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Moderately preterm infants (32-36 weeks of gestational age) have an increased risk of worse health and developmental outcomes compared to infants born at term. Optimal nutrition may alter this risk. The aim of this study was to investigate the neurological, growth, and health outcomes up to six years of age in children born moderately preterm who receive either exclusive or fortified breast milk and/or formula in the neonatal unit. In this longitudinal cohort study, data were collected for 142 children. Data were collected up to six years of age via several questionnaires containing questions about demographics, growth, child health status, health care visits, and the Five to Fifteen Questionnaire. Data on the intake of breast milk, human milk fortification, formula, and growth during hospitalization were collected from the children's medical records. No statistically significant differences in neurological outcomes, growth, or health at six years of age were found between the two groups (exclusive breast milk, n = 43 vs. fortified breast milk and/or formula, n = 99). There is a need for research in larger populations to further assess potential effects on health and developmental outcomes when comparing the use of exclusive versus fortified breast milk for moderately preterm infants during neonatal hospitalization.

Aim. Early intervention and detecting early signs are often cited as a goal by professionals working with children, but detecting and describing early signs is not well explored. Thus, the study’s aim was to explore professionals’ experiences and challenges in the early identification of psychosocial concerns in children aged 0–16. Materials and Methods. Data were collected from semistructured interviews with 26 professionals (e.g., nurses, psychologists, social workers, teachers, principals, and managers) working with children. The participants engaged in a pilot cooperation model between preschools, schools, social services, and healthcare to reach out early to children in need of support. The interviews were analyzed using thematic network analysis. Results. Four organizing themes were created as follows: “The idea of promoting and preventing is the key to success,” “Identifying the children who need support and intervention,” “Identifying observable early signs,” and “Occupied with children needing immediate support.” The organizing themes were interpreted into one global theme as follows: “All want an early intervention but putting it into practice is challenging.” Conclusion. The study shows that it is difficult to identify children in need of psychosocial support at an early stage because the early signs are difficult to detect. Thus, our results suggest that both preventive interventions targeting all children and specific interventions for those in need of support are needed to promote health and wellbeing.

Aim To compare mental health in parents of preterm/ill infants and parents of term and healthy infants before birth and 1 month after hospital discharge.Methods A comparative cohort design was used. In total 439 parents from six neonatal intensive care units (NICUs) and 484 parents from four maternity units (MUs) in Sweden answered a survey 1 month after discharge.Results Parents in neonatal units experienced significantly more psychologically traumatic births and rated their health and the health of their infants less favourably the first week after delivery than parents in MUs. In the neonatal units, both parents had better possibilities to stay together with the infant during hospital stay. There was no difference between the NICU and MU groups in postpartum depressive symptoms 1 month after discharge. Experiencing a traumatic birth was not related to an increased risk of perinatal depressive symptoms (Edinburgh Postnatal Depression Scale >= 13) for mothers in NICUs. In contrast, the risk of depression increased for mothers in MUs.Conclusion Family togetherness, parent-infant closeness and emotional support at NICUs may contribute to the positive outcome. Further studies are needed to assess the long-term effects of how family togetherness and closeness influence families long term.

This article contributes knowledge regarding professionals’ experiences, conceptions, and expectations of a coordinator role in preschools/schools while multiprofessionally collaborating for supporting children "at risk". Data were collected via semi-structured interviews with professionals involved in a project in a Swedish municipality intended to prevent children from getting into difficulties. Procedures for thematic analysis were followed, and Billig’s ideological dilemmas were used as a methodological tool. A coordinator role, assigned to head teachers, emerges as tense where dilemmas need to be addressed. The dilemmas are related to opposed, overarching ideas – education for "all" versus treatment for specific children – which require coordination. This article suggests that dialogues between actors need to be held when opposite positions can be articulated. To initiate and maintain such dialogues, a coordinator role is important.

