Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks-A Qualitative Descriptive Study.

(1) Background. The birth of an infant at 23 to 24 weeks poses a significant challenge to healthy parent-infant bonding because of the high risk of infant loss and the prolonged separation. The aim of this study was to retrospectively explore the narratives of parents with children born at 23-24 weeks about their bonding formation and relational experiences. (2) Methods. This was a qualitative descriptive study conducted with Finnish parents of children born at 23 or 24 weeks of gestation. Twenty-nine mothers and eight fathers were retrospectively interviewed using a semi-structured interview about the bonding process with their infant during the period in the neonatal intensive care unit (NICU) and their later parent-child relationship. Parents' narratives were deductively analysed according to a framework previously developed for studying parental bonding. (3) Results. Our results showed that several parents described the bonding process as natural or even easy despite the traumatic start to parenthood. Support from NICU staff and providing opportunities for participation in infant care and parent-infant physical closeness were reported to enhance the bonding process. Our study identified earlier parenting experience as a new element supporting bonding. (4) Conclusions. According to our results, essential elements enhancing parent-infant bonding in NICU settings seem to be supporting parents psychologically, promoting parent-infant closeness, and encouraging parental participation in the infants' care, even with the most immature infants.

Mothers' experiences of parenting and everyday life of children born at 23 weeks of gestation - a qualitative descriptive study.

BACKGROUND: Surviving children born at 23 gestational weeks are a growing population. As many of these children face developmental challenges during childhood and adolescence, more knowledge is needed about the everyday life of this group. The parental perspective is important, as developmental problems often pose a challenge for the parents. The aim of this qualitative study was to explore mothers' experiences of parenting children born at 23 gestational weeks and of the children's everyday lives. METHODS: This was a qualitative descriptive study conducted with mothers of children born at 23 weeks of gestation. These purposively sampled eight mothers were interviewed using a semi-structured interview. Thematic analysis was used to analyse the interviews. RESULTS: Seven themes were formed on the basis of the interview data and they are presented in three dimensions: 1) the child seen from maternal perspective included themes 'emphasizing strengths in the midst of challenges', 'relations with peers and siblings', and 'emotional well-being and active life'; 2) the parenting experience included themes 'intensive mothering' and 'gratitude'; 3) the support included themes 'support from the social network' and 'support from society'. CONCLUSIONS: The mothers described how the lives of their children were active and rich. The mothers were dedicated to motherhood and they also expressed feelings of gratitude. Mothers received support from social networks and from society. This qualitative study provided an important complementary perspective to the discussion on extremely premature children's quality of life. It also highlighted the importance of parental perspectives in assessing neonatal care and its outcomes.

Prereading skills of very-low-birth-weight prematurely born Finnish children.

Our objective was to study the prereading skills of very-low-birth-weight (VLBW; ≤ 1500 g) prematurely born children at the age of five years. A regional cohort of 89 VLBW children and 152 full-term (FT) born children was assessed for letter knowledge, phonological processing, and speeded naming. Full-scale IQ (FSIQ) was assessed using a short version of WPPSI-R. The associations of parental and neonatal factors, and FSIQ with prereading skills were assessed. VLBW group had poorer prereading skills, and there were more VLBW children at-risk (performing < -1 SD) compared to FT children in phonological processing (23% vs. 9%, p = .002), letter knowledge (27% vs. 14%, p = .017), and the accuracy of speeded naming (26% vs. 13%, p = .020). VLBW children had lower average FSIQ and Performance IQ (both comparisons p < .001) than FT controls, but Verbal IQ did not differ. When FSIQ was used as a covariate, VLBW children did not differ from the FT group in prereading skills indicating that they are at risk for more global developmental problems. Lower parental level of education as well as parent's reading problems were negatively associated with VLBW children's prereading skills. Positively, about 75% of VLBW children performed within the normal range in each individual prereading skill.

Relations between brain volumes, neuropsychological assessment and parental questionnaire in prematurely born children.

The objective of this study is to assess the relationship between brain volumes at term equivalent age and neuropsychological functions at 5 years of age in very low birth weight (VLBW) children, and to compare the results from a neuropsychological assessment and a parental questionnaire at 5 years of age. The study group included a regional cohort of 97 VLBW children and a control group of 161 children born at term. At term equivalent age, brain magnetic resonance imaging (MRI) was performed on the VLBW children, and analysed for total and regional brain volumes. At 5 years of age, a psychologist assessed the neuropsychological performance with NEPSY II, and parents completed the Five to fifteen (FTF) questionnaire on development and behaviour. The results of the control group were used to give the age-specific reference values. No significant associations were found between the brain volumes and the NEPSY II domains. As for the FTF, significant associations were found between a smaller total brain tissue volume and poorer executive functions, between a smaller cerebellar volume and both poorer executive functions and motor skills, and, surprisingly, between a larger volume of brainstem and poorer language functions. Even after adjustment for total brain tissue volume, the two associations between the cerebellar volume and the FTF domains remained borderline significant (P = 0.05). The NEPSY II domains Executive Functioning, Language and Motor Skills were significantly associated with the corresponding FTF domains. In conclusion, altered brain volumes at term equivalent age appear to affect development still at 5 years of age. The FTF seems to be a good instrument when used in combination with other neuropsychological assessment.