BACKGROUND:Mothers at high risk for developing depression due to psychosocial vulnerabilities that need to be supported in the perinatal period. A theory-based, user-centered mobile health application-based perinatal intervention can potentially improve at-risk mothers' maternal and infant outcomes. AIM:To describe the development of SMART, a mobile health application-based perinatal intervention designed to support at-risk mothers across the perinatal period. METHODS:The SMART intervention was developed using a combined information systems research framework and design thinking approach. The development process included identification of user needs, intervention design, prototype development, integration of theory, treatment fidelity planning, and user acceptance testing. User acceptance testing was conducted with 21 perinatal women using a SMART-specific questionnaire and the user version of the Mobile Application Rating Scale. RESULTS:The development process resulted in a mobile health intervention comprising educational content, an activity hub, peer support chat, discussion forum, gratitude journal, helplines, and useful links, push notifications, and personalisation features. User acceptance testing indicated favourable ratings for app quality, information quality, usability, and perceived impact. Participant feedback informed refinements to the intervention, including improvements to content presentation, search/filter functions, pregnancy-related resources, and the user-guide video. Interdisciplinary collaboration and treatment fidelity planning supported the systematic development of the intervention. CONCLUSION:This study described the key processes in developing a mobile health application-based perinatal intervention. Researchers can learn from the insights gained to plan future multidisciplinary, technology-based perinatal interventions. TRIAL REGISTRATION:The SMART study was registered on clinicaltrials.gov (Registration ID: NCT06363019) on 04 September 2024.

AIM:A landmark trial published in 2021 demonstrated a 25% reduction in neonatal mortality when comparing immediate skin-to-skin contact (iSSC) to conventional care in infants with birthweight 1-1.8 kg in low- and middle-resource settings. New evidence from randomised clinical trials on iSSC in high-resource settings has recently become available. This systematic review aimed to evaluate evidence for immediate/early SSC, defined as initiated within 1 h after birth, versus conventional care in inborn preterm infants in high-resource settings. METHODS:Ten electronic databases, including PubMed, Embase, and Cochrane CENTRAL, from 2000 until February 2026, were searched. Randomised clinical trials comparing iSSC to conventional care in inborn preterm infants in high-resource settings were included. RESULTS:Four randomised clinical trials encompassing 325 infants were included. iSSC was feasible and safe. Cardiorespiratory stability, thermoregulation, breastfeeding practices, maternal-infant interaction, infant stress regulation, and parental mental health outcomes were in favour of the intervention. CONCLUSIONS:This systematic review provides updated evidence on the effectiveness of iSSC for preterm infants admitted to neonatal intensive care units in high resource settings. The findings support that there is a sensitive window in the first hours after birth when preterm infants and parents should not be separated.

