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Diane Holditch-Davis, PhD, RN, FAAN Rosemary White-Traut, DNSc, RN, FAAN Janet Levy, PhD

Maternal Administration of Interventions for the Preterm Infants in the NICU: Effects on Maternal Distress and Mother-Infant Interactions . Diane Holditch-Davis, PhD, RN, FAAN Rosemary White-Traut, DNSc, RN, FAAN Janet Levy, PhD Richard David, MD T. Micheal O’Shea, MD Victoria Geraldo, MD.

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Diane Holditch-Davis, PhD, RN, FAAN Rosemary White-Traut, DNSc, RN, FAAN Janet Levy, PhD

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  1. Maternal Administration of Interventions for the Preterm Infants in the NICU: Effects on Maternal Distress and Mother-Infant Interactions  Diane Holditch-Davis, PhD, RN, FAAN Rosemary White-Traut, DNSc, RN, FAAN Janet Levy, PhD Richard David, MD T. Micheal O’Shea, MD Victoria Geraldo, MD

  2. Maternal Consequences of Prematurity • Psychological Distress • Depressive Symptoms • Anxiety • Post Traumatic Stress

  3. Maternal Distress • Disrupts the mother-child relationship • Thus, contributing to health and developmental problems in the infant

  4. Purpose of This Study • To examine the effects of the auditory-tactile-visual-vestibular (ATVV) intervention and kangaroo care on maternal psychological well-being and the maternal-child relationship as compared to an attention control group.

  5. Interventions Kangaroo Care (KC)—Holding with skin-to-skin contact

  6. Interventions ATVV Intervention—Structured massage that included auditory stimulation (affectionate talking), tactile stimulation, visual stimulation (eye-to-eye contact), and vestibular stimulation (rocking)

  7. Interventions Attention Control—Education about equipment needed for home care of preterm infants

  8. Methods: Sample • 240 mothers and their preterm infants • Infants weighed less than 1750 gm • Recruited from 4 hospitals when their infant was no longer critically ill • Randomly assigned to intervention • Stratified by hospital • Stratified by multiple vs singleton

  9. Infant Characteristics Control ATVV Kangaroo Mean (SD) Mean (SD) Mean (SD) ________________________________________________________ Gestational Age (Weeks) 27.5 (3.1) 27.0 (2.8) 27.2 (2.9) Birthweight in Grams 1030 (343) 989 (324) 1012 (319) Sex: % Male 46.9% 45.7% 46.4% Size: % AGA 80.3% 84.6% 76.9% Apgar Score: 1 Minute 5.4 (2.4) 4.8 (2.6) 5.0 (2.5) 5 Minute 7.5 (1.6) 7.1 (1.7) 7.1 (1.7) Mechanical Ventil. (Days) 14.6 (19.9) 19.2 (36.7) 15.4 (18.7) IVH: None 67.9% 73.1% 60.7% % Grade I/II 27.2% 18.0% 26.2% % Grade III/IV 4.9% 9.0% 13.1% % Having Surgery 40.0% 30.8% 38.5% % Multiple Births 16.1% 19.0% 19.2%

  10. Maternal Characteristics Control ATVV Kangaroo Mean (SD) Mean (SD) Mean (SD) ________________________________________________________ Maternal Age 26.8 (6.5) 26.4 (5.4) 28.0 (6.2) Race: Non-Hisp. White 17.5% 21.3% 19.7% Non-Hisp. Black 77.5% 66.3% 67.1% Hispanic 5.0% 10.0% 10.5% Other 0.0% 2.5% 2.6% % Mothers Married 26.3% 36.3% 32.9% % First-Time Mothers* 43.8% 66.7% 57.7% Education in Years 13.1 (2.3) 13.6 (2.0) 13.5 (2.5) % Cesarean Section 58.0% 61.7% 53.9% % on Public Assistance 22.5% 18.8% 19.7%

  11. Procedures • Study nurses instructed the mothers in the intervention and supported the mother in administering the interventions during hospitalization • Data collected at enrollment and again at discharge, 2, 6 & 12 months • Home visits at 2 & 6 months • 45-minute videotapes of mother-infant interactions • HOME Inventory scored

  12. Maternal Psychological Well-Being Variables • Depressive symptoms • Situational anxiety • Post-traumatic stress symptoms • Parenting stress • Worry about child health

  13. Maternal Psychological Well-Being for the Intervention Groups Post-Traumatic Stress Symptoms Anxiety Parenting Stress ---- Control ---- ATTV ---- Kangaroo

  14. Depressive Symptoms for the Intervention Groups ---- Control ---- ATTV ---- Kangaroo Weeks Past EDC

  15. Worry for the Intervention Groups Weeks Past EDC

  16. Maternal Parenting Variables • Interactive Dimensions • Maternal Positive Involvement • Developmental Stimulation • Maternal Negative Control • Child Social Behaviors • Child Developmental Maturity • Child Irritability • HOME total

  17. Maternal Parenting Variables

  18. Maternal Parenting Variables Child Irritability

  19. Child Developmental Maturity +++ ATTV +++ Control +++ Kangaroo Care

  20. Child Locomotion --- ATTV --- Control --- Kangaroo Care

  21. Child Arousal/Activity Level Sleep Sedentary Activity

  22. Conclusions • Kangaroo care had both positive and negative effects on maternal psychological well-being • slowing the decrease in depressive symptoms over time • increasing the decline in worry about child health • ATVV did not affect maternal psychological well-being

  23. Conclusions • Child developmental maturity was higher for the ATTV infants. • This was due to the greater motor maturity of the ATTV infants. • Kangaroo care infants showed less arousal and lower activity levels, especially at 2 months. • These findings indicate that kangaroo care and ATVV have minor but important effects on the mother-premature infant relationship.

  24. Attrition • 195 dyads completed the study Control ATVV Kangaroo  ________________________________________ Completed Study 82.7% 79.8% 76.3% Study Withdrawals Early Infant Death 2.5% 2.4% 3.8% Later Infant Death 1.2% 0.0% 1.3% Early Withdrawal 8.6% 16.7% 13.8% Late Withdrawal 4.9% 1.2% 5.0%

  25. Nurse Contacts of the ATVV and Kangaroo Care Mothers Both ATVV Kangaroo ___________________________________ No Contacts 9 5 4 1 Contact 77 42 35 2 Contacts 34 16 18 3 Contacts 24 12 12 4 or More 15 6 9

  26. Maternal Reports of Engaging in ATVV and Kangaroo Care ATVV Kangaroo Control Group Group Group ___________________________________ ATTV None 7.3% 77.8% 69.1% < 1/week 14.6% 3.7% 7.3% 1-3 / week 51.2% 9.3% 23.6% 3 or more 26.8% 9.3% 0.0% Kangaroo Care None 68.3% 5.6% 61.8% < 1/week 26.8% 20.4% 16.4% 1-3 / week 4.9% 46.3% 21.8% 3 or more 0.0% 27.8% 0.0%

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