Social Determinants of Health and Parenting Self-Efficacy Among Mothers of Preterm Infants.

Objective: To explore the relationships between social and environmental factors and parenting self-efficacy (PSE) among mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) using a social determinants of health (SDoH) framework. Method: We analyzed data from a prospective cohort study that included 187 mother-infant dyads admitted to four NICUs in the Mountain West region between June 2017 and December 2019. We used multivariable linear regression models to assess the independent associations between maternal and infant characteristics and PSE. Results: Our final multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant (F(12,160) = 3.17, p = .0004, adjusted R¬2 = .131). Significant predictors of PSE were race/ethnicity (ß= 3.3, p = .022), having another child/children (ß= 4.2, p = .005), and depression (ß= -4.2, p = .004). Conclusions: Findings suggest that social workers and medical practitioners should consider SDoH, such as insurance type, household income, and employment, along with traditional clinical indicators when assessing families' infant care needs. Social workers, medical practitioners, and researchers should be mindful of how implicit bias may influence the allocation of care and parental supports.

NICU Visitation Time and Adherence to Safe Sleep Practices Among Mothers of Very Preterm Infants.

BACKGROUND: Sleep-associated infant death is the leading cause of postneonatal mortality in the United States. Preterm infants are at higher risk for sleep-associated death, but maternal adherence to safe sleep practices is lower than for mothers of full-term infants. Data are lacking on whether maternal neonatal intensive care unit (NICU) visitation time impacts safe sleep compliance after hospital discharge. PURPOSE: For mothers of preterm infants, to investigate the association of time days per week spent in the NICU and adherence to safe sleep practices after discharge. METHODS: A prospective observational study of 109 mothers with infants born at less than 32 weeks from 4 Colorado NICUs who completed a survey at 6 weeks after discharge about infant sleep practices. Maternal time spent in the NICU was defined as the average number of days spent in the NICU per week of infant hospitalization, as documented in the electronic medical record. Multivariable logistic regression models assessed the relationship between time in the NICU and safe sleep adherence. Covariates included maternal/infant characteristics significant at P < .2 level in bivariate analysis. RESULTS: Predictors of compliance with all safe infant sleep practices included public/no insurance compared with private insurance (adjusted odds ratio [AOR] 0.29; 95% confidence interval [CI] 0.09-0.96), some college/associate-level education versus bachelor's degree (AOR 5.88; 95% CI 1.21-28.67), and depression/anxiety symptoms (AOR 0.37; 95% CI 0.14-0.97). NICU visitation days was not associated with adherence to safe sleep practices. IMPLICATIONS FOR PRACTICE AND RESEARCH: Maternal visitation days was not associated with adherence to safe infant sleep practices after discharge, highlighting the need to identify barriers and facilitators to engaging families about SUID risk-reducing behaviors.

Factors Which May Contribute to the Success or Failure of the Use of Mother's Own Milk in a Level IV Neonatal Intensive Care Unit.

BACKGROUND: Benefits of mother's own milk (MOM) for infants in neonatal intensive care units (NICUs) are well known. Many mothers provide for their infant's feedings during their entire hospitalization while others are unable. Knowledge is limited about which infant and maternal factors may contribute most to cessation of MOM feedings. PURPOSE: Study aims were to (1) identify which maternal and infant risk factors or combination of factors are associated with cessation of provision of MOM during hospitalization, (2) develop a lactation risk tool to identify neonatal intensive care unit infants at higher risk of not receiving MOM during hospitalization, and (3) identify when infants stop receiving MOM during hospitalization. METHODS: A data set of 797 infants admitted into a level IV neonatal intensive care unit before 7 days of age, whose mothers chose to provide MOM, was created from analysis of data from the Children's Hospital Neonatal Database. Maternal and infant factors of 701 dyads who received MOM at discharge were compared with 87 dyads who discontinued use of MOM by discharge using χ 2 , t tests, and Wilcoxon rank tests. Logistic regression was used to build a risk-scoring model. RESULTS: The probability of cessation of MOM increased significantly with the number of maternal-infant risk factors. A Risk Calculator was developed to identify dyads at higher risk for cessation of MOM by discharge. IMPLICATIONS FOR PRACTICE: Identifying mothers at risk for cessation of MOM can enable the healthcare team to provide optimal lactation management and outcomes. IMPLICATIONS FOR RESEARCH: Although the Risk Calculator has potential to identify dyads at risk of early MOM cessation, further research is needed to validate these results.

