Mood disorders in children following neonatal hypoxic-ischemic encephalopathy.

BACKGROUND: Few studies on the consequences following newborn hypoxic-ischemic encephalopathy (NHIE) assess the risk of mood disorders (MD), although these are prevalent after ischemic brain injury in adults. OBJECTIVE: To study the presence of MD in children survivors of NHIE. METHODS: 14 children survivors of NHIE treated with hypothermia and without cerebral palsy and 15 healthy children without perinatal complications were studied aged three to six years for developmental status (Ages and Stages Questionnaire 3 [ASQ-3]) and for socio-emotional status (Preschool Symptom Self-Report [PRESS] and Child Behavior Checklist [CBCL] 1.5-5 tests). Maternal depression was assessed using Montgomery-Asberg Depression Rating Scale (MADRS). Socio-economic factors such as parental educational level or monthly income were also studied. RESULTS: NHIE children did not present delay but scored worse than healthy children for all ASQ3 items. NHIE children showed higher scores than healthy children for PRESS as well as for anxious/depressive symptoms and aggressive behavior items of CBCL. In addition, in three NHIE children the CBCL anxious/depressive symptoms item score exceeded the cutoff value for frank pathology (P = 0.04 vs healthy children). There were no differences in the other CBCL items as well as in maternal MADRS or parental educational level or monthly income. Neither ASQ3 scores nor MADRS score or socio-economic factors correlated with PRESS or CBCL scores. CONCLUSIONS: In this exploratory study children survivors of NHIE showed increased risk of developing mood disturbances, in accordance with that reported for adults after brain ischemic insults. Considering the potential consequences, such a possibility warrants further research.

Cognitive deficits and impaired hippocampal long-term potentiation in KATP-induced DEND syndrome.

ATP-sensitive potassium (KATP) gain-of-function (GOF) mutations cause neonatal diabetes, with some individuals exhibiting developmental delay, epilepsy, and neonatal diabetes (DEND) syndrome. Mice expressing KATP-GOF mutations pan-neuronally (nKATP-GOF) demonstrated sensorimotor and cognitive deficits, whereas hippocampus-specific hKATP-GOF mice exhibited mostly learning and memory deficiencies. Both nKATP-GOF and hKATP-GOF mice showed altered neuronal excitability and reduced hippocampal long-term potentiation (LTP). Sulfonylurea therapy, which inhibits KATP, mildly improved sensorimotor but not cognitive deficits in KATP-GOF mice. Mice expressing KATP-GOF mutations in pancreatic ß-cells developed severe diabetes but did not show learning and memory deficits, suggesting neuronal KATP-GOF as promoting these features. These findings suggest a possible origin of cognitive dysfunction in DEND and the need for novel drugs to treat neurological features induced by neuronal KATP-GOF.

Congenital Zika Infection and the Risk of Neurodevelopmental, Neurological, and Urinary Track Disorders in Early Childhood. A Systematic Review.

It was late 2015 when Northeast Brazil noticed a worrying increase in neonates born with microcephaly and other congenital malformations. These abnormalities, characterized by an abnormally small head and often neurological impairment and later termed Congenital Zika Syndrome, describe the severity of neurodevelopmental and nephrological outcomes in early childhood, and the implication of microcephaly at birth. The purpose of the study was to describe the neurodevelopmental outcomes in children exposed to Zika virus during fetal life, with and without microcephaly at birth. The systematic review included research studies about the neurodevelopmental outcomes with and without microcephaly, as well as nephrological outcomes in early childhood. We searched PubMed, Crossref, PsycINFO, Scopus, and Google Scholar publications and selected 19 research articles published from 2018 to 2021. Most studies have linked the severity of microcephaly in childbirth to the neurodevelopmental and urinary outcomes in early childhood. However, most children without microcephaly at birth develop typically, while others may be at risk for language impairment.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization.

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.

