Maternal health-related quality of life at 1 year after a preterm birth: role of socioeconomic status at birth.

BACKGROUND: Maternal problems in the postpartum period may lead to suboptimal long-term health for women and could affect mother-child attachment. Social disadvantage is a risk factor for preterm birth, which carries its own burden of health issues and stress. The main aim of this study was to investigate the role for social factors in mothers' physical and emotional health-related quality of life (HRQoL) at 1 year after a preterm birth. METHODS: EPIPAGE-2 is a French nationwide, prospective, population-based cohort of preterm children born before 35 weeks' gestation (N=3614 women). At birth, detailed data on the family's social status were collected. At 1 year after birth, mothers completed a mailed questionnaire to report information on their HRQoL, assessed by the Medical Outcomes Study 12-item Short Form. We used multivariate linear regression models to assess the association between social factors and maternal HRQoL. RESULTS: At 1 year after childbirth, the emotional HRQoL of mothers of preterm children was worse than their physical HRQoL, even in women without any previous signs of psychological distress at the infant's discharge from hospital. Baseline social characteristics were the most important factors influencing the physical component of HRQoL. None of the studied social factors had any clear association with the mental component of HRQoL. CONCLUSION: Our study underlines the importance of social disadvantage during pregnancy as risk factors for poor physical HRQoL at 1 year after a preterm birth.

Editorial: Considerations and Implications of a Nuanced Understanding of Neonatal Intensive Care Unit Distress for the Long-term Mental Health of Diverse Mothers and Children.

The perinatal period (pregnancy up to 1 year postpartum) is one of immense psychological and physical changes, many of which increase the risk for psychopathology for parent-child dyads. Families with infants requiring neonatal intensive care unit (NICU) interventions face additional challenges and distress in both the short and long term. Approximately 7% to 12% of infants require NICU admission for many factors including prematurity and neonatal complications1; 2% to 30% experience postpartum depression.2 Although something is known about NICU distress, a nuanced understanding of the experiences of NICU families is lacking, including their effects on longer-term mental health for parents and children. This is particularly true for families of minoritized groups, who often experience additional stressors, including interpersonal and systemic racism as well as differential Social Determinants of Health (SDoH)-the conditions in which people are born, grow, live, work, and age.

Parent Survey Identifies Low-Cost Emotional and Educational Supports in NICU and Beyond.

BACKGROUND: Families face significant mental health challenges after preterm birth. However, there are few low-cost and sustainable services to help with mental health challenges. PURPOSE: To understand suggestions for low-cost and sustainable mental health supports to help families. METHODS: This was an internet-based survey made available to preterm families through the Canadian Premature Babies Foundation social media (Facebook private parents' group). RESULTS: Families reported that peer support, such as connecting with other parents and families who experience preterm birth, was most beneficial. Parents also reported ways to allow families to access the existing mental health services, such as providing child care options and improving advertisement of available resources. IMPLICATIONS: Our results can help implement beneficial low-cost and sustainable mental health supports across many contexts (eg, hospitals and community organization) both in-person and online.

Assessing factors associated with poor maternal mental health among mothers of children born small and sick at 24-47 months in rural Rwanda.

BACKGROUND: Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24-47 months of age in rural Rwanda. METHODS: Cross-sectional study of children 24-47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015-April 2016 or discharged and enrolled in a NCU follow-up program from May 2016-November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child's development; children's anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression. RESULTS: Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70-0.92) and being married (OR = 0.12, 95% CI 0.04-0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health. CONCLUSIONS: Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother's poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.

Socioeconomic status and brain injury in children born preterm: modifying neurodevelopmental outcome.

Improved intensive care therapies have increased the survival of children born preterm. Yet, many preterm children experience long-term neurodevelopmental sequelae. Indeed, preterm birth remains a leading cause of lifelong neurodevelopmental disability globally, posing significant challenges to the child, family, and society. Neurodevelopmental disability in children born preterm is traditionally linked to acquired brain injuries such as white matter injury and to impaired brain maturation resulting from neonatal illness such as chronic lung disease. Socioeconomic status (SES) has long been recognized to contribute to variation in outcome in children born preterm. Recent brain imaging data in normative term-born cohorts suggest that lower SES itself predicts alterations in brain development, including the growth of the cerebral cortex and subcortical structures. Recent evidence in children born preterm suggests that the response to early-life brain injuries is modified by the socioeconomic circumstances of children and families. Exciting new data points to the potential of more favorable SES circumstances to mitigate the impact of neonatal brain injury. This review addresses emerging evidence suggesting that SES modifies the relationship between early-life exposures, brain injury, and neurodevelopmental outcomes in children born preterm. Better understanding these relationships opens new avenues for research with the ultimate goal of promoting optimal outcomes for those children born preterm at highest risk of neurodevelopmental consequence.

