Date of Award

2005

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Elaine Amella

Second Advisor

Tara Hulsey

Third Advisor

Thomas C. Hulsey

Fourth Advisor

Marilyn Laken

Abstract

This case-control study used an academic health sciences center sample to examine differences in prenatal care utilization (defined by the number of prenatal care visits and gestational age at entry into prenatal care) between failure to thrive infants and healthy infants; and test prenatal care utilization as a predictor of failure to thrive. This study described maternal bonding characteristics (prenatal care utilization, infant length of hospital stay, feeding method, frequency of all/visits, and discharge teaching) of hospitalized failure to thrive infants. Using the Medical University of South Carolina Perinatal Information System, Keane System, and Practice Partner databases, a study sample (N=222) was obtained from mothers who received prenatal care service, delivered their child at MUSC, and obtained pediatric health services through the university network during 2001-2004. The conceptual model used to guide this study was Barnard and Eyres' (1979) Child Health Assessment Model; an ecological model based on the assumption that the mother, infant and environment are all in interaction. Failure to thrive often results from dysfunctional maternal infant interactions triggered by interference. The maternal health seeking behavior of prenatal care use was utilized as a proxy for maternal-fetal/infant attachment. Maternal variables examined in this study were: adequacy of prenatal care utilization, education, age, parity, and pregnancy interval. The environmental variable was marital status and child variables were intrauterine growth and gender. Cases and controls were matched 1 to 1 in terms of age, race, and insurance status. Preliminary data analyses found that prenatal care utilization, based on the number of prenatal care visits and gestational age at entry into care, and gender were independently associated with failure to thrive. There were no significant differences in adequate/less than adequate prenatal care utilization, maternal age, education, parity, pregnancy interval, and intrauterine growth between cases and controls. The odds for females developing failure to thrive were 1.834 times higher than for males (p = 0.027); prenatal care utilization was not a predictor of failure to thrive when controlling for confounding variables (p = 0.502). Using the Child Health Assessment Model only 2.5% of the variance of the predictive independent variables were explained.

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