Comparisons of Three Measures of Maternal Engagement Activities in the Neonatal Intensive Care Unit.

BACKGROUND: Mothers' engagement with their hospitalized preterm infant(s) is recognized as an important aspect of treatment in neonatal intensive care units (NICUs). However, no gold standard exists for measuring maternal engagement, and the various methods used to measure mothers' time have documented limitations. OBJECTIVES: This study sought to compare three measurement methods of maternal engagement (a five-item maternal cross-sectional survey, time use diaries, and electronic health records [EHRs]) to identify whether these methods capture consistent data and patterns in detected differences in measures of engagement. METHODS: Maternal engagement was defined as time spent visiting the infant in the NICU (presence), holding (blanket holding in the mother's arms or by kangaroo care [KC]), and caregiving (e.g., bathing and changing diapers). The survey estimating daily maternal engagement was administered in two Level III NICUs and one Level IV NICU at study enrollment, at least 2 weeks after admission. Mothers then completed the daily time use diaries until infant discharge. Data were also collected from participants' EHRs, charted by nursing staff. Wilcoxon signed-rank tests were used for pairwise analysis of the three measures for maternal engagement activities. RESULTS: A total of 146 participants had data across all three measurement types and were included in the analysis. In the Level III NICUs (n = 101), EHR data showed significantly more time spent with all engagement activities than the diary data. In the Level IV data, only differences in time holding were significant when comparing EHR data with survey data, with mothers reporting more time doing KC and less time blanket holding. Comparison of EHR data with diary data showed more time in all activities except KC. DISCUSSION: In most cases, time spent in engagement activities measured in the EHR was higher than in the surveys or time use diaries. Accuracy of measurements could not be determined because of limitations in data collection, and there is no gold standard for comparison. Nevertheless, findings contribute to ongoing efforts to develop the most valuable and accurate strategies for measuring maternal engagement-a significant predictor of maternal and infant health.

The Association of Social Factors and Time Spent in the NICU for Mothers of Very Preterm Infants.

OBJECTIVES: Evaluate the association between maternal social factors and maternal time spent in the NICU for very preterm infants admitted to 4 level III and IV NICUs. METHODS: In this prospective observational cohort study, we enrolled mother-infant dyads whose infants were born <32 weeks' gestation. Enrollment occurred after 2 weeks of NICU exposure, when maternal social factors and demographic information was collected. Maternal time spent in the NICU was abstracted from the electronic medical record and was dichotomized into 0 to 6 days and ≥6 days per week. Demographic differences between the 2 groups were compared by using χ2 tests. Logistic regression was used to assess the independent association between maternal social factors and the average number of days per week spent in the NICU. RESULTS: A total of 169 mother-infant dyads were analyzed. Maternal social factors associated with more time spent in the NICU included an annual household income of >$100 000, compared with those with an annual household income of <$50 000 (adjusted odds ratio [aOR]: 5.68; 95% confidence interval [CI] 1.77-18.19), a travel time <30 minutes to the NICU (compared with those who traveled >60 minutes [aOR: 7.85; 95% CI 2.81-21.96]), and the lack of other children in the household, compared with women with other children (aOR: 3.15; 95% CI 1.39-7.11). CONCLUSIONS: Maternal time spent in the NICU during a prolonged birth hospitalization of a very preterm infant differed by socioeconomic status, travel time, and presence of other dependents. Strategies to better identify and reduce these disparities to optimize engagement and, subsequently, improve infant health outcomes is needed.

Comparison of electromagnetic guided imagery to standard confirmatory methods for ascertaining nasogastric tube placement in children.