Cross-cultural adaptation of the Preterm Parenting & Self-efficacy Checklist.

OBJECTIVE: To conduct a cross-cultural adaptation of the Preterm Parenting & Self-Efficacy Checklist to the Brazilian Portuguese. METHOD: A methodological study was carried out with 51 parents of premature infants. Data analysis was based on psychometric and inferential statistical analyses. RESULTS: The instrument content validation by experts obtained excellent agreement (97%) and the semantic analysis by the target population showed good understanding of the terms and ease of use. In test-retest, most participants were female (64.7%); and parents with higher education (47.1%). The instrument showed stability over time, with good internal consistency (α = 0.84). Four factors were generated in the subscales parenting self-efficacy, importance of tasks and self-perceived parental competence (67.0% to 74.2% of the variance). CONCLUSION: The properties of the Preterm Parenting & Self-Efficacy Checklist - Brazilian Version were maintained, which is a reliable indicator to evaluate the hospital discharge of premature infants.

Prediction of school outcome after preterm birth: a cohort study.

OBJECTIVE: To identify if the educational trajectories of preterm infants differ from those of their term peers. DESIGN: This work is based on the Avon Longitudinal Study of Parents and Children (ALSPAC). Educational measures were categorised into 10 deciles to allow comparison of measures across time periods. Gestational age was categorised as preterm (23-36 weeks) or term (37-42 weeks). Multilevel mixed-effects linear regression models were derived to examine the trajectories of decile scores across the study period. Gestational group was added as an interaction term to assess if the trajectory between educational measures varied between preterm and term infants. Adjustment for possible confounders was performed. SUBJECTS: The final dataset contained information on 12 586 infants born alive at between 23 weeks and 42 weeks of gestation. MAIN OUTCOME MEASURES: UK mandatory educational assessments (SATs) scores throughout educational journal (including final GCSE results at 16 years of age). RESULTS: Preterm infants had on average lower Key Stage (KS) scores than term children (-0.46 (-0.84 to -0.07)). However, on average, they gained on their term peers in each progressive measure (0.10 (0.01 to 0.19)), suggesting 'catch up' during the first few years at school. Preterm infants appeared to exhibit the increase in decile scores mostly between KS1 and KS2 (p=0.005) and little between KS2 and KS3 (p=0.182) or KS3 and KS4 (p=0.149). CONCLUSIONS: This work further emphasises the importance of early schooling and environment in these infants and suggests that support, long after the premature birth, may have additional benefits.

Non-Nutritive Sucking in the Preterm Infant.

OBJECTIVE: To identify the progression of non-nutritive sucking (NNS) across postmenstrual age (PMA) and to investigate the relationship of NNS with medical and social factors and oral feeding. STUDY DESIGN: Fifty preterm infants born at ≤32 weeks gestation had NNS assessed weekly starting at 32 weeks PMA with the NTrainer System. Oral feeding was assessed at 38 weeks PMA. RESULTS: There were increases in NNS bursts per minute (p = 0.005), NNS per minute (p < 0.0001), NNS per burst (p < 0.001), and peak pressure (p = 0.0003) with advancing PMA. Level of immaturity and medical complications were related to NNS measures (p < 0.05). NNS measures were not related to Neonatal Oral Motor Assessment Scale scores. Smaller weekly change in NNS peak pressure (p = 0.03; ß = -1.4) was related to feeding success at 38 weeks PMA. CONCLUSION: Infants demonstrated NNS early in gestation. Variability in NNS scores could reflect medical complications and immaturity. More stable sucking pressure across time was related to feeding success at 38 weeks PMA.

