Prematurity

Question 1

preterm/premature

Answer 1

• Delivery before 36/37 weeks
• 8-12% of births
• Very preterm = less than 32 weeks
• Boys are more likely to be born preterm
• Prematurity is associated with SES (people with low SES more likely to give birth preterm)

Question 2

Low birth weight

Answer 2

• Weight under 5.5lbs

- Very low birth weight = under 2.5/3.5lbs

Question 3

NICU

Answer 3

• Standard of care for preterm infants
• Primary goal = maintain and enhance physical well-being of child, often through artificial means (ex. Surgery, chemical/drug intervention)
• Problems: limited parent-child bonding; not a natural environment (lights, noises, not like womb or home environment); parents feel overwhelmed/unimportant

Question 4

preterm birth outcomes

Answer 4

• Survivability: Youngest age of survivability around 22 weeks, smallest around .5lbs
• Health problems
• Developmental delays: Motor delays, lower IQ/cognitive abilities, learning/school disabilities
• Behaviour problems, social difficulties: Higher behavioural symptoms and lower adaptive skills (esp. For boys)

Question 5

health problems associated with prematurity

Answer 5

• Immediate difficulty breathing, lung disease, brain complications, seizures, feeding difficulties, gastrointestinal issues
• Long-term frequent hospital stays, continued issues with breathing, eyesight issues

Question 6

parents and pre-term infants (challenges)

Answer 6

• Difficulty with hospital environment
• Preterm infants seen as less attractive; cry less, less arousing cries; less likely to trigger automatic parenting responses
• Delays in reaching developmental milestones (because they’re gestationally less old than full-term babies -> difference between gestational age and chronological age)
• “prematurity stereotype”: parents react differently to pre-term babies
• different parent-infant interactions

Question 7

prematurity stereotype study

Answer 7

• moms watch video of same baby, but some are told that the baby is pre-term while others are told it’s full-term. Moms then rate baby on variety of measures (social, competency, cuddly, etc.). “Pre-term” baby receives less positive ratings
• Parents think of preterm babies as less advanced, may give them less advanced toys

Question 8

parent-infant interactions

Answer 8

• Parents unsure; may be worried/afraid of what to do with baby
• Infants more passive, less reactive -> incites mothers to respond in a more active, more directive, providing more stimulation (less socially competent parenting -> overstimulating)

Question 9

interventions for preterm infants

Answer 9

• Kangaroo care
• Infant massage
• Music
• Parent training/support
• Goal: support the best medical care for infants, while also supporting the best parent-child relationships

Question 10

Kangaroo Care

Answer 10

• Parent-infant skin-to-skin contact

- Initially developed for premature infants in areas where there was a shortage of incubators and healthcare workers

Question 11

Outcomes of kangaroo care study (discharge, 3 months, 6 months)

Answer 11

• Are there long-term benefits associated with kangaroo care vs standard care?
• at discharge: improved mother-infant interactions (ex. mom had more positive affect, touch, etc; infant was more alert)
• at 3 months: more stimulating home environments (both mothers and fathers); lower maternal depression
• at 6 months: Infants who had KC were more developmentally advanced (mental and psychomotor); Mothers who had done KC were engaging in more sensitive parenting
• Conclusions: Parents who engage in kangaroo care are more sensitive/warm, provide more nurturing/stimulating home environments, and have lower rates of depression; Pre-term infants who receive kangaroo care show more advanced development

Question 12

why are there benefits to kangaroo care?

Answer 12

• Effects of parent proximity vs. Separation after birth
• • Heat, touch, smell, nursing, etc.
• Skin to skin contact releases oxytocin in mother
• Transactional model -> kangaroo care impacts both mother and child, who then impact each other
• • Parent: feelings of effectiveness, importance

Question 13

History of Preterm Care

Answer 13

• Used to be born/raised at home
• Early incubators created in late 1800s
• Parental contact initially discouraged (fear of germs)
• 70s was first time mothers allowed into NICU to handle babies

Question 14

Conditions unique to preterm infants and parents

Answer 14

• the timing of birth (before parents are truly prepared, before parents can care for baby on their own)
• the nature of the hospital experience (intimidating for parents)
• behavioral characteristics of preterm behavior and development (going home can be stressful/overwhelming; parents become overprotective due to their view that the child is vulnerable)

Question 15

theories of parent-child relationships and their respective interpretations of prematurity

Answer 15

• Social interaction approaches (ex. Infant cues determine parents’ competence)
• Bonding theory (ex. Critical period exists for optimal mother-infant bonding)
• Attachment theory (ex. Prematurity may disrupt parental responsiveness)
• Transactional approach (ex. Baby shapes parent and vice versa)

Question 16

parent-infant relationships (in hospital, interaction, attachment)

Answer 16

• In hospital: many factors influence parental visitation and engagement (ex. SES, what hospital mom is in); hospital policies play a role in encouraging it (ie. Weekly “appointments” led to more positive expectations)
• Infant-parents interaction: fathers are initially more engaged than those of full-term infants, mothers sometimes overstimulate; prematurity, immaturity, and illness affect interactions; long-term continuities in mother-child interaction style -> linked to positive outcomes
• Prematurity typically does not affect attachment (most form secure)

Question 17

interventions designed to improve parent-child relationships

Answer 17

• Infant-focused: providing experiences similar to those in utero or in home; tailoring to needs of individual infants
• Parent-focused: encouraging caregiving opportunities, contact with veteran parents/support groups
• Parent-infant focused: kangaroo care; training in rocking/massaging procedures