Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs. / Dissertation (MA)- University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MA / Unrestricted

The experience of becoming a mother is a personal and social experience influenced by individual characteristics, friends and family, and the infant. The journey to become a mother encompasses concepts of maternal competence and responsiveness. The purpose of this study was to examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mothers of full term infants. The conceptual model for this work was based on the work of Reva Rubin describing maternal identity and role development. Maternal competence and responsiveness are components of maternal role and are influenced by social support, maternal self-esteem, well-being, stress and mood. In addition, infant temperament and perception of infant vulnerability influence development of maternal competence and responsiveness. A non-experimental repeated measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers. One group consisted of mothers of late preterm infants 34-36, 6/7 weeks gestation. The second group consisted of mothers of term infants, >/=37 weeks gestation. Both primiparas and multiparas were included in the study. Data was collected in the initial postpartum period prior to discharge from the hospital and again at six-weeks postpartum. No statistically significant differences in development of maternal competence or responsiveness between mothers of LPIs and term infants were identified. This study adds to our knowledge concerning outcomes of mothers of late preterm infants and development of competence and responsiveness.

Globalt födds varje år 15 miljoner barn prematurt före gestationsvecka 37+0.Barn som födds mellan gestationsvecka 34+0 – 36+6 benämns som sent prematurt födda. Sent prematurt födda barn kan bedömas både som låg vårdkrävande och högvårdkrävande. De kan både vårdas på en neonatalavdelning eller på ett barnbördshus. Mödrar är inte alltid förberedda att ta hand om sitt sent prematurt födda barn eftersom det sker ett avbrott i mödrarnas omställningsprocess från graviditet till moderskap. Amningen har många fördelar för de ammande mödrarna och barnen. Amningsprocessen kan skilja sig vid amning av sent prematurt födda barn i jämförelse med fullgångna barn. Syftet med denna litteraturöversikt är att beskriva mödrars upplevelse vid amning av sent prematurt födda barn under barnets första levnadsår. Metoden som tillämpades var en icke systematisk litteraturöversikt. Databassökningen i databaserna PubMed och Cinahl genererade i 14 artiklar som besvarade arbetets syfte. Även en manuell sökning utfördes, vilket genererade i en artikel. Totalt inkluderades 15 vetenskapliga artiklar av kvalitativt, kvalitativt ansats samt mixed metod. Med hjälp av en kvalitetsbedömningsmall har artiklarnas kvalitet granskats och därefter har en integrerad dataanalys använts för att besvara arbetes syfte. Resultatet presenterar tre huvudkategorier och åtta underkategorier. Resultatet visade att mödrar till sent prematurt födda barn upplevde en önskan och längtan om att få amma sitt barn, de förstod bröstmjölkens betydelse för det prematurt födda barnets utveckling. Amningen upplevdes som en känslomässig period som ingav känsla av glädje, harmoni och avslappning. Men amningen orsakade även känslor av stress, utmattning och ångest främst på grund av utmaningarna som tillkom vid amningen. Fysiska utmaningar både hos barnet och mödrarna var återkommande. Behov av stöd, undervisning och uppmuntran från anhöriga och sjukvårdspersonalen var betydelsefullt för mödrarna och amningsutfallet. Slutsatsen i studien indikerar att mödrar till sent prematurt födda barn upplever amningen som utmanande men betydelsefull. Under amningen upplevs starka känslor. Mödrars anknytning till barnet och barnets bindning till mödrarna stärktes genom amningen. Behov av stöd och undervisning under amningsperioden identifierades som kan underlätta amningsutmaningar och främja fortsatt amning. Arbetet belyser vikten av undervisning och stöd från sjukvårdspersonal, bland annat barnmorskor, som arbetar nära denna patientgrupp. / Globally every year 15 million infants are born prematurely before gestational week 37 + 0. Infants born between gestational week 34 + 0 to 36 + 6 are referred to as late preterm infants. Late preterm infants can be assessed both as low care- requiring or high care-requiring. They may require neonatal care or care in a maternity unit. Mothers are not always prepared to care for their infant due to early interruption in mother´s transition process from pregnancy to motherhood. Breastfeeding has many benefits for both the breastfeeding mother and the infant. The breastfeeding process may differ when breastfeeding late preterm infants compared to full-term infants.  This study aims to describe mothers' experience of breastfeeding late preterm infants during the infants first year of live.  The method applied was non-systematic literature review was. The databases PubMed and Cinahl generated 14 articles. A manual literature search was conducted, which generated one more article. A total of 15 scientific articles of quantitative, qualitative approach and mixed method were included. Using a quality assessment templet of the articles and an intergrade analysis, the quality and results of the articles have been analyzed. The result presents three main categories and eight subcategories. The results of this study showed that mothers of late preterm infants experienced a desire and longing to breastfeed their infants because the mothers were aware of the importance of breast milk for their late preterm infant for the infants’ development. Breastfeeding was considered as an emotional period which was experienced as joyful, gave harmony and a feeling of relaxation but also feelings of stress, exhaustion and anxiety was experienced mainly due to the challenges that emerged during breastfeeding the late preterm infant. Physical challenges for both the infant and the breastfeeding mother were recurring. The need for support, education and encouragement from relatives and healthcare staff was significant for the mothers and the outcome of breastfeeding.   The conclusion of this study showed that mothers of late preterm infants experienced breastfeeding as challenging but significant. Strong emotions were recurring during breastfeeding. Mothers’ attachment to their infants were strengthened through breastfeeding. The need for support and education during the breastfeeding period was identified to facilitate breastfeeding challenges and promote continued breastfeeding. It is essential for healthcare professionals, as midwives, to have an understanding of breastfeeding experience of mother of late preterm in order to offer adequate care and support.

Preterm birth (< 37 weeks gestation) is a major health burden for affected children. Although the risk of health problems increases as the gestational age decreases, research in the last decades has revealed that even late preterm infants born at 34-36 weeks gestational age have higher mortality and morbidity than term infants. Because late preterm infants constitute three fourths of preterm infants, they are important from both public health and health policy perspectives. This doctoral thesis sought to answer important knowledge gaps in health service utilization of late preterm infants via three studies. Study A, a systematic review and meta-analysis comparing health service utilizations of late preterm infants with those of term infants, found that late preterm infants had increased hospitalization compared with term infants that persisted from the neonatal period through adolescence. Study B is a cohort study evaluating the re-admissions and emergency department visits by late preterm and term singletons and twins for the first 5 years after birth. Study B demonstrated that late preterm infants had higher re-admission rates than term infants although differences in twins were less pronounced than in singletons. Study C is a population-based cohort study with cost analyses assessing the health care costs and resource utilization related to three different discharge timings of late preterm and term singletons: early (< 48 hours), late (48-71 hours), and very-late (72-95 hours) discharge after birth. Study C found that early discharge was not associated with the reduction of health care cost in late preterm infants, and instead was associated with an increase in the cost in term infants over the first year after birth. These findings are useful for parents, care providers, health policy makers, and guideline developers to provide optimal care for late preterm infants. / Thesis / Doctor of Philosophy (PhD)