Brief reaching training with “sticky mittens” in preterm infants: Randomized controlled trial

ObjectiveTo examine whether a brief reaching training with sticky mittens was effective to improve reaching behavior in newly reaching preterm infants.MethodsIn this randomized controlled trial, twenty four 5-month-old (±16-week-old corrected age) preterm infants were randomly allocated into experimental or control groups. Infants were assessed three times in a single session: pretraining (immediately before training), posttraining (immediately after training), and retention (4 min after the posttraining). During training, infants in the experimental group wore open fingers Velcro covered mittens. Training consisted of one 4-minute session of stimulated reaching using Velcro covered toys. Controls did not receive the training. During assessments, infants were placed in a baby chair and toys without Velcro were offered at their midline for 2 min. Number of total reaches, proximal adjustments and distal adjustments of reaching were primary outcomes. Grasping was a secondary outcome.ResultsGroups were similar in the pretraining. In the posttraining, trained infants performed greater amount of total reaches and bimanual reaches than untrained infants. Greater amount of bimanual reaches in trained infants was maintained in the retention test. Distal adjustments and grasping outcome were not influenced by the training.ConclusionsA brief-term training with open fingers sticky mittens benefited reaching behavior and favored retention of increased bimanual reaches in newly reaching late preterm infants. However, it was not sufficient to influence hand openness and early grasping.     

Effect of Short-Term Training on Reaching Behavior in Infants: A Randomized Controlled Clinical Trial

The purpose of this study was to test the effect of short-term training on reaching behavior in infants at the onset of reaching. The study was a single-blind, parallel group design, randomized controlled clinical trial. Thirty healthy infants were randomly assigned to a social control group (n = 15) or a reaching training group (n = 15). Infants began the study up to 3 days after the onset of reaching and were assessed three times across 2 days: pretraining (before training), posttraining 1 (after 1 session of training), and posttraining 2 (after 3 sessions of training). The reaching training group received 3 sessions of training by a physical therapist while the control group received a similar amount of time sitting in the therapist's lap. The data were analyzed using repeated-measures analyses of variance, and independent-samples tests with Bonferroni adjustments. Short-term training resulted in increased frequency of object contacts, shorter and smoother reaches, and improved hand positioning. The few short training sessions likely provided opportunities for infants to explore and learn to select movements from their existing movement repertoire. These results demonstrate that adaptive changes in infants' novel behaviors can emerge rapidly, and highlight the need for increased understanding of how to most effectively time early interventions.     

The effect of a short course of moderate pressure sunflower oil massage on the weight gain velocity and length of NICU stay in preterm infants

ObjectiveThe aim of this study was to evaluate the efficacy of five-day course of sunflower oil massage with moderate pressure on the weight gain and length of NICU stay in preterm infants.MethodsForty-four healthy preterm infants with a corrected gestational age of 30–36 weeks at the time of the study, were randomly assigned to the study group receiving body massage with sunflower oil and the control group receiving only routine NICU care. The massage was performed three times per day, each session including three consecutive five-minute stages, for five days. The primary outcome was to evaluate the efficacy of a short course of moderate pressure sunflower oil massage on the weight gain velocity. The secondary outcome was to compare the length of NICU stay between the two groups.ResultsDuring the study period, the increase in the average daily and fifth-day weight gain was significant in the intervention group. The length of NICU stay was shorter in the intervention group significantly.ConclusionOur findings suggest that even a short course of body massage with sunflower oil for only five days increases preterm infants’ weight gain and decreases their duration of NICU stay significantly.     

The efficacy of massage on short and long term outcomes in preterm infants

Purpose

Premature infants lack the tactile stimulation they would have otherwise experienced in the womb. Infant massage is a developmentally supportive intervention that has been documented for several decades to have a positive effect on both full term and preterm infants. The purpose of this study was to assess the short and long term benefits of massage on stable preterm infants.