BACKGROUND:At-risk mothers experience disproportionately higher rates of antenatal depression and anxiety, which can hinder mother-infant bonding and adversely affect infant socioemotional development. Despite growing evidence on postpartum mental health, antenatal risk factors among psychosocially vulnerable mothers remain underexplored, particularly in multi-ethnic Asian settings. AIM:To identify factors associated with antenatal depression, anxiety, and maternal-fetal bonding among at-risk mothers. METHODS:This cross-sectional observational study was nested within an ongoing randomised controlled trial. Two hundred at-risk mothers, defined as single, of low socioeconomic status, referred for psychosocial support, at risk of depression, with adverse childhood experiences, or with a fetus with a congenital malformation, were recruited from outpatient obstetric clinics between February and September 2024. Participants completed online self-administered questionnaires assessing antenatal depression, anxiety, perceived stress, social support, parenting self-efficacy, and maternal-fetal bonding. General Linear Models were used to analyse data and identify factors associated with depression, anxiety, and bonding. RESULTS:Higher perceived stress was associated with increased depression (β = 0.28, p < 0.001) and anxiety (β = 1.28, p < 0.001) and poorer bonding (β = 0.08, p = 0.02), while greater social support predicted lower anxiety (β = -0.31, p < 0.001). Higher parenting self-efficacy was linked to stronger bonding (β = -0.09, p = 0.06). Younger mothers (β = -2.68, p = 0.025) and Indian mothers (β = 7.46, p = 0.017) were particularly vulnerable to anxiety, whereas post-secondary education was protective against depression (β = -1.44, p = 0.02). Model fit ranged from 0.14 to 0.65. CONCLUSION:Perceived stress, social support, and parenting self-efficacy significantly influenced antenatal mental health and bonding in at-risk mothers. These findings underscore the need for culturally sensitive, nurse/midwife-led interventions that integrate early screening, stress reduction, and empowerment strategies within routine antenatal care to strengthen maternal mental health and early bonding outcomes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: (1) Nurses and midwives play a critical role in screening for antenatal depression and anxiety in mothers with risk profiles highlighted in this study. (2) Culturally responsive nursing practice that demonstrates sensitivity towards sociocultural pressures is needed to provide individualised care. (3) Integration of digital and community-based antenatal education programs could provide more equitable access to care for at-risk mothers who may face barriers to in-person care. IMPACT:(1) Despite having a higher susceptibility for antenatal mental health conditions, risk factors for antenatal depression, anxiety, and maternal-infant bonding have been underexplored in at-risk mothers. (2) Antenatal stress and anxiety are universally associated with depression across risk groups, while maternal self-efficacy and perceived social support serve as key protective factors. (3) The findings from this study suggest the need for early screening and nurse-led interventions that support maternal parenting self-efficacy and stress management to improve maternal mental health outcomes among at-risk mothers. REPORTING METHOD:STROBE reporting checklist. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

OBJECTIVE:To explore the effects of immediate parent-infant skin-to-skin contact (iSSC) at very preterm birth on maternal-infant behavioural responses and hypothalamic-pituitary-adrenal (HPA) axis reactivity to age-appropriate socio-emotional stress at 4 months corrected age. DESIGN:Two secondary outcomes from a multicentre randomised controlled trial with two non-blinded parallel groups. SETTING:Three Scandinavian neonatal intensive care units, level 2 and level 3. PARTICIPANTS:91 infants born at gestational age 28+0 to 32+6 from April 2018 to June 2021. Singletons and twins with a second caregiver present were included, regardless of mode of birth. Higher-order births, infants with congenital infections and major malformations were excluded. INTERVENTION:Infants were randomised before birth to iSSC (n=46) or conventional care (n=45) during the first 6 hours of life. At 4 months corrected age, the infants were exposed to socio-emotional stress using the Face-to-Face Still-Face procedure (FFSF). Salivary cortisol was collected before and after FFSF. MAIN OUTCOME MEASURES:Behavioural and hormonal stress responses at 4 months of age. RESULTS:65 of 91 infants were assessed by FFSF, of which 37 infants had cortisol sampling. The iSSC group demonstrated heightened positive emotionality during FFSF compared with controls (beta 0.74, 95% CI 0.40 to 1.07; p<0.001). Also, the iSSC group showed an association between mother-infant cortisol levels at baseline (r 0.55, 95% CI 0.13 to 0.80; p=0.014) and 30 min post-FFSF (r 0.55, 95% CI 0.05 to 0.83; p=0.035). CONCLUSION:Infants who experienced iSSC during the first 6 hours after very preterm birth showed improved infant socio-emotional stress coping and suggested enhanced mother-infant HPA axis synchrony at 4 months.

