Influence d'une hospitalisation prénatale sur les facteurs de stress

But. - Investiguer l'influence d'une hospitalisation prénatale précédant une naissance préma¬turée sur les facteurs de stress parentaux et la relation parent-enfant lors de l'hospitalisation en néonatologie ainsi que sur les symptômes de stress post-traumatique parentaux. Population et méthodes. - Population : 51 enfants prématurés et 25 enfants nés à terme (groupe témoin). Quatre groupes : groupe témoin, prématurés sans hospitalisation prénatale, prématu¬rés avec hospitalisation courte (< 8 jours) et prématurés avec hospitalisation longue (> 8 jours). Instruments: le Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU, Miles et al., 1993 [14]) et le Perinatal PTSD Questionnaire (PPQ, Quinnell et Hynan, 1999 [16]). Résultats. -En cas d'hospitalisation prénatale, les parents se disent plus stressés par l'environnement du bébé en néonatologie. Les mères avec une hospitalisation prénatale courte (< 8 jours) se différencient significativement du groupe témoin par plus de symptômes de stress post-traumatique. Les parents présentant plus de symptômes post-traumatiques décrivent la relation avec leur bébé en néonatologie comme significativement plus difficile. Conclusion. - Cette étude indique l'attention à apporter aux patientes hospitalisées brièvement en prénatal (< 8 jours). Il s'agit d'un groupe plus à risque de présenter des symptômes de stress post-traumatique qui peuvent engendrer des troubles dans la relation à l'enfant

Spontaneous childbirth-related mental images among pregnant women: a mixed-method study.

Mental imagery may reflect the present, past or future. Childbirth is often anticipated with joy but also in some cases with fear, which may negatively impact on the childbirth experience. So far, research on birth-related mental imagery in pregnancy is lacking. This study aimed to investigate in detail the phenomenology of spontaneous childbirth-related mental images and the association between main imagery characteristics (valence, positive/negative percentage ratio and impact on behaviour and decision-making) and fear of childbirth. A concurrent triangulation mixed methods design was employed. Thirty-seven nulliparous, French-speaking women, aged ≥ 18 years in their third trimester of pregnancy completed self-report questionnaires assessing fear of childbirth, spontaneous use of mental imagery, prenatal depression and trait anxiety, and participated in a mental imagery interview to assess spontaneous childbirth-related mental images. Women with a prenatal diagnosis of malformation were excluded. All participants reported having spontaneous mental images of their impending childbirth. The images captured were rich in detail and included a variety of sensory modalities. More positive mental images were associated with less fear of childbirth (r = -0.533, p = .008) and women who had a higher proportion of negative mental images had a higher fear of childbirth (r = 0.428, p = .005). The impact of the most negative mental images on behaviour and decision-making was positively correlated with fear of childbirth (r = 0.342, p = .038). Our results indicate that negative spontaneous childbirth-related imagery is associated with fear of childbirth. Intervention techniques could be developed that focus on enhancing positive childbirth-related mental images during pregnancy and thus fostering a more positive childbirth experience

The Joint Observation in Neonatology and Neurodevelopmental Outcome of Preterm Infants at Six Months Corrected Age: Secondary Outcome Data from a Randomised Controlled Trial.

This study aimed to evaluate the impact of a standardised joint observation (JOIN) performed in the neonatal intensive care unit (NICU) on the neurodevelopment of preterm infants at six months corrected age (CA) compared with a preterm control group. In this monocentric interventional randomised controlled trial, we allocated 76 mothers and their preterm neonates to either JOIN, an early one-session intervention, or standard care during the NICU hospitalisation. The neurodevelopment of the preterm infants was assessed by standardised developmental tests at six months CA and compared between the intervention and the control groups. This randomised controlled trial was registered on clinicaltrials.gov (NCT02736136) in April 2016. Sixty-five infants underwent neurodevelopmental assessment at six months CA. There were no significant differences between the two groups in neurodevelopmental outcome measures. The JOIN intervention was not associated with significant improvement in neurodevelopment at six months CA in preterm infants

The impact of disease severity on the psychological well-being of youth affected by an inborn error of metabolism and their families: A one-year longitudinal study.