Methods

A quasi experimental design was used, 66 infants were recruited from two university hospitals with tertiary level NICUs; 32 infants received the massage therapy by their mothers. Data collection by a researcher blind to the infants’ group assignments included weight at discharge, pain responses on the PIPP scale at discharge, length of stay in hospital, neuro-developmental outcome (Bayley scores) and breastfeeding duration at 12 months corrected age.

Results

Infants who were massaged had significantly lower scores on the PIPP after a heel-stick compared to before the massage and had lower PIPP scores at discharge compared to the control group. Massaged infants had higher cognitive scores at 12 months corrected age. Weight gain, length of stay, breastfeeding duration and motor scores did not differ between groups.

Conclusion

Stable preterm infants benefit from massage therapy given by their mothers and may be a culturally acceptable form of intervention to improve the outcomes of preterm infants.     

The influence of prematurity,maternal anxiety,and infants' neurobiological risk on mother–infant interactions

In this study, we investigated how the birth of a very low birth weight preterm (VLBW) infant influences the mother–infant interaction at 3 months. We also focused on the impact of the infant's neurobiological risk and maternal anxiety, and their interaction. The comparison of the VLBW preterm sample (n = 79) with an external full‐term sample (n = 35) showed mother–infant interactions of the families with the preterm infant to be more vocally responsive during the interaction, but less facially responsive during the interaction. Additionally, higher levels of maternal anxiety were associated with preterm infants being less facially responsive in interaction with their mother. While neurobiological risk of the infant played a part in this association, with higher risk infants also being less facially responsive, the relationship with maternal anxiety and the mother–child interaction was stronger. How these findings may influence therapeutic interventions is discussed.     

Comparison of Maternal Perceptions of Preterm and Fullterm Infants

We compared maternal attitudes and feelings in two groups of mother–infant dyads: 25 mothers with preterm newborns (M=30.9 weeks of gestational age) and 25 mothers with fullterm newborns (M=39.7 weeks of gestational age). Both groups were matched for infant sex, age (corrected in preterms) and birth order as well as for maternal age and education. Semi-structured interviews were used to collect data on maternal attitudes and feelings about pregnancy and the first contacts with the newborn. Mothers completed rating scales to indicate the specific behavioural problems they perceived in their infants at 6 weeks and 3 months of (corrected) age. Observations of infant responses to visual and/or auditory stimuli were made at 6 weeks and 3 months in a laboratory setting. At 3 months, each infant was administered the Bayley Scale of Mental Development. There were no differences in maternal attitudes and feelings between the two groups of mothers prior to the birth. However, significant differences appeared after birth and indicated increased anxiety in mothers of preterm infants. Significantly more 6-week-old preterm infants were perceived by their mothers as irritable and to cry more than fullterm infants. At the age of 3 months, both groups of infants differed only in terms of irritability. Differences between the two groups of mother–infant dyads, age-related changes in these differences and relationships between maternal evaluations and the laboratory-based assessments are discussed in the context of contrasts in the stability of behavioural regulation in preterm and fullterm infants.     

Affective expression among preterm infants of varying levels of biological risk

This investigation examines the association between risk status and the quality of emotional arousal and regulation among preterm infants in the second year of life. The behavior of 55 preterm infants stratified into three risk groups by severity and chronicity of respiratory illness was recorded during the procedures of the Strange Situation. Measures of emotional responsiveness included temporal and intensity features of facial and vocal expressions as well as concurrent activity with toys. Significant relationships between neonatal risk status and these expressive and regulatory features were observed. Infants in the High-Risk group (N = 16) differed from healthy Low-Risk infants (N = 23) and from those in the Moderate-Risk group (N = 16). The High-Risk infants showed a greater sensitivity to distress arousal at low levels of stress and less ability to modulate distress once aroused. High-Risk infants also demonstrated significantly less adaptive play with toys than the other preterm infants. In short, this study suggests that, when placed under stress, High-Risk preterm infants in their second year of life become more distressed and demonstrate less ability to recover from this distress and effectively re-engage their environment than preterm infants born at lower risk.     

