DOI: 10.1097/pcc.0000000000004025 ISSN: 1529-7535

Parental Resolution of Infant Congenital Heart Disease and Bonding in the Pediatric Cardiac Intensive Care

Tamar Bernstein, Efrat Sher-Censor, Uri Pollak
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Objectives:

To evaluate whether parental resolution of infants’ congenital heart disease (CHD) diagnosis contributes to parent-infant bonding above and beyond psychological distress during hospitalization in a pediatric cardiac ICU (PCICU). The study focused on an understudied population of ultra-Orthodox Jews and Muslim-Arabs.

Design:

A cross-sectional study.

Setting:

PCICU; Hadassah University Medical Center, Israel.

Subjects:

Fifty-eight parents (43% fathers; 72% ultra-Orthodox Jewish; 28% Muslim-Arab) of 37 infants ( M days = 65.22;

sd
= 84.61) hospitalized after cardiac surgery or catheterization.

Interventions:

None.

Measurements:

Parents completed the Reaction to Diagnosis Questionnaire, the Postpartum Bonding Questionnaire, the Edinburgh Postnatal Depression Scale, and the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and responded to an open-ended question about how infants’ birth and medical condition affected their lives. Responses’ coding included affect, crisis, growth, religious faith, and social support. Clinical data were extracted from infants’ medical records.

Main Results:

Resolution was associated with healthier bonding ( r = –0.55; p < 0.001; higher bonding scores indicate impaired bonding). Depressive and PTSD symptoms correlated with poorer resolution ( r = –0.47; p < 0.001 and r = –0.51; p < 0.001) and more impaired bonding ( r = 0.44; p = 0.001 and r = 0.48; p < 0.001). Controlling for depressive and PTSD symptoms and diagnosis timing (prenatally vs. postpartum), resolution predicted healthier bonding ( β = –0.35;i p = 0.032; Δ R 2 = 0.08). Parents who expressed less negative affect and addressed personal growth in the open-ended question demonstrated better resolution and healthier bonding ( p ’s < 0.029). Lack of reference to religious faith and framing the experience as a crisis were associated with more impaired bonding ( p ’s < 0.037).

Conclusions:

Parental resolution of infants’ CHD diagnosis may contribute to the formation of nurturing parent-infant relationships. Findings highlight the need for early psychological interventions for families facing a CHD diagnosis.

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