ABSTRACT
Abstract Background Congenital heart disease can have a negative impact on both infant development and maternal adjustment. This study considered the impact of a new programme of early psychosocial interventions on such outcomes, following the birth of a child with severe congenital heart disease. Methods Seventy infants and their mothers were assigned to an intervention or control group based on order of presentation to the unit. Interventions aimed at bolstering mother-infant transactions, through psychoeducation, parent skills training and narrative therapy techniques were implemented. Results Clinically and statistically significant gains were observed at 6-month follow-up on the mental (but not the psychomotor) scale of the Bayleys-II. Positive gains were also manifested on feeding practices, maternal anxiety, worry and appraisal of their situation. Conclusions A programme of generalizable psychosocial interventions is shown to have a positive impact on the infant with severe congenital heart disease and the mother.
Subject(s)
Adaptation, Psychological , Heart Diseases/congenital , Maternal Behavior/psychology , Mothers/psychology , Psychotherapy/methods , Anxiety/psychology , Anxiety/therapy , Child , Child Development , Female , Follow-Up Studies , Grief , Guilt , Humans , Mother-Child Relations , Outcome Assessment, Health Care , Parenting/psychology , Pregnancy , United KingdomABSTRACT
AIMS: To evaluate the relative effect of cyanosis, surgical interventions and family processes on neuropsychological and behavioural outcomes in 4-year-old survivors of serious congenital heart disease (CHD). METHODS: 90 children with a range of cyanotic and acyanotic conditions, who underwent either corrective or palliative surgery, completed a neuropsychological and behavioural evaluation. Families of participants were also profiled by evaluation of maternal mental health, worry, social support, parenting style and family functioning. RESULTS: Compromised neuropsychological outcomes were associated with a combination of cyanotic conditions and open-heart surgery, but this was not exacerbated by having a complex, palliative, status. Both cyanotic and acyanotic conditions were associated with specific sensorimotor delays, regardless of method of the correction. Only children with complex conditions and palliative interventions seemed at risk of poor behavioural outcomes; indeed, children with cyanosis with complete repair showed favourable behavioural outcomes compared with controls. Multivariate analyses highlighted the sometimes greater relevance of family processes (eg parenting style, maternal mental health and worry), rather than disease or surgical factors, in predicting especially behavioural outcomes. CONCLUSIONS: The findings (1) suggest a more complex relationship between cyanosis, surgical methods of correction, neuropsychological and behavioural outcomes than previously charted, (2) highlight that family processes may be aetiologically more important than disease and surgical factors, and (3) indicate specific targets for secondary prevention programmes for this at-risk population.
Subject(s)
Child Behavior Disorders/etiology , Developmental Disabilities/etiology , Heart Defects, Congenital/psychology , Survivors/psychology , Anxiety , Child, Preschool , Cyanosis/psychology , Cyanosis/surgery , Female , Heart Defects, Congenital/rehabilitation , Heart Defects, Congenital/surgery , Humans , Male , Neuropsychological Tests , Palliative Care/psychology , Parent-Child Relations , Parenting , Prognosis , Risk FactorsABSTRACT
Fetuses of diabetic mothers exhibit maturational delays in their behaviour and disturbances in behavioural and intellectual functioning in childhood. This suggests an effect of maternal diabetes on the central nervous system of the fetus. The habituation technique enables the functioning of the higher central nervous system to be examined. A normal habituation pattern reflects an intact central nervous system. Previous studies have found abnormalities in the fetal central nervous system are reflected in habituation performance. This paper examined the habituation ability of fetuses of diabetic mothers and of non-diabetic mothers. The fetuses were tested at 28, 32 and 36 weeks of gestation. After 2 min of fetal inactivity a series of vibroacoustic stimuli were presented to the fetus. This continued until no response was observed on five consecutive stimulus presentations. The number of stimulus presentations to habituate at each gestational age was recorded. The results reveal that there was a highly significant main effect of group (F(1,47)=19.65, P<0.001). Fetuses of diabetic pregnancies took longer to habituate. There was a significant effect of gestational age (F(2,94)=44.67, P<0.0001). In both groups the number of trials to habituate decreased with advancing gestation. There was no relationship between random blood glucose levels and habituation performance. The results demonstrate that maternal diabetes affects higher aspects of central nervous system functioning in the fetus.