Background:A sensitive, well-functioning maternal interaction is vital for healthy infant development. For moderate to late preterm infants, this is even more important as this group of infants are at increased risk of facing neurodevelopmental disorders. The Early Collaborative Intervention supports parent-preterm infant interaction and includes three sessions, two in the hospital and one after discharge. Objective:To investigate the impact of the Early Collaborative Intervention, compared with standard care, on mother-preterm infant interaction at one month corrected age. Design:A longitudinal randomized controlled trial, reporting secondary outcomes from the first follow-up. Setting:The intervention was conducted at a pediatric center with two neonatal intensive care units with an infant and family centered approach. The intervention was evaluated in the homes of the families. Participants:Families with preterm infants born in gestational week 30+0-35+6 (n = 143) were randomized. In this one-month follow up a total of 101 families participated, (standard care with the Early Collaborative Intervention, n = 60, standard care, n = 41). Methods:The mother-infant interactive behavior was videotaped during a bath and later analyzed with Ainsworth's Maternal Sensitivity Scales and the Emotional Availability Scales. The coder was masked to group randomization as well as to demographic data of the dyads. Results:In the analysis the maternal mean scores were statistically significantly higher for the intervention-group versus the standard care group in the Availability subscale, 7.30 vs 6.29 (CI 0.01-0.86, p = 0.045, Cohen's d 0.43), and Acceptance subscale, 8.00 vs 7.22 (CI 0.12-0.97, p = 0.012, Cohen's d 0.55), in the Ainsworth's Maternal Sensitivity Scales. Mean score were also statistically significantly higher for the intervention-group versus the standard care group in the Non-hostility subscale, 6.60 vs 6.12 (CI 0.11-0.97, p = 0.013, Cohen's d 0.54), in the Emotional Availability Scales. The results suggest that these aspects of maternal interactive behavior towards her infant, are the ones most influenced by the Early Collaborative Intervention. Conclusions:The Early Collaborative Intervention had beneficial impacts on maternal interactive behavior for those who took part in three sessions or more of the intervention program. Registration:The project was registered in ClinicalTrials.gov with the number: NCT02034617, registered 19/12/2013, date of the first recruitment 15/01/2014.

PROBLEM:Perinatal research on mobile health interventions has shown limited attention to how at-risk mothers express their needs within structured, moderated, and clinically embedded digital platforms. Little is known about how these needs evolve longitudinally across the perinatal period. BACKGROUND:The perinatal period is marked by increased vulnerability to psychological distress and psychosocial stressors, especially among at-risk mothers. Mobile health interventions have therefore gained prominence as accessible strategies to support maternal wellbeing. AIM:This study examined the nature and timing of support needs expressed by at-risk mothers within a moderated, multimodal digital peer-support intervention from pregnancy to six-months postpartum. METHODS:A qualitative descriptive study using inductive qualitative content analysis was conducted on the Supporting At-risk Mothers Across the Perinatal Period (SMART) intervention in Singapore. Data included discussion forum posts, gratitude journal entries, and private mother-peer messages. Messages were coded inductively and categorised to identify patterns of expressed needs across pregnancy, early postpartum (0-6 weeks), and late postpartum (6-weeks-6-months). FINDINGS:Five main categories were identified: (1)physical recovery and self-care, (2)psychosocial stressors and environmental challenges, (3)preparation for and adaptation to motherhood, (4)emotional coping and resilience, and (5)social and interpersonal relationships, comprising 18 subcategories. DISCUSSION:Findings highlight the dynamic and interconnected nature of mothers' physical, emotional, and social challenges during the transition to motherhood. Analysing naturally occurring digital interactions provides ecologically valid insights into how mothers articulate concerns within supportive environments. CONCLUSION:Mapping expressed maternal needs across perinatal phases can inform the timing and content of midwifery-led psychosocial support, anticipatory guidance, and peer-support training.

BACKGROUND:Mental health issues are common in parents to preterm infants. In the neonatal intensive care unit (NICU), skin-to-skin contact (SSC) as an avenue for parent-infant closeness may improve parental mental health. Few studies exist regarding its benefits when initiated immediately postbirth. The aim was to determine the effect of SSC for very preterm infants at birth on parents' mental health, by assessing symptoms of depression and anxiety within the first year. METHODS:The Immediate Parent-Infant Skin-to-Skin Study was a randomized clinical trial conducted 2018-2021 at three NICUs in Sweden and Norway. Very preterm infants (28-33 weeks of gestation) were allocated to standard incubator care or SSC with either parent, initiated at birth and continued throughout the first 6 h. Symptoms of depression and anxiety in parents were assessed with the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory. RESULTS:The study included 91 infants (36 twins [40 %]) and 73 mothers and 73 fathers. Infants had a mean gestational age of 31 + 1 weeks and birthweight of 1534 g. Immediate SSC was found to significantly reduce depression symptoms in mothers and anxiety symptoms in fathers at one week after birth and depression and anxiety symptoms in fathers at term-equivalent age of infant. LIMITATIONS:Limitations include a small sample size and limited background data on prenatal depression and anxiety. CONCLUSIONS:Immediate parent-infant SSC following a very preterm birth may provide a protective effect on parents' mental health and should be supported in the clinical setting, alongside necessary nursing, and medical care.

