Mothers Of Term Infants Research Articles

Perinatal dissociation during premature childbirth: A comparative study

Premature childbirth is sometimes perceived as a painful and traumatic experience, in which mothers can manifest dissociative symptoms. Our study aims to evaluate dissociative symptoms during premature childbirth compared with full-term delivery and to identify predictors of perinatal dissociation. We conducted a cross-sectional, descriptive and analytical study, including 97 mothers of premature infants who presented to the outpatient unit of neonatology at the UH Hedi Chaker of Sfax in Tunisia. For each mother, we collected sociodemographic and obstetric data. We used the peritraumatic dissociative experiences questionnaire (PDEQ) for screening dissociative symptoms during labor. We assessed severity of prematurity by the perinatal risk inventory (PERI). Responses were compared with a control group of 80 mothers of full-term infants. Average age of mothers was 30.2 years. Average gestational age was 32.82 weeks. Pregnancies were single (83.5%) or twins. 77.3% of mothers gave birth by caesarean section. Prematurity was unexpected by 56.7% of them. According to the PERI, 47.4% of newborns were considered as high-risk preterm infants (PERI ≥ 4). The average score of PDEQ was 16. The prevalence of perinatal dissociation for this sample (20.6%) was significantly higher compared with the control group (P = 0.014). It was also correlated to unexpected prematurity (P < 0.001) and a PERI score ≥ 4 (P = 0,023). Our results show that perinatal dissociation is more frequently occurring in preterm childbirth, especially when prematurity is severe and unexpected. Early interventions providing adequate information and support during delivery for mothers at risk of developing perinatal dissociation can alleviate such distress and prevent the development of subsequent post-traumatic stress disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Greater brain response to emotional expressions of their own children in mothers of preterm infants: an fMRI study.

The birth of a preterm infant and Neonatal Intensive Care Unit hospitalization constitute a potentially traumatic experience for mothers. Although behavioral studies investigated the parenting stress in preterm mothers, no study focused on the underlying neural mechanisms. We examined the effect of preterm births in mothers, by comparing brain activation in mothers of preterm and full-term infants. We used functional magnetic resonance imaging to measure the cerebral response of 10 first-time mothers of preterm infants (gestational age <32 weeks and/or birth weight <1500) and 11 mothers of full-term infants, viewing happy-, neutral- and distress-face images of their own infant, along with a matched unknown infant. While viewing own infant's face preterm mothers showed increased activation in emotional processing area (i.e., inferior frontal gyrus) and social cognition (i.e., supramarginal gyrus) and affiliative behavior (i.e., insula). Differential brain activation patterns in mothers appears to be a function of the atypical parenthood transition related to prematurity.

Preventing large birth size in women with preexisting diabetes mellitus: The benefit of appropriate gestational weight gain

ObjectiveTo estimate the percentage of infants with large birth size attributable to excess gestational weight gain (GWG), independent of prepregnancy body mass index, among mothers with preexisting diabetes mellitus (PDM). Study designWe analyzed 2004–2008 Florida linked birth certificate and maternal hospital discharge data of live, term (37–41weeks) singleton deliveries (N=641,857). We calculated prevalence of large-for-gestational age (LGA) (birth weight-for-gestational age≥90th percentile) and macrosomia (birth weight>4500g) by GWG categories (inadequate, appropriate, or excess). We used multivariable logistic regression to estimate the relative risk (RR) of large birth size associated with excess compared to appropriate GWG among mothers with PDM. We then estimated the population attributable fraction (PAF) of large birth size due to excess GWG among mothers with PDM (n=4427). ResultsRegardless of diabetes status, half of mothers (51.2%) gained weight in excess of recommendations. Large birth size was higher in infants of mothers with PDM than in infants of mothers without diabetes (28.8% versus 9.4% for LGA, 5.8% versus 0.9% for macrosomia). Among women with PDM, the adjusted RR of having an LGA infant was 1.7 (95% CI 1.5, 1.9) for women with excess GWG compared to those with appropriate gain; the PAF was 27.7% (95% CI 22.0, 33.3). For macrosomia, the adjusted RR associated with excess GWG was 2.1 (95% CI 1.5, 2.9) and the PAF was 38.6% (95% CI 24.9, 52.4). ConclusionPreventing excess GWG may avert over one-third of macrosomic term infants of mothers with PDM. Effective strategies to prevent excess GWG are needed.

