Mothers' perceptions of the care-by-parent program prior to hospital discharge of their preterm infants

PURPOSE: This research was conducted to gain an understanding of the care-by-parent experience for mothers of preterm infants. DESIGN: Phenomenologic methodology was used to explore the experiences of six mothers. Each participant slept overnight with her infant in a private hospital room. The mother assumed responsibility for her infant's care, knowing that nursing staff assistance was available if needed. Interviews were conducted on the following day and again after the infant had been home at least four days. SAMPLE: The participants were six mothers of preterm infants. MAIN OUTCOME VARIABLE: Mothers' experiences as they assumed responsibility in caring for their preterm infants away from the intensive care nursery. RESULTS: Findings revealed that the care-by-parent experience gives the mother an opportunity to assume full responsibility for her preterm infant's care, tests the reality of caregiving, helps her learn about caregiving activities and her infant's patterns of behavior, and confirms her readiness for independent parenting and the infant's readiness for discharge home. These findings confirm the benefits of rooming-in prior to discharge of preterm infants and provide guidelines for discharge planning.     

Maternal hypertension and neurodevelopmental outcome in very preterm infants

AIM: To determine the outcome of preterm infants born to mothers with hypertension during pregnancy, and preterm controls. METHODS: 107 infants of 24-32 weeks gestation, born to hypertensive mothers, and 107 controls matched for gestational age, sex, and multiple pregnancy, born to normotensive mothers, were prospectively enrolled over 2 years. Information on maternal complications and medication was obtained and neonatal mortality and morbidities recorded. Survivors were followed up to at least 2 years, corrected for prematurity. RESULTS: One third of the hypertensive mothers were treated with antihypertensive drugs, while 18% received convulsion prophylaxis with phenytoin. Magnesium sulphate was not prescribed. Both groups had a mean gestational age of 29.9 weeks, with the study infants having a significantly lower birthweight than the controls. Four study and three control infants died in the neonatal period. Cerebral palsy was not diagnosed in any infant of a hypertensive mother compared with five of the controls. The mean general quotient for the two groups was very similar and no difference in the incidence of minor neuromotor developmental problems was shown. CONCLUSIONS: Maternal hypertension seems to protect against cerebral palsy in preterm infants without increasing the risk of cognitive impairment. This was independent of the use of maternally administered magnesium sulphate.     

Impact of premature birth on the development of the infant in the family.

This article describes effects of the birth of a premature infant on the family system and focuses on how problems associated with premature birth such as infant illness, hospitalization, and immaturity can place the family at risk. New data are presented describing differences in the behavior of preterm and full-term infants and in the feelings of mothers toward their infants at 12 months. Mothers of preterm infants reported feeling overprotective toward them, were less willing to leave them with sitters, and believed that their birth had an initially negative effect on the family. Preterm infants showed less exploratory play and stayed closer to their mothers during free play. The fact that these differences are not reflected in patterns of attachment, a key measure of the mother–infant relationship, is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal language in infancy.

Observations of 36 preterm infants and their English-speaking mothers suggest that maternal language to the infant varies as a function of the age and ordinal position of the infant and maternal education. The relationship between maternal language at 1 mo of age and the mother's verbal style to her older infant allows for early identification of maternal language input styles and, therefore, has important implications for mother–infant intervention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum

The purpose of this article is to describe how nurses can assist the new mother of a high-risk infant, especially a preterm infant, in identifying and obtaining the social support needed to help the family adapt in the first few weeks after the birth. The interventions recommended are based on a research study conducted by the authors and colleagues and summarized within this article. Because support was more important than these mothers expected it to be, it is important that nurses in prenatal, postpartum, neonatal, home health, and extended care settings recognize the need to assist women in identifying their support needs. In addition, nurses can help the mothers identify individuals within their social network who could assist them with those needs. Meeting the social support needs of a mother is important for her own mental and physical health and well-being. It also helps her meet the social and developmental needs of her infant.     

