Maternal anxiety and depression after a premature infant's discharge from the neonatal intensive care unit: explanatory effects of the creating opportunities for parent empowerment program

Enhancing caregivers self-management for their children who require medical technology: A feasibility study for the COPE-STAR intervention

PURPOSE

To test feasibility of the Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention for caregivers of children who require medical technologies of tracheostomies and feeding tubes.

DESIGN AND METHODS

Quasi-experimental one group design with measures at baseline and at 4 weeks. Intervention feasibility was tested from August 2019-June 2021, including recruitment, retention, and adherence, and caregiver satisfaction. Caregiver and child characteristics and outcomes were assessed.

RESULTS

Caregivers were enrolled (n = 22) and completed (n = 16) the study. Caregivers were primarily female (n = 21), were predominately Caucasian (n = 14, 64%) followed by African-American (n = 8, 36%), and Non-Hispanic/Latino (n = 18, 82%). Feasibility indicators of recruitment (92%), retention (73%), and adherence (100%) were satisfactory. Outcome measures of management of child's chronic condition, caregiver beliefs about managing their child's symptoms and medical technology, anxiety, and depressive symptoms remained stable. Caregivers agreed that the intervention was useful, easy to use, and acceptable, and had positive feedback.

CONCLUSIONS

This is a feasible and acceptable intervention. With further development and efficacy testing, the intervention has potential for use and expansion to a larger population of caregivers of children who require medical technology.

PRACTICE IMPLICATIONS

Children who require medical technology have multiple complex chronic conditions and complex care needs at home. This intensive and focused care is provided by informal caregivers who need education and resources for their child's care. This intervention addressed caregiver management of common symptoms and medical technologies of children in the home setting.

Does Educational Status Influence Parents' Response to Bad News in the NICU?

Communication in neonatal intensive care units and the relationship between families and staff have been reported to influence parental mental well-being. Research has also shown an impact of parental educational level on their well-being. However, whether different educational levels result in different reactions to breaking bad news (BBN) by physicians remains unanswered so far. We therefore examined the impact of parental level of education on their mental state after a BBN conversation and their relation to physicians. A prospective quantitative survey was conducted amongst 54 parents whose preterm or term infants were hospitalized in three German neonatal units. Parental education was classified as low (lower secondary/less (1), n: 23) or high (higher secondary/more (2), n: 31). Parents answered questions about certain aspects of and their mental state after BBN and their trust in physicians. The two groups did not differ significantly in their mental condition after BBN, with both reporting high levels of exhaustion and worries, each (median (min;max): (1): 16 (6;20) vs. (2): 14 (5;20), (scaling: 5-20)). However, lower-educated parents reported a lower trust in physicians (median (min;max): (1): 2 (0;9) vs. (2): 1 (0;6), p < 0.05 (scaling: 0-10)) and felt less safe during BBN (median (min;max): (1): 15 (9;35) vs. (2): 13 (9;33), p < 0.05). Only among higher-educated parents was trust in physicians significantly correlated with the safety and orientation provided during BBN (r: 0.583, p < 0.05, r: 0.584, p < 0.01). Concurrently, only among less-educated parents was safety correlated with the hope conveyed during BBN (r: 0.763, p < 0.01). Therefore, in BBN discussions with less-educated parents, physicians should focus more on giving them hope to promote safety.

Web-based follow-up tool (ePIPARI) of preterm infants-study protocol for feasibility and performance

BACKGROUND

Preterm infants have a risk of health and developmental problems emerging after discharge. This indicates the need for a comprehensive follow-up to enable early identification of these problems. In this paper, we introduce a follow-up tool "ePIPARI - web-based follow-up for preterm infants". Our future aim is to investigate whether ePIPARI is a feasible tool in the follow-up of preterm infants and whether it can identify children and parents in need of clinical interventions.

METHODS

ePIPARI includes eight assessment points (at term age and at 1, 2, 4, 8, 12, 18, and 24 months of corrected age) when the child´s health and growth, eating and feeding, neurodevelopment, and parental well-being are evaluated. ePIPARI consists of several widely used, standardized questionnaires, in addition to questions typically presented to parents in clinical follow-up visits. It also provides video guidance and written information about age-appropriate neurodevelopment for the parents. Parents of children born before 34 weeks of gestation during years 2019-2022 are being invited to participate in the ePIPARI study, in which web-based follow-up with ePIPARI is compared to clinical follow-up. In addition, the parents of children born before 32 weeks of gestation, who reached the corrected age of two years during 2019-2021 were invited to participate for the assessment point of 24 months of ePIPARI. The parents are asked to fill in the online questionnaires two weeks prior to each clinical follow-up visit.

DISCUSSION

The web-based tool, ePIPARI, was developed to acquire a sensitive and specific tool to detect infants and parents in need of further support and clinical interventions. This tool could allow individualized adjustments of the frequency and content of the clinical visits.

TRIAL REGISTRATION

ClinicalTrials.cov, NCT05238168 . Registered 11 April 2022 - Retrospectively registered.

Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey

OBJECTIVE

To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand.

STUDY DESIGN

A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices.

RESULTS

Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P < .001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents.

CONCLUSIONS

Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.

Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks-A Qualitative Descriptive Study

(1) Background. The birth of an infant at 23 to 24 weeks poses a significant challenge to healthy parent-infant bonding because of the high risk of infant loss and the prolonged separation. The aim of this study was to retrospectively explore the narratives of parents with children born at 23-24 weeks about their bonding formation and relational experiences. (2) Methods. This was a qualitative descriptive study conducted with Finnish parents of children born at 23 or 24 weeks of gestation. Twenty-nine mothers and eight fathers were retrospectively interviewed using a semi-structured interview about the bonding process with their infant during the period in the neonatal intensive care unit (NICU) and their later parent-child relationship. Parents' narratives were deductively analysed according to a framework previously developed for studying parental bonding. (3) Results. Our results showed that several parents described the bonding process as natural or even easy despite the traumatic start to parenthood. Support from NICU staff and providing opportunities for participation in infant care and parent-infant physical closeness were reported to enhance the bonding process. Our study identified earlier parenting experience as a new element supporting bonding. (4) Conclusions. According to our results, essential elements enhancing parent-infant bonding in NICU settings seem to be supporting parents psychologically, promoting parent-infant closeness, and encouraging parental participation in the infants' care, even with the most immature infants.

The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey

The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.