Smoking during pregnancy in association with maternal emotional well-being

ObjectiveThe aim of the study was to investigate psychosocial predictors of smoking during pregnancy. Materials and methodsIt was a cross-sectional analysis of a prospective birth-cohort study. The participants were 514 mothers of full-term infants. Women completed questionnaires during hospital stay after delivery. Questionnaire included items on sociodemographic characteristics, planning and emotional acceptance of pregnancy, reproductive history, health-related behavior, emotional well-being, and relationships with a partner. ResultsSmoking during pregnancy was reported by 14.8% of the participants. Prenatal smoking was associated with secondary or lower education, maternal age less than 20 years, childbirth outside of marriage, history of elective abortion, unplanned pregnancy, lack of positive emotional acceptance of pregnancy by mother and father, emotional distress and alcohol consumption during pregnancy. Smoking during pregnancy remained significantly associated with prenatal alcohol consumption, previous elective abortion, and lack of positive emotional acceptance of pregnancy by mother even after adjustment for maternal age, education, and family structure. ConclusionsResults support an idea of complexity of the relationships among smoking, alcohol use, and emotional well-being. Lack of positive emotional acceptance of pregnancy by mother and history of elective abortions can be considered as possible associates of smoking during pregnancy and suggest that strengthening of positive attitudes toward motherhood could add to lower smoking rates among pregnant women.

Breast Milk Iron Concentrations may be Lower than Previously Reported: Implications for Exclusively Breastfed Infants

Objective: Atomic Absorption Spectrophotometry (AAS) is the most common technique for detecting iron in human milk. Quantifying the iron in human milk is essential for determining the amount of dietary iron available to the exclusively breastfed infant. To determine whether more sensitive procedures for iron analyses would yield different values than those obtained using the AAS, flame atomic absorption, we investigated and compared three different analytical techniques using AAS. Methods: The present experiment was conducted as part of a larger study on the iron supplementation of 77 exclusively breast-fed infants. Breastmilk samples were collected from 10 mothers of full-term infants at one and 3½ months of age. Each sample was analyzed with a Perkin-Elmer 2380 Atomic Absorption Spectrophotometer by the following analytical methods: flame atomic absorption spectrophotometry (FAAS), direct sample analysis with graphite furnace atomic absorption spectrophotometry (GFAAS) and the method-of-standard-additions with GFAAS. Results: While all values were within reported ranges, there was significant inter-method variability. The decrease in iron concentration between 1-month and 3.5-month milk samples found in the present study is in agreement with a previous report. GFAAS methods produced consistently lower values than did FAAS: 1 month: direct GFAAS, 0.50 (0.33-0.86) μg/ml; method-of-addition GFAAS, 0.45 (0.31-0.66) μg/ml; FAAS 0.76 (0.25-1.60 μg/ml), mean (range): 3.5-month: direct GFAAS, 0.29 (0.13-0.46 μg/ml; method-of-addition GFAAS, 0.29 (0.11-0.44 μg/ml); FAAS method 0.78 (0.19-1.64) μg/ml. There was no difference between the two GFAAS methods at either time point. Conclusion: The findings obtained from this study suggest that much of the variability seen in the reported values of human milk iron concentrations could be due to the use of different analytical procedures. GFAAS results are consistently lower than those determined by FAAS suggesting that the exclusively breastfed infant consumes less iron than previously thought.

Low Rate of Perinatal Sepsis in Term Infants of Mothers with Chorioamnionitis.

