Impact of maternal stressors and neonatal clinical factors on post-partum depression screening scores.

BACKGROUND: Higher rates of postpartum depression (PPD) are reported in mothers of neonatal intensive care unit (NICU) hospitalized infants. The relationship of neonatal clinical risk factors and self-reported maternal stress levels to positive PPD screening is not well characterized. OBJECTIVE: To determine the feasibility of postpartum depression screening in a regional perinatal center, and assess the association of NICU-specific comorbidities and maternal stress levels with PPD screening scores. DESIGN/METHODS: Prospective study of mothers of NICU-hospitalized infants conducted between 21and 30 days of their infant's life. Mothers completed the Edinburgh Postpartum Depression scale (EPDS) and the Parental Stressor Scale: NICU (PSS: NICU) in the environmental, infant behavior and parental domains. Total EPDS scores and positive PPD screening were correlated with NICU comorbidities, demographic factors and PSS: NICU scores. RESULTS: The incidence of positive PPD screening was 19% (25/135). In bivariate analysis, positive PPD screen was associated with exclusive breastfeeding (67% vs, 35%, p < .05) and maternal age <35 years (32% vs. 12%, p < .05). No observed differences in maternal and infant demographic factors or neonatal comorbidities were seen in mothers with positive PPD screening. Mean PPD screening scores were higher in infants with intraventricular hemorrhage of any grade and necrotizing enterocolitis. In adjusted analysis, overall and domain-specific PSS: NICU scores were associated with positive PPD screening. CONCLUSION: Cumulatively and within each PSS: NICU domain, parental stress correlated with positive PPD screening but was unrelated to NICU comorbidities. Reducing modifiable factors which exacerbate parental stress may impact the incidence of positive PPD screening among NICU mothers.

Fluid management during the first postnatal day in very low birth weight neonates and rates of patent ductus arteriosus requiring treatment.

PURPOSE: Previous studies have suggested an association between high maintenance fluid volumes during the first several postnatal days and patent ductus arteriosus (PDA) requiring treatment in very low birth weight (VLBW) neonates. However, no studies have specifically examined fluid administration during the first postnatal day with regard to PDA-related outcomes. We seek to determine whether additional intravenous fluid administration beyond prescribed goals during the first postnatal day is associated with PDA requiring treatment. MATERIALS AND METHODS: Retrospective data were collected from neonates with birth weight <1250 g. Infants receiving fluids beyond initially documented goals, stratified by relative degree of additional fluids, were compared to those receiving no additional intravenous fluids for the primary outcome of PDA requiring treatment and secondarily for other neonatal morbidities. RESULTS: Two hundred VLBW neonates were included. Controlling for birth weight and gestational age, fluid administration beyond prescribed goals during the first postnatal day was not associated with increased PDA requiring treatment. Additionally, no statistically significant associations between additional fluids and secondary outcomes were observed. CONCLUSIONS: No significant relationship between fluid volumes during the first postnatal day and PDA requiring treatment were observed. Further prospective analysis of early fluid management in VLBW neonates is warranted.

The Development of a Postpartum Weight Management Intervention for Low-Income Women: End-User Perspectives as Groundwork.

BACKGROUND: Postpartum weight retention (PPWR) leads to increased rates of maternal and childhood obesity, especially among low-income families. Literature is sparse regarding interventions to address PPWR. OBJECTIVE: To gain practical insight into low-income women's preferences and opinions regarding PPWR management at a community-based organization (CBO). METHODS: Mixed female focus groups composed of CBO staff and clients (n = 17) were asked open-ended questions about PPWR and potential intervention components. Systematic analysis of the discussions was performed to identify overarching themes. CONCLUSIONS: The tenets of community-engaged research state the necessity of developing community-based interventions with initial input and partnership with the potential end-users. In this study, low-income women were eager to share their thoughts about the postpartum period and potential solutions to correct unhealthy weight, thus completing a critical step in intervention development. The majority of women wanted to manage their weight in the postpartum setting, but needed structure, social support, assurance they would not injure themselves or their babies, and time saving strategies to do so.

Differential effects of systemic and intraseptal administration of the acetylcholinesterase inhibitor tacrine on the recovery of spatial behavior in an animal model of diencephalic amnesia.

Several lines of evidence suggest that acetylcholinesterase inhibitors (AChE) have their cognitive enhancing effects by stimulating cholinergic receptors within the medial septum. However, intraseptal administration of cholinergic enhancing drugs produce mixed results that appear to depend on both the integrity of the medial septum as well as task demands. Three experiments were conducted to determine the relationship between increased cholinergic activity within the medial septum and hippocampus and behavioral recovery in a model of diencephalic amnesia produced by pyrithiamine-induced thiamine deficiency (PTD). In Experiment 1, systemic tacrine (0.0, 0.75, 1.5mg/kg) was administered to PTD and pair-fed (PF) rats prior to a spontaneous alternation task. Without tacrine, PF rats alternated at a higher rate than PTD rats. Both doses of tacrine increased alternation in PTD rats to within the range of PF rats. In Experiment 2, three doses of intraseptal tacrine (2.5, 5.0, 12.5microg) were administered to PTD and PF rats and changes in hippocampal acetylcholine efflux were assessed. Both the 5.0 and 12.5microg doses significantly increased hippocampal acetylcholine levels, but the change was greater in the PTD rats. In Experiment 3, despite the fact that both intraseptal doses of tacrine (5.0, 12.5microg) increased hippocampal acetylcholine levels, only 5.0microg significantly improved alternation scores in PTD rats. Thus, when there is basal forebrain cholinergic cell loss in conjunction with diencephalic pathology, the therapeutic range of AChE-I in the medial septum and the effective doses do not directly map onto changes in acetylcholine efflux in the hippocampus.