Cross-cultural adaptation of the Preterm Parenting & Self-efficacy Checklist / Adaptación transcultural de Preterm Parenting & Self-efficacy Checklist / Adaptação transcultural do Preterm Parenting & Self-Efficacy Checklist

ABSTRACT Objective: To conduct a cross-cultural adaptation of the Preterm Parenting & Self-Efficacy Checklist to the Brazilian Portuguese. Method: A methodological study was carried out with 51 parents of premature infants. Data analysis was based on psychometric and inferential statistical analyses. Results: The instrument content validation by experts obtained excellent agreement (97%) and the semantic analysis by the target population showed good understanding of the terms and ease of use. In test-retest, most participants were female (64.7%); and parents with higher education (47.1%). The instrument showed stability over time, with good internal consistency (α = 0.84). Four factors were generated in the subscales parenting self-efficacy, importance of tasks and self-perceived parental competence (67.0% to 74.2% of the variance). Conclusion: The properties of the Preterm Parenting & Self-Efficacy Checklist - Brazilian Version were maintained, which is a reliable indicator to evaluate the hospital discharge of premature infants.

RESUMEN Objetivo: Realizar la adaptación transcultural de Preterm Parenting & Self-Efficacy Checklist para el portugués de Brasil. Método: Estudio metodológico, en el cual participaron 51 padres de recién nacidos prematuros. En el análisis de datos se utilizaron la psicometría y la estadística inferencial. Resultados: La validación de contenido del instrumento por los expertos obtuvo una concordancia excelente (97%), y el análisis semántico con la población demostró comprensión de los términos y facilidad en su utilización. En el test-retest, hubo la mayoría de participantes del sexo femenino (64,7%); y de padres con enseñanza superior (47,1%). El instrumento fue estable a lo largo del tiempo, presentando una buena consistencia interna (α = 0.84). Se generaron cuatro factores en las subescalas: autoeficacia parental; importancia de las tareas; y competencia parental autopercibida (del 67,0% al 74,2% de la varianza). Conclusión: Las propiedades de Preterm Parenting & Self-Efficacy Checklist -versión brasileña- se mantuvieron, lo que configura como un indicador fiable de evaluación del alta hospitalaria del prematuro.

RESUMO Objetivo: Realizar a adaptação transcultural do Preterm Parenting & Self-Efficacy Checklist para o português brasileiro. Método: Estudo metodológico, realizado com 51 pais de recém-nascidos prematuros. A análise dos dados utilizou-se da psicometria e da estatística inferencial. Resultados: A validação de conteúdo do instrumento pelos especialistas obteve concordância excelente (97%), e a análise semântica com a população-alvo demonstrou compreensão dos termos e facilidade na sua utilização. No teste-reteste, houve maioria de participantes do sexo feminino (64,7%) e de pais com ensino superior (47,1%). O instrumento apresentou estabilidade ao longo do tempo, com boa consistência interna (α = 0.84). Quatro fatores foram gerados nas subescalas "autoeficácia parental", "importância das tarefas" e "competência parental autopercebida" (67,0% a 74,2% da variância). Conclusão: Houve a manutenção das propriedades do Preterm Parenting & Self-Efficacy Checklist - Versão Brasileira, que se configura como um indicador confiável para avaliar a alta hospitalar do prematuro.

Being a mother of preterm multiples in the context of socioeconomic disadvantage: perceived stress and psychological symptoms / Ser mãe de múltiplos prematuros no contexto de desvantagem socioeconômica: estresse percebido e sintomas psicológicos

Abstract Objective: This study aimed to examine the differences between mothers of preterm multiples and mothers of preterm singletons regarding perceived stress and maternal psychological symptoms, and to explore the putative adverse amplified effect of socioeconomic disadvantage. Method: Ninety-five mothers of 1-year-olds born preterm participated in this cross-sectional study. Data collection was carried out in two public hospitals from Northern Portugal. To assess maternal perceived daily stress and psychological symptoms, mothers completed two questionnaires. Mothers reported on socioeconomic factors, including family poverty, parent unemployment, and low education, and two groups of family socioeconomic disadvantage were created. A child medical risk index was calculated. Results: Results indicated that mothers of preterm multiples reported higher levels of stress than mothers of preterm singletons. Moreover, and specifically regarding psychological functioning, mothers of preterm multiples reported more symptoms than mothers of preterm singletons, but only when living in a context of socioeconomic adversity. Conclusions: The results of the present study have important implications for practice. Mothers of preterm multiples are at higher risk to present mental health difficulties, in comparison to mothers of singletons, especially when exposed to socioeconomic adversities. The development of psychosocial intervention programs and public policies are of decisive importance in helping mothers of multiples adjust to parenthood.