BACKGROUND:Childhood functional constipation, a common concern within child healthcare, necessitates oral and rectal medical treatments, that are mostly administered by parents in the home environment. It is important to gather children's perspectives in child- and family-centred care. The private nature of toileting, bowel movements, and faecal incontinence are areas of taboo and stigmatisation. Research is scarce on how children perceive this common but private situation of oral and rectal constipation treatment. OBJECTIVE:To explore children's experiences of functional constipation and its treatments. DESIGN:A qualitative interview study with a constructionist epistemology and a predominantly experiential orientation. SETTING:Individual interviews were conducted in the child's home, in the child's familiar outpatient clinic, or on university premises. Open and permissive conversations about bowel habits, constipation, medical treatments, faecal leakage, and related feelings were digitally recorded and transcribed. PARTICIPANTS:Twenty children (thirteen boys and seven girls) with functional constipation, aged 6-14 years, from four different outpatient clinics in southeast Sweden, who had experiences of oral and rectal medical treatments, were purposively recruited. Exclusion criteria were anorectal malformation or prior rectal surgery. METHODS:Transcripts were analysed using reflexive thematic analysis by Braun & Clarke. FINDINGS:This study provides a deeper understanding of why children choose not to go to the toilet. It explains how children perceive constipation treatment as simultaneously good and bad, and describes how faecal incontinence is strongly associated with the fear of exposure. The study also outlines the hopes and prospects of a cure. Four themes were created: 1) Procrastinating toilet visits - focus elsewhere, 2) Dreading exposure in a vulnerable position, 3) Enemas, a nightmare and a relief, 4) A doubtful hope during the treatment journey. CONCLUSIONS:Care providers must acknowledge and validate the child's perspective in constipation treatment situations. Our study provides an understanding of this perspective, which should be incorporated into clinical conversations with children about their diagnosis and proposed constipation treatment regimen. Adopting an approach that acknowledges children's views based on this new information may enhance collaboration between care providers, parents, and children during constipation care.

There is a gap between children’s right to report on their own experience of inpatient care, and availability of a validated measure to facilitate consistent reporting by children and young people. This study aimed to understand children and young peoples (aged 12–18 years) preferences for reporting their own experience of inpatient health care, and validate a revised question set. A three-phase study assessed: content analysis of focus group discussions; face and content validity of an adapted question set; construct validity using confirmatory factor analysis. Children and young people chose to adapt a survey titled ‘Australian Hospital Patient Experience Question Set’. Suggested changes to wording reflected their experiences of feeling listened to, heard, and safe, in contrast to feeling overlooked or overpowered. Assessment of construct validity demonstrated a sound one-factor model ( n = 193, Root Mean Square Error of Approximation 0.033, Comparative Fit Index 0.997, Tucker Lewis Index 0.996, composite reliability 0.951). Children and young people valued participating in survey design. The resulting question set is a reliable and valid tool to measure self-reported experience of care for children and young people aged 12 to 17 years on their own or with their parent.