Risk factors for aboriginal low birthweight, intrauterine growth retardation and preterm birth in the Darwin Health Region

Risk factors for Aboriginal low birthweight (< 2500 g), preterm birth (< 37 weeks' gestation) and intrauterine growth retardation (under the tenth percentile of Australian birthweights for gestational age) were examined in 503 live-born singletons recorded as born to an Aboriginal mother and routinely delivered at the Royal Darwin Hospital between January 1987 and March 1990. Infants born to mothers with body mass index less than 18.5 kg/m2 had five times the risk of having low birthweight and 2.5 times the risk of intrauterine growth retardation. Population-attributable risk percentages suggest that 28 per cent of low birthweight and 15 per cent of growth retardation could be attributed to maternal malnutrition. Risk percentages for maternal smoking of more than half a packet of cigarettes a day were 18 per cent for low birthweight and 10 per cent for growth retardation. For growth retardation, 18 per cent could be attributed to a maternal age under 20 years. Risk factors for preterm birth were predominantly obstetric: the population-attributable risk percentage for pregnancy-induced hypertension was 26 per cent and for other obstetric conditions was 16 per cent. For Aboriginal births in the Darwin Health Region, maternal malnutrition and smoking are key elements in the prevention of low birthweight and intrauterine growth retardation. Teenage pregnancy is an important risk for intrauterine growth retardation, and pregnancy-induced hypertension is a risk for preterm birth.     

Selection and identification of single domain antibody fragments from camel heavy-chain antibodies

OBJECTIVE: Our purpose was to determine whether women who were themselves small for gestational age at birth are at risk of giving birth to a small-for-gestational-age child and whether women who were themselves preterm at birth are at risk for preterm delivery. STUDY DESIGN: Women born in Copenhagen as subjects in the Danish Perinatal Study (1959 to 1961) were traced through the Danish Population Register. Information was obtained on their pregnancies during 1974 through 1989. RESULTS: A total of 25% of the children of small-for-gestational-age women were small for gestational age compared with 11% of the children of non-small-for-gestational-age women. Eleven percent of the children of preterm women were preterm compared with 7% of the children of women born at term. The adjusted odds ratios were 2.0 (95% confidence interval 1.4 to 3.0) for women who were small for gestational age to have small-for-gestational-age children and 1.5 (95% confidence interval 0.9 to 2.5) for women who were born preterm to have preterm children. Small-for-gestational-age women were not at significantly increased risk of preterm delivery (odds ratio 1.2), and preterm women were not at significantly increased risk of having small-for-gestational-age children (odds ratio 1.3). CONCLUSIONS: Reduced intrauterine growth of the mother is a risk factor for reduced intrauterine growth of her children. However, preterm birth of the mother is not strongly associated with preterm birth of her children.     

Early weaning in the rat: Effects on whole-brain RNA and free amino acids.

Each of 67 CAW:CFE(SD)spf rat litters was reared with its mother or with its mother and a virgin female ("aunt"). At pup age 15 days, some litters were deprived of their mothers, some remained with mothers whose nipples were cauterized to prevent suckling, and some remained intact until 21 days when all pups were housed individually or in peer groups until tested at 56 days. While increases in whole-brain free aspartic acid were attributed to loss of opportunity for suckling since they occurred in pups without mothers or with cauterized mothers, decreases in brain RNA caused by deprivation were prevented by the presence of mother or aunt. Rearing with aunts increased brain weight and emotional reactivity. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postnatal undernutrition: an alternative method

Rat pups were undernourished from birth by placing them for 12 hr/day with a normal lactating mother and 12 hr/day with a nipple-ligated mother each day for 25 days. The method resulted in a marked delay in the body growth of the undernourished pups, especially during the first 2 weeks of life. Observations of the behavior of the mothers towards the underfed pups were made at different times of the day and compared to the behavior of the mothers suckling well-fed pups. The results show that (1) nipple-ligated mothers are able to provide adequate maternal care for undernourished pups, and (2) both ligated and nonligated mothers caring for underfed pups spend more time with those pups than mothers caring for well-fed pups.     

Maternal entrainment of the developing circadian system in the Siberian hamster (Phodopus sungorus)

