Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences.

BACKGROUND: In recent decades, modern neonatal intensive care has improved, increasing the survival of extremely preterm children. Few studies have examined the experiences of parents of extremely preterm children from a long-term perspective. AIM: To describe parents' experiences of parenting extremely preterm children during their childhood and transition to adulthood. STUDY DESIGN: A qualitative interview study with a descriptive design. SUBJECTS: Thirteen parents of eleven children born at 24 gestational weeks in Sweden, 1990-1992, participated in individual semi-structured interviews. OUTCOME MEASURES: Data were analyzed using qualitative reflexive thematic analysis. RESULT: Five themes forming a timeline were created in the analytic process: parenthood, at the NICU, young childhood, adolescence, and adulthood. Various aspects affecting parenthood were described throughout the timeline, and occasionally the parents experienced difficulties dealing with their children's special physical and/or mental needs. Today, some families have established a functioning situation despite their children's physical and/or mental difficulties, while some still struggle with their children's everyday life. CONCLUSION: Having an extremely preterm family member profoundly affects the whole family for various lengths of time. Parents expressed a need for support from both healthcare and school throughout their children's childhood and in their transition to adulthood, although the need varies between parent-child pairs. By studying the parents' experiences, their need for support can be further recognized and understood, and developed and improved accordingly.

Lipid Peroxidation and Antioxidative Capacity Are Unaltered in Transitional Breast Milk Exposed to Light from Women Giving Birth to Preterm Infants before 32 Weeks of Gestation.

Breast milk (BM) is the primary nutrition for infants and has a high content of lipids. Preterm infants receive expressed BM via tube feeding, and they are frequently treated with phototherapy. When parenteral nutrition (PN) is exposed to light and/or phototherapy, lipid peroxidation (LPO) increases. By light-protecting PN, morbidity and mortality are reduced in preterm infants through the reduction of oxidative stress. We aimed to investigate whether light-protecting breast milk could reduce LPO. Twelve mothers giving birth to a preterm infants of less than 32 weeks of gestational age were included. Transitional BM was collected and divided into three study groups; light-protected, ward light and phototherapy light. Baseline samples were collected after expression and the exposures started within one hour. Feeding syringe samples were exposed to light for 30 up to 360 min. Nasogastric tube samples were run through a tube under the same light conditions. Samples were stored in -80 °C until analyses of malondialdehyde (MDA), 4-hydroxynonenal (4-HNE) and total antioxidant capacity (TAC). There were no significant differences in MDA, 4-HNE or TAC levels observed between the different study groups. This study indicates that the light exposure of expressed transitional BM does not affect LPO and the levels of MDA, 4-HNE or TAC.

Neonatal resuscitation after birth: Swedish midwives' experiences of and perceptions about separation of mothers and their newborn babies.

INTRODUCTION: This study aimed to investigate midwives' experiences of and perceptions about mother-baby separation during resuscitation of the baby following birth. METHODS: A qualitative study was conducted using an author-designed questionnaire. Fifty-four midwives from two Swedish birth units with different working methods regarding neonatal resuscitation - at the mother's bedside in the birth room or in a designated resuscitation room outside the birth room - completed the questionnaire. Data were analyzed using qualitative content analysis. RESULTS: Most midwives had experience of removing a newborn baby in need of critical care from the birth room, thus separating the mother and baby. The midwives identified the difficulties and challenges involved in carrying out emergency care in the birth room after birth and had divergent opinions about what they considered possible in these birth situations. They agreed on the benefits, for both mother and baby, in performing emergency care in the birth room and avoiding a separation altogether, if possible. CONCLUSIONS: There are good opportunities to reduce separation of mother and baby after birth; training, knowledge, education and the right environmental conditions are important factors in successfully implementing new ways of working. It is possible to work towards reducing separation and this work should continue and strive to eliminate separation as far as possible.

Interventions for the Management of Pain and Sedation in Newborns Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: A Systematic Review.

