Abstract
Infants born sick or preterm and admitted to the neonatal intensive care unit (NICU) face challenges to their sleep and the establishment of breastfeeding. The reported sleep patterns of NICU graduates are conflicting, and there is evidence of bi-directional relationships between infant feeding and sleep challenges and poor maternal mental health. A prospective observational longitudinal cohort study was conducted on mothers of sick/preterm infants with ≥ 5 days admission to the NICU. Participants were recruited at discharge, with follow up at 2 and 6 weeks, and 3, 6, and 9 months. Infant sleep, settle and cry patterns, maternal bother with infant behaviours, and maternal confidence were measured using the Sleep and Settle Questionnaire (SSQ). Feeding information was obtained, and breastfeeding confidence was measured using the Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF). Our sample consisted of 94 mothers of 101 sick/preterm infants. The range of infant birth gestations was 23–42/40 weeks, with n = 37 (36.6%) born < 33/40 weeks, n = 26 (25.7%) born at 33 to 36+6/40 weeks, and n = 38 (37.6%) born ≥ 37 weeks. The NICU length of stay was 5–173 days. Linear mixed modelling was used to examine associations between maternal bother and infant feeding and sleep variables. Night waking frequency (p < 0.001), durations of crying (day, evening, night; all p ≤ 0.001), and durations of settling (evening, p = 0.010) were positively associated with increased maternal bother scores. Maternal confidence was negatively associated with maternal bother (p < 0.001). The median BSES-SF score at discharge was 59/70, with 49.5% of mothers no longer breastfeeding by 6 months. Maternal bother did not differ according to feeding method (p = 0.44), or birth gestation subgroup (i.e., born < 33 weeks, 33 to 36+6 weeks, or term sick) (p = 0.44). Whether NICU infants were term sick or preterm was not associated with maternal concern with infant sleep and settling patterns in the 9 months after hospital discharge. Mothers of sick/preterm infants reported greater bother with increased night waking and longer durations of crying and evening settling. The findings from this study can inform individualised anticipatory guidance and support for this vulnerable population.
Author Contributions
Conceptualisation, S.L.P. and J.W.; methodology, S.L.P.; formal analysis, E.S.M.L. and P.V.; investigation, S.L.P. and E.S.M.L.; resources, D.T.G.; data curation, S.L.P.; writing—original draft preparation, E.S.M.L.; writing—review and editing, S.L.P., D.J.I. and D.T.G.; visualisation, P.V.; supervision, S.L.P., D.J.I. and D.T.G.; project administration, S.L.P.; funding acquisition, S.L.P. and D.T.G. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by the Women and Infants’ Research Foundation and Western Australian Nurses Memorial Charitable Trust. The salaries of D.T.G. and S.L.P. were funded by an unrestricted research grant from Medela AG (Switzerland) and administered by The University of Western Australia. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Women’s & Children’s Health Service (reference EC06-05, October 2006).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Acknowledgments
We thank all of our participants for their time and help with this research.
Conflicts of Interest
D.T.G. declares participation in the Scientific Advisory Board of Medela AG. P.V., D.T.G. and S.L.P. are supported by an unrestricted research grant from Medela AG, administered by The University of Western Australia. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. All other authors declare no conflicts of interest.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).