The effect of the separation of mother-preterm newborn infants hospitalized during the COVID-19 pandemic on maternal depression and stress levels, infant development, and bonding quality on Chilean dyads.

Early infant development is a maturation process critically depends on the infant's interaction with primary caregivers. Hence, neonatal units prioritize their proximity. In COVID-19, parental visitation hours were limited, reducing caregivers time with their infants. This follow-up study Analyze? and compares levels of maternal depression and stress, infant development, and bonding quality in preterm mother-infant dyads hospitalized, before and during the pandemic. Out of 66 dyads participated, 36 were admitted before COVID-19, and 30 during COVID-19. The assessed was two video-call sessions in which mothers completed selected questionnaires. No significant differences between mothers' levels of depression and stress. However, low birth weight was associated with greater difficulties in children's communication and interpersonal relationships. Furthermore, infants hospitalized in COVID-19 had a higher risk of experiencing delayed communication. No significant differences were observed in bonding quality. Lower infant gestational age and longer breastfeeding time were associated with better bonding quality in both groups. Psychosocial intervention is considered a valuable tool, capable of preventing maternal mental health difficulties and protecting bonding in premature infants and in highly complex healthcare settings. Nevertheless, it is essential to more actively address the socio-affective needs of newborns during their hospital stay to promote adequate development.

El desarrollo infantil temprano es un proceso de maduracion que depende críticamente de la interacción del infante consus cuidadores primarios. Por tal razón, en las unidades neonatales priorizan su proximidad. Durante el COVID­19, se limitaron las horas de visitas de los progenitores, lo que redujo el tiempo que los cuidadores con sus bebés. Este estudio de seguimiento analiza y compara el nivel de depresión y estrés materno, el desarrollo infantil y la calidad del vínculo afectivo en díadas madre­bebé prematuro hospitalizado al nacer, antes y durante la pandemia. De las 66 díadas participantes, 36 fueron admitidas antes del COVID­199 y a 30 durante el COVID­19. Se realizaron dos sesiones de vídeo­llamada, en las que las madres completaron los cuestionarios seleccionados. No se encontró ninguna diferencia significativa entre los niveles de depresión y estrés en las madres. Sin embargo, un bajo peso al nacer se asoció con mayores dificultades en la comunicación y las relaciones interpersonales en los niños. Además, los infantes hospitalizados durante el COVID­19 presentaron mayor riesgo de experimentar retrasos en la comunicación. No se observaron diferencias significativas en la calidad del vínculo afectivo. Una menor edad gestacional del infante y mayor tiempo de lactancia materna se asociaron con una mejor calidad del vínculo afectivo en ambos grupos. Se considera la intervención psicosocial como una herramienta de valor, capaz de prevenir dificultades en la salud mental materna y de proteger el vínculo afectivo en infantes nacidos prematuramente y en entornos sanitarios altamente complejos. Sin embargo, es esencial abordarmás activamente las necesidades socioafectivas de los recién nacidos durante su estadía en el hospital para promover un desarrollo adecuado.

[Growth until 24 months in preterm of very low birth weight, with or without intrauterine or postnatal growth restriction]. / Crecimiento a 24 meses de prematuros menores de 32 semanas, con o sin restricción de crecimiento intrauterino o postnatal.

INTRODUCTION: The growth of preterm newborns can be affected during the fetal period, hospitalization, and post discharge. OBJECTIVE: to describe the anthropometric development of preterm newborns with or without intrauterine and postnatal growth restriction, and with or without recovery at 40 weeks from birth to 24 months of age. PATIENTS AND METHOD: Retrospective, descriptive study with Z-scores (Fen ton and WHO) of weight, length, head circumference, and weight/length of preterm infants of less than 32 weeks of gestational age at birth up to 24 months of corrected age. 4 groups were defined ac cording to prenatal, postnatal, post-discharge growth as follows: Group AAA: newborns born AGA, with no postnatal growth restriction; Group APA: newborns born AGA, with postnatal growth res triction, weight < p10 at discharge, and weight > p10 at 40 weeks; Group APP: newborns born AGA, with postnatal growth restriction, weight < p10 at discharge and at 40w; and Group PPP: newborns born with intrauterine growth restriction and who maintained postnatal growth restriction (< p10 at birth, at discharge, and at 40w). We used descriptive statistics with ANOVA, Chi-squared, and linear mixed model analysis. RESULTS: 710 preterm newborns were included, birth weight 1272 grams (SD 360) and gestational age 29 weeks (SD 1.9). Group AAA had weight, length, and head circumference Z-scores close to the median until 2 years of age. AGA preterm newborns and with postnatal growth restriction can evolve in two ways: one group presents recovery at 40 weeks (Group APA) while the other group presents weight Z-score < -1 up to 6 months (Group APP). Group PPP (with intraute rine and postnatal growth restriction) presents slow weight and length Z-score recovery, weight Z- score -2.3 at discharge, and slow improvement to < -1 at 2 years of age. All groups had weight/height Z-scores above the median in the first 2 months of corrected age. CONCLUSION: Preterm newborns with good fetal growth but restricted postnatal growth, may recover at 40 weeks, with subsequent normal development or recover at 6 months.

