Does premature birth affect Brazilian parents' practices related to infant positioning? / A prematuridade afeta as práticas maternas brasileiras relacionadas ao posicionamento de lactentes?

Abstract Objective: To verify whether the time spent in prone, supine, or seated positions differed between term and preterm infants; and to determine whether a single verbal guidance session for parents changed the time spent in different positions, and, consequently, the motor development scores, after one month in preterm infants. Methods: Sixty-one infants from a full-term and preterm group from Brazil were included. Motor development was assessed by the Alberta Infant Motor Scale (AIMS) and the parents registered the time spent in each position on a 24-hour schedule. A month after verbal guidance, a second assessment was performed only on the preterm infants. Results: The positioning times awake determined for the full-term and preterm parents were similar. Preterm infants spent more time in the prone sleeping position (2.1 vs. 0.8 h; p=0.037) than full-term infants. The AIMS percentile scores did not differ significantly between the groups. For preterm infants, the time spent in all positions did not change during the second assessment (n=18). Conclusions: The fact that some parents position their infants in the prone posture during sleeping periods reinforce the importance of parental education approaches for sudden infant death syndrome (SIDS) prevention during the first months of life. The verbal guidance provided to parents of preterm infants did not influence the AIMS percentile and time spent in various positions but increased preterm parents' confidence in placing their infants in a prone position to play.

RESUMO Objetivo: Verificar se o tempo nas posições prono, supino ou sentado difere entre lactentes a termo e pré-termo; bem como determinar se uma única sessão de orientação verbal aos pais alterou o tempo despendido nas diferentes posições e, consequentemente, o escore de desenvolvimento motor, após um mês em lactentes pré-termo. Métodos: Foram incluídos 61 lactentes brasileiros nos grupos a termo e pré-termo. O desenvolvimento motor foi avaliado pela Alberta Infant Motor Scale (AIMS), e os pais registraram o tempo despendido em cada posição em uma linha do tempo de 24 horas. Um mês após a orientação verbal, uma segunda avaliação foi realizada apenas nos lactentes pré-termo. Resultados: O tempo de posicionamento acordado determinado pelos pais de lactentes a termo e pré-termo foi semelhante. Os lactentes pré-termo passaram mais tempo dormindo na posição prona (2,2 vs. 0,8 h; p=0,037) do que os lactentes a termo. Os escores de percentil AIMS não diferiram significativamente entre os grupos. Para lactentes pré-termo, o tempo despendido em todas as posições não se modificou durante a segunda avaliação (n=18). Conclusões: O fato de alguns pais posicionarem os lactentes em decúbito ventral durante os períodos de sono reforça a importância das abordagens educativas parentais para a prevenção da síndrome da morte súbita do lactente (SMSL) durante os primeiros meses de vida. A orientação verbal fornecida aos pais de prematuros não influenciou o percentil da AIMS e o tempo de permanência em várias posições, mas aumentou a confiança dos pais de lactentes prematuros em utilizar a posição prona para brincar.

Perfil de psicoterapeutas pais-bebê de Porto Alegre: formação e atuação profissional / Profile of parent-infant psychotherapists of Porto Alegre: training and professional actuation / Perfil de psicoterapeutas padres-bebés de Porto Alegre: formación y actuación profesional

A psicoterapia pais-bebê é uma modalidade terapêutica que enfoca a relação da díade/tríade pai-mãe/bebê, geralmente embasada no referencial teórico psicanalítico. No Brasil, são escassas as pesquisas sobre o tema. Este estudo teve como objetivo investigar o perfil de profissionais que atuam como psicoterapeutas pais-bebê em Porto Alegre e as características e especificidades deste campo de atuação. Trata-se de estudo qualitativo, de caráter exploratório-descritivo. Os dados foram coletados por meio de entrevista semiestruturada realizada presencialmente. Participaram do estudo 10 psicoterapeutas do sexo feminino, selecionadas por conveniência. Utilizou-se a Análise de Conteúdo proposta por Laurence Bardin para a análise dos dados. A possibilidade de intervir precocemente foi descrita como a principal motivação para a inserção na área, que ocorreu sem uma formação acadêmica estruturada. Possuir conhecimentos sobre desenvolvimento infantil, constituição de vínculos e dinâmica familiar foi citado como imprescindível para a atuação profissional. Quanto às características pessoais e técnicas, foram mencionadas a necessidade de identificação com a técnica e com o trabalho com bebês e de possuir formação sólida, pautada em estudo teórico, supervisão e análise pessoal. A importância da experiência prática e da observação de bebês enquanto ferramentas de aprendizagem também foi destacada, e constatou-se a necessidade de ampliar a visibilidade desse campo de atuação entre profissionais e público em geral.(AU)

The parent-infant psychotherapy is a therapeutic approach that focus on the father-mother/baby dyad/triad, usually based on the psychoanalytic theoretical framework. In Brazil, research on this theme is scarce. This study aimed to investigate the profile of parent-infant psychotherapists that work in Porto Alegre and the characteristics and specificities of their field of actuation. This is a qualitative study, with a descriptive and exploratory design. Data were collected by semi-structured in person interviews. A total of 10 female psychotherapists, selected by convenience, participated in the study. Content Analysis proposed by Laurence Bardin was used for data analysis. The possibility of early intervention was described as the main motivation for the choice of this field, which occurred without a formal training. Knowledge about child development, bonding and family dynamics stood out as essential for professional performance. Regarding personal and technical characteristics, the need for identification with this technique and with working with babies and a solid training, based on theoretical study, supervision and personal analysis, were mentioned. The importance of the practical experience and of the infant observation as learning tools was also highlighted, and the need to increase the visibility of this practical field among professionals and the general public was observed.(AU)

La psicoterapia padres-bebé es una modalidad terapéutica que se enfoca en la relación de la díada/tríada padre-madre/bebé, generalmente basada en el referencial teórico psicoanalítico. En Brasil, pocas son las investigaciones sobre el tema. Este estudio analizó el perfil de profesionales que actúan como psicoterapeutas padres-bebé en Porto Alegre (Brasil) y las características y especificidades de este ámbito de actuación. Este es un estudio cualitativo, de naturaleza exploratoria descriptiva. Para la recopilación de datos se realizó una entrevista semiestructurada de modo presencial. Se entrevistaron a 10 psicoterapeutas mujeres, elegidas por conveniencia. Se aplicó el Análisis de Contenido propuesto por Laurence Bardin para analizar los datos. La posibilidad de intervenir precozmente se describió como la principal motivación para la selección del área, que ocurrió sin una formación académica estructurada. Poseer conocimientos sobre desarrollo infantil, constitución de vínculos y dinámica familiar se destacó como imprescindible para la actuación profesional. Respecto a las características personales y técnicas, se mencionaron la necesidad de identificación con dicha técnica y con el trabajo con bebés, y tener una sólida formación, regida por estudios teóricos, supervisión y análisis personal. Además, se destacó la importancia de la experiencia práctica y de la observación de bebés como herramienta de aprendizaje, y se constató la necesidad de ampliar la visibilidad de este campo de actuación entre los profesionales y el público en general.(AU)

