Parenting a preterm infant: experiences in a regional neonatal health services programme

In an Australian regional health service, parents’ experiences of the neonatal intensive care (NICU), neonatal nurseries and a community discharge programme were investigated. Parents from 12 families participated in an in-depth interview. Three themes captured a partial, yet significant, view of these parents’ experiences as they strived to develop their identity and competence as parents. The findings are explored as they reveal issues associated with the provision of family centred, developmental care in neonatal services. Opportunities for nurses in this context to expand and clarify their role in ways that are responsive to parenting needs are discussed.

Markers of inflammation in South Asian and European infants from birth to 2 years in Manchester, UK

Inflammatory markers, including serum C-reactive protein (CRP), are predictors of coronary heart disease (CHD) in adults. South Asians in the UK have higher rates of CHD in adulthood than national rates.We tested the hypotheses that South Asian infants would have higher serum concentrations of CRP and homocysteine than European infants up to 2 years of age and that higher infant weight is associated with elevation of inflammatory markers. Infants of South Asian and European origin were investigated in a mixed cross sectional-longitudinal cohort study. Mothers were recruited ante-natally from St Mary’s Hospital,Manchester by postal invitation and telephone call to non-responders. Infants with metabolic or congenital abnormalities, known syndromes or pre-maturity were excluded. Measurements were collected at birth and either 3, 6, 12 or 24 months. High sensitivity CRP and homocysteine were measured by an immulite immunoassay. We used mixed linear modelling to assess whether infant weight, ethnicity, length of follow-up or their interaction were associated with inflammatory makers in infants during follow-up. Data are presented on 306 infants (109 South Asian and 197 European). We found that European infants had higher serum CRP than South Asian infants during follow-up which was of borderline significance.There was no difference in serum homocysteine between ethnic groups during followup and no significant interaction between ethnicity and follow-up. Infant weight was significantly associated with CRP but not homocysteine. In this ongoing longitudinal study,we found little difference in inflammatory markers in infants from birth to 2 years despite markedly higher rates of CHD in South Asian than European adults. Life course exposure to risk factors may play a more dominant role in the development of CHD.

Support needs of parents of sick and/or preterm infants admitted to a neonatal unit

Background: The sudden unexpected delivery of a preterm infant is a shock to parents with studies confirming the importance of providing them with nursing support. The purpose of this descriptive study was to identify the type and level of support that nurses provided to the parents of sick and/or preterm infants. It also investigated whether parents were satisfied with the support provided by nursing staff.
Method: A convenience sample of 112 parents in an Australian tertiary neonatal unit were invited to complete the ‘Nurse Parent Support Tool’ (NPST), which is a 21-item questionnaire. The NPST consists of four domains: emotional, informational, appraisal and instrumental support. A second tool was used to assess parents’ satisfaction with the nurse to parent support.
Results: Instrumental support had the highest mean score for both nurse to parent support at 4.51 (out of 5) and 4.36 (out of 5) for satisfaction. The mean score for nursing support was 4.21 followed by parental satisfaction with nurse to parent support which was 4.16. In contrast, emotional support had the lowest mean score for both nurse to parent support at 3.94 and 3.97 for satisfaction. Parents indicated that they needed further support with lactation, breastfeeding and assistance with parenting skills.
Conclusion: Overall, the results from the study indicated that parents’ perception of nursing support was positive and that parents were highly satisfied with the nursing support provided in the neonatal unit. However, some attention needs to be given to providing more support and information on breastfeeding and parenting skills.

Effectiveness of a modified mother–infant transaction program on outcomes for preterm infants from 3 to 24 months of age

Mothers of hospitalised preterm infants were randomised into an intervention or control condition. Intervention mothers received a modified Mother–Infant Transaction Program over seven sessions prior to infant discharge and two sessions over the next 3 months. Infant temperament, mother–infant interaction and parenting stress were assessed at 3 and 6 months and infant development was measured by parental report at 24 months. Intervention compared with control dyads showed enhanced mother–infant interactions, infants were temperamentally more “approaching” and “easier”, had fewer regulatory problems (colic, sleep, excessive crying), and had more developed communication skills, while mothers were less stressed by their infant at 3 months. These early gains in the development of preterm infants and in the relationship with and adjustment of their mothers, may explain the process by which intervention infants in the original study showed increasing cognitive advantages to 9 years of age [Rauh, V. A., Nurcombe, B., Achenbach, T., & Howell, C. (1990). The mother–infant transaction program. Clinical Perinatology, 17, 31–45].

