Encontro com Especialistas - Contato pele a pele imediato e prolongado com os pais: experiências exitosas

Encontro com as Especialistas Aline Hennemann, enfermeira materno infantil, referência técnica do Método Canguru CACRIAD/DGCI/SAPS/Ministério da Saúde; Silvia Cavalcante, CNR HUUFMA; Geisy Lima, CNR IMIP; e Carmem Guimarães, CNR IMIP. Apresentação de experiências exitosas: (1) CPP imediato, precoce e prolongado: com Marivanda Goudard, neonatologista, coordenadora do CER Maternidade de Alta Complexidade do Maranhão (MACMA) e Euda Maria Aranda, neonatologista, coordenadora do CER Instituto Cândida Vargas/PB; (2) O uso de fotografias como facilitador da Posição Canguru: com Gláucia Maria Moreira Galvão, neonatologista, tutora do MC, docente FAMINAS-BH.

Encontro com Especialistas - Contato pele a pele imediato e prolongado com os pais: o que estamos fazendo para sua garantia?

Encontro com as Especialistas Sônia Venâncio, Coordenadora da Atenção à Saúde da Criança e do Adolescente (CACRIAD/DGCI/SAPS/Ministério da Saúde); Mônica Iassanã Reis, Coordenadora da Atenção à Saúde da Mulher (COSMU/DGCI/SAPS/Ministério da Saúde); Patrícia Santana Santos, Coordenadora da Atenção à Saúde do Homem (COSAH/DGCI/SAPS/Ministério da Ssúde); Zeni Lamy, médica neonatologista da UFMA e Coordenadora do Método Canguru; Aline Hennemann, enfermeira materno infantil, referência técnica do Método Canguru CACRIAD/DGCI/SAPS/Ministério da Saúde; e Denise Suguitani, diretora executiva da ONG Prematuridade.com.

Encontro com Especialistas - Contato pele a pele pela perspectiva obstétrica: como garantir esse cuidado desde o pré-natal?

Encontro com os Especialistas Janini Ginani, Coordenadora-Geral de Saúde Perinatal e Aleitamento Materno (CGSPAM/SAPS/MS); Luana Flausino Melo da Silva, médica ginecologista e obstetra, consultora técnica da CGPAM/SAPS/MS; Francisco Lázaro Pereira de Souza, médico ginecologista e obstetra, membro da Rede Brasileira para Estudos da Hipertensão na Gravidez (RBEHG); e Sérgio Marba, médico neonatologista da Universidade Estadual de Campinas (Unicamp).

Encontro com Especialistas - Garantindo o contato pele a pele imediato com os pais

Encontro com os Especialistas Janini Ginani, Coordenadora-Geral de Saúde Perinatal e Aleitamento Materno (CGSPAM/SAPS/MS); Licia Maria Oliveira Moreira, médica neonatlogista, professora do Departamento de Pediatria da Universidade Federal da Bahia (UFBA) e presidente do Departamento Científico de Neonatologia da Sociedade Brasileira de Pediatria (SBP); Maria Aparecida Munhoz Gaíva, representante da Sociedade Brasileira de Enfermeiros Pediatras (SOBEP); Sérgio Marba, médico neonatologista da Universidade Estadual de Campinas (Unicamp); e Zeni Lamy, médica neonatologista da Universidade Federal do Maranhão (UFMA).

Encontro com Especialistas - Aleitamento Materno Exclusivo até os seis meses: o papel dos profissionais de saúde

Encontro com as Especialistas Maria José Guardia Mattar, pediatra/neonatologista, membro do Departamento Científico de Amamentação da Sociedade de Pediatria de São Paulo, Coordenadora da Rede Paulista Banco de Leite Humano, e Renata Oliveira Giesta, enfermeira supervisora da equipe técnica de saúde do Banco de Leite Humano no Hospital Maternidade Leonor Mendes de Barros (SP) e assessora técnica da Coordenação Regional Sudeste do SAMU.

Panic or peace - prioritising infant welfare when medicating feverish infants: a grounded theory study of adherence in a paediatric clinical trial.

