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Objective: Early psychosocial interventions for preterm infants and their parents are diverse. This study aimed to structure the knowledge on psychosocial parent-infant interventions and to identify gaps in the intervention studies. Methods: We included studies on early (during first year of life) psychosocial parent-infant interventions with parent-infant relationship outcomes after preterm birth (< 37 weeks). We excluded studies that did not focus on preterm infants, failed to indicate the studied intervention and outcomes, were not written in English, were not controlled or peer-reviewed studies, or did not provide essential information for eligibility. The search included studies published between January 2000 and March 2024 in PubMed and PsycINFO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in reporting. Psychosocial parent-infant intervention studies were classified adapting the International Classification of Health Interventions (ICHI) and the Template for Intervention Description and Replication (TIDieR). Results: The included 22 studies reported data from 18 different interventions with preterm infants (< 37 weeks). Studies excluded preterm infants with health risks (19/22, 86%), with very low gestational age and/or birth weight (7/22, 32%), and/or mothers with psychosocial risks (14/22, 64%). Of the 18 interventions, 12 (67%) were classified as counseling, 3 (17%) as emotional support, 2 (11%) as psychotherapeutic, and 1 (6%) as educational. The parent-child relationship was assessed using 30 different methods and varying time points up to 18 months of age. Most studies (17/22, 77%) reported positive changes in the parent-child relationship favoring the intervention group. Conclusion: We identified four types of interventions to influence parenting behavior; the most used was counseling. All four intervention types showed positive effects on parent-infant relationships, although the preterm populations studied were selective, the effects were evaluated using different methods, and the follow-up periods were short. These findings indicate a need for studies with standardized methods, longer follow-up, and less-restricted preterm populations to develop guidelines for all families with preterm infants. [ABSTRACT FROM AUTHOR]

This study examined longitudinal associations between parental psychological distress (stress and depression) when the child was 2 to 4 years and a child's emotional and behavioural problems at ages 3 to 4, and social functioning (loneliness and social competence) at age 11 in very preterm born children. The participants were Finnish families of 172 very preterm infants (gestational age < 32 weeks and/or birth weight ≤ 1500 g). In girls, higher levels of maternal depression were associated with higher levels of social and emotional loneliness. Furthermore, higher levels of maternal stress and children's externalizing problems were associated with lower levels of experienced empathy. In boys, higher levels of paternal depression were associated with lower levels of social loneliness and impulsive behaviour. In conclusion, early parental psychological distress is associated with early socioemotional development and the later experienced social functioning in former very preterm infants. The sex of the child moderates these associations. [ABSTRACT FROM AUTHOR]

Background: Preterm infants have a risk of health and developmental problems emerging after discharge. This indicates the need for a comprehensive follow-up to enable early identification of these problems. In this paper, we introduce a follow-up tool "ePIPARI – web-based follow-up for preterm infants". Our future aim is to investigate whether ePIPARI is a feasible tool in the follow-up of preterm infants and whether it can identify children and parents in need of clinical interventions. Methods: ePIPARI includes eight assessment points (at term age and at 1, 2, 4, 8, 12, 18, and 24 months of corrected age) when the child´s health and growth, eating and feeding, neurodevelopment, and parental well-being are evaluated. ePIPARI consists of several widely used, standardized questionnaires, in addition to questions typically presented to parents in clinical follow-up visits. It also provides video guidance and written information about age-appropriate neurodevelopment for the parents. Parents of children born before 34 weeks of gestation during years 2019–2022 are being invited to participate in the ePIPARI study, in which web-based follow-up with ePIPARI is compared to clinical follow-up. In addition, the parents of children born before 32 weeks of gestation, who reached the corrected age of two years during 2019–2021 were invited to participate for the assessment point of 24 months of ePIPARI. The parents are asked to fill in the online questionnaires two weeks prior to each clinical follow-up visit. Discussion: The web-based tool, ePIPARI, was developed to acquire a sensitive and specific tool to detect infants and parents in need of further support and clinical interventions. This tool could allow individualized adjustments of the frequency and content of the clinical visits. Trial registration: ClinicalTrials.cov, NCT05238168. Registered 11 April 2022 – Retrospectively registered. [ABSTRACT FROM AUTHOR]

