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Poster #34 - Mismatch Between Perceived and Objective Indices of Infant Vulnerability: NICU Status and Parental Mental Health

Fri, March 24, 2:30 to 3:15pm, Salt Palace Convention Center, Floor: 1, Hall A-B

Abstract

Introduction:

Parental misperceptions of child vulnerability have detrimental effects on parenting behaviors and children’s health (Green & Solnit, 1964; Anthony et al., 2011; Anthony et al., 2003; Connelly et al., 2012; Driscoll et al., 2018). Hence, there is a pressing need to understand factors that affect alignment between children’s objective vulnerability and parental perceptions about children’s medical vulnerability.

Previous studies about parental vulnerability perceptions primarily examine school-age children with chronic illnesses and lack comparative objective measurements of children’s health status. Thus, the goals of this study were to measure the alignment between objective and perceived infant vulnerability, assess differences in alignment across infants admitted to neonatal intensive care units (NICU) and well-baby nurseries, and determine how such alignment differed across parental mental health risk.

Methods:

From 2015-2019, the BabySeq Project, a newborn genomic sequencing study, enrolled 519 parents of 325 infants, including 257 well-baby nursery infants and 68 NICU infants (Pereira et al., 2021). At two timepoints across seven months, parents filled out the Child Vulnerability Scale (CVS) (Forsyth et al., 1996), Patient Health Questionnaire (PHQ-9) (Kroenke & Spitzer, 2002), and Generalized Anxiety Disorder Screener (GAD-7) (Spitzer et al., 2006). Mean infant age was 245 and 458 days at both timepoints, respectively.

Two novel variables were created for this study – objective vulnerability and match/mismatch scores. Objective vulnerability was the sum of the following infant health indicators’ fractional percentiles: total ER visits, hospital visits, days in the hospital, ICU visits, days in the ICU, surgeries, medicines, PCP visits, and specialist visits. Perceived vulnerability (CVS data) and objective vulnerability scores were standardized. Match/mismatch scores, which equaled objective vulnerability z-scores – perceived vulnerability z-scores, represented alignment between objective vulnerability and parents’ perceived vulnerability of their child. “Match” signified an equivalence between objective and perceived vulnerability, or a low risk of infant vulnerability misperception.

Results and Discussion:

Independent (Welch’s) t-tests were conducted among objective vulnerability, perceived vulnerability, and match/mismatch scores between NICU and well-baby nursery infants (Table 1). Match/mismatch, objective, and perceived vulnerability scores at the first timepoint were significantly greater among NICU infants (all ps < 0.05). When comparing vulnerability scores across mental health risk (Table 2), parents at risk for anxiety (GAD-7 sum ≥ 10) at the first timepoint and parents at risk for depression (PHQ-9 sum ≥ 10) at the second timepoint perceived their infants to be significantly more vulnerable (p = .001 for anxiety, p = 0.011 for depression) and had a greater extent of vulnerability mismatch (p = 0.041 for anxiety, p = 0.001 for depression) than parents who were not at risk for anxiety or depression, respectively.

In this first look at longitudinal data from families with infants in NICUs and well-baby nurseries, results show that parental infant vulnerability perceptions, including mismatch with objective vulnerability, are associated with infant medical health and parental mental health status. Findings underscore the importance of identifying both objective and perceived measures of infant health to better understand ways to promote alignment between objective and perceived vulnerability, optimal parent-child interactions, and child health.

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