Hasta un 15% de progenitores tiene un infante que pasará un tiempo en una Unidad de Cuidado Intensivo Neonatal (NICU). Después de la salida, los progenitores deben cuidar de un infante médicamente débil y preocuparse por su desarrollo. El presente estudio examinó cómo la severidad de la enfermedad del infante se asocia con la adaptabilidad familiar. Los participantes eran progenitores con infantes que habían salido de la Unidad de Cuidado Intensivo Neonatal entre 6 meses y 3 años antes de participar en el estudio (N = 199). Por medio de una encuesta electrónica tipo Qualtrics, los progenitores reportaron el historial médico de su infante, el estrés de la crianza, la carga familiar, el funcionamiento como pareja y el acceso a recursos. Los análisis de regresión de variables múltiples revelaron que asuntos médicos más severos del infante durante la hospitalización (v.g. período más largo de hospitalización, más aparatos médicos) se asociaban con mayor carga familiar, aunque no así con estrés o el funcionamiento como pareja. Los asuntos de salud infantil posteriores a la hospitalización (v.g. diagnóstico médico, más médicos especialistas) se asociaron con mayor estrés, un más pobre funcionamiento como pareja y mayor carga familiar. Menos tiempo para los progenitores se asoció con un aumento en el estrés y un más pobre funcionamiento como pareja. De modo sorprendente, los progenitores de infantes que habían sido hospitalizados otra vez reportaron menos estrés y mejor funcionamiento como pareja, pero mayor carga familiar. Las intervenciones con enfoque familiar que incorporan educación sicológica acerca de la comunicación entre proveedor y paciente, apoyo a la propia pareja y el cuidado propio pudieran ser eficaces para prevenir la secuela sicosocial entre familias.

Jusqu'à 15% des parents ont un bébé qui passera du temps en Unité Néonatale de Soins Intensifs. A la sortie de l'hôpital les parents peuvent se retrouver à prendre soin d'un bébé fragile du point de vue médical et s'inquiéter de son développement. Cette étude a examiné comment la sévérité de la maladie du bébé est liée à l'ajustement de la famille. Les participants ont inclu des parents avec des bébés étant sortis de l'Unité Néonatale de Soins Intensifs 6 mois à trois ans avant la participation à l'étude (N = 199). Au travers d'un questionnaire Qualtrics en ligne, les parents ont fait état de l'histoire médicale des bébés, du stress de parentage, du poids sur la famille, du fonctionnement du couple et de l'accès aux ressources. Des analyses de régression multivariables ont révélé que les problèmes médicaux du bébé durant l'hospitalisation les plus graves (i.e. durée plus longue du séjour, plus de dispositifs médicaux) étaient liés à un poids sur la famille plus fort, mais pas au stress ni n'affectait le fonctionnement du couple. Les problèmes de santé du bébé après l'hospitalisation (soit un diagnostic médical, plus de spécialistes médicaux) étaient liés à un stress plus élevé, à un fonctionnement du couple moins bon, et à un poids sur la famille plus fort. Moins de temps pour les parents était lié à un stress supplémentaire et à un fonctionnement du couple moins bon. Avec surprise, les parents de bébés qui étaient réhospitalisés ont fait état de moins de stress et d'un meilleur fonctionnement de couple, mais d'un poids plus fort sur la famille. Les interventions centrées sur la famille qui incorporent une psychoéducation sur la communication médecin-parent, le soutien du partenaire et le soin de soi peut s'avérer efficace afin d'éviter des séquelles psychosociales négatives chez les familles.

Intellectual Disability in KATP Channel Neonatal Diabetes.

OBJECTIVE: Neonatal diabetes has been shown to be associated with high neuropsychiatric morbidity in a genotype-phenotype-dependent manner. However, the specific impact of different mutations on intellectual functioning is still insufficiently characterized. Specifically, only a small number of subjects with developmental delay have been comprehensively assessed, creating a knowledge gap about patients carrying the heaviest burden. RESEARCH DESIGN AND METHODS: We assessed the intellectual functioning and mental health of the complete Norwegian population with KATP channel neonatal diabetes. Eight sulfonylurea-treated children (five with the p.V59M genotype [KCNJ11]) were assessed using age-matched control subjects with type 1 diabetes. The investigations included a physical and motor developmental examination, cerebral MRI, psychometrical examination, and questionnaires assessing intellectual capabilities and psychiatric morbidity. RESULTS: A strong genotype-phenotype correlation was found, revealing the p.V59M genotype as highly associated with substantial intellectual disability, with no significant correlation with the time of sulfonylurea initiation. Consistent with previous studies, other genotypes were associated with minor cognitive impairment. Cerebral MRI verified normal brain anatomy in all but one child. CONCLUSIONS: We here presented a comprehensive assessment of intellectual functioning in the largest cohort of p.V59M subjects to date. The level of intellectual disability revealed not only changes the interpretation of other psychological measures but downplays a strong protective effect of sulfonylurea. Within the scope of this study, we could not find evidence supporting an early treatment start to be beneficial, although a weaker effect cannot be ruled out.