Single session email consultation for parents: an evaluation of its effect on empowerment

This study evaluated the effect of single session email consultation (SSEC) on empowerment of parents. Practitioners in a control group (n = 19) received no training and practitioners in an experimental group (n = 21) were trained to use empowerment-oriented techniques in online consultation. Parental empowerment was measured (n = 96) through a questionnaire based on the Family Empowerment Scale before and after receiving advice from a trained or a non-trained practitioner. Parents showed a significant increase in the subscale of self-confidence (Cohen's d = 0.33). Study findings lend support to the feasibility of SSEC as a brief intervention to improve self-confidence of parents. A training for practitioners did not influence the outcomes.     

Maternal perceptions of the sleep patterns of premature infants at seven months corrected age compared to full-term infants

It has been reported that 83%–87% of full-term infants regularly sleep through the night (from midnight to 5 a.m.) by 6 months of age, but there is little information about the sleep patterns of premature infants. The purpose of the current study was to identify maternal perceptions of the sleep patterns of premature infants. Parents of 32 premature infants with birth weight below 1,750 gm and of 13 full-term infants completed a 24-hour sleep record in 30-minute epochs for 1 week at 7 months of chronological (term) or corrected age (premature). Mean birth weight of premature infants was 1,278 ± 340 gm, with a gestational age of 30.4 ± 2.7 weeks. The daily total sleep time, longest sleep segment, frequency of sleep-wake transitions, and percentage of night sleep (8 p.m.–8 a.m.), averaged from the 1-week sleep record and number of night wakenings per week, were used as indicators of sleep patterns. The longest reported sleep segments of premature infants were significantly shorter than those of full-term infants (8.2 ± 2 hours versus 9.6 ± 1 hour, p < 0.01) and the number of night wakenings per week was significantly greater (3.13 ± 3 versus 0.54 ± 7, p < 0.005). Total reported sleep time, percentage of night sleep, and sleep-wake transitions did not differ significantly between premature and full-term infants. However, analysis of feeding events revealed that premature infants received significantly more feedings between midnight and 5 a.m. (M = 0.31 + 3 versus M = 0.06 + 1, p < 0.001). We conclude that sleep pattern diaries kept by parents indicate that premature infants have developed a diurnal sleep rhythm by 7 months corrected age, but they still have shorter sleep segments and they awaken more during the night than term infants.     

The influence of infant irritability on maternal sensitivity in a sample of very premature infants

The relationship between maternal sensitivity and infant irritability was investigated in a short‐term longitudinal study of 29 very preterm infants. Infant irritability was assessed at term with the Brazelton NBAS, the Mother and Baby Scales (MABS) and the Crying Pattern Questionnaire (CPQ). Maternal sensitivity was assessed by nurses' ratings in the neonatal care unit and at three months during mother–infant interaction observation. Cross‐lagged panel analysis indicated that neonatal irritability did not influence sensitivity at 3 months nor did maternal sensitivity in the newborn period lead to reduced irritability at 3 months. Both irritability and maternal sensitivity showed moderate stability over time (r = 0.55 and r = 0.60, respectively). It is concluded that in early infancy maternal sensitivity shows little influence on infant irritability in very preterm infants. Copyright © 2003 John Wiley & Sons, Ltd.     

Maturation constrains the effect of exposure in linking language and thought: evidence from healthy preterm infants

The power of human language rests upon its intricate links to human cognition. By 3 months of age, listening to language supports infants’ ability to form object categories, a building block of cognition. Moreover, infants display a systematic shift between 3 and 4 months – a shift from familiarity to novelty preferences – in their expression of this link between language and core cognitive processes. Here, we capitalize on this tightly‐timed developmental shift in fullterm infants to assess (a) whether it also appears in preterm infants and (b) whether it reflects infants’ maturational status or the duration of their postnatal experience. Healthy late preterm infants (N = 22) participated in an object categorization task while listening to language. Their performance, coupled with that of fullterm infants, reveals that this developmental shift is evident in preterm infants and unfolds on the same maturational timetable as in their fullterm counterparts.     