Inborn errors of metabolism (IEMs) refer to rare heterogeneous genetic disorders with various clinical manifestations that can cause serious physical and psychological sequelae. Results of previous studies on the impact of an IEM on health-related quality of life (HR-QoL) were incongruent and only few studies considered more broadly the psychological well-being of children with IEM and their families. Our objectives were to examine: (1) the impact of the IEM severity on the HR-QoL and psychological functioning of patients and their parents at baseline; and (2) its evolution over time; and (3) the correlation between parental and children's perspectives. Methods: The sample included 69 pediatric patients (mean age = 7.55 y, SD = 4.59) with evaluations at baseline and after one year. We collected data on HR-QoL, child mental health and emotional regulation as well as on parental mood and stress using different validated questionnaires. IEM severity was rated by a clinician through the biological subdomain of the pediatric INTERMED instrument. Results: Two groups of patients based on IEM severity scores were created (n = 31 with low and n = 38 with moderate/high IEM severity). The two groups differed with respect to age, diet and supplement intake. IEM severity had an impact on HR-QoL and behavioral symptoms in children, as well as on HR-QoL and stress in parents. For patients with moderate/high IEM severity, child and parental HR-QoL improved after 1-year of follow-up. We did not observe any significant difference between evaluations by patients versus parents. Conclusions: Our findings demonstrate that moderate/high IEM severity altered child and parental psychological well-being, but also revealed a significant improvement after one-year follow-up. This observation suggests that patients with a moderate/high IEM severity and their families benefit from the care of an interdisciplinary team including a child psychologist specialized in IEMs. Moreover, in patients with higher IEM severity there may also be more room for improvement compared to patients with low IEM severity. Future studies should focus on observations over a larger time span, particularly during adolescence, and should include objective measurements

Assessment of Multiple Dimensions of Psychological Well-Being in Swiss Youth Born with a Unilateral Cleft Lip and Palate.

This study examines the psychological well-being of Swiss youths born with a unilateral cleft lip and palate (UCLP), in a multi-dimensional and clinical perspective. Retrospective cross-sectional study. Self-report questionnaires completed by youths born with UCLP, followed at a specialized cleft clinic in Switzerland, and by peers without UCLP, recruited in schools of the Vaud county, Switzerland. Youths aged 7.5 to 16, born with UCLP (clinical group, n = 41, 29.2% female) or without UCLP (control group, n = 56, 49.0% female). Adverse life events (ALE; Adverse Life Events), behavioral and emotional symptoms (Strengths and Difficulties Questionnaire and Post-Traumatic Checklist Scale), bodily self-esteem (Body Esteem Scale), quality of life (Kidscreen-27), emotion regulation (Cognitive Emotion Regulation Questionnaire), social support (Sarason's Social Support Questionnaire). Most outcomes showed no significant group-difference. Compared to matched peers, youths with UCLP reported lower psychological quality of life and social support satisfaction, along with positive factors of fewer ALE and lower non-adaptive emotion regulation. In youths with UCLP, higher scores for ALE were associated with higher total scores for behavioral and emotional symptoms. Higher scores for bodily self-esteem were associated with higher scores for satisfaction of social support and adaptive emotion regulation. Youths with UCLP show globally similar psychological well-being as matched peers. We observed some vulnerabilities but also protective factors, which support the need for psychological perspective within multidisciplinary care. The relationships between dimensions suggest specific targets that may have an impact in context of intervention

Joint observation in NICU (JOIN): study protocol of a clinical randomised controlled trial examining an early intervention during preterm care.

