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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Doing Everything We Can to Help Our High-Risk Newborns: A Qualitative, Lifeworld-Led Study of What Early Risk
Kristin Bjørnstad Åberg1,2, Karin Dahlberg3, Gunfrid Vinje Størvold2,4
1Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
Insights
Parents of high-risk infants experience prolonged uncertainty during early predictive assessments for cerebral palsy (CP). These assessments impact the parent-infant relationship, especially when results remain uncertain.
Area of Science:
- Pediatrics
- Developmental Psychology
- Parenting Studies
Background:
- Early predictive assessments for cerebral palsy (CP) are recommended for high-risk infants.
- Parents of infants with risk factors often face prolonged uncertainty and repeated assessments.
- Understanding parents' experiences with these assessments is crucial for timely diagnosis and support.
Purpose of the Study:
- To investigate the lived experiences of parents of high-risk infants undergoing early predictive assessments for CP.
- To describe the meaning parents ascribe to these assessments before a definitive CP diagnosis.
- To explore the emotional and psychological impact of predictive assessments on parents.
Main Methods:
- Qualitative study employing a phenomenological, reflective lifeworld approach.
- Conducted 14 in-depth individual interviews with parents of high-risk infants.
- Interview data were analyzed for meaning to understand parental experiences.
Main Results:
- Parents perceive early predictive assessments as examinations to detect signs of illness or disability.
- Key experiences include navigating uncertainty about the child's future and the parental role.
- Parents described seeing their child through the 'eyes of strangers' due to repeated evaluations.
Conclusions:
- Parents of high-risk infants experience significant uncertainty and worry, affecting the parent-infant bond.
- Predictive assessments can alleviate anxiety if results indicate low CP risk.
- Uncertain assessment results amplify and prolong parental distress and the burden of uncertainty.
Abstract:
Background/Objectives: Early predictive assessments for CP are recommended for infants with medical risk factors after birth. For parents of children with CP, receiving an early diagnosis is important. But most children with risk factors who have not yet developed CP are labeled "high-risk infants" and repeatedly assessed for abnormal signs. We aim to investigate the experience of parents of high-risk infants and describe the meaning that "early predictive assessments for CP" has for them before they know whether their children have CP. Methods: This was a qualitative study conducted using a phenomenological, reflective lifeworld approach. Fourteen individual in-depth interviews were conducted with parents who received different GMA results to learn about their experiences involving early predictive assessments. The interviews were analyzed for meaning. Results: Early predictive assessments take place over time while parents process the traumatic experience of becoming parents to an infant at risk. "Early predictive assessment" is perceived as any examination or assessment intended to unveil signs of illness or disability. The child's future well-being and fulfillment, and the demands of parenthood, are at stake. Essential meaning structures are (1) on a spectrum from death to insignificancies, (2) living with uncertainty of what the parental role will entail, and (3) seeing one's own child through the eyes of strangers, just in case. Conclusions: For months following the birth of a high-risk child, parents experience uncertainty and worrying, affecting the parent-infant relationship. Predictive assessments reduce their sense of alarm when the GMA result indicates a low risk of CP. But when the GMA result is uncertain, the burden of uncertainty is amplified and prolonged.
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