Heart Centre for Children, The Sydney Children's Hospitals Network, Australia.
School of Psychology, The University of Sydney, Australia.
J Pediatr Psychol. 2024 Jan 19;49(1):13-26. doi: 10.1093/jpepsy/jsad069.
Parents and their infants with complex congenital heart disease (CHD) face relational challenges, including marked distress, early separations, and infant hospitalizations and medical procedures, yet the prevalence of parent-infant interaction difficulties remains unclear. Using a standardized observational paradigm, this study investigated mother-infant dyadic synchrony, interactional patterns, and associated predictors in mother-infant pairs affected by CHD, compared with typically-developing pairs.
In this prospective, longitudinal cohort study, mothers and their infants requiring cardiac surgery before age 6-months (n=110 pairs) and an age- and sex-matched Australian community sample (n=85 pairs) participated in a filmed, free-play interaction at 6.9±1.0 months. Mother-infant dyadic synchrony, maternal and infant interactional patterns, and relational risk were assessed using the Child-Adult Relationship Experimental (CARE) Index. Maternal and infant predictors were assessed at 32 weeks gestation, 3- and 6-months postpartum.
Most mother-infant interactions were classified as "high risk" or "inept" (cardiac: 94%, control: 81%; p=.007). Dyadic synchrony (p<.001), maternal sensitivity (p=.001), and infant cooperativeness (p=.001) were lower for cardiac than control pairs. Higher maternal traumatic stress at 6-months postpartum predicted lower dyadic synchrony for mother-infant pairs affected by CHD (B=-.04, p=.03). Dyadic synchrony was higher among older infants in the total (B=.40, p=.003) but not cardiac sample (B=.24, p=.06).
Relational difficulties were almost universal among mother-infant pairs affected by CHD and were also high in the Australian community sample. Widespread education initiatives are recommended to increase awareness of heightened mother-infant relational risk in congenital heart care and well-child settings, alongside relationally-focused prevention and early intervention programs.
患有复杂先天性心脏病（CHD）的父母及其婴儿面临着关系挑战，包括明显的痛苦、早期分离以及婴儿住院和医疗程序，然而父母-婴儿互动困难的普遍性仍不清楚。本研究使用标准化观察范式，比较了患有 CHD 的母婴对子和典型发育的母婴对子的母婴二元同步性、互动模式以及相关预测因素。
在这项前瞻性、纵向队列研究中，在 6 个月前（n=110 对）需要心脏手术的母亲及其婴儿，以及年龄和性别匹配的澳大利亚社区样本（n=85 对），在 6.9±1.0 个月时参与了拍摄的自由玩耍互动。使用儿童-成人关系实验（CARE）指数评估母婴二元同步性、母婴互动模式和关系风险。在 32 周妊娠、3 个月和 6 个月产后评估母亲和婴儿的预测因素。
大多数母婴互动被归类为“高风险”或“不熟练”（心脏：94%，对照：81%；p=.007）。与对照组相比，心脏组的二元同步性（p<.001）、母亲敏感性（p=.001）和婴儿合作性（p=.001）较低。产后 6 个月时母亲创伤后应激更高，预测 CHD 母婴对子的二元同步性较低（B=-.04，p=.03）。在总样本中，年龄较大的婴儿二元同步性较高（B=.40，p=.003），但在心脏样本中没有（B=.24，p=.06）。
患有 CHD 的母婴对子几乎普遍存在关系困难，在澳大利亚社区样本中也很高。建议开展广泛的教育计划，以提高先天性心脏病护理和常规儿童保健环境中对母婴关系风险的认识，并开展以关系为重点的预防和早期干预计划。