BACKGROUND: Literature on factors influencing medication adherence within paediatric clinical trials is sparse. The Paracetamol and Ibuprofen in the Primary Prevention of Asthma in Tamariki (PIPPA Tamariki) trial is an open-label, randomised controlled trial aiming to determine whether paracetamol treatment, compared with ibuprofen treatment, as required for fever and pain in the first year of life, increases the risk of asthma at age six years. To inform strategies for reducing trial medication crossovers, understanding factors influencing the observed ibuprofen-to-paracetamol crossovers (non-protocol adherence) is vital. The aim of this study was to investigate the factors influencing the decision-making process when administering or prescribing ibuprofen to infants that may contribute to the crossover events in the PIPPA Tamariki trial. METHODS: Constructivist grounded theory methods were employed. We conducted semi-structured interviews of caregivers of enrolled PIPPA Tamariki infants and healthcare professionals in various healthcare settings. Increasing theoretical sensitivity of the interviewers led to theoretical sampling of participants who could expand on the teams' early constructed codes. Transcribed interviews were coded and analysed using the constant comparative method of concurrent data collection and analysis. RESULTS: Between September and December 2020, 20 participants (12 caregivers; 8 healthcare professionals) were interviewed. We constructed a grounded theory of prioritising infant welfare that represents a basic social process when caregivers and healthcare professionals medicate feverish infants. This process comprises three categories: historical, trusting relationships and being discerning; and is modified by one condition: being conflicted. Participants bring with them historical ideas. Trusting relationships with researchers, treating clinicians and family play a central role in enabling participants to challenge historical ideas and be discerning. Trial medication crossovers occur when participants become conflicted, and they revert to historical practices that feel familiar and safer. CONCLUSIONS: We identified factors and a basic social process influencing ibuprofen use in infants and trial medication crossover events, which can inform strategies for promoting adherence in the PIPPA Tamariki trial. Future studies should explore the role of trusting relationships between researchers and treating clinicians when conducting research.

Consumo de alimentos açucarados e qualidade do sono no primeiro ano de vida: dados de uma coorte de nascimentos no nordeste do Brasil / Consumo de alimentos azucarados y calidad del sueño en el primer año de vida: datos de una cohorte de nacimiento en el noreste de Brasil / Consumption of sugary foods and quality of sleep in the first year of life: data from a birth cohort in northeastern Brazil

RESUMO Objetivo: investigar a duração do sono (DS), a frequência de despertares noturnos (DN) e o consumo de alimentos açucarados no primeiro ano de vida e verificar a associação entre o consumo desses alimentos e a má qualidade do sono. Métodos: a população do estudo foi composta de 179 crianças integrantes de uma coorte de nascimentos de Rio Largo-AL. As mães foram questionadas sobre a oferta regular de alimentos açucarados (açúcar/farinhas de cereais instantâneas com açúcar/bebidas açucaradas/doces) e o sono foi investigado pelo questionário traduzido e validado Brief Infant Sleep Questionnaire. Foram considerados indicadores de má qualidade do sono DS<12h e DN>2. Os testes de qui-quadrado de Pearson e exato de Fisher foram adotados para verificar associações entre o consumo de açucarados e a má qualidade do sono aos seis e 12 meses (p<0,05). Resultados: mais da metade das crianças apresentou DS<1 2h (60,3%) e cerca de » DN>2. O consumo regular de pelo menos uma das categorias de açucarados foi verificado entre 50,6, 91,1 e 100% das crianças aos três, seis e 12 meses de idade, respectivamente. Não foram encontradas associações entre o consumo desses alimentos e os indicadores de má qualidade de sono. Conclusão: o consumo de açucarados e a má qualidade de sono foram frequentes em nosso estudo, no entanto, não se identificou associação entre as variáveis. Mais investigações são necessárias para elucidar como o sono e a alimentação se inter-relacionam e se potencializam mutuamente como fatores determinantes do crescimento e desenvolvimento de lactentes.