INTRODUCTION:Despite a growing multidisciplinary interest in the Child and Family Centred Care approach, its meaning remains unclear in extant literature. It is, therefore, crucial to explore, analyse, describe, and clarify the concept of the Child and Family Centred Care approach and its associated terms. METHOD:A three-phased principle-based concept analysis approach was used to analyse the concept of Child and Family Centred Care. A systematic search of literature was completed using the CINAHL, PsycINFO, Medline, Scopus, and Web of Science databases. Peer-reviewed articles on Child and Family Centred Care, published from inception to 2023 were included if they were available in English and discussed children aged zero to 17 years, healthcare providers, and/or caregivers. A systematic screening of articles was undertaken to remove duplicates and articles that did not meet the inclusion criteria. A concept quality criteria assessment was performed independently based on a recommended appraisal tool. RESULTS:Full texts of the retained 23 titles were included in the deductive thematic analysis. Guided by the three-phased principle-based concept analysis approach, data were grouped into epistemological, pragmatic, linguistic, and logical principles. The study revealed various characteristics of the concept of interest to highlight the common terms associated with the concept, primarily being collaboration, participation, communication, and respect/dignity. CONCLUSIONS AND IMPLICATIONS:This concept analysis provides a theoretical definition of the Child and Family Centred Care approach. The definition emphasises the child as an individual and an active collaborator with healthcare providers and their family. Standardised language improving health outcomes, patient satisfaction, and healthcare systems. No Patient or Public Contribution.

CONTEXT:In adults, cortisol levels show a pronounced 24-hour rhythm with a peak in the early morning. It is unknown at what age this early-morning peak in cortisol emerges during infancy, hampering the establishment of optimal dosing regimens for hydrocortisone replacement therapy in infants with an inborn form of adrenal insufficiency. OBJECTIVE:We aimed to characterize daily variation in salivary cortisol concentration across the first year of life. METHODS:We conducted a systematic review followed by an individual participant data meta-analysis of studies reporting on spontaneous (ie, not stress-induced) salivary cortisol concentrations in healthy infants aged 0-1 year. A one-stage approach using linear mixed-effects modeling was used to determine the interaction between age and time of day on cortisol concentrations. RESULTS:Through the systematic review, 54 eligible publications were identified, reporting on 29 177 cortisol observations. Individual participant data were obtained from 15 study cohorts, combining 17 079 cortisol measurements from 1904 infants. The morning/evening cortisol ratio increased significantly from 1.7 (95% CI: 1.3-2.1) at birth to 3.7 (95% CI: 3.0-4.5) at 6 to 9 months (P < .0001). Cosinor analysis using all available data revealed the gradual emergence of a 24-hour rhythm during infancy. CONCLUSION:The early-morning peak in cortisol secretion gradually emerges from birth onwards to form a stable morning/evening ratio from age 6 to 9 months. This might have implications for hydrocortisone replacement therapy in infants with an inborn form of adrenal insufficiency.

The prevalence of and growth in digital technology present opportunities for educational and social enrichment; however, there are also many health and digital safety risks for children engaging with digital technology. While there is a growing body of research on digital safety programs to enhance children’s digital safety through parental support, evidence regarding the effectiveness of such interventions remains limited. This study aimed to evaluate the effectiveness of digital safety interventions on parental practices related to safeguarding children’s digital activities. The review was conducted following the Joanna Briggs Institute methodology for systematic reviews and has been reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search was performed in May 2024 in MEDLINE, CINAHL Ultimate, PsycINFO, Web of Science, The Allied and Complementary Medicine Database, ProQuest Central, and IEEE Xplore databases to identify peer reviewed articles that were (1) published in English, (2) included parents as participants, and (3) reported on programs or interventions designed to enhance parents’ knowledge and skills to safeguard children’s digital safety. A total of 11 published studies between 2012 and 2024 were included in the review. Data from 8 studies were included in the meta-analysis. A significant effect (Hedges g=–0.47; 95% CI –0.85 to –0.08; P<.001) was observed in children’s screen time in the 5 randomized controlled studies, while a large effect size was observed in 3 quasi-experimental studies (Hedges g=1.90; 95% CI –4.36 to 8.16; P<.001). A substantial level of heterogeneity was evident in the randomized studies (I2=87.95%). The quasi-experimental studies exhibited no heterogeneity (I2=0%). Overall, parents’ digital safety knowledge and skills improved as a result of the digital safety interventions. Notably, children’s screen time (P=.04) and parents’ own screen time (P=.001) decreased following the digital safety intervention. Parents who participate in digital safety interventions report higher levels of knowledge and skills related to digital safety, as well as a shift in attitudes, including the intention to implement strategies to safeguard their children engaging with technology. The enhanced knowledge and skills reported in these studies led to measurable reductions in both parents’ and children’s screen time. Future research should identify strategies that address community norms and other digital safety risks beyond screen time and bullying, which were predominant outcomes in these studies.

