Increased Risk of Parental Instability for Children Born Very Preterm and Impacts on Neurodevelopmental Outcomes at Age 12

Abstract

Caring for a child born preterm places significant emotional and financial burdens on family relationships. This paper examines (a) the extent to which children born very and extremely preterm are more likely to experience parental change/caregiver instability than children born full term, (b) predictors of parental change/s for preterm infants, and (c) whether exposure to parental change/caregiver instability increases child neurodevelopmental risk. Data were collected as part of a prospective longitudinal study of 110 very preterm and 113 full-term born infants and their parents studied from birth to corrected age 12 years. At ages 2, 4, 6, 9 and 12 years, detailed information was collected about the frequency and nature of all parent/caregiver changes for 3–6 monthly intervals of each child’s life. At age 12, all children completed a comprehensive neurodevelopmental evaluation of their emotional and behavioural adjustment, cognition, and educational achievement. Results showed that children born very preterm were at increased risk of experiencing parental/caregiver changes, with this risk being greatest for those born extremely preterm. Neonatal medical complexity, family socioeconomic disadvantage, maternal psychological wellbeing, and child neurodevelopmental impairment were associated with a higher risk of parental change. Preterm birth and exposure to parental change/instability contributed additively to poorer child outcomes. Findings support the need for family-focused neonatal and postnatal care strategies for high-risk infants, to support parents as well as their infants to optimize child health and developmental outcomes.

Stress of Prematurity in the Experience of the COVID-19 Pandemic—Current State of Knowledge

“…Around-the-clock care for the preterm infant, hospital visits, uncertain prognosis, and frequent stressful situations can lead to significant emotional exhaustion in the family. This has a negative impact on relationships and the well-being of the family [ 73 , 74 , 77 , 78 , 80 , 81 , 82 , 83 ].…”

“…A total of 3161 tweets from parents of premature infants were analyzed. It was found that the COVID-19 pandemic and the associated restrictions, which affected parents’ contact with preterm infants, imposed significant emotional burdens on the studied group [ 76 , 80 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ]. Health safety concerns: Mothers of premature infants have heightened concerns about their children’s health in the context of the pandemic.…”

“…The result of this study highlights the importance of kangaroo care for the mental health of mothers, which was often impossible or limited during the COVID-19 pandemic. According to WHO, Kangaroo mother care has been demonstrated to reduce baby mortality by as much as 40%, hypothermia by more than 70%, and severe infections by 65% in infants delivered preterm or at low birthweight [ 76 , 80 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ]. Restrictions on accessing medical care: The COVID-19 pandemic and the associated restrictions significantly hindered access to medical care and contact with doctors.…”

“…At the beginning of the pandemic noticed that clinics and rehabilitation centers suspended their operations during the lockdown, follow-up appointments, therapy, and psychological support services have been discontinued in many locations around the world. This has many parents extremely concerned for the unpredictable effects on their child’s health [ 76 , 80 , 88 , 89 , 90 , 91 , 92 , 93 , 94 ]. Separation of the premature baby from parents: Uncertainty related to coronavirus infection and its health consequences necessitated extraordinary precautions and safety measures in medical facilities.…”

“…During the initial phase of the pandemic, mothers were completely isolated from their newborn babies and often saw them for the first time after completion of treatment in the NICU. This prolonged separation caused significant anxiety and stress in mothers of premature infants [ 76 , 80 , 89 , 90 , 91 , 92 , 93 , 94 ]. Altered care conditions: Due to the pandemic, the standard procedures for care in neonatal intensive care units (NICUs) had to be modified to ensure the safety of both healthcare staff and patients.…”