The uncertainty regarding the future well-being of very low birth weight infants is a source of considerable anxiety for parents, even after discharge from the hospital. We identify factors related to postdischarge anxiety levels of parents of 65 infants. Infant's weight relative to gestational age; the presence of central nervous system complications; informational support; and a warm, caring attitude by hospital staff explained 35% of the variance in mothers' anxiety levels. Father's age, infant's gender, perception of the infant as problematic, and the availability of child care support explained 33% of the variance in fathers' anxiety levels. Practice implications, including both identification of high-risk groups and interventions aimed at bringing about change in specific factors, are discussed.

Parental adjustment following the death of a premature singleton or multiple birth infant has hitherto been studied by mailed questionnaires or telephone survey. In the present study, using an in-depth personal interview, grief reactions and adjustment patterns of nine families who lost a singleton premature infant ('Single Group') were compared with those of nine families who lost one of a premature multiple birth cohort ('Multiple Group'). The interview was conducted 1-4 years after the death of the infant and evaluated specific areas or 'scales' of life adjustment, including individual feelings, relationship between husband and wife, and functioning at home and at work. There was no significant difference between the paternal and maternal level of adjustment of the two groups in any of the studied scales. A positive correlation was found between maternal and paternal grief reaction of the same family in the scales of individual feelings (r = 0.65), relationships between husband and wife (r = 0.70), and functioning at home (r = 0.57). Comparing the father's scale with the mother's scale revealed a significant difference only in the area of 'individual feelings'. The gestational age, maternal bonding during hospitalisation of the infant and the parental attendance at the event of death were significantly associated with the process of parental adjustment. The results of this study support previous reports of similar parental reactions following the demise of a premature singleton or multiple birth infant. Since societal environment may not recognise the need for consolation of these families, care, compassion, and sensitivity should be encouraged in dealing with these parents at the time of their infant' death, and for a long time thereafter.

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Background: It has been hypothesized that early initiation of oral feeding in premature infants may enhance the maturation of sucking patterns. Aim: To compare preterm infant sucking characteristics in urban level III neonatal care units in the USA and Israel. The two hospitals have different practices regarding the introduction of oral feeding. Methods: Infants were assessed at 34–35 wk postconceptional age (PCA) and at term. Sucking parameters were assessed with the Kron's Nutritive Sucking Apparatus. Results: 70 infants (38 Americans and 32 Israelis) participated in the study. Oral feedings were initiated earlier (32.6±4.3 vs 34.5±1.8 wk PCA, p<0.01) and full oral feedings were reached earlier (35.4±2.8 vs 36.5±2.5 wk PCA, p<0.05) in the USA infants. American preterm infants produced significantly more sucks (p<0.001), had a higher suck rate (p<0.001), more sucks per burst (p<0.05), and a shorter interburst width (p<0.01) at 34 wk PCA than Israeli infants. At term, American infants produced significant more sucks (p<0.001), higher suck rate (p<0.001), shorter intersuck width (p<0.001), and a shorter interburst width (p<0.05) than the Israeli infants of the same PCA. Conclusion: Different practices in the care of preterm infants, such as postconceptional age at introduction of oral feeding, may play a role in the development of feeding and feeding organization at term.

Par ental adjustment fol l ow i ng the death of a pr ematur e si ngl eton or mul ti pl e bi r th i nfant has hi ther to been studi ed by mai l ed questi onnai r es or tel ephone sur vey. I n the pr esent study, usi ng an i n-depth per sonal i nter vi ew, gr i ef r eacti ons and adjustment patter ns of ni ne families who lost a si ngl eton pr ematur e i nfant ('Si ngl e Gr oup') w er e compar ed w i th those of ni ne fami l i es w ho l ost one of a pr ematur e mul ti pl e bi r th cohor t ('M ul ti pl e Gr oup'). The i nter vi ew w as conducted 1-4 year s after the death of the i nfant and eval uated speci fi c ar eas or 'scal es' of l i fe adjustment, i ncl udi ng i ndi vi dual feel i ngs, r el ati onshi p betw een husband and w i fe, and functi oni ng at home and at w or k . Ther e w as no si gni fi cant di ffer ence betw een the pater nal and mater nal l evel of adjustment of the tw o gr oups i n any of the studi ed scal es. A posi ti ve cor r el ati on w as found betw een mater nal and pater nal gr i ef r eacti on of the same fami l y i n the scal es of i ndi vi dual feel i ngs (r = 0.65), r el ati onshi ps betw een husband and w i fe (r = 0.70), and functi oni ng at home (r = 0.57). Compar i ng the father 's scal e w i th the mother 's scal e r eveal ed a si gni fi cant di ffer ence onl y i n the ar ea of 'i ndi vi dual feel i ngs'. The gestati onal age, mater nal bondi ng dur i ng hospi tal i sati on of the i nfant and the par ental attendance at the event of death w er e si gni fi cantl y associ ated w i th the pr ocess of par ental adjustment. The r esul ts of thi s study suppor t pr evi ous r epor ts of si mi l ar par ental r eacti ons fol l ow i ng the demi se of a pr ematur e si ngl eton or mul ti pl e bi r th i nfant. Si nce soci etal envi r onment may not r ecogni se the need for consol ati on of these fami l i es, car e, compassi on, and sensi ti vi ty shoul d be encour aged i n deal i ng w i th these par ents at the ti me of thei r i nfant' death, and for a l ong ti me ther eafter.Keyw or ds: preterm death, si ngl eton, tw i n, parental adjustment I ntr oducti on Neonatal l oss i s a very traumati c event for the fami l y involved, and its psychological implications have become the subject of expandi ng research.1-14 Some evi dence has been presented i ndi cati ng that the l onger the antenatal or postnatal bondi ng peri od w i th the i nfant, the deeper and more persi stent are the gri ef reacti ons experi enced by the parents. 1,3,5,6,11,15 Father and mother apparentl y do not gri eve uni forml y. 5,6,9,12,13,[16][17][18][19][20][21][22][23][24][25][26] M ost studi es of i nfant death refer to mi xed popul ati ons: mi scarri age, still birth, neonatal death and SIDS. 3,5,12,13,[16][17][18]20,21,23,25 The grow i ng number of mul ti pl e gestati on del i veri es resul ti ng from hormonal therapy and in vitro ferti l i sati on has l ed al so to an i ncreasi ng occurrence of a neonatal mul ti pl e bi rth death i n the premature nurseri es. 6,[27][28][29][30] In these turbul ent si tuati ons, parents m...