Positive experiences in the parent-child relationship during the COVID-19 lockdown in Poland: The role of emotion regulation, empathy, parenting self-efficacy, and social support.

Despite the impact of the COVID-19 outbreak being largely negative on parents and children, for some families, lockdown could also bring about some positive effects, for example, increased emotional closeness, and more time for joint activity. The aim of the current study was to investigate cross-sectionally the most important correlates of the positive experiences in the parent-child relationship among Polish mothers and fathers during the lockdown in the initial phase of the COVID-19 outbreak. In May 2020, 228 mothers and 231 fathers completed the Brief version of the Empathic Sensitivity Questionnaire, Difficulties in Emotion Regulation Scale Short Form, Social Support Scale, Parenting Self-Agency Measure, and Scale of Positive Experiences in Parent-Child Relationship during the COVID-19 lockdown. Our results showed that parenting self-efficacy and social support were the strongest correlates of positive experiences in the parent-child relationship in both mothers and fathers during the lockdown. Perspective-taking was positively related to the positive experiences in mothers, whereas personal distress was positively associated with the positive experiences in the parent-child relationship in fathers. Our results point to factors of potential importance in designing preventive and therapeutic interventions for mothers and fathers to enhance positive experiences in the parent-child relationship during the pandemic.

Maternal Mood and Perception of Infant Temperament at Three Months Predict Depressive Symptoms Scores in Mothers of Preterm Infants at Six Months.

Postpartum depression is more prevalent in mothers and fathers of preterm infants compared to parents of full-term infants and may have long-term detrimental consequences for parental mental health and child development. The temperamental profile of an infant has been postulated as one of the important factors associated with parental depressiveness in the first months postpartum. This study aimed to examine the longitudinal relationship between depressive symptoms and perceived infant temperament at 3 months corrected age, and depressive symptoms at 6 months corrected age among mothers and fathers of infants born preterm. We assessed 59 families with infants born before the 34th gestational week using the Edinburgh Postnatal Depression Scale (EDPS) and the Infant Behavior Questionnaire-Revised. We found that mothers' scores on EPDS and infants' Orienting/regulation at 3 months corrected age predicted mothers' EPDS scores at 6 months corrected age. In particular, higher depressive scores were related to higher depressive symptoms at 6 months corrected age, whereas higher infant Orienting/regulation was related to lower depressive symptoms at 6 months corrected age. Due to the low internal consistency of EPDS at 6 months for fathers, we were unable to conduct similar analyses for fathers. Our results point to the importance of considering both early indices of maternal mood as well as mother-reported measures of preterm infant temperament in the attempts to predict levels of maternal depressiveness in later months of an infant's life. Further studies are urgently needed in order to better understand the associations between depressiveness and infant temperament in fathers, and with more consideration for the severity of the effects of infant prematurity.

Silence matters: The role of pauses during dyadic maternal and paternal vocal interactions with preterm and full-term infants.

This study examined the characteristics of the vocal behaviors of parents and preterm infants, as compared to their term-born peers, at three months of age. Potential links between specific features of parental IDS and infants' vocal activity were also sought. We analyzed the frequencies and durations of vocalizations and pauses during the dyadic interactions of 19 preterm and 19 full-term infants with their mothers and fathers. The results showed that the duration of the vocalizations was shorter for the preterm than for the full-term infants, regardless of the interactive partner. Mothers vocalized more frequently and for a longer time than fathers, regardless of the group, but only the frequency of paternal utterances was significantly and positively correlated with the frequency and duration of infant vocalizations. Frequent conversational pauses of a relatively short total duration seemed to be related to more active infants' vocal participation, regardless of prematurity and parent gender.

