Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T06:05:14.942Z Has data issue: false hasContentIssue false

Psychosocial responses of parents to their infant’s diagnosis of hypoplastic left heart syndrome

Published online by Cambridge University Press:  12 September 2014

Annie M. Cantwell-Bartl*
Affiliation:
Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia
James Tibballs
Affiliation:
Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia
*
Correspondence to: A. M. Cantwell-Bartl, PhD, MAPS, Honorary Research Fellow, Paediatric Intensive Care Unit, Royal Children’s Hospital, Melbourne, VIC 3052, Australia. Tel: +61 419875570; E-mail: annie.cantwell-bartl@rch.org.au

Abstract

Objective: To evaluate the psychosocial status of mothers and fathers in response to their infant’s diagnosis of hypoplastic left heart syndrome. Design: A study on interviews with parents whose children had survived staged surgery. Setting: Tertiary hospital paediatric ICU. Subjects: A total of 29 parents (16 mothers and 13 fathers) of surviving children. Intervention: A semi-structured face-to-face interview was conducted to explore experiences of parents in response to their infant’s diagnosis, their interaction with the doctor delivering the diagnosis, their deliberation about staged surgery, and their reasons for this choice. Measurement and Main Results: All parents were devastated about their infant’s diagnosis, and most (83%) of them said that the time of the diagnosis and the aftermath was the worst time of their lives. Parents reported helpful and unhelpful communication at this time. Although all parents in this study chose surgery for their infant, when faced with the choice, 17 of them made an immediate decision “to protect their infant’s life”, 8 were initially unsure when their infant was diagnosed in utero, and 4 were unsure when the infant was diagnosed after birth. Parents also experienced loss and other stressors. Conclusions: All parents of the infants diagnosed with hypoplastic left heart syndrome experienced intense loss and stressors. Physicians need to be sensitive to the needs and thinking of the parents when discussing treatment options before surgery. The nature of the relationship with the doctor at this time can support parents or be a further source of stress.

