Ludman, Lorraine; (1990) The psychological effects of major neonatal surgery on infants and their families. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This work is the first prospective longitudinal study to investigate the effects of major neonatal surgery on infants born at full term. Over a 3 year period, the intellectual social and emotional development of thirty full-term infants, who underwent major emergency surgery soon after birth, was compared with that of a matched group of twenty-nine healthy newborn babies. An additional group of thirteen full-term neonates, admitted to a neonatal intensive care unit for medical reasons, was included for the study of selected issues, such as the effects of hospitalization and the separation of the mother from her baby. The effects of a sick newborn on the mental health of the mother and on the parental relationship were important aspects of the study. The infants and their families were intensively studied during the first year of life, and followed up when the child reached three years of age. At the 6 month stage there were no significant differences between the groups of infants in terms of developmental progress. At one year however, the development of the 'surgical' babies was significantly delayed in all areas, except for social and gross motor development. During the first year, there was a higher proportion of 'surgical' babies, classified as temperamentally 'difficult', than of the control babies. The early separation of the mother from her baby appeared to have no detrimental effects on the mother-infant relationship. At 3 years of age the surgical children as a group, performed less well on all the tests of cognitive functioning compared to the controls, and their scores on a test of speeded motor skills were significantly slower. Within the surgical group however, the cognitive functioning of the children who required no further treatment after the age of 6 months was comparable with that of the controls. In contrast, the children who had required further hospitalization and/or operative procedures, and those who had persisting medical problems at 3 years of age, were functioning at lower levels than the rest of the group The children in the 'surgical' group as a whole, showed an increased Incidence of behavioural problems, but at this stage there were no differences between the surgical and control groups in the ratings of temperament At three years the 'surgical' mothers tended to be less sensitive, more Indulgent, and more inconsistent in their handling of their children's behaviour. This tendency, together with the increased incidence of behavioural problems in this group, suggest that when the children were 3 years old there were difficulties in the mother-child relationship, in contrast to the findings at 1 year. In conclusion, the findings from the study suggest that full-term babies with abnormalities requiring major neonatal surgery are at risk for behavioural problems in early childhood, and that the cognitive development of children who require further operative procedures or medical treatment, may be adversely affected in the preschool years.

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