Functional performance according to gestational age and birth weight of preschool children born premature or with low weight

Premature labour is a major health problem.Besides medical factors, risk factors include lowersocial class, less education, single marital status,low income younger maternal age, low body weight,ethnicity, smoking, poor housing. The long termsequelae can be severe and the cost - financiallyand socially - of care is high. Preterm birth is indeeda major clinical public heath problem that accountsfor nearly 50% of all neonatal deaths

Neonatal Psychology: Theories and Practice

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The impact of birthweight on adult minor illness: a study on a subclinical population

Official classification for low birth weight is 2500 gram or below. Whilst there is no consensus of what constitutes normal birth weight, it has been suggested that the optimal birthweight for long term health is 3500 - 4500 gram; hence those with birth weight between 2500 and 3490 gram could be deemed to be a sub clinical population. The objective was to investigate the relationship between disease and birthweight and to compare vulnerability of those with suboptimal and optimal birthweight in adulthood. This is a cohort study; with cross sectional retrospective design involving 258 adults aged 18-62 who knew their birth weight. Participants completed a minor illness checklist, using a median split, participants were categorised as high or low minor illness group. Results indicate a negative correlation between birthweight and minor illness score (r = -.155, p = .013). Those born with sub optimal birthweight are more likely to report minor illness symptoms above the media score of 16 (OR 1.70 CI 95% 1.04-2.79).It is concluded that there is a relationship between birthweight and level of minor illness in adulthood. Those born with birthweight 2500 - 3490 gram appear to be more vulnerable to minor illness. Thus, working with Foetal Origins theory, it may be possible that this group experienced a degree of foetal compensation, the consequence being that the immune system is compromised. Application of a three dimensional equilibrium model is suggested in designing interventions that improve foetal environment and subsequent health chances

Understanding the impact of newborn touch upon mothers of hospitalized preterm neonates.

Many interventions have been designed to support the development of the preterm baby and minimise the complications of prematurity. However, there is limited evidence of the possible psychological benefits of touch to the mother when she is the one performing the support programme during the hospitalisation of her newborn. This study explored whether the type of touch provided to preterm neonates had an impact on maternal self-efficacy, self-esteem and maternal-to-infant attachment, as-well-as newborn weight gain. Using a randomised cluster trial, forty babies and their mothers were allocated to one of two groups receiving either a touch-based intervention (TAC-TIC; Touching And Caressing; Tender In Caring) or spontaneous touch. Mothers who provided the touch-based intervention demonstrated greater increases in self-efficacy, self-esteem and attachment, and babies gained more weight than those using spontaneous touch. The results indicate that systematic touch interventions may be used to facilitate the mother-baby relationship as well as to promote newborn weight gain

Validation of the scale of perceived self-efficacy of maternal parenting in Brizilian sample

Self-efficacy matches the belief that a person has that she is able to produce theresults she wants to achieve. The beliefs of self-efficacy that parents have about the baby emerge asa powerful predictor of positive parenting. Objective: this study aimed to evaluate the maternalself-efficacy behavior in hospitalized mothers and validate an instrument for measuring this conceptdeveloped and validated in England by Barnes and Adamson-Macedo, in 2007. Method: this cross-sectional exploratory study convenience cohort comprised 87 mothers of newborn babies, 26premature and 61 full-term infants. The scale Perceived Maternal Parenting Self-Efficacy (PMP S-E),which consists of 20 items that represent four subscales was tested for reliability and validity. Results:the internal consistency of the scale PAEPM reached a value of .86, the internal consistency andreliability estimates for each of the subscales also reached acceptable values. Exploratory FactorAnalysis (EFA) confirmed the validity of the construct and the scores of self-efficacy were normallydistributed for both subgroups and total sample. Conclusions: PMP S-E scale proved to be an easyapplication tool and psychometrically robust, reliable and valid for use with mothers of hospitalizednew-borns both premature as the term clinically stable. It is a reliable method of identifying mothersof babies who need more support from the hospital staff

Love or protection? : defining and measuring maternal-fetal attachment from the woman's perspective