BACKGROUND: Newborn infants undergoing therapeutic hypothermia (TH) are exposed to multiple painful and stressful procedures. The aim of this systematic review was to assess benefits and harms of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing TH for hypoxic-ischemic encephalopathy. METHODS: We included randomized and observational studies reporting any intervention (either drugs or non-pharmacological interventions) to manage pain and sedation in newborn infants (> 33 weeks' gestational age) undergoing TH. We included any dose, duration and route of administration. We also included any type and duration of non-pharmacological interventions. Our prespecified primary outcomes were analgesia and sedation assessed using validated pain scales in the neonatal population; circulatory instability; mortality to discharge; and neurodevelopmental disability. A systematic literature search was conducted in the PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, and Web of Science databases, with no language restrictions. Included studies underwent risk-of-bias assessment (Cochrane risk-of-bias tool and ROBINS-I) and data extraction performed by two authors independently. The plan had been to use effect measures such as mean difference for continuous outcomes and risk ratio for dichotomous outcomes, however the included studies are presented in a narrative synthesis due to their paucity and heterogeneity. RESULTS: Ten studies involving 3551 infants were included-one trial and nine observational studies. Most studies examined the use of phenobarbital or other antiepileptic drugs with primary outcomes related to seizure activity. The single trial that was included compared pentoxifylline with placebo. Among the primary outcomes, six studies reported circulatory instability and five reported mortality to discharge without relevant differences; two studies reported on neurodevelopmental disability and one study reported on pain scale. Three studies were ongoing. CONCLUSIONS: We found limited evidence to establish the benefits and harms of the interventions for the management of pain and sedation in newborn infants undergoing TH. Long-term outcomes were not reported. Given the very low certainty of evidence-due to imprecision of the estimates, inconsistency and limitations in study design (all nine observational studies with overall serious risk of bias)-for all outcomes, clinical trials are required to determine the most effective interventions in this population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42020205755.

Nursing care of infants born extremely preterm.

With improving survival at the lowest gestations an increasing number of tiny and vulnerable infants are being cared for, and optimal outcomes require an approach to care that takes their specific characteristics into account. These include immature organ function and a risk for iatrogenic injury, and parental/familial strain due to the high degree of uncertainty, infant-mother separation, and long hospital stay. While the challenges in providing nursing care to these infants are obvious it is also clear that this field has tremendous potential to influence both short and long-term outcomes of this population. This mini-review discusses aspects of the nursing care provided to infants born at the very lowest gestations and their families, with focus on doing less harm by establishing an adequate care environment, actively promoting parental closeness and care-giving, and conservative skin care.

Interventions for the management of Pain and Sedation in Newborns undergoing Therapeutic hypothermia for hypoxic-ischemic encephalopathy (IPSNUT): protocol of a systematic review.

BACKGROUND: Clinical research has shown that therapeutic hypothermia after neonatal hypoxic-ischemic injury improves survival without disability. There is no consensus regarding pain relief or sedation during therapeutic hypothermia in newborns; however, therapeutic hypothermia seems to be associated with pain and stress, and adequate analgesia and sedation are central to maximize the effect of therapeutic hypothermia. Pain needs to be adequately managed in all patients, especially the newborn infant due to the potential short- and long-term negative effects of inadequately treated pain in this population. METHODS: We will perform a systematic review of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy. We will include randomized, quasi-randomized controlled trials and observational studies. The use of pharmacological or non-pharmacological interventions will be compared to other pharmacological and or non-pharmacological interventions or no intervention/placebo. The primary outcomes for this review will be analgesia and sedation assessed with validated pain scales, circulatory instability, mortality to discharge, and moderate-to-severe neurodevelopmental disability. We will search the following databases: CINAHL, ClinicalTrials.gov , Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Two independent researchers will screen the records for inclusion, extract data using a data extraction form, and assess the risk of bias in the included trials. DISCUSSION: The result of this review will summarize the knowledge regarding the management of pain and sedation in infants treated with therapeutic hypothermia and potentially provide clinicians with guidance on the effective and safe methods. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020205755.

Developing the Preterm Breastfeeding Attitudes Instrument: A tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive care.

