Effect of neurological status on interactions between mothers and their medically fragile infants

2.50
Hdl Handle:
http://hdl.handle.net/10755/166192
Category:
Abstract
Type:
Presentation
Title:
Effect of neurological status on interactions between mothers and their medically fragile infants
Author(s):
Tesh, Esther
Author Details:
Esther Tesh, PhD, Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA, email: etesh@hsc.vcu.edu
Abstract:
Due to improved medical and nursing care, more infants with significant and chronic medical problems are surviving. The effect of an infant who needs prolonged hospitalization and continuing care even after hospital discharge on parent-infant interactions is unknown. In addition, an infant's neurological problems further impairs interactive abilities. The purpose of this study was to explore the effect of neurological impairment on the interactions between mothers and their medically fragile infants. Forty-one medically fragile infants and their mothers were observed interacting together for about 1 hour in the hospital on entry into the study at an average of 5.5 weeks after term (SD 8.1), every 1-2 months while in the hospital, 1 month after hospital discharge, and at 6 months corrected age. An average of 3.1 observations were conducted on each subject (range2-6). All infants had chronic life-threatening illnesses; most were technologically dependent. Medical diagnoses included multiple anomalies, CNS anomalies, intracranial bleeds, bronchopulmonary dysplasia, renal impairment, tracheal abnormalities, and prenatal substance exposure. Twenty-four infants were born prematurely; 25 infants were first born. At 6 months 19 subjects had abnormal or questionable neurological examinations and were considered neurologically impaired. The mothers had a mean age of 26.7 (range 17 to 41); 25 of them were married. The observations were scheduled at a time when a feeding was expected. Four maternal caregiving activities, 9 mother behaviors, 3 infant sleep-wake states, and 5 infant behaviors were recorded every 10 seconds. A mixed general linear model, or hierarchical linear model, was calculated for each mother and infant variable using infant age at the observation, neurological status, the interactions of age and neurological status, and location home or hospital as independent variables. Fifteen variables changed significantly with age. Mothers fed older infants less, achieved more vis-a-vis, and had less body contact time with them. They also touched, held, rocked, looked at, and gestured to them less. Older infants were alert more of the time and had fewer large movements, startles, jitters, and coughs or sneezes. Only two variables showed a direct effect of neurological status: neurologically impaired infants were moved less and jittered more. Three variables had significant age by neurological status interactions. Mothers of neurologically normal infants spent about the same time together but not caregiving or playing with their infants over age; whereas mothers of neurologically impaired infants spent more time together at an early age in comparison with neurologically normal infants, but less time together at a later age. Impaired infants had much more jittering, but only at early ages, and showed negative facial expressions more of the time, but only at older ages. Observation location affected 5 variables. Mothers achieved more vis-a-vis and moved their infants more, and the infants were asleep less, moved less, and vocalized more during observations in the home. Thus, the neurological status of the infants has relatively small impact on the interactions of medically fragile infants and their mothers during the first year. The age of the infant affected many more maternal and infant behaviors than did neurological status. It may be the the behaviors of medically fragile infants differ so greatly from the behaviors typical of normal healthy infants or that the mothers are so concerned about the survival of the infant that neurological impairment has only minor additional effects on interactions. However, neurological impairment probably has a great effect in the second year of life as impaired infants fail to achieve the normal developmental milestones of walking and talking, and survival becomes more assured.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
Feb 29 - Mar 2, 1996
Conference Host:
Southern Nursing Research Society
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleEffect of neurological status on interactions between mothers and their medically fragile infantsen_GB
dc.contributor.authorTesh, Estheren_US
dc.author.detailsEsther Tesh, PhD, Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA, email: etesh@hsc.vcu.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/166192-
dc.description.abstractDue to improved medical and nursing care, more infants with significant and chronic medical problems are surviving. The effect of an infant who needs prolonged hospitalization and continuing care even after hospital discharge on parent-infant interactions is unknown. In addition, an infant's neurological problems further impairs interactive abilities. The purpose of this study was to explore the effect of neurological impairment on the interactions between mothers and their medically fragile infants. Forty-one medically fragile infants and their mothers were observed interacting together for about 1 hour in the hospital on entry into the study at an average of 5.5 weeks after term (SD 8.1), every 1-2 months while in the hospital, 1 month after hospital discharge, and at 6 months corrected age. An average of 3.1 observations were conducted on each subject (range2-6). All infants had chronic life-threatening illnesses; most were technologically dependent. Medical diagnoses included multiple anomalies, CNS anomalies, intracranial bleeds, bronchopulmonary dysplasia, renal impairment, tracheal abnormalities, and prenatal substance exposure. Twenty-four infants were born prematurely; 25 infants were first born. At 6 months 19 subjects had abnormal or questionable neurological examinations and were considered neurologically impaired. The mothers had a mean age of 26.7 (range 17 to 41); 25 of them were married. The observations were scheduled at a time when a feeding was expected. Four maternal caregiving activities, 9 mother behaviors, 3 infant sleep-wake states, and 5 infant behaviors were recorded every 10 seconds. A mixed general linear model, or hierarchical linear model, was calculated for each mother and infant variable using infant age at the observation, neurological status, the interactions of age and neurological status, and location home or hospital as independent variables. Fifteen variables changed significantly with age. Mothers fed older infants less, achieved more vis-a-vis, and had less body contact time with them. They also touched, held, rocked, looked at, and gestured to them less. Older infants were alert more of the time and had fewer large movements, startles, jitters, and coughs or sneezes. Only two variables showed a direct effect of neurological status: neurologically impaired infants were moved less and jittered more. Three variables had significant age by neurological status interactions. Mothers of neurologically normal infants spent about the same time together but not caregiving or playing with their infants over age; whereas mothers of neurologically impaired infants spent more time together at an early age in comparison with neurologically normal infants, but less time together at a later age. Impaired infants had much more jittering, but only at early ages, and showed negative facial expressions more of the time, but only at older ages. Observation location affected 5 variables. Mothers achieved more vis-a-vis and moved their infants more, and the infants were asleep less, moved less, and vocalized more during observations in the home. Thus, the neurological status of the infants has relatively small impact on the interactions of medically fragile infants and their mothers during the first year. The age of the infant affected many more maternal and infant behaviors than did neurological status. It may be the the behaviors of medically fragile infants differ so greatly from the behaviors typical of normal healthy infants or that the mothers are so concerned about the survival of the infant that neurological impairment has only minor additional effects on interactions. However, neurological impairment probably has a great effect in the second year of life as impaired infants fail to achieve the normal developmental milestones of walking and talking, and survival becomes more assured.en_GB
dc.date.available2011-10-27T14:42:08Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T14:42:08Z-
dc.conference.dateFeb 29 - Mar 2, 1996en_US
dc.conference.hostSouthern Nursing Research Societyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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