Treyvaud Karli, Doyle Lex W, Lee Katherine J, Ure Alexandra, Inder Terrie E, Hunt Rod W, Anderson Peter J
Murdoch Childrens Research Institute, Melbourne, Vic., Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
J Child Psychol Psychiatry. 2016 Jul;57(7):814-21. doi: 10.1111/jcpp.12489. Epub 2015 Nov 29.
Parenting influences child development, but it is unclear whether early parenting behavior can influence school-age outcomes in very preterm (VPT) children, and/or if certain groups of VPT children may be more affected by early parenting behavior. These research questions were examined.
Participants were 147 children born <30 weeks' gestation or birth weight <1250 g and their primary caregiver. At term corrected age (CA), magnetic resonance imaging (MRI) was used to determine presence and severity of brain abnormality and medical data collected. High medical risk was defined as the presence of at least one of sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, moderate to severe white matter abnormality on MRI, or postnatal corticosteroids. At 2 years CA, parent-child interaction was assessed, and at 7 years CA, general intelligence (IQ), language, executive function, academic skills, and social-emotional functioning were assessed.
Higher levels of parent-child synchrony, and parent facilitation, sensitivity and positive affect at 2 years were associated with better child outcomes at 7 years, while higher levels of intrusiveness and negative affect were associated with poorer outcomes. Many of these relationships remained after controlling for early child cognitive development. Interactions between child medical risk (higher/lower) and parenting were limited to child reading, math, and executive functioning outcomes, with stronger relationships for lower medical risk children.
The contribution of early parenting to VPT children's school-age performance is significant, with stronger effects for lower medical risk children in some outcomes. These findings support the premise that parenting strategies should be included in the NICU and early interventions programs for VPT infants.
养育方式会影响儿童发育，但尚不清楚早期养育行为是否会影响极早产（VPT）儿童的学龄期结局，和/或某些VPT儿童群体是否可能受早期养育行为的影响更大。对这些研究问题进行了探究。
研究对象为147名孕周<30周或出生体重<1250克的儿童及其主要照料者。在足月矫正年龄（CA）时，使用磁共振成像（MRI）确定脑异常的存在及严重程度，并收集医学数据。高医学风险定义为存在败血症、坏死性小肠结肠炎、支气管肺发育不良、MRI显示中度至重度白质异常或出生后使用皮质类固醇中的至少一项。在矫正年龄2岁时，评估亲子互动，在矫正年龄7岁时，评估一般智力（IQ）、语言、执行功能、学业技能和社会情感功能。
2岁时较高水平的亲子同步性、父母促进、敏感性和积极情感与7岁时更好的儿童结局相关，而较高水平的侵扰性和消极情感与较差的结局相关。在控制儿童早期认知发展后，许多这些关系依然存在。儿童医学风险（高/低）与养育方式之间的相互作用仅限于儿童阅读、数学和执行功能结局，医学风险较低的儿童的关系更强。
早期养育对VPT儿童学龄期表现的贡献显著，在某些结局中对医学风险较低的儿童影响更强。这些发现支持了养育策略应纳入VPT婴儿的新生儿重症监护病房和早期干预项目这一前提。