PURPOSE: Evaluate the accuracy of an electromagnetic device (EMD) guided nasogastric tube (NGT) placement compared with standard confirmation methods. A secondary aim was to determine if EMD guided NGT placement would avert potential pulmonary misplacements of the tube. DESIGN AND METHODS: Pediatric Intensive Care Unit (PICU) patients were enrolled if they had an NGT order during the study period of April 2014 through December 2016. Patients were included if they were one through 18 years of age. An EMD trained nurse inserted the NGT using EMD guidance. An insertion questionnaire, confirming if the nurse determined the NGT to be gastric per EMD, was completed immediately after NGT placement and before confirmation via either pH testing or radiographic imaging. RESULTS: Forty-five patients were enrolled in the study. Nurses reported, based on EMD, that 86.7% (n = 39) of placements were gastric. Overall agreement between EMD guided tube placement and pH testing was 58% (n = 26). The marginal distribution was significantly different between the two methods (p = .0029). When compared to radiographic confirmation, sensitivity of the pH method was 32% (95% confidence interval [CI]: 17%-51%) compared with 85% (95% CI 69%-95%) for the EMD method. CONCLUSIONS: EMD guidance was superior to pH testing when compared with radiographic confirmation of nasogastric tube placement in children. PRACTICE IMPLICATIONS: EMD guided NGT placement is a potentially viable method for confirming nasogastric tube placement in children when done by appropriately trained clinicians. More research on EMD guided NGT placement in children is needed before any practice recommendation can be made.

Youth and Pet Survivors: Exploring the Experiences of Pediatric Oncology and Bone Marrow Transplant Patients in a Virtual Animal-Assisted Therapy Pen Pal Program.

Introduction: YAPS™ (Youth and Pet Survivors™) is a form of virtual animal-assisted therapy (AAT), a pen pal program designed for children and adolescents with cancer and/or having a bone marrow transplant (BMT) to engage in virtual visits with a dog or a cat (who has also been treated for cancer or serious medical illness) through letter writing and pictures. The purpose of this qualitative descriptive study was to explore the experiences of YAPS participants over time and to explore how virtual AAT may be an additional or alternative intervention to the traditional form of AAT, which involves live visits with animals, primarily dogs. Method: Open-ended, face-to-face interviews were conducted throughout the participants' involvement with their animal pen pal. Interviews were digitally recorded. Data were analyzed using a content analysis method. Results: Fifteen children and adolescents, aged 7 to 16 years, participated. Three main themes and five subthemes were found, including connection, shared experience, and friendship. Themes suggested that a virtual AAT letter writing program can provide a source of fun and a way to process the cancer experience with a dog or cat pen pal who has also faced cancer or serious medical treatment. Discussion: Interventions that promote well-being for pediatric oncology and BMT patients are needed, and virtual AAT seems to be one such intervention suited for those who have an affinity for animals and enjoy letter writing. The findings of this study also presented an exciting and intriguing gap for further research in virtual AAT.

Mothers' Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care.

BACKGROUND: Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. PURPOSE: The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago. METHODS: In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant's birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis. RESULTS: Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother-nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving. IMPLICATIONS FOR PRACTICE: Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance. IMPLICATIONS FOR RESEARCH: Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers.

Mothering in the NICU: A qualitative exploration of maternal engagement.

Research suggests maternal engagement in the neonatal intensive care unit (NICU) may positively impact maternal and infant health outcomes. However, the U.S. has lower rates of maternal engagement in the NICU compared to other developed countries. This qualitative study reflects a transdisciplinary research partnership between social work, nursing, and neonatology. Qualitative inquiry explores maternal experiences in the NICU from the perspectives of mothers of preterm infants hospitalized in 2 U.S. NICUs. Results support an ecological systems framework to understanding barriers and facilitators to maternal engagement in the NICU and the utilization of a trauma-informed health care approach in NICU settings.

Comparison of two tools to assess dyad feeding interaction in infants with gastroesophageal reflux disease.

PURPOSE: The aim of this study was to compare the Mother-Infant/Toddler Feeding Scale (MITFS) and the Nursing Child Assessment Feeding Scale (NCAFS). Specific questions were as follows: (1) Are there differences between the results of the MITFS and the NCAFS tools in terms of rating infant feeding interactions? And (2) does one tool provide a more detailed, nuanced overview of the quality of feeding interactions than the other? DESIGN AND METHODS: This comparative descriptive study is a secondary analysis of a study evaluating a massage intervention for infants with symptoms of gastroesophageal reflux disease (GERD). A feeding observation for each dyad was scored using both the NCAFS and MITFS. Infants were 6-18 weeks of age. RESULTS: There were moderate correlations (r = 0.3-0.8) between 11 of 20 possible NCAFS and MITFS mother-related subscales, and between 3 of 10 possible NCAFS and the MITFS infant-related subscales. A total of 19 dyads (83%) had one or more NCAFS subscale scores that were at least 1 standard deviation (SD) below normative scores, and 21 dyads (91%) had one or more MITFS subscale T-scores that deviated 1 SD from the normative T-scores. Agreement between the two instruments on scores deviating from the norm was 78%. PRACTICE IMPLICATIONS: Both instruments discussed in this paper are standardized ways of assessing an infant feeding. Use of a standardized feeding tool is an objective way to evaluate feedings and can potentially identify specific areas of concern to guide an individualized intervention for a mother-infant dyad. Thus, nurses and other health professionals working with mothers and babies, whether in the hospital, pediatrician offices, or clinics would benefit from learning how to use a standardized feeding tool. Use of a feeding tool also provides the opportunity for nurses to understand the basis of important qualities of a feeding interaction, and a way for nurses who regularly feed infants to self-evaluate their feeding methods. This may minimize less than optimal interactions and allow for optimal support for infants during feedings by mothers and nurses.