The effect of mother-infant skin-to-skin contact on plasma cortisol and β-endorphin concentrations in preterm newborns

The aim of this study was to assess the effect of mother-infant skin-to-skin contact on plasma β- endorphin and cortisol concentrations in stable, preterm infants on a newborn intensive care unit. Blood samples were obtained before and at the end of a 20-min period of skin-to-skin contact. Similarly paired samples, obtained at the same times and after the same interval, without skin-to- skin contact, were obtained on another day and served as controls. Both cortisol and β-endorphin concentrations fell significantly after the skin-to-skin session (cortisol: geometric mean change 66%, p=0.008; β-endorphin: geometric mean change 74%, p=0.002). There was also a significant fall in cortisol levels during the control session (geometric mean change 78%, p=0.02), in contrast to β-endorphin levels, in which there was no significant change. Analysis of variance showed that the fall in β-endorphin, but not the fall in cortisol, during the skin-to-skin session was significant when compared with the control session. These results emphasize the hormonal responsiveness of the preterm newborn to relatively minor interventions. We conclude that maternal skin-to-skin contact results in a significant reduction in circulating β-endorphin in the newborn; there was no evidence of any adverse effect.     

Mothers' depressed mood and anxiety levels are reduced after massaging their preterm infants

Forty mothers whose preterm infants were about to be discharged from the Neonatal Intermediate Care Nursery (NICU) were randomly assigned to two groups: the first group of mothers conducted preterm infant massage and the second group only observed their preterm infants receiving massage. Both groups of mothers had lower depressed mood scores following the session. However, only the group who massaged their infants had lower anxiety scores after the session.     

Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial

This study tested the effects of optimized neonatal mother–infant transactions on joint attention performance at 12 months. Surviving infants <2000 g from a geographically defined area were randomly assigned to a preterm intervention (n = 71) or preterm control group (n = 69). Comparisons were made between preterm groups, secondary with a term group (n = 75). Joint attention was measured using the Early Social Communication Scales. Preterm intervention infants scored significantly higher than preterm control infants on elements Initiating Joint Attention (p < 0.05), Initiating Object Requests (p < 0.05), and Responding to Social Interaction (p < 0.0005). Intervention was not associated with performance on elements Responding to Joint Attention, or on Responding to Requests. ELBW infants scored significantly lower than VLBW and LBW infants on imperative functions. Girls outperformed boys on all communication elements. An intervention implemented during the neonatal period can be of advantage for certain aspects of joint attention performance in preterm infants.     

The Effect of Spiritual Self-care Training on the Quality of Life of Mothers of Preterm Infants: A Randomized Controlled Trial

The present study was carried out with the aim of determining the effect of spiritual self-care training on the quality of life of mothers of preterm infants. This trial was carried out on 60 mothers with premature infants. Mothers were randomly divided into two intervention and control groups. Training for increasing awareness about the condition of the infants was carried out in both groups. In the intervention group, spiritual self-care training was also done. Data were completed in both groups before, immediately after, and two weeks after the intervention by using the standard WHO quality of life questionnaire. Data were analysed using statistical tests, including ANOVA and Repeated Measures. The results showed that the average quality of life of mothers under study was significantly different at different points of measurement in the intervention group (first, second, and third time-points) (P = 0.016). An increase was observed in the intervention group at the second time-point compared to the first time-point (84.2–88.4, P < 0.001) and in the third time-point compared to the first time-point, (87.9), which was also statistically significant (P < 0.001). According to the results of post hoc tests, there was a decrease in quality of life in the control group at the second time-point compared to the first time-point and the average score of mothers decreased from 82.9 to 75.3, which was statistically significant (P < 0.001). Spiritual self-care training can increase the quality of life and can be used as a form of holistic nursing care for mothers with premature infants in neonatal intensive care units.

     

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother–infant interaction: The case of preterm birth

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother–infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother–infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n = 26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months’ corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother–infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers’ posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother–infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother–infant interactions.     

