The complex management of ventilator-assisted children cared for in the home can place emotional and mental strain on parents, in particular, mothers. The purpose of this study was to explore the relationships among functional status of the child, impact of ventilator-assistance on the family, coping, social support, and depression in mothers caring for ventilator-assisted children at home. Thirty-eight mothers participated in the study. Almost half of the mothers experienced depressive mood symptoms. Impact on family was positively related to depression and social support was inversely related to depression. In addition, social support was a significant predictor of depression. The findings show that the high demands related to the care of ventilator-assisted children can be a significant risk factor for poor mental health outcomes of those mothers providing care at home. Interventions by mental health and pediatric nurses should focus on enhancing mothers' coping skills and assisting mothers in accessing a positive social network to help mediate the stress related to caring for their child.

A randomized clinical trail (RCT) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury. The control group infants received the State-funded follow-up program provided by the Los Angeles (LA) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System (CAMS) taught by public health nurses (PHNs). The developmental assessments and outcome measures were performed at 6, 12 and 18 months corrected age and included the Bayley motor and mental development, the Home, mother-infant interaction (Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment Teaching Scale (NCATS)), parental stress and social support. At 18 months, 43 infants remained in the study.The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group. Likewise, the intervention did not contribute to less stress or better mother-infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months. There was a significant trend, however, for the control group to have a significant decrease over time on the Bayley mental scores. Although the sample was not large and attrition was at 31%, this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome. Keywords Newborn brain injury; Stimulation; Intervention; OutcomeOver the past 30 years, evidence has been accumulating for the neuro-plasticity of the human brain, allowing for recovery of important brain regions after injury. The organization of interconnected neurons, which make up neural systems, is not structurally or functionally rigid as once believed. Rather, individual neurons are able to modify their intrinsic membrane properties and the strength of their synaptic connections in response to varying levels of stimulation (du Plessis & Volpe, 2002;Kennedy & Marder, 1992). The newborn's brain develops in a stepwise, organized fashion. It involves the unfolding of discrete, sequential embryonic processes that include the division, migration and differentiation of neural elements, dendritic arborization, and maturation of synapses. As the brain develops and matures, behavioral patterns emerge that reflect the integration of complex cerebral networks (Berger & Garnier, 1999;Volpe, 2000).Several factors are implicated in the etiology of brain injury. The most common cause is hypoxic-ischemic encephalopathy (HIE) which has been associated with neuronal reorganization. Current data suggest that about 2-5 of 1000 live term births experience hypoxic-ischemic brain injury or intraventricular hemorrhage (IVH) of those, 30-40% die during the newborn period and 20-50%; of those, who survive develop signif...

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Research results can be better interpreted and used when reliable and valid instruments are used to measure concepts. Researchers and clinicians, especially those from locations outside the United States, have difficulty locating existing instruments for use in their research studies. The dilemma is further exaggerated when such instruments are not published and when the author of the instrument cannot be located. This review looked at the results of 20 studies which have utilized the Maternal Confidence Questionnaire (MCQ) (Zahr, 1991) with the purpose of familiarizing researchers and clinicians with its flexibility, reliability, and validity. Examples of specific published studies which have used the instrument are discussed along with unpublished studies which have used the instrument.

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