Preterm birth may generate significant distress among the parents, who often present with difficulties in appropriating their parental role. Parental stress and low perceived parental self-efficacy may interfere with the infant's socioemotional and cognitive development, particularly through disrupted parent-infant interactions. Perceived parental self-efficacy represents the belief of efficacy in caring for one's own infant and successful incarnation of the parental role, as well as the perception of one's own abilities to complete a specified task. Interventions to support parental role, as well as infant development, are needed, and parental self-efficacy represents a useful indicator to measure the effects of such early interventions. This study protocol describes a randomised controlled trial that will test an early intervention in the neonatal intensive care unit (NICU) (JOIN: Joint Observation In Neonatology) carried out by an interdisciplinary staff team. Mothers of preterm neonates born between 28 and 32 6/7 weeks of gestational age are eligible for the study. The intervention consists of a videotaped observation by a clinical child psychologist or child psychiatrist and a study nurse of a period of care delivered to the neonate by the mother and a NICU nurse. The care procedure is followed by an interactive video guidance intended to demonstrate the neonate's abilities and resources to his parents. The primary outcome will be the difference in the perceived maternal self-efficacy between the intervention and control groups assessed by self-report questionnaires. Secondary outcomes will be maternal mental health, the perception of the parent- infant relationship, maternal responsiveness and the neurodevelopment of the infant at 6 months corrected age. Ethical approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 496/12). Results from this study will be disseminated at national and international conferences, and in peer-reviewed journals. NCT02736136, Pre-results

Influence d'une hospitalisation prénatale sur les facteurs de stress parentaux lors d'une naissance prématurée [Influence of prenatal hospitalization on parental stressful experience in the case of a premature birth].

OBJECTIVES: To investigate the influence of prenatal hospitalization before a premature birth, on the parental stressful experience, parental symptoms of post-traumatic stress and quality of parent-infant interaction during the hospitalization in neonatology. POPULATION AND METHODS: Population: 51 preterm infants born and 25 full term infants control. Four groups: controls, premature without prenatal hospitalization, premature with a short (<8 days) prenatal hospitalization and premature with a long (≥8 days) prenatal hospitalization. Instruments: the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU, Miles et al., 1993 [14]) and the Perinatal PTSD Questionnaire (PPQ, Quinnell and Hynan, 1999 [16]). RESULTS: When prenatal hospitalization of the mother occurred, parents acknowledged increased stress induced by the environmental factors during the infant's hospitalization. Furthermore, mothers from the group with a short prenatal hospitalization presented significantly more symptoms of post-traumatic stress. Parents presenting more symptoms of post-traumatic stress describe a significantly more difficult interaction with their infant in neonatology. CONCLUSION: This study highlights the necessity to deliver special care to women hospitalized shortly (<8 days) prior to the delivery of their premature baby. This group is at high risk of presenting post-traumatic stress symptoms, which could have a negative impact on the quality of parent-infant interactions

Perinatal stress moderates the link between early and later emotional skills in very preterm-born children: An 11-year-long longitudinal study.

Very preterm (VPT) birth refers to an early stressful event putting children at heightened risk for emotional difficulties. However, there is an important individual variability, leaving unexplained why some VPT children do not develop emotional difficulties, while others develop such difficulties in the early years or later in life. In this study, we examined whether perinatal stress is a risk factor explaining heterogeneities in emotional problems in VPT children. Thirty-six VPT children and 22 full-term born (FT) children participated in an 11 year-long study. Risk for perinatal stress was assessed at birth with the Perinatal Risk Inventory. Mothers reported children's emotional difficulties at 18 months of child age on the Symptom Checklist and at 11 years on the Child Behavior Checklist. Results indicated significant differences in emotional scores at 11 years not only between VPT and FT children but also between the low and high perinatal stress groups. More importantly, emotional scores at 18 months influenced variability in internalizing scores at 11 years only in VPT children with high perinatal stress. Although prematurity affects the emotional abilities of preadolescents, the link between emotional skills in early and later childhood is moderated by the severity of perinatal stress. In particular, VPT children who are born with more complications, and as such experience a more stressful perinatal environment, are more likely to show emotional difficulties at preadolescence