OBJECTIVE: The aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care. DESIGN: The study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme. SETTING AND PARTICIPANTS: A total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis. MEASUREMENTS AND FINDINGS: Higher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the pre- and the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeeding- and skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (rs = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Neonatal intensive care units need to increase their efforts to support breastfeeding. An important factor for mothers when establishing breastfeeding is support from well-trained professionals with a positive attitude to breastfeeding. The PreBAI could be a useful tool for identifying attitudes among HCPs before and after attending a breastfeeding training programme.

"Paying it Forward" - Swedish Women's Experiences of Donating Human Milk.

BACKGROUND: Human milk is recommended as the only nutritional source during the first 6 months of life. For preterm infants, the benefits of human milk are even more important and can alleviate the negative influences of preterm birth. RESEARCH AIM: To describe how Swedish human milk donors experienced the donation process. METHOD: A prospective mixed methods mail survey was designed. It was sent to human milk donors (N = 72) at two Swedish hospitals. Quantitative data are presented with descriptive statistics and qualitative data were analyzed using qualitative content analysis. RESULTS: The infants were between newborn and 17 weeks of age when the participants started their human milk donations, and the duration of the donation period lasted 1-24 weeks. The overall theme identified was the participants' strong desire to help infants, often expressed as being involved in saving infants' lives. Many participants experienced difficulties getting the information needed to become human milk donors; for others, expressing milk required both time and energy that they could otherwise spend with their own newborn infants. CONCLUSION: Donating human milk can be experienced as a demanding and strenuous task. Therefore, it is important that women who donate human milk receive the practical help from health care staff that they feel they need. Furthermore, information and knowledge about the possibility of donating human milk, and how important human milk is for preterm and/or sick infants, are important in order to increase the number of women willing to donate human milk.

Physiological Stability in Very Preterm Infants During Skin-to-Skin Contact as Assessed by Near-Infrared Spectroscopy.

BACKGROUND: Skin-to-skin contact (SSC) has been demonstrated to allow adequate thermal stability in high-technology settings with extremely preterm infants, while other aspects on how SSC influences basic physiological parameters have been less extensively investigated. PURPOSE: To evaluate physiological stability during SSC and incubator care in a group of preterm infants born at a gestational age (GA) of 32 weeks or less and receiving respiratory support. METHODS: Descriptive, observational study including 10 preterm infants (GA 22-32 weeks, postnatal age 2-48 days) were evaluated during SSC compared with flanking time periods in the incubator. Cerebral and systemic regional oxygen saturation (rSaO2), pulse oximetry (SpO2), heart rate (HR), and body temperature were recorded, and the fractional tissue oxygen extraction (fTOE) was calculated. RESULTS: A total of 16 periods of SSC (mean duration 3 hours 30 minutes) were evaluated, 9 during nasal continuous positive airway pressure and 7 during mechanical ventilation. Cerebral rSaO2 was 68% ± 4% (SE) and 69% ± 4% during incubator care and SSC, respectively (P = .56). Somatic rSao2 was 64% ± 4% during incubator care and 66% ± 4% during SSC (P = .54). Also, fTOE, HR, and SpO2 was similar during the 2 modes of care. Body temperature increased during SSC (P < .01). IMPLICATIONS FOR PRACTICE: The present study reveals no differences in cerebral and somatic tissue oxygenation between periods of SSC and care in the incubator. The findings indicate that SSC supports physiological stability also during management of very preterm infants receiving respiratory support. IMPLICATIONS FOR RESEARCH: Further studies directed to further optimize SSC performance should enable its safe implementation at gradually lower gestational and postnatal ages.

Pain Assessment and Management in Swedish Neonatal Intensive Care Units.

