Early relationship between very preterm infant and mother: The role of infant, maternal and dyadic factors

Pienipainoisen keskosen ja äidin varhainen suhde: Lapsen, äidin ja dyadisten muuttujien vaikutus Tämän tutkimuksen tavoitteena oli tutkia keskosvauvan ja äidin varhaista suhdetta. Tutkimuksessa selvitettiin myös vauvan itkukäyttäytymisen, vauvan sylissä olon ja äidin masentuneisuuden yhteyttä äidin ja keskosvauvan varhaiseen suhteeseen. Tutkimusryhmät koostuivat 32:sta (tutkimus I-II) ja 38:sta (tutkimus III-IV) keskosena syntyneestä vauvasta (syntymäpaino < 1501 g tai GI < 32 viikkoa) sekä 46:sta täysiaikaisena syntyneestä terveestä verrokkivauvasta. Lapsen ja äidin vuorovaikutusta arvioitiin 6 ja 12 kuukauden iässä (korjattu ikä) PCERAmenetelmällä. Äidin mielikuvia lapsestaan tutkittiin WMCI-haastattelulla, kun lapsi oli 12 kuukautta. Baby Day Diary -menetelmää käytettiin vauvan itkukäyttäytymisen ja sylissä olon keston mittaamisessa vauvan ollessa 5 kuukautta. Äidin masentuneisuutta arvioitiin EDPS-lomakkeella, kun lapsi oli 6 kuukautta. Tulokset osoittivat, että turvallisten kiintymyssuhdemielikuvien määrä tai vuorovaikutuksen laatu eivät keskosvauvan äideillä eronneet täysiaikaisina syntyneiden vauvojen äitien vastaavista. Ryhmien välillä ei löytynyt eroja myöskään dyadisen vuorovaikutuksen laadussa. Keskosena syntyneet lapset olivat kuitenkin vetäytyvämpiä ja heillä oli laadullisesti heikommat keskittymisen ja leikin taidot vuorovaikutustilanteessa 12 kuukauden iässä täysiaikaisina syntyneisiin lapsiin nähden. Lisäksi äidin masentuneisuus ja lapsen pitkittynyt itkuisuus olivat negatiivisessa yhteydessä vuorovaikutuksen laatuun keskosvauvojen ryhmässä. Vauvan itkukertojen määrän, sylissä olon keston sekä äidin ja vauvan vuorovaikutuksen laadun välillä löytyi positiivinen yhteys ainoastaan keskosena syntyneiden lasten ryhmässä. Tulostemme perusteelle toteamme, että lapsen ennenaikainen syntymä itsessään ei näytä muodostavan riskiä äidin vuorovaikutuksen laadulle tai turvalliselle kiintymyssuhteelle. Yhdessä muiden riskitekijöiden kanssa keskosuus kuitenkin altistaa vauvat ja heidän äitinsä varhaisen vuorovaikutuksen ongelmille. Lisäksi tuloksemme viittaavat siihen, että vauvan itku ja siitä seuraava sylissä olo toimivat suojaavana mekanismina pienipainoisen keskosen ja äidin varhaisessa suhteessa.The primary purpose was to assess the quality and the organization of mother–infant relationship in Finnish firstborn singleton preterm infants and their mothers. In addition, the aim was to study modifying factors such as infant crying, caregiver holding and maternal depression in relation to the mother–preterm infant relationship. The study groups included 32 (Study I-II) and 38 (Study III-IV) preterm infants (< 1501 g or < 32 weeks) and 46 full term infants. The mother–infant interaction was assessed using PCERA at 6 and 12 months of corrected age. Maternal representations were studied using WMCI at 12 months of infant’s corrected age. Baby Day Diary was used to explore the infant’s crying and the caregiver’s holding behaviors at 5 months of corrected age. Maternal depression was evaluated using EPDS at 6 months of infant’s corrected age. This study showed no differences in the maternal attachment classifications, or maternal or dyadic interaction between groups of preterm and full term infants. However, preterm infants demonstrated more sober and withdrawn mood and lower quality in the play and attention skills than full term infants in the interaction situation at 12 months. This study also showed that prolonged crying and maternal depression are negatively related to the mother–infant interaction in the preterm group. Interestingly, the frequent but soothable infant’s crying was positively related to the duration of holding and the duration of holding was positively related to the quality of mother–infant interaction only in the preterm group. The results of the present study suggest that preterm birth does not, in and of itself, form a risk for maternal attachment or for maternal or dyadic interaction, but together with other risk factors preterm birth may negatively influence the mother–infant relationship. The results also suggests that mothers and their preterm infants develop a different kind of interaction style where the infant’s crying may be a trigger for holding and thus for positive, mutual and reciprocal interaction. This may be an adaptive mechanism protecting the mother–preterm infant relationshipSiirretty Doriast