RESUMEN Objetivo: investigar la duración del sueño (DS), la frecuencia de despertares nocturnos (DN) y el consumo de alimentos azucarados en el primer año de vida y verificar la asociación entre el consumo de estos alimentos y la mala calidad del sueño. Métodos: la población de estudio consistió en 179 niños de una cohorte de nacimiento en Rio Largo-AL. Se preguntó a las madres sobre el suministro regular de alimentos azucarados (azúcar / harinas de cereales instantáneas con azúcar / bebidas endulzadas / dulces) y se investigó el sueño mediante el cuestionario traducido y validado BriefInfantSleepQuestionnaire. Fueron considerados indicadores de mala calidad del sueño DS <12h y DN> 2. Se utilizaron las pruebas de chi-cuadrado de Pearson y exacta de Fisher para verificar las asociaciones entre el consumo de azúcar y la mala calidad del sueño a los seis y 12 meses (p <0.05). Resultados: más de la mitad de los niños tenían DS <1 2 h (60,3%) y alrededor de » DN> 2. Se verificó el consumo regular de al menos una de las categorías azucaradas entre el 50,6, el 91,1 y el 100% de los niños a los tres, seis y 12 meses de edad, respectivamente. No se encontraron asociaciones entre el consumo de estos alimentos y los indicadores de mala calidad del sueño. Conclusión: el consumo de azucarados y la mala calidad del sueño fueron frecuentes en nuestro estudio, sin embargo, no se identificó asociación entre las variables. Se necesita más investigación para dilucidar cómo el sueño y la alimentación se interrelacionan y se mejoran mutuamente como determinantes del crecimiento y desarrollo infantil.

ABSTRACT Objective: to investigate sleep duration (SD), frequency of night awakenings (NA) and consumption of sugary foods in the first year of life and to verify the association between consumption of these foods and poor sleep quality. Methods: the study population consisted of 179 children from a birth cohort in Rio Largo-AL. Mothers were asked about the regular supply of sugary foods (sugar/instant cereal flours with sugar/sweetened drinks/sweets) and sleep was investigated by the translated and validated Brief Infant Sleep Questionnaire. DS<12h and AN>2 were considered indicators of poor sleep quality. Pearson's chi-square and Fisher's exact tests were used to verify associations between sugary consumption and poor sleep quality at six and 12 months (p<0.05). Results: more than half of the children had SD<1 2h (60.3%) and about » AN>2. Regular consumption of at least one of the sugary categories was verified among 50.6, 91.1 and 100% of children at three, six and 12 months of age, respectively. No associations were found between the consumption of these foods and indicators of poor sleep quality. Conclusion: sugary consumption and poor sleep quality were frequent in our study; however, no association was identified between the variables. More investigations are needed to elucidate how sleep and feeding are interrelated and mutually potentiate as determinants of infant growth and development.

Protecting Breastfeeding during the COVID-19 Pandemic: A Scoping Review of Perinatal Care Recommendations in the Context of Maternal and Child Well-Being.

The objective of this scoping review is to determine to what extent the recommendations on perinatal care protect breastfeeding during the COVID-19 pandemic. The review follows the PRISMA ScR Extension guidelines. The research was conducted in Scopus, Medline via Pubmed, and Web of Science databases from 1 March 2020 to 31 May 2021, using 392 combinations of keywords. We searched for reviews and original papers published in English providing recommendations on delivery mode, companion during labor, the possibility of skin-to-skin contact (SSC), breastfeeding, and visitors policy. After screening, 86 out of 8416 publications qualified for data extraction. The majority of them indicated that COVID-19 infection is not a sufficient reason for a cesarean section; however, on a national level, cesarean births in severely ill patients were overrepresented. A significant number of recommendations deprived mothers of the necessary support during their labor and stay in the maternity ward. A shared decision-making model was hardly visible. Only the earliest COVID-19 recommendations suspended direct breastfeeding; in later publications, decisions were related to the mother's health, but other options of natural feeding were rarely discussed.

Impact of Plans of Safe Care on Prenatally Substance Exposed Infants.