Mediating role of alexithymia in the relationship between self-compassion and postpartum depression in premature mothers separated from their infants / 中国实用护理杂志

Objective:To investigate the status and correlation of 6 weeks postpartum self-compassion, alexithymia and postpartum depression in preterm mothers separated from their infants.Methods:Convenience sampling method was used to select 300 premature mothers separated from their infants in Binzhou Medical University Hospital as the research objects. A cross-sectional survey was conducted by the general data, the Chinese version of the Self-Compassion Scale (SCS-C), the Chinese version of the Toronto Alexithymia Scale (TAS-20) and the Edinburgh Postnatal Depression Scale (EPDS).Results:The total scores of SCS-C, TAS-20 and EPDS at 6 weeks postpartum were (19.94 ± 2.64), (48.74 ± 3.87) and (10.61 ± 3.07) respectively. The self-compassion ability was negatively correlated with alexithymia and postpartum depression ( r = -0.365, -0.313, both P<0.01), alexithymia was positively correlated with postpartum depression ( r = 0.657, P<0.01). Alexithymia played a partial mediating role in the relationship between self-compassion and postpartum depression, accounting for 72.83% of the total effect. Conclusions:Self-compassion and alexithymia are both important factors affecting postpartum depression in premature mothers separated from their infants. By enhancing emotional cognition and processing ability of premature mothers, self-compassion ability can be improved to reduce the incidence of postpartum depression.

Filhos da quarentena: Percepção de mães sobre o seu processo de maternagem e o desenvolvimento de seus filhos durante a pandemia / Child of quarantine: Mother's perception of their mothering process and their children's development during the pandemic

O objetivo deste trabalho é investigar a percepção de mães em relação ao seu processo de maternagem e desenvolvimento de seus bebês nascidos no período de isolamento social devido à pandemia da Covid-19, através de um estudo qualitativo de caráter exploratório. A amostra foi constituída por 8 mulheres que tiveram filhos de janeiro a novembro de 2020. as quais foram acessadas através da técnica bola de neve utilizando cadeias de referência para a sua composição a partir da indicação de sujeitos da rede dos participantes. Para a realização da pesquisa foi feita uma entrevista semi-estruturada individualmente com cada participante. Os dados coletados foram analisados através da análise de conteúdo, considerada a abordagem analítica mais utilizada para pesquisas qualitativas. Os resultados foram subdivididos em seis categorias e vinte subcategorias, baseadas na vivência da maternagem e no desenvolvimento dos filhos, tais como o aumento do tempo das mães com seus filhos; a dificuldade da ausência da rede de apoio e do convívio social; os sentimentos de angústia e dúvida despertados por estar vivenciando uma pandemia; e a modificação das atividades rotineiras devido à pandemia. Como conclusão, destaca-se que a carência de uma rede de apoio e a falta de convívio social foi âmbito que unanimemente acarretou dificuldades para as mães nesse momento. No entanto, as participantes percebem o benefício de disponibilizarem mais tempo aos filhos e menos interferências de opiniões alheias em momentos mais íntimos. Sugere-se a continuidade mais aprofundada desse tema, pois o processo de quarentena ainda é um evento recente para estas mães, portanto, ainda podem decorrer impactos emocionais posteriores.(AU)

The objective of this article is to investigate the perception of mothers in relation to their mothering process and the development of their babies, borned in the period of social isolation due to Covid-19 pandemic, through an exploratory qualitative study. The sample consisted of 8 women, who were accessed using the snowball technique, which qualifies as a form of non-probabilistic sample, using reference chains for its composition, based on the indication of subjects in the participant's network. To do the research, a semi-structured interview was conducted individually with each participant. The collected data were analyzed through content analysis, which is considered the most used analytical approach for research with qualitative methods. The results were subdivided into six categories and twenty subcategories, based on the mother's perception of their children's development and their mothering experiences. As a conclusion, it is highlighted that support network and social interaction were similar themes identified as difficult to mothers in this moment. However, the mothers realized as benefic the spare time with their children and less outside criticism in this intime moments. It is suggested that this theme be further researched, mainly due to the scarcity of studies on the processes of mothering and baby development in contexts of pandemics and catastrophes.(AU)

El objetivo de este trabajo es investigar la percepción de las madres en relación con su proceso de maternidad y el desarrollo de sus bebés nacidos en el período de aislamiento social debido a la pandemia Covid-19, a través de un estudio exploratorio cualitativo. La muestra estuvo conformada por 8 mujeres, a las que se accedió mediante la técnica de bola de nieve utilizando cadenas de referencia para su composición a partir de la indicación de sujetos de la red de participantes. Para la realización de la investigación se realizó una entrevista semiestructurada individualmente con cada participante. Los datos recopilados se analizaron mediante análisis de contenido, considerado el enfoque analítico más utilizado para la investigación cualitativa. Los resultados se subdividieron en seis categorías y veinte subcategorías, en base a la experiencia de la maternidad y el desarrollo de sus hijos, como el aumento del tiempo de las madres con sus hijos; la dificultad de la ausencia de la red de apoyo y la vida social; los sentimientos de angustia y duda que despierta la experiencia de una pandemia; y la modificación de las actividades rutinarias debido a la pandemia. En conclusión, se destaca que la red de apoyo y la interacción social fue el área que unánimemente causó dificultades a las madres en ese momento. Sin embargo, perciben el beneficio de poner más tiempo a disposición de sus hijos y menos interferencia de las opiniones de otras personas en momentos más íntimos. Se sugiere una continuidad más profunda de este tema, ya que el proceso de cuarentena es todavía un evento reciente para estas madres, por lo que aún pueden ocurrir impactos emocionales posteriores.(AU)

Psychological distress and mother-child relationship: influence of life context on a population sample (BRISA) through the use of directed acyclic graphs (DAG)

This study aimed to investigate the association between maternal psychological distress and impairment in mother-child relationship in a sample from a Northeast capital city in Brazil with a low Human Development Index, using directed acyclic graphs (DAG). A total of 3,215 women were evaluated for the presence of psychological distress through the Self Reporting Questionnaire instrument and for the mother-child relationship by the first factor of Postpartum Bonding Questionnaire, considered the most appropriate in the literature. Demographic and socioeconomic variables were used to construct a theoretical model and, after this, multivariate logistic regression was performed using variables suggested by Directed Acyclic Graphs (DAG). Psychological distress was present in 22.7% of the women and 12.6% of them presented impaired mother-child relationships. After adjustment, the variable 'maternal mental distress' remained associated with impaired mother-child relationship (RR=3.03), and among the explanatory variables only 'primary school level' (RR=1.48) was associated as a risk factor to this outcome. The results indicated that, in this population, women with psychological distress and lower schooling are more likely to present impaired mother-child relationships.

