Families Of Preterm Infants Research Articles

Music Therapy with Preterm Infants and Their Families after Hospital Discharge: An Integrative Review.

After discharge from a neonatal unit, families of preterm infants may require therapeutic support to address challenges related to their infant/s' development, changed family circumstances, and/or parent wellbeing. This integrative review (IR) sought to examine the impact of music therapy on preterm infants and their families post-hospital discharge. A systematic search encompassing seven databases resulted in 83 citations, with six studies initially meeting the inclusion criteria. A further six studies were evaluated and selected upon their publication during the review process. Each study was assessed using the Mixed Methods Appraisal Tool (MMAT), followed by the identification of major themes and sub-themes. Our results suggest that music therapy contributed to creating supportive physical and metaphorical environments for preterm infants and their families, in which they could acquire essential skills, tools, and resources for fostering communication and connection with one another. Preterm infants and toddlers may have also enhanced their developmental skills through music therapy sessions post-discharge. Further investigation into the impact of music therapy on preterm infants and their caregivers at different timepoints after hospital discharge is recommended, as well as a comparison of individual and group music therapy outcomes on infant development and parent health. Future research should include a broader spectrum of family members, along with caregivers from diverse family structures and gender identities, reflecting practices already established in some clinical settings.

Exploring parents’ musical agency in resource-oriented music therapy with their preterm infants in the NICU and at home

ABSTRACT Introduction Engaging parents in musical interactions through singing to their preterm infants is becoming a primary music therapy (MT) approach within the neonatal context. Parents describe their positive experiences during MT in the NICU and post-discharge. A recent longitudinal study offered families resource-oriented music therapy services from birth to home. Aim Based on an interpretive phenomenological analysis of parental experiences of MT in the LongSTEP trial, I posit musical agency as a theoretical framework for understanding the processes that are enabled during MT with families of preterm infants from birth to home. Method I explore the concept of musical agency through social and psychotherapy theories and through examples taken from MT sessions and interviews. I illustrate how the guiding principles of a resource-oriented approach to MT correspond with enhancing musical agency. Results Musical agency is every person’s ability to use music for personal and social needs. Musical agency is released and interchanged through musical interactions between parents and their preterm infants during MT. Resource-oriented principles in MT may offer music therapists ways to empower clients’ musical agency. Discussion Musical agency may increase other forms of agency and support parents to connect to themselves and their preterm infants, depending on parental appropriation of music’s affordances. Embracing the framework of agency calls for music therapists to be aware of power dynamics and shift to a collaborative approach within MT sessions, aligning with a resource-oriented approach.

0775 Differences in subjective sleep measures in mothers and fathers of premature infants: A preliminary study

Abstract Introduction It has been documented that newborn’s sleep is strongly associated with maternal and paternal sleep. However, mothers seem to be more affected by their infant’s sleep than fathers. These associations are not well known in families of premature newborns yet. This was the objective of the present study. Methods 30 families of premature newborns (mothers, fathers and infants) participated in this study one month after discharge from the hospital. Parents completed, among other measures, sleep diaries during three consecutive weekdays for themselves and their child. Multiple linear regression analyses were computed to examine the association between sleep duration and nocturnal awakenings of the premature infant and their mothers’ and fathers’ sleep duration and number of awakenings during the night. Analyses were done separately for mothers and fathers. Results Regression models for parents’ sleep duration were significant and explained 31.7% of the variance in mothers’ sleep duration (p=.009) and 30.8% of the variance in fathers’ sleep duration (p=.01). Infants’ sleep duration was the only significant predictor in both models (□=.663, p=.005 and □=.670, p=.005, respectively for mothers and fathers). Thus, shorter sleep duration in premature infants predicted shorter sleep duration in mothers and fathers. Analyses of parents’ nocturnal awakenings showed that the model was significant for mothers (p<.001), but not for fathers (p=.372). The variables explained 73.4% of the variance in mothers’ awakenings, and infants’ nocturnal awakenings was the only significant predictor (□=.801, p<.001). Conclusion Our results suggest that premature infants’ sleep is strongly associated with mothers and fathers’ sleep. In addition, it seems that nocturnal awakenings are particularly associated with the mothers, but not the fathers’ awakenings during the night, which may be related to their involvement in feeding schedules during the night. Future studies should focus on sleep disturbances in families of preterm infants and on interventions targeted for both mothers and fathers that can be implemented to improve sleep in this population. Support (if any)