AIMS: To investigate registered nurses' (RNs') and physicians' knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden. DESIGN: Descriptive and explorative study using an online questionnaire. METHODS: A researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden. RESULTS: Most NICUs had pain assessment guidelines, but there was a discrepancy regarding interprofessional discussions of pain assessments. A total of seven different pain assessment instruments were reported from the included NICUs and RNs were reportedly those who usually performed the pain assessments. Most respondents expressed a positive attitude toward pain assessment but recognized a lack of intervention after the assessment. Forty-six percent (n = 11) of the physicians said they had sufficient knowledge of assessing pain using pain assessment instruments, versus 75% (n = 110) of the RNs. Difficulties assessing pain in certain populations of infants, such as the most premature infants and infants receiving sedative medicines, were recognized. CONCLUSIONS: RNs in this study reported that their pain assessments did not lead to appropriate pain management interventions. They were thus discouraged from further pain assessments or advocating for ethical pain management. An interprofessional team effort is needed to effectively assess and manage pain in neonates.

Parental participation during therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy.

OBJECTIVES: To examine parental participation in the care of newborn infants receiving therapeutic hypothermia, and to explore the possible impact of in-born vs out-born status, and location of hospital accommodation. STUDY DESIGN: Retrospective, quantitative and descriptive design. MAIN OUTCOME MEASURES: Infants medical charts were reviewed for defined aspects of parental participation (infant holding, tube feeding, and diaper change), and related to their in-born vs out-born status, and whether the parents were accommodated in the NICU or elsewhere. All infants have been cared for at the University Hospital Neonatal Intensive Care Unit, serving as a regional referral center for hypothermia treatment. This study is a part of a population-based regional cohort of asphyxiated newborn infants (n = 112) that received therapeutic hypothermia in 2007-2015. RESULTS: Parents engaged in holding (60/112, 54%) or tube feeding (59/112, 53%) their infant. Parents of in-born infants (24/112, 21%) were more likely to check the placement of the feeding tube (11/24, 46% vs 15/88, 17%; p < 0.01) and change diapers (9/24, 38% vs 14/88, 16%; p < 0.05) than parents of out-born infants (88/112, 79%). A similar pattern of more extensive involvement was observed for both mothers and fathers who stayed at the neonatal intensive care compared to those accommodated elsewhere (p < 0.05). CONCLUSIONS: Active parental participation is feasible at the NICU even during therapeutic hypothermia. Timely postnatal transfer of parents of out-born/transported infants, and the provision of on-site accommodation may influence the quality of parental involvement.

Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit.

BACKGROUND: There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care. PURPOSE: To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions. METHODS: A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis. RESULTS: Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses. IMPLICATIONS FOR PRACTICE: This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support. IMPLICATIONS FOR RESEARCH: Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.

Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial.

INTRODUCTION: Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge. METHODS AND ANALYSIS: A randomised intervention study with two arms-intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents' gender. ETHICS AND DISSEMINATION: The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89-31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings. TRIAL REGISTRATION NUMBER: NCT03004677.

Becoming a mother - Mothers' experience of Kangaroo Mother Care.

OBJECTIVE: To describe mothers' experiences of providing their preterm infants with Kangaroo Mother Care (KMC). STUDY DESIGN: A qualitative descriptive design. SETTING: Two level III neonatal intensive care units (NICUs) in Sweden. PARTICIPANTS: Thirteen mothers of preterm infants. METHODS: The mothers were interviewed when their infant had reached a corrected age of 4 months ±â€¯2 weeks. The interviews were recorded and transcribed and data were analyzed using qualitative content analysis. RESULTS: The mothers described the skin-to-skin contact with, and closeness to, the preterm infant as something they valued, and involuntary physical separation as something they had to accept and adapt to. Providing the infant with breast milk by expressing and tube feeding was experienced as time-consuming and as impinging on the skin-to-skin contact. CONCLUSION: Mothers want to stay close to their preterm infant. The NICU environment and staff can facilitate KMC by providing a private space for parents and infants, and enable mothers to breastfeed and express breast milk by giving them support based on science and proven experience.

Parents need support to find ways to optimise their own sleep without seeing their preterm infant's sleeping patterns as a problem.

