Parents Of Full-term Infants Research Articles

Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence

Introduction: Infant- and family-centered developmental care can reduce adverse outcomes in both infants and parents. Parents’ experiences of the care and staff treatment remain to be evaluated. Methods: Parents of infants admitted to neonatal units in Sweden from July 2020 to May 2022 responded to a questionnaire with standardized questions about in-hospital care. Exposures were hospital, gestational age, length of hospital stay, unit level, and bed density. The proportions of parents rating aspects of neonatal care as excellent, defined as five on a Likert scale, and the determinants of excellence were described. The results were benchmarked with ratings in adult somatic care. Results: A total of 4,475/13,108 (34%) parents responded. The ratings of excellent care varied by question from 65% to 90%. The largest variation in excellence between neonatal units (range 43–80%) was found for “participation and involvement.” The proportion of excellence was significantly lower among parents of extremely preterm infants. Confidence in the staff was lower in parents of extremely preterm infants than in parents of term infants (56% vs. 83%). Longer hospital stays affected the experience of neonatal care adversely, whereas level of care and bed density were overall unrelated to the parental experience. Parents in neonatal care rated the care as excellent to a higher extent than patients cared for in adult medicine. Conclusion: A majority of parents rated neonatal care in Sweden as excellent. The less frequent ratings of excellence among parents of extremely preterm infants indicate that more could be done to optimize parental involvement and support.

The Effect of Educational-supportive Interventions on Distress Tolerance of Parents of Premature Infants in Neonatal Intensive Care Unit

Background: Parents of premature infants are more likely to be exposed to stressful situations than parents of term infants. This study aimed to determine the effect of educational-supportive interventions on the tolerance of parents of premature infants admitted to the neonatal intensive care unit (NICU).
 Methods: In this quasi-experimental study, the participants included 50 parents of premature infants admitted to one of the NICUs in Shiraz, Iran from October 2019 to May 2020. Parents were randomly assigned to intervention and control groups. Educational intervention (training package and its content) was done in five 45-minute sessions for two weeks and three times a week. The supportive care was provided one day after the intervention. The data were collected using a demographic questionnaire and Distress Tolerance Scale and analyzed by SPSS 24 using paired t-test, independent t-test, and chi-square test.
 Results: The mean scores of the mothers' and fathers’ distress tolerance in the pre-intervention stage were 36.0 ± 6.1, 33.9 ± 7.4 in the control group (P < 0.14), and 38.4 ± 5.8, 38.0 ± 5.9 in the experimental group (P < 0.001), respectively. After the intervention, the mean scores of the mothers’ and fathers’ distress tolerance in the control group were 35.9 ± 5.3 and 36.5 ± 6.3, and in the experimental group 54.7 ± 5.3, 53.0 ± 6.0, which compared to before the intervention showed a significant increase (P < 0.001).
 Conclusion: Supportive-educational programs can increase distress tolerance in parents of premature infants. In the future, these programs can be planned to promote the quality of infant care.

Exploring Adjustment and Parent-Infant Relations in Mothers of Premature Infants: Thematic Analysis Using a Multisensory Approach.

ObjectiveThe aim of the study was to explore mothers’ experiences of having an infant born prematurely (28–32 weeks gestation). In particular, the study aimed to explore the developing parent–infant relationship 12–30 months since birth and the developing parental identity during hospitalization and discharge.MethodsTwelve mothers, aged between 22 and 43, participated in the semi-structured interviews. The mean age of infants was 19 months. Interviews comprised open-ended questions and visual stimuli consisting of photographs brought by participants, word selection, and card sorting techniques. Data were analyzed using Braun and Clarke’s thematic analysis (Braun & Clarke, 2013).ResultsThree themes arose from a clustering of 10 subthemes: (a) Emotional Impact, (b) Searching for Parent Identity, and (c) Moving Beyond Adversity. Participants expressed experiencing heightened emotional distress during the time of their infants’ birth and hospitalization and initially not feeling like parents. Their parental identity strengthened as they became more involved in the care of their infant and began to accept the situation. Participants described parenting their premature infants differently compared with parents of full-term infants, and described adjusting to this difference over time.ConclusionsThe findings highlight the emotional experience and adjustment of mothers of premature infants, from hospital and postdischarge. The need for psycho-educational interventions postdischarge and parent-partnered models during hospitalization is discussed. In addition, the study demonstrates the use of integrating visual stimuli in qualitative data collection procedures, to elicit further meaning and interaction from participants with the interview process.

