Monday, July 12, 2010

Parenting a VLBW Child May Have Both Positive and Negative Outcomes

Arch Pediatr Adolesc Med. 2010;164:518-524. Abstract

Clinical Context

VLBW and extremely LBW infants are increasing, with more than 63,000 annually in the United States. Family stress and financial burden are higher, with maternal coping strategies also adversely affected.

This is a longitudinal study of mothers of VLBW vs term infants to examine the maternal impact associated with having a VLBW child.
Study Highlights

* The study included high-risk and low-risk VLBW and term infants born in a US city between 1989 and 1992.
* Mothers and children were followed up at 7 time points for assessment: ages 1 and 8 months, and 1, 2, 3, 8, and 14 years.
* Children with VLBW were categorized as high risk or low risk.
* High-risk VLBW children had a diagnosis of bronchopulmonary dysplasia, had a birth weight less than 1500 g, required supplemental oxygen for 28 days or more, and had radiologically proven chronic lung disease.
* Low-risk VLBW infants did not have a diagnosis of bronchopulmonary dysplasia, had a birth weight of less than 1500 g, and required oxygen supplementation for less than 25 days.
* Excluded were infants with congenital malformations, whose mothers had alcohol exposure during pregnancy, psychiatric illness, HIV, or mental retardation.
* Also excluded were 4 infants in whom cancer subsequently developed.
* The cohort consisted of 113 high-risk, 80 low-risk, and 122 term infants, of whom 78% were seen at 4 or more visits at the duration of follow-up.
* Mothers completed several questionnaires at the follow-up visits.
* The Parenting Stress Index measured parental perceptions of stress related to child-rearing including 7 dimensions of stress (attachment, depression, role restriction, health, sense of competence, social isolation, and partner support) and child characteristics.
* The Stress Index for Parents of Adolescents (the adolescent version of the Parenting Stress Index) was given at 14 years.
* The Impact on Family Scale measures maternal perceptions of the child's negative and positive impact on the family, including financial impact.
* The Multidimensional Scale of Perceived Social Support, measured at 2 to 14 years, assessed the mother's perceived support from friends, family, and significant other.
* The Peabody Picture Vocabulary Test–Revised at infant birth was administered to mothers at all visits.
* All children were administered standardized normative IQ and developmental assessments at each visit including the Bayley Scales of Infant Development and the Wechsler Intelligence Scale for Children for IQ.
* High-risk VLBW infants had lower birth and gestational ages, more neurologic and medical risk factors at birth, and lower IQs at 8 years vs low-risk VLBW and term infants.
* IQ scores were less than 70 (intellectual disability) for 22% of high-risk VLBW, 10% of low-risk VLBW, and 3% of term infants.
* Mothers of term infants increased their educational level at a faster rate vs mothers of high-risk and low-risk VLBW infants and by 14 years had attained significantly more years of education (14.51 vs 13.82 years; P = .04).
* Mothers did not differ in use of coping mechanisms from birth through 3 years.
* However, mothers of high-risk VLBW infants reduced use of mental disengagement and denial from 8 to 14 years, resulting in lower use vs mothers of low-risk VLBW and term infants.
* Social support was similar for all groups during follow-up.
* Mothers of high-risk VLBW infants reported more financial stress, but the effect was neutralized when they had high levels of social support.
* High-risk VLBW birth was associated with higher child-related stress, mediated by lower IQ.
* However, by 14 years, mothers of high-risk VLBW infants had lower child-related stress than mothers of both low-risk VLBW and term infants.
* The authors concluded that mothers of high-risk VLBW infants were less likely to advance in education and to experience higher financial stress under situations of low social support.
* However, they noted that mothers of high-risk VLBW infants adapted their coping mechanisms and were less likely than mothers of low-risk VLBW and term infants to use mental disengagement and denial for coping, demonstrating resilience to having a VLBW child.
* They suggested that mothers of VLBW infants with low social support be provided with greater monitoring and help.

Clinical Implications

* Mothers of high-risk VLBW infants attain fewer years of education by 14 years after birth than mothers of term infants.
* Mothers of high-risk VLBW infants are less likely to use disengagement and denial as coping mechanisms by 8 years after birth.

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