Existing commonly used maternal-fetal attachment instruments have not been thoroughly tested for reliability and validity; criticism can be levelled for a variety of problems ranging from lack of reliability due to an inadequate underpinning framework to facilitate objective interpretation to limited generalizability due to the sample. The aim of this study is to acknowledge the centrality of the mother, to use the experiences of pregnant women to generate a definition of maternalfetal attachment and ultimately create a tool that will act as a reliable, valid and simple measurement. A mixed method framework utilising a sequential exploratory strategy has allowed qualitative exploration of the phenomenon under investigation followed by quantitative testing of the emerging theory on a much larger and different sample. Phase 1 involved face to face open structured interviews on an opportunity sample of 10 (5 primigravid; 5 multiparous) women in the final trimester of pregnancy followed by 3 focus groups targeting specific groups – primigravid women (6 participants); multiparous women (7 participants) and teenagers (4 participants). Data analysis was through constant comparative methodology. A multidimensional, psycho-biological definition of attachment was generated from the women’s own perception of their attachment to their fetus. This was used as a framework to design a questionnaire for the measurement of maternal-fetal attachment. Phase 2 involved the validation of the questionnaire and further testing of the definition. Cohort 1 tested for reliability with 200 participants within their second or third trimester of pregnancy. Following modification of the questionnaire, Cohort 2 a sample of 150 women within the final trimester of pregnancy tested the tool for internal reliability and validity. The generated Maternal-Fetal Attachment Tool (MFAT) following rigorous testing proved both reliable and valid. Maternal fetal attachment is founded in psycho-biological theory and is a complex multi-dimensional construct. Central to the definition is the woman’s need to protect her fetus, attachment develops as the fetus becomes more tangible, it is facilitated through the woman’s intergenerational experience of attachment and through appropriate social support. Maternal-fetal attachment facilitates behavioural change to ensure a favourable intra-uterine environment.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Mortalidade infantil continua sendo um grave problema de saúde pública

The identification of factors related to infant deaths can help in the planning of public health actions for the restructuring and improvement of maternal and child care, with a view to reducing infant mortality. The variables related to infant mortality continue to be incident in males, in those of brown color, with birth weight below normal and children of young mothers. Actions with technical and financial investment throughout prenatal care with a complete care network and strengthening childcare services for children by the Primary Care network at municipal level are necessary and urgent strategies to reduce the drama of preventable deaths of children in the first year of life.A identificação de fatores relacionados aos óbitos infantis pode auxiliar no planejamento de ações de saúde pública para a reestruturação e a melhoria da assistência materno-infantil, visando à redução da mortalidade infantil. As variáveis relacionadas à mortalidade infantil continua sendo incidente no sexo masculino, naqueles de cor parda, com peso ao nascer abaixo do normal e filhos de mães jovens. Ações com investimento técnico e financeiro ao longo do pré-natal com rede assistencial completa e fortalecimento no atendimento de puericultura das crianças pela rede de Atenção Básica em nível municipal são estratégias necessárias e urgentes para reduzir a dramaticidade das mortes evitáveis de crianças no primeiro ano de vida

Cognitive, emotional and environmental mediators of early parenting in high risk families

