title: Perception of child vulnerability among mothers of former premature infants.
abstract: OBJECTIVE
  Parents of premature infants often perceive their infants as medically vulnerable. High parental perception of child vulnerability (PPCV) is associated with disproportionately high health care utilization. The objectives of this study were to determine whether higher PPCV is correlated with worse developmental outcome in premature infants at 1-year adjusted age and to identify factors, present at neonatal discharge, that predict high PPCV.
  
  
  METHODS
  This prospective cohort study assessed mothers of 116 premature infants who were </=32 weeks' gestation and required supplemental oxygen at 36 weeks postmenstrual age. At neonatal discharge, mothers completed the Spielberger State Anxiety Inventory, Beck Depression Inventory, Impact on Family Scale, Life Orientation Test, General Health Survey, and Medical Outcomes Study social support survey. At 1-year adjusted age, child development was assessed using the Bayley Scales of Infant Development and Vineland Adaptive Behavior Scales, and mothers completed the Vulnerable Child Scale, a 16-item self-report measure of PPCV. Chart review was performed to determine the presence or absence of specific indicators of medical vulnerability at 1-year adjusted age.
  
  
  RESULTS
  Mean infant gestational age and birth weight were 26.5 +/- 2.5 weeks and 894 +/- 287 g. A total of 69% of mothers were white, and 78% were high school graduates. Higher PPCV (lower Vulnerable Child Scale score) was correlated with lower scores on the Vineland Adaptive Behavior Composite and Bayley Psychomotor Developmental Index but not on the Bayley Mental Developmental Index. After controlling for the presence of 1 or more indicators of medical vulnerability, higher PPCV was still correlated with lower adaptive development. This correlation was stronger in the group of children with no indicators of medical vulnerability. In univariate analyses, higher PPCV was predicted by nonfirstborn status; longer neonatal hospitalization; higher maternal anxiety and depression; greater impact of the illness on the family; and lower maternal optimism, life satisfaction, and social support. PPCV was not associated with maternal age, education, marital status, income, or ethnicity or with child gender, gestational age, birth weight, or length of mechanical ventilation. A linear regression model containing all variables significant at the univariate level explained 29% of the variance in PPCV. Maternal anxiety was the only variable that was statistically significant in the full model.
  
  
  CONCLUSIONS
  Higher PPCV is associated with worse developmental outcome in premature infants at 1-year adjusted age. Maternal anxiety at neonatal discharge predicts later high PPCV. Interventions to prevent or decrease PPCV in premature infants should be targeted at parents who are more anxious at hospital discharge.
authors.affiliation: Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27103, USA. eallen@wfubmc.edu
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Allen
authors.forename: Janeen C
authors.initials: JC
authors.lastname: Manuel
authors.forename: Claudine
authors.initials: C
authors.lastname: Legault
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Naughton
authors.forename: Carol
authors.initials: C
authors.lastname: Pivor
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
mesh_terms: D000704:Analysis of Variance; D001724:Birth Weight; D002657:Child Development; D003863:Depression; D005260:Female; D005865:Gestational Age; D006304:Health Status; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000145:classification; D007234:Infant, Premature; D016014:Linear Models; D008297:Male; D008425:Maternal Behavior; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D010465:Perception; D011446:Prospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors