Maternal parenting stress and its correlates in families with a young child with cerebral palsy.

OBJECTIVE: To investigate factors predicting parenting stress in mothers of pre-school children with cerebral palsy. METHOD: Eighty mothers and children participated. Mothers completed the Parenting Stress Index (PSI) and the following measures of family functioning: family support, family cohesion and adaptability, coping strategies, family needs and locus of control. Children were assessed using the Griffiths Scales and the Gross Motor Function measure. The child's home environment was assessed using Home Observation for Measuring the Environment. RESULTS: Mothers had higher mean total PSI scores than the means for the typical sample; 43% had total PSI scores above the threshold for clinical assessment. Cluster analysis demonstrated five distinct clusters of families, more than half of whom were coping well. High stress items were role restriction, isolation and poor spouse support, and having a child who was perceived as less adaptable and more demanding. Lower stress items indicated that this sample of mothers found their children emotionally reinforcing and had close emotional bonds. Regression analysis showed that the factors most strongly related to parenting stress levels were high family needs, low family adaptability and cognitive impairment in the child. CONCLUSIONS: The results confirmed the individuality of families, and that individual characteristics of coping and feeling in control, together with family support and cohesion, are associated with variation in amount of stress experienced in parenting a child with cerebral palsy.

Recommendations to increase the validity and comparability of peripheral measurements by near infrared spectroscopy in neonates. 'Round table', section of haematology, oxygen transport and microcirculation, 48th annual meeting of ESPR, Prague 2007.

Several studies of peripheral measurements with near infrared spectroscopy (NIRS) and venous or arterial occlusion have been performed in neonates. Results have been variable. Reasons include differences in patient populations, technical aspects of the devices used or the way measurements were made. It is therefore important that there should be common elements for measurement protocols. This statement proposes a standardised approach to allow comparison between different study populations and devices.

[EuroNeoStat: a European information system on the outcomes of care for very-low-birth-weight infants (< 1500 g)]. / EuroNeoStat: ein Europäisches Informationssystem zur erfassung der behandlungsergebnisse von sehr untergewichtigen Frühgeborenen mit einem Geburtsgewicht < 1500 g.

BACKGROUND: Prematurity rates are increasing throughout the world. Despite an overall rather small percentage of very low birth weight infants (VLBWI), which is approx. 1-2 % in most countries, these infants contribute significantly to morbidity and neonatal and infant mortality rates. METHODS: EuroNeoStat was initiated as an European information system on the outcomes of VLBWI to monitor and improve the care of these infants throughout Europe. EuroNeoStat includes an initiative, called EuroNeoSafe, to promote the safety of these high risk preterm infants. Perinatal and neonatal data from VLBWI is collected without using data that identify individuals or institutions. These data is analyzed at the coordination center in Bilbao. All institutions taking care on VLBWI in Europe can participate in this network and will be able to compare their own outcome data with other institutions from the network. Information on EuroNeoStat and the current data set is available on www.euroneostat.org. CONCLUSION: Successful initiatives aiming at improving outcomes in perinatal and neonatal care require collaborative networking, an attitude of constructive criticism and thorough comparative analysis of the outcomes and incidents in the health-care process.

Families' views on ward rounds in neonatal units.

OBJECTIVE: To discover parental preferences about visiting during ward rounds. DESIGN: Survey using a short structured interview SETTING AND PARTICIPANTS: Families of babies cared for in a regional neonatal intensive care unit. RESULTS: Eighty six respondents, no refusals. Sixty three had visited during a ward round, and 13 had come in especially for the round. About half had overheard conversations about other babies or thought discussions about their baby had been overheard. Concerns about these experiences were only expressed by respondents who had actually experienced overhearing. Parents and families had little information about the ward round, held diverse views, and expressed different priorities. They described a mixture of concerns about communication, practicalities, and issues of ethics and principle. Confidentiality was a matter of concern for some, but many parents expected some sharing of information between families on the unit. CONCLUSIONS: Units should consider: the information they have for parents about ward rounds; the possibility that consultations may be overheard; the opportunities for parents to communicate with the clinical team.

Systemic effects of screening for retinopathy of prematurity.

AIMS: To detect systemic complications of screening for retinopathy of prematurity (ROP), paying particular attention to the physical examination. METHODS: Oxygen saturation, pulse rate, and blood pressure were monitored before, during, and after 110 ROP screening examinations. RESULTS: Following topical mydriatics diastolic blood pressure was elevated by a mean of 6 (SD 7.2) mm Hg. Immediately after the examination there was a further rise in both systolic and diastolic pressure of 4.3 (14.5) mm Hg and 3.3 (11.6) mm Hg, respectively. Oxygen saturation and pulse rate remained stable during the control period and administration of eyedrops. Saturation fell by a median of 3% (95% confidence interval plus or minus 1.2%) after the examination while there was rise in pulse rate of 7 (SD 23.1) beats per minute. This change in pulse rate was not observed in infants on concurrent methylxanthine therapy. No infant had clinically significant changes at the end of the study. CONCLUSION: The initial changes in blood pressure may represent side effects of topical mydriatics but the later changes following the physical examination may be an additional response to the stress of ROP screening.

The changing incidence of chronic lung disease.

This paper reports an examination of the incidence of chronic lung disease in premature infants admitted to the neonatal intensive care unit at Liverpool Maternity Hospital. From January 1980 to December 1989 details were obtained for these infants such as gestation, weight, sex, survival to discharge and ventilatory support received. The findings show that a total of 242 infants had developed chronic lung disease; one-third of these were born in 1988 or 1989. Logistic regression suggests that chronic lung disease was significantly associated with being male, low birthweight, low gestation, surviving to discharge, and being born in 1988 or 1989. Among infants at 'high risk' of this condition, mortality had significantly decreased and the incidence had significantly increased. This increase is not fully explained by changes in the population admitted during the last decade. A rising workload should be anticipated in terms of the specialised follow-up and care required by these babies.

Influence of exposure to tobacco smoke on serum alpha fetoprotein levels of women in midtrimester pregnancy.

The influence of exposure to tobacco smoke on maternal serum alpha-fetoprotein (AFP) levels at 16 wk gestation was examined. Urinary cotinine levels were used to quantify exposure to tobacco smoke. Significantly higher levels of maternal serum AFP were found in 101 women who had more than 1.0 microgram cotinine/mg urinary creatinine compared with 180 women whose urinary cotinine levels were below this level [(mean +/- SD) 1.23 +/- 0.64 and 1.06 +/- 0.54 respectively; 95 per cent CI of difference of means 0.01-0.31; P < 0.05]. There was a mild albeit statistically significant correlation between urinary cotinine levels and maternal serum AFB (r 0.099; P < 0.05). However, the difference in maternal serum AFP levels between the two groups was not found to be significant, when adjustments for maternal body mass index were made.

Delayed vascular reactivity to ischemia in diabetic microangiopathy.

To investigate vascular responses in insulin-dependent diabetic patients both with and without retinopathy, we have assessed vasodilation by forearm transcutaneous pO2 measurement after 10 min of ischemia produced by a sphygmomanometer cuff. Diabetic patients with proliferative retinopathy had a delayed vasodilatory response at 60 s (mean +/- SD pO2 = 9 +/- 3 mm Hg) compared with those having diabetes without retinopathy (15 +/- 4 mm Hg, P less than 0.01) and matched normal subjects (14 +/- 4 mm Hg, P less than 0.01). Recently diagnosed insulin-dependent diabetic patients had a very similar response (15 +/- 5 mm Hg) to matched normal subjects (15 +/- 3 mm Hg). The diminished vascular reactivity may be a consequence of microangiopathy and neuropathy, although patients with an impaired vascular response might be particularly at risk from the development of capillary closure.