Symptoms of depression in parents after discharge from NICU associated with family-centred care

Effects of home-based integrated sensory stimulation program to preterm infants on parents' depression and anxiety: a randomized controlled trial

BACKGROUND

Preterm parents face higher risks of postpartum depression and anxiety, affecting bonding and infant development. Sensory stimulation shows promise, but its long-term impact on parental mental health needs further study.

OBJECTIVES

This study aimed to evaluate whether a home-based integrated sensory stimulation program, administered to preterm infants by their parents, could alleviate parental mental health issues and enhance maternal bonding and parenting competence.

METHODS

The program, including tactile, auditory, visual, gustatory, and olfactory stimuli, was assessed in a block-randomized controlled trial from November 2018 to January 2020. A total of 200 parents of preterm infants were recruited, and the intervention continued at home until the infants reached six months corrected age. Parents' depression and anxiety were assessed using validated scales at baseline, and at first, third, and sixth month follow-ups.

RESULTS

The intervention group included 98 parents, and the control group comprised 102 parents. At the six-month follow-up, the intervention group demonstrated significant improvements in maternal depression, state anxiety, and trait anxiety compared to the control group. In the mixed linear model, the intervention was associated with reductions in maternal trait anxiety (d =-2.18; 95% CI: -4.30, -0.06), paternal trait anxiety (d =-3.37; 95% CI: -5.62, -1.11) and state anxiety (d =-4.63; 95% CI: -7.00, -2.26).

CONCLUSION

The home-based integrated sensory stimulation program, when provided by parents to preterm infants, was effective in improving parents' mental health and can serve as an alternative treatment for postpartum depression and anxiety in parents of preterm infants at home.

Skin-to-skin contact at birth for very preterm infants and symptoms of depression and anxiety in parents during the first year - A secondary outcome of a randomized clinical trial

BACKGROUND

Mental health issues are common in parents to preterm infants. In the neonatal intensive care unit (NICU), skin-to-skin contact (SSC) as an avenue for parent-infant closeness may improve parental mental health. Few studies exist regarding its benefits when initiated immediately postbirth. The aim was to determine the effect of SSC for very preterm infants at birth on parents' mental health, by assessing symptoms of depression and anxiety within the first year.

METHODS

The Immediate Parent-Infant Skin-to-Skin Study was a randomized clinical trial conducted 2018-2021 at three NICUs in Sweden and Norway. Very preterm infants (28-33 weeks of gestation) were allocated to standard incubator care or SSC with either parent, initiated at birth and continued throughout the first 6 h. Symptoms of depression and anxiety in parents were assessed with the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory.

RESULTS

The study included 91 infants (36 twins [40 %]) and 73 mothers and 73 fathers. Infants had a mean gestational age of 31 + 1 weeks and birthweight of 1534 g. Immediate SSC was found to significantly reduce depression symptoms in mothers and anxiety symptoms in fathers at one week after birth and depression and anxiety symptoms in fathers at term-equivalent age of infant.

LIMITATIONS

Limitations include a small sample size and limited background data on prenatal depression and anxiety.

CONCLUSIONS

Immediate parent-infant SSC following a very preterm birth may provide a protective effect on parents' mental health and should be supported in the clinical setting, alongside necessary nursing, and medical care.

Direct, non-medical out-of-pocket expenditures for mothers of moderate or late preterm infants in a level II NICU: Comparison of Alberta Family Integrated Care versus standard care

Objective

To compare direct, non-medical out-of-pocket expenditures (OOPE) between mothers receiving Alberta Family Integrated Care (FICare™) versus standard care (SC) during their infant's neonatal intensive care unit (NICU) admission and explore factors influencing spending extremes.

Methods

In this exploratory, concurrent mixed-methods sub-study, we compared mother-reported OOPE from Alberta FICare™ and SC parent journals. We thematically analyzed hand-written notes from 30 journals with the highest and lowest 5 % of OOPE.

Results

There was no difference in total direct, non-medical OOPE between Alberta FICare™ (n = 194) and SC (n = 132) groups (U = 12,679.50, p = 0.882). Compared to mothers receiving SC, mothers receiving Alberta FICare™ reported spending less for parking (U = 970.00, p < 0.001) and more for food (U = 14,857.50, p = 0.014) and lodging (U = 15,160.00, p < 0.001). Spending extremes related to travel and proximity of the NICU to their home.

Conclusion

Total family financial burden was similar between groups; there were differences in spending categories. Supports to offset OOPE, particularly for families living distant to the NICU or facing transportation challenges, would reduce financial burden and could enhance family-integrated care.

Innovation

This novel analysis describes mother-reported OOPEs and strategies to mitigate financial barriers to family integrated care.

Experiences of parents with very premature-born children at risk of neurodevelopmental disorders: A qualitative study

BACKGROUND

Premature birth is a traumatic and stressful situation for parents who are immediately separated from their infant because of the newborn's need for specialized care. The staff of these units are in charge of following the principles of family-centred care and practices for neonates at risk of neurodevelopmental disorders, including providing training to the family during their hospital stay and after being discharged.

