Parent and family outcomes following very preterm or very low birth weight birth: A review

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Summary

Parents and the family environment have a pronounced influence on child development. For children at increased risk such as those born very preterm (VPT) or with very low birth weight (VLBW), parent and family functioning can influence the child’s level of risk or resilience. This review describes parent and family outcomes after VPT/VLBW birth, specifically parental mental health, parenting stress and the impact of the child on the family. Factors associated with these outcomes are examined, as well as the specific outcomes for fathers. Overall the influence of VPT/VLBW birth on parents and the family appears to be more pronounced in early childhood, with less influence seen by the time of adolescence. Emerging evidence suggests that fathers experience high rates of psychological distress in the first months after VPT birth. Whereas characteristics of the VPT/VLBW child are strongly associated with parent and family outcomes, parent and social factors are also important influences.

Introduction

Sameroff and Seifer [1] proposed that a child's developmental risk relates to the ability of parents and the environment to moderate the effects of risk factors on the child. This statement reflects the widely accepted assertion that parents and the family environment have a pronounced influence on child development [2], and have the potential to provide a buffer against poor outcomes for children at high risk. This statement is directly relevant to children born very preterm (VPT, born <32 weeks of gestational age), who have an increased risk for impairments in neurosensory, physical, social–emotional, and academic functioning [3], [4], [5]. Although the research is limited, a more optimal home environment has been associated with improved cognitive and social–emotional development for VPT children, supporting this buffering effect [6], [7], *[8].

Within an ecological framework, the daily activities and social interactions between family members in the home environment are the most immediate and proximal influences on child development, but these relationships are also reciprocal [9]. Thus in order to understand how parents and the family may be able to buffer against risk and promote optimal outcomes for VPT children, we need to know the levels and patterns of distress and adaptive functioning of parents and families of VPT infants. It is important that parent and family outcomes are understood over the course of time from birth to early adulthood, because in addition to the significant and stressful event of the preterm birth itself and subsequent stay in the neonatal intensive care unit (NICU), the consequences for the child and parents associated with VPT birth can be ongoing, such as impairments in child neurodevelopment.

This review examines the relationship between preterm birth and parent and family outcomes over time. The focus of the review is on the most vulnerable infants, such as those born VPT or extremely preterm (<28 weeks of gestation). Given that for many earlier studies (prior to the introduction of routine prenatal ultrasound in the 1990s) birth weight was used to classify infants rather than gestational age, studies reporting parent and family outcomes for very low birth weight (VLBW; <1500 g) or extremely low birth weight infants (ELBW; <1000 g) are also discussed.

Section snippets

Parental mental health outcomes

Understanding parental mental health outcomes following VPT/VLBW birth is particularly important due to potential negative effects on children's health and development. In the general population, maternal postnatal depression has been associated with increased maternal negativity, unresponsive or negative maternal–child interaction, impairment in ability to recognize infant cues, providing fewer learning opportunities, more child behavior and emotional problems, and poorer language and

Parenting stress outcomes

The Parenting Stress Index (PSI) [30] is the most commonly used measure of stress associated with parenting that has been used with families with VPT/VLBW children, and includes domains of parent-related stress, child-related stress, parent–child relationship stress, and overall stress. The interest in stress associated with the parenting role is based on research suggesting a negative influence of high parenting stress on child outcomes for VPT children [12]. There is also a measure of parent

Family functioning outcomes and impact on the family

Some studies have looked to the family unit more broadly to examine the impact that having a VPT/VLBW child has on family systems. Many of these studies have used the Impact on Family questionnaire (IOF [41]), which is based on parental report of the influence the child has (whether chronically ill or not) on the social systems of the family, such as disruption of social relationships, parental coping, and financial impact. In the preschool years, research suggests an increased negative impact

Outcomes for fathers after VPT/VLBW birth

The majority of research on mental health and family outcomes for families after VPT/VLBW birth has been based on maternal self-report, with fathers rarely included. The few studies that have attempted to capture the experiences of fathers after VPT birth have been based on small samples, primarily from the newborn or NICU period, and have used qualitative measures. However, there is preliminary evidence that fathers also experience high rates of distress in the first months after birth. In 35

Conclusions and clinical implications

Within the first 2 years after VPT/VLBW birth, parents report higher levels of mental health problems, higher levels of stress associated with being a parent, and an increased negative impact on family systems compared with parents of term-born or NBW children. Rates of psychological distress and depression appear to be particularly high, with between 13% and 40% of mothers of VPT/VLBW infants reporting significant clinical symptoms within the first few months after the birth [18], [48], and

Conflict of interest statement

None declared.

Funding sources

Dr Treyvaud is supported by the NHMRC Centre for Clinical Research Excellence in Newborn Medicine (546519) and the Murdoch Childrens Research Institute Clinical Sciences Theme.

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