Type
Original Articles
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Washington, RL. Hypoplastic left heart syndrome – the rest of the story. J Pediatr 2008; 152: 456457.CrossRefGoogle ScholarPubMed
2 Rempel, G. Parenting a child with HLHS whose infant includes the Norwood surgical approach. Unpublished doctoral dissertation, University of Alberta, Edmonton, Canada, 2005.Google Scholar
3 Dadlani, GH, Braley, K, Perez-Colon, E, et al. Long-term management of patients with hypoplastic left heart syndrome: the diagnostic approach at All Children’s Hospital. Cardiol Young 2011; 21 (Suppl 2): 8087.CrossRefGoogle ScholarPubMed
4 Feinstein, JA, Benson, DW, Dubin, AM, et al. Hypoplastic left heart syndrome: current considerations and expectations. JACC 2012; 59: S1S42.CrossRefGoogle ScholarPubMed
5 Murtuza, B, Jones, T, Barron, D, Brawn, W. Temporary restriction of right ventricle-pulmonary artery conduit flow using haemostatic clips following Norwood I reconstruction: potential for improved outcomes. Interact Cardiovasc Thorac Surg 2012; 14: 327329.CrossRefGoogle Scholar
6 Lee, A, Rempel, G. Parenting children with hypoplastic left heart syndrome: finding a balance. J Spec Pediatr Nurs 2011; 16: 179189.CrossRefGoogle ScholarPubMed
7 Newburger, JW, Sleeper, LA, Bellinger, DC, et al. Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial. Circulation 2012; 125: 20812091.CrossRefGoogle ScholarPubMed
8 Goldberg, CS, Schwartz, EM, Brunberg, JA, et al. Neurodevelopmental outcome of patients after the fontan operation: a comparison between children with hypoplastic left heart syndrome and other functional single ventricle lesions. JAMA Pediatr 2000; 137: 646652.CrossRefGoogle ScholarPubMed
9 Mahle, W, Visconti, K, Freier, MC, et al. Relationship of surgical approach to neurodevelopmental outcomes in hypoplastic left heart syndrome. Pediatrics 2006; 117: e90e97.CrossRefGoogle ScholarPubMed
10 Mahle, WT, Clancy, RR, Moss, EM, Gerdes, M, Jobes, DR, Wernovsky, G. Neurodevelopmental outcome and lifestyle assessment in school-aged and adolescent children with hypoplastic left heart syndrome. Pediatrics 2000; 105: 10821089.CrossRefGoogle ScholarPubMed
11 Marino, BS New concepts in predicting, evaluating, and managing neurodevelopmental outcomes in children with congenital heart disease. Curr Opin Pediatr 2013; 25: 574584.CrossRefGoogle Scholar
12 Galindo, A, Nieto, O, Villagra, S, Graneras, A, Herraiz, I, Mendoza, A. Hypoplastic left heart syndrome diagnosed in fetal life: associated findings, pregnancy outcome and results of palliative surgery. Ultrasound Obstet Gynecol 2009; 33: 560566.CrossRefGoogle ScholarPubMed
13 Kon, A. Ethics of cardiac transplantation in hypoplastic left heart syndrome. Pediatr Cardiol 2009; 30: 725728.CrossRefGoogle ScholarPubMed
14 Menahem, S, Teoh, M, Wilkinson, D. Should clinicians advise terminating a pregnancy following the diagnosis of a serious fetal cardiac abnormality? Case Rep Perinatal Med 2012; 1: 2328.CrossRefGoogle Scholar
15 Rychik, J. What does palliative care mean in prenatal diagnosis of congenital heart disease? World J Pediatr Congenit Heart Surg 2013; 4: 8084.CrossRefGoogle ScholarPubMed
16 Arafa, M, Zaher, S, El-Dowaty, A, Moneeb, D. Quality of life among parents of children with heart disease. Health Qual Life Outcomes 2008; 6; 91.CrossRefGoogle ScholarPubMed
17 Menahem, S, Grimwade, J. Effective counselling of pre-natal diagnosis of serious heart disease – an aid to maternal bonding? Fetal Diagn Ther 2004; 19: 470474.CrossRefGoogle ScholarPubMed
18 Re, J, Dean, S, Menahem, S. Infant cardiac surgery: mothers tell their story: a therapeutic experience. World J Pediatr Congenit Heart Surg 2013; 4: 278285.CrossRefGoogle Scholar
19 Rempel, G, Harrison, M, Williamson, D. “Is treat your child normally” helpful advice for parents of survivors of treatment of hypoplastic left heart syndrome? Cardiol Young 2009; 19: 135144.CrossRefGoogle ScholarPubMed
20 Lee, A, Rempel, GR. Parenting children with hypoplastic left heart syndrome: finding a balance. J Spec Pediatr Nurs 2011; 16: 179189.CrossRefGoogle ScholarPubMed
21 Meakins, L, Ray, L, Hegadoran, K, Rempel, G. Parental vigilance in caring for their children with hypoplastic left heart syndrome. Circulation 2011; 28 (5: Suppl. S107).Google Scholar
22 Vandvik, I, Forde, R. Ethical issues in parental decision-making: an interview study of mothers of children with hypoplastic left heart syndrome. Acta Paediatr 2000; 89: 11291133.CrossRefGoogle ScholarPubMed
