Executive function in 7-9-year-old children born extremely preterm or with extremely low birth weight: effects of biomedical history, age at assessment, and socioeconomic status.

Forty-five children born extremely preterm and/or with extremely low birth weight (ELBW), who were of average intelligence, were assessed at age 7-9 on a raft of measures of executive function (EF) designed to assess inhibition, set shifting, planning, fluency, and working memory. Relative to 45 full-term controls, the preterm/ELBW children showed reliable impairments of inhibition, fluency, and working memory. Among the 7-year olds, the preterm/ELBW group also showed significantly worse set shifting. After controlling for age and family socioeconomic status (SES), within-group analyses of the preterm/ELBW data revealed that higher birth weights were associated with better inhibition, whereas lower neurobiological risk (gauged by such aspects of neonatal medical history as a number of days on oxygen) was associated with better planning. Moreover, there were interactions between neurobiological risk and SES on the measures of inhibition, fluency, and working memory, indicating that the adverse effects of risk were greater among children from low-income households. These findings demonstrate that neonatal medical problems are associated with considerable variability in EF among normally developing preterm/ELBW children and implicate an important influence of the family environment on the maturation of EF.

A comparison of executive function in very preterm and term infants at 8 months corrected age.

BACKGROUND: Executive function (EF) emerges in infancy and continues to develop throughout childhood. Executive dysfunction is believed to contribute to learning and attention problems in children at school age. Children born very preterm are more prone to these problems than their full-term peers. AIM: To compare EF in very preterm and full-term infants at 8 months after expected date of delivery. SUBJECTS: 37 very preterm infants without identified disabilities, and 74 gender and age matched healthy full-term infants. The very preterm infants were all

Attentional problems in children born very preterm or with extremely low birth weight at 7-9 years.

Behavioral rating scales and tests of attention were used to study attentional problems in children born very preterm (< or =27 weeks gestation) or with extremely low birth weight (ELBW; < or =1000 g). Psychological tests of attention (viz., Digits and Spatial Span Forward, Visual Attention from the NEPSY, Trail Making Test B, and Stroop Color and Word Test) were administered to 45 children born very preterm/ELBW and 49 full-term controls, aged 7-9 years of age. Behavioral ratings on an ADHD scale were provided by parents and teachers on inattentive and hyperactive-impulsive symptoms. Children born very preterm/ELBW were found to perform significantly more poorly on Spatial Span Forward, Visual Attention, and Trail Making B than controls. Group differences were also found on parents' ratings on inattentive and total symptoms. Finally, measures of psychological tests of attention were found to be significant predictors of parents' and teachers' ratings of symptoms.

Towards a developmental framework of consumer and carer participation in child and adolescent mental health services.

OBJECTIVE: This paper examines the concept of consumer participation in the context of developmental changes in parent/child relationships and associated differences in the utilization of child and adolescent mental health services. METHOD: Existing definitions and characteristics of mental health service delivery for children and young people are examined to answer the question,"Who is the consumer in the context of clinical services for young clients and their parents, and does this change with the child or young person's developmental stage?". RESULTS: As children, young people and parents utilize services in this area of mental health, the roles of consumer and carer need redefinition to accommodate both young clients and parents as consumers, and parents also as carers. CONCLUSION: The proposed framework addresses the changing roles of parents and young clients from infancy to early adulthood to guide consumer and carer participation strategies. If child and adolescent mental health services are to apply a developmental perspective and engage both young clients and parents as 'consumers', they need to address challenges related to the differences in expectations and capacities of young clients and parents, to the complexity associated with dual roles, and to promoting meaningful participation.

Developmental patterns from 1 to 4 years of extremely preterm infants who required home oxygen therapy.

BACKGROUND: Bronchopulmonary dysplasia (BPD) remains a common complication of prematurity, with those being discharged on home oxygen at particularly high risk of adverse developmental outcomes. AIMS: To compare the developmental patterns, from 1 to 4 years, of extremely preterm infants with BPD discharged from hospital on home oxygen, extremely preterm infants with BPD discharged breathing room air, and extremely preterm infants without BPD. SUBJECTS: Two hundred and seventy-six infants with a gestational age of <28 weeks or birthweight <1000 g, free from sensory and motor disabilities who were followed up longitudinally to 4 years corrected age. OUTCOME MEASURES: Children were assessed on the Griffiths Mental Development Scales at 1 and 2 years corrected age, and the McCarthy Scales of Children's Abilities at 4 years corrected age. RESULTS: The developmental trajectories of the three groups did not differ significantly, however at 1 year corrected age the non-BPD group had significantly higher developmental scores than both BPD groups. At 2 years corrected age the non-BPD group had significantly higher developmental scores than the BPD-home oxygen group, and at 4 years corrected age no differences between the groups were evident. CONCLUSIONS: Extremely preterm children with BPD exhibited an initial developmental lag compared to preterm peers. Children with BPD discharged breathing room air had developmental scores at 2 years corrected age that were comparable to the non-BPD group, but those discharged on home oxygen still had lower developmental scores. At 4 years, no differences between the groups were evident.