Hormonal and Neuromuscular Responses to Breastfeeding: A Pilot Study.

OBJECTIVES: Difficult breastfeeding in the first weeks after birth may result in muscle tension in infants and activation of the maternal hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS). Our primary objective was to examine the feasibility of collecting neuroendocrine markers of maternal HPA axis and SNS activation (salivary cortisol and α-amylase [sAA]) and electromyographic (EMG) markers of infant distress during feeding in the first 2 weeks after birth. We also examined the relationships of these indices to each other and to mother-infant interactive behaviors during feeding. METHODS: We recruited mothers in the postpartum unit of a teaching hospital and observed a feeding in the dyad's home. Cortisol and sAA were sampled before feeding, 10 min into feeding, at feeding end, and 20 min after feeding. Infant muscle activity was recorded continuously with an EMG data logger. We used the Nursing Child Assessment Feeding Scale to measure mother-infant interaction. RESULTS: The 20 mothers reported no disruption to breastfeeding and no change in infant behavior due to collection measures. Mean cortisol levels decreased significantly; there was no significant change in sAA levels. Relationships were found between interactive behavior and trends in neuroendocrine biomarkers. Longer bursts of infant muscle activity were associated with higher levels of maternal cortisol during feeding but not mother-infant interactive behaviors. CONCLUSIONS: Maternal salivary biomarkers and their association with feeding behaviors can be a useful tool for clinical longitudinal research beginning soon after birth. Infant EMG data may be useful for assessing maternal arousal.

Prepregnancy Obesity and a Biobehavioral Predictive Model for Postpartum Depression.

OBJECTIVE: To test a predictive model of the associations among prepregnancy body mass index (BMI), third-trimester biological and behavioral variables, and symptoms of depression at 4 weeks postpartum. DESIGN: Secondary data analysis from a longitudinal, biobehavioral repeated-measures study of women during the third trimester of pregnancy through 6 months postpartum. SETTING: Communities surrounding a Midwestern and a Western U.S. city. PARTICIPANTS: Participants were 111 women enrolled during their third trimesters of pregnancy who were studied through 4 weeks postpartum. METHODS: Whole blood and saliva were used for biological measures, and validated questionnaires were used for behavioral measures. Principal component analysis and path analysis with principal component variables were used to iteratively test the model. RESULTS: There were three statistically significant direct effects in the model: the path from prepregnancy BMI to inflammation, the path from prepregnancy BMI to stress, and the path from stress to symptoms of depression at 4 weeks postpartum. Indirect effects of prepregnancy BMI on postpartum depression through intervening variables were not statistically significant, nor was the model-based total effect of prepregnancy BMI on postpartum depression. CONCLUSION: Stress was significantly linked to prepregnancy BMI and postpartum depression. This finding highlights continuing possibilities for improving outcomes for mothers, infants, and families through stress-mitigating preventive strategies.

Sleep in mother and child dyads during treatment for pediatric acute lymphoblastic leukemia.