119 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high-risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis, because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents' retrospective perceptions of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted: 20 with the biological mother, two with both biological parents, and one with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews included parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.

A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study.

BackgroundParents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications.ObjectiveThe aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants.MethodsParents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics.ResultsOf 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as “easy” to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were “satisfied” (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to “discomfort” and “tiredness” were more prevalent in preterm group conversations, whereas the topic of “positive feelings” occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents’ ability to get adequate sleep or rest.ConclusionsThe chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns.Trial RegistrationClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679

21 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

Abstract Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents’ retrospective perception of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted, 20 with the biological mother, 2 with both biological parents, and 1 with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews include parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.

Parental Depression Symptoms at Neonatal Intensive Care Unit Discharge and Associated Risk Factors

To investigate the prevalence and risk factors associated with parental depressive symptoms at neonatal intensive care unit (NICU) discharge and determine the relationships among depressive symptoms, stress, and social support. Parents participating in the Giving Parents Support trial (n=300) were surveyed before NICU discharge. Depressive symptoms, stress, and social support were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10), Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support (MSPSS). Regression analyses examined relationships among depressive symptoms, stress, social support, and parent/infant factors. At NICU discharge, 45% of parents reported depressive symptoms and 43% reported elevated perceived stress. Increased odds of elevated depressive symptoms were associated with older gestational age (P=.02), female infant (P=.02), and longer length of stay (P=.045). Odds of depression were 7.87 (95% CI, 2.15-28.75) for parents of infants with gestational age ≥37weeks compared with gestational age <28weeks. Parental NICU stress was higher in younger parents (P<.01). Depressive symptoms were positively associated with parental stress. Each 1-point increase in PSS:NICU score was associated with a 2.1-point (95% CI, 1.6-2.9; P<.001) increase in CESD-10 score. Social support was inversely associated with depressive symptoms. The prevalence of depressive symptoms in parents at NICU discharge was high, even among parents of term infants. Older gestational age, greater parental stress, and lower levels of social support were strong correlates of depressive symptoms. Strategies to support parents, including depression screening, stress reduction strategies, and mental health referrals, are needed.

Postpartal Affective and Endocrine Differences Between Parents of Preterm and Full-Term Infants.

BackgroundDuring the postpartum period, new parents frequently experience emotional stress and exhibit symptoms of depression and anxiety, accompanied by substantial endocrine changes. However, evidence predominantly exists from parents of full-term infants, while data on parents of preterm infants are scarce. In this exploratory, cross-sectional study, we compared psychological well-being and endocrine parameters in parents of very preterm and term born infants.MethodsMothers (N = 28) and fathers (N = 30) of full-term infants as well as mothers (N = 18) and fathers (N = 21) of very or extreme preterm infants (< 32nd gestational week) were recruited in the days following birth. Anxiety, depression, and perceived stress were assessed with the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Perceived Stress Questionnaire (PSQ), respectively. Physiological measures included serum levels of estradiol, progesterone, prolactin, and thyroid-stimulating hormone (mothers only), as well as the salivary cortisol awakening response (mothers and fathers).ResultsNew mothers and fathers of very preterm infants exhibited higher scores of depression, anxiety and stress than parents of term infants. Besides, mothers of very preterm infants showed lower levels of estradiol, progesterone, and prolactin, as well as a heightened post-awakening cortisol response compared to mothers of term infants. Furthermore, in mothers of preterm infants we found significant negative associations between serum prolactin levels and BDI and STAI scores, respectively.ConclusionsParents of very preterm infants suffered from a higher burden of psychological distress than parents of full-term infants. The affective symptoms in preterm mothers were accompanied by altered endocrine profiles that, at least to some extent, may contribute to the psychological changes. The profound psychological and physiological disturbances in mothers of preterm infants may have an impact on long-term mental health and early pharmacological and psychological interventions may help to ameliorate postpartum affective symptoms.

