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Improving maternal–infant bonding after prenatal diagnosis of CHD

Published online by Cambridge University Press:  06 August 2018

Piers C. A. Barker Open the ORCID record for Piers C. A. Barker [Opens in a new window] ,
Gregory H. Tatum ,
Michael J. Campbell ,
Michael G. W. Camitta ,
Angelo S. Milazzo ,
Christoph P. Hornik ,
Amanda French  and
Stephen G. Miller
Piers C. A. Barker*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
Gregory H. Tatum
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
Michael J. Campbell
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
Michael G. W. Camitta
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
Angelo S. Milazzo
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
Christoph P. Hornik
Affiliation:
Duke Clinical Research Institute, Duke University, Durham, NC, USA
Amanda French
Affiliation:
Advanced Practice Nursing, Duke University Medical Center, Durham, NC, USA
Stephen G. Miller
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
*
Author for correspondence: P. C. A. Barker, Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, CHC 1927A, Durham, NC 27710, USA. Tel: 919 684 3574; Fax: 919 681 5903; E-mail: piers.barker@duke.edu
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Abstract

Background

Infants with prenatally diagnosed CHD are at high risk for adverse outcomes owing to multiple physiologic and psychosocial factors. Lack of immediate physical postnatal contact because of rapid initiation of medical therapy impairs maternal–infant bonding. On the basis of expected physiology, maternal–infant bonding may be safe for select cardiac diagnoses.

Methods

This is a single-centre study to assess safety of maternal–infant bonding in prenatal CHD.

Results

In total, 157 fetuses with prenatally diagnosed CHD were reviewed. On the basis of cardiac diagnosis, 91 fetuses (58%) were prenatally approved for bonding and successfully bonded, 38 fetuses (24%) were prenatally approved but deemed not suitable for bonding at delivery, and 28 (18%) were not prenatally approved to bond. There were no complications attributable to bonding. Those who successfully bonded were larger in weight (3.26 versus 2.6 kg, p<0.001) and at later gestation (39 versus 38 weeks, p<0.001). Those unsuccessful at bonding were more likely to have been delivered via Caesarean section (74 versus 49%, p=0.011) and have additional non-cardiac diagnoses (53 versus 29%, p=0.014). There was no significant difference regarding the need for cardiac intervention before hospital discharge. Infants who bonded had shorter hospital (7 versus 26 days, p=0.02) and ICU lengths of stay (5 versus 23 days, p=0.002) and higher survival (98 versus 76%, p<0.001).

Conclusion

Fetal echocardiography combined with a structured bonding programme can permit mothers and infants with select types of CHD to successfully bond before ICU admission and intervention.

Keywords

Fetal echocardiographyCHDmaternal–infant bondingprenatal diagnosis
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 11 , November 2018 , pp. 1306 - 1315
Copyright
© Cambridge University Press 2018 

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