85 IMPACT OF FAMILY STRUCTURE AND STABILITY ON DEVELOPMENTAL OUTCOME IN PRETERM INFANTS

Abstract

The impact of family structure and stability on developmental outcome was assessed in a 7 year prospective study of 121 of 125 surviving infants < 32 weeks' gestation (born 7/1/85 to 6/30/86) and 125 demographically matched term infants. Five preterm and four term children experienced the death of a parent. At 7 years, 66 (55%) preterm and 71 (59%) term children live with 2 parents (group I); 12 (10%) preterm and 13 (11%) term children live with 1 parent and have regular contact with the other parent (group II); 36 (30%) preterm and 34 (28%) term children live with a single parent and have no regular contact with the other parent (group III); and 7 (6%) preterm and 2 (2%) term children live in foster care (group IV). The preterm groups I - IV did not differ for gestational age (28.5 ± 2.1, 27.3 ± 2.4, 28.4 ± 1.9 and 27.1 ± 1.3 wk, respectively), birthweight (1187 ± 346, 1068 ± 394, 1208 ± 338, and 1019 ± 252 g) or NICU morbidities including mechanical ventilation, IVH or duration of hospitalization. Cognitive ability (McCarthy GCI) was significantly related to family structure in both preterm (groups I-IV: 96 ± 13, 90 ± 19, 87 ± 16, and 77 ± 15, respectively, p < .001) and term children (106 ± 13, 103 ± 12, 96 ± 12 and 81 ± 25, respectively, p < .001). One or more changes in family structure (marriage, divorce, custody) were more common in preterm (47%) than in term children (28%) (p < .01) and also were related to decreased I.Q. in preterm children (no change, 95 ± 14; single change, 93 ± 13; multiple changes, 80 ± 17, p < .001). Additionally, > 4 family moves occurred twice as often among preterm (30%) than among term children (17%) and was associated with poorer cognitive outcome in both groups (preterm children: 85 ± 16 vs 95 ± 14, p < .01; term children: 96 ± 14 vs 104 ±14, p < .05). Parents' reports of problematic behaviors (Child Behavior Checklist) were greatest for preterm children raised by single parents (p < .005), those with changes in family structure (p < .01) and preterm children with multiple moves (p < .05). Changes in family structure and stability occur more often for preterm than term children and impact significantly on their developmental outcome.