[Pain management and coping behaviour in premature babies (< 1500 g) at corrected age of 36 months influence of neonatal experience and maternal anxiety]. / Schmerzverhalten und Bewältigungsformen von Frühgeborenen (< 1500g) im korrigierten Alter von 36 Monaten -- Einflüsse neonataler Erfahrungen und mütterlicher Angste.

INTRODUCTION: Neonatal experience of pain and distress can lead to developmental problems, which can be associated with long-term emotional and behavioural disorders. The aim of the study was to analyse the effects of early experiences of pain and maternal reactions on the pain and coping behaviour of preterm infants. METHODS: In a prospective longitudinal study of 69 very low birth weight (VLBW) preterm infants, neonatal data regarding painful manipulations, analgesics and sedatives, and general medical condition (Nursery Neurobiological Risk Score; NBRS) were assessed. At the (corrected) age of 36 months, 53 preterm infants and a control group of 23 full-term infants were re-examined. Pain and coping behaviour were estimated by a questionnaire. Maternal anxiety was assessed in semi-structured interviews at the age of 3, 12 and 36 months in the preterm group. RESULTS: The mean gestational age was 29 + 0 weeks (23 + 3 to 34 + 1), the mean birth weight 1058 g (380 to 1480 g) in preterms and 39 + 3 weeks (37 + 0 to 42 + 0) and 3379 g (2400 to 4130 g), respectively, for the full-terms. The sex ratio was equal, 45.3 % of the preterms were multiples (controls 34.8 %). Preterms had higher descriptive scores for all types of pain situations. After controlling for other associated factors, a negative correlation between birth weight and later pain behaviour in medical situations remained. Preterms had a more negative coping behaviour during every day injuries. In terms of coping behaviour, only a shorter inpatient treatment in the neonatal period was associated with social withdrawal after controlling for other associated factors. Maternal anxiety at the age of 12 and 36 months was associated with negative coping behaviour following simple injuries. CONCLUSIONS: While preterms do not have a higher pain threshold in general, a subgroup does have a higher risk for later sensation to pain. Preterms use more unfavourable coping strategies in simple injuries which, in turn, seem to be decisively mediated by maternal anxiety. Future research should focus on psycho-social factors involved in the development of pain reactions, as these can predispose towards behavioural disorders.

[Mother-infant Interactions with Very Low Birth Weight multiple newborns (< 1500 g). A comparison of mother-multiple and mother-single births]. / Mutter-Kind-Interaktion bei sehr leichtgewichtig frühgeborenen Mehrlingen (< 1500 g). Ein Vergleich von Mutter-Mehrlings- und Mutter-Einlings-Dyaden.

BACKGROUND: Assisted reproductive techniques and fertility enhancing therapies have increased the rate of multiple births and, therefore, the risk of prematurity. Our hypothesis is that mothers of preterm multiples are less able to provide such enhancing interactions than mothers of preterm singletons, resulting in a developmental disadvantage for preterm twins and triplets. PATIENTS AND METHODS: Of 77 very low birth weight preterms (VLBW) who were examined prospectively with their mothers in a longitudinal study, 35 were multiples and 42 were singletons. At a corrected age of three months the quality of the mother-infant interaction with multiples vs. singletons was examined. The Mannheim Rating System, a 40-item standardized observation instrument based on a 10 minute videotaped sequence of interaction, was used. RESULTS: The analyses showed several differences between mother-singleton and mother-multiple interactions. Mothers of multiples were less stimulating and reactive and showed less babytalk. Multiple infants were also less reactive than singletons. In mother-multiple dyads there were less verbal exchanges between mother and child. CONCLUSIONS: There are definite differences in mother-multiple compared to mother-singleton interactions, so that VLBW multiples may be at even greater risk for negative mother-infant interactions than singletons.

[The effect of biological and psychosocial factors on maternal distress and coping in the first months after preterm delivery of an infant weighing less than 1500 g]. / Die Bedeutung biologischer und psychosozialer Einflussfaktoren für das Belastungs- und Bewältigungserleben bei Müttern Frühgeborener < 1500 g in den ersten Lebensmonaten des Kindes.

PROBLEM: Several studies have shown that maternal coping after a premature birth has an influence on the psychosocial development of preterm infants. As maternal coping is so important for development of premature infants, in this prospective study the medical state of the child, previous negative experiences, personal and partnership resources and social support outside the family were examined regarding their effects on maternal distress and coping after preterm birth. SAMPLE, MATERIAL, METHODS: 63 of 68 consecutive mothers with a preterm infant weighing less than 1500 g were examined with a semistructured interview and questionnaires (F-Sozu, ADS-L, FPI-R) at the time of discharge. RESULTS: 30.2 % (n = 19) of the mothers had multiples. The mean gestational age of the infants was 28 + 4 weeks (23 + 3 to 34 + 1 weeks), the mean birthweight was 1035 g (380 -1480 g). Although many mothers had fears concerning a handicap of their child, not medical complications per se influenced the mothers perception, but the duration of the medical treatment. Previous distressing experiences through complications of previous pregnancies and deliveries, as well as handicaps, chronic disorders and behavior problems of siblings influenced the perception of the child's health negatively, if they have had an effect on the current pregnancy. The mother's mood was not associated with the perception of the child's health, but with the atmosphere of the intensive care unit, partnership resources and social support outside the family. CONCLUSIONS: As both biological and psychosocial factors had an effect on the mother's experiences, it is necessary to evaluate previous maternal experiences and coping resources and offer practical counselling for the mothers to optimize the clinical care in the future.