Maternal-Infant Bonding Improves Infant Outcomes After Prenatal CHD Diagnosis

Study shows Duke bonding algorithm successfully identifies appropriate patients

Newborn baby sleeping on mom
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New research demonstrates that maternal-infant bonding is safe for infants with select types of prenatally diagnosed congenital heart disease (CHD). Published in August 2018 in Cardiology in the Young, the study suggests that a change to the current standard of care may be warranted to allow these infants to receive the benefits of maternal-infant bonding.

Currently, pregnancies with a prenatal diagnosis of CHD are considered high-risk, which extends to the labor and delivery environment, and the approach to perinatal infant care. In order to prevent hemodynamic instability after the ductus arteriosus closes, infants with CHD are delivered in a medically intensive environment with minimal physical contact with the parents.

However, maternal-bonding during the “early sensitive period”—the 2-hour window immediately after birth of increased infant alertness and vocalization—confers significant physiologic and psychologic benefits to both mother and infant. In addition, several studies show that the ductus arteriosus maintains patency for hours after birth.

“There has been this rush after birth to get the baby with CHD to the ICU to keep the ductus arteriosus open to prevent hemodynamic decompensation or shock,” explains the study’s lead author, Piers Barker, MD, professor of Pediatric Cardiology and OB-GYN at Duke. “But we know from experience and the natural history that these babies don’t get sick in the first 12 hours, so why are we overmedicalizing the delivery process, and why are we preventing parental-child bonding when we know there are huge benefits that can’t be recovered later on?”

Barker and his Duke colleagues developed a “Hearts for Bonding” algorithm with the goal of enabling Duke newborns with CHD to safely receive the benefits of maternal-infant contact. In the algorithm, fetuses are classified as either “approved” or “not approved” for bonding during initial Fetal Cardiology consultation and subsequent Fetal Cardiology visits. Bonding duration in infants who are approved for bonding immediately after delivery is targeted for 30 minutes beyond the time of initial resuscitation.

In the study, the team assessed patient outcomes from the first two years of the Duke Hearts for Bonding program. A total of 157 fetuses were ultimately included in the analysis, with 91 prenatally approved for bonding, 38 prenatally approved but deemed unsuitable for bonding upon delivery, and 28 who were not prenatally approved. In those infant prenatally approved for bonding but deemed unsuitable to bond upon delivery, the decision to defer bonding was not based on cardiac disease–related problems for any of the patients.

The researchers reported three main findings:

•    Immediate postnatal maternal-infant bonding is safe for infants with select CHD diagnoses.

•    Echocardiography can be used to identify which infants can safely undergo bonding.

•    Infants who bonded had better outcomes: higher birth weight, later gestation, less likely to be delivered via cesarean delivery or have additional non-cardiac diagnoses, higher Apgar scores, shorter hospital and ICU lengths of stay, and higher survival.

The need for cardiac intervention before hospital discharge was the same in both groups.

The findings provide support for the wider adoption of maternal-infant bonding programs, Barker says: “Although this research seems extraordinarily intuitive, our formalized bonding program at Duke marks a radical departure from standard management, so it was important to show that our protocol successfully determines which patients can safely bond after delivery. The question now is whether we can extend bonding to the full 2-hour early sensitive period.”