Maternal Administration of Interventions for the Preterm

Infants in the NICU: Effects on Maternal Distress and Mother-

Infant Interactions 

Diane Holditch-Davis, PhD, RN, FAANRosemary White-Traut, DNSc, RN, FAAN

Janet Levy, PhDRichard David, MD

T. Micheal O’Shea, MDVictoria Geraldo, MD

Maternal Consequences of Prematurity

• Psychological Distress

• Depressive Symptoms

• Anxiety

• Post Traumatic Stress

Maternal Distress

• Disrupts the mother-child relationship

• Thus, contributing to health and developmental problems in the infant

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.

Interventions

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

Interventions

ATVV Intervention—Structured

massage that included auditory

stimulation (affectionate talking), tactile stimulation, visual stimulation (eye-to-eye

contact), and vestibular

stimulation (rocking)

Interventions

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

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

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%

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%

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

Maternal Psychological Well-Being Variables

• Depressive symptoms

• Situational anxiety

• Post-traumatic stress symptoms

• Parenting stress

• Worry about child health

Maternal Psychological Well-Being for the Intervention Groups

Predicted

20253035404550556065707580

timmn

-10 0 10 20 30 40 50

AnxietyPost-Traumatic

Stress Symptoms

Parenting Stress

---- Control---- ATTV---- Kangaroo

Depressive Symptoms for the Intervention Groups

---- Control---- ATTV---- Kangaroo

Weeks Past EDC

Worry for the Intervention Groups

Weeks Past EDC

Maternal Parenting Variables

• Interactive Dimensions– Maternal Positive Involvement– Developmental Stimulation– Maternal Negative Control– Child Social Behaviors– Child Developmental Maturity– Child Irritability

• HOME total

Maternal Parenting Variables

Maternal Parenting Variables

Child Irritability

Child Developmental Maturity

+++ ATTV+++ Control+++ Kangaroo Care

Child Locomotion

--- ATTV--- Control--- Kangaroo Care

Child Arousal/Activity Level

Sleep

Sedentary Activity

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

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.

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%

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

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%