Psychofunctional symptoms in infants of young mothers: Association with maternal mental health and parental bonding.

OBJECTIVES: To evaluate the presence of psychofunctional symptoms (PFS) in infants of young mothers from southern Brazil and to examine the association of those symptoms with indicators of maternal mental health and maternal perception of marital adjustment, family support, and quality of parental bonding. METHODS: A quantitative, cross-sectional study of descriptive and correlational nature was conducted using a convenience sample of 71 young mother-infant dyads. The following instruments were administered: Sociodemographic Data and Clinical Data Forms, Symptom Check-List (SCL), Mini International Neuropsychiatric Interview Plus (MINI-Plus), Beck Anxiety Inventory (BAI), Beck Depression Inventory II (BDI-II), Edinburgh Postnatal Depression Scale (EPDS), Revised Dyadic Adjustment Scale (RDAS), Parental Bonding Instrument (PBI), and Perception of Family Support Inventory (IPSF). Spearman and Kruskal-Wallis correlation analyses and multiple linear regression were performed to identify explanatory variables of PFS in infants. RESULTS: 39.4% of infants had some PFS, and those related to behavior were most prevalent (e.g. fear, separation anxiety). Maternal depressive symptoms (EPDS; -0.74) and perception of quality of paternal care (PBI; -0.29) explained that type of symptom in infants (adjusted R2 = 0.15; p < 0.05). In regression analysis, major depressive episode (MINI-Plus) and depressive symptoms (BDI-II) were explanatory variables of feeding (2.19; adjusted R2 = 0.06; p < 0.05) (e.g., do not accept certain food types) and digestion symptoms (0.04; adjusted R2 = 0.05; p < 0.01) (e.g., diarrhea or constipation). Finally, perception of quality of maternal care explained allergy symptoms (-0.06; adjusted R2 = 0.12; p < 0.05) (e.g. rhinitis, certain foods). CONCLUSION: A comprehensive assessment of physical symptoms in infants of young mothers is needed, focusing on maternal mental health, especially depression, and family relationships.

Does preterm birth affect child temperament? A meta-analytic study.

The present meta-analytic study was conducted to examine differences in temperament between preterm and full-term children, considering behavior style and psychobiological approaches. Moreover, we explored the potential moderators of the associations between prematurity and temperament. A systematic literature search was performed on PubMed, Scopus, Web of Science, and CINAHL. Twenty-two studies were analyzed. Preterm children showed a higher Activity level as well as lower Attentional Focusing and Attention Span/Persistence, in comparison with their full-term counterparts. Extremely preterm children showed a higher Activity level than other preterm levels. These findings support the conclusion that preterm children present with a less regulated temperament relative to those born full term.

Development of parenting self-efficacy in mothers of high-risk infants.

PURPOSE: The aim of this prospective, longitudinal study was to (1) examine the development of parenting self-efficacy (PSE), (2) explore the influence of contextual factors (e.g., family functioning, family centered care, and infant medical caregiving complexity) on PSE development, and (3) whether PSE and contextual factors predict parent and infant health outcomes in a high-risk infant population. METHOD: Mothers (n = 67) of infants diagnosed with a complex medical condition following birth were enrolled within 3 weeks of their infant's diagnosis and admission to intensive care. Participants completed an online study survey at study enrollment (T1), infant discharge (T2), and 3 months after discharge (T3). Change in PSE was examined using mixed modeling and predictors of parent and infant health outcomes were explored using multiple regression. RESULTS: PSE significantly increased over time (b = 2.08, p < .0001). Family functioning was the only significant contextual factor, where worse family functioning at enrollment was associated with lower confidence over time. Mothers who were older and had more than one child were significant predicators of higher PSE. Interestingly, being married, compared to being single, was associated with decreased PSE. Higher PSE was also predictive of positive maternal psychological wellbeing at 3 months after discharge and a decrease in infant's medical complexity was associated with higher maternal psychological well-being. CONCLUSION: These are important findings given that PSE is known to contribute to infant development and health status.

Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation.

BACKGROUND: Psychosocial adversity escalates medical risk for poor outcomes in infants born <30 weeks gestation. Neonatal neurobehavior and maternal psychological and socioenvironmental assessments may identify the earliest specific intervention needs. We hypothesized that maternal prenatal anxiety, depression, and adverse medical and socioenvironmental conditions would be associated with less optimal neonatal neurobehavior at neonatal intensive care unit (NICU) discharge. METHODS: We studied 665 infants at 9 university NICUs. Risk indices of socioenvironmental, maternal, and neonatal medical factors were obtained from standardized, structured maternal interviews and medical record reviews. Brain injuries were classified by consensus ultrasonogram readings. NICU Network Neurobehavioral Scale (NNNS) exams were conducted at NICU discharge. RESULTS: On the NNNS, generalized estimating equations indicated infants of mothers with prenatal anxiety had less optimal attention, and those born to mothers with prenatal depression had increased lethargy. Maternal medical complications predicted suboptimal reflexes. Socioenvironmental risk predicted lower self-regulation and movement quality. Infants with more severe neonatal medical complications had lower attention, increased lethargy, and suboptimal reflexes. CONCLUSIONS: Combined information from the observed associations among adverse prenatal maternal medical and psychosocial conditions, and neonatal complications may assist in the early identification of infants at elevated neurobehavioral risk.

Withholding and withdrawal of life-sustaining treatments for neonate in Japan: Are hospital practices associated with physicians' beliefs, practices, or perceived barriers?

OBJECTIVE: To describe the current status of withholding or withdrawal of life-sustaining interventions (LSI) for neonates in Japan and to identify physician- and institutional-related factors that may affect advance care planning (ACP) practices with parents. STUDY DESIGN: A self-reported questionnaire was administered to assess frequency of withholding and withdrawing intensive care at the respondent's facility, the physician's degree of affirming various beliefs about end-of-life care that was compared to 7 European countries, their self-reported ACP practices and perceived barriers to ACP. Three neonatologists at all 298 facilities accredited by the Japan Society for Neonatal Health and Development were surveyed, with 572 neonatologists at 217 facilities responding. RESULTS: At 76% of facilities, withdrawing intensive care treatments was "never" done, while withholding intensive care had been done "sometimes" or more frequently at 82% of facilities. Japanese neonatologists differed from European neonatologists regarding their degree of affirmation of 3 out of 7 queried beliefs about end-of-life care. In hospitals that were more likely to "sometimes" (or more often) withdraw treatments, respondents were less likely to affirm beliefs about doing "everything possible" or providing the "maximum of intensive care". Self-reported ACP practices did not vary between neonatologists based on their hospital's overall pattern of withholding or withdrawing treatments. CONCLUSION: Among NICU facilities in Japan, 21% had been sometimes withdrawing LSI and 82% had been "sometimes" withholding LSI. Institutional treatment practices may have a strong association with physicians' beliefs that then affect end-of-life discussions, but not with self-reported ACP practices.

Evaluation of the prognostic factors in school age children who experienced neonatal seizures.

BACKGROUND: This prospective study aimed to evaluate long-term neurodevelopmental outcomes and risk factors of the previously reported cohort, at their school age. METHOD: We included neonates whose seizures were directly observed by the child neurologist or neonatologist based on clinical observations. They were assessed for cognitive and neurological outcomes at the age of 9-11 years. The test battery included a neurological examination, the Wechsler Intelligence Scale for Children-Revised (WISC-R) test, and patients with the diagnosis of cerebral palsy (CP) were graded according to the Gross Motor Function Classification System (GMFCS). The primary outcome of this study was to determine risk factors for the long-term prognosis of neonatal seizures. RESULTS: For the long-term follow-up, 97 out of 112 patients of the initial cohort were available (86.6%). We found that 40 patients (41%) have the normal prognosis, 22 patients (22.7%) have the diagnosis of CP, and 30 patients (30.9%) were diagnosed as having epilepsy. Twelve out of 22 patients with CP had the diagnosis of epilepsy. The WISC-R full-scale IQ scores were <55 points in 27 patients (27.8%) and were >85 points in 40 patients (41.2%). According to GMFCS, 10 patients were classified as levels 1-2, and 12 patients were classified as levels 3-5. In multivariate regression analyses, 5-min APGAR score <6 was found to be an independent risk factor for CP, and 5-min APGAR score <6 and neonatal status epilepticus were independent risk factors for epilepsy. CONCLUSIONS: This prospective cohort study reveals that abnormal school age outcome after neonatal seizures are significantly related to 5-min APGAR score <6 and neonatal status epilepticus.