Resumo Objetivo: Examinar as diferenças entre mães de múltiplos prematuros e mães de filhos únicos prematuros a respeito de estresse percebido e sintomas psicológicos maternos e explorar o efeito adverso amplificado putativo da desvantagem socioeconômica. Método: Participaram deste estudo transversal 95 mães de crianças de um ano nascidas prematuras. A coleta de dados foi feita em dois hospitais públicos do norte de Portugal. Para avaliar o estresse diário percebido e os sintomas psicológicos maternos, as mães responderam dois questionários. As mães relataram fatores socioeconômicos, incluindo pobreza familiar, desemprego dos pais e baixo nível de escolaridade, e foram criados dois grupos de desvantagem socioeconômica familiar. Foi calculado um índice de risco médico infantil. Resultados: Os resultados indicaram que as mães de múltiplos prematuros relataram maiores níveis de estresse do que as mães de filhos únicos prematuros. Além disso e especificamente com relação ao funcionamento psicológico, as mães de múltiplos prematuros relataram mais sintomas do que as mães de filhos únicos prematuros, porém apenas quando moravam em um contexto de adversidade socioeconômica. Conclusões: Os resultados deste estudo possuem importantes implicações para a prática. As mães de múltiplos prematuros apresentam maior risco de dificuldades de saúde mental, em comparação a mães de filhos únicos, principalmente quando expostas a adversidades socioeconômicas. O desenvolvimento de programas de intervenção psicossocial e políticas públicas é de importância decisiva ao ajudar as mães de filhos múltiplos a se ajustarem à maternidade.

Nonword Repetition and Language Outcomes in Young Children Born Preterm.

Purpose: The aims of this study were to examine phonological short-term memory in children born preterm (PT) and to explore relations between this neuropsychological process and later language skills. Method: Children born PT (n = 74) and full term (FT; n = 60) participated in a nonword repetition (NWR) task at 36 months old. Standardized measures of language skills were administered at 36 and 54 months old. Group differences in NWR task completion and NWR scores were analyzed. Hierarchical multiple regression analyses examined the extent to which NWR ability predicted later performance on language measures. Results: More children born PT than FT did not complete the NWR task. Among children who completed the task, the performance of children born PT and FT was not statistically different. NWR scores at 36 months old accounted for significant unique variance in language scores at 54 months old in both groups. Birth group did not moderate the relation between NWR and later language performance. Conclusions: These findings suggest that phonological short-term memory is an important skill underlying language development in both children born PT and FT. These findings have relevance to clinical practice in assessing children born PT.

Maternal sociodemographic factors differentially affect the risk of behavioral problems in Brazilian and Italian preterm toddlers.

The main aim of the present study was to examine differences in behavioral problems in toddlers born very preterm in Brazil and Italy. The sample comprised 154 toddlers (18-24 months of age) born very preterm, including 76 toddlers from Brazil and 78 toddlers from Italy. The Child Behavior Checklist was used to assess behavioral problems. Specific sociodemographic factors (i.e., maternal age at childbirth and maternal education) and neonatal factors (i.e., gestational age, sex, and length of hospitalization) were tested as potential mediators of country-related differences in behavioral problems. Brazilian toddlers presented more internalizing, externalizing, and total behavioral problems compared with their Italian counterparts. The effect of country on the toddlers' internalizing and total behavioral problems was mediated by maternal age at childbirth and education. Independent effects of country, maternal age at childbirth, and maternal education emerged for externalizing behavioral problems. No significant effect emerged for neonatal variables. These findings suggest that sociodemographic factors, in addition to country-related differences, should be considered when assessing the risk of behavioral problems in preterm toddlers.

Being a mother of preterm multiples in the context of socioeconomic disadvantage: perceived stress and psychological symptoms.

