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Perception of Child Vulnerability Among Mothers of Former Premature InfantsAllen EC, Manuel JC, Legault C et al. Pediatrics 2004;113:267-273
Reviewed by: Thomas J. Mancuso, MD, FAAP
It is known that high parental perception of child vulnerability is associated with disproportionately high use of health care. Parents of former preterms often feel that their child is highly medically vulnerable. The objective of this study was to determine whether or not parental perception that their child was highly medically vulnerable was associated with worse developmental outcome at one year.
Mothers of 116 preterm (< 32 weeks gestation) infants were enrolled. Indices of anxiety, depression, impact on family life, general health were obtained from participants at the outset of the study and at one year of age the child's development was assessed as well as maternal anxiety. A chart review was conducted to determine presence or absence of specific indicators of medical vulnerability.
The authors concluded, through multi-variate analyses and use of linear regression model that of all factors, greater maternal anxiety was the only variable that was statistically significantly related to poorer developmental outcome of these ex-preterms.
Ex-preterms often come for surgical procedures, such as the very commonly performed inguinal herniorraphy. While this a relatively minor procedure to us it certainly is not at all minor to the parents of any infant but even more so to the parents of an ex-preterm. I think this paper points out how important it is that we, as anesthesiologists, understand the parents of these infants so that we can provide the best overall care to the family, which is more than excellent medical care to the infant. I am sure that most, if not all of you, have had parents confide, during the preanesthetic visit, that the anesthetic is much more frightening to them than the surgical procedure. Maternal anxiety was the only factor that reached statistical significance in affecting developmental outcome. Strongly associated with increased maternal anxiety were: longer neonatal hospitalization and greater impact of the illness on the family, factors that should come up during the pre-anesthetic interview. With information such as contained in this paper, we should be better able to connect with and reassure anxious parents of ex-preterm infants even during a brief preanesthetic visit.
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