Factors associated with burnout in Polish healthcare workers during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has placed the healthcare system under substantial strain that has caused elevated psychological distress among healthcare workers (HCWs). Previous studies have found a high prevalence of burnout among HCWs exacerbated by the COVID-19 pandemic and have delineated some associated factors, but further research is needed. Little is known, for example, whether the economic status of HCWs or experiencing negative and positive emotions contribute to burnout. The present study was meant to fill this gap. Methods: A total of 412 HCWs (i.e.: nurses - 47%, physicians-28%, psychologists-14%, and other healthcare professionals-11%), aged 21-69 years (M = 36.63; SD = 11.76) participated in a web-based cross-sectional study. Data was collected from June to November 2020. The participants filled out measures assessing two dimensions of burnout (Exhaustion and Disengagement), depression, generalized anxiety, positive and negative emotions, along with the survey evaluating organizational aspects of their work during the pandemic. Results: Burnout thresholds were met by 54 and 66% of respondents for Disengagement and Exhaustion, respectively, which is high but comparable to levels found in other countries during the pandemic. Similarly to previous work, depression and anxiety were high in HCWs, with 24 % of them being in the risk group for clinical severity of depression and 34% in the risk group for a clinical generalized anxiety disorder (GAD). Regression analysis showed that the intensity of negative emotions was the strongest predictor of Exhaustion, whereas the intensity of positive emotions was the strongest predictor of Disengagement. Depression and GAD symptoms were positively related to Exhaustion, and economic status was inversely related to Disengagement. Discussion: These results suggest that distress in HCWs during the pandemic was related to symptoms of burnout, whereas higher income and experiencing positive emotions were associated with reduced burnout levels. Our findings call for the development of burnout intervention programs that could build capacities for dealing with depression and other negative emotions and at the same time teach skills on how to increase positive emotions in HCWs.

Generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown in Poland. Specific predictors and differences in symptoms severity.

BACKGROUND: Previous studies carried out in different countries have indicated that young adults experienced higher levels of emotional distress, in the form of depressive and anxiety symptoms, than older age groups during the COVID-19 pandemic. However, little is known about which pandemic-related difficulties and factors may contribute to these forms of emotional distress in various age groups. PURPOSE: The aim of the current study was to investigate: (i) differences in levels of depressive and generalized anxiety symptoms in four age groups in the Polish population during the COVID-19 lockdown; (ii) differences in perceived difficulties related to the pandemic in these groups; and (iii) which factors and difficulties related to the pandemic are the best predictors of generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown. METHOD: A total of 1115 participants (aged 18-85) took part in the study. The sample was representative of the Polish population in terms of sex, age, and place of residence. Participants completed the following online: the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, a Scale of Perceived Health and Life Risk of COVID-19, a Social Support Scale, and a Scale of Pandemic-Related Difficulties. RESULTS: Younger age groups (18-29 and 30-44) experienced higher levels of depressive and generalized anxiety symptoms than older adults (45-59 and 60-85 years). Household relationship difficulties were among the most significant predictors of depressive and generalized anxiety symptoms in all age groups. Fear and uncertainty related to the spread of the virus was one of the most important predictors of emotional distress in all the groups apart from the adults between 18 and 29 years, whereas difficulties related to external restrictions were one of the most significant predictors of depressive and anxiety symptoms exclusively in the youngest group. CONCLUSIONS: The youngest adults and those experiencing difficulties in relationships among household members are the most vulnerable to depressive and generalized anxiety symptoms during the COVID-19 lockdown. It is important to plan preventive and therapeutic interventions to support these at-risk individuals in dealing with the various challenges related to the COVID-19 pandemic.

Drainage, irrigation and fibrinolytic therapy (DRIFT) for posthaemorrhagic ventricular dilatation: 10-year follow-up of a randomised controlled trial.

BACKGROUND: Progressive ventricular dilatation after intraventricular haemorrhage (IVH) in preterm infants has a very high risk of severe disability and death. Drainage, irrigation and fibrinolytic therapy (DRIFT), in a randomised controlled trial (RCT), reduced severe cognitive impairment at 2 years. OBJECTIVE: To assess if the cognitive advantage of DRIFT seen at 2 years persisted until school age. PARTICIPANTS: The RCT conducted in four centres recruited 77 preterm infants with IVH and progressive ventricular enlargement over specified measurements. Follow-up was at 10 years of age. INTERVENTION: Intraventricular injection of a fibrinolytic followed by continuous lavage, until the drainage was clear, and standard care consisting of control of expansion by lumbar punctures and if expansion persisted via a ventricular access device. PRIMARY OUTCOME: Cognitive quotient (CQ), derived from the British Ability Scales and Bayley III Scales, and survival without severe cognitive disability. RESULTS: Of the 77 children randomised, 12 died, 2 could not be traced, 10 did not respond and 1 declined at 10-year follow-up. 28 in the DRIFT group and 24 in the standard treatment group were assessed by examiners blinded to the intervention. The mean CQ score was 69.3 (SD=30.1) in the DRIFT group and 53.7 (SD=35.7) in the standard treatment group (unadjusted p=0.1; adjusted p=0.01, after adjustment for the prespecified variables sex, birth weight and IVH grade). Survival without severe cognitive disability was 66% in the DRIFT group and 35% in the standard treatment group (unadjusted p=0.019; adjusted p=0.003). CONCLUSION: DRIFT is the first intervention for posthaemorrhagic ventricular dilatation to objectively demonstrate sustained cognitive improvement. TRIAL REGISTRATION NUMBER: ISRCTN80286058.

Parenting Self-Efficacy in Immigrant Families-A Systematic Review.

Introduction: Parenting self-efficacy (PSE) refers to parents' belief in their ability to perform the parenting role successfully, and derives from Bandura's concept of personal self-efficacy formulated within the social cognitive theory. PSE has been demonstrated to be a strong predictor of parenting functioning. At the same time, relatively less is known about its possible role in the situation of migration, when a family experiences acculturation stress in the process of adaptation to the new culture. Therefore, the aim of this systematic review was to summarize available data on the conceptualization, measurement, and the role of parenting self-efficacy in the context of acculturation processes, and in various groups of immigrant parents. Methods: An extensive search of eight electronic databases was conducted in August 2018 and updated in February 2020 to identify peer-reviewed articles on parenting self -efficacy among immigrants. Eleven studies met pre-specified criteria for inclusion. Nine of the studies employed a quantitative design, whereas the remaining two studies used qualitative methods. In three of the quantitative studies, interventions/programs for immigrants were assessed. Results: Three different approaches to conceptualizing and measuring PSE were identified in the analyzed papers: domain-general, domain-specific, and narrow domain. Incongruent results were found with regards to the links between the strength of PSE and immigrants' cultural orientation. Additionally, PSE was identified as a mediator between a stronger orientation toward the mainstream culture and more supportive parenting. The qualitative studies indicated that a reduction in PSE was typical for the initial period of immigration and might be a consequence of a forced orientation toward the standards of the receiving country, which was a consequence of the parents wanting to maintain close relations with their teenage children. Discussion: Overall, the theoretical and methodological quality of the reported studies varied and hence their findings have to be interpreted with caution. Our analysis clearly points to the usefulness of a multifaceted approach to PSE. Further research is needed to understand the mechanisms by which parental self-efficacy may exert a positive effect on the functioning of immigrant families.

Antenatal depression and anxiety in primiparous Polish mothers and fathers.

OBJECTIVES: Mood disturbances are the most prevalent mental health problems in expectant parents. The knowledge about the factors which increase the risk of perinatal depression is insufficient, especially in fathers. The aims of the present study were to estimate the prevalence and to compare mean levels of antenatal depression and anxiety as well as to examine the relationship between the risk for depression and anxiety in primiparous Polish parents. MATERIAL AND METHODS: 250 parental couples participating in antenatal classes took part in the study. Depression and anxiety were measured with the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI), respectively. Paired t-test with bootstrapping was applied to compare parental EPDS, as well as STAI raw scores. Pearson correlation coefficients were calculated for depression and anxiety scores for women and men separately. The factors predictive for the increased risk of depression were investigated with the use of a multivariate logistic regression analysis. RESULTS: 10% of women and 4% of men were at risk of depression. High level of state anxiety was found in 7.7% of expectant mothers and 10% of fathers, whereas elevated state anxiety was found in 19% of both parents. EPDS scores correlated moderately with anxiety. The risk of depression was increased by state anxiety in the case of mothers and by trait anxiety in the case of fathers. CONCLUSIONS: High level of anxiety increases the risk of antenatal depression. Both parents should be screened for depression and anxiety in the prenatal period.

