The neglected sibling? – Investigating the implications of having a preterm born sibling on the quality of life of the term born sibling

Siblings are one’s first peer group experience. Growing up, they contribute greatly to identity building and childhood development. However, there is little data on how having a preterm child affects the lives of term born siblings. A study from Finland therefore reviewed the available data to investigate the siblings’ quality of life after the birth of a preterm newborn. The study revealed that the absence of the mother and father for their daily visits to the preterm infant in hospital can cause negative feelings in the sibling, such as frustration, reduced attention, uncertainty, and separation anxiety. Their needs and feelings are often downplayed, both by themselves to protect the newborn sibling and by their parents. This may be explained by a reporting bias, where parents’ own experiences alter their perception of their children’s feelings. They therefore need more involvement in the family routines of visiting the neonatal intensive care unit (NICU).

Every year, approximately 13.4 million newborns are born preterm. Most of these preterm born children and adults grow up with a healthy quality of life that is not made more challenging by long-term impairments. However, many of the preterm children experience lifelong sequelae, with those born most preterm having the highest risk for adverse consequences. There are a number of studies investigating the impact of preterm birth (PTB) on the quality of life of those affected and their parents. Increased stress, financial burden, and more time spent caring for the needs of the preterm child may lead to poorer health and quality of life of the parents.

However, there is little data on the impact on siblings when a PTB child joins the family. Siblings play a crucial role in childhood development and identity building as they are each other’s first peer group experience. In order to explore this new perspective on siblings’ quality of life, a Finish study conducted a systematic review of the effects of preterm birth on term-born siblings. The ages of the term-born siblings included in the study ranged from the first year of life into adulthood.

Siblings often experience negative changes after the birth of a preterm infant

The studies analysed revealed a very heterogenous picture of siblings’ well-being after the birth of their preterm sibling. Some reported negative experiences following the birth of their preterm sibling, associated with reduced parental attention and other social problems that can be attributed to changes in family routines and dynamics. Older siblings were often left under the care of other family members while both parents spent a lot of time in the NICU where the preterm infant was hospitalised. The siblings reported separation anxiety and uncertainty about being reunited with their absent mother, as mothers spent much more time in the NICU than fathers. At the same time, the newborn sibling was blamed for the mother’s absence and the sudden changes in the family routine.

Emphasising the need for attention and involvement of siblings in the preterm’s care

Despite the challenge of having a preterm infant in the family, other siblings reported a hero or protector syndrome and a sense of loyalty and caring for and sheltering the preterm sibling. In these cases, the term-born sibling tended to downplay their own experiences in order to protect the preterm sibling from the world. The available studies made it clear that the PTB of a sibling can affect the term-born sibling in many ways.

Notably, the study authors also compared quality of life indicators between siblings of preterm children and siblings of term born children and found that the difference was often not significant. This indicates that that the quality of life of siblings is not necessarily worse due to the birth of their preterm sibling. These conclusions are tentative, however, as there are fewer studies with fewer number of participants and a marked lack in diversity as they tend to focs on high- and upper-middle income countries. Therefore, the study authors strongly encourage including siblings in family cohort studies to close this knowledge gap and involving siblings early in the care of the preterm newborn in hospital.

Paper available at: https://onlinelibrary.wiley.com/doi/10.1111/apa.17105

Ful list of authors: Wnurinham Silva, Eeva Virtanen, Eero Kajantie, Sylvain Sebert

DOI: https://doi.org/10.1111/apa.17105

Find more ideas how for involving siblings in the care of the preterm newborn during hospitalisation here and here