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Objective To compare the trajectories and determine the predictors of maternal distress, defined as a continuous spectrum of symptomatology and elevated symptomatology, of depression, anxiety and perinatal-specific post-traumatic stress (PPTS), in mothers of very low birth weight (VLBW) infants throughout the neonatal intensive care unit (NICU) hospitalization. Method 69 mothers completed psychological questionnaires within the first month of their infant’s NICU hospitalization and again two weeks prior to NICU discharge. Multiple regression models determined maternal psychological, reproductive, sociodemographic, and infant medical predictors of maternal distress. Results PPTS remained stable throughout the NICU hospitalization while other aspects of distress declined. Previous psychological history and infant medical variables predicted higher PPTS but no other aspects of distress. Reproductive variables predicted anxiety and PPTS; history of fetal loss initially predicted lower PPTS, but throughout hospitalization primipara status emerged as a predictor of higher anxiety and PPTS. Sociodemographic variables predicated initial, but not later, depressive distress. Conclusion Psychological screening is important in the NICU. The PPTS profile suggests it may require distinct treatment. Primiparas should be targeted for intervention.

Aim To examine associations between maternal NICU visitation rates, maternal psychological distress (“distress”), and preterm infant outcome post-NICU discharge in a contemporary cohort of very low birth weight (VLBW) infants. Methods This was a prospective study of 69 mothers and their VLBW infants. Distress was assessed 1 month post-birth, 2 weeks prior to NICU discharge and after NICU discharge at 4 months corrected age [CA]. Maternal NICU visitation rates were calculated for the first 2 weeks and 1 month post-birth as well as for the entire NICU hospitalization. Regression analyses adjusted for the impact of 1. maternal and infant characteristics and distress on maternal visitation rates and 2. the impact of visitation on long-term maternal distress, and rates of infant clinic attendance and rehospitalization. Results Greater number of children in the home, maternal exposure to a greater number of potentially traumatic events prior to childbirth, and lower maternal anxiety consistently predicted lower visitation rate. Lower maternal visitation rate predicted higher maternal depression scores at infants’ 4 month CA visit. Maternal NICU visitation rate did not predict post-NICU discharge infant clinic attendance or rehospitalization. Conclusion Distress is an important predictor of visitation. In turn, visitation is associated with long-term maternal distress.

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Background: The association between human milk (HM) feeding in the NICU and neurodevelopmental (ND) outcome in very low birth weight (VLBW) infants is unclear. Limitations of previous studies include a lack of exact estimates of HM dose and of generalizability to minority populations. Objective: To determine the impact on ND outcome of an exact dose of HM received in the NICU in a diverse, contemporary cohort of VLBW infants. Methods: We included 430 VLBW infants born in the period 2008-2012 for whom the mean daily dose (DD) of HM received during the stay in the NICU (NICU HM-DD) was calculated prospectively from the daily nutritional intake from admission to discharge. Outcomes included Bayley-III index scores at 20 months' corrected age (CA) as assessed upon ND follow-up, which were collected retrospectively. Multivariable linear regression analyses controlled for neonatal and social risk factors. Results: Each 10 mL/kg/day increase in NICU HM-DD was associated with a 0.35 increase in cognitive index score (95% CI [0.03-0.66], p = 0.03), but no significant associations were detected for the language or motor indices. Conclusions: There is a significant dose-dependent association between NICU HM intake and cognitive scores at 20 months' CA. Further follow-up will determine whether these findings persist at school age, and could help alleviate the special-education and health-care burden in this population.

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Objective To evaluate the relative impact of maternal education level (MEL) on cognitive, language, and motor outcomes at 20 months’ corrected age (CA) in preterm infants. Study Design A total of 177 preterm infants born between 2008 and 2010 were tested at 20 months’ CA using the Bayley Scales of Infant and Toddler Development-III. Multiple regression analyses were done to determine the relative impact of MEL on cognitive, language, and motor scores. Results Infants born to mothers with high school MEL were 3.74 times more likely to have a subnormal motor index, while those born to mothers with some college and graduate school MEL had reduced odds (0.36 and 0.12, respectively) of having subnormal language index at 20 months. In linear regression, MEL was the strongest predictor of cognitive, language, and motor scores, and graduate school MEL was associated with increases in cognitive, motor, and language scores of 8.49, 8.23, and 15.74 points, respectively. Conclusions MEL is the most significant predictor of cognitive, language, and motor outcome at 20 months’ CA in preterm infants. Further research is needed to evaluate if targeted interventions that focus on early childhood learning and parenting practices can ameliorate the impact of low MEL.