A. Tooten

The effectiveness of video interaction guidance in parents of premature infants: A multicenter randomised controlled trial

BackgroundStudies have consistently found a high incidence of neonatal medical problems, premature births and low birth weights in abused and neglected children. One of the explanations proposed for the relation between neonatal problems and adverse parenting is a possible delay or disturbance in the bonding process between the parent and infant. This hypothesis suggests that due to neonatal problems, the development of an affectionate bond between the parent and the infant is impeded. The disruption of an optimal parent-infant bond -on its turn- may predispose to distorted parent-infant interactions and thus facilitate abusive or neglectful behaviours. Video Interaction Guidance (VIG) is expected to promote the bond between parents and newborns and is expected to diminish non-optimal parenting behaviour.Methods/designThis study is a multi-center randomised controlled trial to evaluate the effectiveness of Video Interaction Guidance in parents of premature infants. In this study 210 newborn infants with their parents will be included: n = 70 healthy term infants (>37 weeks GA), n = 70 moderate term infants (32–37 weeks GA) which are recruited from maternity wards of 6 general hospitals and n = 70 extremely preterm infants or very low birth weight infants (<32 weeks GA) recruited by the NICU of 2 specialized hospitals. The participating families will be divided into 3 groups: a reference group (i.e. full term infants and their parents, receiving care as usual), a control group (i.e. premature infants and their parents, receiving care as usual) and an intervention group (i.e. premature infants and their parents, receiving VIG). The data will be collected during the first six months after birth using observations of parent-infant interactions, questionnaires and semi-structured interviews. Primary outcomes are the quality of parental bonding and parent-infant interactive behaviour. Parental secondary outcomes are (posttraumatic) stress symptoms, depression, anxiety and feelings of anger and hostility. Infant secondary outcomes are behavioral aspects such as crying, eating, and sleeping.DiscussionThis is the first prospective study to empirically evaluate the effect of VIG in parents of premature infants. Family recruitment is expected to be completed in January 2012. First results should be available by 2012.Trail registration numberNTR3423

Parenting in Complex Conditions: Does Preterm Birth Provide a Context for the Development of Less Optimal Parental Behavior?

OBJECTIVE To examine the predictive value of parent, infant, and contextual factors related to preterm childbirth for later parenting behaviors. METHODS Mothers (n = 217) and fathers (n = 204) of term, moderately preterm, and very preterm infants were interviewed 1 month postpartum using the Clinical Interview for Parents of high-risk infants (CLIP), to assess their experiences and perceptions related to the pregnancy, delivery, infant, hospitalization, support system, and their narratives. Their responses were factor analyzed and entered into prediction models of parental behaviors (National Institute of Child Health and Human Development observations) 6 months postpartum. RESULTS Preterm birth was associated with negative experiences and concerns in parents. Regression analyses revealed, however, that irrespective of preterm birth, negative and unrealistic parental perceptions predicted less sensitive, more intrusive, and more withdrawn behavior. CONCLUSIONS Not prematurity per se, but particularly the presence of negative perceptions in parents, is predictive of difficulties in parent-infant interaction. The CLIP is a potentially useful instrument to identify families at risk.

Maternal and paternal infant representations: A comparison between parents of term and preterm infants

OBJECTIVE Research on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations. METHOD Mothers and fathers of term infants (≥ 37 weeks of gestational age, n=71), moderately preterm infants (≥ 32-37 weeks of gestational age, n=62) and very preterm infants (<32 weeks of gestational age, n=56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D). RESULTS The three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal. CONCLUSION Given the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations.

The Quality of Parent–Infant Interaction in the First 2 Years After Full-Term and Preterm Birth

SYNOPSIS Objective. Relatively few studies have examined stability and/or change in the quality of parenting behaviors across the first years of a preterm infant’s life and how this course may differ from parents of term infants. Design. The present study examined the quality and stability of mother–infant and father–infant interaction across the first 2 years post-partum in a sample of 231 Dutch families with either a term or a preterm infant. Video recordings of parent–infant interactions were made at four points (1 day, 1 month, 6 months, and 24 months post-partum), and three aspects of parental behavior (sensitivity, intrusiveness, and withdrawal) and four aspects of infant behavior (positive mood, negative mood, activity level, and sustained attention) were analyzed by the National Institute of Child Health and Human Development coding scales. Results. The study found moderate levels of stability in parenting behaviors, but not in infant behaviors, across time. Prematurity had negligible effects on parental interactive behavior, but clear effects on infant behaviors. Parental background factors (educational level) had strong effects on parental interactive behaviors. Parents who displayed a relatively poor quality parent–infant interaction were likely to have partners who also demonstrated relatively poor quality parent–infant interaction. Conclusions. Results recommend early identification of parents who are likely to show poor levels of parenting, inclusion of both mothers and fathers in prevention/intervention programs.