PURPOSE/OBJECTIVES: To compare the sleep of children with acute lymphoblastic leukemia (ALL) during maintenance treatment with controls and to measure the effect on maternal sleep. DESIGN: Comparative, descriptive. SETTING: Pediatric oncology clinic and communities in Colorado. SAMPLE: 26 dyads of mothers and children with ALL and matched controls. METHODS: Mothers completed insomnia severity, mood, and stress questionnaires and wore a wrist actigraph, and mothers and children completed a seven-day sleep diary. MAIN RESEARCH VARIABLES: Mother and child sleep parameters (e.g., total sleep time, sleep latency, sleep efficiency, awakenings); maternal insomnia severity, mood, and stress; child sleep habits. FINDINGS: Mothers of children with ALL reported greater insomnia compared to controls, which was correlated with anxiety, depressive symptoms, and stress. Maternal groups did not differ on diary- and actigraph-measured sleep outcomes; both groups experienced sleep fragmentation. Children with ALL took longer to fall asleep and had more variable sleep patterns. CONCLUSIONS: Actigraph and sleep diary data indicated adequate maternal sleep duration and sleep latency. Self-reported insomnia severity in mothers of children with ALL suggested sleep fragmentation that may be undetected by these measures. IMPLICATIONS FOR NURSING: Oncology nurses are in a unique position to identify sleep problems in mothers and children with ALL, which may lead to recommendations for improved sleep and referrals for treatment.

Interactions during feeding with mothers and their infants with symptoms of gastroesophageal reflux.

OBJECTIVES: To examine whether maternal-child interaction during feedings was suboptimal in dyads in which the infant had gastroesophageal reflux disease (GERD) and to compare massage therapy to a nonmassage therapy sham treatment in improving the mother-child interaction in these dyads. DESIGN: In this randomized, controlled pilot study, infants received massage therapy (n=18) or a nonmassage touch/holding sham treatment (n=18). Mothers, data collectors, and the investigator who scored the feeding observations were blinded to group assignment. SETTINGS/LOCATION: Dyads were recruited from pediatric care providers in the Denver metropolitan area and online advertisements at the University of Colorado. Treatments were given in the home of the dyad. PARTICIPANTS: Healthy infants, born at 38-42 weeks gestational age, were 5-10 weeks of age at enrollment; had a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised; and were diagnosed with GERD by their pediatric provider. Mothers were English speaking and at least 18 years of age. INTERVENTIONS: Treatments were given for 30 minutes twice weekly for 6 weeks. A certified infant massage therapist administered massage, and a registered nurse or physical therapist experienced with infants administered the control treatment. OUTCOME MEASURES: Maternal and infant scores on the Nursing Child Assessment of Feeding Scale (NCAFS). RESULTS: NCAFS scores were significantly lower than national norms. Small to moderately sized effects showing improvement in the massage group relative to the nonmassage group were seen for Sensitivity to Cues, Social-Emotional Growth Fostering, Cognitive Growth Fostering, and Clarity of Cues (Cohen d) and ranged from 0.24 to 0.56. CONCLUSIONS: Mothers and infants with GERD experience significantly worse interactions than those without GERD. Massage given twice weekly by a professional trended toward improved interaction during feeding. Daily maternal administration of massage may have a positive effect on the relationship.

Anxiety, depression, stress, and cortisol levels in mothers of children undergoing maintenance therapy for childhood acute lymphoblastic leukemia.

The purpose of this study was to compare anxiety, depression, and stress between mothers of children during maintenance treatment for acute lymphoblastic leukemia (ALL) and matched controls. Twenty-six mothers were recruited from the hematology unit at a children's hospital, and 26 mothers were recruited from the community. Participants were matched to their child's age and gender. Mothers completed the Hospital Anxiety and Depression Scale, the Perceived Stress Sale, and collected salivary cortisol 4 times a day for 3 consecutive days. Compared with mothers of healthy children, anxiety scores did not differ (P=.10), but depression scores were higher (P=.003) in mothers of children with ALL. More mothers in the ALL group scored above the cutoff of 7 indicating clinical anxiety (46%) and depressive symptoms (27%). A trend toward increased stress was found in mothers in the ALL group. No difference was found in overall daily cortisol (area under the curve), daily decrease in cortisol (slope), and cortisol awakening response. Mothers of children with ALL experienced emotional symptoms many months after the initial diagnosis.

Effect of holding on co-regulation in preterm infants: a randomized controlled trial.