Reducing parental trauma and stress in neonatal intensive care: systematic review and meta-analysis of hospital interventions.

To classify NICU interventions for parental distress and quantify their effectiveness. We systematically reviewed controlled studies published before 2017 measuring NICU parental distress, defined broad intervention categories, and used random-effects meta-analysis to quantify treatment effectiveness. Among 1643 unique records, 58 eligible trials predominantly studied mothers of preterm infants. Interventions tested in 22 randomized trials decreased parental distress (p < 0.001) and demonstrated improvement beyond 6 months (p < 0.005). In subgroup analyses, complementary/alternative medicine and family-centered instruction interventions each decreased distress symptoms (p < 0.01), with fathers and mothers improving to similar extents. Most psychotherapy studies decreased distress individually but did not qualify for meta-analysis as a group. NICU interventions modestly reduced parental distress. We identified family-centered instruction as a target for implementation and complementary/alternative medicine as a target for further study. Investigators must develop psychosocial interventions that serve NICU parents at large, including fathers and parents of full-term infants.

The Quality of Parent–Infant Interaction in the First 2 Years After Full-Term and Preterm Birth

SYNOPSISObjective. Relatively few studies have examined stability and/or change in the quality of parenting behaviors across the first years of a preterm infant’s life and how this course may differ from parents of term infants. Design. The present study examined the quality and stability of mother–infant and father–infant interaction across the first 2 years post-partum in a sample of 231 Dutch families with either a term or a preterm infant. Video recordings of parent–infant interactions were made at four points (1 day, 1 month, 6 months, and 24 months post-partum), and three aspects of parental behavior (sensitivity, intrusiveness, and withdrawal) and four aspects of infant behavior (positive mood, negative mood, activity level, and sustained attention) were analyzed by the National Institute of Child Health and Human Development coding scales. Results. The study found moderate levels of stability in parenting behaviors, but not in infant behaviors, across time. Prematurity had negligible effects on parental interactive behavior, but clear effects on infant behaviors. Parental background factors (educational level) had strong effects on parental interactive behaviors. Parents who displayed a relatively poor quality parent–infant interaction were likely to have partners who also demonstrated relatively poor quality parent–infant interaction. Conclusions. Results recommend early identification of parents who are likely to show poor levels of parenting, inclusion of both mothers and fathers in prevention/intervention programs.

The Agreement Rate about Unintended Pregnancy and Its Relationship with Postpartum Depression in Parents of Preterm and Term Infants

Introduction: Postpartum depression (PPD) affects women’s health and self-confidence, and infant’s social, emotional, cognitive and even physical development. Studies show that parents of preterm infants frequently experience symptoms of depression and anxiety. Women with unintended pregnancy are subjected to more risk of depression than women with planned pregnancy. Unintended pregnancy may lead to increased maternal exposure to psychosocial stressors, reduced social support by the spouse, increased levels of depressive symptoms and decreased life satisfaction. Findings: No significant difference was observed between term and preterm infants’ mothers (p = 0.85) in terms of postpartum depression. However, two groups of fathers in terms of depression showed a significant difference (p = 0.045). McNemar’s test showed that parents of term infants (K = 0.322, p = 0.077), and parents of preterm infants (k = 0.17, p = 0.144) agreed with each other on unintended pregnancy. Conclusion: Fathers of preterm infants are at higher risk for mental disorders than fathers of term infants and they need more attention in future studies.