Background/Objective: Parents express great readiness to actively deliver comfort for their infant during painful procedures. Previous research shows evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. Live parental lullaby singing combined with skin-to-skin contact and breastfeeding has not previously been investigated during painful procedures. Parents as pain management in Swedish neonatal care (SWEpap), is a cutting-edge interdisciplinary multi-center study with mixed methods. The randomized controlled trial investigates the efficacy of combined parent-delivered pain management compared with standard care during routine blood sampling of healthy newborn infants. Method: The aim of this analysis was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant in the three treatment groups; standard care with glucose, skin-to-skin contact, or a combination of skin-to-skin contact, breastfeeding (if applicable) and live parental lullaby singing. The parents rated the meaningfulness of the various conditions on a 100 mm visual analogue scale (VAS) from “not meaningful” on the left end point, up to “most possible meaningful” on the right end point of the scale. The parents were also asked to comment on how they experienced providing pain management. Result: A total number of 151 newborn infants with at least one parent, participated in this analysis. The mean VAS-ratings for meaningfulness were 82.1 for standard care with glucose, 89.5 for skin-to-skin contact, and 88.9 for combined interventions with live parental lullaby singing, breastfeeding and skin-to-skin contact. The ratings for parent-delivered pain-alleviation were significantly higher than for standard care (p=0.036). Parents in all groups expressed that it was meaningful to provide pain-relief and participate in the pain management of their newborn infant. Conclusion: Parents found it meaningful to provide pa, SWEpap

Background: Parents are a valuable but underutilized resource in procedural pain management in newborn infants. Parents want to take an active role in their infants’ pain management. Yet, there is a lack of knowledge concerning the parents’ experiences of providing pain management. Newborn infants experience several painful procedures related to postnatal care and immunizations. Not all infants receive adequate pain management during these procedures causing unnecessary suffering and leaves the infant at risk of complications. Parent-delivered pain management such as skin to skin contact and breastfeeding alleviate the infant’s pain during painful procedures. Live parental infant-directed lullaby singing has not been previously investigated during painful procedures. Infant-directed singing can be an apt medium for parents and infants to communicate in affective mutual relationship during painful procedures. Parents have a unique expertise about their infants and by including them in the pain management they could become valuable partners for the health professionals. The aim of the study was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant. Method: This study was part of a multi-center randomized controlled trial (RCT) with three parallel groups of healthy newborn infants and their parents. The SWEpap study (Parents as pain management in Swedish neonatal care), investigates the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, and compared with just holding skin-to-skin during routine metabolic screening of newborn infants. The infant-parent dyads were randomly assigned to one of three treatment groups. For the parents’ ratings of meaningfulness, a visual analogue scale (VAS) with a 100mm line anchored at the ends is used; from “not meaningful” on the left end poi

Background: Parents who have been at neonatal units (NICUs) with their infants have increased risks for exhibit symptoms of depression or psychological trauma. Key risk factors for the onset of depression, symptoms of psychological trauma, or parental anxiety during the time in NICU are; a stressful birth experience, early and prolonged separation and unclear responsibilities for the infant (de Paula Eduardo et al., 2019; R. Flacking et al., 2012). Maternal depression levels in NICU mothers could decrease if parents' have [ME1] unlimited access to their infants, a trustworthy staff-parent partnership, substantial emotional support (Axelin et al., 2021), and a single-family room (Tandberg et al., 2019). In Sweden most parents can stay at the unit day and night and therefore staff has good opportunities to give support (Flacking et al., 2019). Aim: To compare mental health in parents of preterm/ill infants and parents of term and healthy infants before birth and 1 month after hospital discharge. Method: A comparative cohort design where parents from six NICUs (n=439) and four maternal units (MUs) (n=484) in Sweden answered a survey one month after discharge. Results:Parents from NICUs experienced significantly more traumatic births and rated their health worse the first week after giving birth, compared to MU parents. NICU parents also rated their infant’s health worse the first week after birth and they had longer hospital stay. One month after discharge there was no difference between NICU and MU parents regarding symptoms of postnatal depression (EPDS). However, an association between traumatic birth and depression was only observed in mothers from MUs. Both parents at all NICUs had access to their infant 24/7 and they were significantly more often staying together as a family at the NICU. In total 80% of NICU parents were satisfied with the emotional support given by staff and significantly more NICU fathers were satisfied compared to MU fathers. Conclusion: ‘Fami, PANC

Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. Pain and separation cause adverse interruptions for the parent-infant attachment process in neonatal care. Repeated, cumulative, and inadequately treated procedural pain in addition to separation from the parent, might harm the critically ill infant physically and psychologically including increasing the risk for abnormally heightened sensitivity to pain. The new family’s attachment process and mental health for generations to come are also put at risk. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, including parental infant-directed lullaby singing, where parents themselves mediate pain relief, consistent with modernfamily-integrated care.There are many challenges and barriers in implementing parent-delivered procedural support including music therapeutic interventions in neonatal pain management. A fundamental barrier is the lack of research. Data from a new cutting-edge interdisciplinary clinical study with mixed methods will be presented. Parents as pain management in Swedish neonatal care (SWEpap), includes participatory action research and a multi-center randomized controlled trial informed by music therapy expertise and research using the Nordic NICU MT pain management strategy as a model for its design. The Nordic NICU MT pain management strategy provides a theoretical and practical resource-oriented music therapy model of how parent-delivered infant-directed singing can be comprehensively used in neonatal pain management. When including parents’ voices, this strategy can be useful in informing interdisciplinary neonatal pain research, bringing forth a systematic and structured scheme to investigate live parental infant-directed singing as procedural support., SWEpap

Frequent and inadequately treated pain combined with separation from the parent cause adverse interruptions to the parent-infant attachment process. The pain might harm the infant physically and psychologically including increasing the risk for abnormally heightened sensitivity to pain. Effective pain management strategies are needed and parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief, is consistent with a modern understanding of pain and of family-integrated care. Important for translating research into practice is to involve healthcare professionals and parents as co-researchers. Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. The Nordic neonatal music therapy pain management strategy provides a theoretical and practical resource-oriented music therapy model of how parent-delivered infant-directed singing can be comprehensively used in interdisciplinary neonatal pain research. Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-centre clinical study with mixed methods. The collaborative participatory action research design for the qualitative part of the SWEpap study aims to democratise the research process involving both parents and health professionals in the knowledge-making. The second part of SWEpap is a randomised controlled trial informed by music therapy expertise and research using the Nordic neonatal music therapy pain management strategy as a theoretical framework for its design. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine metabolic screening of newborn infants.

Background: For improving the management of infant pain and translating research into practice, parents’ active involvement during painful procedures is considered a critical first step. Research into parents’ motivations for and experiences of alleviating infant pain, is scarce. More research on combined parent-delivered pain alleviation including relationship-based interventions such as the parent’s musical presence is needed to advance infant pain care. Aim: Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-center clinical study. Using a mixed methods approach, SWEpap investigates parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief. This approach is consistent with a modern understanding of pain and of family-integrated care. Material and method: The qualitative part of the SWEpap study applies collaborative participatory action research design, video observations and interviews to investigate health care professionals’ and parents’ motivational factors in and experiences of parent- delivered pain alleviation. The second part is a randomized controlled trial. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine blood sampling of newborn infants. The enrollment has started and is expected to be completed during 2023. Results: Preliminary results acknowledge the need for parents to be educated and prepared about the effectiveness of the parent-delivered methods and how to apply them prior to the procedure. In addition, when preparing for the actual procedure, both parents and health care professionals emphasize the importance of allowing the parents sufficient time to cope with the situation and the dyad to relax before the skin puncture. Conclusion: Video observations and

AIM: To describe the structure and content of telephone support calls between mothers of preterm infants and support team members after hospital discharge. DESIGN: This is a qualitative study. METHODS: Data consisted of 19 recordings of telephone calls that occurred between March 2013 and December 2015. The calls were made by support team members to mothers within two weeks of discharge from the neonatal unit. Analyses were performed using content analysis. RESULTS: One category referred to what the support team members said that facilitated or did not facilitate the conversation. It was found that the support team members managed to have conversations that were tailored to the mother's current needs and conversations where the focus was on what the support team members thought was important. A second category referred to the topics the mothers talked about and that the mothers expressed both negative and positive feelings.

