METHOD: We studied 47 newborns with low perinatal risk, whose behavior was assessed using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). Scores were obtained by item and area, and then were compared with 7 historical referents.RESULTS: Low scores were found, both by item and by areas in up to 25% of the population. NBAS scores were related primarily with age of newborn, weight, and height. Significant differences were found in relation to referents for which higher scores were reported in the majority of cases.CONCLUSIONS: A pattern was found of behavior, in which the same areas or items caused greater or lesser difficulty in achieving higher scores or those which required a certain level of adaptation to the environment, which would lead us to believe that our newborns should attain the scores seen in other populations as they advance in age.

The effect of labor medications on normal newborn behavior in the first hour after birth: A prospective cohort study

BackgroundSkin-to-skin contact after birth between mother and baby has immediate and long-term advantages. Widström's 9 Stages of Newborn Behavior offer an opportunity to evaluate a baby in the natural, expected and optimal habitat. Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin (synOT), have been studied in relation to neonatal outcomes with conflicting results. AimsDetermine the effects of common intrapartum medications on the instinctive behavior of healthy newborns during the first hour after birth through a prospective cohort study. Study designVideo record newly-born term infants during the first hour after birth while in skin-to-skin contact with mother. Code and analyze videos using Widström's 9 Stages; compare with the labor medications mothers received. SubjectsConvenience sample of sixty-three low-income mothers self-selected to labor with or without intrapartum analgesia. Outcome measuresDuration of time infants spend in each of Widström's 9 Stages for four cohorts: 1) exposed to no synOT or epidural fentanyl during labor, 2) exposed to fentanyl (but not synOT), 3) exposed synOT (but not fentanyl), 4) exposed to both fentanyl and synOT. ResultsA strong inverse correlation was found between intrapartum exposure to fentanyl and synOT and the normal behavior of an infant, as measured by time in each Stage. ConclusionsIntrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. Widström's 9 Stages offer an opportunity to analyze newborn behavior whilst in the optimal habitat of the infant.

Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk

ObjectiveTo compare the behavior of preterm newborns and full‐term newborns using the Newborn Behavioral Observation and to evaluate the mothers’ experience when participating in this observation. MethodThis was a cross‐sectional study performed at a referral hospital for high‐risk births, involving mothers and neonates before hospital discharge. The mothers answered the sociodemographic questionnaire, participated in the Newborn Behavioral Observation session, and evaluated the experience by answering the parents’ questionnaire at the end. The characteristics of the preterm newborns and full-term newborns groups and the autonomic, motor, organization of states, and responsiveness scores were compared. Linear regression was performed to test the association of the characteristics of mothers and neonates with the scores in the autonomic, motor, organization of states, and responsiveness domains. ResultsThe Newborn Behavioral Observation was performed with 170 newborns (eight twins and 77% preterm newborns). Approximately 15% of the mothers were adolescents and had nine years of schooling, on average. The groups differed regarding weight for gestational age, age at observation, APGAR score, feeding, and primiparity. The linear regression adjusted for these variables showed that only prematurity remained associated with differences in the scores of the motor (p=0.002) and responsiveness (p=0.02) domains. No statistical difference was observed between the groups in the score attributed to one's own knowledge prior to the session (p=0.10). After the session, these means increased in both groups. This increase was significantly higher in the preterm newborn group (p=0.02). ConclusionsThe Newborn Behavioral Observation increased the mothers’ knowledge about the behavior of their children, especially in mothers of preterm newborns, and identified differences in the behavior of preterm newborns and full-term newborns regarding the motor and responsiveness domains.

