Table 1.

Research Examining Parental Perceptions of Vulnerability in Premature Infants

Citation	Study Design	Study Sample	Principle Research Questions/Findings
1. Culley, BS, Perrin, EC, & Chaberski, MJ. (1989). Parental perceptions of vulnerability of formerly premature infants. Journal of Pediatric Health Care, 3(5), 237-245.	Cross sectional Survey	80 healthy 3 year-olds who had been admitted to a NICU either because of birth weight <1500 grams or hyaline membrane requiring ventilation attenders at follow-up clinic. Comparison = 41 children born at same hospital during same time period but with no problems – randomly sampled from nursing records.	• Is there a persistent sense of vulnerability in mothers of children admitted to a NICU but who at 3 are healthy. • Factors related to vulnerability • Is vulnerability related to behavior problems
2. Perrin, EC, West, PD, & Culley, BS. (1989). Is my child normal yet? Correlates of vulnerability. Pediatrics, 83(3), 355-363.	Cross sectional Survey	80 healthy 3 year-olds who had been admitted to a NICU either because of bw <1500 grams or hyaline membrane requiring ventilation attenders at follow-up clinic. Comparison = 41 children born at same hospital during same time period but with no problems – randomly sampled from nursing records. All children born in NICU between 4/82 and 3/83: 186 total. 105 were contacted, 103 agreed to participate.	• Is there a persistent sense of vulnerability in mothers of children admitted to a NICU but who at 3 are healthy. • Factors related to vulnerability • Is vulnerability related to behavior problems • 49 = premature, 39 healthy, 10 problems • 54 = full term, 4 healthy, 4 previous problems with neonatal morbidity, 9 are neonatal morbidity but healthy
3. Burger, JA, Horwitz, SM, Forsyth, BWC, Leventhal, JM, & Leaf, PJ. (1993). Psychological Sequelae of Medical Complications During Pregnancy. Pediatrics, 91(3), 566-571.	Longitudinal Cohort	1095 4-8 year old children recruit from a stratified random sample of pediatric practices	• Whether women with severe medical complications during pregnancy are at increased risk of postpartum depression and/or viewing their child as vulnerable • Depression associated with pregnancy complications
4. Miles, MS, & Holditch-Davis, D. (1995). Compensatory parenting: how mothers describe parenting their 3-year-old, prematurely born children. Journal of pediatric nursing, 10(4), 243.	Longitudinal Cohort	Convenience subsample of premature children born ≤ 1500 grams or needed mechanical ventilation Included 27 caretakers of 30 3 year olds	• Do mothers’ memories of birth and NICU hospitalizations affect perceptions and parenting of their 3 year olds • 50% seen as vulnerable at age 3 – no correlates of vulnerability
5. Thomasgard, M, & Metz, WP. (1997). Parental overprotection and its relation to perceived child vulnerability. American Journal of Orthopsychiatry, 67(2), 330-335.	Cross sectional Survey	Parents of 5-year olds recruited from 2 pediatric practices serving Worcester, MA 4/92 – 6/92 Of 300 parents, 7% refused	• Child vulnerability related to antecedent medical factors • Child vulnerability and parental overprotection are not related • Vulnerability and overprotection not the same
6. Estroff, Debra Bendell, Yando, Regina, Burke, Kathleen, & Synder, David. (1994). Perceptions of preschoolers’ vulnerability by mothers who had delivered preterm. Journal of pediatric psychology, 19(6), 709-721.	Cross sectional Survey	50 preschool children 36-37.5 months enrolled in a follow up clinic since discharged from NICU	• Characteristics related to perceived vulnerability • Do vulnerable versus non vulnerable children differ developmentally and behaviorally
7. Thomasgard, M. (1998). Parental perceptions of child vulnerability, overprotection, and parental psychological characteristics. Child psychiatry and human development, 28(4), 223-240.	Cross sectional Survey	871 parents of 22 72-month old children recruited from 5 primary care pediatric practices in Columbus, OH 3/94 – 8/94, which represents 84% of those approached	• Are vulnerability and overprotectiveness related • Outcomes of vulnerability • Maternal psychological factors related to vulnerability