OBJECTIVE: This study aimed to examine the differences between mothers of preterm multiples and mothers of preterm singletons regarding perceived stress and maternal psychological symptoms, and to explore the putative adverse amplified effect of socioeconomic disadvantage. METHOD: Ninety-five mothers of 1-year-olds born preterm participated in this cross-sectional study. Data collection was carried out in two public hospitals from Northern Portugal. To assess maternal perceived daily stress and psychological symptoms, mothers completed two questionnaires. Mothers reported on socioeconomic factors, including family poverty, parent unemployment, and low education, and two groups of family socioeconomic disadvantage were created. A child medical risk index was calculated. RESULTS: Results indicated that mothers of preterm multiples reported higher levels of stress than mothers of preterm singletons. Moreover, and specifically regarding psychological functioning, mothers of preterm multiples reported more symptoms than mothers of preterm singletons, but only when living in a context of socioeconomic adversity. CONCLUSIONS: The results of the present study have important implications for practice. Mothers of preterm multiples are at higher risk to present mental health difficulties, in comparison to mothers of singletons, especially when exposed to socioeconomic adversities. The development of psychosocial intervention programs and public policies are of decisive importance in helping mothers of multiples adjust to parenthood.

Factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit: a qualitative study.

AIM: The aim of this study was to explore factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit. BACKGROUND: Transition to motherhood often causes significant issues in terms of adaptation to the role of motherhood. The main factors leading to parental stress, especially in the neonatal intensive care unit, have shown that the greatest source of stress is the loss of women's role as mothers. DESIGN: It was a qualitative study with content analysis approach. METHODS: Semi-structured in-depth interviews were used for data collection. Interviews were conducted with 17 mothers of preterm infants (under 36 weeks) who had been hospitalized for at least one week in the neonatal intensive care unit. Purposive sampling with maximum diversity was used to recruit mothers in Kermanshah province (west of Iran). Data was collected during 2013-2014. Interviews were recorded and transcribed verbatim. Data were analysed using conventional content analysis. FINDINGS: Explanation of the mothers' perspective towards factors affecting adaptation to the role of motherhood led to two main categories of individual factors (emotional distress, self-efficacy, interaction and alienation) and social factors (support, prejudice). CONCLUSION: Adaptation to the role of motherhood can be promoted through supporting mothers of preterm infants, empowering them and increasing their self-efficacy, to eliminate negative factors and emotions.

Low Exercise Capacity Increases the Risk of Low Cognitive Function in Healthy Young Men Born Preterm: A Population-Based Cohort Study.

BACKGROUND: Preterm birth is a risk factor for decreased exercise capacity and impaired cognitive functions in later life. The objective of this study was to disentangle the associations between preterm birth, physical fitness and cognitive performance in young adulthood. METHODS: This population-based cohort study included 218,802 young men born in Sweden 1973-1983. Data on birth characteristics was obtained from the Medical Birth Register and linked to exercise capacity assessed by ergometer cycling and cognitive tests performed at conscription for military service in 1993-2001. Cognitive performance was assessed using stanine (STAndard NINE) scores. The results were adjusted for socioeconomic factors. RESULTS: Exercise capacity was positively associated with cognitive performance across all gestational ages. The sub-group of men who were born extremely preterm (gestational age <28 weeks) and had low exercise capacity exhibited the lowest odds ratio (OR = 0.26, 95%CI:0.09-0.82) of having a cognitive function above the mean stanine score (2.9) for men born at term with normal birth weight. Men born extremely preterm with a high exercise capacity had similar or even higher ORs for cognitive function (OR = 0.59; 95% CI:0.35-0.99) than men born at term with low Wmax (OR = 0.57; 95% CI:0.55-0.59). CONCLUSIONS: Physical fitness is associated with higher cognitive function at all gestational ages, also in young men born extremely preterm. Targeting early physical exercise may be a possible intervention to enhance cognitive performance and educational achievements in populations at risk, such as childhood and adult survivors of preterm birth.