Evaluation of Health-Related Values and Preferences of Adults Who Were Preterm Infants and Parents of Preterm Infants Concerning Use of Prophylactic Cyclooxygenase Inhibitor Drugs

There is wide variability in the use of prophylactic cyclooxygenase inhibitor (COX-I) drugs to prevent morbidity and mortality in preterm infants. Parents of preterm infants are rarely involved in this decision-making process. To explore the health-related values and preferences of adults who were preterm infants and families of preterm infants concerning the prophylactic use of indomethacin, ibuprofen, and acetaminophen initiated within the first 24 hours after birth. This cross-sectional study used direct choice experiments conducted in 2 phases of virtual video-conferenced interviews between March 3, 2021, and February 10, 2022: (1) a pilot feasibility study and (2) a formal study of values and preferences, using a predefined convenience sample. Participants included adults born very preterm (gestational age <32 weeks) or parents of very preterm infants currently in the neonatal intensive care unit (NICU) or having graduated from the NICU in the last 5 years. Relative importance of clinical outcomes, willingness to use each of the COX-Is when presented as the only option, preference for using prophylactic hydrocortisone vs indomethacin, willingness to use any of the COX-Is when all 3 options are available, and relative importance of having family values and preferences included in decision-making. Of 44 participants enrolled, 40 were included in the formal study (31 parents and 9 adults born preterm). The median gestational age of the participant or the participant's child at birth was 26.0 (IQR, 25.0-28.8) weeks. Death (median score, 100 [IQR, 100-100]) and severe intraventricular hemorrhage (IVH) (median score, 90.0 [IQR, 80.0-100]) were rated as the 2 most critical outcomes. Based on direct choice experiments, most participants were willing to consider prophylactic indomethacin (36 [90.0%]) or ibuprofen (34 [85.0%]), but not acetaminophen (4 [10.0%]) when offered as the only option. Among participants who initially chose indomethacin (n = 36), if prophylactic hydrocortisone was offered as a potential therapy with the caveat that both cannot be used simultaneously, only 12 of 36 (33.3%) preferred to remain with indomethacin. Variability in preference was noted when all 3 COX-I options were available, indomethacin (19 [47.5%]) being the most preferred option followed by ibuprofen (16 [40.0%]), while the remainder opted for no prophylaxis (5 [12.5%]). The findings of this cross-sectional study of former preterm infants and parents of preterm infants suggest that there was minimal variability in how participants valued the main outcomes, with death and severe IVH being rated as the 2 most important undesirable outcomes. While indomethacin was the most preferred form of prophylaxis, variability was noted in the choice of COX-I interventions when participants were presented with the benefits and harms of each drug.

Family resiliency and family functioning in Non-Hispanic Black and Non-Hispanic White families of preterm infants

PurposeThe purpose of this study was to examine the relationship between resiliency factors and family functioning in families of preterm infants (< 37 weeks gestation) from two different racial groups hospitalized in a neonatal intensive care unit (NICU). Design and methodsA cross-sectional design was used at five Level III/IV NICUs in a Midwestern city/suburbs. Seventy-nine family units (24 Non-Hispanic Black and 55 Non-Hispanic White) completed four instruments that assessed families' use of specific resiliency factors and a measure of family functioning. Demographic data were also collected. ResultsUsing linear mixed modeling, the significant predictors of family functioning for both Non-Hispanic Black and Non-Hispanic White, even after adjusting for education, income and race, were the protective factors “hardiness” (coefficient = −0.021) and “resources” (coefficient = −0.0052). The fixed effects in the model accounted for 48% (Marginal R2 = 0.48) of the variance on family functioning and the fixed and random effects accounted for 59% (Conditional R2, 0.59) of the variance on family functioning. Sixteen percent of the total sample rated their family as dysfunctional. ConclusionsFindings from this study suggest that assessment of protective factors related to hardiness and resources individualize nursing interventions to support the resiliency of both Non-Hispanic Black and Non-Hispanic White families, regardless of differences in income and education. Further research studying resiliency in families of preterm infants is needed to understand the impact on long-term family functioning. Practice implicationsUnderstandingindividual family strengths,through the identification of resiliency (protective and recovery) factors could predict at-risk families before discharge. In collaboration with other health care professionals, nurses can assess individual family needs and strengths, within the context of their socioeconomic environment, and the racial and cultural influences that are important to the family.

