Parental Anxiety Following Discharge From Hospital of Their Very Low Birth Weight Infants*

• Author: Gail K. Auslander,Ilan Arad,Dvorah Netzer
• DOI: http://doi.org/10.1111/j.1741-3729.2003.00012.x
• Date: 01 January 2003
• Published date: 01 January 2003

12 Family Relations

Parental Anxiety Following Discharge From Hospital of Their

Very Low Birth Weight Infants*

Gail K. Auslander,** Dvorah Netzer, and Ilan Arad

The uncertainty regarding the future well-being of very low birth weight infants is a source of considerable anxiety for parents, even

after discharge from the hospital. We identify factors related to postdischarge anxiety levels of parents of 65 infants. Infant’s weight

relative to gestational age; the presence of central nervous system complications; informational support; and a warm, caring attitude

by hospital staff explained 35% of the variance in mothers’ anxiety levels. Father’s age, infant’s gender, perception of the infant as

problematic, and the availability of child care support explained 33% of the variance in fathers’ anxiety levels. Practice implications,

including both identification of high-risk groups and interventions aimed at bringing about change in specific factors, are discussed.

The birth of a child represents an important life event for

families; the birth of a very low birth weight (VLBW)

infant is particularly stressful. Parents often are affected

by the unexpected nature of the birth, feel guilty and helpless,

and express disappointment and concern for their ability to fulfill

parental roles (Miles, Funk & Kasper, 1992; Pederson, Bento,

Chance, Evans & Fox, 1987). The neonatal intensive care unit

(NICU) itself also is a source of stress, with its sophisticated

equipment, intrusive procedures, exposure to other sick infants

and their parents, and on-going interactions with health care pro-

fessionals. Of particular concern to most parents is the condition

and prognosis of the infant—fears for the child’s survival, health,

and appearance (Hughes, McCollum & Sheftel, 1994; Miles et

al.). A definitive prognosis regarding the child’s normal devel-

opment typically cannot be provided at the time of discharge

(Palta, Sadeh-Badawi, Evans, & Weinstein, 2000).

The current study focuses on anxiety as an outcome of this

stress and uncertainty. We assumed thatanxiety is an undesirable

emotional state, particularly if it persists over time or reaches

high levels (Siefert, Thompson, Ten Bensel, & Hunt, 1983; Sing-

er et al., 1999). Given the growing body of evidence indicating

the importance of parents’ psychological status for the long-term

well-being of children (e.g., Black, Heyman, & Slep, 2001; Ega-

mi, Ford, Greenfield, & Crum, 1996), it is important to under-

stand which parents are at particular risk for high levels of anx-

iety.As an outcome of the stress process, anxiety levels can be

affected by various factors (Taylor & Aspinwall, 1993). Key

among them are the objective nature of the stressor, the individ-

ual’s appraisal of that stress, and the availability of personal and

social coping resources (Lazarus & Folkman, 1984; Moos &

Schaefer, 1993; Pearlin & Schooler, 1978). Among the social

resources of key interest are the social support received from the

informal social network and formal service providers (Ben-Sira,

1984). The current study examines these factors in relation to

levels of anxiety among parents following the discharge of their

VLBW infants from an NICU in Israel.

*This study was funded by the Warburg Foundation of JDC—Israel and Hebrew

University and the Aimes-Biodex Foundation.

**Paul Baerwald School of Social Work, The Hebrew University of Jerusalem, Mt.

Scopus 91905, Jerusalem, Israel (msgail@mscc.huji.ac.il).

Key Words: anxiety, infants, low birth weight, parents, preterm.

(Family Relations, 2003, 52, 12–21)

Literature Review

Advances in neonatal intensive care have led to increased

survival rates of VLBW infants. However, these children remain

at risk for a range of difficulties, such as delayed growth, de-

velopmental problems, attention deficit disorders, hyperactivity,

language delay, and learning disabilities (e.g., Cronin, Shapiro,

Casiro, & Cheang, 1995; Hack, Taylor, Klein, & Mercuri-Min-

ich, 2000). Infants born prematurely also use more chronic and

acute care resources than those born at full-term (Bar-Oz,Netzer,

& Arad, 1995; Slonim, Patel, Ruttimann, & Pollack, 2000). Fol-

low-up studies in various countries of VLBW infants 1–2 years

of age show that between 8% and 15% have severe limitations,

and another 12–23% have mild limitations (Coccia, Pezzani,

Moro, & Minoli, 1992; Wang, Wang, Huang, & Lin, 1998). Lon-

ger term follow-ups of children and teenagers show that those

born with VLBW have more functional limitations, cognitive

impairments, and neurosensory impairments than their full-term

or normal birth weight age peers (Dewey, Crawford, Creighton,

& Sauve, 2000; Saigal, Hoult, Streiner, Stoskopf, & Rosenbaum,

2000).

Several investigators have tried to pinpoint factors that pre-

dict which VLBW infants are likely to be adversely affected

(Miceli et al., 2000; Palta et al., 2000). Various combinations of

birth status (gestational age, birth weight), medical complica-

tions, and parent-child interactions explain about one third of the

variance in the development of VLBW infants by 1–2 years

(Arad & Netzer, 1990; Miceli et al.). Although statistically sig-

nificant, these findings leave a good deal of variance unex-

plained. Thus, the developmental outcomes of many such infants

cannot be predicted with certainty at birth or at discharge from

the hospital.

The prolonged uncertainty surrounding a VLBW infant is a

major source of anxiety for parents that can persist for years

(Hughes et al., 1994; Miles et al., 1992). For instance, Singer et

al. (1999) found that 3 years after giving birth, mothers of high-

risk VLBW infants (with bronchopulmonary dysplasia) contin-

ued to be more depressed and anxious than mothers of full-term

infants.

Researchers posit a number of elements that may affect

long-term outcomes of stress. Key among them is the nature of

the stressful situation and its subjective appraisal (Lazarus &

Folkman, 1984). A second major factor is coping resources (i.e.,

the social and personal characteristics upon which people may

draw when dealing with stressful situations; Thoits, 1995). Al-

though resources represent a potential for action, some believe

they may be more important than actual coping activity, partic-

ularly in situations over which people have little direct control