Objective: Retention is essential in follow-up studies to reduce missing data, which can cause bias and limit the generalizability of the results. We investigated whether pre-notification letters would increase the response rates of approval forms and questionnaires and reduce the need for post-notifications in a prospective follow-up study of 17-year-old adolescents. Study design: and settings This long-term follow-up study included 269 adolescents were randomized (1:1) into a pre-notification group (n = 132) and a no pre-notification group (n = 137). The pre-notification letter was sent prior to the approval form and questionnaires. The outcome measures were the response rates to the approval forms and questionnaires and the rate of post-notifications required. Results: The adolescents who received the pre-notifications were more likely to return approval forms (n = 88/132, 67%) than the adolescents who did not receive the pre-notifications (n = 79/137, 58%) (OR 1.5, 95% CI 0.9–2.4). The rates of returned questionnaires were higher in the pre-notification group (n = 82/88, 93%) than in the no pre-notification group (n = 68/79, 86%) (OR 2.2, 95% CI 0.8–6.3). The adolescents who did not receive the pre-notifications were more likely to need the post-notifications than the adolescents who received the pre-notifications (OR 3.0, 95% CI 1.4 to 6.5). Conclusions: Pre-notifications decreased the need for post-notifications and may increase retention in 17-year-old adolescents. Based on our findings, pre-notification letters are recommended in future follow-up studies in adolescents. Trial registration: The Ethics Review Committee of the Hospital District of South-West Finland approved the 17-year PIPARI Study protocol in January 2018 (23.1.2018; 2/180/2012). The study has been registered to the SWAT repository as SWAT 179. Filetoupload,1457904,en.pdf (qub.ac.uk). [ABSTRACT FROM AUTHOR]

Aim: Very preterm children born <32 weeks of gestation are at risk for motor difficulties such as cerebral palsy and developmental coordination disorder. This study explores the association between diffusion tensor imaging metrics at term and motor outcomes at 11 years of age.Methods: A cohort of 37 very preterm infants (mean gestational age 29 4/7, SD 2 0/7) born in 2004-2006 in Turku University Hospital underwent diffusion tensor imaging at term. A region of interest analysis of fractional anisotropy and mean diffusivity was performed. Motor outcomes at 11 years of age were measured with the Movement Assessment Battery for Children - Second Edition.Results: The diffusion metrics of the corpus callosum (genu P = .005, splenium P = .049), the left corona radiata (P = .035) and the right optic radiation (P = .017) were related to later motor performance. Mean diffusivity decreased and fractional anisotropy increased in proportion to the improving performance.Conclusion: The diffusion metrics of the genu and splenium of the corpus callosum, the left corona radiata and the right optic radiation at term were associated with motor skills at 11 years of age. Diffusion tensor imaging should be further studied as a potential tool in recognising children at risk for motor impairment. [ABSTRACT FROM AUTHOR]

Aim: This Finnish regional birth-cohort study compared the school performance of very preterm and full-term children when they reached 11 years of age.Methods: Teachers rated the educational abilities of 123 preterm children and 133 full-term controls at the age of 11 years as well as the support services they received. The children were all born in the Turku University Hospital between 2001 and 2005. In the preterm group, neurosensory impairments were confirmed at two years of corrected age, and full-scale intelligence quotient (IQ) was assessed at 11 years of age using the Wechsler Intelligence Scale, Fourth Edition.Results: Educational abilities, including academic skills and classroom functioning, did not differ between the two groups after excluding the children with a full-scale IQ < 70. However, 40% of the preterm group and 26% of the controls had received at least one support service (p <0.02). The 13 preterm children with a full-scale IQ <70 and the 10 with neurosensory impairment received more support services. Boys in both groups displayed more classroom-functioning problems than girls.Conclusion: A full-scale IQ ≥ 70 and age-appropriate educational abilities do not exclude a significant need for support services in very preterm children at the age of 11 years. [ABSTRACT FROM AUTHOR]

Aim: To study the prognostic value of volumetric brain magnetic resonance imaging (MRI) at term equivalent age (TEA) and neurological examinations at TEA and at 2 years of corrected age for long-term neuromotor outcome in infants born very preterm.Method: A total of 98 infants born very preterm were included. Structural and volumetric brain MRI and the Dubowitz neurologic examination were done at TEA. The Hammersmith Infant Neurological Examination (HINE) was performed at 2 years of corrected age. The Touwen examination was used for the assessment of minor neurological dysfunction (MND) at the age of 11 years.Results: Of all children (median birthweight 1083g [quartiles 820, 1300]; gestational age 28 5/7wks [26 4/7, 30 2/7]), 41 had simple MND, 11 had complex MND (cMND), and eight had cerebral palsy (CP). The negative and positive predictive value of structural brain MRI for cMND or CP was 88% and 50% respectively. Reduced volumes of total brain tissue, frontal lobes, basal ganglia and thalami, and cerebellum associated with cMND or CP. The results of the Dubowitz neurologic examination and the HINE correlated with the Touwen examination.Interpretation: Structural and volumetric MRI at TEA and structured neurological examinations predict long-term neuromotor outcome in infants born preterm. [ABSTRACT FROM AUTHOR]