Effects of Live Music Therapy on Autonomic Stability in Preterm Infants: A Cluster-Randomized Controlled Trial.

Unbuffered stress levels may negatively influence preterm-infants’ autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm infants and their parents and enhance family-centered care. Accordingly, we aimed to compare the effects of combined MT and SSC and SSC alone on ANS stabilization in preterm infants. In a single-center, cluster-randomized trial design, ten two-month time-clusters were randomized to either combined MT and SSC or SSC alone. Families of preterm infants were offered two sessions of the allocated condition in the NICU, and a three-month follow up session at home. The primary outcome variable was stabilization of the ANS, defined by change in the high frequency (HF) power of heart rate variability (HRV) during the second session. Secondary outcomes included other HRV measures, parent–infant attachment, and parental anxiety at each session. Sixty-eight families were included. MT combined with SSC improved infants’ ANS stability, as indicated by a greater increase in HF power during MT compared to SSC alone (mean difference 5.19 m2/Hz, SE = 1.27, p < 0.001) (95% confidence interval 0.87 to 2.05). Most secondary outcomes were not significantly different between the study groups. MT contributes to preterm-infants’ autonomic stability, thus laying an important foundation for neuro-behavioral and psycho-emotional development. Studies evaluating longer-term effects of MT on preterm infants’ development are warranted.

Personality traits and subjective well-being among fathers of preterm infants in Taiwan: a cross-sectional study

ABSTRACT Objective This study examined the association of personality traits and paternal/infant background characteristics with subjective well-being (SWB) among fathers of preterm infants. Background While studies of parental care of preterm infants have focused on mothers or both parents, studies focusing specifically on fathers are relatively rare. In this study, we provide new information on the personality traits and paternal/infant background characteristics and their association with SWB among fathers of preterm infants. Methods This study used a cross-sectional design. Participants included fathers of preterm infants hospitalised in the neonatal intensive care unit, neonatal intermediate care nursery, or postpartum ward of a medical centre in northern Taiwan within 5 days of birth. The Personality Inventory Scale and Subjective Well-being Scale were administered and background characteristics of fathers and preterm infants were measured. Results A total of 104 fathers participated, of whom 73.1% showed a moderate level of SWB. Fathers with higher extraversion and openness exhibited higher SWB, while fathers with higher neuroticism exhibited lower SWB. SWB was also predicted by age, infant weight, family structure, and paternal education level. These factors cumulatively accounted for 48% of the variance in SWB. Conclusion Fathers’ SWB was associated with extraversion, openness, neuroticism, age, education, family structure, and infant weight. The personality traits of fathers should be considered when developing plans for family support after following preterm infant birth. In addition to focusing on maternal well-being, programmes to increase paternal well-being would benefit the families of preterm infants.

INFORMATION NEEDS OF FAMILIES ON THE HEALTH/DISEASE OF PRETERM INFANTS IN A NEONATAL INTENSIVE CARE UNIT

ABSTRACT Objective: to identify the information needs of the families of preterm infants hospitalized to the Neonatal Intensive Care Unit on health/disease. Method: exploratory study, with a qualitative approach, performed with 33 relatives of preterm infants admitted to the Neonatal Intensive Care Unit, through a semi-structured interview, recorded in audio, transcribed and analyzed with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software. Results: two categories were identified, which are called: Reality versus expectation of obtaining information about the preterm infant; and Information on health/disease on-line: useful, positive and unattractive aspects. Conclusion: it has been found that the information needs of family members are wide, and different means are employed to satisfy them, ranging from the traditional and every day to the use of technological means to find data and used for different purposes.

The impact of prematurity and maternal socioeconomic status and education level on achievement-test scores up to 8th grade.