Effect of withdrawal time on postpartum liver function in pregnant women receiving tenofovir disoproxil fumarate therapy for blocking mother to child transmission of hepatitis B / 中华临床感染病杂志

Objective:To investigate the effect of withdrawal time on postpartum liver function in pregnant women receiving tenofovir disoproxil fumarate (TDF) therapy for blocking mother-to-child transmission of HBV.Methods:A prospective study was conducted in Hangzhou First People’s Hospital from June 2016 to August 2018. A total of 84 pregnant women with HBsAg and HBeAg positive were enrolled and divided into two groups according to simple randomized grouping method with 42 cases in each group. In group A TDF was withdrawn immediately after delivery and in group B TDF was withdrawn 12 weeks after delivery. Finally, 66 patients completed the follow-up for 24 weeks postpartum, 35 cases in group A and 31 cases in group B. All patients were administered TDF from week 24-28 of pregnancy. HBV DNA loads and ALT levels were regularly measured and compared. Multivariate logistic regression was used to explore the risk factors of postpartum ALT flare. SPSS 26.0 statistical software was used for statistical processing.Results:Compared with the baseline levels, the HBV DNA loads at 16 weeks postpartum had no significant changes in both groups( Z=-0.742 and -1.891, both P>0.05). Postpartum ALT flare was observed in 21 of the 66 patients, 9 cases (25.71%, 9/35) in group A, and 12 cases (38.71%, 12/31) in group B ( χ2=1.280, P>0.05); and there was no significant difference in the severity of postpartum ALT flare between the two groups ( χ2=0.527, P>0.05). Binary logistic regression analysis showed that increased ALT level during pregnancy was an independent risk factor of postpartum ALT flare ( OR=13.75, 95% CI 1.49-126.85, P<0.05). Conclusions:When TDF was used for preventing mother-to-child HBV transmission, withdrawal at different times after delivery had no effect on postpartum liver function. ALT flare during pregnancy is a risk factor for postpartum ALT flare, so TDF should be discontinued carefully and liver function should be closely monitored postpartum for such patients.

Effect of Wenyang， Jieyu， and Wenyang Jieyu Prescriptions on Hippocampal Microglia of Mice with Depression-Like Behavior Induced by Secondary LPS Exposure / 中国实验方剂学杂志

Objective:To observe the activation of microglia and the expression of inflammatory factors in hippocampus of mice with depression-like behavior after mother-infant separation （MS） combined with lipopolysaccharide （LPS） stress， and to explore the possible anti-depression mechanisms of Wenyang （WY）， Jieyu （JY）， and Wenyang Jieyu （WYJY） prescriptions from the perspective of warming Yang and relieving depression. Method:Seventy offspring mice were randomly divided into a normal group （<italic>n</italic>=10）， a LPS stress group （<italic>n</italic>=10）， and a modeling group （<italic>n</italic>=50）. After undergoing 8 h·d^-1mother-infant separation during postnatal day 5 （PD₅）–PD₁₄， mice in the modeling group were further divided into the MS + LPS group， WY group， JY group， WYJY group， and fluoxetine （FLU） group， with 10 in each group. The birth date of the offspring mice was recorded as PD₀. The mice in the normal， LPS， and MS + LPS groups were fed a normal diet during PD₂₁–PD₉₀， while those in the other groups were treated with the mixtures of corresponding drugs and feed， followed by seven-day intraperitoneal injection of LPS since PD₉₁ for inducing depression. The depression-like behavior of mice in each group was detected in the open-field， O-maze， and social interaction tests. The protein expression of microglia-specific ionized calcium-binding adaptor molecule 1 （Iba-1） in the hippocampus was assayed by immunohistochemistry， and the mRNA expression of interleukin-1<italic>β </italic>（IL-1<italic>β</italic>）， interleukin-6 （IL-6）， tumor necrosis factor-<italic>α </italic>（TNF-<italic>α</italic>）， Iba-1， and glucocorticoid receptor （GR） by real-time fluorescence quantitative PCR （Real-time PCR）. Result:Compared with the normal group， the LPS group exhibited significantly reduced residence time at the central area within 5 min （<italic>P</italic><0.01） and shortened total exercise distance （<italic>P</italic><0.01）. In the MS + LPS group， the open-arm activity time and the total activity distance decreased significantly （<italic>P</italic><0.01， <italic>P</italic><0.05）， whereas the training， discrimination and exploration time increased significantly （<italic>P</italic><0.01）. The expression of Iba-1 in hippocampal CA1 region of mice in the LPS and MS + LPS groups was remarkably elevated （<italic>P</italic><0.01）. Compared with the LPS group， the MS + LPS group displayed significantly prolonged distance of 5-min exercise （<italic>P</italic><0.05）， increased training， discrimination and exploration time （<italic>P</italic><0.05， <italic>P</italic><0.01）， and up-regulated Iba-1 expression in hippocampal CA1 area （<italic>P</italic><0.01）. As revealed by comparison with the MS + LPS group， both the total 5-min exercise distance （<italic>P</italic><0.01） and the training and discrimination time （<italic>P</italic><0.01， <italic>P</italic><0.05） of mice in each administration group was significantly shortened. The discrimination and exploration time of mice in the JY， WYJY， and FLU groups was significantly reduced （<italic>P</italic><0.01）， and the expression of Iba-1 in hippocampal CA1 region of mice in each administration group was significantly down-regulated （<italic>P</italic><0.01）. Conclusion:The warming Yang and relieving depression method helps to inhibit the occurrence and development of depression due to its efficacy in activating microglia in hippocampus of depression mice and lowering the expression of IL-1<italic>β</italic>， IL-6， and TNF-<italic>α</italic>.

Variaciones de las vocalizaciones del bebé y del habla materna en función de la depresión posparto: Modulaciones según edad y sexo infantil / Variations of Babies Vocalizations and Maternal Speech Depending on Postpartum Depression: Modulations According to Infant's Age and Sex

Resumen El presente trabajo indaga sobre la influencia de la depresión posparto (DPP) materna en las características prosódicas del Habla Dirigida al Bebé (HDB) y las emisiones preverbales infantiles en diversos contextos de interacción madre-hijo/a. Participaron 40 madres y sus bebés entre 3 y 6 meses de edad. Las madres fueron evaluadas con la Escala de DPP de Edimburgo (Cox, Holden y Sagoysky, 1987) y las díadas madre-hijo fueron filmadas en sesiones de juego no estructurado; 27 madres no presentaron indicadores de DPP y 13, sí. Las madres con DPP emitieron menor cantidad de vocalizaciones que las del grupo control y presentaron menor intensidad media y máxima al hablarle a sus bebés de 5-6 meses y esto fue particularmente observable en bebés varones (p < .07). Además, estas madres usaron menos curvas descendentes al dirigirse a bebés más pequeños (3-4 meses) y curvas ascendentes y descendentes al dirigirse a sus hijos varones (p < .01). En los bebés -tanto en los de 5-6 meses como en varones- (con madres con DPP se observó menor producción de emisiones preverbales, aunque sin ser significativa. La DPP materna impactó en los bebés más pequeños observándose una disminución de la frecuencia fundamental (p < .01) y de las intensidades media y máxima, pero solo en bebés varones (p < .05). También se halló una ausencia de curvas con forma de U en los varones e hijos de madres con DPP (p < .05). Aparentemente, la DPP afecta el HDB materno, el que varía a nivel acústico y prosódico en función de la edad del bebé afectando las emisiones preverbales, siendo mayor el impacto en los varones.