Aim: This study examined the impact of prematurity-related morbidity on the health-related quality of life (HRQoL) of premature children at eight years of age, compared to term born controls of same age.Methods: We focused on 155 premature, very low birth weight (VLBW) infants weighing up to 1500 g who were born from 2001 to 2006 in Turku University Hospital, Finland, and compared them with 129 full-term controls. Cognitive development and length was assessed at five years of age and the children self-reported 17 dimensions of HRQoL at eight years of age. The VLBW group was subdivided into healthy children and those with prematurity-related morbidities.Results: Our findings showed that 64.5% of the VLBW children did not have prematurity-related morbidities. The HRQoL of the healthy preterm VLBW children was very good and did not differ significantly from the controls. However, the VLBW children with one or more morbidities had significantly lower scores in nine of the 17 HRQoL dimensions than the children in the control group.Conclusion: The majority of the VLBW children survived without prematurity-related morbidities, and their HRQoL was very good and similar to the control children. The main goal of neonatal care for preterm infants should be to prevent long-term morbidities. [ABSTRACT FROM AUTHOR]

Objective. Early mother-infant relationships in preterm populations were evaluated in the context of a systematic review of the literature. Design and setting. A systematic search of three electronic databases (PsychINFO, PubMed and Cochrane Library) was undertaken. Three studies of maternal attachment, 18 studies of mother-preterm infant interaction and eight studies of infant attachment were included. Studies of preterm infant attachment were also evaluated using a meta-analysis. Results. Studies of mother-preterm infant interactions showed that the differences in maternal interaction behavior between mothers of preterm infants and mothers of full-term infants seem to be most evident during the first six months of life. Differences in the preterm infant's interaction behavior seem also to continue for six months after birth. However, five of 18 studies showed an equal or even higher quality of mother-infant interaction in groups of preterm compared to groups of full-term infants. Studies of maternal and infant attachment indicated that preterm infants and their mothers are not at higher risk of insecure attachment than full-term infants and their mothers. Conclusions. The mother-preterm infant relationship is complex, and some relational patterns forecast greater psychological risk than others. It is important to decrease maternal stress and early separation in every possible way during hospitalization as well as after discharge. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the study was to assess the relationship between maternal representations and the quality of mother–infant interaction in a group of preterm and full-term infants. The study groups consisted of 38 mothers and their preterm infants (≤1500g or<32 gestational weeks) and 45 mothers and their full-term infants. Maternal representations were assessed using the Working Model of Child Interview (WMCI) at 12 months of the infant''s corrected age. The quality of mother–infant interaction was studied using the Parent–Child Early Relational Assessment (PCERA) method at 6 and 12 months of the infant''s corrected age. The results showed that maternal representations are related to the quality of mother–infant interaction in a parallel manner in preterm and full-term infants and their mothers. Furthermore, distorted representations were more strongly related to a higher number of areas of concern in mother–infant interaction than other representation classifications. Our results underline the importance of combined assessment of the subjective experiences of the mother and the quality of mother–infant interaction in clinical follow-up. This is the first study to describe the relation between maternal attachment representations and the quality of mother–infant interaction involving preterm infants. [Copyright &y& Elsevier]

Abstract: The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant''s corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant''s corrected age was studied. There were 38 mothers of preterm infants (<1500g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers’ representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants. [Copyright &y& Elsevier]

