SOCIAL ENVIRONMENT AND DEVELOPMENT IN HIGH RISK INFANTS

Abstract

The importance of social environment on infant development was prospectively studied. Social worker assessment (SWA) and a psychosocial inventory (PSI) were administered before discharge to mothers of 138 ill newborns: 93 patients with no neurological disorder (group I) and 45 with intraventricular hemorrhage (group II). The PSI included a summary psychosocial score (PSS) and subscores measuring stress, support systems, parenting skills, psychological profile, child abuse potential (CAP) and pregnancy attitudes (PA) (Altemeier 1979, others). Testing was done at 6, 12 and 18 months of age. Abnormal neurodevelopment was defined as Bayley indices <69, failure on Denver Development testing or major neurological abnormality.

In both groups I and II, abnormal SWA (Ia, IIa) had an additive effect compared to normal SWA (In, IIn) on risk of abnormal development (%): 12% (In), 28% (Ia), 50% (IIn), 64% (IIa), p<.001. PSI scores were higher in group I with normal versus abnormal development for CAP (p<.05), PA (p<.005), and PSS (p<.001). PSS significantly correlated with later neurodevelopment:

Differences remained, controlling income and mother's education.

A relationship is shown between social environment at birth and subsequent development which may allow earlier prediction and help for families of neonates at high risk of abnormal outcome.

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