Abstract The present work aims to study the influence of postpartum depression (PPD) on the acoustic and melodic characteristics present in the vocal interaction between the mother and her baby. We analyze acoustic qualities of the mother's voice when she is talking to her baby (Infant-Directed Speech) such as fundamental frequency (F0 maximum, medium and minimum values) and intensity (maximum, medium and minimum values). The changes of F0 during a vocalization (intonation contours such as rising, falling, bell-shape, U-shape and sinusoidal and flat contours) were also examined. The same prosodic parameters were investigated in regard to prelinguistic vocalizations. The mothers were healthy, primiparous and native speakers of argentinian spanish. The babies were 3 to 6 month old, and those with congenital diseases or diseases that could affect the assessment of the variables under consideration were excluded. We evaluated 40 dyads of mother and child who attend the University Hospital of Maternity and Neonatology of Córdoba, Argentina. The presence of indicators for PPD was examined through the Edinburgh postpartum depression Scale (Cox, Holden & Sagoysky, 1987). The mother-infant interactions were filmed in unstructured play sessions. The categorization of different contexts in which those interactions occur were taken into account for the acoustic and melodic analysis. The types of interactional contexts were distinguished according the classification made in Papousek, Papousek & Symmes (1991). The results showed that 27 mothers did not present indicators of PPD and 13 did. Acoustically, the infant-directed speech of mothers who exhibit the presence of postpartum depression indicators featured lower values of medium and maximum intensity (p < .07, in both measures) in babies between 5 and 6 months old, and in male babies in particular (F0 medium p < .04 and F0 maximum p < .03). According to the melodic characteristics of IDS, less use of falling contours (p < .01) was found in mothers with PPD when addressing smaller babies -3 and 4 month old- and the same happened with the rising (p < .02) and falling (p < .01) contours when their children were males. In preverbal vocalizations, children whose mothers had indicators of postpartum psychopathology showed a lower number of emissions at a later age (p < .1) and in males (p < .1). Also, lower values of F0 were found in smaller babies (F0 minimum p < .01 and F0 medium p < .002). Male infants of mothers with PPD also presented a decrease in intensity (medium p < .05 and maximum p < .03). Finally, at the melodic analysis, the rising contours were not used at all for the oldest babies (p < .01) nor the U-shaped contours in males (p < .02). In conclusion, the findings of the present study not only confirm -through physiological measures- the effect of the interaction of mothers with their babies as a function of the presence of signs of postpartum depression, already from the first months of childhood life, but also that these alterations are modulated by the age and the gender of the infant. It is essential, therefore, to continue investigating whether these difficulties related to the primary bond that each mom and her child share are perpetuated over time. It is also necessary to adopt a gender perspective of maternal and child relationships and the importance of therapeutic approach and intervention of the dyad as early as the first months after birth. At the same time, the exhaustive and immediate diagnosis of PPD cases is a matter of primary healthcare and the multidisciplinary intervention is urgent from the beginning in order to ensure maternal-infant metal health and harmonic social, cognitive and emotional development in children.

Infant-direct speech and mother-infant attention in depressed and nondepressed mothers / Discurso direcionado à criança e atenção mãe-criança em mães com e sem depressão pós-parto

Postpartum depression (PPD) is associated with disturbances in mother-infant interaction. We compared the content of the infant-directed speech (IDS), the expression of positive affection in the maternal voice and the attentional engagement in dyads of PPD and non-PPD mothers. The participants of this study were 80 mothers and their infants at 3-6 months; 40 mothers presented PPD. The dyads were videotaped during free play interactions. No significant differences were found between the groups in any of these categories. A linear regression analysis indicated that the mother's years of education were a predictive factor for the quality of the interaction only for PPD mothers. PPD influenced mother-infant interaction when associated with maternal sociodemographic characteristics.

A depressão pós-parto (DPP) está associada a distúrbios na interação mãe-bebê. Nós comparamos o conteúdo do discurso direcionado à criança, a expressão de afeto positivo e o engajamento em episódios de atenção em díades de mães com e sem DPP. Participaram deste estudo 80 mães e seus bebês entre 3-6 meses; quarenta mães foram consideradas deprimidas. As díades foram filmadas durante interação livre. Não foram encontradas diferenças significativas entre os grupos em nenhuma dessas categorias. Uma análise de regressão linear indicou que os anos de escolaridade da mãe foram um fator preditivo para a qualidade da interação apenas para as mães com DPP. A DPP influenciou a interação mãe-bebê quando associada a características sociodemográficas maternas.

Leitura materna sobre depressão pós-parto e sintomas psicofuncionais: um caso de psicoterapia mãe-bebê / Maternal perception about postpartum depression and psychofunctional symptoms: a case of mother-baby psychotherapy / Comprensión materna sobre depresión postparto y síntomas psicofuncionales: un caso de psicoterapia madre-bebé

Este estudo investigou as mudanças na leitura materna sobre seus sintomas depressivos e sobre os sintomas psicofuncionais do bebê num contexto de psicoterapia mãe-bebê em grupo. Participaram uma díade mãe-bebê em que a mãe apresentava depressão pós-parto e o bebê sintomas psicofuncionais. Os instrumentos empregados foram a Escala de Depressão Pós-Parto de Edimburgo (EPDS), Entrevista MINI, Entrevista sobre a Gestação e Parto, Entrevista sobre a Experiência da Maternidade e o questionário Symptom Check List (SCL). Foi utilizado o delineamento de estudo de caso único e realizada uma análise qualitativa, relacionando os materiais clínicos das onze sessões de psicoterapia com a literatura a partir de uma compreensão psicanalítica. Os resultados revelaram que os sintomas depressivos maternos e os sintomas psicofuncionais do bebê estavam mutuamente associados e que, a partir da intervenção utilizada, a leitura materna sobre seus sintomas e os do bebê foi modificada, associada a uma melhora dos sintomas em ambos.