Dynaamiset perhesuhteet vauvaperheissä

&nbsp; Varhaisten perhesuhteiden merkitys lapsen kehitykselle on ilmeinen. Vauva osallistuu ja vaikuttaa jo varhain perheen vuorovaikutukseen ja on toisaalta my&ouml;s altis muiden perheenj&auml;senten ja n&auml;iden v&auml;listen suhteiden vaikutuksille. Perheen vuorovaikutuksen laadun merkitys lapsen hyvinvoinnille onkin noussut keskeiseen asemaan perheiden parissa teht&auml;v&auml;ss&auml; kliinisess&auml; ja kasvatusty&ouml;ss&auml;. T&auml;ss&auml; katsauksessa tarkastelemme perheen sis&auml;isi&auml; suhteita 1) parisuhteen ja yhteisvanhemmuuden, 2) triadisen vuorovaikutuksen ja 3) kokonaisvaltaisten perhesysteemien n&auml;k&ouml;kulmista. Esittelemme olemassa olevan tutkimustiedon valossa vauvaperheiden vuorovaikutussuhteiden lainalaisuuksia sek&auml; sit&auml;, mill&auml; tavoin perhedynamiikka on yhteydess&auml; lapsen psykososiaaliseen kehitykseen ja ennustaa sit&auml;.</p

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

BackgroundSurviving 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.MethodsThis was a qualitative descriptive study conducted with mothers of children born at 23weeks of gestation. These purposively sampled eight mothers were interviewed using a semi-structured interview. Thematic analysis was used to analyse the interviews.ResultsSeven 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'.ConclusionsThe 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.</div

Aktiivihoidon saaneiden raskausviikolla 23 syntyneiden pitkäaikaisennuste 14 vuoden aineisto

Lähtökohdat Tavoitteena oli tutkia vuosina 2001–14 Turun yliopistollisessa keskussairaalassa ­raskausviikolla 23 elävinä syntyneiden keskosten pitkäaikaisennustetta.Menetelmät Tietoa kerättiin vastasyntyneisyysajan potilaskertomusteksteistä, seurantakäyntien raporteista sekä kehitystasoarvioista.Tulokset 21:stä elävänä syntyneestä lapsesta 8 (38 %) oli elossa aineiston keruun hetkellä. Eloonjääneistä lapsista useimmilla oli todettu keskosuuteen liittyvä pitkäaikaisdiagnoosi ja/tai vähintään lieviä oppimiseen vaikuttavia kognitiivisia tai tarkkaavuuden ongelmia.Päätelmät Koska ongelmat ovat yleisiä, tiivis jatkoseuranta, kehitystasoarviot ja tarvittaessa tarjottavat tukitoimet ovat tärkeitä raskausviikolla 23 syntyneille keskosille.</div

Changes in emotions and personal goals in primiparous pregnant women during group intervention for fear of childbirth

The changes in emotions, subjective fear of childbirth, and personal goals were examined during a group intervention to treat fear of childbirth (FOC). The objective was to gain a more detailed understanding of the changes occurring during the group intervention of FOC. The changes in emotions, subjective FOC, and personal goals were studied in primiparous pregnant women with severe FOC participating in a group intervention (n = 105). The group intervention contained six sessions during pregnancy and one after childbirth. At every session, the participants filled in a questionnaire regarding their experiences of current positive and negative emotions and the subjective FOC. The participants also set and reported their personal goals in their preparation for childbirth and parenthood. The negative emotions decreased from the beginning of the intervention. The change became significant after the fourth session. The amount of positive emotions increased but became statistically significant only after the delivery. The subjective FOC decreased significantly from the beginning of the intervention. Personal goals shifted from being mainly self-related to being mostly related to parenthood. The group intervention decreased FOC and promoted changes in emotions and personal goals that foster emotional preparedness for childbirth. It seems that the decrease in FOC was made possible through gaining a better capacity to regulate emotions, especially negative emotions. As negative emotions and fear decreased, personal goals simultaneously changed in the direction known to be adaptive for the new life situation as a parent of a newborn.Peer reviewe

Fewer maternal depression symptoms after the Close Collaboration with Parents intervention : Two-year follow-up