8. Green, M, & Solnit, AJ. (1964). Reactions to the Threatened Loss of a Child: A Vulnerable Child Syndrome Pediatric Management of the Dying Child, Part III. Pediatrics, 34(1), 58-66.	Case study	25 parents of children who were expected to die prematurely	• Description of the vulnerable child syndrome • Predisposing factors
9. Forsyth, BWC, Horwitz, SM, Leventhal, JM, & Burger, J. (1996). The Child Vulnerability Scale: an instrument to measure parental perceptions of child vulnerability. Journal of pediatric psychology, 21(1), 89-101.	Longitudinal Cohort	1095 children and families recruited from stratified random sample of pediatric practices in the greater New Hampshire area	• Understand the diagnosis and management of psychosocial problems by primary care pediatricians • Develop the Child Vulnerability Scale • Look at correlates of vulnerability
10. Miceli, PJ, Goeke-Morey, MC, Whitman, TL, Kolberg, KS, Miller-Loncar, C, & White, RD. (2000). Brief report: birth status, medical complications, and social environment: individual differences in development of preterm, very low birth weight infants. Journal of pediatric psychology, 25(5), 353-358.	Longitudinal Cohort	30 infants and families in a longitudinal study of preterm infant development	• Importance of birth status, medical complications and social outcomes for development outcomes in a sample of preterm very low birth weight infants across 3 years
11. De Ocampo, AC, Macias, MM, Saylor, CF, & Katikaneni, LD. (2003). Caretaker perception of child vulnerability predicts behavior problems in NICU graduates. Child psychiatry and human development, 34(2), 83-96.	Cross sectional Survey	90 low income parents consecutively enrolled at a high risk neonatal developmental follow-up clinic	• Constructs of parental perceptions of child vulnerability and child medical severity
12. Teti, DM, Hess, CR, & O'Connell, M. (2005). Parental Perceptions of Infant Vulnerability in a Preterm Sample: Prediction from Maternal Adaptation to Parenthood during the Neonatal Period. Journal of Developmental & Behavioral Pediatrics, 26, 283-292.	Randomized Controlled Trial	97 low income AA mothers of preterm infants recruited from 4 NICUs near DC, in a parent-child interaction intervention, 54-58 weeks post birth follow-up	• Mother's assessment that child is unresponsive, inattentive will presage CVS later • Parental self-efficacy will be related to CVS and can be moderated by infant health, depression and social support
13. Allen, EC, Manuel, JC, Legault, C, Naughton, MJ, Pivor, C, & O'Shea, TM. (2004). Perception of child vulnerability among mothers of former premature infants. Pediatrics, 113(2), 267-273.	Longitudinal Cohort	116 mothers of preterm (≤32 weeks) infants	• Is higher PPCV associated with worse developmental outcomes • Assessed at discharge and at 1 year adjusted age
14. Chambers, PL, Mahabee-Gittens, EM, & Leonard, AC. (2011). Vulnerable Child Syndrome, Parental Perception of Child Vulnerability, and Emergency Department Usage. Pediatric Emergency Care, 27(11), 1009-1013.	Cross sectional Survey	351 parents/legal guardians of children 1-15 years with no emergent problems	Relationship between high Emergency Department use and perceptions of vulnerability
15. Stern, M, Karraker, K, McIntosh, B, Moritzen, S, & Olexa, M. (2006). Stereotyping and Mothers’ Interactions with their Premature and Full-term Infants during the First Year. Journal of pediatric psychology, 31(6), 597-607.	Longitudinal Cohort	Premature and full-term infants identified through newspaper birth listings were sent a letter. 25% contacted researchers, 22% participated. 115 mothers, 59 of full-term, 56 of premature infants assessed at 5.9 months	• Are premature stereotypes and perceptions of vulnerability stable across time • Are these related • Are these related to later infant outcomes