Aim To compare experiences of stress in mothers and fathers of preterm infants during the first year of life, assess changes in parental stress and explore potential predictors of parental stress. Methods Between 2013 and 2015, data on parental stress were collected at 8 weeks after discharge and at 6 and 12 months postpartum from 493 mothers and 329 fathers of 547 preterm infants in Sweden. The Swedish Parenting Stress Questionnaire was used as a secondary outcome in a randomised clinical trial of breastfeeding support. Results At the three time points, mothers perceived more role restriction and fathers more social isolation (P < .001). Stress decreased in mothers during the first year (P = .018), whereas stress increased in fathers between 6 and 12 months (P = .048). Mothers of very preterm infants (P = .024), parents of twins (P = .038) and parents with lower perceived general health (P = .003) reported higher levels of stress during the first year after birth. Conclusion This study identified several factors that influenced parental stress. Mothers and fathers showed different patterns of stress levels during the first year after birth. This finding indicates different needs for mothers and fathers regarding the time at which parental support after discharge might be most beneficial.

Background Breastfeeding support is important for breastfeeding mothers; however, it is less clear how mothers of preterm infants (< 37 gestational weeks) experience breastfeeding support during the first year. Thus, the aim of this study was to describe how mothers of preterm infants in Sweden experience breastfeeding support during the first 12 months after birth. Methods This qualitative study used data from 151 mothers from questionnaires with open‐ended questions and telephone interviews. The data were analyzed using an inductive thematic network analysis with a hermeneutical approach. Results The results exposed two organizing themes and one global theme. In the organizing theme “genuine support strengthens,” the mothers described how they were strengthened by being listened to and met with respect, understanding, and knowledge. The support was individually adapted and included both practical and emotional support. In the organizing theme “inadequate support diminishes,” the mothers described how health professionals who were controlling and intrusive diminished them and how the support they needed was not provided or was inappropriate. Thus, the global theme “being thrown into a lottery—dependent on the health professional who provided breastfeeding support” emerged, meaning that the support received was random in terms of knowledge and support style, depending on the individual health professionals who were available. Conclusion Breastfeeding support to mothers of preterm infants was highly variable, either constructive or destructive depending on who provided support. This finding clearly shows major challenges for health care, which should make breastfeeding support more person‐centered, equal, and supportive in accordance with individual needs.

Aim: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU). Methods: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress. Results: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66–1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t = 2.44, 95% CI 0.03–0.23, effect size d = 0.26. Conclusion: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.

Introduction The first months at home may be troublesome for mothers of preterm infants (< 37 gestational weeks) due to lack of support and thereby an increased risk for ceasing breastfeeding (Kair, Flaherman, Newby, & Colaizy, 2015; Niela-Vilen, Axelin, Melender, & Salantera, 2015). Breastfeeding prevalence in preterm infants is lower than in term infants and decreases during the first months at home (Akerstrom, Asplund, & Norman, 2007; Flacking, Nyqvist, Ewald, & Wallin, 2003). The aim of this trial was to evaluate the effects of a proactive breastfeeding telephone support to mothers of preterm infants on breastfeeding, method of feeding and to describe breastfeeding duration and risks for ceasing breastfeeding up to one year of infant age. Method This is a multicentre randomized controlled trial with six neonatal units in Sweden participated. At each unit a breastfeeding support team, BST (10 staff/unit) recruited, randomized and delivered the telephone support to eligible and participating mothers. The intervention was a proactive telephone call initiated by the BST day 1-14 after discharge from the neonatal unit. In the control group, the mothers received a telephone number to the BST if they wanted to call and ask or talk about anything. The outcomes reported were breastfeeding, method of feeding, duration of and risks for ceasing breastfeeding. All researchers were blind to group allocation throughout the study period. Results In total 493 mothers were randomized. There were no statistical significant differences between intervention (n=231) and control (n=262) group on breastfeeding, at discharge (OR 0.70, 95% CI 0.44-1.12, p=0.09), eight weeks after discharge (OR 1.12, 95% CI 0.75-1.69, p=0.45), six months (OR 1.21, 95% CI 0.78-1.88, p=0.29) and 12 months (OR 0.87, 95% CI 0.42-1.79, p=0.52) of infant age. Not either on method of feeding. Most infants received human milk directly at the breast; few infants received human milk by bottle