Ethics and Medico-legal implications in delivery room emergencies.

There is very little law-either case law or statutory law - that regulates delivery room decisions about resuscitation of critically ill newborns. Most of the case law that exists is decades old. Thus, physicians cannot look to the law for much guidance about what is permissible or prohibited. Local hospital policies and professional society statements provide some guidance, but they cannot be all-inclusive and encompass all potentially encountered scenarios. Ultimately, the physician, the medical team, and the parents must try to reach a shared decision about the best course of action for each individual infant and each unique family. In this paper, we review some of the case law that may be applicable to such decisions and make recommendations about how decisions should be made.

Understanding and addressing barriers to communication in the context of neonatal neurologic injury: Exploring the ouR-HOPE approach.

Predicting neurologic outcomes for neonates with acute brain injury is essential for guiding the development of treatment goals and appropriate care plans in collaboration with parents and families. Prognostication helps parents imagine their child's possible future and helps them make ongoing treatment decisions in an informed way. However, great uncertainty surrounds neurologic prognostication for neonates, as well as biases and implicit attitudes that can impact clinicians' prognoses, all of which pose significant challenges to evidence-based prognostication in this context. In order to facilitate greater attention to these challenges and guide their navigation, this chapter explores the practice principles captured in the ouR-HOPE approach. This approach proposes the principles of Reflection, Humility, Open-mindedness, Partnership, and Engagement and related self-assessment questions to encourage clinicians to reflect on their practices and to engage with others in responding to challenges. We explore the meaning of each principle through five clinical cases involving neonatal neurologic injury, decision making, and parent-clinician communication. The ouR-HOPE approach should bring more cohesion to the sometimes disparate concerns reported in the literature and encourage clinicians and teams to consider its principles along with other guidelines and practices they find to be particularly helpful in guiding communication with parents and families.

Ethical Dilemmas in Neonatology - Four Theoretical Cases and Three Monotheistic Approaches: A Pilot Study.

BACKGROUND: Israel's population is diverse, with people of different religions, many of whom seek spiritual guidance during ethical dilemmas. It is paramount for healthcare providers to be familiar with different religious approaches. OBJECTIVES: To describe the attitudes of the three major monotheistic religions when encountering four complex neonatal situations. METHODS: A questionnaire related to four simulated cases was presented to each participant: a non-viable extremely premature infant (case 1), a severely asphyxiated term infant with extensive brain damage (case 2), a small preterm infant with severe brain hemorrhage and likely extensive brain damage (case 3), and a term infant with trisomy 21 syndrome and a severe cardiac malformation (case 4). RESULTS: Major differences among the three religious opinions were found in the definition of viability and in the approach towards quality of life. CONCLUSIONS: Neonatologists must be sensitive to culture and religion when dealing with major ethical issues in the neonatal intensive care unit.

Prevalence and Associated Factors to Depression and Anxiety in Women with Premature Babies Hospitalized in a Neonatal Intensive-Care Unit in a Mexican Population.

PURPOSE: The aims of this study were to investigate the frequency of depression and anxiety in mothers of children hospitalized in a neonatal intensive care unit, and to determine the characteristics associated with depression and anxiety in a sample of Mexican mothers. METHOD: We studied 188 mothers who had premature babies in a neonatal intensive-care. Sociodemographic and clinical characteristics were collected through a face to face interview performed by professional staff. We assessed depression using the Beck Depression Inventory (BDI) and clinical anxiety using the Hamilton Anxiety Rating Scale (HAM-A). RESULTS: Clinical anxiety was reported in more than one-third of women (34.0%, n = 64) followed by depression (19.7%, n = 37), while twenty-six women reported both significant depression and anxiety (13.8%). Women with both clinical symptoms were younger, they were more frequently students and were living within extended families. Women who presented only symptoms of depression reported lower educational level (elementary school 29.7%, n = 11). CONCLUSION: Our results show a high incidence of anxiety, depression, and both emotional disorders in Mexican mothers of premature babies hospitalized in a neonatal intensive care unit. Demographic features such as occupation or age may impact the occurrence and severity of joint symptoms of depression and anxiety which should be monitored by the health team and referred to a mental health service.