OBJECTIVE: To assess the impact of recent federal statute changes mandating child welfare-based Plan of Safe Care (POSC) supportive programming and community-based linkages to treatment providers, resources, and services for families of infants affected by prenatal substance exposure (IPSE). STUDY DESIGN: Retrospective review of Delaware's statewide child welfare case registry data for IPSE birth notifications and subsequent hotline reports for serious physical injury/fatality concerns from November 1, 2018-October 31, 2020. Abstracted variables included IPSE sex, substance exposure type, family characteristics (maternal personal child welfare history or mental health diagnosis, treatment engagement), and POSC referrals. RESULTS: Of 1436 IPSE, 1347 (93.8%) had POSC support. Most IPSE (67.2%) had exposure to single substance types prenatally. Nearly 90% avoided out-of-home placement. Nearly one-fourth of mothers delivered a prior IPSE; 40% of mothers had personal histories of childhood protective services involvement. Also, 43.5% of mothers and 9.1% of fathers were referred to community-based resources, including substance use, mental health treatment, parenting classes, and home visiting nursing. Nearly 58% of IPSE were referred for pediatric/developmental assessment. Notably, 0.82% (11 out of 1347) of IPSE with POSC sustained serious physical or fatal injury. CONCLUSIONS: POSC promote supportive, potentially protective linkages to community-based programming for IPSE and their families.

Interconception Care and Safe Sleep: Adapting the IMPLICIT Toolkit for Pediatrics.

BACKGROUND: A woman's health in the interconception period has an impact on birth outcomes. Pediatric visits offer a unique opportunity to provide interconception care (ICC). Our aim was to screen and provide interconception and safe sleep screening, counseling, and interventions for 50% of caregivers of children <2 years of age in a pediatric medical setting. METHODS: Two pediatric clinics implemented the March of Dimes' Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit, in addition to standardized safe sleep assessments. A quality improvement learning collaborative was formed with a local "infant mortality champion" leading quality improvement efforts. Monthly webinars with the clinic teams reviewed project successes and challenges. Framework for Reporting Adaptations and Modifications was used to document adaptations. RESULTS: For each individual IMPLICIT domain, clinics screened and provided needed interventions for ICC and safe sleep in >50% of eligible encounters. Over the course of the quality improvement learning collaborative, the number of caregivers screened for at least 4 of the 5 IMPLICIT domains increased from 0% to 95%. CONCLUSIONS: To successfully implement the IMPLICIT toolkit in pediatrics, adaptations were made to the existing model, which had previously been used in family medicine clinics. Pediatricians should consider providing ICC as an innovative way to impact infant mortality rates in their community. Framework for Reporting Adaptations and Modifications can be used to systematically describe the adaptations needed to improve the fit of IMPLICIT in the pediatric clinic, understand the process of change and potential application to local context.

Association of Eviction With Adverse Birth Outcomes Among Women in Georgia, 2000 to 2016.

Importance: More than 2 million families face eviction annually, a number likely to increase due to the coronavirus disease 2019 pandemic. The association of eviction with newborns' health remains to be examined. Objective: To determine the association of eviction actions during pregnancy with birth outcomes. Design: This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020. Exposures: Eviction actions occurring during gestation. Main Outcomes and Measures: Five metrics of neonatal health included birth weight (in grams), gestational age (in weeks), and dichotomized outcomes for low birth weight (LBW) (<2500 g), prematurity (gestational age <37.0 weeks), and infant death. Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, -26.88 [95% CI, -39.53 to 14.24] g) and gestational age (difference, -0.09 [95% CI, -0.16 to -0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, -0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, -57.51 to -11.97) and 35.80 (95% CI, -52.91 to -18.69) g, respectively. Conclusions and Relevance: These findings suggest that eviction actions during pregnancy are associated with adverse birth outcomes, which have been shown to have lifelong and multigenerational consequences. Ensuring housing, social, and medical assistance to pregnant women at risk for eviction may improve infant health.

Association of WIC Participation and Electronic Benefits Transfer Implementation.

Importance: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that states transition WIC benefits by 2020 from paper vouchers to electronic benefits transfer (EBT) cards, which are more convenient to use, are potentially less stigmatizing, and may improve WIC participation. Objective: To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation. Design, Setting, and Participants: This economic evaluation of state-level WIC monthly benefit summary administrative data regarding participation between October 1, 2014, and November 30, 2019, compared states that did and did not implement WIC EBT during this time period. Difference-in-differences regression modeling allowed associations to vary by time since policy implementation and included stratified analyses for key subgroups (pregnant and postpartum women, infants younger than 1 year, and children aged 1-4 years). All models included dummy variables denoting state, year, and month as covariates. Data analyses were performed between March 1 and June 15, 2020. Exposures: Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year. Main Outcomes and Measures: Monthly number of state residents enrolled in WIC. Results: A total of 36 states implemented WIC EBT before or during the study period. EBT and non-EBT states had similar baseline rates of poverty and food insecurity. Three years after statewide WIC EBT implementation, WIC participation increased by 7.78% (95% CI, 3.58%-12.15%) in exposed states compared with unexposed states. In stratified analyses, WIC participation increased by 7.22% among pregnant and postpartum women (95% CI, 2.54%-12.12%), 4.96% among infants younger than 1 year (95% CI, 0.95%-9.12%), and 9.12% among children aged 1 to 4 years (95% CI, 3.19%-15.39%; P for interaction = .20). Results were robust to adjustment for state unemployment and poverty rates, population, and Medicaid expansion status. Conclusions and Relevance: In this study, the transition from paper vouchers to WIC EBT was associated with a significant and sustained increase in enrollment. Interventions that simplify the process of redeeming benefits may be critical for addressing low rates of enrollment in WIC and other government benefit programs.

Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study.

BACKGROUND: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. METHOD: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. RESULTS: The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16-112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. CONCLUSIONS: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.

Video-based neonatal state assessment method for timing of procedures.

BACKGROUND: Procedures should be performed when an infant is most receptive to disruptions in order to reduce the stress on the infant. However, frequent direct observations place a heavy burden on medical staff. There is therefore a need for a method for quantitatively and automatically evaluating the neonatal state. METHODS: Ten infants in our hospital were enrolled in this study. The states of the infants were assessed by medical staff using the Brazelton Neonatal Behavioral Assessment Scale and were recorded on video at the same time. The recorded states were reclassified as activity levels, a new state classification method that includes middle activity, which is the appropriate time for a procedure. Using image analysis, motions of the infant were quantified as two indices: activity and pause time. Activity and pause time were compared for each activity level. The cutoff values of the indices were calculated, and the sensitivity and specificity of the middle activity were calculated. RESULTS: There was a significant difference between all groups of activity level (P < 0.01). The maximum sensitivity and specificity of middle activity were 71.7% and 51.2%, respectively. CONCLUSIONS: The neonatal state of infants can be quantitatively and automatically evaluated using video cameras, and the activity level can be used to determine an appropriate time for procedures in infants. This will reduce the burden on medical staff and lead to less stressful procedures for infants.

Resumption of Sexual Intercourse and Family Planning use Among Postpartum Women Attending Infant Welfare Clinics in Ibadan, Southwest Nigeria - A Cross-Sectional Study.

BACKGROUND: Women may resume sexual intercourse anytime during the postpartum period with little consideration for contraceptive. AIM: To determine factors associated with resumption of sexual activity, explore FP practices and influence on sexual resumption among postpartum women. SUBJECT AND METHODS: A cross-sectional study of postpartum women at the infant-welfare clinic of Adeoyo Maternity Teaching Hospital and University College Hospital, Ibadan between July and October, 2014. Data on socio-demographic characteristics, contraceptive use, and sexual behavior were collected using interviewer-administered semi-structured questionnaires. Associations were tested using Chi-square tests and Logistic regression analysis for crude and adjusted odds ratios. Level of significance was 5%. RESULTS: There were 256 women with mean age of 29.1 years(SD = 5.2). Majority had tertiary education; were currently married in monogamous marriages and had 1-3 children. Ninety-one(38.7%) had started sexual intercourse at the time of interview. Among those who had not started having sex, about a quarter (24.2%) gave no reason and 20% felt it was too early. The fear of pain and child-spacing were reasons given by 5.7% and 5.1% respectively. Current use of contraceptive method was 20.7% among women and 36.4% among women who had resumed sexual activity. On multiple logistic regression, Family-planning users were about five times more-likely than non-users to resume sexual intercourse (Odd Ratio = 5.66, 95% Confidence interval = 2.61 - 12.28). CONCLUSION: Women commonly resume sexual intercourse during postpartum period without contraceptive use. Interventions during antenatal and early postnatal periods are needed to improve early adoption of Family planning by postpartum women.

Effectiveness of a psycho-educational intervention for expecting parents to prevent postpartum parenting stress, depression and anxiety: a randomized controlled trial.