The Effect of Supportive-Educational Interventions on Stress and Adaptation to Maternal Role: A Quasi-Experimental Study

BACKGROUND

Preterm delivery is a stressful event and stress can affect adaptation to maternal role. The purpose of this study is to determine the effect of supportive-educational interventions on stress and adaptation to the maternal role among women with premature infants hospitalized in the neonatal intensive care unit.

METHODS

This quasi-experimental study was conducted on 60 women with premature infants hospitalized in the neonatal intensive care unit. A control group (n = 30) was initially selected from eligible female participants. Sampling was stopped for three weeks and then the intervention group was sampled. The entire sampling process was carried out from December 2018 to June 2019. The control group received usual care at the hospital and the intervention group (n = 30) received three sessions of supportive-educational intervention in addition to routine care. Data were collected through the perceived stress and the maternal role adaptation questionnaires completed by both groups at the time of infant discharge, and also at the follow-up period (one month after discharge).

RESULTS

The results showed that maternal stress score changed considerably over time and a significant difference between the two groups was observed (P < 0.05). Additionally, adaptation to the maternal role changed substantially over time and the difference between the two groups was statistically significant (P < 0.05).

CONCLUSION

The supportive-educational program reduced the stress of mothers with premature infants hospitalized in the neonatal intensive care unit and increased their adaptation to the maternal role.

Types, Evidence, and Resources of Interventions Focused on Improving the Psychosocial Well-being of Parents of Premature/Sick Infants: A Scoping Review

BACKGROUND

Parents of infants born premature and/or sick and who require neonatal care are at risk of poor mental health. Currently, there is no comprehensive knowledge about interventions (ie, types, evidence, resources) that have been exclusively designed to improve the psychosocial well-being of this population group.

PURPOSE

To undertake a systematic scoping review of interventions focused on improving the psychosocial well-being of parents of sick/premature infants who required neonatal care to identify the ( a ) types of interventions, ( b ) evidence of the interventions, and ( c ) level of resources required to deliver the interventions.

SEARCH STRATEGY

e searched 7 databases (MEDLINE, CINAHL, PsycINFO, Cochrane, EMBASE, Web of Science, and Global Index), reviewed references, and followed up key authors.

RESULTS

From 10,516 hits, 38 articles met the inclusion criteria (36 different studies/interventions). Studies included creative oriented (n = 11), group/peer support (n = 4), relaxation/mindfulness (n = 3), spiritual/religious (n = 4), psychotherapeutic-based (n = 11), and "other" (n = 3) (eg, sleep, acupuncture). Most had been undertaken in high-income settings with mothers and required varying levels of resources within and between the different intervention types. While some interventions were effective, there was high heterogeneity with similar interventions using different designs, protocols, and outcomes. Most intervention types included studies that highlighted what parents valued (eg, self-care, relaxation, social opportunities).

IMPLICATIONS FOR RESEARCH

Evidence highlights a wide range of potential interventions for nursing and other specialist staff to consider and offers insights into potential mechanisms of effectiveness to underpin future intervention design.

Counseling parents of premature neonates on neuroimaging findings

While medical advancements have led to improved survival of extremely premature infants, children remain at risk for brain injury and neurodevelopmental impairment. Brain imaging can offer insight into an infant's acute and long-term outcome; however, counseling parents about the results and implications of brain imaging remains challenging. The purpose of this article is to review the current literature and describe the challenges associated with counseling families of premature infants on neuroimaging findings. We propose a framework to guide clinicians in counseling parents about brain imaging results, informed by best practices in other disciplines: (FIGURE): 1) Formulate a plan 2) Identify parental needs and values 3) Give information 4) Acknowledge Uncertainty 5) Recognize and Respond to emotions 6) Discuss Expectations and Establish follow-up.

The Experiences of Parent Dyads in the Neonatal Intensive Care Unit: A Qualitative Description

Background The hospitalization of an infant in the neonatal intensive care unit (NICU) is a distressing and often unexpected event for parents. Parents have risk for depression, anxiety, and posttraumatic stress, which can adversely impact them and their relationship. The hospitalization and subsequent stress may affect parents' capability to connect with and parent their child. Purpose Describe parents' experiences and ability to cope with the NICU; identify experiential and coping differences between mothers and fathers; examine the effect of the NICU hospitalization on the parent dyad relationship. Methods A qualitative descriptive design with dyadic interviews examined parents' experiences and coping skills, and subsequent effects on the parental relationship. Data collection continued until saturation was achieved and no new themes emerged. Through content analysis, an accurate description of parents' experiences in the NICU was rendered. Findings Nine themes from eight dyad interviews emerged and were categorized within the six domains of the transactional theory of stress and coping. The major themes were: Deeply Distressing, Unexpected and Unprepared, Expecting to Hear and Be Heard, Becoming Parents, Stronger Together, Support is Key, Parents Want Better Communication, and Adjusting to the NICU. Implications for practice Support from professionals and family, and clear and consistent communication from the treatment team helped alleviate parents' anxiety about their infant. Implications for research Research regarding the impact of a NICU hospitalization on the relationship between parent dyad members, specifically longitudinal studies, may lead to a better understanding of the long-term effects of this specific stressor on parents.

Empowerment programs for parental mental health of preterm infants: A meta-analysis

OBJECTIVE

To assess the effectiveness of empowerment programs on mental health in parents of preterm infants.

METHODS

Ten databases were searched for randomised controlled trials and quasi-experimental studies published from inception to March 2020, and two reviewers independently and critically assessed trial quality and extracted data.

RESULTS

Eight studies with a total of 1029 participants met the inclusion criteria. Empowerment programs significantly improved parental mental health, particularly maternal stress and depression. This meta-analysis also indicated that Creating Opportunities for Parent Empowerment (COPE) had a medium effect on maternal mental health. Both empowerment-based health education and empowerment programs conducted during the infants' hospitalisation had large effects on maternal mental health, whereas those conducted from hospitalisation to one week after discharge showed no significant effect.

CONCLUSION

Empowerment programs have positive effects on parental mental health, especially for mothers.

PRACTICE IMPLICATIONS

Our study provides objective evidence for the development of future empowerment programs.

Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative

Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.

Beliefs and needs of fathers of newborns hospitalised in a neonatal unit: A descriptive correlational study

BACKGROUND

Transition to parenthood is a wonderful yet stressful period especially when it involves the newborn's hospitalisation. To support and facilitate this transition, it is essential to understand parental beliefs and needs. The father's perspective remains an understudied yet fundamental question.