Ten-year follow-up of a randomised trial of drainage, irrigation and fibrinolytic therapy (DRIFT) in infants with post-haemorrhagic ventricular dilatation.

BACKGROUND: The drainage, irrigation and fibrinolytic therapy (DRIFT) trial, conducted in 2003-6, showed a reduced rate of death or severe disability at 2 years in the DRIFT compared with the standard treatment group, among preterm infants with intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation. OBJECTIVES: To compare cognitive function, visual and sensorimotor ability, emotional well-being, use of specialist health/rehabilitative and educational services, neuroimaging, and economic costs and benefits at school age. DESIGN: Ten-year follow-up of a randomised controlled trial. SETTING: Neonatal intensive care units (Bristol, Katowice, Glasgow and Bergen). PARTICIPANTS: Fifty-two of the original 77 infants randomised. INTERVENTIONS: DRIFT or standard therapy (cerebrospinal fluid tapping). MAIN OUTCOME MEASURES: Primary - cognitive disability. Secondary - vision; sensorimotor disability; emotional/behavioural function; education; neurosurgical sequelae on magnetic resonance imaging; preference-based measures of health-related quality of life; costs of neonatal treatment and of subsequent health care in childhood; health and social care costs and impact on family at age 10 years; and a decision analysis model to estimate the cost-effectiveness of DRIFT compared with standard treatment up to the age of 18 years. RESULTS: By 10 years of age, 12 children had died and 13 were either lost to follow-up or had declined to participate. A total of 52 children were assessed at 10 years of age (DRIFT, n = 28; standard treatment, n = 24). Imbalances in gender and birthweight favoured the standard treatment group. The unadjusted mean cognitive quotient (CQ) score was 69.3 points [standard deviation (SD) 30.1 points] in the DRIFT group compared with 53.7 points (SD 35.7 points) in the standard treatment group, a difference of 15.7 points, 95% confidence interval (CI) -2.9 to 34.2 points; p = 0.096. After adjusting for the prespecified covariates (gender, birthweight and grade of IVH), this evidence strengthened: children who received DRIFT had a CQ advantage of 23.5 points (p = 0.009). The binary outcome, alive without severe cognitive disability, gave strong evidence that DRIFT improved cognition [unadjusted odds ratio (OR) 3.6 (95% CI 1.2 to 11.0; p = 0.026) and adjusted OR 10.0 (95% CI 2.1 to 46.7; p = 0.004)]; the number needed to treat was three. No significant differences were found in any secondary outcomes. There was weak evidence that DRIFT reduced special school attendance (adjusted OR 0.27, 95% CI 0.07 to 1.05; p = 0.059). The neonatal stay (unadjusted mean difference £6556, 95% CI -£11,161 to £24,273) and subsequent hospital care (£3413, 95% CI -£12,408 to £19,234) costs were higher in the DRIFT arm, but the wide CIs included zero. The decision analysis model indicated that DRIFT has the potential to be cost-effective at 18 years of age. The incremental cost-effectiveness ratio (£15,621 per quality-adjusted life-year) was below the National Institute for Health and Care Excellence threshold. The cost-effectiveness results were sensitive to adjustment for birthweight and gender. LIMITATIONS: The main limitations are the sample size of the trial and that important characteristics were unbalanced at baseline and at the 10-year follow-up. Although the analyses conducted here were prespecified in the analysis plan, they had not been prespecified in the original trial registration. CONCLUSIONS: DRIFT improves cognitive function when taking into account birthweight, grade of IVH and gender. DRIFT is probably effective and, given the reduction in the need for special education, has the potential to be cost-effective as well. A future UK multicentre trial is required to assess efficacy and safety of DRIFT when delivered across multiple sites. TRIAL REGISTRATION: Current Controlled Trials ISRCTN80286058. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 4. See the NIHR Journals Library website for further project information. The DRIFT trial and 2-year follow-up was funded by Cerebra and the James and Grace Anderson Trust.