Perinatal exposure to energy drink induces oxidative damage in the liver, kidney and brain, and behavioral alterations in mice offspring

The worldwide consumption of energy drinks (EDs) has increased in recent years. EDs have several side effects and can be linked to liver injury, kidney damage and risk-seeking behavior. The impact of perinatal consumption of EDs on the newborns has not been previously investigated. In this study, we evaluated the effects of perinatal exposure to a caffeinated ED on the liver, kidney, brain, locomotor activity and anxiety in mice newborns. Pregnant mice received 2.5 or 5 ml ED by oral gavage from the first day of pregnancy until day 15 after birth. Perinatal exposure to the ED induced a significant increase in lipid peroxidation and declined antioxidant defenses in the liver, kidney, cerebrum, cerebellum and medulla oblongata of the newborns at days 21 and 35 after birth. ED induced several histological alterations, including vacuolations and lipid infiltration of hepatocytes, developing and degenerated glomeruli and dilated urinary spaces in the renal cortex, pyknosis and chromatolysis of the cerebral and medullary neurons, and degenerated and abnormal Purkinje cells in the cerebellum. In addition, ED increased the locomotion and induced anxiety-like behavior in mice newborns. In conclusion, perinatal exposure to EDs induces oxidative stress, tissue injury and behavioral alterations in the mice newborns. Therefore, the consumption of EDs during pregnancy and lactation has a negative impact on the newborns and should be treated as a significant health problem that warrants attention.

Mental disorders in pregnancy and newborn conditions: longitudinal study with pregnant women attended in primary care.

This study aimed to determine the presence and association of possible mental disorders diagnoses in primary care pregnant women and newborns' conditions. This is a longitudinal study with pregnant women (18-39 years), in the second and third trimesters of pregnancy, attended at primary care facilities in the metropolitan region of São Paulo (February to August/2014). The following tools were used: sociodemographic questionnaire; Mental Disorders in Primary Care Assessment tool; and an interview with information and mother´s perception of the behavior of newborns. Of the 300 pregnant women interviewed, 76 had possible diagnosis of mental disorders, 46 women had depression/dysthymia and 58 anxiety/panic symptoms. Low birth weight and prematurity was observed in 14 and 19 newborns, respectively, and there was no association with the probable diagnosis of mental disorders; the possible presence of mental disorders was associated with the mother's perception of newborns behavior. Pregnant women attended at low risk prenatal care showed relevant frequency of mental disorders; thus, the identification of these changes during pregnancy can also contribute to a better understanding of the mother-and-child dynamics and in the quality of family care.

A Web-Based Module to Enhance BSN Students' Knowledge and Confidence in Teaching Parents About Newborn Behavior.

As an adjunct to traditional instructional strategies, students enrolled in a Bachelor of Science in Nursing maternity course completed a Web-based module called "HUG Your Baby" (HYB) about newborn behavior, interpreting and responding to an infant's cues and body language, and teaching new parents. Students who completed the HYB program were compared with students enrolled in another semester of the same maternity course in which only traditional teaching strategies were used. Both groups were compared on knowledge and confidence about newborn behaviors and teaching new parents. Knowledge and confidence scores increased significantly in both groups from beginning to end of the semester. Students who completed the HYB program demonstrated a significantly greater increase in knowledge and confidence compared with students who did not complete the HYB program. Students highly rated the HYB program and recommended it for incorporation into the maternity course.

Clinical application of the Newborn Behavioral Observation (NBO) System to characterize the behavioral pattern of newborns at biological and social risk

ObjectiveTo compare the behavior of preterm newborns and full-term newborns using the Newborn Behavioral Observation and to evaluate the mothers’ experience when participating in this observation. MethodThis was a cross-sectional study performed at a referral hospital for high-risk births, involving mothers and neonates before hospital discharge. The mothers answered the sociodemographic questionnaire, participated in the Newborn Behavioral Observation session, and evaluated the experience by answering the parents’ questionnaire at the end. The characteristics of the preterm newborn and full-term newborn groups and the autonomic, motor, organization of states, and responsiveness scores were compared. Linear regression was performed to test the association of the characteristics of mothers and neonates with the scores in the autonomic, motor, organization of states, and responsiveness domains. ResultsThe Newborn Behavioral Observation was performed with 170 newborns (eight twins and 77% preterm newborns). Approximately 15% of the mothers were adolescents and had nine years of schooling, on average. The groups differed regarding weight for gestational age, age at observation, APGAR score, feeding, and primiparity. The linear regression adjusted for these variables showed that only prematurity remained associated with differences in the scores of the motor (p=0.002) and responsiveness (p=0.02) domains. No statistical difference was observed between the groups in the score attributed to one's own knowledge prior to the session (p=0.10). After the session, these means increased in both groups. This increase was significantly higher in the preterm newborn group (p=0.02). ConclusionsThe Newborn Behavioral Observation increased the mothers’ knowledge about the behavior of their children, especially in mothers of preterm newborns, and identified differences in the behavior of preterm newborns and full-term newborns regarding the motor and responsiveness domains.

