PSYCHIC CARE IN VERY-LOW-BIRTH-WEIGHT INF ANTS

The ongoing progress in neonatal intensive care is modifying the psych ic context of prematurity for all the partners, infants as well as par ents and physicians. Comfort and prognosis of preterm infants have muc h improved. Since newborns under 24 weeks of gestational age are now s urviving, they spend approximately half the duration of pregnancy out of the maternal uterus. All the psychological issues of such an early separation have to be considered, including the developmental outcome of a sensorial environment which is quite different from the intra-ute rine one. Research has been developing in this field. The cooperation between neonatalogists and psychologists has been profitable to parent s. Problems linked to the separation, such as difficulty in representi ng the infant, are no more frequent owing to the attention paid to the mother-child bond and subsequent early contacts. What is forward now is the impact of an hyper technical world of intensive care on the par ents, and of the strange aspect of the tiny baby surrounded by engines and tubes. Such an overpresence of reality often results in a reactio n of traumatic daziness among parents. The cooperation of the whole st aff is necessary for the resumption of an imaginary process of psychic functioning. Finally, the survival of very-low-birth weight infants c onfronts the neonatalogists with some delicate ethical questions. Psyc hiatrists and psychologists might have an important part to play in ai ding the profession in its sorting out of these ethical issues.