Mother Sibling Interactions Following Very Low Birth Weight (VLBW) Infant Homecoming

The proposed 2-year study will use a longitudinal, comparative, mixed method design to
explore the impact of a Very Low Birth Weight (VLBW) (≤33 weeks gestational age) infant on
mother-sibling interactions and sibling adjustment. A comparison group of full term infants
(≥38 weeks gestational age) will be included to elucidate sibling adjustment problems that
are typical to having a new baby in the home and sibling adjustment problems that are
associated with the unique stress of having to care for a VLBW infant. Participants will be
fifty mothers and siblings of VLBW infants and fifty mothers and siblings of full term
infants. Data collection will take place within one week of infant discharge from the
hospital (enrollment), and at 1 month and 6 months post infant discharge using self-report
measures, qualitative interviews, and mother-sibling interaction observation. Variables of
interest include mother's worry, anxiety, depression, and post-traumatic stress;
mother-sibling interactions including uninvolvement, positive affect, negative affect, talk,
looking and playing; internalizing and externalizing behaviors, sleep/somatic problems, and
growth in siblings of VLBW and in siblings of the comparison group with full term infants.
Mixed modeling and Ordinary Least Squares (OLS) regression modeling will be conducted to
identify factors that make siblings vulnerable to psychological and emotional adjustment
problems in response to having a VLBW infant in the home. There are no anticipated risks for
the infant participants of the study aside from the small risk of violating confidentiality
of infant participants and their mothers. No risks for siblings are anticipated aside from
the small risk of violating confidentiality.

Inclusion Criteria for siblings:

- Siblings of very low birth weight or healthy, full-term infants

- age 4 years old or younger

- siblings and infants must live with the mother

Inclusion Criteria for mothers:

- no previous or current diagnosis of major psychological disorder (including bipolar
disorder, psychosis, or active substance abuse)

- age 18 years or older

- English speaking,

- living within 1 hour's travel distance from Duke University, for feasibility.

- Mothers at-risk for preterm birth who meet all other eligibility criteria

Exclusion Criteria:

Mother/sibling pairs of infants who:

- have congenital neurological problems (congenital hydrocephalus or microcephaly),

- are symptomatic from substance exposure,

- are hospitalized longer than 1 month after term, or

- are technology dependent.