OBJECTIVES

The objective of the study was to measure beliefs and needs of fathers of newborns hospitalised in a neonatal intensive care unit (NICU) and their correlations with sociodemographic variables.

METHODS

Fathers with a newborn hospitalised for 4-15 days in a level III NICU in Western Switzerland completed the NICU Parental Beliefs Scale and the short form of the NICU Family Needs Inventory. For each item of the NICU Family Needs Inventory, fathers also answered with regard to their satisfaction level. Additional needs were collected with an added open-ended question. Simple linear regressions were used to correlate beliefs, needs, and the sociodemographic data.

RESULTS

Seventy fathers were included. The average score for paternal beliefs was 68.44 (standard deviation = 10.29), indicating a good perception of their role. The majority (77%) considered all needs as very important or important, and 70% were very satisfied or satisfied. Fathers described communication as a very important, but unmet, need. Fathers' beliefs were higher in those who were not first-time fathers (71.88 ± 8.27 vs 66.06 ± 10.97, p = 0.028), who had a paternity leave (72.68 ± 10.19 vs 66.05 ± 9.68, p = 0.014), and who were of foreign nationality (71.86 ± 9.39 vs 63.85 ± 9.80, p = 0.002).

CONCLUSIONS

Fathers with a newborn hospitalised in the neonatal unit had good paternal beliefs. Most of the listed needs were perceived as very important and had a good level of satisfaction. Significant differences between Swiss fathers and fathers of foreign nationality were measured. Reasons of these differences should be explored in a forthcoming study.

Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health

Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.

Effect of a Parent Empowerment Program on Parental Stress, Satisfaction, and Length of Stay in the Neonatal Intensive Care Unit

Parental stress is high when infants are admitted to a neonatal intensive care unit in community-based hospital. This quasi-experimental study explored the effect of implementing the "Creating Opportunities for Parent Empowerment" (COPE) program on parental stress, postpartum depression, parental satisfaction with care, and length of stay in a community-based hospital. A cohort of nurses completed a 1-day "COPE for HOPE" parent empowerment training session. A nurse implemented the COPE parent training at the bedside soon after birth and extended throughout hospitalization. The following instruments were used to collect data: a demographic data sheet, Parental Stress Scale: Neonatal Intensive Care Unit, Edinburgh Postnatal Depression Scale, and an investigator-designed parent satisfaction survey. Forty-nine parent sets participated in the study (29 in the intervention group, 20 in the comparison group). A significant difference was found between the groups related to lower parental stress. There was no difference in terms of parental depression scores or length of hospital stay. However, clear trends revealed that parents in the COPE group exhibited lower depression scores. Parents in both groups reported being greater than 95% satisfied with care across all items. These findings may motivate administrators in other community-based hospitals to implement this intervention.

Parental Depression Symptoms at Neonatal Intensive Care Unit Discharge and Associated Risk Factors

OBJECTIVE

To investigate the prevalence and risk factors associated with parental depressive symptoms at neonatal intensive care unit (NICU) discharge and determine the relationships among depressive symptoms, stress, and social support.

STUDY DESIGN

Parents participating in the Giving Parents Support trial (n = 300) were surveyed before NICU discharge. Depressive symptoms, stress, and social support were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10), Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support (MSPSS). Regression analyses examined relationships among depressive symptoms, stress, social support, and parent/infant factors.

RESULTS

At NICU discharge, 45% of parents reported depressive symptoms and 43% reported elevated perceived stress. Increased odds of elevated depressive symptoms were associated with older gestational age (P = .02), female infant (P = .02), and longer length of stay (P = .045). Odds of depression were 7.87 (95% CI, 2.15-28.75) for parents of infants with gestational age ≥37 weeks compared with gestational age <28 weeks. Parental NICU stress was higher in younger parents (P < .01). Depressive symptoms were positively associated with parental stress. Each 1-point increase in PSS:NICU score was associated with a 2.1-point (95% CI, 1.6-2.9; P < .001) increase in CESD-10 score. Social support was inversely associated with depressive symptoms.

CONCLUSION

The prevalence of depressive symptoms in parents at NICU discharge was high, even among parents of term infants. Older gestational age, greater parental stress, and lower levels of social support were strong correlates of depressive symptoms. Strategies to support parents, including depression screening, stress reduction strategies, and mental health referrals, are needed.

Parent experience of caring for neonates with seizures

OBJECTIVE

Neonates with seizures have a high risk of mortality and neurological morbidity. We aimed to describe the experience of parents caring for neonates with seizures.

DESIGN

This prospective, observational and multicentre (Neonatal Seizure Registry) study enrolled parents of neonates with acute symptomatic seizures. At the time of hospital discharge, parents answered six open-ended response questions that targeted their experience. Responses were analysed using a conventional content analysis approach.

RESULTS

144 parents completed the open-ended questions (732 total comments). Four themes were identified. Sources of strength: families valued medical team consensus, opportunities to contribute to their child's care and bonding with their infant. Uncertainty: parents reported three primary types of uncertainty, all of which caused distress: (1) the daily uncertainty of the intensive care experience; (2) concerns about their child's uncertain future and (3) lack of consensus between members of the medical team. Adapting family life: parents described the many ways in which they anticipated their infant's condition would lead to adaptations in their family life, including adjusting their family's lifestyle, parenting approach and routine. Many parents described financial and work challenges due to caring for a child with medical needs. Emotional and physical toll: parents reported experiencing anxiety, fear, stress, helplessness and loss of sleep.

CONCLUSIONS

Parents of neonates with seizures face challenges as they adapt to and find meaning in their role as a parent of a child with medical needs. Future interventions should target facilitating parent involvement in clinical and developmental care, improving team consensus and reducing the burden associated with prognostic uncertainty.

Assessment of stress among parents of neonates admitted in the neonatal intensive care unit of a tertiary care hospital in Eastern India

BACKGROUND

An infant admitted to the neonatal intensive care unit (NICU) is a potentially stressful event for parents. Severe stress is experienced by parents, affecting their mental health and relationship, and infants' development. The current study aims to assess the stress levels among parents of neonates admitted to NICU and to identify the factors influencing their stress levels.

MATERIALS AND METHODS

A cross-sectional study was conducted in a tertiary care hospital of Eastern India over 2 months. Stress levels were assessed using Parental Stressor Scale: NICU questionnaire among 100 NICU parents (mother or father) with more than 24 h of admission. Stress was quantified using the Likert scale. The statistical analysis was performed using the SPSS software.