Neuroimaging results, short-term assessment of psychomotor development and the risk of autism spectrum disorder in extremely premature infants (≤28 GA) - a prospective cohort study (preliminary report).

OBJECTIVE: Infants ≤28 GA are at particular risk of psychomotor and neurological developmental disorder. They also remain at a higher risk of developing autism spectrum disorder (ASD), characterized by persistent deficits in communication/social interactions and restricted, repetitive behaviors, activities and interests. Monitoring their development by a team of specialists (a neurologist, psychologist, psychiatrist) allows us to make an early diagnosis and to implement appropriate therapy. Neuroimaging studies during the neonatal period may be helpful in clarifying diagnosis and prognosis. Objective: The aim of the study was to search for the interrelation between the results of neuroimaging and the neurological, psychological and psychiatric evaluation at the age of 2. PATIENTS AND METHODS: Material and methods: Neonates born at ≤28 weeks between 01.06.2013 and 31.12.2015 and hospitalized at NICU were enrolled. We present the results of the first 12 children who have attained 2 years of corrected age and have undergone both neuroimaging, and neurological, psychological and psychiatric assessments. Transfontanel ultrasound was performed according to general standards, MRI between 38 and 42 weeks of corrected age. Neurological examination based on the Denver scale, ASD screening with use of the STAT test and psychological DSR assessment were performed at 2 years of corrected age. RESULTS: Results: Median GA was 26 weeks and median weight 795 g. The ultrasound examination was normal in 9 cases (75%) and MRI in 4 (33%). Abnormalities in the cerebellum were the main additional information found in MRI as compared to US. Neurological examination was normal in 8 infants (67#37;), in 4 of whom neuroimaging was normal. In 4 (33%) infants the neurological examination was abnormal. Psychomotor development at an average level or above was found in seven (58#37;) children. In 4 of them neuroimaging was normal, whereas 3 had ventricular dilatation and haemorrhagic infarct. There were no abnormalities within the cerebellum in this group. In the remaining 5 children (42#37;) psychomotor development was rated as delayed. All of them had cerebellar haemorrhage. An increased risk of ASD was observed in 4 children who developed cerebellar hemorrhage. CONCLUSION: Conclusions: 1. The use of MRI at a term-equivalent age may contribute to the prognosis of neurodevelopmental outcomes in extremely premature infants, allowing risk stratification and thus enhancing early monitoring of a child's development and functional status 2. There is a clear tendency towards abnormal psychomotor development and positive screening for ASD to co-occur with abnormal MRI findings in the cerebellum.

Quantitative cranial ultrasound prediction of severity of disability in premature infants with post-haemorrhagic ventricular dilatation.

BACKGROUND: Infants with post-haemorrhagic ventricular dilatation (PHVD) have a high risk of severe disability and parenchymal infarction increases this risk. Existing cranial ultrasound (CUS) markers of neurodevelopmental outcome are based on categorical features. OBJECTIVE: To investigate to what extent quantitative CUS measurements correlated with severity of developmental outcome and the need for ventriculoperitoneal (VP) shunt at 2 years of age. DESIGN: 69 premature infants with PHVD had lateral ventricle area, intraventricular echodensity and parenchymal lesion dimensions measured at the start of treatment for PHVD. Outcome measures were the Bayley Scales of Infant Development-II and functional ability at 2 years of age. Bayley developmental quotients (DQ) were used in preference to index scores to enable inclusion of severely disabled children. RESULTS: Quantitative CUS measurements of parenchymal lesion area correlated significantly with later mental and motor DQ. Intraventricular echodensity area correlated with motor DQ in infants with grade 4 intraventricular haemorrhage (IVH). Neither ventricular area nor ventricular width correlated with DQ in grade 3 IVH. Infants who ultimately required a VP shunt had a significantly larger intraventricular echodensity area. CONCLUSIONS: CUS measurement of parenchymal lesions in infants with PHVD can increase the precision of predicting severe mental and motor disability, but ventricular size at the start of treatment is not predictive of outcome in infants with PHVD following grade 3 IVH.