OBJECTIVE: To determine whether kangaroo holding of healthy preterm infants over the first eight weeks of an infant's life facilitates co-regulation of salivary cortisol between mother and infant. STUDY DESIGN: Randomized control trial. Infants were assigned to receive 1h of daily kangaroo (skin-to-skin contact on the chest of mother) or blanket holding (dressed and held in mother's arms). A registered nurse visited mothers weekly for eight weeks to encourage holding and provide information about infant development. A control group had no holding restrictions and received weekly brief social visits. SUBJECTS: The study included 79 preterm infants, born between 32 and 35weeks gestational age and were a mean of 15days (±5.7) at enrollment. OUTCOME MEASURES: Co-regulation was conceptualized as progressive reduction in the absolute difference between mother and infant cortisol levels across 60min of holding at each holding session. Mother and infant cortisol levels were measured before holding and at 30 and 60min after holding began during three holding sessions (baseline and at two and eight weeks after study initiation). Primary analyses were conducted using hierarchical linear models. RESULTS: There was much variability in cortisol levels. Levels of mother and infant cortisol decreased during holding. No significant co-regulation occurred in any group at any holding session or over time. CONCLUSIONS: Decreasing level of cortisol in both mothers and infants suggests that holding promoted the expected decline in stress hormone levels. However, supported holding methods did not differentially affect co-regulation compared to controls. Holding is pleasurable and stress may need to be present in order for mothers and infants to demonstrate co-regulation in cortisol levels.

Exploring sleep-wake experiences of mothers during maintenance therapy for their child's acute lymphoblastic leukemia.

A qualitative study was designed to explore sleep-wake experience of mothers of children in maintenance treatment for Acute Lymphoblastic Leukemia. Interviews were conducted with 20 participants using open-ended, semi-structured questions and were transcribed verbatim. Two main themes emerged: "It's a whole new cancer world" and "I don't remember what it's like to have sleep." Mothers experience difficulty sleeping during their children's treatment, and expressed several serious issues. Although the mothers were able to employ various mechanisms to address sleep deprivation and disruption, interventions such as social support, journaling, spiritual guidance, and/or self-talk may be most beneficial.

Benefits of massage therapy for infants with symptoms of gastroesophageal reflux disease.

OBJECTIVES: This randomized controlled pilot trial was conducted to evaluate the clinical efficacy of massage therapy (MT) for relief of symptoms of gastroesophageal reflux disease (GERD). The hypothesis was that, when compared to infants who received nonmassage therapy, infants who received MT would display fewer GERD symptoms, greater weight gain, greater amount of sleep, lower cortisol levels before and after treatment, and lower daily (area under the curve [AUC]) cortisol secretion. METHODS: Participants were 36 infants born at term, 4-10 weeks of age at enrollment, healthy except for a diagnosis of GERD by their pediatrician, and with a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R). Infants were randomized to receive either MT or a nonmassage sham treatment in their homes for 30 min twice a week for 6 weeks. Data collectors and parents were blind to study condition. RESULTS: GERD symptoms decreased in both groups and weight increased. Pretreatment salivary cortisol levels decreased significantly over time in the massage group while increasing in the nonmassage group. Daily cortisol level also decreased in the massage group and increased in the nonmassage group, but the difference was not significant. CONCLUSIONS: MT administered by a professional therapist did not affect symptoms of GERD differently than a sham treatment but did decrease infant stress as measured by cortisol. Research focusing on stress reduction in infants with GERD and multimodal treatments addressing GERD symptoms may yield the most effective treatment.

Influence of holding practice on preterm infant development.

PURPOSE: The purpose of this randomized, controlled trial was to determine if nurse-supported kangaroo holding of healthy preterm infants in the first 8 weeks of the infant's life facilitates early behavioral organization and development. METHODS: We randomized 87 infants born between 32 and 35 weeks gestation and their mothers to one of three holding groups: kangaroo (skin-to-skin between mother's breasts), blanket (held in mother's arms), or control (no holding restrictions). Nurse-supported groups (kangaroo and blanket) received 8 weekly visits from a registered nurse who encouraged holding and provided education about infant development. The control group received brief social visits. Mothers recorded time held in a daily diary. The Assessment of Preterm Infant Behavior was administered when infants were 40 to 44 weeks postconceptional age. RESULTS: Total holding time averaged 4 to 5 hr/day and did not differ among groups. Mothers held kangaroo style an average of 59 min/day in the kangaroo group, and 5 and 9 min/day in the blanket and control groups, respectively (p < .001). Infants in the kangaroo and blanket groups had more optimal scores than the control group in Robust Crying (p = .015) indicating that they could arouse to vigorous crying and calm. Scores, except for Attention and State Regulation, were at least as high as those of full-term infants. CLINICAL IMPLICATIONS: When kangaroo holding is compared to blanket holding, both methods may provide equal early behavioral organization and developmental benefit to the infant.