Intake of B vitamins in childhood and adult life in relation to psychological distress among women in a British birth cohort

Background : Lower levels of B vitamins (particularly folate, vitamin B12 and vitamin B6) may be associated with psychological distress. Little is known about the impact of childhood nutrition on psychological distress in adult life.

Objective : We investigated whether prospectively measured childhood and adult dietary intakes of thiamin, riboflavin, niacin, folate, vitamin B6 and vitamin B12 were related to the psychological distress of women in mid-age, taking into account socio-economic, behavioural and lifestyle factors.

Design : Prospective data were collected from a cohort of 636 British women followed up since their birth in 1946. Participants completed a 28-item, scaled version of the General Health Questionnaire (GHQ-28) to measure psychological distress at age 53 years. Dietary intakes in childhood (at age four) were determined by 24h recall and in adulthood (at age 36, 43 and 53 years) by a 5d food record.

Results : Low dietary vitamin B12 intake at age 53 was associated with higher psychological distress at that age. Women in the lowest third of vitamin B12 intake in adulthood had a higher GHQ-28 score compared with those in the highest third (percentage change, adjusted regression coefficient, 21 (95% CI 3, 39)). There were no other significant associations between dietary B vitamin intake in childhood or adulthood and psychological distress in the cohort.

Conclusions : Overall, there is evidence that intake of vitamin B12 at age 53 is related to adult psychological distress but there is no evidence for the effects of other adult B vitamin intakes or childhood intakes on psychological distress.

Depressive and anxiety symptoms through late pregnancy and the first year post birth : an examination of prospective relationships

One hundred and fifty-nine women were measured for depressive and anxiety symptoms from late pregnancy through to 12 months postpartum. Partial correlations revealed stability of depressive and anxiety symptoms across time. Depressive symptoms did not predict anxiety at any time point. Anxiety predicted increases in depressive symptoms from late pregnancy to early postpartum, but not from early postpartum to mid postpartum. Anxiety predicted depressive symptoms from mid postpartum to late postpartum, however, not when social support in late pregnancy was controlled for.

Support needs of parents of sick and/or preterm infants admitted to a neonatal unit

The sudden unexpected delivery of a preterm infant elicits many emotional responses from parents, with studies confirming the importance of providing parents with nursing support. The purpose of this study was to measure parents' perception of the type and level of support that nurses provided in an Australian neonatal unit, and to determine the extent to which parents were satisfied with the support currently provided. A convenience sample of 112 parents in an Australian tertiary neonatal unit were invited to complete the nurse parent support tool (NPST), which is a 21-item questionnaire used to measure the level of nursing support. The NPST consists of four domains -emotional, informational, appraisal and instrumental support. A second tool was used to assess parent satisfaction with nurse-to-parent support. A total of 62 parents completed the NPST and satisfaction tool.

Results showed that instrumental support had the highest mean score for both nurse-to-parent support 4.51 (out of 5) and 4.36 for satisfaction. The mean score for nursing support was 4.21 followed by satisfaction with nurse-to-parent support at 4.16. In contrast, emotional support had the lowest mean score for both nurse-to-parent support at 3.94 and 3.97 for satisfaction. Parents indicated that they needed further support with lactation, breastfeeding and assistance with parenting skills. Overall, results indicated that parent perception of nursing support was positive and that parents were highly satisfied with the nursing support provided in the neonatal unit. However, some attention needs to be given to providing more support and information on breastfeeding and parenting skills.

Teaching Zambian traditional birth attendants to monitor growth of infants : evaluation of an education program