BACKGROUND: The first months postpartum can be challenging for parents, leading to elevated symptoms of parenting stress, depression and anxiety. In turn, distressed parents are at higher risk for providing suboptimal quality of caregiving. As psychoeducational interventions can be effective in reducing psychological distress, the goal of this randomized controlled trial was to examine the effectiveness of low-intensity universal psychoeducational program to prevent postpartum parenting stress, and to enhance parental well-being and caregiving quality. METHOD: Between 26 and 34 weeks of pregnancy, 138 pregnant women and 96 partners were randomized to the intervention or a waitlist control group. The intervention consisted of a booklet, a video, a home visit, and a telephone call. Information was provided on (1) sensitive responsiveness, adapting to the parental role, and attending to own needs; (2) crying patterns; (3) feeding (arrangements); and (4) sleeping (arrangements). The primary outcome was parenting stress postpartum. Secondary outcomes were additional measures of distress (depression and anxiety), parental well-being, and caregiving quality. RESULTS: Both groups showed a rise in distress after birth. No between-group differences were observed on parenting stress, nor on the secondary outcomes. The intervention was rated as useful and of added value by the parents. CONCLUSION: This study offered no evidence that our universal prevention program was effective in decreasing parental distress or in increasing caregiving quality. However, parents found aspects of the intervention useful. More research is needed, including a longer period of follow-up as well as observational measures of parents' responsiveness. TRIAL REGISTRATION: This trial has been registered on 15 September 2016 in the Netherlands National Trial Register, ID: NTR6065, https://www.trialregister.nl/trial/5782 .

Characterizing newborn and older infant entries into care in England between 2006 and 2014.

BACKGROUND: The risk of entry to state care during infancy is increasing, both here in England and abroad, with most entering within a week of birth ('newborns'). However, little is known about these infants or of their pathways through care over early childhood. OBJECTIVE: To characterize infant entries to care in England. PARTICIPANTS AND SETTING: All children in England who first entered care during infancy, between April 2006 and March 2014 (n = 42,000). METHODS: We compared sociodemographic and care characteristics for infants entering care over the study period by age at first entry (newborn: <1wks, older infant 1-51wks). Among those who entered before April 2010, we further characterized care over follow-up (i.e. 4 years from first entry) and employed latent class analysis to uncover any common pathways through care. RESULTS: Almost 40 % of infants first entered care as a newborn. Most infants first entered care under s 20 arrangements (i.e. out-of-court, 60 % of newborns vs 47 % of older infants). Among infants entering before April 2010, most were adopted over follow-up (60 % vs 37 %), though many were restored to parental care (20 % vs 32 %) or exited care to live with extended family (13 % vs 19 %). One in six infants (17.7 %) had particularly unstable care trajectories over early childhood, typified by three or more placements or failed reunification. CONCLUSIONS: Evidence-based strengthening of pre-birth social work support is needed to improve preventive interventions before birth, to more effectively target infant placement into care. Linkages between child protection records and information on parents are needed to inform preventive strategies.

Factors Associated with Child-Welfare Involvement among Prenatally Substance-Exposed Infants.

OBJECTIVE: To assess factors impacting child-welfare involvement and child abuse and neglect outcomes among prenatally substance-exposed infants. STUDY DESIGN: This was a retrospective review of case registry data regarding substance-exposed infants tracked statewide in Delaware from 2014 to 2018. Differences in maternal, infant, and substance exposure factors by level of child-welfare involvement (screened-in vs screened-out case status) and child abuse and neglect outcomes were examined. Screened-in status was defined as case acceptance for investigation, family assessment, or treatment referral. Using logistic regression, associations between factors and screened-in status and between factors and child abuse and neglect outcomes were assessed. Cases involving child abuse and neglect were analyzed qualitatively. RESULTS: Among 1222 substance-exposed infants, 70% were screened-in by child welfare for ongoing involvement; 28 (2.3%) of substance-exposed infants were identified as child abuse and neglect victims sustaining serious physical or fatal injury before 1 year of age. Most substance-exposed infants remained with caregivers; few entered foster care. Polysubstance exposure and maternal mental health condition were factors associated with screened-in status. Neither substance exposure type nor maternal mental health condition reliably predicted future child abuse and neglect. CONCLUSIONS: Substance-exposed infants had a significant risk for child abuse and neglect. Although maternal and substance exposure factors were associated with screened-in case status, they unreliably predicted future risk of child abuse and neglect.