Madalynn Neu

Maternal holding of preterm infants during the early weeks after birth and dyad interaction at six months.

OBJECTIVE To examine whether a supportive nursing intervention that promoted kangaroo holding of healthy preterm infants by their mothers during the early weeks of the infants life facilitated coregulation between mother and infant at 6 months of age. DESIGN Randomized controlled trial. PARTICIPANTS Sixty-five mother/infant dyads with mean gestational age at birth of 33 weeks. Fifty percent of infants were male, and 50% were non-White. INTERVENTIONS An 8-week home intervention encouraged daily 1-hour, uninterrupted holding with either blanket (baby wrapped in blanket and held in mothers arms) or the kangaroo (baby in skin-to-skin contact on mothers chest) method. In both conditions, weekly home visits by an experienced RN included encouragement to hold the infant, emotional support, and information about infant behavior and development. A control group received brief social visits, had no holding constraints, and participated in all assessments. MAIN OUTCOME MEASURES When infants were 6 months of age, the Still-Face Paradigm was used to assess mother/infant interaction. Outcome measures were coregulation of the dyads responses during the play episodes of the Still-Face Paradigm and vitality in infant efforts to reengage the mother during the neutral face portion of the Still-Face Procedure. RESULTS Significant differences among groups were found in mother/infant coregulation. Post hoc analysis showed that dyads who were supported in kangaroo holding displayed more coregulation behavior during play than dyads in the blanket-holding group. No differences were found between groups in infant vitality during the neutral face portion of the Still-Face Procedure. CONCLUSION Dyads supported in practicing kangaroo holding in the early weeks of life may develop more coregulated interactional strategies than other dyads.

Coregulation in Salivary Cortisol During Maternal Holding of Premature Infants

Purpose: The purpose of this study was to examine coregulation between mothers and preterm infants in hypothalamic-pituitary-adrenocortical (HPA) system activity, as indicated by salivary cortisol levels, while mothers held their infants. The research questions were (a) does mother—infant coregulation in HPA activity occur during holding? and (b) if mother— infant coregulation in HPA activity exists during holding, do type of holding, antenatal steroids, sound level, and maternal touch influence this coregulation? Sample: The sample consisted of 20 mother— infant dyads with infants at a mean postconceptional age of 34.7 weeks (+0.7) and average postnatal age of 15 days (+9) at the time of cortisol sampling. Design: The design was exploratory using convenience sampling. Maternal and infant cortisol levels were obtained at Time 1 (baseline) and Time 2 (end of holding); at each time, the absolute differences in levels between mother and infant were determined. Coregulation was operationalized as less difference between maternal-infant cortisol levels immediately after holding (Time 2) as compared to before holding (Time 1). Results: The two variables with the highest correlation with the Time 1/Time 2 difference score included antenatal steroids and ambient sound level, which were entered into a linear regression equation as predictor variables. A coregulatory relationship in cortisol levels existed between mothers and infants during holding, which was moderated by sound levels. Nurses in the neonatal intensive care unit (NICU) can facilitate the mother—infant relationship, as reflected in coregulatory measures, by promoting a quiet environment, particularly around mothers who are holding their infants.

A Review of Nonsurgical Treatment for the Symptom of Irritability in Infants with GERD

PURPOSE The purpose of this review was to assess effectiveness of nonsurgical treatment on irritable behavior of infants with gastroesophageal reflux disease. DESIGN AND METHODS A systematic literature review was conducted. RESULTS Research targeted treatment for irritability in infants with gastroesophageal reflux disease. All interventions including placebo were similar in reducing irritability. Which specific intervention is best for which infant is not yet known. Minor adverse effects that could increase discomfort in infants were found with pharmacologic treatments. PRACTICE IMPLICATIONS Knowledge of the effects of treatment on irritability and regurgitation can assist the nurse to work with other care providers in deciding how best to treat an individual infant.

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.

Early weeks after premature birth as experienced by Latina adolescent mothers.

ObjectiveTo examine the early adaptation challenges and strengths of young mothers with preterm infants. Study DesignNaturalistic inquiry was used to obtain a subjective description of the postpartum experience of 12 adolescent Latina mothers who enrolled in an intervention study subsequent to the preterm birth of their first baby. Intervention visits with the mother and infant offered the opportunity to repeatedly observe them and discuss with the mother her views on this life transition. ResultsThemes that emerged from discussions with the mothers were (a) devotion to the baby, (b) responsibilities, and (c) relationships. The adolescent mothers displayed devotion to their babies in their gentle touch and positive comments to and about their baby, their interest and adherence to an intervention program that promoted holding and provided information about infant development, and their advocacy with medical professionals and family members for their babys well-being. Interdependence regarding the sharing of responsibilities to benefit the family was evident within families. Family relationships were supportive and vital to the adolescent mothers. Clinical ImplicationsLatina adolescent mothers may benefit from recognizing their strengths and incorporating these strengths into the care plan for their infants. Warm, supportive relationships between the young mothers and the healthcare professional in this study resulted in the mothers considering new information addressing care of their infants, even if the information was different from their cultural mores.

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 infants 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 mothers breasts), blanket (held in mothers 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.

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.