Abstract: Objectives: To investigate how mother''s recollections of birth experiences and first contact with the newborn relate to the child''s behavioral and emotional problems at five to six years of age. Methods: The study included 28 mothers of preterm (birth weight ≤2500 g) and 39 mothers of full-term children, born in Tampere University Hospital in 1998. When the children were five to six years old, maternal recollections of the birth experiences were assessed using the Clinical Interview for Parents of High-Risk Infants (CLIP) and children''s behavioral and emotional problems were assessed using the Child Behavior Checklist (CBCL). Results: Mothers of the preterm children still had more negative recollections of the labor (p <0.001) and first contact with the newborn (p <0.001) than mothers of the full-term children. These recollections related to the child''s behavioral and emotional symptoms when the child was five to six years old in the preterm group but not in the full-term group. Conclusion: The impact of mother''s birth experience seems to have long-lasting effects on the preterm child. This finding emphasizes the importance of early physical mother–infant contact and supporting the mothers of preterm infants, especially if they articulate negative or traumatic experiences related to the birth of their child. [Copyright &y& Elsevier]

Aim: The purpose of this study was to assess the prevalence and the background factors of maternal depressive symptoms and their relation to the quality of mother–infant interaction in a group of preterm infants and their mothers. Methods: The signs of maternal depression were evaluated in 125 mothers of very preterm infants (birth weight ≤ 1500 g or < 32 gestational weeks) at 6 months of infant's corrected age using Edinburgh Postnatal Depression Scale (EPDS). The association between maternal depressive symptoms and the quality of mother–infant interaction as assessed by the parent child early relational assessment method (PCERA) method was studied at 6 and 12 months of corrected age in 32 preterm infants who were their mothers' firstborn infants and singletons. Results: The prevalence of depression assessed by EPDS in mothers of very preterm infants was 12.6%. Most interestingly, the number of postnatal signs of depression associated negatively with the quality of the maternal interaction behaviour with their preterm infants. Conclusions: This study suggests that maternal depression may be a risk factor in the development of the mother–infant relationship between preterm infants and their mothers. Therefore, it would be important to identify signs of depression in mothers of preterm infants to offer early support. [ABSTRACT FROM AUTHOR]

Abstract: Objectives:: The aim of this study was to evaluate associations between infant crying, holding and mother–infant interaction. Methods:: The study groups included 30 firstborn Finnish preterm infants (<1501 g or <32 weeks), and their 36 full-term controls. Caregiver''s holding and infant''s crying behavior was assessed using Baby Day Diary at 5 months of corrected age. The quality of mother–infant interaction was assessed using PC-ERA at 6 and 12 months of corrected age. Results:: The results showed that longer duration of holding in home environment was associated with better quality of mother–infant interaction at 6 and 12 months of corrected age in preterm infants. Preterm infants cried more often and were held more than full-term infants. The frequency of crying was associated with the duration of holding in preterm infants. Mother–infant interaction was comparable between the groups of preterm and full-term infants. Conclusions:: Our results underline the importance of caregiver''s physical closeness for the quality of the mother–infant interaction in preterm infants. Prematurity itself does not necessary affect the quality of mother–infants interaction in a non-risk population. [Copyright &y& Elsevier]

The survival of the smallest and most immature preterm infants, born at 23–24 weeks of gestation, has improved significantly. While there is a substantial amount of research on the neurocognitive and social outcomes of extremely premature birth, little is known about the survivors' subjective experience of being born preterm and its effect on later life. The purpose was to study the subjective experiences of school-aged children born at 23–24 weeks of gestation, in order to understand their perspectives on how being born extremely early had affected their life. Qualitative descriptive study. 18 school-aged children (12 girls and 6 boys, 7–15 years of age), born at 23 or 24 weeks of gestation, were interviewed. The semi-structured interview guide covered six topics about quality of life: somatic health, functioning, learning and memory, emotional health, social relations, experience of prematurity and its effect. Most children reported memories, which were told to them by parents, about their premature birth and early life. Using qualitative thematic analysis, the narratives of the children were classified into three groups: 1) the go-with-the-flow children , who identified little or no effect of prematurity, 2) the ponderers , who reflected on some effects such as minor physical challenges, and 3) the hesitants , who either did not connect their challenges with prematurity, or did not produce much reflection overall. Children had been told about their early life by the parents and repeated these memories indicating that prematurity had become a significant part of the family story. Differences were found how the children reflected on the impact of prematurity in their personal life. It is essential to include preterm survivors' own perspectives already during childhood and adolescence into the research of extreme prematurity. • Very little is known about children's subjective experiences of being born prematurely. • In this article, children born at gestational weeks 23–24 describe their experiences of prematurity. • Some children reflected no affect of prematurity; others, small physical challenges. • One subgroup of children did not connect their challenges with prematurity. • Survivors' perspectives should be an essential feature in prematurity research. [ABSTRACT FROM AUTHOR]