AIM:To examine the perinatal experiences of at-risk mothers and their engagement with mobile-health-based care. DESIGN:A qualitative descriptive study. METHODS:One-to-one semi-structured interviews were conducted with 30 at-risk mothers, defined as those who were single, had low income, were at risk of depression, had adverse childhood experiences, gave birth to a baby with congenital disorders, or had a history of mental health conditions. Participants were purposively sampled at 6 months postpartum from a tertiary public hospital in Singapore between February and September 2024. Interviews continued until data saturation was achieved, were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS:The study identified four overarching themes: (a) Me and my baby versus the world, (b) navigating vulnerability and strength in motherhood, (c) generational tensions in modern parenting and (d) reimagining perinatal care for every mother. Across the perinatal period, both intervention and control group mothers reported social isolation, emotional and physical strain and challenges balancing traditional family expectations with modern parenting practices. While mothers in the intervention group described receiving holistic support through the SMART program, those in the control group relied on ad hoc sources of support, such as social media platforms. CONCLUSIONS:At-risk mothers experienced significant challenges during the perinatal period, and those who used a mobile-health-based perinatal intervention felt supported through its peer support and multimedia educational resources. IMPLICATIONS FOR NURSING:Mobile-health-based interventions can be integral aspects of standard nursing care. Future researchers must ensure that support rendered to at-risk mothers is culturally compatible and specific to the psychosocial vulnerabilities they experience. Increased contact and funding are vital, whereas artificial intelligence, multiple shared access and health monitoring trackers can shape future perinatal interventions. IMPACT:A mobile-health-based perinatal intervention can have an enormous positive impact on the psychological well-being of vulnerable mothers worldwide. REPORTING METHOD:This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. PATIENT OF PUBLIC CONTRIBUTION:This study did not include patient or public involvement in its design, conduct or reporting. STUDY REGISTRATION:ClinicalTrials.gov (Registration ID: NCT06363019). Registered 4/12/23, first recruitment on 26/02/2024.

AIM:To explore peer volunteers' experiences of delivering online support through SMART to at-risk mothers during the perinatal period, to inform future improvements to mobile-health-application (mHealth app) based peer-support interventions. DESIGN:Descriptive qualitative research. METHODS:The study was conducted between February 2024 and June 2025 in a tertiary public healthcare institution in Singapore. Twenty peer volunteers were recruited via convenience and snowball sampling and participated in individual semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS:Four themes were identified: (a) Giving and receiving: the inner world of peer volunteers; (b) Navigating relational complexity in digital peer support; (c) Facilitating connection and continuity in digital peer support; and (d) Building better connections through supportive ecosystems. CONCLUSION:Peers reported experiencing reciprocal benefits, such as a sense of fulfilment and achievement, while supporting mothers. Shared experiences and psychosocial vulnerabilities enhanced relatability, reassurance and rapport, which sustained supportive relationships. Challenges encountered by peers highlighted the need for strengthening both intervention design and peer training. IMPLICATIONS FOR PATIENT CARE:Regular check-ins by programme facilitators, alongside clear information, flexible guidelines and reassurance, can improve peer volunteers' motivation and resilience, thereby ensuring consistent and sustainable support for at-risk mothers. IMPACT:Examined peer volunteers' experiences in providing online perinatal support to mothers with diverse psychosocial vulnerabilities. Peers offered emotional, informational and practical support, while mothers benefited from learning how peers had coped with their psychosocial vulnerabilities. Shared experiences fostered confidence and reassurance among mothers that they, too could overcome similar adversities. Valuable in providing both medically accurate perinatal information and meaningful social support to perinatal mothers. REPORTING METHOD:The reporting of the study adheres to the standards outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTION:Mothers and peer volunteers contributed valuable insights and suggestions that helped in the design of the intervention.