Propuesta de evaluación del procesamiento sensorial de recién nacidos de pretérmino: favoreciendo el goodness of fit con sus padres y la autorregulación / Sensory processing assessment proposal for preterm new born: enhancing self regulation and goodness of fit with their parents

En este artículo se muestra el desarrollo de un instrumento para evaluar el procesamiento sensorial a través de la observación y registro de las conductas de recién nacidos de pretérmino en las unidades de neonatología. Este es un cuestionario que contiene 21 preguntas que se responden en conjunto con los padres. El principal objetivo de esta evaluación es poder facilitar las habilidades de éstos para observar y reconocer las conductas de sus hijos. Lo que podría llevarnos a facilitar un mejor calce entre la madre – padre y el bebé.Este buen calce o Goodness of Fit entre los padres y sus hijos hace referencia a que los padres puedan reconocer e interpretar las conductas de sus hijos o hijas y que de esta forma puedan responder de manera más atingente a sus necesidades. Esto tendría un importante impacto en las capacidades del bebé para regularse y también sobre los padres para desarrollar una mayor sensación de eficacia en su rol de cuidador.

This article presents an instrument for assessing the sensory processing through the observation and record of preterm babies behavior. This instrument has 21 questions that must be answered with the babies’ parents. The main goal of this measure is to favor the parents’ abilities to observe and recognize their babies’ behaviors. This could favor the Goodness of Fit between the mother father and the new born. This Goodness of Fit between the parents and the baby refers to the ability to recognize and read their babies’ cues and being able to answer in a satisfactory way to their new born needs. This could have an important effect on their babies’ regulation and on the parents feeling of efficacy in their role.

SUPPORTING PRETERM INFANT ATTACHMENT AND SOCIOEMOTIONAL DEVELOPMENT IN THE NEONATAL INTENSIVE CARE UNIT: STAFF PERCEPTIONS.

The infant-parent relationship has been shown to be of particular significance to preterm infant socioemotional development. Supporting parents and infants in this process of developing their relationships is an integral part of neonatal intensive care; however, there is limited knowledge of NICU staff perceptions about this aspect of care. To explore NICU staff perceptions about attachment and socioemotional development of preterm infants, experience of training in this area and the emotional impact of their work. A cross-sectional questionnaire survey of staff perceptions of the emotional experiences of parents and the developing parent-infant relationship in an NICU was conducted in a Level III NICU, after pilot testing, revision, and ethical approval. Fifty-seven (68%) of NICU staff responded to the survey. Respondents identified parents' emotional experiences such as "anxiety," "shock," "loss of control," and "lack of feelings of competence as parents" as highly prevalent. Infant cues of "responding to parent's voice" and "quieting-alerting" were ranked most highly; "crying" and "physiological changes" were ranked lowest. Preterm infant medical risk, maternal emotional state, and mental health are perceived to impact most highly on the developing relationship, as compared with infant state or behavior and socioeconomic factors. Fifty-three (93%) respondents felt confident, and 50 (87.8%) felt competent discussing their emotional experiences with parents. Fifty-four (95%) responded that attending to these areas was an integral part of their role; however, staff had seldom received education in this area. Respondents also perceived that specific psychological support for parents was lacking both during and after the infant's discharge. While all staff surveyed perceived the nature of their work to be emotionally stressful, there were differences among NICU staff disciplines and with years of experience in the NICU in terms of their perceptions about education in this area, the place of supervision for staff, and in relation to opportunities to discuss the emotional impact of the work on staff. NICU staff perceive their role as integral to supporting the developing parent-infant relationship and preterm infant socioemotional development; however, education in this area and provision of specific psychological support are lacking. Opportunities for staff to discuss and reflect on this aspect of their work should be developed and evaluated given the essential, but emotionally challenging, nature of their work with preterm babies and their parents.

Effect of socioeconomic status on psychosocial problems in 5- to 6-year-old preterm- and term-born children: the ABCD study.

This study aimed at analysing the association between socioeconomic status (SES) and psychosocial problems in preterm- and term-born children. Scores of mothers and teachers on the Strengths and Difficulties Questionnaire (SDQ) regarding 217 preterm-born children (<37 weeks' gestation, mean 34 weeks) were compared with 4336 term-born children in the Amsterdam Born Children and their Development (ABCD) cohort at age 5-6 years. Associations between SDQ scores and SES (maternal education and perceived income adequacy) were examined with multivariate linear regression analysis. The mean mother-reported total difficulties score was significantly higher for preterm children (6.1 ± 4.7) than for term children (5.2 ± 4.1). After covariate adjustment, this difference was 0.5 (95 % CI 0.0-1.0). For preterm children 16.1 % of the mothers reported psychosocial problems compared with 10.1 % for term children. Lower maternal education and lower income adequacy were significantly related to higher SDQ scores of mothers and teachers. Differences in mothers' SDQ score between preterm and term children were larger in the high-education (Δ0.9, 95 % CI 0.2-1.5) and high-income group (Δ0.9, 95 % CI 0.3-1.6). No significant differences were found between preterm and term children in the SDQ scores reported by teachers. Low level of maternal education and inadequate income showed a much stronger association with psychosocial problems than preterm birth. No combined effect of low SES and preterm birth was found. This study corroborates the evidence for the strength of the disadvantageous effects of low SES on early psychosocial development.