The UK currently has the highest number of premature births (babies born before 37 weeks gestation age and below 2.5kg) in Europe affecting around 70,000 babies and their caregivers each year. Consequently many interventions have been created to support the development of the preterm newborn and minimise the complications of prematurity. Many of the interventions developed have been predominantly tactile and have almost exclusively focused upon their effect upon the baby and not, for example considered the effect that this type of intervention might have upon the parents; specifically the mother, when they are the ones who perform the therapy. In fact there is a severe lack of systematic studies investigating the latter. Hence, the aim of this thesis was to search for research-based evidence on the benefits of environmental support to both babies (e.g. increased weight gain or awake periods) and their mothers (e.g. higher perceptions of themselves as a mother) during hospital confinement and within the context of Neonatal Health Psychology (NNHP). For this reason, the main hypothesis investigated whether mothers’ cognitions and emotions; specifically Maternal Self-Efficacy, Self-Esteem and Attachment, would be affected by environmental mediators in the form of structured or non-structured tactile sensory nurturing interventions. The empirical work reported in this thesis is divided into 3 distinct phases. Firstly, as their was no appropriate measure of maternal Self-Efficacy for mothers of hospitalised preterm neonates the main aim of Phase-1 was to develop and validate an appropriate measure. Using a prospective survey method and a mixed design (between/within and correlational) a total of 160 mother-preterm dyads (pooled from 2 cohorts; cohort 1, N=100; cohort 2, N=60) were recruited. The results demonstrated that the Perceived Maternal Parenting Self-Efficacy (PMPS-E) tool had good initial psychometric properties (including internal/external reliability and construct validity) for its use with mothers of relatively healthy hospitalised preterm neonates. Secondly, in order to investigate mothers’ perceived maternal parenting self-efficacy beliefs further Phase-2 examined whether the type of feeding a mother chose to give to her baby mediated her self-efficacy beliefs. The results suggested that breastfeeding a preterm neonate during hospital confinement may adversely affect mothers’ perceptions of their efficacy in all aspects of parenting. Finally, using an experimental method Phase-3 tested the main hypothesis of this thesis and used a randomised cluster control trial (RCCT) design to allocate 60 mothers and their preterms equally to one of three cluster groups; consisting of either structured (e.g. TAC-TIC therapy or Using a Toy) or non-structured (Placebo/Control) tactile sensory nurturing interventions. The main findings illustrate that tactile sensory nurturing interventions do mediate maternal cognitions and emotions, preterm weight gain and behavioural state. In particular, mothers who performed TAC-TIC demonstrated significantly higher self-reported perceptions in their self-efficacy, self-esteem and attachment, which was attributed to the fact that these babies spent increased amounts of time in an alert and responsive behavioural state, and gained more weight throughout the study period. Thus, the work presented throughout this thesis has implications for Neonatal Health Psychologists and other Health Care professionals’ practice within neonatal units, the use of Neonatal Health Psychology as a framework to study the preterm neonate and their family, and also the way in which both mothers and their hospitalised preterm neonates are supported during hospital confinement.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Psychometric properties of the Spanish version of the perceived maternal parenting self-efficacy (PMP S-E) tool for primiparous women

The objective of this study was to determine the validity and the reliability of the Perceived Maternal Parenting Self-Efficacy tool translated into Spanish and adapted to be used among primiparous women of term babies. Validation study. A total of 210 women participated in the survey to establish construct validity and reliability. The questionnaire has 20 items and four subscales. The higher the score, the higher the self-efficacy. A process of translation/back-translation and cultural adaptation in accordance with international standards and an expert review were conducted to test face and content validity. The Validity Content Index and an exploratory factor analysis were used to identify the structure of the questionnaire. Reliability was estimated using Cronbach’s alpha coefficient. Linguistic and cultural adaptation, validation and reliability were performed. Face validity for women was as follows: high comprehension (99%); and for experts: medium comprehension (84.1%), medium clarity (83.9%) and medium precision (80%). Concerning pertinence, the content validity index was 0.93 (i.e., highly pertinent). Concerning relevance, the content validity index was 0.96 (i.e., highly relevant). Factor validation identified four factors that accounted for 91% of the variance. Overall Cronbach’s alpha value was 0.98 (IC 95 0.97–0.98). Given the robust properties of the Spanish version of the Perceived Maternal Parenting Self-efficacy, it may be used to identify women with low self-efficacy and to assess the effectiveness of health-based interventions.N/

Early prediction and psycho-immunologic mediation of minor illness in adulthood

The Barker Hypothesis suggests that an unfavourable uterine environment can have the effect of programming the body for disease later in life. Research indicates a bidirectional relationship between thought and biochemical reactions, that may be influenced by early programming. Reports suggest that 25% of variance in birthweight is a result of foetal environment and that the health and cognitive deficits do not just affect those with an officially low birthweight. OBJECTIVE: This study investigates the influence of birthweight on cognition and minor illness in adults. METHODS: This is a retrospective, cross sectional design with an opportunity sample of 75 adults. Participants whose birthweight ranged from 2.5 kg to 4.88 kg, completed a symptom check list and general self-efficacy scale, reporting on the previous month. RESULTS: Analysis of variance indicates that those with higher birthweight have fewer minor illness symptom days and higher general self-efficacy. Regression analysis indicates that birthweight is significantly predictive of levels of minor illness and general self-efficacy. CONCLUSION: From the findings of this and previous studies, it is possible to infer vertical coactions between foetal environment and immuno competence. It is suggested that birthweight is an early predictor of levels of a cognitive mediator and minor illness. Data were applied to an equilibrium model to represent the relationship in terms of Gottlieb's concept of horizontal and vertical coactions