RESULTS

In this study, 60.8% parents experienced severe and extreme stress level for overall stress. The mean for overall stress experienced was 3.71 ± 0.70. There was no significant difference in overall stress between father and mother (P = 0.65). The highest levels of stress experienced were in sight and sound subscale (3.23 ± 0.41) followed by relationship with the baby and parental role," i.e., 2.46 30. There was no significant association in overall stress score with maternal age, parity, education level, previous baby being admitted to the NICU (P > 0.05). Stress in sight and sound domain was statistically significantly higher (P = 0.009) among parents of babies with stay of ≤7 days.

CONCLUSION

These results support wider use in research and clinical practice to identify parental stress. Interventions can be developed to ameliorate its negative effects on individual, interpersonal, and societal levels. The stress score was not significantly different between fathers and mothers of neonates admitted to NICU and the length of stay was significantly associated with sight and sound domain. Appropriate counseling should be targeted toward both parents. Future intervention studies should be planned to decrease the stress level among parents.

Observed Progression of Parents' Understanding of Preterm Infants' Behavioral Signs at 33 to 35 Weeks Corrected Age

BACKGROUND

Interventions aimed at improving parental understanding of preterm infants' behavioral signs have drawn increased attention in recent years. However, there are limited data regarding parents' actual perceptions of infants' behavior during parent-infant interactions while infants are in a light-sleep state.

PURPOSES

(1) To describe parental perceptions of infants' behavior at 33 to 35 weeks' corrected age during light-sleep and (2) to identify changes in parental perceptions of preterm infants' behavior over time.

METHODS

This study used a qualitative, longitudinal design based on observations and interviews. Three sets of parents and their infants born between 29 and 30 weeks' gestational age were observed up to 3 times during light sleep states when the infants were 33 to 35 weeks' corrected age. Parents were interviewed regarding their perceptions of infant behavior/growth once at the time of observation and once more within 2 weeks of the final observation. The findings are based on the observation of parents' perception-driven interactions with infants.

RESULTS

Four themes emerged describing the transition of parental perception that progresses to gain a better understanding of their infant's behavior through repeated interaction.

IMPLICATIONS FOR PRACTICE

The findings of this study inform caregivers in neonatal intensive care units regarding the unique experience of parent-infant dyads. This knowledge can help promote family-centered developmental care efforts in neonatal intensive care units.

IMPLICATIONS FOR RESEARCH

Further research should focus on studying a larger sample group to confirm the findings and refining strategies to incorporate the findings to enhance neonatal intensive care unit care.

What Is the Experience of Babywearing a NICU Graduate?

OBJECTIVE

To understand the experiences of caregivers using baby carriers to hold their infant after discharge from the NICU.

DESIGN

The qualitative research design was transcendental phenomenology.

SETTING/LOCAL PROBLEM

Caregiving of NICU graduates is associated with greater incidence of depression, anxiety, and posttraumatic stress disorder, which can impair caregivers' abilities to form secure attachments with their infants. In addition, lack of paid parental leave, especially among those of low socioeconomic status, can result in prolonged separations between infants and caregivers in the NICU, producing toxic stressors.

PARTICIPANTS

Eight caregivers ages 21 to 41 years whose infants were discharged from the NICU of a regional referral academic medical center in Oklahoma City, Oklahoma. Homogenous convenience sampling was used by posting recruitment flyers in common areas of the NICU frequented by family members.

INTERVENTION/MEASUREMENTS

Participants were educated before discharge on using baby carriers that held their infants in kangaroo position. They were asked to carry their infant in the carrier for 3 hours a day for the 2-month study period.

RESULTS

Six total themes were identified; four were previously identified in kangaroo care and skin-to-skin care research: Decreased Stress and Anxiety, Calmness and Sleep, Attachment, and Parental Empowerment; two were independent to this study: Ease of Work and Self-Care.

CONCLUSION

The themes identified indicate that babywearing has the potential to address harms-such as stress, fear, depression, anxiety, and posttraumatic stress disorder-that may be experienced by caregivers of infants discharged from the NICU. Babywearing can be used as an intervention to support caregivers and promote positive health outcomes after a NICU discharge.

Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation

BACKGROUND

Psychosocial adversity escalates medical risk for poor outcomes in infants born <30 weeks gestation. Neonatal neurobehavior and maternal psychological and socioenvironmental assessments may identify the earliest specific intervention needs. We hypothesized that maternal prenatal anxiety, depression, and adverse medical and socioenvironmental conditions would be associated with less optimal neonatal neurobehavior at neonatal intensive care unit (NICU) discharge.

METHODS

We studied 665 infants at 9 university NICUs. Risk indices of socioenvironmental, maternal, and neonatal medical factors were obtained from standardized, structured maternal interviews and medical record reviews. Brain injuries were classified by consensus ultrasonogram readings. NICU Network Neurobehavioral Scale (NNNS) exams were conducted at NICU discharge.

RESULTS

On the NNNS, generalized estimating equations indicated infants of mothers with prenatal anxiety had less optimal attention, and those born to mothers with prenatal depression had increased lethargy. Maternal medical complications predicted suboptimal reflexes. Socioenvironmental risk predicted lower self-regulation and movement quality. Infants with more severe neonatal medical complications had lower attention, increased lethargy, and suboptimal reflexes.

CONCLUSIONS

Combined information from the observed associations among adverse prenatal maternal medical and psychosocial conditions, and neonatal complications may assist in the early identification of infants at elevated neurobehavioral risk.

Effects of a home follow-up program in Turkey for urban mothers of premature babies

OBJECTIVE

To examine the effects of a home follow-up program in Turkey on care problems, anxiety, and depression levels of mothers after the birth of a premature baby.

METHODS

A semi-experimental study with a pretest-posttest control group design. Eighty premature newborns and their mothers were included in the study. Nursing care was given to mothers and babies in the study group through a total of four home visits on weeks 1, 2, 3, and days 40-42 in Kırıkkale, Turkey guided by the Nursing Diagnosis System and Nursing Interventions Classification (NIC) system of the North American Nursing Diagnosis Association (NANDA). Data were collected from a sociodemographics form, home care needs evaluation form, Edinburgh Postpartum Depression Scale, and State Anxiety Inventory.

RESULTS

There were no significant differences between groups for nursing diagnoses at baseline, while the study group resulted in significantly fewer problems on days 40-42, compared to the control group. Mothers had a comparatively lower depression and state anxiety risk in the study group compared to the control group.