Feeding behaivour problems in infants born preterm: a psychological perspective. Preliminary report.

AIM: The study was aimed at exploring feeding behaviour problems reported by parents of premature infants during the first 12 months corrected age. MATERIAL AND METHODS: A subsample of families enrolled in a larger, prospective project on psychological and biological predictors of self-regulation in preterm children participated in the study. The material consisted of data collected from 40 families of preterm infants in the first and fourth and then at six and twelve months corrected age. The children were divided into two groups according to their gestational age: group 1 - 22 children born before 29th week (mean gestational age 26 Hbd and mean birth weight 905 g) and group 2 - 18 children born between 29th and 34th week (mean gestational age 31 Hbd and mean birth weight 1531 g). Semi-structured interviews and daily activity diaries were used. Qualitative, exploratory analysis of parental descriptions of child's feeding behaviour was performed. RESULTS: No feeding behaviour problems were reported in 31.8% infants in group 1 and 44.4% in group 2, whereas chronic feeding behaviour problems - in the case of 5 infants in group 1 (22.7%) and just in one child in group 2 (5.6%). There was a significant association between "gastrointestinal complications of prematurity" and parental reports of feeding behaviour problems at two and more evaluation times. No relationship was found with such variables as: group, child's gender, method of feeding, mother's postnatal depression, or other complications of prematurity. Six major categories of feeding problems were identified: 1) early regulatory problems, 2) pain and/ or excessive spitting, 3) insufficient weight gain, 4) poor eater, 5) difficulties introducing new taste or consistency, and 6) difficulties with introducing self-feeding. These categories occurred with varying frequencies depending on the child's gestational age and the assessment time. CONCLUSION: The results point to an interesting diversity and dynamics of feeding behaviour difficulties in babies born preterm. It was shown that extremely low gestational age as well as gastrointestinal complications of prematurity may contribute to increased parental reports of feeding behaviour difficulties. Further research is needed to disentangle divergent underlying mechanisms of different feeding behaviour problems and describe possible challenges they may imply to the child, parents and their relationship.

Differentiating developmental outcome between infants with severe disability in research studies: the role of Bayley Developmental Quotients.

OBJECTIVES: To investigate whether infants with a score <50 on the Bayley Scales of Infant Development, Second Edition (BSID-II) demonstrated differences in functional ability, and to assess whether the Bayley Developmental Quotients (DQs) indicated such differences. STUDY DESIGN: Preterm infants (n = 67; 47 boys) with posthemorrhagic ventricular dilatation were evaluated at 25 months past term age using the BSID-II and grading of functional ability. Mental and Motor Bayley DQs were derived and compared with functional ability. RESULTS: Among the 34 subjects (51%) with a BSID-II score <50, there were clinically significant differences in the ability to walk, sit, eat, speak, and see. In all subjects, there were significant differences in Mental and Motor Bayley DQs based on grade of disability in each domain except hearing. CONCLUSIONS: Bayley DQ quantified the spread of functional ability in all children, provided a continuous parameter to compare ability in severely delayed children, and should be considered in future therapeutic trials of infants with brain injury.

[Neonatal behavioural assessment of pre-term and full-term infants as experienced by parents].

