Singer L T, Salvator A, Guo S, Collin M, Lilien L, Baley J
Department of Pediatrics, School of Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA.
JAMA. 1999 Mar 3;281(9):799-805. doi: 10.1001/jama.281.9.799.
Few studies document how parents adapt to the experience of a very low-birth-weight (VLBW; <1500 g) birth despite societal concerns about the ethics and justification of intensive care for these infants.
To determine the degree and type of stress experienced over time by mothers whose infants vary in degree of prematurity and medical and developmental risk.
Longitudinal prospective follow-up study of a cohort of mothers of high- and low-risk VLBW and term infants from birth to 3 years.
All level III neonatal intensive care units from a large midwestern metropolitan region.
Mothers and infants prospectively and consecutively enrolled in a longitudinal study between 1989 and 1991. High-risk VLBW infants were diagnosed as having bronchopulmonary dysplasia, and comparison groups were low-risk VLBW infants without bronchopulmonary dysplasia and term infants (>36 weeks, >2500 g).
Standardized, normative self-report measures of maternal psychological distress, parenting stress, family impact, and life stressors.
Mothers of VLBW infants (high risk, n = 122; low risk, n = 84) had more psychological distress than mothers of term infants (n=123) at 1 month (13% vs 1%; P = .003). At 2 years, mothers of low-risk VLBW infants did not differ from term mothers, while mothers of high-risk infants continued to report psychological distress. By 3 years, mothers of high-risk VLBW children did not differ from mothers of term children in distress symptoms, while parenting stress remained greater. Severity of maternal depression was related to lower child developmental outcomes in both VLBW groups.
The impact of VLBW birth varies with child medical risk status, age, and developmental outcome. Follow-up programs should incorporate psychological screening and support services for mothers of VLBW infants in the immediate postnatal period, with monitoring of mothers of high-risk VLBW infants.
尽管社会关注对超低出生体重（VLBW；<1500克）婴儿进行重症监护的伦理和合理性，但很少有研究记录父母如何适应这种情况。
确定早产程度、医疗和发育风险不同的婴儿的母亲在一段时间内所经历的压力程度和类型。
对一组高危和低危超低出生体重儿及足月儿的母亲进行从出生到3岁的纵向前瞻性随访研究。
中西部一个大都市地区的所有三级新生儿重症监护病房。
1989年至1991年期间前瞻性且连续纳入一项纵向研究的母亲和婴儿。高危超低出生体重儿被诊断为患有支气管肺发育不良，对照组为无支气管肺发育不良的低危超低出生体重儿和足月儿（>36周，>2500克）。
母亲心理困扰、育儿压力、家庭影响和生活压力源的标准化、规范性自我报告测量。
超低出生体重儿的母亲（高危组，n = 122；低危组，n = 84）在1个月时比足月儿的母亲（n = 123）有更多心理困扰（13%对1%；P = 0.003）。在2岁时，低危超低出生体重儿的母亲与足月儿的母亲没有差异，而高危婴儿的母亲继续报告有心理困扰。到3岁时，高危超低出生体重儿童的母亲在困扰症状方面与足月儿的母亲没有差异，但育儿压力仍然更大。在两个超低出生体重组中，母亲抑郁的严重程度与儿童较低的发育结果相关。
超低出生体重出生的影响因儿童的医疗风险状况、年龄和发育结果而异。随访项目应在产后立即为超低出生体重儿的母亲纳入心理筛查和支持服务，并对高危超低出生体重儿的母亲进行监测。