This study examined the changes in maternal perception about her own depressive symptoms and the baby's psychofunctional symptoms in a context of mother-baby group psychotherapy. Participants were a mother-baby dyad in which the mother presented postpartum depression and the baby had psychofunctional symptoms. The instruments employed were: EPDS, MINI Interview, Interview on Pregnancy and Childbirth, Interview of the Maternity Experience, and SCL questionnaire. The single-case study design was used and a qualitative analysis was carried out, correlating the clinical materials from the eleven psychotherapy sessions with the theoretical knowledge found in the literature, based on a psychoanalytic understanding. The results revealed that the maternal depressive symptoms and the baby's psychofunctional symptoms were mutually associated and that, through the intervention, the maternal perception about her symptoms and the baby's was modified, associated with an improvement of the symptoms in both.

Este estudio investigó los cambios en la comprensión materna sobre sus síntomas depresivos y sobre los síntomas psicofuncionales del bebé en un contexto de psicoterapia madre-bebé en grupo. Participaron una díada madre-bebé en la que la madre presentaba depresión posparto y el bebé síntomas psicofuncionales. Los instrumentos utilizados fueron: EPDS, Entrevista MINI, Entrevista sobre la Gestación y el Parto, Entrevista sobre la Experiencia de la Maternidad y el cuestionario SCL. Se utilizó el delineamiento de estudio de caso único y realizó un análisis cualitativo, relacionando los materiales clínicos de las once sesiones de psicoterapia con la literatura a partir de una comprensión psicoanalítica. Los resultados revelaron que los síntomas depresivos maternos y los síntomas psicofuncionales del bebé estaban mutuamente asociados y que, a partir de la intervención utilizada, la comprensión materna sobre sus síntomas y del bebé fue modificada, asociada a una mejoría de los síntomas en ambos.

Função materna no contexto da prematuridade: uma revisão da literatura psicanalítica / Maternal role in the context of prematurity: a review of the psychoanalytic / Literature función materna en el contexto de la prematuridad: una revisión de la literatura psicoanalítica

A psicanálise considera a função materna como sendo de extrema importância para o desenvolvimento da criança. No entanto tal função pode se tornar dificultada pelo contexto que envolve o nascimento pré-termo do bebê. O objetivo deste trabalho foi realizar um levantamento da literatura psicanalítica acerca do conceito de função materna e, mais especificamente, sobre as relações entre a função materna e o nascimento pré-termo do bebê. Foram consultados para tanto autores clássicos e contemporâneos. A fim de ilustrar a discussão teórica, o trabalho conta com pequenas vinhetas de dois casos acompanhados em uma UTI neonatal. São elaboradas reflexões sobre como a prematuridade do bebê pode influenciar as primeiras relações entre a díade que se encontra em tal situação. Considera-se que tais perguntas acerca do tema podem ajudar a pensar sobre possíveis intervenções para que, apesar da condição de prematuridade, mãe e bebê possam se encontrar da melhor forma possível.

Psychoanalysis considers the maternal role as being extremely important for children’s development. However, such a role may become troublesome due to the baby’s preterm birth condition. This study aims to carry out a review of the psychoanalytic literature on the concept of maternal role, and, more precisely, about the relationship between the maternal role and a baby’s preterm birth condition. Both, classic and contemporary authors have been approached in this study. In order to illustrate the theoretical discussion, this study displays short passages from two cases followed in a Neonatal ICU. Reflections were brought up about how prematurity may influence the early relations between the mother and the baby who are in such situation. It is considered that these questions about the subject may help to ponder possible interventions that, despite the preterm birth condition, may help mother and baby experience a best level of relationship.

El psicoanálisis considera el papel de la madre como extremadamente importante para el desarrollo del niño. Sin embargo, una función de este tipo puede ser difícil por el contexto del parto prematuro del bebé. El objetivo de este estudio fue revisar la literatura psicoanalítica sobre el concepto de la función materna. Además, revisó al alza sobre los detalles de la relación entre la función materna y parto prematuro del bebé. Fue utilizado ambos autores clásicos y contemporáneos. Con el fin de ilustrar la discusión teórica, la obra tiene pequeñas viñetas de dos casos seguidos en una UCIN. Reflexiones se dibujan sobre como la prematuridad puede influir en la relación temprana entre la madre y el bebé. Se considera que este tipo de preguntas sobre el tema pueden ayudar en posibles intervenciones, y que a pesar de la condición de la prematuridad, la madre y el bebé puedan encontrarse de la mejor manera posible.

Estilos de cuidado materno em primatas: considerações a partir de uma espécie do Novo Mundo / Styles de soins maternels dans les primates: considerations d'une espèce du Nouveau Monde / Estilos de cuidado materno en primates: consideraciones a partir de una especie del Nuevo Mundo / Maternal care styles in primates: considering a New World species

Resumo Quando buscamos entender o comportamento humano, comparações com primatas não humanos são especialmente relevantes para identificar homoplasias (características semelhantes que evoluem independentemente em diferentes espécies). Neste artigo, apresentamos um estudo longitudinal de dois anos sobre o comportamento materno de macacos-prego (Sapajus spp.) em condições naturalísticas. Nossos resultados permitiram identificar estilos de cuidado distintos dentro de um contínuo de permissividade a proteção. O desenvolvimento observado do vínculo entre mães e filhotes sugere que o período de dependência de filhotes de macaco-prego envolve, além de processos de maturação física, o estabelecimento e desenvolvimento de processos psicológicos associados ao sistema de apego. É possível que a variabilidade de estilos maternos resultante da combinação de características de mães, filhotes e contextos socioecológicos, aliada ao prolongamento do vínculo de apego, pavimente caminhos para diferentes trajetórias de desenvolvimento. Como em humanos, esse pode ser um dos mecanismos pelos quais surgem e se consolidam as diferenças interindividuais nas populações adultas.

Résumé Lorsque nous cherchons à comprendre le comportement humain, les comparaisons avec les primates non humains sont particulièrement pertinentes pour identifier les homoplasies (caractéristiques similaires qui évoluent indépendamment dans différentes espèces). Dans cet article, nous présentons les résultats d'une étude longitudinale de deux ans sur le comportement maternel du Sapajou capucin (Sapajus spp.) dans des conditions naturelles. Nos résultats nous ont permis d'identifier différents styles de soins maternels dans un continuum de permissivité à la protection. Nous avons observé que le modèle de lien d'attachement entre la mère et la progéniture suggère que la période de dépendance des bébés singes implique, en plus des processus de maturation physique, l'établissement et le développement de processus psychologiques associés au système d'attachement. Il est possible que la variabilité des styles maternels résultant de la combinaison des caractéristiques de la mère, de la progéniture et du contexte socioécologique, ainsi que l'extension du lien d'attachement, ouvrent la voie à différentes trajectoires de développement. Comme les humains, il peut être un des mécanismes par lequel les différences interindividuelles apparaissent et se consolident au sein des populations adultes.