The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile: Randomized Controlled Trial.

Background: Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year. Objective: To compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants. Design: Multicenter randomized clinical trial. Participants: Ninety nine moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (n = 49) and Control (n = 50). Both groups attended medical check-ups at 2, 6 and 12 months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised. Results: At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03-14.2) for the control group and 22.4% (95% CI: 13.0-35.9) for the intervention group [OR = 0.22, p = 0.028 (95% CI =0.06-0.84)]. At 6 months, the prevalence was 10.0% (95% CI: 3.9-21.8) for the control group and 6.1% (95% CI: 2.1-16.5) for the intervention group [OR = 2.09, p = 0.318 (95% CI = 0.49-8.88)]. At 12 months, the prevalence was 22.0% (95% CI: 12.8-35.2) for the control group and 4.1% (95% CI: 1.1-13.7) for the intervention group [OR = 6.63, p = 0.018 (95% CI = 1.39-31.71)]. Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 [p = 0.022 (95% CI = 1.20-10.44); Cohen's d= 0.70]. In the case of pooled adjusted OR, the model considered diagnosis (0 = Withdrawal, 1 = Normal) as the dependent variable, time of evaluation (1= 6 months, 2 = 12 months) and group (0 = Control, 1 = Experimental) as factors. In this case, the pooled adjusted OR was 3.57 [p = 0.022 (95% CI = 1.20-10.65); Cohen's d = 0.70]. Conclusion: Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes. Clinical Trial Registration: ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03212547, identifier: NCT03212547.

[Risk factors for malnutrition at two years of corrected age in preterm infants under 32 weeks]. / Factores de riesgo de malnutrición a los dos años de edad corregida en prematuros menores de 32 semanas al nacer.

Post-discharge nutrition of preterm newborns must avoid excessive or insufficient weight gain and optimal length and head circumference growth. In Chile, premature infants less than 32 wee ks at birth receive fortified formulas during the first year, unless they are exclusively breastfed. OBJECTIVE: To describe growth and identify the risk of malnutrition at 24 months. PATIENTS AND METHOD: Retrospective cohort study that analyzes growth from birth to 2 years of corrected age in preterm patients < 32 weeks of gestational age. Z-score of weight, length, head circumference, and Body Mass Index (BMI) were analyzed. Factors related to Z BMI at 24 months were analyzed as follows: Eutrophic: Z BMI between -1 and +1; Overweight: Z BMI > +1; Underweight: Z BMI < -1. RESULTS: 996 preterm infants were included, 559 completed check-ups at 24 months. 64.5% were eutrophic, 18.4% overweight, and 17.1% underweight. Multivariate analysis showed that risk of overweight was associated with birth weight > 1460 g: OR 5.77 (2.11-15.77) and Z BMI > 1.6 at 6 months: OR 2.67 (1.91-3.74); underweight risk was associated with birth weight < 1000g: OR 3.1 (1.1-8.8) and Z BMI < -0.75 at 6 months: OR 8.2 (4.3-16.3). CONCLUSIONS: The greater risk of overweight and underweight can be anticipated in premature infants under 32 weeks with birth weight or Z BMI at 6 months of corrected age.

Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial.

BACKGROUND: Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. OBJECTIVE: The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. METHODS: This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised. RESULTS: Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. CONCLUSIONS: This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. TRIAL REGISTRATION: ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17943.

Sobrevida del niño menor de 1500 gramos en Chile / Survival of newborn weighing less than 1500 grams in Chile

Se analiza la sobrevida de recien nacidos en Chile, menores de 1500 gramos de peso. Se evalúan sus complicaciones como sindrome de dificultad respiratoria; difusión broncopulmonar, hemorragia intracraneales, retinopatía y problemas sensoriales