The aim of these studies was to investigate maternal entrainment of developing circadian locomotor activity rhythms in the Siberian hamster. In Experiment 1, mothers were transferred from a 16:8 LD cycle into constant dim red light (DD) from the day of parturition, and wheel-running activity of the mother and pups was individually monitored from the time of weaning. The phases of the individual pups' rhythms were found to be synchronized both to the phase of the mother and to the phase of lights off (ZT 12) of the photo cycle that the mother was exposed to until the day of parturition. To investigate whether this synchrony might reflect direct effects of light acting upon the fetal circadian system in late gestation, the experiment was repeated but with mothers placed into DD early in pregnancy (< or = day 7 of gestation). The results were similar to the first study, suggesting that the mother rather than the photo cycle during the latter part of gestation entrains the developing circadian system. The third experiment investigated whether this entrainment occurred during the postnatal period. Breeding pairs were maintained on alternative light-dark cycles, LD and DL, that were 12 h out of phase. Litters born to mothers on one light-dark cycle were exchanged on the day of birth with foster mothers from the reversed light-dark cycle, then raised in DD. Control litters exchanged between mothers from the same light-dark cycle had similar litter synchrony as shown by nonfostered litters of Experiment 1. However, pups cross-fostered with mothers on reversed LD cycles showed a very different distribution of pup phases. Pups were not synchronized to their natural mother but to their foster mother. Moreover, pups were more scattered over the 24-h period and were found to be significantly synchronized to the phase of the reversed LD cycle. These results demonstrate the occurrence of postnatal entrainment in the Siberian hamster. The increased scatter produced by the cross-fostering paradigm results from some litters being completely entrained to the phase of the foster mother, some with an intermediate distribution between the phase of the natural and foster mothers, and a minority being associated with the phase of the natural mother. These results suggest that Siberian hamster pups are initially synchronized either prenatally or at birth but that the mother continues to provide entrainment signals during the postnatal period.     

A seven-year investigation of marital expectations and marriage among urban, low-income, African American adolescent mothers.

Welfare reform has targeted marriage promotion among low-income women. This study explores patterns of marital expectations and marriage among 181 urban, low-income, African American adolescent mothers and their mothers. Using PROC TRAJ to analyze developmental trajectories of adolescent mother–grandmother relationship quality over 24 months, we categorized relationships as either high or low support. We examined the effects of intergenerational marriage models and adolescent mother–grandmother relationship quality on marital expectations and marriage over the first 7 years postpartum. At 24 months, half (52%) of adolescent mothers expected to marry, but marital expectations did not predict marriage. Marital expectations were associated with concurrent involvement in a romantic relationship, not intergenerational marriage models or a supportive adolescent mother–grandmother relationship. After 7 years, 14% of adolescent mothers were married. Married mothers lived in families characterized by the joint effects of intergenerational marriage models and supportive adolescent mother–grandmother relationships. They were older and had more children than did single mothers, suggesting that they were in a family formation phase of life. Policies that promote the education and employment opportunities necessary to support a family are needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles of living arrangements and grandmother social support in adolescent mothering and infant attachment.

Examined the roles of social support from adolescents' mothers and living arrangements in 197 adolescent mother–infant pairs. Major observational measures were teaching interactions, Home Observation for Measurement of the Environment (HOME) scores, and infant attachment security. Adolescents living with neither mothers nor partners had better teaching interactions but lower HOME scores compared with those living with mothers. High mother support was associated with more secure infant attachment only for those adolescents living with partners. When mother support was low, adolescents living alone had more secure infants than adolescents living with partners. Although parenting scores were related to differences in demographics and personal resources (intelligence and social skills), these did not appear to be responsible for the major findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Synchrony, pseudosynchrony, and dissynchrony: Measuring the entrainment process in mother-infant interactions.

We examined a new method for studying synchrony (i.e., the coordination of movement between individuals in social interactions) in two studies. Raters viewed video clips of interactions and judged the level of synchrony occurring between a mother and a 14-month-old child. Some of the video clips were genuine interactions, but most were pseudointeractions artificially constructed from the genuine interactions via split-screen editing techniques. For mothers interacting with their own children, genuine synchrony was significantly higher than pseudosynchrony, a difference that increased with time. When mothers interacted with an unfamiliar child, however, genuine synchrony was not higher than pseudosynchrony. In fact, mothers with unfamiliar children showed a state of dissynchrony (levels of genuine synchrony significantly lower than levels of pseudosynchrony). Our results suggest that synchrony can be reliably rated, thus allowing future investigations to include such measurements when studying social interaction processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breakdown in high-risk subjects: Familial and early environmental factors.

