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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
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Maternal Consequences of Prematurity
• Psychological Distress
• Depressive Symptoms
• Anxiety
• Post Traumatic Stress
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Maternal Distress
• Disrupts the mother-child relationship
• Thus, contributing to health and developmental problems in the infant
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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.
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Interventions
Kangaroo Care (KC)—Holding with skin-to-skin contact
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Interventions
ATVV Intervention—Structured
massage that included auditory
stimulation (affectionate talking), tactile stimulation, visual stimulation (eye-to-eye
contact), and vestibular
stimulation (rocking)
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Interventions
Attention Control—Education about equipment needed for home care of preterm infants
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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
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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%
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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%
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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
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Maternal Psychological Well-Being Variables
• Depressive symptoms
• Situational anxiety
• Post-traumatic stress symptoms
• Parenting stress
• Worry about child health
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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
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Depressive Symptoms for the Intervention Groups
---- Control---- ATTV---- Kangaroo
Weeks Past EDC
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Worry for the Intervention Groups
Weeks Past EDC
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Maternal Parenting Variables
• Interactive Dimensions– Maternal Positive Involvement– Developmental Stimulation– Maternal Negative Control– Child Social Behaviors– Child Developmental Maturity– Child Irritability
• HOME total
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Maternal Parenting Variables
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Maternal Parenting Variables
Child Irritability
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Child Developmental Maturity
+++ ATTV+++ Control+++ Kangaroo Care
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Child Locomotion
--- ATTV--- Control--- Kangaroo Care
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Child Arousal/Activity Level
Sleep
Sedentary Activity
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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
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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.
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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%
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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
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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%