BackgroundThe relative influence of prematurity vs. maternal social factors (socioeconomic status and education level) on academic performance has rarely been examined.ObjectiveTo examine the impact of prematurity and maternal social factors on academic performance from 3rd through 8th grade.MethodsWe conducted a retrospective cohort study of infants born in 1998 at the University of Arkansas for Medical Sciences. The study sample included 58 extremely low gestational age newborns (ELGANs, 23‒<28 weeks), 171 preterm (≥28‒<34 weeks), 228 late preterm (≥34‒<37 weeks), and 967 term ((≥37‒<42 weeks) infants. Neonatal and maternal variables were collected including maternal insurance status (proxy measure for socioeconomic status) and education level. The primary outcomes were literacy and mathematics achievement-test scores from 3rd through 8th grade. Linear mixed models were used to identify significant predictors of academic performance. All two-way interactions between grade level, gestational-age (GA) groups, and social factors were tested for statistical significance.ResultsPrematurity, social factors, gender, race, gravidity, and Apgar score at one minute were critical determinants of academic performance. Favorable social factors were associated with a significant increase in both literacy and mathematic scores, while prematurity was associated with a significant decrease in mathematic scores. Examination of GA categories and social factors interaction suggested that the impact of social factors on test scores was similar for all GA groups. Furthermore, the impact of social factors varied from grade to grade for literacy, while the influence of either GA groups or social factors was constant across grades for mathematics. For example, an ELGAN with favorable social factors had a predicted literacy score 104.1 (P <.001), 98.2 (P <.001), and 76.4 (P <.01) points higher than an otherwise similar disadvantaged term infant at grades 3, 5, and 8, respectively. The difference in their predicted mathematic scores was 33.4 points for all grades (P <.05).ConclusionWhile there were significant deficits in academic performance for ELGANs compared to PT, LPT, and term infants, the deficit could be offset by higher SES and better-educated mothers. These favorable social factors were critical to a child’s academic achievement. The role of socioeconomic factors should be incorporated in discussions on outcome with families of preterm infants.

The impact of preterm birth

BackgroundLittle is known about the quality of life of parents and families of preterm infants after discharge from the neonatal intensive care unit (NICU). Our aims were (1) to describe the impact of preterm birth on parents and families and (2) and to identify potentially modifiable determinants of parent and family impact.MethodsWe surveyed 196 parents of preterm infants <24 months corrected age in 3 specialty clinics (82% response rate). Primary outcomes were: (1) the Impact on Family Scale total score; and (2) the Infant Toddler Quality of Life parent emotion and (3) time limitations scores. Potentially modifiable factors were use of community-based services, financial burdens, and health-related social problems. We estimated associations of potentially modifiable factors with outcomes, adjusting for socio-demographic and infant characteristics using linear regression.ResultsMedian (inter-quartile range) infant gestational age was 28 (26–31) weeks. Higher Impact on Family scores (indicating worse effects on family functioning) were associated with taking ≥3 unpaid hours/week off from work, increased debt, financial worry, unsafe home environment and social isolation. Lower parent emotion scores (indicating greater impact on the parent) were also associated with social isolation and unpaid time off from work. Lower parent time limitations scores were associated with social isolation, unpaid time off from work, financial worry, and an unsafe home environment. In contrast, higher parent time limitations scores (indicating less impact) were associated with enrollment in early intervention and Medicaid.ConclusionsInterventions to reduce social isolation, lessen financial burden, improve home safety, and increase enrollment in early intervention and Medicaid all have the potential to lessen the impact of preterm birth on parents and families.

Modeling the Potential Impact of the 2014 American Academy of Pediatrics Respiratory Syncytial Virus Prophylaxis Guidance on Preterm Infant RSV Outcomes.

IntroductionThe American Academy of Pediatrics (AAP) Committee on Infectious Diseases issued updated guidance on respiratory syncytial virus (RSV) prophylaxis in 2014. This report models the potential impact of the new guidance on RSV outcomes in preterm infants 29–34 weeks’ gestational age (wGA) without chronic lung disease in the United States.MethodsThe number of preterm infants was estimated using 2012 natality data. Palivizumab utilization prior to the 2014 guidance update was estimated using 2013–2014 specialty pharmacy utilization data. Low, moderate, and high RSV hospitalization (RSVH) rates as well as average hospital length of stay, intensive care unit (ICU) admissions and mechanical ventilation (MV) frequencies were derived from published observational studies. Palivizumab efficacy was derived from two randomized clinical trials. RSV events that would be attributable to the 2014 guidance change were calculated for preterm infants 29–31 and 32–34 wGA.ResultsAnnual number of infants 29–34 wGA surviving the neonatal period was estimated at 123,687. Of these, an estimated 44,712 (37%) would receive palivizumab based on the 2012 guidance. The annual number of RSVH among infants 29–34 wGA would increase from 3580 under the 2012 guidance to 6166 under the 2014 guidance based on moderate rates. This would result in an additional 24,440 hospitalization days, 1162 ICU admissions, and 584 MV events among this population.ConclusionsBased on published historical and contemporary data on RSVH rates in preterm infants 29–34 wGA, the 2014 AAP guidance is expected to result in additional burden to the healthcare system and families of preterm infants. The impact of the new guidance will be difficult to detect among the overall infant population, particularly in settings without routine testing for RSV, but the impact will be substantial for the small high-risk population affected by the changes.FundingAstraZeneca.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0097-3) contains supplementary material, which is available to authorized users.