Current delivery of infant mental health services: are infant mental health needs being met?

OBJECTIVE: To identify services supporting the well-being of infants and their families in an area of South Brisbane, Australia, highlight problems of accessing these services and recommend strategies to make them more readily available. METHOD: Semistructured interviews were conducted with staff from 18 service providers offering antenatal services, or programmes primarily focused on children under the age of 2 years and/or their families. The interview aimed to identify the precise nature of the services offered, problems encountered in providing those services, perceived gaps in services and potential strategies for improvement. RESULTS: Services were diverse, provided by a range of different professionals, in varying locations (home, community, hospital) and with funding from various sources. The major findings were: (i) the fragmentation of services, lack of communication between them, and lack of continuity in services from one stage of family formation to another; (ii) the shortage of services working with the parents and infant together; and (iii) the difficulty of providing services for some at-risk populations. CONCLUSIONS: Recommendations included: (i) maintaining a range of different services networked through a centralized resource/referral centre; (ii) expanding joint mother-infant services and providing training for such services; and (iii) supporting outreach services for difficult to engage populations.

The health of children in immigration detention: how does Australia compare?

We live in an age when the number of refugees worldwide is increasing. All of them have suffered physically or emotionally to a varying degree in their country of origin. The transit to a country of resettlement is fraught with further difficulties or the risk of death. This article explores the different approach taken to the management of this issue by Denmark and Iceland, in comparison to that of Australia. In particular, the different approaches to health care for children and their families are identified. The management of these issues by Denmark and Iceland would appear to be a model to follow. Outcomes of the different managements have not been assessed.

The impact of very premature birth on the psychological health of mothers.

BACKGROUND: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. STUDY DESIGN: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. SUBJECTS AND METHODS: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. RESULTS: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. CONCLUSIONS: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.

Mothers' involvement in caring for their premature infants: an historical overview.

BACKGROUND: Advances in technology have resulted in increasing survival rates even for extremely premature infants. While sophisticated medical management is vital to infant survival, research has found that social factors and care giving processes are important predictors of infants' later outcome. Consequently, evidence is accumulating to demonstrate the fundamental role of mothers and families to the optimal developmental outcome of premature infants. AIM: The aim of the work reported here was to undertake an historical overview of premature infant care practices to increase neonatal nurse's knowledge of the crucial role of mothers and families in the care of their premature infants. Understanding past practice and current trends can provide neonatal nurses with critical insight which will assist in formulating current and future care. METHOD: Research and historical articles focusing on maternal involvement in preterm infant care from the development of the incubator to the present time were examined. A search of the literature between 1960 and 2002 was conducted using the MEDLINE, CINAHL and PSYCLIT databases. The search terms were premature infant, neonatal intensive care, history, and maternal care. FINDINGS: Three major themes were identified which reflect the development of neonatal care. Firstly, over the last century advances in medical and public health practice saw a decline in mortality rates for mothers and infants. Secondly, the application of this new knowledge resulted in the institutionalization and professionalization of obstetric and neonatal care which, in turn, resulted in the isolation of infants from their mothers. Finally, concurrent advances in infant research emphasized the importance of mother-infant relationships to infants' developmental outcome, resulting in greater flexibility in hospital practices regarding parental contact with their infants. CONCLUSION: As biomedical advances in technology continue to help smaller, sicker premature infants to survive, neonatal nurses are strategically placed to promote positive outcomes for infants and their families through the integration of social science and behavioural research into nursing practice.

Mother-infant interaction in premature infants at three months after nursery discharge.

Both the immature and disorganized behaviour of the premature infant and the psychosocial or socioeconomic factors which adversely affect a mother's responsiveness to her premature infant can jeopardize the mother-infant relationship. At three months after infant hospital discharge, the interactions of 50 premature infants (< or = 32 weeks) and their mothers were videotaped and coded using the Nursing Child Assessment Feeding Scale. The relationship between data derived from the feeding interaction and maternal psychosocial and infant perinatal variables collected at one month after birth and at three months after discharge from hospital were examined. Results showed that the mothers' use of coping strategies both in hospital and at home were important factors in explaining mother-infant interaction.