Parent behaviors moderate the relationship between neonatal pain and internalizing behaviors at 18 months corrected age in children born very prematurely

摘要

Children born very preterm (≤32 weeks gestation) show greater internalizing (anxious/depressed) behaviors compared to term-born peers as early as 2 years corrected age (CA), however, the role of early stress in the etiology of internalizing problems in preterm children remains unknown. Therefore, we examined the relationship between neonatal pain and internalizing behavior at 18 months CA in children born very preterm, and examined whether parent behavior and stress moderated this relationship. Participants were 145 children (96 very preterm, 49 full-term) seen at 18 months CA. Neonatal data were obtained from medical and nursing chart review. Neonatal pain was defined as the number of skin-breaking procedures. Cognitive ability was measured using the Bayley Scales of Infant Development-II. Parents completed the Parenting Stress Index-III, Child Behavior Checklist 1.5–5, and participated in a videotaped play session with their child, which was coded using the Emotional Availability Scale-IV. Very preterm children displayed greater Internalizing behaviors compared to full-term controls (P =0.02). Parent Sensitivity and Nonhostility moderated the relationship between neonatal pain and Internalizing behavior (all P <0.05); higher parent education (P <0.03), lower Parenting Stress (P =0.001), and fewer children in the home (P <0.01) were associated with lower Internalizing behavior in very preterm children, after adjusting for neonatal medical confounders, gender and child cognitive ability (all P >0.05). Parent Emotional Availability and stress were not associated with Internalizing behaviors in full-term controls. Positive parent interaction and lower stress appears to ameliorate negative effects of neonatal pain on stress-sensitive behaviors in this vulnerable population.