This study examined whether parental resolution of an infant's congenital heart disease (CHD) diagnosis contributes to the quality of parent-infant bonding during hospitalization in a pediatric cardiac intensive care unit (PCICU), beyond the known impacts of psychological distress. The authors noted a gap in research on bonding in families of infants with CHD and emphasized the importance of studying understudied cultural groups represented in their sample.
The investigation used a cross-sectional design and was conducted in the PCICU at Hadassah University Medical Center, Israel. The sample comprised 58 parents of 37 infants who were hospitalized following cardiac surgery or catheterization. Parents were 43% fathers; 72% identified as ultra-Orthodox Jewish and 28% as Muslim-Arab. Infant age at assessment was reported (mean days = 65.22; SD = 84.61). No interventions were applied as part of the study.
Parents completed validated instruments assessing reaction to diagnosis, bonding, depressive symptoms, and posttraumatic stress symptoms: the Reaction to Diagnosis Questionnaire (measuring resolution), the Postpartum Bonding Questionnaire (higher scores indicate more impaired bonding), the Edinburgh Postnatal Depression Scale, and the PTSD Checklist for DSM-5. In addition, parents answered an open-ended question about how the infant's birth and medical condition affected their lives; responses were coded for affect, crisis, growth, religious faith, and social support. Clinical data for the infants were extracted from medical records.
Correlation analyses showed that better parental resolution was associated with healthier bonding (r = -0.55; p < 0.001), noting that higher bonding scores mean more impaired bonding. Depressive symptoms correlated with poorer resolution (r = -0.47; p < 0.001) and with more impaired bonding (r = 0.44; p = 0.001). Similarly, PTSD symptoms correlated with poorer resolution (r = -0.51; p < 0.001) and with more impaired bonding (r = 0.48; p < 0.001). These associations indicate that psychological distress and lower resolution are linked to worse parent-infant relationship measures.
A multivariable model controlled for depressive symptoms, PTSD symptoms, and timing of diagnosis (prenatal vs postpartum). Even after accounting for these factors, parental resolution remained an independent predictor of healthier bonding (β = -0.35; p = 0.032), with an incremental explained variance of ΔR2 = 0.08. This suggests that resolution contributes uniquely to bonding outcomes beyond the influence of current symptom levels and diagnosis timing.
Analysis of the open-ended question identified themes including negative affect, crisis framing, personal growth, religious faith, and social support. Parents who expressed less negative affect and who addressed personal growth in their narratives demonstrated better resolution and healthier bonding (p's < 0.029). Conversely, lack of reference to religious faith and framing the experience as a crisis were associated with more impaired bonding (p's < 0.037). These qualitative findings mapped onto the quantitative results and provided contextual nuance about coping and meaning-making in this culturally specific sample.
The authors conclude that parental resolution of an infant's CHD diagnosis may facilitate the development of nurturing parent-infant relationships during hospitalization. Given the observed relationships among resolution, depressive and PTSD symptoms, and bonding, the study highlights the need for early psychological screening and interventions for families facing a CHD diagnosis in the PCICU. Interventions that support emotional processing, reduce negative affect, and foster adaptive meaning-making and growth may promote resolution and thereby improve bonding.
The source reports a cross-sectional design, which limits causal inference about whether resolution leads to improved bonding or vice versa. The sample included a culturally specific mix (predominantly ultra-Orthodox Jewish and Muslim-Arab parents) from a single center; generalizability to other populations or settings was not reported in the abstract. No details on specific intervention strategies or longitudinal outcomes were reported in the source. The authors disclosed no conflicts of interest.