The Quality of Spontaneous Movements of Preterm Infants: Associations with the Quality of Mother–Infant Interaction

The assessment of the quality of infants’ spontaneous movements is a diagnostic tool for the young nervous system. We examined whether it relates to the quality of the interactions between infants born preterm and their mothers. Thirty‐nine healthy infants born preterm (Mage in weeks = 14.59, SD = 2.21; 38.46% female) and their mothers participated in the study. Infants’ quality of spontaneous movements was assessed using the General Movement Assessment according to Prechtl (Prechtl, Early Human Development 1990, 23, 151). A new measurement was employed to evaluate the following aspects of the mother–infant interaction: maternal sensitivity in the motor modality (i.e., when touching, picking up, holding, and putting down the infant), maternal sensitivity in the modalities of vocalization and eye contact, and infants’ positive engagement. Several aspects of infants’ quality of movements were associated with maternal sensitivity in the motor modality and infants’ positive engagement, but not with maternal sensitivity in the modalities of vocalization and eye contact. These findings suggest that the quality of infants’ spontaneous movements may explain some of the variability in the interactions between infants born preterm and their mothers. The results also highlight the importance of differentiating between the modalities of mothers’ behavior when assessing their sensitivity. Implications for research and practice with families of preterm infants are discussed.

Development of Home Educational Materials for Families of Preterm Infants.

Parent educational materials describing infant positioning for a home program are vital in supplementing NICU discharge instructions and promoting parent confidence. To document the process of developing a brochure and DVD of a positioning program, using evidence-based practice and NICU expert feedback. A trifold brochure and companion DVD were developed to demonstrate infant positioning to parents of premature infants for a home developmental program following NICU discharge. A standard process of development was followed for the brochure and DVD script and production. The process included review and comment by eight NICU professionals and several revisions. Content of the brochure and DVD and the process entailed in their development is described. Guidelines outlining the process for development of educational materials for families are provided. Creation of multimedia educational materials for parents of infants who are NICU graduates requires a multistep process to ensure usefulness and validity.

Programa de seguimiento de niños prematuros desde el punto de vista terapéutico y educativo

Families of preterm infants need the collaboration of different services to take care of these children. These services must coordinate to give the adequate care, implementing together preventive programs. The preterm infants’ follow up program of Mostoles (Madrid) takes into account this essential coordination. We explain how this coordination develops, what it adds to each service and the importance the joint follow up has, starting from a collaboration that has started a decade ago. We show the most relevant data of the obtained results.

Web Sites that Address Prematurity

Families of preterm infants need a tremendous amount of support. This resource column highlights several Web sites that may be useful to health care providers and childbirth educators, as well as to parents of premature infants and their families.

Family-provider relationships and well-being in families with preterm infants in the NICU

Objective: The purposes of this study were the following: (1) to describe maternal perceptions of family-provider relationships in the neonatal intensive care unit (NICU) and (2) to examine associations between maternal perceptions of family-provider relationships in the NICU and well-being in families with preterm infants. Design: The study’s design was descriptive and correlational. Setting: The study took place in 5 NICUs in midwestern United States. Participants: The study included 55 mothers of preterm infants hospitalized in the NICU. Measures: Self-report measures: the Family-Provider Relationships Instrument–NICU, Ryff’s measure of psychologic well-being, and the General Scale of the Family Assessment Measure. Results: Mothers of preterm infants who depicted their family’s relationship with their child’s primary health care providers in the NICU as positive and family-centered reported more satisfaction with the care received. In addition, these mothers expressed a greater willingness to seek help from health care providers. When mothers reported a discrepancy between what they wanted the family-provider relationships to be like and what they believed the relationship was like, they were less satisfied with care received. Mothers who wanted and believed they had positive family-centered relationships with providers were more satisfied with the care received and they reported higher levels of psychologic well-being. Conclusion: The nature of the relationships that families develop with health care providers in the NICU may have a profound influence on how individuals and families respond to the experience of having a preterm infant. Health care providers who incorporate the key elements of family-centered care into their practice can have a positive influence on well-being in families of preterm infants. (Heart Lung® 2001;30:74-84.)