Resumen Cuando buscamos entender el comportamiento humano, comparaciones con primates no humanos son especialmente relevantes para identificar homoplasias (características similares que evolucionan independientemente en diferentes especies). En este artículo, presentamos los resultados de un estudio longitudinal de dos años sobre el comportamiento materno de monos capuchinos (Sapajus spp.) en condiciones naturales. Los resultados permitieron identificar estilos de cuidado materno distintos dentro de un continuo de permisividad a la protección. Se observó que el patrón de desarrollo del vínculo de apego entre madre y cría sugiere que el período de dependencia de la cría de monos capuchinos involucra, además de procesos de maduración física, el establecimiento y desarrollo de procesos psicológicos asociados al sistema de apego. Es posible que la variabilidad de estilos maternos resultante de la combinación de características de madres, crías y contextos socioecológicos, aliada a la prolongación del vínculo de apego, establezca caminos para diferentes trayectorias de desarrollo. Tal como en humanos, este puede ser uno de los mecanismos por los que surgen y se consolidan las diferencias interindividuales en las poblaciones adultas.

Abstract When aiming understand the human behavior, comparisons with nonhuman primates are especially relevant to identify homoplasies (similar characteristics that evolve independently in different species). In this paper, we present a two-year longitudinal study on the maternal behavior of capuchin monkeys (Sapajus spp.) under naturalistic conditions. Our results revel distinct maternal care styles within a continuum ranging from permissiveness (laissez-faire) to protectiveness. The observed development of mothers and infants bond suggests that the dependence period of capuchin monkeys infants involves, in addition to physical maturation processes, the establishment and development of psychological processes associated with the attachment system. It is possible that the variability of maternal styles - resulting from the combination of mothers' and infants' characteristics, as well as socioecological contexts, along with the extension of the attachment bond - are responsible for paving the way for different developmental trajectories. This may be one of the mechanisms underlying interindividual differences arise in adult populations, as seen in humans.

Codification method and Categories of Content of the Baby-directed Maternal Speech / Método de Codificação e Categorias de Conteúdo do Discurso Materno Dirigido a Bebês

Abstract The maternal speech oriented to the baby has been widely studied due to its importance for the child's development. In this article we present a research method and a set of content categories of maternal speech directed to the child. This methodological proposal is based on a survey of 80 dyads of mothers and babies, with and without postpartum depression (PPD). The distribution of frequency of the categories was similar in both groups. There was no statistical difference in the means of categories for mothers with and without PPD, indicating that there is no change in speech style due to maternal depression. In our view, these categories could be applied to study the speech of both healthy mothers and those with postpartum depression.

Resumo O discurso materno direcionado ao bebê tem sido amplamente estudado devido a sua importância no desenvolvimento infantil. Neste artigo apresentamos um método de investigação e um conjunto de categorias de conteúdo do discurso materno direcionado à criança. Esta proposta metodológica baseia-se numa pesquisa realizada com 80 díades de mães e bebês, com e sem depressão pós-parto (DPP). A distribuição das frequências das categorias foi semelhante nos dois grupos. Não houve diferença estatística nas médias das categorias para as mães com e sem DPP, indicando que não há mudança no estilo de discurso em função da depressão materna. Consideramos que as categorias podem ser aplicadas no estudo do discurso de mães saudáveis ou com depressão pós-parto.

Facilitating the continuous decline on the incidence rates of hepatitis B and liver cancer through cutting off the mother-to-child viral transmission, based on the "prevention first" strategy, in China / 中华流行病学杂志

There have been 6-10 million reported patients with chronic hepatitis B virus (HBV) infection worldwide, and the United Nations (UN) called for a "90% reduction by 2030" strategy. Since the wide practice of HBV vaccination, the numbers of HBV cases have been reduced by 85% and the incidence of hepatocellular carcinoma has also decreased by 50%. As formulated by the UN in 2015, the sustainable development agenda for the eradication of hepatitis B included the success rate of preventing mother-to-child viral transmission by 95%, together with the reduction of new hepatitis B infections by 90% in 2030. In order to achieve the agenda, we proposed a strategy to achieve the "three 96%" goals derived from the Shanghai experience. In brief, hepatitis B vaccine should cover for 96% newborns within 24 h, and the vaccination boosting rate should reach 96% for both one and six months after birth. If cutting off the mother-to-child viral transmission strategy can be successfully achieved, the future of hepatitis B prevention will be promising, and the task of eliminating hepatitis B and controlling hepatocellular carcinoma can be completed ahead of 2030, time proposed by the UN.

Interferências traumáticas da internação na UTI neonatal na capacidade de maternagem: contribuições winnicottianas a partir do conceito de Preocupação Materna Primária / Traumatic interferences in the neonatal ICU in the mothering capacity: Winnicottian contributions based on the concept of Primary Maternal Preoccupation

Este artigo aborda algumas interferências traumáticas na capacidade de maternagem de mães de bebês internados em UTI neonatal acompanhadas em ambulatório de follow up. A hipótese levantada é de que em decorrência da patologia e internação do bebê, a mãe entra no processo psíquico normal de preocupação materna primária, mas não consegue se recuperar dele no tempo comumente esperado. Os efeitos sintomáticos na maternagem se expressam em sua capacidade de agir como uma mãe dedicada comum que, por consequência, decorre no posterior atraso do desenvolvimento global do seu bebê em relação ao que é esperado para a sua idade. Pela perspectiva da ética do cuidado proposta por Winnicott, o psicanalista cuida da mãe, em uma espécie de holding do holding, para que ela possa cuidar de forma adequada do bebê e restabelecer o seu desenvolvimento saudável.

This article addresses some traumatic interferences in the mothering capacity of mothers of infants admitted to neonatal ICU monitored in a follow-up ambulatory. The hypothesis raised is that as a result of the pathology and hospitalization of the baby, the mother enters the normal psychic process of primary maternal preoccupation, but fails to recover from it in the commonly expected time. The symptomatic effects in mothering are expressed in her ability to act as good-enough mother, which as a consequence, occurs in the later delay in the overall development of her baby compared to what is expected for his or her age. From the perspective of the ethics of care proposed by Winnicott, the psychoanalyst takes care of the mother, in a kind of holding of the holding, so that she can adequately care for the baby and restore healthy development.

