Effect of Video Interaction Guidance in families with preterm infants.

Studies have consistently found a high incidence of neonatal medical problems,
premature births and low birth weights in abused children (Creighton, 1985;
Zelenko e.a, 2000). This has led to the common notion that these problems place
a child at a higher risk for maltreatment and neglect. One of the explanations
proposed for the relation between child fitness and adverse parenting and
negative infant outcomes is a delay or disturbance in bonding between the
parent and infant. This hypothesis suggests that due to neonatal disease, the
development of an affectionate bond between the parent and the infant is
impeded (Egeland & Vaughn, 1981). The disruption of an optimal mother-infant
bonding -in its turn- may predispose to distorted parent-infant interactions
and thus facilitate abusive or neglectful behaviours. However, this hypothesis
has not been tested empirically in a retrospective study. In the Netherlands,
with approximately 14.000 preterm (< 37 weeks gestation) births per year and an
alarming number of young children victimized by maltreatment and neglect (Van
IJzendoorn et al., 2007) more insight in this process is badly needed. The
purpose of the current study is 1) to further elucidate the bonding process
between unhealthy (e.g., high- and low-risk premature) infants and their
parents from an evolutionary perspective and 2) to examine the effect of a
short term intervention (Video-Interaction Guidance) in preterm infants to
enhance parental bonding and to prevent adverse parent-infant interaction in
the first months after birth.

The project aims to gain more insight in the process of bonding between parents
and prenature infants, to validate a screening instrument that can be easily
adopted in maternity wards of (general) hospitals to detect parents and
children at risk for adverse parent-infant problems and to evaluate Video
Interaction Guidance in parents with low and high risk premature infants.

In this study, a group of extremely premature, moderately premature and a term
children will be followed from the first days after birth untill the children
are six months old.
The premature children (both extreme and moderate) will be randomly split into
two groups, an intervention group and a control group. The children in the
intervention group will receive Video Interaction Guidance. This enables us to
evaluate the effectiveness of Video Interaction Guidance for premature
children.

Video Interaction Guidance (VIG) will be applied as intervention. The sessions
of the VIG comprise video-taped parent-infant interactions during hospital stay
at the first day, after 3 days and at 1 week after birth. The trained nurse or
pedagogic worker shows the parent part of the video-tape and comments on
selective fragments of the tape. The nurse shows the parent how to interpret
the behaviours of the child. A detailed protocol is made available for all
nurses/VIG workers.
In the control group (care as usual group) on the first day after birth and at
1 week after birth an interaction episode is video-taped by the
nurse-practitioner but no feedback sessions are conducted.

Participation in this study entails no extra risk for the families. The burden
for the participants is limited to being videotaped during an interaction
moment, answering questionnaires and cooperating with an interview. If this is
too much of a burden for the family, they are free to stop participation at any
moment if they decide so. This will have no consequences for further treatment.
If parents or children feel that the need further support, counseling or
treatment, possibilities for referral will be checked within the network of the
cooperating hospitals and organisations.