The risk of infection in infants of mothers with chorioamnionitis (CAM) may be lower than previously reported. This study's objective was to determine the incidence of intrapartum fever (IPF) and culture-positive early-onset bacterial neonatal infection (CPEOI) in the late preterm and term infants of mothers with or without CAM and to assess interhospital variation in neonatal infection management. This retrospective cohort study included mothers and newborns delivered at ≥35 weeks gestation at Kaiser Permanente Southern California Hospitals in 2010 (n = 31,112). Electronic medical and laboratory records from 13 medical centers were examined for maternal temperature, intrapartum, and neonatal antibiotic treatment. Rates for IPF, CAM, and CPEOI were estimated. Rates for starting neonatal antibiotics were calculated. The incidence of IPF was 9% and CAM 4%. The overall rate for CPEOI was 0.61/1,000 (95% confidence interval [CI] 0.34, 0.89/1,000). The rate of CPEOI was 4.0/1,000 (95% CI 0.50, 7.5/1,000) in infants born to mothers with CAM. The rate of beginning antibiotics for infants born to mothers with CAM ranged from 7 to 76% between nurseries. The rate of CPEOI in infants born to mothers with CAM is lower than previously reported. There is heterogeneity in initiation of neonatal antibiotics by neonatologists.

The role of folate receptor autoantibodies in preterm birth

ObjectiveCellular uptake of folate is mediated by folate receptor (FR)α. Prior studies indicate that a FRα autoantibody (FRAb) is implicated in poor pregnancy outcomes. The aims of this study were to determine the prevalence of FRAbs in women with preterm and term pregnancies, and to investigate the role of maternal FRAbs in preterm birth. MethodsThis prospective observational study included 23 mothers and 25 preterm infants (two twin births) born at gestational age (GA) ≤32 wk and/or birth weight ≤1500 g (group 1) and 25 mother–term infant pairs (infants born at GA ≥37 wk, group 2). Blocking and binding FRAbs in maternal and in cord blood were determined. The association between maternal FRAbs and pregnancy outcome was measured using multiple logistic regression, adjusted for maternal age and previous preterm birth. ResultsThe prevalence of FRAbs was 65.2% in women with preterm birth, which was twofold higher than in those with term pregnancy (28%; relative risk [RR], 2.3; 95% confidence interval [CI], 1.2–4.7). The prevalence of FRAbs in preterm infants (64%) was significantly higher than in term infants (24%; RR, 2.7; 95% CI, 1.3–5.7). Pregnant women with positive FRAbs had 4.9 times higher odds of having preterm birth (odds ratio, 4.9; 95% CI, 1.4–17.7), adjusted for maternal age and previous preterm birth. ConclusionsThese findings suggest that the presence of FRAbs might be a contributing factor to preterm birth, which could be prevented with appropriate testing and therapeutic interventions. Further studies are warranted to investigate the possible mechanisms of fetal sensitization resulting in FRAb production in utero and its possible clinical correlates.

Macronutrients in Human Milk

Aim. To study longitudinal macronutrient concentrations of colostrum and mature human milk (HM) and test the hypothesis that colostrum concentration of a given macronutrient might predict the concentration of this macronutrient in mature milk. Methods. We collected samples of expressed HM obtained from mothers of full-term infants. Each mother contributed 2 samples of HM—the first during 72 hours after labor (colostrum) and the second after 14 days. Macronutrient contents of the samples were measured using infrared transmission spectroscopy. Results. In all, 57 women were recruited. Only 44 of them gave both colostrum and 14-day samples. The energy, fat, and carbohydrate content of mature milk was significantly higher than that in colostrum, whereas the opposite was found for protein content. There was no significant relationship between maternal weight for height and protein, fat, or lactose content at any stage. Energy, fat, and protein content in colostrum did not correlate with values in mature milk. In contrast, the lactose content in mature milk was highly correlated with that of colostrum (R2 = 0.47, P &lt; .0001). Conclusion. Energy, fat, and protein content in colostrum do not predict values in mature milk. In contrast, lactose content in mature milk is highly correlated with that in colostrum.

Macronutrient composition of human milk from Korean mothers of full term infants born at 37-42 gestational weeks.

