Aim
Little is known about the amount of physical parent–infant closeness in neonatal intensive care units (NICUs), and this study explored that issue in six European countries.
Methods
The parents of ...328 preterm infants were recruited in 11 NICUs in Finland, Estonia, Sweden, Norway, Italy and Spain. They filled in daily diaries about how much time they spent in the NICU, in skin‐to‐skin contact (SSC) and holding their babies in the first two weeks of their hospitalisation.
Results
The parents' NICU presence varied from a median of 3.3 (minimum 0.7–maximum 6.7) to 22.3 (18.7–24.0) hours per day (p < 0.001), SSC varied from 0.3 (0–1.4) to 6.6 (2.2–19.5) hours per day (p < 0.001) and holding varied from 0 (0–1.5) to 3.2 (0–7.4) hours per day (p < 0.001). Longer SSC was associated with singleton babies and more highly educated mothers. Holding the baby for longer was associated with gestational age. The most important factor supporting parent–infant closeness was the opportunity to stay overnight in the NICU. Having other children and the distance from home to the hospital had no impact on parent–infant closeness.
Conclusion
Parents spent more time in NICUs if they could stay overnight, underlining the importance that these facilities play in establishing parent–infant closeness.
Follow-up of very preterm infants is essential for reducing risks of health and developmental problems and relies on parental engagement. We investigated parents' perceptions of post-discharge ...healthcare for their children born very preterm in a European multi-country cohort study.
Data come from a 5-year follow-up of an area-based cohort of births <32 weeks' gestation in 19 regions from 11 European countries. Perinatal data were collected from medical records and 5-year data from parent-report questionnaires. Parents rated post-discharge care related to their children's preterm birth (poor/fair/good/excellent) and provided free-text suggestions for improvements. We analyzed sociodemographic and medical factors associated with poor/fair ratings, using inverse probability weights to adjust for attrition bias, and assessed free-text responses using thematic analysis.
Questionnaires were returned for 3635 children (53.8% response rate). Care was rated as poor/fair for 14.2% from 6.1% (France) to 31.6% (Denmark); rates were higher when children had health or developmental problems (e.g. cerebral palsy (34.4%) or epilepsy (36.9%)). From 971 responses, 4 themes and 25 subthemes concerning care improvement were identified.
Parents' experiences provide guidance for improving very preterm children's post-discharge care; this is a priority for children with health and developmental problems as parental dissatisfaction was high.
In a European population-based very preterm birth cohort, parents rated post-discharge healthcare as poor or fair for 14.2% of children, with a wide variation (6.1-31.6%) between countries. Dissatisfaction was reported in over one-third of cases when children had health or developmental difficulties, such as epilepsy or cerebral palsy. Parents' free-text suggestions for improving preterm-related post-discharge healthcare were similar across countries; these focused primarily on better communication with parents and better coordination of care. Parents' lived experiences are a valuable resource for understanding where care improvements are needed and should be included in future research.
Background
Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. ...The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents.
Methods
This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents’ presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14 days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4 months corrected age of the infant.
Results
The study included 684 mothers and 574 fathers. The median presence was 469 min (Q1 258 and Q3 1,087) per 24 h for the mothers and 259 min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4 months, respectively. Parents’ presence and depressive symptoms varied greatly between the units. Parents’ presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted).
Conclusion
No association was found between the duration of parent-infant closeness in the neonatal unit and parents’ depressive symptoms. The beneficial effects of family-centered care on parents’ depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents’ depression after NICU stay.
Spontaneous closure of patent ductus arteriosus (PDA) occurs frequently in very preterm infants and despite the lack of evidence for treatment benefits, treatment for PDA is common in neonatal ...medicine.
The aim of this work was to study regional variations in PDA treatment in very preterm infants (≤31 weeks of gestation), its relation to differences in perinatal characteristics, and associations with bronchopulmonary dysplasia (BPD) and survival without major neonatal morbidity.
This was a population-based cohort study in 19 regions in 11 European countries conducted during 2011 and 2012. A total of 6,896 infants with data on PDA treatment were included. The differences in infant characteristics were studied across regions using a propensity score derived from perinatal risk factors for PDA treatment. The primary outcomes were a composite of BPD or death before 36 weeks postmenstrual age, or survival without major neonatal morbidity.
The proportion of PDA treatment varied from 10 to 39% between regions (p < 0.001), and this difference could not be explained by differences in perinatal characteristics. The regions were categorized according to a low (<15%, n = 6), medium (15-25%, n = 9), or high (>25%, n = 4) proportion of PDA treatment. Infants treated for PDA, compared to those not treated, were at higher risk of BPD or death in all regions, with an overall propensity score adjusted risk ratio of 1.33 (95% confidence interval 1.18-1.51). Survival without major neonatal morbidity was not related to PDA treatment.
PDA treatment varies largely across Europe without associated variations in perinatal characteristics or neonatal outcomes. This finding calls for more uniform guidance for PDA diagnosis and treatment in very preterm infants.
The theatres of Estonia celebrated the centenary of Estonian Republic by staging performances depicting different decades of the country’s history. The article dis - cus ses one of these performances ...“BB at Night” that staged the 1940s. The per formance is based on a novel of the same title that tells the story of Berthold Brecht’s journey to Finland during the Second World War. The aim of the article is to show – by describing three particular scenes from the performance and using the theories of Jacques Rancière, more precisely his notion of dissensus to analyse these scenes – how a performance that is not political per se could be received as political. By inviting audience members to participate in certain scenes, the bodies of theatre visitors are politicized, and the performance becomes aesthetically political and politically aesthetical.