Studied 40 children with schizophrenic mothers, selected from a larger study. 20 suffered breakdown; the others were matched controls. The mothers of Ss in the breakdown group experienced more emotional stress during their pregnancies than did the mothers of the improved group. Ss in the breakdown group suffered loss of mother at an earlier age and tended significantly not to acquire a substitute mother. The breakdown group tended to have mentally ill fathers as well as schizophrenic mothers. There were no fathers hospitalized for mental illness in the improved group. Results are discussed in terms of the relative influence of genetic and environmental factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early interaction: consequences for social and mental development at three years

Interaction during feeding sessions between preterm infants and their mothers and that between full-term infants and their mothers were compared. (Mothers and babies were from a low-income, inner-city population.) When the children were about 3 years old, they attended a day camp for 3 weeks, during which their cognitive ability (Stanford-Binet) and social ability (both social competence and social participation) were assessed. Early interaction was quite different for preterms and full-terms, but in general it did not predict either social or cognitive ability at age 3. Birth status (preterm/full-term) did predict cognitive (but not social) ability: preterms scored lower. Finally, the children of mothers who were more emotionally and verbally responsive during a home visit at 20 months exhibited more social and cognitive ability at age 3. These results suggest that the baby, within broad normal limits, may be "buffered" against any long-term consequences of interaction during the first few months of life.     

DiGeorge anomaly with renal agenesis in infants of mothers with diabetes

We report on 2 infants with the DiGeorge anomaly born to diabetic mothers treated with insulin. Both infants had unilateral renal agenesis. One of the mothers has manifestations suggestive of velo-cardio-facial syndrome (VCFS). Cytogenetic studies on both patients and the mother with apparent VCFS were normal. Molecular studies utilizing probes from the DiGeorge critical region did not demonstrate a 22q11 microdeletion in either patient or the mother with apparent VCFS. We conclude that maternal diabetes is a pathogenetic factor in the DiGeorge anomaly, and infants of diabetic mothers who have this anomaly should also be screened for renal agenesis.     

étude comparative de nourrissons prématurés et nés à terme et des modes de stimulations qu'ils expérimentent au cours des six premiers mois.

Compared preterm and fullterm infants' temperament and development and to evaluate the physical and social stimulations they experience at 2, 4 and 6 months (correcting for prematurity). Fifty-six mother–infant dyads, including 28 premature and 28 fullterm infants, participated in the study. The groups did not differ on temperament and developmental measures, neither on physical environment (density, toys, accessories). However, significant differences were found regarding social stimulation. Mothers of preterm infants had less optimal sensibility-contingency scores and used more distal stimulation at 2 months than mothers of fullterm infants. During the first 6 months, premature infants spent more time in activities involving the immediate family, whereas fullterm infants went more frequently on outings. At home, fullterm infants interacted more with people from their social network. These stimulations could eventually have an impact on infant development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enmeshed Lives: Adult Children With Developmental Disabilities and Their Aging Mothers.

This article uses equity theory to examine the ways in which aging mothers and their adult children with developmental disabilities support each other and the effects that this exchange has on the caregiving satisfaction and burden of the mothers. Data from 305 mothers revealed that exchange flows both from mother to child and from child to mother. Results indicate that caregiving satisfaction increased when affection from child to mother was greater. Caregiving burden was not affected by either functional support or affection from child to mother. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal disclosure of mothers' HIV serostatus to their young children.

Mothers' disclosure of their RIV serostatus to their nonaffected young children and factors associated with disclosure were investigated among 135 families. Overall, 30% of the mothers had personally disclosed their serostatus to their children Mothers who disclosed reported higher levels of social support in their lives than mothers who did not disclose. Children whose mothers had disclosed to them displayed lower levels of aggressiveness and negative self-esteem compared to children whose mother had not disclosed. These findings indicate that for this sample, no negative effects were observed among young children to whom mother have personally disclosed their HIV serostatus. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics, determinants, and consequences of maternal separation anxiety.

In order to enhance understanding of the characteristics, consequences, and determinants of maternal separation anxiety, we analyzed information obtained on a sample of 63 mother–infant dyads collected as part of a more extensive longitudinal study of infant and family development. Results revealed that employed mothers evinced less anxiety over time but that mothers of sons indicated more anxiety. Infants who were perceived as dull and unadaptable had more anxious mothers. Separation-related anxiety was also greater among women who during the prenatal period manifested more interpersonal sensitivity and higher self-esteem. Intermediate levels of general separation anxiety were associated with secure infant–mother attachment relationships as were high levels of anxiety specifically related to separation caused by employment. We concluded that separation anxiety is multiply determined by characteristics of the mother, the infant, and the employment situation and that variation in anxiety has consequences for the development of attachment relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)