Parent Perspectives on Readiness for Discharge Home after Neonatal Intensive Care Unit Admission.

OBJECTIVE: To explore the parent perspective on discharge home from the neonatal intensive care unit (NICU). STUDY DESIGN: We interviewed parents of NICU graduates with a range of demographic characteristics and medical complexities to explore parent perspectives on readiness for discharge. Interviews were transcribed and coded by a 6-member team. We performed content analysis to identify themes and develop a family-centered conceptual framework around readiness for NICU discharge. RESULTS: We interviewed a total of 15 parents who experienced NICU stays with 18 infants. Parents who have experienced NICU discharge have a spectrum of needs that evolve from the time the child is in the NICU, at time of discharge, and at home afterward. These needs consistently centered around 5 themes-communication, parent role clarity, emotional support, knowledge sources, and financial resources. CONCLUSIONS: Parents described many ways the system could have better prepared them and connected them with essential resources. Summarizing the voices of the parents who participated in this study, we have compiled a series of practical recommendations for clinicians to use in daily practice to help parents feel prepared and confident for the transition home from the NICU.

Maternal psychological distress during pregnancy and childhood health outcomes: a narrative review.

Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.

Skills attained by infants with congenital Zika syndrome: Pilot data from Brazil.

The recent Zika outbreak and its link to microcephaly and other birth defects in infants exposed in utero have garnered widespread international attention. Based on the severity of birth defects the extent of impairment in these infants is expected to be profound; however, virtually nothing is known regarding the developmental and behavioral sequela of congenital Zika syndrome. This pilot study collected parent-reported patterns of development and sleep in 47 infants with confirmed congenital Zika syndrome who are being followed for clinical services at the Altino Ventura Foundation (FAV) in Recife, Brazil. With assistance from clinicians at FAV, caregivers completed Brazilian Portuguese versions of the Ages and Stages Questionnaire, 3rd edition (ASQ-3) and the Brief Infant Sleep Questionnaire (BISQ). All infants were between 13-22 months of age at the time of the assessment. At 16 months of age, none of the children displayed age appropriate developmental skills. Most (~ 75%) mastered some communication and gross motor skills at around a 6-8-month level. Communication and gross motor skills were relative strengths for the sample, while problem-solving and fine motor skills were relative weaknesses. Sleep was noted to be a problem for around 18% of the sample. In utero exposure to the Zika virus will have lifelong consequences for affected children and their families. Understanding the developmental and behavioral trajectories of affected infants will help identify appropriate family supports to improve quality of life.

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation.

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Roles and Experiences of Parents in Necrotizing Enterocolitis: An International Survey of Parental Perspectives of Communication in the NICU.

BACKGROUND: Although partnering with parents is important to improving neonatal outcomes, no studies have investigated what parents are taught, remember, or experience when their child is afflicted with necrotizing enterocolitis (NEC). PURPOSE: To characterize parental perceptions of communication and support they were given about NEC. METHODS: An online survey was developed, reviewed for face validity, and then administered to parents whose child had experienced NEC. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using a qualitative descriptive approach. FINDINGS: Parents (N = 110) wanted to know the risk factors and warning signs for NEC and wanted to be told as soon as their child was admitted to the neonatal intensive care unit (NICU). Information provided before diagnosis was felt to be poor by the majority of families, with only 32% feeling satisfied or very satisfied. No parent wrote that they were "scared" by information provided to them about NEC; in fact, parents were dissatisfied when they received "sugar-coated" information. Engaged parents were significantly more satisfied than those who were not informed, had their concerns and suggestions dismissed, or who had to advocate for their baby against clinician opposition (eg, activating the chain of command). IMPLICATIONS FOR PRACTICE: Areas for quality improvement include better communication and collaboration with parents through early engagement in NEC prevention using modalities beyond verbal instruction. IMPLICATIONS FOR RESEARCH: More research is needed on how best to engage parents, especially to engage in prevention, and how doing so affects satisfaction and outcomes.