CONCLUSIONS

Providing home-based nursing care for preterm mothers and babies during the first 40-42 days has the potential to decrease postnatal care problems, including maternal depression and state anxiety levels.

The effect of narrative writing on fathers' stress in neonatal intensive care settings

Objective: This study was conducted to examine the effect of narrative writing on fathers' stress in the Neonatal Intensive Care Units (NICUs) during infants' hospitalization.Methods: A quasi-experimental study was conducted among two groups of fathers with preterm infants in the NICUs of two teaching hospitals of Gorgan University of Medical Sciences. Pre- and post-tests were administered to a sample size of 70 during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods.Results: The mean total stress score was 74.05 ± 17.39 in the control and 80.11 ± 15.82 in the intervention group on the 3rd day, suggesting no significant difference. In other words, both groups had a similar stress level before the intervention (p-value = .13, t = 1.52). However, the mean total stress score was 85.45 ± 16.91 in the control group and 48.00 ± 10.49 in the intervention group on the 10th day, suggesting a significant reduction in the stress level in the intervention group following the intervention (p-value = .001, t = -11.01).Conclusion: According to the findings, the narrative writing may be considered as an efficient supportive intervention to reduce the fathers' stress in the NICUs. However, more research is needed to justify its implementation.

VALIDITY AND RELIABILITY OF THE NICU PARENTAL BELIEFS SCALE FOR PARENTS IN TURKEY

This methodological study was conducted for Turkish adaptation of the Neonatal Intensive Care Unit Parental Beliefs Scale (NICU PBS). The study sample consisted of 136 mothers and 97 fathers who had agreed to participate in the study. Turkish linguists were consulted to test the linguistic validity of the scale. Explanatory factor analysis was performed for construct validity of the scale, which indicated that the 18 items in the scale had a three-factor structure, explaining a maximum of 70.24% of total variance. Considering factor loadings, the factor load values ranged from 0.614 to 0.806. Concerning reliability of the scale, the item-total score correlation values were found to be 0.54-0.78, and the Cronbach’s alpha was 0.90. Accordingly, the Turkish version of NICU PBS can be considered valid and reliable.

The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care

There is increasing recognition that parents play a critical role in promoting the health outcomes of low birthweight and preterm infants. Despite a large body of literature on interventions and models to support family engagement in infant care, parent involvement in the delivery of care for such infants is still restricted in many neonatal intensive care units (NICUs). In this article, we propose a taxonomy for classifying parent-focused NICU interventions and parent-partnered care models to aid researchers, clinical teams, and health systems to evaluate existing and future approaches to care. The proposed framework has three levels: interventions to support parents, parent-delivered interventions, and multidimensional models of NICU care that explicitly incorporate parents and partners in the care of their preterm or low birthweight infant. We briefly review the available evidence for interventions at each level and highlight the strong level of research evidence to support the parent-delivered intervention of skin-to-skin contact (also known as the Kangaroo Care position) and for the Kangaroo mother care and family integrated care models of NICU care. We suggest directions for future research and model implementation to improve and scale-up parent partnership in the care of NICU infants.

Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes (Part 1): Randomized Controlled Trial

Background

Transitioning into parenthood can be stressful for new parents, especially with the lack of continuity of care from health care professionals during the postpartum period. Short hospital stays limit the availability of support and time parents need to be well equipped with parenting and infant care skills. Poor parental adjustment may, in turn, lead to negative parental outcomes and adversely affect the child’s development. For the family’s future well-being, and to facilitate a smoother transition into parenthood, there is a need for easily accessible, technology-based educational programs to support parents during the crucial perinatal period.

Objective

This study aimed to examine the effectiveness of a technology-based supportive educational parenting program (SEPP) on parenting outcomes during the perinatal period in couples.

Methods

A randomized, single-blinded, parallel-armed, controlled trial was conducted. The study recruited 236 parents (118 couples) from an antenatal clinic of a tertiary hospital in Singapore. Eligible parents were randomly assigned to the intervention group (n=118) or the control group (n=118). The SEPP is based on Bandura’s self-efficacy theory and Bowlby’s theory of attachment. Components of the intervention include 2 telephone-based educational sessions (1 antenatal and 1 immediately postnatal) and a mobile health app follow-up for 1 month. The control group only received routine perinatal care provided by the hospital. Outcome measures including parenting self-efficacy (PSE), parental bonding, perceived social support, parenting satisfaction, postnatal depression (PND), and anxiety were measured using reliable and valid instruments. Data were collected over 6 months at 4 time points: during pregnancy (third trimester), 2 days postpartum, 1 month postpartum, and 3 months postpartum. Outcomes were standardized using baseline means and SDs. Linear mixed models were used to compare the groups for postpartum changes in the outcome variables.

Results

The intervention group showed significantly better outcome scores than the control group from baseline to 3 months postpartum for PSE (mean difference, MD, 0.37; 95% CI 0.06 to 0.68; P=.02), parental bonding (MD −1.32; 95% CI −1.89 to −0.75; P<.001), self-perceived social support (MD 0.69; 95% CI 0.18 to 1.19; P=.01), parenting satisfaction (MD 1.40; 95% CI 0.86 to 1.93; P<.001), and PND (MD −0.91; 95% CI −1.34 to −0.49; P<.001). Postnatal anxiety (PNA) scores of the intervention group were only significantly better after adjusting for covariates (MD −0.82; 95% CI −1.15 to −0.49; P<.001).

Conclusions

The technology-based SEPP is effective in enhancing parental bonding, PSE, perceived social support and parental satisfaction, and in reducing PND and PNA. Health care professionals could incorporate it with existing hands-on infant care classes and routine care to better meet parents’ needs and create positive childbirth experiences, which may in turn encourage parents to have more children.

Trial Registration

ISRCTN Registry ISRCTN48536064; http://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO).

The Experiences of Parents in the Neonatal Intensive Care Unit: An Integrative Review of Qualitative Studies Within the Transactional Model of Stress and Coping

Having a child hospitalized in the neonatal intensive care unit (NICU) is a deviation from the norms expected for pregnancy and childbirth. A NICU admission may be traumatic for some parents, causing psychological distress and altered parenting roles. The aim of this integrative review is to examine the experiences and perceptions of a NICU hospitalization from the perspective of both parents to inform clinical practice and future research. A systematic search of 3 databases was conducted and included studies were evaluated by the Critical Skills Appraisal Programme checklist for qualitative studies. The Whittemore and Knafl integrative review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were followed to provide a structure for searching and reporting findings. There were 248 participants (153 mothers and 95 fathers) from 9 countries and of varying socioeconomic backgrounds in the 16 primary qualitative studies included in this review. The resulting major themes included panic sequence, emotional upheaval, social support, faith, and adjusting. Interventions directed at managing parents' emotions, supporting their spiritual needs, facilitating parenting skills and infant attachment, and adapting the environment to parents' needs can help improve the NICU experience.

A Vivência de Mães e Pais de Bebês Prematuros com Doença Ocular

Resumo Esta pesquisa tem por objetivo identificar os aspectos psicológicos da experiência de mães e pais em relação à retinopatia da prematuridade (ROP) de seus filhos através de entrevista psicológica. As entrevistas foram transcritas e analisadas segundo a técnica de análise de conteúdo. O impacto do diagnóstico variou de acordo com a expectativa dos pais e a compreensão sobre a doença, sendo amenizado pelo suporte familiar e profissional. As dificuldades foram sentidas em relação ao posicionamento social da criança e suas limitações. Mães e pais adiaram projetos, apresentaram insegurança e receio de sequelas futuras. A assistência psicológica pode ocorrer desde o momento do diagnóstico, levando em consideração os significados compartilhados, promovendo a adequação de expectativas e priorizando a qualidade de vida da família.

Neonatal intensive care unit admission and maternal postpartum depression

Objective: This study aimed to examine the impact of newborns' Neonatal Intensive Care Unit (NICU) admittance on maternal postpartum depression. Background: Prior research on the parental psychological impacts of a NICU admittance typically includes a hospital sample of parents following birth, so the causality of NICU admittance and maternal depressive symptomatology is unclear. Methods: 127 women across 38 counties in a South Central US state participated in online surveys in their third trimester and approximately six weeks post-birth in 2016. Pre- and post-birth assessments of depression were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). NICU admittance was asked in the post-birth survey. t-Tests and multivariable regression analyses were used to determine predictors of NICU admittance and postnatal depressive symptomatology. Results: Findings indicate that prenatal depression does not differ significantly between mothers by NICU admission status, but NICU admission is a significant predictor of postpartum depressive symptomatology. Conclusions: Having a newborn admitted to the NICU is a risk factor for maternal postpartum depression. These findings have implications for practice; screening mothers in the NICU for depression as a target for intervention has the potential to improve maternal well-being, which in turn should enhance subsequent infant developmental outcomes.

The effectiveness of a structured nursing intervention program on maternal stress and ability among mothers of premature infants in a neonatal intensive care unit

AIMS AND OBJECTIVES

To investigate the effectiveness of a structured nursing intervention program on maternal stress and NICU-related maternal ability after the admission of premature infants to a neonatal intensive care unit (NICU).

BACKGROUND

Mothers of premature infants may face stress having premature infants, and their infants may be admitted to the NICU for a few weeks or months. The mothers' experience of stress would be worse if they have low knowledge and poor NICU-related maternal ability. Mothers of infants admitted to the NICU require well-planned interventions to cope with psychological matters arising after an infant hospitalisation.

DESIGN

Quasi-experimental design.

METHODS

A total of 216 mothers were consecutively assigned to control and intervention groups. Each group consisted of 108 mothers. The mothers in both groups received questionnaire concerning maternal stress and NICU-related ability during their first visit to NICU (within 48 hr of admission). A structured nursing intervention was implemented for 10 days on mothers in the intervention group. The control group continued to receive existing practice nursing care. Mothers of both groups were again given the questionnaire on maternal stress and NICU-related ability after 14 days of admission.

RESULTS

In the intervention group, the difference between the mean total score of maternal stress and parental role and relationship subscale decreased significantly, compared to the control group (p = 0.04; p = 0.01) respectively. Maternal ability improved significantly in mothers in the intervention group 2 weeks postintervention, p < 0.001.

CONCLUSION

A structured nursing intervention for mothers could significantly reduce maternal stress and promote maternal NICU-related abilities.

RELEVANCE TO CLINICAL PRACTICE

The results of the study could help neonatal nurses to develop an appropriate nursing intervention for parents with premature infants in the NICU.

Activity based group therapy reduces maternal anxiety in the Neonatal Intensive Care Unit - a prospective cohort study

BACKGROUND

A large proportion of mothers in the Neonatal Intensive Care Unit (NICU) experience psychological distress, which is associated with adverse infant and parenting outcomes. Interventions addressing maternal anxiety in the NICU are scarce.

AIMS

To assess the effect of activity based group therapy on maternal anxiety in the NICU when compared to a control group.

STUDY DESIGN

The study was a prospective phase lag cohort study. In Phase 1 the control group was recruited and assessed using the State-Trait Anxiety Inventory (STAI-S) once at recruitment and again 4 weeks later. In phase 2, mothers were invited to take part in activity-based groups of 1 h duration once a week for 4 weeks. The STAI-S was administered before and after every group session.

SUBJECTS

Mothers of babies admitted in the NICU who consented to participate, had a working knowledge of Tamil or English and were likely to stay for 4 weeks for the treatment were included.

OUTCOME MEASURES

State anxiety assessed using the STAI-S.

RESULTS

Seventeen mothers each in the control and experimental groups completed the study. In the experimental group, there was a significant reduction in the post-test anxiety scores when compared to the pre-test in the first (p = 0.005), third (p = 0.07) and fourth (p = 0.009) sessions. The post-test anxiety scores of the intervention group was significantly lower than that of the control group (p = 0.009).

CONCLUSION

Activity based group therapy is effective as an intervention in reducing maternal anxiety in the NICU.

SUMMARY

Anxiety in mothers of infants admitted in the NICU has been associated with adverse infant and parenting outcomes. This study evaluated the feasibility and effectiveness of an activity based group intervention to reduce anxiety levels in mothers in the NICU. The study was a prospective phase lag cohort study. Anxiety levels were assessed in mothers in the control group at recruitment and then 4 weeks later. In the intervention group, activity based group sessions were conducted once a week for 4 weeks. State anxiety was assessed before and after every group session. In the intervention group the anxiety levels were significantly lower in the post-test, when compared to the pre-test. Also the number of mothers suffering from moderate to severe anxiety and the anxiety scores in the post-test were significantly lower in the intervention group when compared to the control group. We conclude that activity based group sessions are effective in reducing the state anxiety in mothers in the NICU. Improving maternal psychological wellbeing may indirectly contribute to better infant outcomes.

Maternal mental health during the neonatal period: Relationships to the occupation of parenting

PURPOSE

To (1) examine the extent of a range of early mental health challenges in mothers with a very preterm infant hospitalized in the NICU and mothers of full-term infants, (2) identify family social background and infant medical factors associated with higher levels of maternal psychological distress, and (3) assess the relationship between maternal psychological distress and maternal perceptions of the parenting role, parenting confidence and NICU engagement.

METHODS

At hospital discharge 37 mothers of very preterm infants (≤32 weeks gestation) and 47 mothers of full-term infants (≥37 weeks gestation) completed structured assessments of their psychological wellbeing and transition to parenting. Mothers of very preterm infants were also questioned about their NICU visitation and involvement in infant care.

RESULTS

Sixty-four percent (n = 54) of mothers experienced psychological distress (n = 26, 70% of preterm; n = 28, 60% of full-term). Lower infant birthweight was associated with maternal psychological distress (p = .03). Mothers of very preterm infants had significantly more psychological distress related to having a Cesarean section delivery (p = .02). Higher levels of psychological distress were associated with lower levels of parenting confidence in mothers of both very preterm and full-term infants (p < .02).

CONCLUSION

Although parents of very preterm infants have higher rates of maternal mental health challenges, mothers of full-term infants at high social risk are also impacted.

Developmental care, neonatal behavior and postnatal maternal depressive symptomatology predict internalizing problems at 18 months for very preterm children

OBJECTIVE

To provide a prospective developmental model for behavioral outcomes in preterm infants in relation to developmental care (DC) practices and postnatal maternal depression.

STUDY DESIGN

A longitudinal, multicenter, follow-up study conducted in 25 Italian tertiary neonatal intensive care units (NICUs). Participants were 162 healthy very preterm infants and their mothers. The level of quality of DC was assessed for each hospital. Infant's neurobehavioral profile was evaluated twice: at discharge (T1) and at 18 months for behavioral problems (T3). Maternal depressive symptomatology was measured at T1 and at 6 months (T2).

RESULTS

Low-quality DC in NICUs was associated with lower levels of infant neurobehavioral adaptability and higher levels of maternal depressive symptoms. Maternal depressive symptomatology in conjunction with higher infant dysregulation predicted more internalizing problems at 18 months of age.

CONCLUSION

DC interventions and postnatal maternal depression, as well as infant behavior have an impact on short- and long-term infant outcomes.

Breastfeeding Challenges and the Preterm Mother-Infant Dyad: A Conceptual Model

Breastfeeding is an experience that only a mother and her infant(s) can share. Infants who can feed from the breast receive not only the best nutrition but also, due to the close physical contact between mother and child, it is the optimal nurturance they can receive from their mother. When breastfeeding is trouble free, maternal well-being is uniquely heightened. However, breastfeeding remains a challenge for many mother-infant dyads and more so for those whose infants are born prematurely. This article introduces a conceptual model of the breastfeeding challenges facing preterm mother-infant dyads. It distinguishes between a maternal caregiving and an infant growth/development components. Within the maternal component, two primary elements are considered, that is, maternal behavioral and nutritional care. The two primary elements within the infant component include infant non-nutritional and nutritional growth/development. It is proposed that an improved understanding of the factors associated with these four elements and how they interplay with each other within individual dyads will facilitate the identification of the breastfeeding challenges facing these mother-infant entities. Due to the intimate relationships existing between a mother and her infant(s), it is further advanced that breastfeeding studies would be optimized if mother-infant pairs are studied as one entity rather than mother and infant separately. It is proposed that this conceptual model will assist health professionals develop personalized breastfeeding management plans for individual preterm mother-infant dyads, while furthering the development of evidence-based interventions to optimize their breastfeeding experiences.

Parent Psychological Distress in the Neonatal Intensive Care Unit Within the Context of the Social Ecological Model: A Scoping Review

BACKGROUND

Neonatal intensive care unit (NICU) parents are at risk for psychological distress and impaired mental health, and statistics related to parent psychological distress vary.

OBJECTIVE

To determine the scope of literature regarding the mental health and psychosocial well-being of parents in the NICU.

DESIGN

A scoping review within the Arksey and O'Malley framework and the SEM was undertaken to answer, "What factors contribute to parent's mental health in the NICU?" A systematic review of the literature was performed using the PRISMA methodology.

RESULTS

Common socioeconomic factors and infant and parent characteristics may place parents at a greater risk for developing distress. History of mental illness, family cohesion, birth trauma, altered parenting role, gestational age, birth weight, and severity of prematurity/illness emerged as themes.

CONCLUSION

Further research is required to provide a standard for the screening and assessment of parents' mental health and psychosocial well-being during a NICU hospitalization. The experiences of nonbirth parents in the NICU should be explored to examine the effects of the hospitalization on all types of parents.

The neonatal intensive parenting unit: an introduction

This paper describes a paradigm shift occurring in neonatal intensive care. Care teams are moving from a focus limited to healing the baby's medical problems towards a focus that also requires effective partnerships with families. These partnerships encourage extensive participation of mothers and fathers in their baby's care and ongoing bi-directional communication with the care team. The term Newborn Intensive Parenting Unit (NIPU) was derived to capture this concept. One component of the NIPU is family-integrated care, where parents are intimately involved in a baby's care for as many hours a day as possible. We describe six areas of potentially better practices (PBPs) for the NIPU along with descriptions of NIPU physical characteristics, operations, and a relationship-based culture. Research indicates the PBPs should lead to improved outcomes for NIPU babies, better mental health outcomes for their parents, and enhanced well-being of staff.

A systematic review of concepts related to women's empowerment in the perinatal period and their associations with perinatal depressive symptoms and premature birth

Background

The perinatal period, which we here define as pregnancy and the first year postpartum, is a time in women’s lives that involves significant physiological and psychosocial change and adjustment, including changes in their social status and decision-making power. Supporting women’s empowerment at this particular time in their lives may be an attractive opportunity to create benefits for maternal and infant health outcomes such as reductions in perinatal depressive symptoms and premature birth rates. Thus, we here systematically review and critically discuss the literature that investigates the effects of empowerment, empowerment-related concepts and empowerment interventions on reductions in perinatal depressive symptoms, preterm birth (PTB), and low birthweight (LBW).

Methods

For this systematic review, we conducted a literature search in PsychInfo, PubMed, and CINAHL without setting limits for date of publication, language, study design, or maternal age. The search resulted in 27 articles reporting on 25 independent studies including a total of 17,795 women.

Results

The majority of studies found that, for the most part, measures of empowerment and interventions supporting empowerment are associated with reduced perinatal depressive symptoms and PTB/LBW rates. However, findings are equivocal and a small portion of studies found no significant association between empowerment-related concepts and perinatal depressive symptoms and PTB or LBW.

Conclusion

This small body of work suggests, for the most part, that empowerment-related concepts may be protective for perinatal depressive symptoms and PTB/LBW. We recommend that future theory-driven and integrative work should include an assessment of different facets of empowerment, obtain direct measures of empowerment, and address the relevance of important confounders, including for example, ethnicity and socioeconomic status.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1495-1) contains supplementary material, which is available to authorized users.

Conceptualizing pathways linking women's empowerment and prematurity in developing countries

BACKGROUND

Globally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.

METHODS

The key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.

RESULTS

There is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.

CONCLUSIONS

Women's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed.

Parental stress management using relaxation techniques in a neonatal intensive care unit: A randomised controlled trial

OBJECTIVE

The objective of this study was to investigate the effect of relaxation techniques on the stress/anxiety of parents with hospitalised premature infants, three months following discharge from the neonatal intensive care unit.

STUDY DESIGN

A randomised controlled trial was conducted in the neonatal intensive care unit of a tertiary maternity hospital including 59 parents, who were randomised into two groups: 31 in the intervention group and 28 in the control group. Parents in the intervention group practiced three different relaxation techniques, in addition to undergoing the same information-based training courses as did the parents of the control group.

DATA COLLECTION

Data were collected 10-15 days post delivery and three months post discharge. The assessment measures included the Perceived Stress Scale, the State and Trait Anxiety Inventory 1 and 2 and salivary cortisol levels.

RESULTS

The psychometric assessment at baseline was comparable between the two groups. The intervention group showed a significant reduction in trait anxiety (p=0.02) compared with the control group three months post discharge. The perceived stress decreased in both groups (p=0.699). No difference in salivary cortisol levels was detected. The multivariate analysis revealed that higher initial stress levels (p<0.001) and university/college education (p=0.003) were associated with higher parental stress, whereas moderate-to-high income satisfaction was associated with lower parental stress (p=0.003).

CONCLUSION

Further long-term follow-up of families with a neonatal intensive care unit experience could assess more delayed effects of stress management by relaxation techniques.

Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of Preterm Infants

OBJECTIVE

To examine the association of maternal mental health, perceptions of readiness at neonatal intensive care unit (NICU) discharge, and social risk factors with depressive symptoms 1 month postdischarge in mothers of early (<32 weeks), moderate (32-33 weeks), and late (34-36 weeks) preterm infants. A secondary objective was to compare depressive symptoms among mothers in all preterm groups.

STUDY DESIGN

Mothers (n = 734) of preterm infants cared for >5 days in the NICU and participating in a Transition Home Program completed the Fragile Infant Parent Readiness Evaluation prior to discharge for perceptions of NICU staff support, infant well-being, maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant). Mental health history and social risk factors were obtained. At 1 month postdischarge the Edinburgh Postnatal Depression Scale was administered. Group comparisons and logistic regression analyses were run to predict possible depression (Edinburgh Postnatal Depression Scale  ≥10).

RESULTS

Mothers of early, moderate, and late preterm infants reported similar rates of possible depression (20%, 22%, and 18%, respectively) 1 month after NICU discharge. History of mental health disorder, decreased perception of maternal well-being, decreased maternal comfort regarding infant, and decreased perception of family cohesion were associated with possible depression at 1 month postdischarge.

CONCLUSIONS

Mothers with a previous mental health disorder and experiencing negative perceptions of self and infant at NICU discharge were at increased risk for depressive symptomatology 1 month postdischarge regardless of infant gestational age. Comprehensive mental health assessment prior to discharge is essential to identify women at risk and provide appropriate referral.

Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study

OBJECTIVES

To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice.

DESIGN

Prospective national cohort study of all births before 32 weeks of gestation.

SETTING

Twenty-five French regions.

PARTICIPANTS

All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p < 0.001). Individual factors associated with kangaroo care initiation were gestational age (odds ratio, 5.79; 95% CI, 4.49-7.48 for babies born at 27-31 wk compared with babies born at 23-26 wk) and, to a lesser extent, single pregnancy, birthweight above the 10th centile, and mother's employment before pregnancy. At unit level, policies and training in neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p < 0.0001).

CONCLUSIONS

Dissemination of neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.

Parent Perspectives of Neonatal Intensive Care at the End-of-Life

This descriptive qualitative study explored parent experiences related to their infant's neonatal intensive care unit (NICU) hospitalization, end-of-life care, and palliative care consultation. "Life and death in the NICU environment" emerged as the primary theme with the following categories: ups and downs of parenting in the NICU, decision-making challenges in the NICU, and parent support. Parents encountered challenges with areas for improvement for end-of-life and palliative care in the NICU. Further research is necessary to understand barriers with integrating palliative care and curative care in the NICU, and how NICU care affects bereavement and coping outcomes after infant death.

The effect of mothers' empowerment program on premature infants' weight gain and duration of hospitalization

Background:

The readiness of mothers to take care for infants at discharge is a critical issue. Poor readiness of mothers in taking care of premature infants at the time of discharge is associated with potential adverse consequences. This study examined the effect of implementing mothers’ empowerment program on the weight gain and duration of hospitalization in premature infants.

Materials and Methods:

This study was a quasi-experimental before-after study with a control group, in which 80 mothers with premature infants who were hospitalized in NICU Level II of two hospitals were recruited in the study. Mothers’ empowerment program was implemented as a three-stage training program for the intervention group. Mothers’ readiness questionnaire was completed by the mothers before the intervention and at the discharge time. The changes in mean of mothers’ readiness scores were compared in both the groups.

Results:

The mean of daily weight gain in infants of the intervention group (3.95 g) was significantly higher than that of the infants in the control group (−0.9 g) (P = 0.003). The average duration of hospitalization for infants in the intervention and control groups was 15.45 days and 20.95 days, respectively, showing a statistically significant difference (P = 0.003).

Conclusions:

Providing training to the mothers regarding how to care for premature infants can be a useful and effective method in the process of weight gain of premature and low-birth newborns, and may shorten the duration of infants’ hospitalization.