AIM: The analysis of similarities and differences of parental experience of observing preterm versus full term babies assessed with the Neonatal Behavioural Assessment Scale (NBAS). MATERIAL AND METHOD: 95 pairs of parents participated in the study, including 33 mothers and fathers of babies born before 29th gestational week, 31 - between 29th and 34th week and 31 - at term. All infants were assessed with the NBAS in the first month of life (or corrected age) in the presence of both parents. Semi-structured clinical interviews were conducted with each parental pair and the qualitative analysis of the obtained co-constructed narratives was carried out. RESULTS: Seven common categories of parental experience related to the NBAS were empirically discerned in all groups of parents. There were also two categories of experience related to the NBAS that were different in the group of parents of preterm versus full term babies. Apart from that, three specific categories characteristic of the parental narratives in the two preterm groups were identified: parental tendency to compare NBAS assessment with medical examination, hope for having the child's health confirmed and parental tendency to compare preterm with full term babies. CONCLUSIONS: Mothers and fathers of preterm vs full term babies experience the observation of NBAS assessment differently. Parents of preterm babies are extremely sensitive to any information regarding their child. Therefore specialists should pay a special attention to the process of communicating with the family. Effective support of any family in the perinatal period requires special appreciation of the individual parental needs.

Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years.

BACKGROUND: Preterm infants who develop posthemorrhagic ventricular dilatation (PHVD) have a high risk of cognitive and motor disability. No clinical intervention has been proven to reduce neurodevelopmental disability in such infants. We investigated whether drainage, irrigation, and fibrinolytic therapy (DRIFT), which aims to lower pressure, distortion, free iron, and cytokines, reduces death or severe disability in PHVD. METHODS: We randomly assigned 77 preterm infants with PHVD to either DRIFT or standard treatment (ie tapping off cerebrospinal fluid to control excessive expansion). Severe disability was assessed at 2 years' corrected age and included severe sensorimotor disability and cognitive disability (<55 on the Bayley Mental Development Index). RESULTS: Of 39 infants assigned to DRIFT, 21 (54%) died or were severely disabled versus 27 of 38 (71%) in the standard group (adjusted odds ratio 0.25 [95% confidence interval: 0.08-0.82]). Among the survivors, 11 of 35 (31%) in the DRIFT group had severe cognitive disability versus 19 of 32 (59%) in the standard group (adjusted odds ratio: 0.17 [95% confidence interval: 0.05-0.57]). Median Mental Development Index was 68 with DRIFT and <50 with standard care. Severe sensorimotor disability was not significantly reduced. CONCLUSIONS: Despite an increase in secondary intraventricular bleeding, DRIFT reduced severe cognitive disability in survivors and overall death or severe disability.

[The process of disclosure of an HIV/AIDS problem in the family to children--an exploratory study]. / Proces ujawniania dzieciom problemu HIV/AIDS w rodzinie--badania eksploracyjne.

AIM: The aim of the study was to describe the process of disclosing HIV/AIDS problem in the family to children and to explore its possible determinants. MATERIAL AND METHODS: The investigations were carried in 37 children, aged 4-16 years, living in families with HIV/AIDS problem (25 children were HIV+ and 12 HIV-) and in their parents/ caregivers. Empirical material consisted of protocols of clinical interviews with parents and children, observation of child's behaviour in different contexts and results of selected projective tests. RESULTS: Only six children (3 were HIV+ and 3 HIV-) had been informed about the problem of HIV/AIDS by the parents and could freely talk with them on that subject. The most important reasons impeding the process of disclosure according to the parents were: risk of depriving the child of a happy childhood and fear that the child may not be able to keep the family secret. As a result of cluster analysis four distinct subgroups of the children under study were discerned. The largest number of emotional and behavioural problems was noted in the case of older, infected children, who were quite aware of their serious medical condition and whose parents were in the phase of secrecy or exploration in the process of disclosure. CONCLUSIONS: The process of disclosing HIV/AIDS problem in the family by parents to children requires taking into account many different factors. Providing professional psychological services may be of great importance in many instances.