Attachment Quality in Very Low-Birthweight Premature Infants in Relation to Maternal Attachment Representations and Neurological Development

Objective. To study the development of attachment in very low-birthweight preterm infants with respect to neurological development and maternal attachment representations. Design. Emotional development in a high-risk sample (N = 79) of very low-birthweight preterm infants ( 1,500 g) is reported. The quality of attachment in preterm infants was classified using the Strange Situation Procedure at 14 postnatal months (corrected for prematurity) and was associated with maternal attachment representation assessed with the Adult Attachment Interview at 6 postnatal months. Neurological development at 14 months was taken into account. Results. The distribution of the quality of attachment in preterm infants (60.3% secure, 23.5% insecure - avoidant, 2.9% insecure - ambivalent, 10.3% insecure - disorganized, and 2.9% not classifiable) was comparable with results of studies of term infants. There was no correspondence between maternal representations of attachment and infant quality of attachment. However, neurologically impaired infants were more often insecurely than securely attached. Conclusions. Very low-birthweight preterm infants more often develop an insecure quality of attachment if their neurological outcome is impaired. Therefore, minimizing risk factors for the development of neurological deficits may have a preventive effect both on the somatic and on the emotional development of high-risk infants.