School of Nursing, Shanghai Jiao Tong University, 227 South Chong Qing Road, Building 1, Room 213, Shanghai 200025, China.
Shanghai First Maternity and Neonatal Hospital affiliated to Tongji Universityy, 550 Hu Nan Road, Shanghai 201204, China.
Int J Nurs Stud. 2020 Sep;109:103656. doi: 10.1016/j.ijnurstu.2020.103656. Epub 2020 Jun 1.
Growth retardation during the first year of life is frequently observed in prematurely born infants. Few reports have considered the effects of maternal emotional distress and perceptions of care burden on the outcomes of these infants.
This study investigated the physical growth trajectories of prematurely born infants treated in neonatal intensive care unit and determined the effects of perinatal factors, maternal emotional distress and perceptions of care burden on growth retardation at 12 months' corrected age.
Retrospective chart review and prospective cohort study.
Single neonatal intensive care unit and follow-up outpatient clinics at a maternity and neonatal hospital.
288 mother-infant pairs in the retrospective chart review and 169 dyads in the prospective cohort study.
Medical records of prematurely born infants, perinatal factors and physical growth over a 1-year period were retrospectively reviewed. For the prospective study, mothers completed the Self-Rating Anxiety Scale, Perinatal Post-traumatic Stress Disorder Questionnaire, and Condition Management Effort Scale when infants reached 3 months' corrected age. The generalized linear mixed model was applied to explore effects of maternal emotional disorders and perceptions of care burden on growth retardation at 12 months' corrected age.
The retrospective data showed 13.9%, 10.1%, and 10.1% retardation for head circumference, length, and weight, respectively. Birth weight was negatively associated with physical growth retardation. Delayed breastfeeding initiation, younger mothers, and lower 5-min Apgar score were associated with head circumference retardation. Male sex, higher gestational age, and delayed breastfeeding initiation were risk factors for length retardation; male sex, higher gestational age, and younger mothers for weight. The prospective study showed that head circumference, length, and weight retardation rates were 18.3%, 10.3%, and 16.3%, respectively. Male sex and birth weight, were still significant, while others were not. Moreover, alternative models based on these included factors revealed that maternal perceptions of a higher care burden was a risk factor for overall growth retardation and maternal post-traumatic stress disorder only for a weight problem.
Physical growth remained a significant problem for prematurely born infants during the first year. This study identified perinatal factors, the level of maternal emotional distress, and perceptions of care burden were related to adverse infant's growth outcomes. Multidisciplinary interventions targeting maternal emotional distress and perceptions of care burden should be developed to promote the growth of prematurely born infants within the first 3 months after birth.
生长迟缓在早产儿中很常见。很少有研究考虑母亲的情绪困扰和对护理负担的感知对这些婴儿结局的影响。
本研究调查了接受新生儿重症监护病房治疗的早产儿的体格生长轨迹，并确定了围产期因素、母亲的情绪困扰和对护理负担的感知对 12 个月校正年龄生长迟缓的影响。
回顾性图表审查和前瞻性队列研究。
单家新生儿重症监护病房和一家妇产医院的随访门诊。
回顾性图表审查中的 288 对母婴和前瞻性队列研究中的 169 对母婴。
回顾性分析早产儿的病历、围产期因素和 1 年内的体格生长情况。对于前瞻性研究，当婴儿达到 3 个月校正年龄时，母亲完成了自我评定焦虑量表、围产期创伤后应激障碍问卷和状态管理努力量表。应用广义线性混合模型探讨母亲情绪障碍和对护理负担的认知对 12 个月校正年龄生长迟缓的影响。
回顾性数据显示，头围、身长和体重的生长迟缓率分别为 13.9%、10.1%和 10.1%。出生体重与体格生长迟缓呈负相关。延迟开奶、母亲年龄较小和较低的 5 分钟 Apgar 评分与头围迟缓有关。男性、较高的胎龄和延迟开奶是身长迟缓的危险因素；男性、较高的胎龄和较小的母亲是体重迟缓的危险因素。前瞻性研究显示，头围、身长和体重的生长迟缓率分别为 18.3%、10.3%和 16.3%。男性和出生体重仍然是显著的，而其他的则不是。此外，基于这些包括因素的替代模型表明，母亲感知到更高的护理负担是整体生长迟缓的危险因素，而母亲创伤后应激障碍仅与体重问题有关。
早产儿在出生后的第一年仍然存在明显的生长问题。本研究确定了围产期因素、母亲的情绪困扰程度以及对护理负担的感知与婴儿生长不良结局有关。应制定针对母亲情绪困扰和对护理负担认知的多学科干预措施，以促进早产儿在出生后前 3 个月的生长。