Aim To test whether the implementation of the Close Collaboration with Parents intervention at a neonatal intensive care unit (NICU) decreases depression symptoms of mothers up to two years after the delivery of preterm infants. Methods We used a non-equivalent two-group design, comparing mothers of very low birthweight infants in the same NICU before (2001–2006) and after (2011–215) the intervention. The unit carried out the educational intervention (2009–2012) that was targeted at its healthcare team and aimed to improve their skills to collaborate with parents. Maternal depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) six months and two years after the expected birth date of the infant. Results We found a median difference of 2.56 (95% CI from 1.64 to 3.48) in EPDS at the two-year follow-up between the pre-intervention and post-intervention groups, p < 0.001. Furthermore, we found no interaction between measurement time-points and group, implying that the intervention effect on maternal depression symptoms was similar at the six-month and two-year time-points. Conclusion The intervention seems to have long-term preventive effects on maternal depressive symptoms. This effect is of clinical significance as prolonged maternal depression associates with adverse child outcomes.© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.fi=vertaisarvioitu|en=peerReviewed

Theraplay terapian vaikuttavuus vanhempi-lapsi suhteeseen ja lapsen psykiatriseen oireiluun: pilottitutkimus

BSTRACT Theraplay® is a short-term parent–child interaction therapy combining structured, attachment-based, joyful and adult-led playful sessions with reflective guidance work with the parents. This pilot study evaluates the impact of Theraplay® therapy in improving the quality of parent–child interaction and decreasing the internalizing and externalizing symptoms of children diagnosed with emotional and/or behavioral disorders. Participants were eighteen 4–8 year-old children (M = 4.42, SD = 1.54) from two outpatient child psychiatric clinics whose mothers, and in 13 of those cases fathers also participated in the Theraplay® therapy together with the child. Pre- and post- treatment measures included videotaped observations of parent–child interaction quality, and child psychiatric symptoms (CBCL). The results showed improvements in parent–child interaction quality as well as decreases in children’s internalizing and externalizing symptoms. The results of this pilot study indicate that Theraplay® therapy may be an effective treatment among children diagnosed with emotional and/or behavioral psychiatric disorders.Theraplay® is a short-term parent–child interaction therapy combining structured, attachment-based, joyful and adult-led playful sessions with reflective guidance work with the parents. This pilot study evaluates the impact of Theraplay® therapy in improving the quality of parent–child interaction and decreasing the internalizing and externalizing symptoms of children diagnosed with emotional and/or behavioral disorders. Participants were eighteen 4–8 year-old children (M = 4.42, SD = 1.54) from two outpatient child psychiatric clinics whose mothers, and in 13 of those cases fathers also participated in the Theraplay® therapy together with the child. Pre- and post-treatment measures included videotaped observations of parent–child interaction quality, and child psychiatric symptoms (CBCL). The results showed improvements in parent–child interaction quality as well as decreases in children's internalizing and externalizing symptoms. The results of this pilot study indicate that Theraplay® therapy may be an effective treatment among children diagnosed with emotional and/or behavioral psychiatric disorders.Peer reviewe

Insomnia symptoms increase during pregnancy, but no increase in sleepiness - Associations with symptoms of depression and anxiety

Objective: To evaluate alteration in insomnia and sleepiness symptoms during pregnancy and assess early pregnancy risk factors for these symptoms, especially depressive and anxiety symptoms. Methods: A cohort of 1858 women was enrolled from the FinnBrain Birth Cohort Study. Insomnia and sleepiness symptoms were measured in early, mid- and late pregnancy with the Basic Nordic Sleep Questionnaire. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale and anxiety symptoms with the Symptom Checklist-90/Anxiety Scale. General linear models for repeated measures were conducted. Results: General sleep quality decreased (p < 0.001) and all insomnia types (p < 0.001) and sleep latencies (p < 0.001) increased as pregnancy proceeded. Snoring increased, but witnessed apneas remained rare. Nevertheless, morning (p ¼ 0.019) and daytime (p < 0.001) sleepiness decreased from early to both mid-pregnancy and late pregnancy (p ¼ 0.006 and p ¼ 0.039). Women took more naps in early and late pregnancy compared to mid-pregnancy (both p < 0.001). Women with higher baseline anxiety symptoms had greater increase in sleep latency. At each pregnancy point, higher depressive and anxiety symptoms were associated with higher insomnia (p < 0.001) and sleepiness scores (p < 0.001) and higher depressive symptoms with longer sleep latencies (p < 0.001). Conclusion: We found a marked increase in insomnia symptoms throughout pregnancy. However, sleepiness symptoms did not increase correspondingly. Both depressive and anxiety symptoms in early pregnancy were associated with higher insomnia and sleepiness symptoms in later stages of pregnancy which emphasizes the importance of their assessment in early pregnancy.Peer reviewe