Fathers and/or non-birthing partners are now actively involved in child-rearing globally; however some experience emotional difficulties during the perinatal period. With the birth of a preterm infant, parents experience additional stress beyond that normally engendered by having a baby, which can impact on parent-infant relationship and infant development. In Australia, there is limited evidence on fathers' experiences of preterm birth. Thus, this study aimed to explore the experiences of Australian fathers of preterm infants including their emotional and physical wellbeing when they have a preterm infant. Narrative inquiry guided the study; 13 fathers whose preterm infant was admitted to Australian neonatal units participated in in-depth interviews lasting 22-72 min. Data analysis generated four themes: (i) emotional response, (ii) fathers' wellbeing, (iii) fathering in neonatal unit and during transition home (iv) fathers' needs in the neonatal unit. The findings revealed that fathers felt emotionally overwhelmed, had specific needs but their role in the neonatal unit was not well defined and they felt mothers were given more attention. Despite feeling excluded, many continued to support their partner and infant. Health professionals must be aware of their unconscious biases toward gender roles in the neonatal unit and utilize strategies to actively include fathers and non-birthing partners.

AIM:This study aimed to determine the longitudinal impact of the EArly Collaborative Intervention (EACI), a three-session early intervention designed to enhance parent-infant interaction, on the developmental outcomes of preterm infants born between 30 + 0 and 35 + 6 weeks of gestation. METHODS:This randomised controlled blinded study recruited families in two neonatal intensive care units in Sweden. In this one-year follow-up, 87 infants (standard care = 37, standard care with EACI = 50) were included in the intention-to-treat analysis. The primary study outcomes were cognition, receptive and expressive communication, and fine and gross motor development measured with the Bayley-III. RESULTS:At one year of age (mean age 13.1 months SD = 0.64), there was a statistically significant effect in the intention-to-treat analysis on receptive communication F(1, 85) = 4.61, p = 0.035, η2 = 0.051. No statistically significant effects were found on the other Bayley-III outcome measures. There were no significant differences between the groups regarding gestational age, birth weight, gender, parents' education, or age at assessment. CONCLUSION:This new intervention indicates a small positive effect on moderate-to-late preterm infants' communication ability at one year of age. Though the attrition rate was relatively large, results are encouraging since clinical interventions supporting moderate-to-late preterm infants and parents are lacking. TRIAL REGISTRATION:ClinicalTrials.gov: NCT02034617.

AIM:The purpose of this study was to describe and evaluate the effectiveness of a six-month structured bowel management programme (SBMP) for children with therapy-resistant functional constipation (FC). METHOD:A retrospective review of medical records with a pre-post design was conducted at an outpatient paediatric clinic in Sweden. Bowel frequency, stool form, faecal incontinence, and abdominal pain were compared before and after the intervention. Predictive factors for successful discharge and duration of care through long-term follow-up were calculated. RESULTS:Of the 142 children enrolled in the SBMP, 132 completed the programme. Despite previous FC therapy resistance, the SBMP achieved a treatment success rate of 44 % within 6 months, and 58 % after 12 months. The need for additional contacts beyond those scheduled and persistent faecal leakage were significant predictors of non-recovery. Long-term follow-ups indicate that after 2 years of care, approximately 80 % of the children achieved recovery. CONCLUSION:This study highlights the effectiveness of the SBMP in managing therapy-resistant FC in children at a general outpatient paediatric clinic, while also emphasising the necessity of long-term follow-up for sustainable results. IMPLICATIONS TO PRACTICE:The results suggest that a structured care programme like the SBMP helps set realistic expectations and ensures consistent quality of care for children with FC, despite the severity and complexities involved.