The Newborn in the Intensive Care Unit

This revised edition of a classic work on the development of premature infants has been updated and extended with the addition of chapters on the death of the child and on the experience of siblings.

This book is all about the emotional experience of the baby who has not had enough of one type of life to be able to transfer its emotional allegiances to the new one. The approach to this problem, as it is illustrated here, involves a philosophy that goes far beyond the humane attitude of alleviating suffering which operates in hospital medicine.

Foreword Donald Meltzer The ugly duckling A story by Meg Harris Williams Introduction Table 1: alarm symptoms Table 2: preventive environmental actions 1. Work with the parents The approach with parents Anxieties about death The narcissistic wound The aesthetic conflict The methodology of intervention Interrupted pregnancy The separation-individuation process Catastrophic anxiety and the sense of guilt Conclusions 2. The death of the newborn Death at the very outset of the life The death of the newborn Confusion of feelings and thoughts Odd actions and reactions How the death of the newborn is dealt with in hospital How parents face the grief caused by the death of their child Bereavement Problems encountered by staff when faced by the death of a newborn Considerations on the sharing of the parents' grief Conclusions 3. Work with the staff Work method and level Model evolution Theoretical discussion and presentation of the clinical experience Phase I The emotional atmosphere: the state of paranoid anxiety Phase II The concept of the neutral role Phase III Mirror resonance: nurses experience mothers' and children's feelings Phase IV Thinking about the work group: nurses talk about themselves Conclusions 4. Infant observation Methodological aspects Difficulties of infant observation in the incubator The first period The child's suffering The child's physiognomy The image of the living child in the parents' mind The child's states of irritability and first mental movements; object differentiation Removal of the tracheal tube: a second birth The child's abrupt starting; grasping; sleep The child's first waking moments; the nurses start to separate from the child The child's first organizational patterns: 32-34 weeks Thought formation: the integration of sensorimotor experiences and emotional experiences deriving from the object relation The mother's depression and its mirror-like repercussions on the nursing staff: the emotional experience modulated by the child Splitting; the "toilet-breast"; the experience of trusting, of being contained Conclusions 5. The neuropsychological screening of the infant before discharge from hospital Infant examination 6. Follow-up after discharge from hospital Neurobiological premise The follow-up procedure Intervention methodology 7. Psychopathological risks Claustrophobic anxieties Semiological elements: alarm symptoms The parents' role Alarm symptoms and early psychopathology Correlation between alarm symptoms and confirmed early psychopathologies Multisystemic development disorders The psychosomatic syndrome The "minimal brain dysfunction syndrome", or "attention deficit disturbance with hyperactivity" Feeding disorders Pregnancies at risk Sleep disorders 8. Treatment of cases at psychopathological risk The therapeutic work group The transference with the therapist The function of non-saturation during the session Psychosomatic disorders and prognosis Conclusions 9. The problems of the siblings The birth of a sibling The birth of a premature sibling The risk of collusion between the parents resulting in attitudes of omnipotence and tyranny The unresolved problems of the elder sibling The sibling's difficulties when the newborn suffers from cerebral palsy or a pervasive development disorder The sibling as spectator The sibling as an ally Meetings with groups of siblings Observations of the family group Conclusions 10. The treatment and development of children with cerebral palsy The child The parents A difficult development Risks involved in the first period The process of separation and individuation The mothers' group The health providers' group References and bibliography Name index Subject index,

• By (author) Romana Negri