A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants

Nordhov, S. M., Kaaresen, P. I., Rønning, J. A., Ulvund, S. E. & Dahl, L. B. (2010). A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants. Scandinavian Journal of Psychology, 51, 385–391. The background for this study was that nurturant child‐rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child‐rearing attitudes and early intervention (EI) in parents of LBW infants from 12–36 months corrected age. LBW infants (BW < 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in‐hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child‐rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child‐rearing attitudes in mothers of preterms.     

Mutual touch during mother–infant face-to-face still-face interactions: Influences of interaction period and infant birth status

Contact behaviours such as touch, have been shown to be influential channels of nonverbal communication between mothers and infants. While existing research has examined the communicative roles of maternal or infant touch in isolation, mutual touch, whereby touching behaviours occur simultaneously between mothers and their infants, has yet to be examined. The present study was designed to investigate mutual touch during face-to-face interactions between mothers and their 5½-month-old fullterm (n = 40), very low birth weight/preterm (VLBW/preterm; n = 40) infants, and infants at psychosocial risk (n = 41). Objectives were to examine: (1) how the quantitative and qualitative aspects of touch employed by mothers and their infants varied across the normal periods of the still-face (SF) procedure, and (2) how these were associated with risk status. Mutual touch was systematically coded using the mother–infant touch scale. Interactions were found to largely consist of mutual touch and one-sided touch plus movement, highlighting that active touching is pervasive during mother–infant interactions. Consistent with the literature, while the SF period did not negatively affect the amount of mutual touch engaged in for mothers and their fullterm infants and mothers and their infants at psychosocial risk, it did for mothers and their VLBW/preterm infants. Together, results illuminate how both mothers and infants participate in shaping and co-regulating their interactions through the use of touch and underscore the contribution of examining the influence of birth status on mutual touch.     

Differential effects of massage and heelstick procedures on transcutaneous oxygen tension in preterm neonates

The present study investigated the differential effects of heelsticks and tactile-kinesthetic massage on transcutaneous oxygen tension (TcPO₂) in preterm infants. The sample was comprised of 37 stabilized preterm neonates from the Neonatal Intensive Care Unit. During the heelstick procedure, TcPO₂ significantly declined an average of 14 mmHg. When compared to the tactile-kinesthetic massage, TcPO₂ levels during the heelstick (M = 39.8) were significantly lower than during the stimulation (M = 72.8). Mean TcPO₂ levels remained clinically safe during the four massage sessions evaluated. The TcPO₂ levels during kinesthetic stimulation were somewhat more varied, and movement and pressurization of the TcPO₂ electrode were investigated as possible artifactual explanations for this phenomenon. Overall, the findings indicate that social forms of touch such as tactile-kinesthetic massage do not appear to have a medically compromising effect on TcPO₂ in the preterm neonate. These findings are evaluated in relation to the “minimal touch” policy, and implications for future handling of the stabilized preterm neonate are discussed.     

Neurocognitive profiles of preterm infants randomly assigned to lower or higher hematocrit thresholds for transfusion

Objective: Preterm infants are frequently transfused with red blood cells based on standardized guidelines or clinical concerns that anemia taxes infants' physiological compensatory mechanisms and thereby threatens their health and well-being. The impact of various transfusion guidelines on long-term neurocognitive outcome is not known. The purpose of this study is to evaluate long-term neurocognitive outcome on children born prematurely and treated at birth with different transfusion guidelines.

Methods: Neurocognitive outcomes were examined at school age for 56 preterm infants randomly assigned to a liberal (n?=?33) or restrictive (n?=?23) transfusion strategy. Tests of intelligence, achievement, language, visual-spatial/motor, and memory skills were administered. Between-group differences were assessed.

Results: Those in the liberal transfusion group performed more poorly than those in the restrictive group on measures of associative verbal fluency, visual memory, and reading.

Conclusions: Findings highlight possible long-term neurodevelopmental consequences of maintaining higher hematocrit levels.