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The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU. Full article

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. Full article

Background: Transportation of sick newborns is a major predictor of outcome. Prompt identification of the sickest newborns allows adequate intervention and outcome optimization. An optimal scoring system has not yet been identified. Aim: To identify a rapid, accurate, and easy-to-perform score predictive for neonatal mortality in outborn neonates. Material and methods: All neonates admitted by transfer in a level III regional neonatal unit between 1 January 2015 and 31 December 2021 were included. Infants with congenital critical abnormalities were excluded (N = 15). Gestational age (GA), birth weight (BW), Apgar score, place of birth, time between delivery and admission (AT), early onset sepsis, and sick neonatal score (SNS) were collected from medical records and tested for their association with mortality, including in subgroups (preterm vs. term infants); GA, BW, and AT were used to develop MSNS-AT score, to improve mortality prediction. The main outcome was all-cause mortality prediction. Univariable and multivariable analysis, including Cox regression, were performed, and odds ratio and hazard ratios were calculated were appropriate. Results: 418 infants were included; 217/403 infants were born prematurely (53.8%), and 20 died (4.96%). Compared with the survivors, the non-survivors had lower GA, BW, and SNS scores (p < 0.05); only the SNS scores remained lower in the subgroup analysis. Time to admission was associated with an increased mortality rate in the whole group and preterm infants (p < 0.05). In multiple Cox regression models, a cut-off value of MSNS-AT score ≤ 10 was more precise in predicting mortality as compared with SNS (AUC 0.735 vs. 0.775) in the entire group and in the preterm infants group (AUC 0.885 vs. 0.810). Conclusions: The new MSNS-AT score significantly improved mortality prediction at admission in the whole study group and in preterm infants as compared with the SNS score, suggesting that, besides GA and BW, AT may be decisive for the outcome of outborn preterm infants. Full article