Developmental assessment of VLBW infants at 18 months of age: A comparison study between KSPD and Bayley III.

AIM: To assess the developmental characteristics of very low-birth-weight (VLBW) infants using the Kyoto Scale of Psychological Development (KSPD) and to compare with those using the Bayley Scales, third edition (Bayley III). METHODS: KSPD and Bayley III were performed on 124 Japanese VLBW infants at 18months of corrected age at a 2-week interval by trained psychologists. The relationships between KSPD and Bayley III in corresponding pairs: Cognitive-Adaptive (C-A) developmental quotient (DQ) and cognitive composite (Cog) scores, Language-Social (L-S) DQ and language composite (Lang) scores, and Postural-Motor (P-M) DQ and motor composite (Mot) scores were analyzed. RESULTS: The means [SD] of C-A DQ, L-S DQ, P-M DQ, and overall DQ of KSPD were 94 [15], 90 [17], 89 [15], and 93 [14], respectively. The means [SD] of the Cog, Lang, and Mot scores of Bayley III were 96 [13], 84 [12], and 91 [12], respectively. The DQ of KSPD strongly correlated with the corresponding composite score of Bayley III; Spearman rank correlations between the Cog score and C-A DQ, the Lang score and L-S DQ, and the Mot score and P-M DQ were 0.65, 0.71 and 0.55, respectively. The selected cut-off of the Cog score of <85 accurately identified development delay, defined by KSPD, with sensitivity of 100% and specificity of 85%. CONCLUSION: Although absolute value of the Bayley III score may not represent the degree of impairment, the developmental characteristics on KSPD well correlated with those on Bayley III. The developmental outcomes of Japanese VLBW infants were verified by the two tests.

Comparison of Griffiths-II and Bayley-II tests for the developmental assessment of high-risk infants.

INTRODUCTION: Two important risk factors for abnormal neurodevelopment are preterm birth and neonatal hypoxic ischemic encephalopathy. The new revisions of Griffiths Mental Development Scale (Griffiths-II, [1996]) and the Bayley Scales of Infant Development (BSID-II, [1993]) are two of the most frequently used developmental diagnostics tests. The Griffiths-II is divided into five subscales and a global development quotient (QD), and the BSID-II is divided into two scales, the Mental scale (MDI) and the Psychomotor scale (PDI). The main objective of this research was to establish the extent to which developmental diagnoses obtained using the new revisions of these two tests are comparable for a given child. MATERIAL AND METHODS: Retrospective study of 18-months-old high-risk children examined with both tests in the follow-up Unit of the Clinic of Neonatology of our tertiary care university Hospital between 2011 and 2012. To determine the concurrent validity of the two tests paired t-tests and Pearson product-moment correlation coefficients were computed. Using the BSID-II as a gold standard, the performance of the Griffiths-II was analyzed with receiver operating curves. RESULTS: 61 patients (80.3% preterm, 14.7% neonatal asphyxia) were examined. For the BSID-II the MDI mean was 96.21 (range 67-133) and the PDI mean was 87.72 (range 49-114). For the Griffiths-II, the QD mean was 96.95 (range 60-124), the locomotors subscale mean was 92.57 (range 49-119). The score of the Griffiths locomotors subscale was significantly higher than the PDI (p<0.001). Between the Griffiths-II QD and the BSID-II MDI no significant difference was found, and the area under the curve was 0.93, showing good validity. All correlations were high and significant with a Pearson product-moment correlation coefficient >0.8. CONCLUSIONS: The meaning of the results for a given child was the same for the two tests. Two scores were interchangeable, the Griffiths-II QD and the BSID-II MDI.