23 Connolly, D, McClowry, S, Hayman, L, Mahony, L, Artman, M. Posttraumatic stress disorder in children after cardiac surgery. JAMA Pediatr 2004; 144: 480484.CrossRefGoogle ScholarPubMed
24 Helfricht, S, Latal, B, Fischer, JE, Tomaske, M, Landolt, MA. Surgery-related posttraumatic stress disorder in parents of children undergoing cardiopulmonary bypass surgery: a prospective cohort study. Pediatr Crit Care Med 2008; 9: 217223.CrossRefGoogle ScholarPubMed
25 Nagata, S, Funakosi, S, Amae, S, et al. Posttraumatic stress disorder in mothers of children who have undergone surgery for congenital disease at a pediatric surgery department. J Pediatr Surg 2007; 43: 14801486.CrossRefGoogle Scholar
26 Balluffi, A, Kassam-Adams, N, Kazak, A, Tucker, M, Dominguez, T, Helfaer, M. Traumatic stress in parents of children admitted to the pediatric intensive care unit. Pediatr Crit Care Med 2004; 5: 547553.CrossRefGoogle Scholar
27 Colville, G, Darkins, J, Hesketh, J, Bennett, V, Alcock, J, Noyes, J. The impact on parents of a child's admission to intensive care: integration of qualitative findings from a cross-sectional study. Intensive Crit Care Nurs 2009; 25: 7279.CrossRefGoogle ScholarPubMed
28 Nelson, LP, Gold, JI. Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: a review. Pediatr Crit Care Med 2011; 13: 338342.CrossRefGoogle Scholar
29 Ularntinon, S, Bernard, R, Wren, F, St. John, N, Horwitz, S, Shaw, R. Traumatic stress reactions in parents in pediatric intensive care: a review. Curr Psychiatry Rev 2010; 6: 261268.CrossRefGoogle Scholar
30 Board, R. Father stress during a child's critical care hospitalization. J Pediatr Health Care 2004; 18: 244249.Google ScholarPubMed
31 Cantwell-Bartl, AM. Parenting a child with a constant life-threatening condition: the psychosocial experiences of parents whose child has hypoplastic left heart syndrome. PhD thesis, University of Melbourne, Melbourne, Victoria, Australia, 2012.Google Scholar
32 Shudy, M, de Almeida, M, Ly, S, et al. Impact of pediatric critical illness and injury on families: a systematic literature review. Pediatrics 2006; 118: 203218.CrossRefGoogle ScholarPubMed
33 Menahem, S, Grimwade, J. Counselling strategies in the prenatal diagnosis of major heart abnormality. Heart Lung Circ 2004; 3: 261265.CrossRefGoogle Scholar
34 Azoulay, E, Chevret, S, Leleu, G, et al. Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000; 28: 30443049.CrossRefGoogle ScholarPubMed
35 Needle, JS, O'Riordan, M, Smith, PG. Parental anxiety and medical comprehension within 24 hrs of PICU admission: conclusions. AACN Clin Issues Crit Care Nurs 1991; 10: 329337.Google Scholar
36 Hilton-Kamm, D, Sklansky, M, Chang, R-K. How not to tell parents about their child’s new diagnosis of congenital heart disease: an internet survey of 841 parents. Pediatr Cardiol 2014; 35: 239252.CrossRefGoogle ScholarPubMed
37 Ellinger, M, Rempel, G, Catlin, A. Parental decion-making regarding treatment for hypoplastic left heart syndrome. Adv Neonatal Care 2010; 10: 316322.CrossRefGoogle ScholarPubMed
38 Rempel, G, Cender, L, Lynam, M, Sandor, G, Farquharson, D. Parents' perspectives on decision making after antenatal diagnosis of congenital heart disease. J Obstet Gynecol Neonatal Nurs 2004; 33: 6470.CrossRefGoogle ScholarPubMed
39 Cantwell-Bartl, AM, Tibballs, J. Psychosocial experiences of parents of infants with hypoplastic left heart syndrome in the PICU. Pediatr Crit Care Med 2013; 14: 869875.CrossRefGoogle ScholarPubMed
40 Liamputtong, P, Ezzy, D. Qualitative Research Methods. Oxford University Press, Melbourne, 2005.Google Scholar
41 Hilton Kamm, D. Caring for a child with a congenital heart disease: practical tools and resources. Congenit Cardiol Today 2006; 4: 9.Google Scholar
42 Upham, M, Medoff-Cooper, B, Upham, M, Medoff-Cooper, B. What are the responses & needs of mothers of infants diagnosed with congenital heart disease? MCN Am J Matern Child Nurs 2005; 30: 2429.Google ScholarPubMed
43 Colville, G, Cream, P. Post-traumatic growth in parents after a child's admission to intensive care: maybe Nietzsche was right? Intensive Care Med 2009; 35: 919923.CrossRefGoogle ScholarPubMed
44 Carnevale, FA, Canoui, P, Cremer, R, et al. Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec. Pediatr Crit Care Med ADDIN EN.REFLIST ADDIN 2007; 8: 337342.Google Scholar