The Newborn in the Intensive Care Unit: A Neuropsychoanalytic Prevention Model

by Romana Negri

Overview

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.

Product Details

ISBN-13:	9781782201168
Publisher:	Karnac Books
Publication date:	08/28/2014
Series:	Harris Meltzer Trust Series
Edition description:	Revised Edition
Pages:	400
Product dimensions:	6.00(w) x 8.90(h) x 1.30(d)

About the Author

Romana Negri graduated in medicine and trained as a child neuropsychiatrist at the University of Milan. From 1970 onwards she attended the seminars of Martha Harris and Donald Meltzer and commenced work projects inspired and influenced by their teaching. From 1976 to 2004 she was a consultant in the Special Care Baby Unit at the Caravaggio Hospital, Treviglio, publishing some of her research findings in The Newborn in the Intensive Care Unit. Since 1982 she has been a professor at Milan University, teaching in the paediatric department of the School of Medicine and the School of Psychiatry and Psychology. She is also responsible for early pathology consultation at the Sacco Hospital in Milan. She has published over one hundred papers in the field of early psychopathology and child psychiatry in Italy, Germany, France, Spain, and England.

Table of Contents

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

Editorial Reviews

"This powerful and moving book grows out of Romana Negri’s thirty years of psychoanalytically informed work as Consultant Neuropsychiatrist to a neo-natal intensive care unit. The premature babies she observes are suspended between life and death, as are the feelings of their parents and the nurses who care for them. The reader witnesses how Dr Negri opens herself to the babies’ experience and introduces the tiny human beings she encounters to their parents as well as to the professionals. Her ability to support the adults, whether in maintaining hope or in dealing with death, creates a family atmosphere within a high-tech hospital department.

This book brings psychoanalytic insight and academic scholarship in medicine and child development together with a profound humanity. It was recognised as a classic when it was first published twenty years ago, and has now been updated and extended, with the addition of chapters on the death of the child and on the experience of siblings. It provides a fascinating glimpse of the interface between mind and body, as well as an illuminating exposition of theoretical concepts. It will be of interest to parents, to doctors and nurses, to psychoanalysts and psychotherapists, and to anyone concerned with the beginnings of the mind."

Maria Rhode