Association of antenatal care and place of delivery with newborn care practices: evidence from a cross-sectional survey in rural Uttar Pradesh, India

BackgroundAppropriate immediate newborn care is vital for neonatal survival. Antenatal period is a crucial time to impart knowledge and awareness to mothers regarding newborn care, either during facility visits or during home visits by community health workers (CHWs) especially in the rural context. In this paper, we report newborn care practices in rural Uttar Pradesh (UP) and have explored association between newborn care practices with antenatal care, contact with community health workers during pregnancy and place of childbirth.MethodsWe use cross-sectional baseline data (which is part of a larger intervention project) collected from 129 gram panchayats (GPs) from 15 administrative blocks spread over five districts of UP in 2013. From currently married women (n = 2208) of 15–49 years, who delivered 15 months prior to the survey, we collected information on women’s demographic and socio-economic characteristics, knowledge and practice of reproductive, maternal, newborn, child health and nutrition behaviours. Association of newborn practices with antenatal care, contacts by community health worker during pregnancy and place of childbirth were tested using random intercept logistic regression, adjusting for socio-economic and demographic factors and accounting for clustering at the GP and block levels.ResultsEighty-three percent of 2208 mothers received ANC, but only half of the respondents received a minimum of three ANC visits. More than two thirds of respondents delivered at a health facility. Practice of newborn care was poor: merely one fourth of women practised clean cord care, one third of women followed good breastfeeding practices (initiation with an hour of birth, fed colostrum and did not give pre-lacteal feeds) and one third provided adequate thermal care (kept baby warm and delayed bathing). Only 5% followed all above practices with evidence of clustering of newborn care practices at the block and GP levels. While facility-based childbirth was strongly associated with appropriate newborn care practices, ANC visits and contacts with CHWs was not associated with all newborn care practices.ConclusionThe quality of ANC care provided needs to be improved to have an impact on newborn care practices. Our finding emphasizes the importance of facility-based birthing. There is a need for training CHWs to strengthen their counselling skills on newborn care. Variation of newborn care practices between communities should be taken into consideration while implementing any intervention to optimize benefits.

Prolactin, a potential mediator of reduced social interactive behavior in newborn infants following maternal perinatal depressive symptoms

BackgroundThe hormone prolactin (PRL) plays a crucial role for the initiation and maintenance of maternal behavior, and is also associated with the etiology of mood disorders in women, especially for depression. The present study aimed to determine whether maternal peripheral prolactin would be associated with newborn behavior disorders following maternal perinatal depressive symptoms, and further to explore the efficacy of the Newborn Behavioral Observations (NBO) in improving newborn social interactive behavior. MethodsInterview and the 24-item Hamilton Rating Scale for Depression (HAMD) were used to assess the hospitalized pregnant women waiting for delivery at 37-42weeks of gestation. A total of 255 subjects were recruited, diagnosed with depression (n=135), and control group (n=120). Within 2 weeks postpartum, mothers were asked to fill with Maternal Attachment Inventory (MAI) to measure maternal care. Neonatal Behavioral Assessment Scale (NBAS) were used to evaluate newborn behavior. The depressed mother-newborns dyad was randomly assigned to NBO intervention and control group. Serum prolaction in mothers and cortisol in mothers and newborns were measured. ResultsThe newborns of mothers exposed to maternal perinatal depressive symptoms displayed the reduced newborn social interactive behavior accompanied by decreased maternal serum PRL as well as increased maternal and neonatal serum cortisol. The NBO could be an effective intervention tool. LimitationsOur study could not be double-blind. The mothers knew which group their infant were in. ConclusionsMaternal peripheral PRL had the potential to be a mediator in reduced social interactive behavior in newborn infants following maternal perinatal depressive symptoms.