Mother Sibling Interactions Following Very Low Birth Weight (VLBW) Infant Homecoming

Duke University300 enrolled

Overview

The proposed study will explore longitudinally the impact of a very low birthweight (VLBW) infant on mother-sibling interactions and sibling adjustment. The study will also include a comparison group of fullterm infants to determine which sibling adjustment problems are typical of having a new baby in the home and which are associated with the unique stress of having a VLBW infant. This study will be the initial step in identifying factors affecting the adjustment of siblings of VLBW infants.

The proposed 2-year study will use a longitudinal, comparative, mixed method design to explore the impact of a Very Low Birth Weight (VLBW) (≤33 weeks gestational age) infant on mother-sibling interactions and sibling adjustment. A comparison group of full term infants (≥38 weeks gestational age) will be included to elucidate sibling adjustment problems that are typical to having a new baby in the home and sibling adjustment problems that are associated with the unique stress of having to care for a VLBW infant. Participants will be fifty mothers and siblings of VLBW infants and fifty mothers and siblings of full term infants. Data collection will take place within one week of infant discharge from the hospital (enrollment), and at 1 month and 6 months post infant discharge using self-report measures, qualitative interviews, and mother-sibling interaction observation. Variables of interest include mother's worry, anxiety, depression, and post-traumatic stress; mother-sibling interactions including uninvolvement, positive affect, negative affect, talk, looking and playing; internalizing and externalizing behaviors, sleep/somatic problems, and growth in siblings of VLBW and in siblings of the comparison group with full term infants. Mixed modeling and Ordinary Least Squares (OLS) regression modeling will be conducted to identify factors that make siblings vulnerable to psychological and emotional adjustment problems in response to having a VLBW infant in the home. There are no anticipated risks for the infant participants of the study aside from the small risk of violating confidentiality of infant participants and their mothers. No risks for siblings are anticipated aside from the small risk of violating confidentiality.

Study Type

OBSERVATIONAL

Enrollment

300

Conditions

Very Low Birthweight

Eligibility

Sex: ALLMax age: 4 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria for siblings: * Siblings of very low birth weight or healthy, full-term infants * age 4 years old or younger * siblings and infants must live with the mother Inclusion Criteria for mothers: * no previous or current diagnosis of major psychological disorder (including bipolar disorder, psychosis, or active substance abuse) * age 18 years or older * English speaking, * living within 1 hour's travel distance from Duke University, for feasibility. * Mothers at-risk for preterm birth who meet all other eligibility criteria Exclusion Criteria: Mother/sibling pairs of infants who: * have congenital neurological problems (congenital hydrocephalus or microcephaly), * are symptomatic from substance exposure, * are hospitalized longer than 1 month after term, or * are technology dependent.

Locations (2)

Duke University Medical Center

Durham, North Carolina, United States

Wake Medical Center

Raleigh, North Carolina, United States

Outcomes

Primary Outcomes

Differences in level of maternal worry in mothers of very low birthweight (VLBW) infants compared to mothers of full-term infants

Explore how the trajectories of maternal worry about the infant and sibling, anxiety, depression, post traumatic stress, concerns for and expectations of the sibling, and perceptions of sibling growth over the 6-month post discharge period differ between mothers of VLBW infants and mothers of fullterms.

Time frame: baseline, one month, six months

Differences in mother-sibling interaction between two groups

Explore differences in mother-sibling interactions, including involvement, positive/negative affect, talking, looking and playing, at 1 and 6 months after infant discharge between the two groups of siblings and mothers, using a coding schema to score videotaped interactions.

Time frame: one month and six months

Differences in internalizing and externalizing behaviors between two groups

Explore differences in internalizing and externalizing behaviors, vulnerability, and sleep/somatic problems at 6-months post-infant discharge between siblings of VLBW infants and siblings of fullterms, using a coding schema to score videotaped interactions.

Time frame: one month and six months

Secondary Outcomes

Effects of maternal worry, anxiety, depression and Post-Traumatic Stress Disorder (PTSD) on two groups

Examine the effects of maternal worry, anxiety, depression, and post traumatic stress on group differences in mother-sibling interactions at 1 and 6 months after infant discharge.

Time frame: one month and six months

Change in mother-sibling interactions between groups

Examine the effects of changes in mother-sibling interactions from 1 to 6 months after infant discharge on group differences in siblings' internalizing and externalizing behaviors, vulnerability, and sleep/somatic problems.

Data from ClinicalTrials.gov

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