COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU-An exploratory cross-sectional study.

AIM: To describe the impact of the COVID-19 restrictions on the caregiving activities and psychological well-being of fathers with infants admitted to neonatal units. METHODS: Cross-sectional study using adapted COPE-IS and COPE-IU tools. Participants' recruitment occurred online via social media and parents' associations. Online survey in English, French and Italian were distributed and promoted via websites and social media platforms of parent's associations. The study was undertaken across 12 countries in Asia, Australia, Africa and Europe. RESULTS: A total of 108 fathers of NICU infants completed the survey. COVID-19 related restrictions were categorised into 3 types: no restrictions, partial and severe restrictions. Fathers who experienced partial restrictions reported more involvement in caregiving activities but high levels of emotional difficulties and sleeping problems compared to those who experienced full or no restrictions. CONCLUSION: Given the impact on the psychological well-being of fathers, restrictions should be avoided as much as possible in the neonatal unit and fathers given free access to their infants if they follow appropriate infection control precautions.

Supporting the adolescent mother-infant relationship: preliminary trial of a brief perinatal attachment intervention.

The purpose of this study is to test a brief, attachment intervention added to routine maternity care that aims to improve the adolescent mother-infant relationship during transition to motherhood. A pre-test, post-test, peer-control-group trial was set in a large tertiary maternity hospital in Melbourne, Australia. Participants were multi-cultural, pregnant adolescents (n = 97). The two-session 'AMPLE' intervention was provided in late pregnancy and neonatally. The main outcome measure was mother-infant interaction quality at age 4 months, blind-coded using the Emotional Availability Scales (EAS) (fourth edition). Study acceptability was high: participation rate 82.9 % and completion rate 75.3 %. Thirty-five participants received the intervention plus usual care (intervention group) and 38 received usual care (control group). There were no pre-test between-group differences across demographic, psychosocial or obstetric domains. At post-test, mother-infant interaction was significantly better in the intervention group. MANOVA analyses showed an overall intervention effect on emotional availability in 20 min of free play (n = 73), F (6,65) = 5.05, p < .01, partial η (2) = .32, and in 25 min of play plus brief separation-reunion (n = 55), F (6,48) = 2.72, p = .02, partial η (2) = .25. T tests showed significant between-group differences in specific EAS subscales. All effect sizes were medium-large. This promising intervention appears to exert a clinically meaningful effect on the adolescent mother-infant relationship. Further research is warranted to replicate the findings and confirm causality. The study suggests a brief attachment focus, incorporated into routine maternity care, could influence the developmental trajectory of infants of young mothers from birth.

A randomised trial of two techniques for bottle feeding preterm infants.

AIM: Preterm infants begin the transition from gastric tube feeds to sucking feeds around 34 weeks' postmenstrual age. We compared physiological stability in two bottle feeding positions, cradle hold versus side lying in preterm infants. METHODS: Randomised crossover trial of infants <34 weeks' gestation at birth, ≥34 weeks' postmenstrual age at study and receiving at least two sucking feeds/day. Two feeds were studied on successive days. A pulse oximeter measured oxygen saturation (SpO2) and heart rate (HR) before, during and 30 min after feeds. Continuous data were compared using paired t-tests and proportions using chi squared. RESULTS: Twenty-five study infants were mean (standard deviation (SD)) 37 (2.4) weeks' post-menstrual age and 2740 (589) g at study. There was little difference in mean (SD) SpO2 during feeds between the cradle-hold and side-lying position 94 (6) % versus 95 (6) %, respectively (P = 0.55, confidence interval (CI) -1.4, 5.4). During feeds, 17/25 (68%) experienced a period of SpO2 <80% in the cradle-hold position compared with 14/25 (56) % in the side-lying position (P = 0.26, CI 0.68, 4.10). There were no significant differences in the mean HR or number of episodes of bradycardia HR <100 bpm. There was a trend towards infants consuming a smaller mean (SD) proportion of their feed in the cradle-hold position compared with the side-lying position, 82 (25) % versus 87 (20) % (P = 0.08, CI -0.64, 10.00). CONCLUSIONS: There was little difference in infants' physiological stability between the two bottle feeding positions. Both methods may be appropriate for the transition from gastric tube to sucking feeds in preterm infants.

Consultation-liaison psychiatry in a maternity hospital.

OBJECTIVE: The aim of the study was to describe referral patterns of maternity inpatients to the consultation-liaison psychiatry (CLP) service at a large women's hospital in metropolitan Melbourne, Australia. METHOD: Clinicians recorded socio-demographic data, referring unit, consultee's reason for referral, psychiatric diagnosis made, and treatment provided for all maternity inpatients referred from 2004 to 2008. RESULTS: Main reasons for referral were detection of depression, past psychiatric history, and concern regarding a woman's coping. Most common diagnoses were depression, substance use disorders and anxiety disorders. Many women referred for assessment while inpatients were initially seen in the antenatal period. CONCLUSIONS: Pregnant women referred to a CLP service present with a range of mental health problems, most often depression, anxiety and substance use disorders. Many of these problems are evident in and require intervention during the antenatal period as well as at the time of confinement. CLP services to maternity hospitals should be provided in the antenatal as well as the inpatient setting.

