Nederlands: Het effect van Video Interactie Begeleiding (VIB) bij te vroeggeborenen.

Engels: Effect of Video Interaction Guidance (VIG) in parents of 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 prospective 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.

Hypotheses 0-6 months after birth:

The project consists of two integrated parts. In part A, the development of the bonding process and the consequences for adverse parent-child interaction in premature and unhealthy infants will be studied. In Part B, the effect of a short-term video-feedback intervention (i.e., video interaction guidance) to promote intuitive parenting cq. parental bonding will be examined in a randomized controlled trial.



Main hypotheses Part A:

1. In high and low risk preterm infants the bonding process between parent and child is delayed compared to the bonding process in healthy term parent-infant dyads;

2. A disturbed bonding process results in adverse parental interactive behaviour (e.g., increase in intrusiveness and hostile behaviour), which -in its turn- constitutes a serious risk factor for negative infant outcomes (e.g., sleeping and eating problems, social-emotional delay);

3. Responses to infant (crying) characteristics are determined by maternal, parental and contextual characteristics, such as personality and spousal support.



Main hypotheses Part B:

1. The quality of parental bonding towards the infant is increased in the VIG group compared to the control (Care as usual) group (measured at 1 week, 1 month, 3 months and 6 months after delivery);

2. Parental interactive behavior (i.e., sensitivity/emotional availability) is significantly higher in the VIG group compared to the control (i.e., care as usual) group during week 1, at 3 months and 6 months after delivery;

3. Parents in the VIG group have fewer feelings of anxiety and depression moreover; they show less intrusive and hostile behavior towards their infant at week 1, 1 month and 6 months after delivery as compared to the control group;

4. The infants in the VIG group show less sleeping and less feeding problems compared to the control group.



Hypotheses: 2 years after childbirth:

1. The quality of bonding and parent-infant interaction is a predictor for the quality of attachment at the infants’ age of two. Full-term infants have more secure attachment styles compared to preterm infants. In the VIG group there are more parent-infant dyads that show a secure attachment style, compared to the control group;

2. Controlling for gestational age, there is a difference in social-emotional, behavioural and cognitive development between preterm infants and full term infants, in favour of the latter group. The infants’ development is moderated by the quality of early bonding, interaction and attachment;

3. The risk of infant abuse is higher in parents of preterm infants compared to parents of full-term infants. The quality of interactive behaviour correlates with the risk of maltreatment, with more intrusive behaviour during interaction in parents with higher risk of abuse;

4. Parents of preterm infants have more mental health problems (PTSD/depression) than parents of full term infants at the age of two.

The data will be collected using video recordings, questionnaires and semi-structured interviews. At day 1, 3 and 7 and at 1, 3, 6 and 24 months after the delivery, measurements will be conducted.

VIG will be applied as intervention. Video Interaction Guidance (VIG) is a method for nurses and pedagogic workers in the clinical (hospital) setting to guide and support the attunement and positive contact between parent and infant during the hospital stay. VIG uses edited video feedback to help parents identify their strengths and to achieve desired goals. Key elements of the method are adoption of a collaborative and empowering approach to the parent and to offer a framework of theoretically derived communication/contact principles to analyze interactions. Edited film elements are used to provide feedback of “positive exceptions” and, through discussion of these self-modeling examples, to facilitate reflection and develop parental self-efficacy.



The intervention group:

The sessions of the VIG intervention will comprise videotaped parent-infant interactions during hospital stay at the 1st, 3rd and 7th day after birth. The trained nurse or pedagogic worker will show the parents a part of the videotape and comments on selective fragments of the tape thereby showing the parents how to interpret the behaviours of the child. To execute the VIG intervention in a proper manner, a detailed protocol will be made available for all nurses/VIG workers.



Control group:

In the control group (care as usual group) on the first day after birth and at 1 week after birth, the nurse practitioner videotapes an interaction episode but no feedback sessions are conducted.