BACKGROUND/OBJECTIVESBreast milk is the best available food for optimum growth and development of infants and the breastfeeding rate is increasing in Korea. The purpose of this study is to measure the concentrations of macronutrients and to evaluate their changes according to lactation period in breast milk from lactating Korean women.SUBJECTS/METHODSMilk samples were obtained from 2,632 healthy lactating women (mean age; 32.0 ± 3.3 years), where the lactating period was up to a period of 8 months, who also volunteered to participate in the Human Milk Macronutrient Analysis Research. Lactose, protein, fat and water content in the breast milk samples were analyzed with infrared spectrometry using MilkoScan FT-2.RESULTSThe mean macronutrient composition per 100 mL of mature breast milk was 7.1 g for lactose, 1.4 g for protein and 3.0 g for fat, and energy content was 61.1 kcal. The protein concentration was significantly lower in milk samples at 1-2 weeks (2.0 g/dL) to 2-3 months (1.4 g/dL) than those at 0-1 week (2.2 g/dL), but it was similar among samples from 3-4 months to 7-8 months (1.3 g/dL). Mean lipid levels varied among different lactational period groups (2.7-3.2 g/dL), but presented no significant difference. Lactose concentration in the milk samples did not differ with lactation period. Maternal body mass index was positively related to protein and lipid breast milk contents, but was negatively related to lactose content. General linear models examining the associations between maternal variables and milk macronutrient content revealed that lactation period had a major impact on protein and lipid, but not on lactose content in breast milk.CONCLUSIONSThese results warrant future studies to explore factors that may be associated with changes in macronutrient content in human milk.

Dilute Versus Full-Strength Formula in Exclusively Formula-Fed Preterm or Low-Birth-Weight Infants

Dilute Versus Full-Strength Formula in Exclusively Formula-Fed Preterm or Low-Birth-Weight Infants

PO-0078 The Relationship Between Maternal And Neonatal 25(oh) Vitamin D Status

Background In this study we aimed to investigate the relationship between maternal and neonatal 25(OH)D levels. Methods The subjects were 58 mothers and their newborns who were born between February 2012 and April 2012. Blood specimens were obtained within 72 h of birth and from mothers. Serum 25(OH)D concentrations were measured. Vitamin D deficiency was defined as serum concentrations ≤20 ng/mL. Results The mean gestational age and birth weight of preterm infants were 33.06 ± 2.2 weeks and 2125.4 ± 546 g and for term infants were 38.84 ± 1 weeks and 3470.3 ± 451 g, respectively. Sociodemographic characteristics of mothers were not significantly different between groups. Twelve percent of infants born before 32 completed weeks, 16% infants born between 32–36 weeks and 28% of term infants had vitamin D deficiency. Vitamin D deficiency was found in 27% mothers of preterm infants and 42% mothers of term infants. Conclusion Vitamin D receptors plays an important role in calcium absorption and bone metabolism. In the literature there are reports that vitamin D deficiency during pregnancy had adverse gestational outcomes including risk of pre-eclampsia, gestational diabetes. The mean vitamin D levels were normal in infants whereas their mothers had low levels of vitamin D. When we consider that all mothers in the study received vitamin D supplements, we should give appropriate vitamin D prophylaxis during pregnancy. Also we should give adequate vitamin D supplementation to the infants without any delay.

Changes in Preterm Breast Milk Nutrient Content in the First Month

The primary aim of the study was to investigate the changes in composition of breast milk from mothers with preterm infants (gestation age < 35 weeks) during the first 4-6 weeks of lactation. Breast milk from 17 mothers who had delivered preterm infants was collected longitudinally for 4-6 weeks. Breast milk from 15 mothers of full-term infants was also collected at the 1(st) week and 4(th) week. Fat, protein, lactose, energy, minerals (calcium and phosphate), and immune components [secretory immunoglobulin A (IgA), leptin, lysozyme, and lactoferrin] content were measured weekly in each participant. A mid-infrared human milk analyzer was used to measure the protein, fat, and lactose contents. Calcium and phosphate components were checked via spectrophotometry. The concentrations of major immune components (secretory IgA, lactoferrin, lysozyme, and leptin) were quantified using enzyme-linked immunosorbent assay kits. Eighty samples from 17 preterm mothers were collected. The mean gestational age was 29.88 ± 2.39 weeks. There were significant changes in nutrient components during these periods, with increases in lactose (p < 0.001), lipid (p = 0.001), calorie (p = 0.012), and phosphate (p = 0.022) concentration and decreases in protein (p < 0.001) and secretory IgA (p < 0.001) concentration. There were no differences in calcium (p = 0.919), lactoferrin (p = 0.841), leptin (p = 0.092), and lysozyme (p = 0.561) levels. Furthermore, there were no significant differences in most components of breast milk between full-term and preterm mothers. The longitudinal study revealed significant changes in macronutrient contents and secretory IgA concentration in preterm milk over the 4-6 week period, which is compatible with the results of previous studies. The quantification of phosphate in preterm breast milk was lower than the normal range, suggesting that close monitoring of body bone mass may be indicated. More studies are warranted to evaluate the clinical significance of alterations of major milk components during the postnatal stage.

Child-Rearing History and Emotional Bonding in Parents of Preterm and Full-Term Infants

Some parents fail to develop strong emotional bonds with their newborn infants. As the quality of the parent–infant relationship contributes to the infant’s development, it is of great importance to identify protective and risk factors that facilitate or impede the development of the parent–infant bond. The present study examined both infant-related and parent-related factors. We investigated whether or not the infant’s gestational age at birth influenced the quality of the mother–infant and father–infant bond. In addition, we examined whether or not parents’ own child-rearing history predicts bonding with their newborn infant. Mothers and fathers of full-term infants (born >37 weeks of gestational age, n = 72), moderate preterm infants (born between 32 and 37 weeks of gestational age, n = 69) and very preterm infants (born <32 weeks of gestational age, n = 70) completed the Parental Bonding Instrument—assessing their own child-rearing history—and the Postpartum Bonding Questionnaire at two points in time—which examines the quality of the bond with their infant. Results reveal that mothers of preterm infants report higher feelings of bonding than mothers of full-term infants. For fathers, no differences were found between the gestational age groups. These findings are discussed in light of compensatory care theory and the supporting role of hospital staff. Furthermore, bonding with the infant was strongly influenced by parents’ perceptions of their own child-rearing history in both mothers and fathers of full-term and preterm infants. Clinicians working with parents of newborn infants should pay attention to parental recollections of their own upbringing during early screening in parents of full-term and preterm infants.

Prevalence and Factors Associated with Depressive Symptoms in Mothers with Infants or Toddlers

The objective of this study is to explore the prevalence of and factors associated with depressive symptoms in mothers with young children. This is a cross-sectional face-to-face study performed between January 1, 2010 and June 30, 2011. Mothers of premature infants with a gestational age of less than 37 weeks were recruited. Premature infants with any congenital anomaly or severe congenital heart disease were excluded. Controls were mothers of full-term infants with birth weight over 2500 g and without admission to a neonatal intensive care unit. Outcome measures included the Center for Epidemiologic Studies Depression Scale for maternal depressive symptoms, the Family Apgar Index for family support, and the Chinese Maudsley Personality Inventory for personality traits. A total of 102 mothers of preterm infants and 111 mothers of full-term infants were recruited. The prevalence of depressive symptoms was 27.7% (59/213) in all mothers of this study, 29.4% (30/102) in mothers of preterm infants, and 26.1% (29/111) in mothers of full-term infants. Predictors of maternal depressive symptoms included the following: extended family structure, lack of postpartum confinement, low family support, and a personality characterized by neuroticism. Depressive symptoms were common among mothers of young children. Family function and neurotic personality were highly correlated with depressive symptoms in mothers caring for young children. Pediatric health care providers are suggested to screen for maternal depressive symptoms and provide family-oriented support in Taiwan.

Review of Interventions to Reduce Stress Among Mothers of Infants in the NICU

Nearly half a million preterm infants are born each year in the United States. Preterm delivery has significant psychosocial implications for mothers, particularly when their baby spends time in the neonatal intensive care unit (NICU). The decrease in length of gestation causes mothers to have to parent prematurely, without the less time for emotional preparation than mothers of full-term infants. Parents of NICU infants experience stress related to feelings of helplessness, exclusion and alienation, and lack sufficient knowledge regarding parenting and interacting with their infants in the NICU. There are a number of interventions that nurses can do that help reduce the stress of mothers of infants in the NICU.