AIM: This study described how parents perceived their own sleep, and their infants', during neonatal intensive care unit (NICU) admission and after discharge. It also explored the infants' sleeping location at home. METHODS: The study was conducted in the NICUs of two Swedish university hospitals. The parents of 86 infants - 86 mothers and 84 fathers - answered questionnaires during their infants' hospital stay, at discharge and at the infants' corrected ages of two, six and 12 months. The parents' own sleep was explored with the Insomnia Severity Index. RESULTS: Mothers reported more severe insomnia than fathers during their infants' hospitalisation, and these higher insomnia severity scores were associated with more severe infant sleep problems at discharge (p = 0.027) and at two months (p = 0.006) and 12 months (p = 0.002) of corrected age. During the study period, 4%-10% of the parents reported severe or very severe infant sleeping problems. The bed-sharing rate was 75% after discharge and about 60% at the corrected age of 12 months. CONCLUSION: Maternal insomnia during an infant's hospital stay was associated with later perceptions of sleep problems in their children. Parents need support to find solutions for optimal sleep without seeing their child's sleeping patterns as a problem.

Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks.

BACKGROUND: Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support. OBJECTIVE: This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age. METHODS: As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions. RESULTS: In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8). CONCLUSION: Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.

Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents.

BACKGROUND: Kangaroo Mother Care (KMC) supports parents' role at the neonatal intensive care unit (NICU). To enhance parents' provision of KMC, it is essential to obtain knowledge of what parents perceive as supportive factors and barriers regarding their opportunities to perform KMC. AIM: To identify factors that parents of preterm infants perceived as supportive factors or barriers for their performance of KMC and to explore the timing of and reasons for parents' discontinuation of KMC. METHODS: A descriptive study performed at two NICUs in Sweden with 76 mothers and 74 fathers of preterm infants born at gestational ages ranging from 28 to 33 weeks. Data on infant characteristics were obtained from the infants' medical records. A questionnaire, based on scientific literature and the researchers' clinical experience, was completed by the mothers and the fathers separately, shortly after the infant's discharge from the hospital. The data were analyzed with qualitative content analysis and descriptive statistic. RESULTS: Four categories were identified in parents' responses regarding support and barriers for their performance of KMC: Parent related factors, Time, Infants related factors and The NICU and home environment. The hospital staff and environment were described by the parents as both supportive and barriers for their application of KMC. Some mothers described the infants' feeding process as an obstacle to KMC. Sleeping with the infant skin-to-skin in the same position throughout the night could be difficult, as an uncomfortable sleeping position caused insufficient sleep. A majority of both mothers and fathers continued providing their infant with KMC to some extent after discharge. CONCLUSION: Interventions for enhancing parents' opportunities for performing KMC should address both hospital staff attitudes and practices and the NICU environment.

Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units.

AIM: To describe initiation and extent of parents' application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units. METHODS: The duration of SSC was recorded in 104 infants' medical charts during their hospital stay, and the parents answered a questionnaire. RESULTS: Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 24-78 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min. CONCLUSION: Early initiation of SSC had positive impact on the extent of parents' application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.

Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role.

AIM: This article is a report on a descriptive study of fathers' experiences of providing their preterm infants with Kangaroo Mother Care. BACKGROUND: During neonatal intensive care, fathers describe the incubator as a barrier and the separation from their infant as stressful. Fathers consider it important to be close to the infant, and performing Kangaroo Mother Care makes them feel an important participant in their infants' care. METHOD: Individual interviews conducted in 2009 with seven fathers who performed Kangaroo Mother Care were analysed using qualitative content analysis. RESULTS: The fathers' opportunity for being close to their infants facilitated attainment of their paternal role in the neonatal intensive care unit. Kangaroo Mother Care allowed them to feel in control and that they were doing something good for their infant, although the infant's care could be demanding and stressful. As active agents in their infant's care, some fathers stayed with the infant during the whole hospital stay, others were at the neonatal intensive care unit all day long. Despite the un-wished-for situation, they adapted to their predicament and spent as much time as possible with their infants. CONCLUSION: Fathers' opportunities for Kangaroo Mother Care helped them to attain their paternal role and to cope with the unexpected situation. The physical environment and conflicting staff statements influenced their opportunity for, and experience of, caring for their preterm infants.