IS THE IMPACT OF BURDEN OF ILLNESS ON FAMILIES OF PREMATURE INFANTS LONG-LASTING? † 1651

The negative impact of premature birth on the families of preterm infants is well described. There is less information on whether the adverse effects are long-lasting. Objectives: To compare the impact of burden of illness on families of teenaged extremely low birth weight (ELBW) infants compared with controls (C). Design: Cross-sectional survey/cohort study. An 18-item self-completed questionnaire, encompassing work, marital and family-related issues, was administered to parents. Setting: Geographically defined region. Participants: Parents of 146/169(86%) teenaged ELBW survivors, born between 1977 and 1982; 123/145 (85%) sociodemographically matched term controls (proportion with neurosensory impairments: ELBW = 26%; C = 2%). Results: 87% of the respondents were mothers answering on their own behalf and their spouse/partner, 87% were 2-parent families. There were no significant differences between ELBW and C parents in the current emotional suffering or worry about their child's physical (19% vs 10%) and/or emotional health (33% vs 25%); nor did ELBW parents perceive that they had limited amount of personal timecurrently due to their child's physical health (9% vs 4%) or emotional health (20% vs 15%). Since the birth of their child, few ELBW parents felt that they had difficulty in making friends (6% vs 3%), were unable to work (8% vs 1%, p = 0.02), had to quit or change jobs (5% vs 1%), move residence or had major financial problems because of their child's illness (5% vs 2%). Both positive (25% vs 7%, p = 0.0003) and negative (18% vs 6%, p < 0.005) effects on marriage were higher in ELBW parents; more ELBW parents felt that their child had brought their families closer together (39% vs 13%, p = 0.0001), and that their relatives had been more helpful and understanding (54% vs 25%, p = 0.0001). However, a significantly higher proportion of ELBW parents felt that, overall, their child's health had adversely affected their emotional health (21% vs 10%, p = 0.02) and that of other children in the family (22% vs 7%, p = 0.003). Of the total cohort, 57% of ELBW and 39% of C did not have any subsequent children (p = 0.007); among these, 58% of ELBW and 6% of C said that the decision not to have more children was directly influenced by the birth of the study child (p < 0.00001). Conclusions: In the long-term, it appears that parents of ELBW have adjusted remarkably well to their work and family life. Although some positive effects were identified, the experience discouraged a significant proportion of ELBW parents from having more children.

Respiratory illness in families of preterm infants with chronic lung disease.

AIMS--To examine the relation, based on two types of questionnaires, between (1) chronic lung disease of the newborn (CLDN) and lower respiratory illness (LRI) in siblings, and between (2) CLDN and asthma, chronic obstruction pulmonary disease (COPD), or allergy in parents and grandparents. METHODS--Data from 209 children born before 32 weeks of gestation were randomly taken from the records of three neonatal units. Taking into account age and gender, the excess of LRI was calculated for each family compared with the average of all families. Subsequently whether CLDN was associated with an excess of LRI in the family was tested. RESULTS--Thirty one (14.8%) children were diagnosed as having CLDN. The family probability index for LRI did not differ between children with or without CLDN. The prevalence of COPD, asthma, and allergy in parents of children with CLDN was similar to that of children without CLDN. The prevalence of LRI was 18.1% in study children, 29.6% in children with CLDN, and 16.9% in children without CLDN (P < 0.01). These prevalences were higher compared with that of a group of term siblings (9.3%) (P = 0.05). CONCLUSIONS--These findings suggest that CLDN in preterm children is not related to a genetic or familial predisposition towards asthma, COPD, or allergy.

A Longitudinal Study of Families of Preterm Infants: Changes in Stress and Support over the First Two Years

Families of 44 preterm infants were followed to determine if there were changes over time in the amount of stress and support they reported. Primary caregivers were interviewed in their homes at 3, 6, 12, and 24 months of age. Results indicated that there were significant changes in the amount of stress reported by parents. However, these changes were tied to specific types of child problems identified by the parent. There were no significant changes in the amount of social support parents received over time. Informal social support was significantly negatively correlated with stress at 3, 12, and 24 months. A number of factors contributed significantly to the prediction of stress; however, the particular constellation of variables changed at each age. Results are interpreted in terms of their implications for intervention.