Parenting a VLBW Child May Have Both Positive and Negative Outcomes

From MedscapeCME Clinical Briefs

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd


June 29, 2010 — Parenting a very low-birth-weight (VLBW) child has both positive and negative outcomes, according to the results of a prospective cohort follow-up study reported in the June issue of Archives of Pediatric & Adolescent Medicine.

"Long-term outcome studies indicate persistent functional disabilities in a significant proportion of...VLBW children, leading to research interest in parental stress and adaptation to preterm birth and their effects on the family," write Lynn T. Singer, PhD, from Case Western Reserve University in Cleveland, Ohio, and colleagues. "Understanding the experiences of parents of VLBW children is important for medical decision making and the design of intervention programs to improve child outcomes. Children's behavioral and cognitive outcomes are known to be related to maternal psychological status, family stress, financial burden, and maternal coping strategies, all of which have been shown to be affected by VLBW birth."

The goal of the study was to evaluate longitudinal outcomes and factors affecting parental stress and coping in mothers of 113 high-risk VLBW children with bronchopulmonary dysplasia, 80 low-risk VLBW children without bronchopulmonary dysplasia, and 122 term children. These 3 groups had similar demographic characteristics and were followed up from birth to age 14 years.

From November 8, 1989, to February 22, 1992, participants were recruited from level III neonatal intensive care and term nurseries in a large Midwestern region, and they were subsequently followed up at an academic medical center. The main study endpoints were child IQ and self-reported measures of parenting stress, family impact, maternal coping, education, and social support.

Compared with term mothers, mothers of VLBW children had fewer additional years of education (P = .04). Compared with term mothers, mothers of high-risk VLBW children also reported more personal stress (P = .006) and family stress (P = .009) under conditions of low social support, as well as greater child-related stress. Despite greater perceived stress, however, mothers of high-risk VLBW children also reported the highest levels of parenting satisfaction at 14 years. With time, they became less likely to use coping mechanisms of denial (P = .02) and mental disengagement (P = .03).

Except for educational level, mothers of low-risk VLBW infants did not differ from mothers of term children. At 14 years, mothers of low-risk VLBW infants reported the lowest stress of all 3 groups.

"Parenting a VLBW child had both positive and negative outcomes, dependent on child medical risk, child IQ, social support, and maternal coping mechanisms, suggesting that mothers experience posttraumatic growth and resilience after significant distress post partum," the study authors write.

Limitations of this study include reliance on mothers' self-report of stress and coping and long intervals between follow-up visits.

"Although mothers of VLBW children demonstrate significant resilience through their children's early adolescence on the whole, mothers with low social support, with avoidant coping styles, and whose children have significant disabilities should continue to be monitored by health care and education professionals," the study authors conclude. "It will be important to educate health care providers about the role of coping mechanisms and social support in modifying stress. More research is needed into the best ways to support parents of VLBW children and to help them develop adaptive coping mechanisms."

The Maternal and Child Health Program, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland, supported this study. The study authors have disclosed no relevant financial relationships.

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