Conocimientos sobre los aspectos formales y referenciales del dibujo, la escritura y los numerales en la lectura compartida entre madres y niños pequeños / Knowledge about the formal and referential aspects of drawing, writing and numerals during mothers and young children shared book reading

Los niños construyen conocimientos sobre los sistemas de representación externa en interacción con adultos que obran como mediadores de sus procesos cognitivos. Distintas investigaciones muestran que los niños reconocen el dibujo a partir de los 2 años y medio y pueden diferenciar entre dibujo, escritura y numerales alrededor de los 4 años. En este estudio se examinan los conocimientos sobre las propiedades formales y la función referencial de estos tres sistemas que niños de 2 años y medio y 4 años despliegan junto con sus madres durante la lectura compartida de un libro. Para ello se utilizó un libro que presenta en cada página dibujos de un animal, su nombre escrito y el numeral correspondiente a la cantidad de animales (1 a 9). Los análisis se centran en el foco de atención de las díadas, los aspectos del conocimiento notacional y las bases comunicativo-educativas de las interacciones, en función de la edad de los niños. Los resultados indican que las díadas centraron su atención en la función referencial del dibujo, como representación de la identidad del referente a los 2 años y medio, y de la identidad y la cantidad a los 4 años. Aunque la atención en la escritura y los numerales fue menor, las madres de los niños más pequeños brindaron información sobre las propiedades formales de los numerales, y las madres y los niños de 4 años elaboraron este aspecto del conocimiento de ambos sistemas. Se discuten estos resultados en relación con el potencial de la lectura compartida para la apropiación temprana del conocimiento notacional.

Children acquire knowledge about external representational systems in interaction with adults who operate as mediators of their cognitive processes. Several studies have shown that 2.5-year-old children are able to recognize drawings, and 4-year-old children can distinguish between drawing, writing and numerals. The present study focuses on a developmental analysis of the knowledge about the formal properties and the referential function of these three systems that 2.5- and 4-year-old children unfold with their mothers during shared reading sessions. The referential function is the representational relation between the system and the referent. Each system has a referential function that is the result of a social convention: figurative drawing depicts the identity and characteristics of the referent, writing is a graphic representation of oral language and numerals represent numerical information. The formal properties include the name of the representational systems and their graphic units, the form of the strokes, their spatial disposition and their compositional rules. Our specific goals were:(1) to establish which representational system isthe main focus of attention; (2) to describe and analyze whether and how mothers and children elaborate knowledge about the formal properties and referential function of the systems; (3) to understand how notational knowledge emerges describing the educative-communicative basis of the interactions; and (4) to compare the focus of attention, notational knowledge and the educative-communicative basis of interactions as a function of children's age. Twenty-six mothers and their 2.5- (n = 13) and 4-year-old children (n = 13) participated. They were given a book and told to look at it together. The book was specially designed for this study; it includes in each page drawings of an animal, its written name and the numeral for the number of animals depicted (1 to 9). We designed a system of categories with three levels of analysis, related to the specific goals of the study: focus of attention, notational knowledge and educative-communicative basis. We performed non-parametric statistical analysis: Wilcoxon test and Mann- Whitney's U test. Results show that dyads of both age groups focused their attention on drawings more than on writing and numerals. However, 4-year-old children and their mothers made significantly more utterances about writing and numerals than the other group. Attention to writing and numerals in the older group seemed to be guided by mothers' interest to teach those systems to their children. Dyads talked especially about the referential function of drawing, as a representation of the identity of the referent at 2.5 years of age and as a representation of the identity and quantity at 4 years. Although less attention was paid to writing and numerals, the youngest children's mothers provided information about the formal properties of numerals and the mothers and the 4-year-old children elaborated this aspect of knowledge of both representational systems. Furthermore, in the older group, dyads started to discuss the referential function of numerals. With regard to the educative-communicative basis of the interactions, the mothers of both age groups tended to request information about the referents of drawings more than to provide their children with this kind of information. The mothers in the 2.5-year-olds' group provided information about the formal properties of numerals, while in the 4-year-olds' group the mothers both requested and provided this kind of information. Finally, the formal properties of writing were elaborated only by mothers in the older group. We discuss these results in terms of the potential of shared reading for the early acquisition of notational knowledge.

A relação mãe-bebê no contexto da depressão pós-parto: estudo qualitativo / Mother-infant relationship within the context of post-partum depression: a quantitative analysis

O objetivo deste estudo foi analisar como a sintomatologia depressiva em mulheres no período pós-parto influencia na relação mãe-bebê. Trata-se de uma pesquisa qualitativa, em que foram entrevistadas seis mães com idade entre 20 e 38 anos, atendidas em uma Unidade Básica de Saúde e que apresentaram sintomas depressivos no período pós-parto. Para a coleta de dados, utilizou-se a entrevista semiestruturada. Os resultados obtidos, a partir da análise de conteúdo, possibilitaram a compreensão de que os sintomas depressivos maternos afetam a relação mãe-bebê e a identificação de três categorias: a ambivalência afetiva na díade, a dificuldade materna na amamentação e a instabilidade no sono do bebê. Conclui-se que a mulher no período gravídico-puerperal necessita de apoio e suporte psicológico, a fim de reconhecer, prevenir e intervir sobre os fatores que interferem na sua saúde mental e promover o desenvolvimento saudável da relação mãe-bebê.

Current study analyzes how depressive symptomology in females during the post-partum period affects the mother-infant behavior. Qualitative research comprised interviews with six mothers, aged between 20 and 38 years, attended to at a Basic Health Unit, and who exhibited symptoms of depression during the after-birth period. The half-structured interview was employed for data collection. Results from content analysis revealed that mother´s depression symptoms affected the mother-child relationship within three categories: affective ambivalence during dyade, mother´s difficulties in breast feeding and instability in the infant´s sleep. During the pregnancy-puerperal period, the mother has to be psychologically supported to acknowledge, prevent and interfere on factors that affect her mental health and promote the healthful development in mother-child relationship.

Sintomas psicofuncionais e depressão materna: um estudo qualitativo / Psychofunctional symptoms and maternal depression: a qualitative study / Síntomas psicofuncionales y depresión materna: un estudio cualitativo

Esta pesquisa objetivou compreender a manifestação de sintomas psicofuncionais em bebês entre seis e 12 meses, cujas mães apresentaram depressão. Assim, realizaram-se qualitativamente estudos de casos múltiplos, com três duplas mãe-bebê, sendo aplicados: entrevista de dados sociodemográficos e de dados clínicos, MINI PLUS, Questionário Symptom Check-List, EPDS, entrevista sobre gestação, parto e experiência da maternidade e IAP. Os resultados apontaram a presença de diversos fatores de riscos à depressão comuns a todas as mães, como também de aspectos psicodinâmicos singulares relacionados à história de vida delas. Também, identificou-se dificuldade na interação mãe-bebê em todos os casos, indicando que a depressão prejudica a mãe no exercício da maternidade e nas tarefas que esse período demanda, sobretudo interpretar ao bebê o que seu corpo manifesta. Portanto, o sintoma psicofuncional pode ser visto como uma resposta defensiva do bebê às dificuldades maternas de compreender suas manifestações corporais e interpretá-las. (AU)