The article focuses on the establishment and closing down of Theatre NO99 (2005-2018), one of the most nationally and internationally acclaimed theatres of Estonia. These events are analysed from two ...perspectives: (1) the political, because in both cases the Estonian Ministry of Culture made quite radical decisions that had a strong effect for the theatre field in general; (2) the discursive, to understand how NO99 legitimized its beginning and justified the ending. The latter is compared to the discourse of the written media to understand the dialogue between these two discourses. Pierre Bourdieu’s field theory is used to show how the external and internal forces influenced the position taking of NO99 in the Estonian theatre field and how paradoxical and even impossible it is for an avant-garde state theatre to balance between autonomous and heteronomous principals of hierarchization.
Parents' involvement during hospital care is beneficial for preterm infants and their parents. Although parents are encouraged to be present in many neonatal intensive care units (NICUs), little is ...known about their role during medical rounds.
To study parents' presence in the NICU, the degree of parents' participation during medical rounds, and to identify underlying factors for participation.
A prospective study was performed in 11 neonatal units in six European countries including parents of preterm infants born before 35 gestational weeks.
Parents' presence and the degree of participation (7-point Likert scale) during medical rounds were asked using a text-message question sent to the mobile phone of each parent separately.
A total of 241 families were included in the study; mothers responded to 630 and fathers to 474 text-message questions, respectively. In studied units, mothers were present during medical rounds on 62.5% to 91% and fathers 30.8% to 77.8% of the days. The degree of mothers' and fathers' participation also varied between units (p < 0.001 and p = 0.022, respectively). In multivariate analysis, parents' presence increased by increasing gestational age (p = 0.010), fathers' education (p = 0.009), and by the policy in the unit to invite parents to medical rounds (p = 0.036). The background characteristics did not explain the degree of participation.
There is significant variation between neonatal units in how they include parents in medical rounds. Only few background characteristics explained the differences suggesting that unit culture plays a major role in welcoming parents to participate.
•Parents were present in medical rounds most of the days in the study units.•Parents' presence and participation varied significantly between the units.•Gestational age, fathers' education and unit policy affected parental presence.•Parents' participation did not associate with family characteristics.
To date, there are contradictory findings concerning if, at which age, and to what extent children's language development is affected by prematurity at birth.
The objective was to compare language ...skills of extremely preterm (EPT) and very preterm (VPT) girls and boys at 24 months corrected for gestational age (GA) at birth with those of full-term (FT) girls and boys, and to explore the effect of perinatal and demographic factors.
Parents of 138 preterm (PT) children born <32 weeks' gestation (48 EPT with GA below 28 weeks, 90 VPT with GA 28–31 weeks) and of 150 FT controls completed the short Estonian version of the MacArthur-Bates Communicative Development Inventory: Words and Sentences (ECDI-II SF). Language skills of PT children were also assessed with the Bayley-III Language Scale (BSID-III), and compared with data from 152 FT controls.
Mean scores of all language measurements were significantly lower in boys (not girls) from both PT groups compared to FT girls and boys, while no significant differences were found between PT groups. Across groups, girls obtained significantly better language scores than boys. In PT children, being a girl, and attending day care at corrected age (CA) 2;0 years, predicted a larger expressive vocabulary (measured by the ECDI-II SF). Bayley language composite scores (sum of expressive and receptive language) were higher in PT girls than in boys, and the scores were negatively affected by the number of severe neonatal morbidities.
The findings highlight the importance of systematic language-focused assessments (using parents and trained examiners) of EPT and VPT boys, as well as the need to support their development.
•Very preterm boys had poorer language skills than full-term boys and girls at CA 2;0.•Language scores did not differ between extremely and very preterm children.•Female sex and attending day care predicted a larger expressive vocabulary.•Male sex and neonatal morbidities negatively affected Bayley language scores.
In the years 2009–2015, a comparison of theatre systems in seven smaller European cities was conducted and named the STEP City Study. The study also included reception research, conducted with an ...extensive questionnaire, and qualitative research comprised of focus groups and interviews with audience members. One of the surprising results showed that, generally, the spectators enjoyed the performances a lot, but at the same time, did not rate them as very personally or socially relevant. That is why we decided to explore the notion of relevance in this article, or in other words, to examine what we are measuring when we ask the audience if the performance was relevant for them. In this study, we combine audience research and performance analysis of the shows that were evaluated as the most personally or socially relevant. The shows had either existential or contemporary political topics, were created in rather traditional ways, and did not stand out in any particularly innovative theatrical approach. We also conclude that relevance is a complex issue expressed in different dimensions of theatrical experience and cannot be straightforwardly measured.
Objectives To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute ...a driver for reducing mortality and neonatal morbidity.Design Prospective multinational population based observational study.Setting 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project.Participants 7336 infants born between 24+0 and 31+6 weeks’ gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission.Main outcome measures Combined use of four evidence based practices for infants born before 28 weeks’ gestation using an “all or none” approach: delivery in a maternity unit with appropriate level of neonatal care; administration of antenatal corticosteroids; prevention of hypothermia (temperature on admission to neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal continuous positive airway pressure. Infant outcomes were in-hospital mortality, severe neonatal morbidity at discharge, and a composite measure of death or severe morbidity, or both. We modelled associations using risk ratios, with propensity score weighting to account for potential confounding bias. Analyses were adjusted for clustering within delivery hospital.Results Only 58.3% (n=4275) of infants received all evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants.Conclusions More comprehensive use of evidence based practices in perinatal medicine could result in considerable gains for very preterm infants, in terms of increased survival without severe morbidity.
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