Anxiety, post-traumatic stress disorder and social supports among parents of premature and full-term infants.

Background:Premature birth is one of the most important unresolved reproductive health problems. Premature birth is often traumatic and a source of distress for parents. Increased parental stress during the first year of their infant's life is a risk factor for later behavioral problems in infants.Objectives:This study was designed to compare anxiety, post-traumatic stress, and social supports in parents of premature and mature infants.Patients and Methods:This was a comparative descriptive study conducted at healthcare centers of Qom city, in 2012. In this study, 82 couples (164 parents) divided into two groups including parents who have preterm and term infants. Questionnaires including items such as demographic characteristics, obstetric and post-traumatic stress disorders, Spielberger anxiety and Multidimensional Scale of Perceived Social Support were completed two months after childbirth. Data were analyzed using χ2 test, Fisher’s exact test, Mann-Whitney test, independent t-test, and regression logistic using SPSS18 software.Results:The levels of anxiety was not significantly different in mothers and fathers in the two groups, but the trait anxiety level of mothers (P < 0.001) and fathers who had preterm infants (P = 0.01) was significantly greater than the parents of full-term infants. Post-traumatic stress disorder was significantly greater in mothers of preterm infants than those of term infants (P = 0.03), but this amount was not significantly different between the two groups of fathers. Mothers' social support did not differ significantly (P = 0.08), however, it was significantly different in fathers (P = 0.01).Conclusions:Premature infants' parents are more at risk of mental disorders than term infants' parents. This result shows the need of interventions, so these parents can better deal with the problems of premature infants.

Factors associated with posttraumatic stress disorder and its coping styles in parents of preterm and full-term infants.

Introduction:Birth of a premature infant and subsequent neonatal intensive care leads to psychological distress and trauma in parents. A large proportion of mothers show signs of trauma long after discharge from hospital. Fathers of premature infants are known to experience more stress than fathers of full-term infants. The sorrow experienced by parents of preterm infants is significantly higher than that experienced by parents of full-term infants because they have not been adequately prepared for the experience of birth, and need to cope with the stress caused by the clinical state and intensive care of the infant.Method:This was a descriptive-comparative study conducted in medical centers of Qom, Iran in 2012. In this study, 82 couples (164 mothers and fathers), participated in two groups as parents of preterm and full-term infants and completed demographic, midwifery, posttraumatic stress disorder, Spielberg anxiety questionnaires, and the Coping Inventory with Stressful Situation within 2 months after birth of their infant. Data were analyzed using Chi-square, Fisher’s exact, Mann-Whitney, independent t tests, logistic regression, and Repeated measures ANOVA in SPSS-18 software.Results:Posttraumatic stress disorder in preterm group mothers was significantly higher than in term group mothers (P=0.03), but no significant difference in this disorder was observed between fathers in these groups. There was a significant difference in coping styles with stress between mothers in the two groups (P<0.001) and between fathers in the two groups (P<0.001). Logistic model showed a significant correlation between posttraumatic stress and housing and coping strategies with stress in mothers.Conclusion:Parents of premature infants are more exposed to psychological disorders, and there is a need to adopt educational approaches to improve parents’ coping ability with preterm infant’s circumstance.

The Impact of Premature Childbirth on Parental Bonding

The development of an affectionate parent-infant bond is essential for a newborn infant's survival and development. However, from evolutionary theory it can be derived that parental bonding is not an automatic process, but dependent on infants' cues to reproductive potential and parents' access to resources. The purpose of the present study was to examine the process of bonding in a sample of Dutch mothers (n = 200) and fathers (n = 193) of full-term (n = 69), moderately premature (n = 68), and very premature infants (n = 63). During the first month postpartum parents completed the Pictorial Representation of Attachment Measure (PRAM) and Postpartum Bonding Questionnaire (PBQ). Longitudinal analyses revealed that mothers' PRAM scores decreased after moderately preterm delivery, whereas decreases in PRAM scores occurred in both parents after very preterm delivery. As lower PRAM scores represent stronger feelings of parent-infant connectedness, our findings suggest a higher degree of bonding after premature childbirth. Results of the PBQ analysis were in line with PRAM outcomes, as parents of preterm infants reported less bonding problems compared to parents of full-terms. These findings support the hypothesis that in affluent countries with adequate resources, bonding in parents of preterm infants on average may be higher than in parents of full-term infants.