This study aimed to understand the manifestation of psychofunctional symptoms in infants between six and 12 months, whose mothers presented depression. For this purpose, multiple case studies with three mother-infant pairs were qualitatively performed, and the following instruments were administered: interviews on socio-demographic and clinical data, M.I.N.I. PLUS, Symptom Checklist Questionnaire, EPDS, interview about pregnancy, childbirth and maternity experience, as well as IAP. The results showed the presence of several risk factors for depression common to all mothers, as well as singular psychodynamic aspects related to their life story. Also, we identified difficulty in the mother-infant interaction in all cases, indicating that depression damages the mother in the exercise of motherhood and in the tasks that this period demands, especially in interpreting to the baby what his/her body is expressing. Therefore, the psychofunctional symptom can be seen as a defensive response by the infant to maternal difficulties of understanding the baby's body manifestations and interpreting them. (AU)

Esta investigación tuvo como objetivo comprender manifestaciones de síntomas psicofuncionales en bebés entre 6 y 12 meses cuyas madres presentaron depresión. Se han realizado estudios de casos múltiples,con tres duplas madre-bebé, siendo aplicados: entrevista de datos sociodemográficos y datos clínicos, M.I.N.I. PLUS, Cuestionario Symptom Check-List, EPDS, entrevista sobre embarazo, parto y experiencia de maternidad e IAP. Los resultados mostraron presencia de diversos factores de riesgo para la depresión, comunes a todas las madres, así como también aspectos psicodinámicos singulares relacionados con la historia de vida de ellas. Además, se identificaron dificultades en la interacción madre-bebé en todos los casos, lo que indica que la depresión perjudica a la madre en el ejercicio de la maternidad y en las tareas que ese período demanda, principalmente interpretar lo que el cuerpo del bebé manifiesta. Por lo tanto, síntoma psicofuncional puede ser visto como una respuesta defensiva del bebé a las dificultades maternas para comprender sus manifestaciones corporales e interpretarlas. (AU)

The research on milk volume and its influencing factors in mothers with preterm infants hospitalized in NICU during periods of mother-infant separation / 中华护理杂志

Objective To explore the milk production and its regularity in mothers with preterm infants hospitalized in NICU during periods of mother-infant separation,and to analyze the associating factors.Methods Totally 122 mothers with preterm infants hospitalized in NICU were recruited from February to December,2017.Continuous measurements of daily breast milk production were performed.The maternal lactation related comprehensive questionnaire and Edinburgh Postnatal Depression Scale (EPDS) were used.The Pearson correlation analysis and multiple linear regression analysis were conducted using the Statistical Analysis Systems (version 9.2).Results The milk volumes for the first 14 days postpartum showed a trend of rising among mothers.The mean milk volume on day 14 postpartum was (535.43±256.97) ml.The mean initiation time of lactogenesis stage Ⅱ was (68.23±26.42) h.The correlation coefficient of lactation between day 4 and day 14 was 0.707 0(P＜0.01).The multiple linear regression analysis revealed that the pregnancy induced hypertension syndrome,initiation time of lactogenesis stage Ⅱ,EPDS score,gestational age,maternal age were the influencing factors of milk volume for mothers during periods of mother-infant separation.Conclusion The milk volume of mothers with preterm infants was relatively lower compared with mothers with full-term infants during the early stage postpartum,and the onset of lactogenesis stage Ⅱ was later.In clinical nursing work,healthcare providers should pay special attention to mothers with older maternal age,smaller gestational age,pregnancy induced hypertension syndrome,higher EPDS score,and later initiation time of lactogenesis stage Ⅱ.

Vivências da maternidade e da relação mãe-bebê no primeiro ano de vida do bebê prematuro / Maternity and mother-baby-relationship experiences during the first year of the premature baby’s life / Experiencias de la maternidad y de la relación madre-bebé en primer año de vida del bebé prematuro

Este estudo objetivou investigar a vivência da maternidade e da relação mãe-bebê nos primeiros nove meses de vida de bebês prematuros que estiveram internados em UTIN logo após o nascimento. Utilizou-se delineamento de estudo de casos múltiplos, de caráter longitudinal, sendo participantes três duplas mãe-bebê. Durante a internação, utilizou-se como instrumentos a Ficha de Dados Sócio Demográficos, a Ficha de Dados Clínicos e a Entrevista Clínica Materna – versão hospitalar, para investigar as expectativas e os sentimentos das mães sobre a maternidade, o bebê e seu desenvolvimento futuro. Após a alta aplicou-se a domicílio a Entrevista Clínica Materna – versão ambulatorial, entre o terceiro e quarto mês e entre o oitavo e nono mês de vida dos bebês. A análise dos dados apontou que durante a internação hospitalar, as mães experimentaram uma sobrecarga emocional que atenuou com o passar dos meses, embora o nascimento prematuro ainda fosse lembrado com tristeza pelas três mães. Observou-se, ainda, uma grande dificuldade de separação vivida pelas mães, que pareceu se agravar com o passar do tempo e com o crescimento dos bebês.

This study aimed to investigate the experience of motherhood and the mother-infant relationship in the first nine months of life of premature babies who were admitted to the NICU right after birth. For that, a multiple-case-study design was used, in a longitudinal perspective, and the participants were three mother-infant pairs. During hospitalization time, we have used the Social-Demographic Data Sheet; the Clinical Data Sheet for information about the circumstances surrounding the premature birth, as well as information about age, marital status and mother's family situation of the participants; and the Mother’s Interview – hospital version, in order to search for both the expectations and feelings of the mothers regarding maternity, regarding their baby and their future development. After being released from hospital, at home, the Maternal Clinical Interview - Ambulatory Version was applied between the third and fourth months, and also between the eighth and ninth months of babies lives. Data analysis showed that during hospitalization mothers experienced emotional overload, which eased over the months although the premature birth was still remembered with sadness by the three mothers. There was also great difficulty separating mothers and babies, which seemed to get worse as time passed and as babies grew.

Este estudio tuvo como objetivo investigar la experiencia de la maternidad y de la relación madre-hijo en los primeros nueve meses de los bebés prematuros que fueron hospitalizados en la UCIN después del nacimiento. Se utilizó el diseño del estudio de casos múltiples de carácter longitudinal, y los participantes fueron tres parejas madre-hijo. Durante la hospitalización, fue utilizado como instrumentos uma Hoja Socio de datos demográficos, la Hoja de Datos Clínicos y la Entrevista Clínica Materna - versión hospital, para investigar las expectativas y los sentimientos de las madres acerca de la maternidad, el bebé y su desarrollo futuro. Después fue aplicada la Entrevista Clínica Materna - versión ambulatorio, entre el tercer y cuarto mes y entre el octavo y el noveno mes de vida los bebés. Análisis de los datos mostró que durante la hospitalización, las madres experimentaron una sobrecarga emocional casi aliviado durante el mes, aunque el nacimiento prematuro todavía se recuerda con tristeza por los tres madres. También había una gran dificultad de la separación experimentada por las madres que parecían empeorar con el paso del tiempo y el crecimiento de los bebés.