Department of Psychology, Lifespan Health and Wellbeing Group, University of Warwick, Coventry, UK.
Arch Dis Child Fetal Neonatal Ed. 2014 Jan;99(1):F70-5. doi: 10.1136/archdischild-2013-303788. Epub 2013 Jun 21.
To investigate whether there are differences in attachment security and disorganisation between very preterm or very low birthweight (VP/VLBW) (<32 weeks gestation or <1500 g birthweight) and full-term infants (37-42 weeks gestation) and whether the pathways to disorganised attachment differ between VP/VLBW and full-term infants.
The sample with complete longitudinal data consisted of 71 VP/VLBW and 105 full-term children and their mothers matched for twin status, maternal age, income and maternal education. Infant attachment was assessed with the Strange Situation Assessment at 18 months of age. Maternal sensitivity in the VP/VLBW and full-term samples was rated by neonatal nurses and community midwives in the neonatal period, respectively, and mother-infant interaction was observed at 3 months. Infant difficultness was assessed by maternal report at 3 months and infant's developmental status was assessed with the Bayley Scales (BSID-II).
Most VP/VLBW (61%) and full-term (72%) children were found to be securely attached. However, more VP/VLBW (32%) than full-term children (17%) had disorganised attachment. Longitudinal path analysis found that maternal sensitivity was predictive of attachment disorganisation in full-term children. In contrast, infant's distressing cry and infant's developmental delay, but not maternal sensitivity, were predictive of disorganised attachment in VP/VLBW children.
A third of VP/VLBW children showed disorganised attachment. Underlying neurodevelopmental problems associated with VP/VLBW birth appear to be a common pathway to a range of social relationship problems in this group. Clinicians should be aware that disorganised attachment and relationship problems in VP/VLBW infants are frequent despite sensitive parenting.
研究极早产儿或极低出生体重儿（<32 周胎龄或<1500 克出生体重）与足月产儿（37-42 周胎龄）之间是否存在依恋安全性和组织混乱的差异，以及极早产儿和足月产儿之间的组织混乱依恋途径是否不同。
具有完整纵向数据的样本包括 71 名极早产儿或极低出生体重儿和 105 名足月产儿及其母亲，这些母亲在双胞胎状态、母亲年龄、收入和母亲教育方面相匹配。婴儿依恋在 18 个月时通过陌生情境评估进行评估。极早产儿和足月产儿样本中的母婴敏感性分别由新生儿护士和社区助产士在新生儿期进行评估，在 3 个月时观察母婴互动。婴儿困难程度通过母亲在 3 个月时的报告进行评估，婴儿的发育状况通过贝利婴幼儿发育量表（BSID-II）进行评估。
大多数极早产儿（61%）和足月产儿（72%）被发现安全依恋。然而，更多的极早产儿（32%）比足月产儿（17%）有组织混乱的依恋。纵向路径分析发现，母亲敏感性是足月产儿依恋组织混乱的预测因素。相比之下，婴儿痛苦的哭声和婴儿发育迟缓，而不是母亲敏感性，是极早产儿依恋组织混乱的预测因素。
三分之一的极早产儿表现出组织混乱的依恋。与极早产儿出生相关的潜在神经发育问题似乎是该组一系列社会关系问题的共同途径。临床医生应该意识到，尽管有敏感的育儿方式，但极早产儿婴儿的组织混乱依恋和关系问题仍然很常见。