Psychological distress among postpartum mothers of preterm infants and associated factors: a neglected public health problem

The aim of the present study was to determine the prevalence of psychological distress, depression, anxiety, and stress among postpartum Arab mothers of preterm or low birth weight (LBW) infants and to identify maternal characteristics that can predict psychological distress among mothers of preterm infants. A hospital-based study was conducted. A representative sample of 2,091 postpartum mothers was surveyed and 1,659 women (79.3%) gave their consent to participate in the study. The study was based on a face-to-face interview with a designed questionnaire covering sociodemographic characteristics, anthropometric measures, medical history, and maternal characteristics. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale (DASS-21). In the study sample, 10.2% of the postpartum mothers had preterm/LBW infants. Depression (29.4 vs. 17.3%) and anxiety (26.5 vs. 11.6%) were significantly more common among mothers of preterm births compared to mothers of full term infants (p < 0.001). The risk of depression in mothers of preterm/LBW infants was two times the risk in mothers of full term infants, while the risk of anxiety was 2.7 times in mothers of preterm/LBW infants than in mothers of full term infants. Young mothers and those who had less than secondary education (42.0 vs. 21.7%; p = 0.007) and lower monthly household income (72.0 vs. 53.3%; p = 0.024) were more depressed and anxious after the preterm birth when compared with mothers of full term infants. Psychological distress was higher in mothers with history of preterm birth (30.0 vs. 21.7%) and delivery complications (52.0 vs. 33.3%). We found a greater risk of depression and anxiety in mothers of preterm births than in mothers of full term infants. Our analysis revealed that depressed and anxious women of preterm infants were younger, less educated, had a lower body weight and low household income than non-depressed and non-anxious women.

Relation between sleep status of preterm infants aged 1–2 years and mothers’ parenting stress

The aim of this study was to compare infants' sleep measures through an actigraph and maternal parenting stress among preterm and full-term mothers, and to explore the factors affecting maternal parenting stress in relation to infants' sleep. The subjects were 44 pairs of mothers and children. Twenty-one were in the preterm group, and 23 were in the full-term group. Inclusion criteria for preterm infants were born at less than 36 weeks and birthweight of less than 2500 g. The Parenting Stress Index (PSI) Short Form assesses maternal perception of the degree of parenting stress: the children's domain, and the parent's domain. An actigraph was applied to assess the infants' sleep measures. The PSI showed significant differences, with high scores in parenting stress in the preterm group. Also, the number of mothers who complained about their infant's sleep issues was significantly higher in the preterm group. Most of the sleep measures showed improvement by their age in both preterm and full-term infants. Multiple linear regression analysis showed that sleep efficiency, longest sleep duration at nighttime accounted for 71% of stress in the children's domain of the PSI of the preterm group. The parenting stress among mothers of preterm infants was significantly higher than that of mothers of full-term infants. The mothers of preterm infants were concerned about their infant's nocturnal sleep quality.

Parenting stress in mothers of very preterm infants — Influence of development, temperament and maternal depression

ObjectiveTo measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants. MethodsOne hundred and five mothers who delivered 124 babies at ≤30weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared. ResultsQuestionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p=0.022), with 19% of the preterm group and 9% of the term group having high scores (p=0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis. ConclusionsParenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.

The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial.

BackgroundAlthough breast milk has numerous benefits for infants’ development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers’ sense of trust in their own capacity and thereby facilitate breastfeeding.Methods/designA multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff.DiscussionThis paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed.Trial registrationNCT01806480

Competence and Responsiveness in Mothers of Late Preterm Infants Versus Term Infants

To compare maternal competence and responsiveness in mothers of late preterm infants (LPIs) with mothers of full-term infants. A nonexperimental repeated-measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers and the relationship of the theoretical antecedents to these outcomes. Urban academic medical center. Mothers of late preterm infants (34-36, 6/7-weeks gestation) and mothers of term infants (≥37-weeks gestation), including primiparas and multiparas. Data were collected after delivery during the postpartum hospital stay and again at 6-weeks postpartum. Descriptive and inferential analysis. A total of 70 mothers completed both data collection periods: 49 term mothers and 21 LPI mothers. There were no differences between the two groups related to their perception of competence or responsiveness at delivery or 6-weeks postpartum. At 6-weeks postpartum, none of the assessed factors in the model was significantly related to competence or responsiveness. The results, which may have been limited by small sample size, demonstrated no difference in the perceptions of LPI and term mothers related to competence or responsiveness. Maternal stress and support were significantly related to other factors in the model of maternal competence and responsiveness.