早期介入對於極低出生體重早產兒之父母親壓力的療效

Intervention Effects on Parental Stress in Preterm Infants with Very Low Birth Weight

陳珮姍(Pei-Shan Chen)

指導教授 ： 鄭素芳

國立臺灣大學/醫學院/物理治療學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.00538

摘要

背景與目的： 縱使在西方國家中已有一些研究探討早期介入對於早產兒父母壓力的療效，但研究結果並不一致。故本篇研究的目的為探討早期介入對於臺灣早產兒父母親於介入期間之親職壓力的療效。方法：本研究將178名極低出生體重(出生體重低於1,500公克)早產兒隨機分配至常規、門診介入或家訪介入組，從住院期到矯正年齡一歲給予介入。父母親於孩子矯正年齡1、6和12個月時分別填寫短版親職壓力問卷。結果：早產兒三組的父母親相較於常規組的父母親在三個年齡時的親職壓力皆無顯著差異。但是在介入期間，門診介入組母親於親子互動障礙(b = -0.36, p< 0.01)、困難型孩童(b = -0.32, p=0.03)和總壓力分數(b = -0.64, p= 0.02)均隨年紀增加呈現下降的程度顯著高於常規組母親。而家訪介入組與常規組母親則在壓力分數下降幅度無明顯差異，且三組早產兒父親在壓力分數亦無明顯差異。結論: 早期介入，尤指門診介入計劃，於介入期間有效率地幫助極低出生體重早產兒的母親降低在親子互動障礙、困難型孩童和總壓力的程度，但未明顯改善父親各方面的親職壓力。

關鍵字

早產 ； 早期介入 ； 親職壓力

並列摘要

Background and Purpose: Although several studies have examined the effectiveness of early intervention on the stress of parents with preterm infants in Western societies, the results varied from no to significant reduction. The purpose of this study was therefore to examine the effect of early intervention on the parenting stress of Taiwanese parents with preterm infants. Method: A total of 178 Taiwanese preterm infants with very low birth weight (VLBW, birth weight <1,500 g) were randomly assigned into the usual care program (UCP), clinical-based intervention program (CBIP) or home-based intervention program (HBIP) for interventions from hospitalization until 12 months of age (corrected for prematurity). Maternal and paternal stress was each evaluated by the Parenting Stress Index-Short Form when infants were at 1, 6, and 12 months of age. Results: The CBIP, HBIP and UCP groups manifested comparable maternal and paternal stress scores at each age. However, the CBIP group mothers showed a significantly greater magnitude of reduction in the parent-child dysfunction interaction (b=-0.36, p<0.01), difficult child (b=-0.32, p=0.03) and total stress scores (b= -0.64, p=0.02) during the intervention period than the UCP group mothers. In contrast, the HBIP and UCP group mothers did not vary in the magnitude of reduction in any stress scores across ages and neither did the fathers of the three preterm groups. Conclusions: Early interventions, specifically the CBIP, efficiently reduced mothers’ parent-child dysfunction interaction, difficult child and total stress, but did not alter fathers’ parenting stress among Taiwanese preterm infants with VLBW during the intervention period.

並列關鍵字

Preterm ； early intervention ； parenting stress

參考文獻

Chen, P. S., Jeng, S. F., & Tsou, K. I. (2004). Developmental function of very-low-birth-weight infants and full-term infants in early childhood. J Formos Med Assoc, 103(1), 23-31.

Als, H., Gilkerson, L., Duffy, F. H., McAnulty, G. B., Buehler, D. M., Vandenberg, K., Sweet, N., Sell, E., Parad, R. B., Ringer, S. A., Butler, S. C., Blickman, J. G., & Jones, K. J. (2003). A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects. J Dev Behav Pediatr, 24(6), 399-408.

Chen, L. C., Wu, Y. C., Hsieh, W. S., Hsu, C. H., Leng, C. H., Chen, W. J., Chiu, N. C., Lee, W. T., Yang, M. C., Fang, L. J., Hsu, H. C., & Jeng, S. F. (2013). The effect of in-hospital developmental care on neonatal morbidity, growth and development of preterm Taiwanese infants: a randomized controlled trial. Early Hum Dev, 89(5), 301-306.

Fegran, L., Helseth, S., & Fagermoen, M. S. (2008). A comparison of mothers' and fathers' experiences of the attachment process in a neonatal intensive care unit. J Clin Nurs, 17(6), 810-816.

Hack, M., Flannery, D. J., Schluchter, M., Cartar, L., Borawski, E., & Klein, N. (2002). Outcomes in young adulthood for very-low-birth-weight infants. N Engl J Med, 346(3), 149-157.