The high infant mortality in Zambia is largely attributable to malnutrition. It is exacerbated by the inability of mothers to recognise threats to nutritional status and take corrective action. Advice in ‘Health Centres’ is often inaccessible to mothers. The Traditional Birth Attendants (TBAs) work with pregnant women in local communities, and the purpose of this study was to develop and implement an educationprogram in growth monitoring and nutrition for the TBAs and then to evaluate its effects. Twenty five TBAs from two peri-urban areas of Kitwe were enrolled in this pilot study and eighteen completed the program. The researcher developed and taught a program to the TBAs over ten days. A pretest was given before the teaching program to enable the researcher to obtain information about the knowledge and skills of the TBAs. Following the teaching program the TBAs were re-tested, with the same questionnaire. Focus groups were conducted to enable the TBA to provide information on the teaching materials and the education program. The TBAs then returned to their communities and put into practice the skills and knowledge they had learned for six months. Their practice was monitored by a trained Public Health Nurse. The researcher also surveyed 38 pregnant women about their knowledge of growth monitoring and nutrition before the TBAs went into the field to work with their local communities. The same questionnaire used with the pregnant women was administered to 38 new mothers with children aged 0 to 6 months to gain information of their knowledge and skills following the work of the TBAs. The program was evaluated by assessing the extent to which TBAs knowledge and skills were increased, the knowledge and understanding of a selection of their clients and the rates of malnutrition of infants in the area under study. The results from the research clearly indicated that the teaching program on growth monitoring and nutrition given to the selected group of TBAs had a positive effect on their knowledge and skills. It was found that the teaching developed their knowledge, practical skills, evaluative skills. That they were able to give infants’ mothers sound advice regarding their children’s nutrition was revealed by the mother’s increased knowledge and the decrease in numbers of malnourished children in the study areas at the conclusion of the research. The major outcomes from the study are: that Zambian TBAs can be taught to carry out an expanded role; field experience is a key factor in the teaching program; making advice available in local communities is important; and preliminary data on the Zambian experience were generated. Recommendations are: The pilot program should be expanded with continuing support from the Health Department. Similar educational programs should be introduced into other areas of Zambia with support from the Ministry of Health. That in administering a teaching program: Sufficient time must be allocated to practical work to allow poorly educated women to attain the basic skills needed to master the complex skills required to competently reduce faltering in their communities. The teaching materials to illustrate nutritional principles for feeding programs must be developed to suite locally available foods and conditions. Methods of teaching should suit the local area, for example, using what facilities are locally available. The timing of the teaching program should be suitable for the TBAs to attend. This may vary from area to area, for example it may be necessary to avoid times traditionally given to fetching water or working in the fields. For similar reasons, the venue for the teaching program should be suitable to the TBAs. The teachers should go into the TBAs’ community rather than causing disruption of the TBAs’ day by expecting them to go to the teacher. Data should be collected from a larger group of TBAs and clients to enable sophisticated statistical analysis to complement data from this pilot program. The TBAs should be given recognition for their work and achievement. This is something which they asked for. They do not ask for payment, rather acknowledgment through regular follow up and approbation.

Vigorous exercise and birth outcomes in a sample of recreational exercisers : a prospective study across pregnancy

Objective: This study examined the question of whether vigorous exercise undertaken by recreational exercisers across pregnancy, defined in two ways, were associated with reduced infant birthweight and gestational age at birth.

Methods: A prospective approach was implemented. A total of 148 pregnant women participated. Average intensity duration and frequency of vigorous exercise reported were examined and compared with two existing definitions of vigorous exercise. Participants completed questionnaires (including retrospective reports on 3 months prepregnancy) and an exercise diary at 16–23 weeks pregnancy, 24–31 weeks pregnancy and 32–38 weeks pregnancy, and at 7 to 14 days post-partum a birth outcomes questionnaire was completed.

Results: There were no significant differences between exercise groups for birthweight and gestational age at birth.

Conclusions: There was no evidence that the intensity duration and frequency of vigorous exercise were associated with significant reductions in mean birth outcomes for the infants of women who participated in the study. Replication in a large, more diverse sample is recommended.

Prelude to the birth of Wayo-Secchu (Japanese hybrid style) in Japanese early modern architecture

This paper will investigate the background of the emergence of Wayo-secchu (Japanese Hybrid Style), by re-examining the rhetoric of the government-oriented early Meiji Western style architecture and Japanese traditionalism's reaction to it. I will elucidate the undercurrent of the intentional shift in nineteenth-century Japan towards the recuperation of traditional Japanese style, a shift which initiated the Japanese hybrid style we now call Wayo-secchu. I will discuss the effect of institutional pressure to Westernize, by investigating what was meant by a new architectural method as expressed by the government of the time.

Duly delivered : women's experiences of birth planning

Critically examines the construct of power differentials in the childbirth experiences of forty-two women following the birth of their first child. Detailed data was collected using questionnaires and in-depth interviews with women from a range of localities around the State. The research demonstrated that childbirth processes in Victoria effectively ignore the wishes of pregnant women leading to them suffering significant physical and psychological health consequences.