Mother and father interactions over the first year with term and preterm infants

Mothers and fathers of 54 term infants and 49 preterm infants were observed individually interacting with their infant in the home during a structured task (Nursing Child Assessment Teaching Scale) when the child was 3 and 12 months old. Parents of preterm infants had lower interaction scores than parents of term infants. Differences between the groups were not explained by differences in the behavior of the infant, in levels of stress (measured by the Parenting Stress Index), in marital support (measured by the Dyadic Adjustment Scale), or in level of involvement with their child. Fathers of both term and preterm infants had lower interaction scores than mothers. Parents' interaction scores decreased over time, while the responsiveness and clarity of cues of the infants increased over time. The results are discussed in relationship to other research on prematurity stereotyping and the vulnerable child syndrome. © 1996 John Wiley & Sons, Inc.

Mothers' and fathers' interactions with their preterm infants during the initial period at home

Abstract The relations of 38 Israeli mothers and fathers with their preterm infants during the initial period at home were examined in three 30-min periods of observations, and by self-report parental perception of their infants as being difficult. Mothers in both groups were found to engage more in caregiving and holding than fathers. Fathers of preterm infants, however, were more involved in caregiving and holding than were fathers of full-term infants. Fathers in both groups surpassed mothers in playing and stimulating, but mothers and fathers of preterm infants played with and stimulated their infants more than did parents of full-term infants. Parents of preterm infants also perceived their infants as being more difficult than did parents of full-term infants. Infant characteristics, namely birth weight and medical complications, as well as parental education were found to be significant variables underlying parental variations within the group of preterm infants, but not the duration of the hospital...

The effects of premature birth on parents and their relationship.

This study examined the effects of a relatively low-risk premature birth on the parents and their relationship. The results indicate that the birth caused a crisis in the immediate postpartum period, but that distress decreased once the babies were at home. At one month and seven months after discharge, parents of both preterm and fullterm infants described their feelings in similar ways--the only difference at one month was that mothers of fullterm infants were more upset than those in the preterm group. Parents of preterm babies became more attuned to each other with time than did parents of fullterm infants, and only preterm mothers became pregnant within the 26 months following their first baby's birth. Mothers in both groups rated themselves as more distressed than fathers throughout the study period, which suggests that within the low-risk preterm sample, becoming a mother for the first time had more impact than did giving birth prematurely.

Parent—Infant interaction in free play at 8 and 12 months: Effects of prematurity and immaturity

In Study 1, three groups of ten infants with differing neonatal problems (full-term, healthy preterm, sick preterm) were observed with their parents in four 15-minute play sessions. Each infant—parent dyad was observed once in the home and once in the laboratory when the infants were 8 months and again at 12 months of age. At 8 months, the sick preterm infants fussed more and played less than those in other groups whereas the full-term infants smiled more and spent more time in play than infants in other groups. This was parallelled by group differences in parent behavior. Parents of sick preterm infants spent more time close to their infants, more time in physical contact with them, and more time demonstrating toys to them than parents in other groups while parents of full-term infants were less actively involved than those in other groups. By 12 months most of the group differences were no longer evident. Study 2 compared the 8-month-old sick preterm group to full-term infants pair-matched by postconceptional age. The sick preterm infants fussed more and smiled less than their age-matched controls, whereas their parents were more active than those in the matched control group. These comparisons suggest that although the lesser amount of play in the sick preterm group is attributable to immaturity, their fussiness, and their parents' high level of activity are associated with prematurity and not immaturity.