My Kite Will Fly: Improving Communication and Understanding in Young Children When a Mother Is Diagnosed with Life-Threatening Gynecological Cancer.

STUDY AIMS: The My Kite Will Fly (MKWF) research program is built on the well-documented need for effective clinical communication tools and therapeutic interventions where a child's mother is diagnosed with life-threatening gynecological cancer. METHODS: The Dignity Model and Child-Centered approach were two key study foundations in this pilot cohort. Quantitative survey and qualitative semistructured methods were employed to gather data from patient families at three distinct phases: Diagnosis, Treatment, and Palliative care. Participants were identified from patient groups at The Royal Women's Hospital and Peter MacCallum Cancer Center, Melbourne, Australia. A purposive sample (n = 36 children) (24 girls and 12 boys aged between 3 and 12 years) drawn from 19 families completed structured art therapy workbook activities. The principal researcher and a specialist educational assistant undertook cross-case thematic analysis of all interviews and children's drawings. RESULTS: Five central themes were profiled in six illustrative case studies. Interviews with all families (n = 19) showed 86.1% positive evaluation of the MKWF workbook template at diagnosis. During treatments, 66.6% of parents reported better understanding of the chemotherapy process and better communication with younger family members. At palliative care, 97.3% of families reported stabilization of family routines and improved illness coping. Exit interviews with six children and surviving parents (n = 4) showed that the program substantially prepared them for parental bereavement. CONCLUSIONS: Results from this pilot cohort confirm the importance of enhanced parent-child communication and stabilized family routines. Current results provide an important platform for future evaluative research among larger patient-family populations across multisite oncology settings.

Recognizing the infant as subject in infant-parent psychotherapy.

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.

Perinatal mental health: Fathers - the (mostly) forgotten parent.

INTRODUCTION: The importance of parental mental health as a determinant of infant and child outcomes is increasingly acknowledged. Yet, there is limited information regarding paternal mental health during the perinatal period. The aim of this review is to summarize existing clinical research regarding paternal mental health in the perinatal period in various contexts, and its possible impact on infant development. METHOD: An electronic literature search was conducted using MEDLINE and PubMed databases. Key texts were used to cross-check for any further articles of interest. RESULTS: Men are at increased risk of mental health problems during the transition to fatherhood, as well as during the perinatal period. Paternal mental health during the perinatal period has been shown to impact on their child's emotional and behavioral development. However, research addressing the needs of fathers with mental illness and the impact of their illness on their infant and family has been limited. CONCLUSIONS: A paradigm shift is required, from a focus on women following childbirth and women with pre-existing psychiatric disorders, to a broader family perspective with the focus firmly on parent-infant relationships. This paradigm shift needs to involve greater research into the fathering role and paternal mental illness during the perinatal period, including further studies into risk factors, impact on the family system, and the most appropriate form of intervention and service provision.

A contribuição de um bebê para o feminino com prazer na intervenção perinatal / An infant's contribution towards the joyful feminine in perinatal intervention / La contribución de un bebé para el femenino con placer en la intervención perinatal / La contribution d'un bébé au féminin et au plaisir dans l'intervention périnatal

O artigo defende dois pontos de vista principais: analisa a contribuição de um bebê para o feminino, de acordo com noções psicanalíticas ocidentais, para tentar alinhar a psicanálise com a clínica da saúde mental de bebês, ligar esses pontos de vista ao dos estudos sobre o bebê (e da neurociência), vincular a psicanálise às ciências afins e ilustrar a abordagem intersubjetiva em psicoterapia breve perinatal pais-bebê.

The paper makes two main points, firstly, considering a baby's contribution to the feminine within psychoanalytic western notions, to try to align psychoanalysis with clinical infant mental health, to bridge these perspectives with those from infant studies (and neuroscience), linking psychoanalysis with nearby sciences and illustrating an intersubjective approach in brief perinatal infant-parent psychotherapy.

El artículo defiende dos puntos de vista principales: en primer lugar, analiza la contribución de un bebé para el femenino, de acuerdo con nociones psicoanalíticas occidentales, para intentar alinear el psicoanálisis con la clínica de salud mental de bebés, relacionar estos puntos de al de los estudios sobre el bebé (y la neurociencia), vincular el psicoanálisis a las ciencias afines e ilustrar el abordaje intersubjetivo en psicoterapia breve perinatal papás-bebé.

L'article soutient deux points de vue principaux : d'abord, il analyse la contribution d'un bébé au féminin, selon les notions psychanalytiques occidentales, pour ensuite essayer d'aligner la psychanalyse sur la clinique de santé mental de bébés, relier ces points de vue aux études concernant ces derniers (et la neuroscience), lier la psychanalyse aux sciences affins et illustrer l'approche intersubjective en psychothérapie brève périnatale parents-bébé.