AIM

The aim of this study is to explore the perceptions of parents of premature children at risk of neurodevelopmental disorders in regard to care, interventions and assistance provided during the first months of their child's life.

STUDY DESIGN

A qualitative descriptive study was carried out through individual interviews. The data analysis was conducted through a thematic analysis. The methodology and results were reported following the standards for preparing qualitative research reports and recommendations.

RESULTS

Twenty-one parents of premature children were interviewed. From these interviews, three main themes emerged: (i) parents' perspectives on preterm birth risk communication, (ii) navigating parental support and early interventions in preterm birth and (iii) perceptions of preterm birth protective and challenging factors.

CONCLUSIONS

The parents of premature children need to receive better communication about the care and interventions for their child, and it is necessary that health personnel are better trained in terms of management and administration of public resources. Strategies must be implemented that continuously guide parents on the follow-up and care of their premature child not only during their first moments of life but also after being discharged from the hospital.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the need to improve care for parents with premature infants at risk, emphasizing the necessity for health care system reforms and support structures, allowing health care professionals to enhance attention and care.

Culture of Family-Centered Care in the NICU

BACKGROUND

Family centered-care (FCC) has documented benefits for infants, parents, and staff, but is variably practiced.

PURPOSE

To describe parental and staff perspectives on the quality of FCC culture in a neonatal intensive care unit (NICU).

METHODS

Parents of hospitalized infants and staff at a referral NICU completed validated survey instruments to measure NICU FCC quality on topics including trust, communication, and shared decision-making at multiple time points. We compared parent and staff responses using a cumulative log-odds model with a single predictor to model the odds of a score lower than a prespecified value.

RESULTS

A total of 92 parents of 80 NICU infants and 96 NICU providers participated. Most rated items highly, indicating a positive experience with FCC. The items with the highest scores for parents were receiving guidance and being trusted in their infant's care (both 97.1% positive); for staff, listening to parents (95%). Receiving/providing emotional support received the lowest scores from parents (19.1% negative or neutral) and staff (24.5%). Parent and staff answers differed significantly for 6 of 8 questions, with lower scores reported by staff relative to parents.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Parents and staff have variable perspectives on different aspects of FCC. Understanding these nuances of centers' FCC culture can help target interventions and may strengthen FCC delivery for NICU infants and families and career satisfaction for staff. Future directions include assessing FCC quality over time and among specific infant, family, and staff cohorts, especially diverse populations to determine if FCC is equitably delivered.

Transition-to-home arrangements for very preterm infants and related parental needs at perinatal centres in Austria and Switzerland: a cross-sectional multicentred study

INTRODUCTION

The current study aims to give an overview of transition-to-home services provided by perinatal centres in Austria and Switzerland and to evaluate parental satisfaction with the care provided.

METHODS

This cross-sectional multicentred study was conducted by performing two surveys between May 2022 and November 2023: one among all level III perinatal centres in Austria (n=7) and Switzerland (n=9) (institutional survey) and one among parents of very preterm infants treated at one selected perinatal centre in each of the two countries (parental survey). Both questionnaires consisted of matching questions focusing on current transition-to-home services.

RESULTS

All perinatal centres participated in the institutional survey and 61 out of 84 parents completed the parental questionnaire (response rate 72.6%). The discharge process to home was identified as a multidisciplinary effort involving various healthcare professionals with discrepancies in responses within and between institutional and parental questionnaires. Certain disparities were observed in the timing of discharge conversations between healthcare providers and parents. Most physicians mentioned initiating discharge discussions while the child was still in the intensive care unit, but only 14.8% of parents recalled these early conversations. One-fourth of perinatal centres actively contact patients after discharge. So far, video consultations or mobile applications have not been offered. While 95.1% of parents expressed satisfaction with the care received, there were concerns about contradictory medical information, particularly regarding breastfeeding.

CONCLUSION

The transition-to-home process for very preterm infants presents several opportunities for improvement, especially concerning communication between healthcare providers and parents, lactation counselling services and the timely outreach to parents shortly after discharge. The findings of the current study may further improve this transition process and might aid in the development of a standardised programme that is tailored to parental needs.

Parents' Need for Support From Family and Friends During Their Preterm Infants' Hospitalisation: A Cross-National Qualitative Study

AIM

To explore the need for support from family and friends among parents of preterm infants within neonatal intensive care.

DESIGN

A cross-national qualitative study.

METHODS

In autumn 2019, 73 parents of preterm infants hospitalised in neonatal intensive care units in Denmark, Finland, Iceland and Sweden were interviewed. Data were analysed using reflexive thematic analysis.

RESULTS

The infant's hospitalisation created a complex context for parental support from family and friends. Social, emotional and practical support were crucial but often hindered by challenges related to the environment, timing, individual circumstances and relationships. Parents emphasised the need for family and friends to be supported in understanding the situation.

CONCLUSION

Encouraging the presence and involvement of family and friends, implementing adaptive unit policies and sensitivity of staff are pivotal in fostering a supportive environment.

IMPLICATIONS

By better understanding parents' need for support, neonatal units can further develop their practices and enhance the parental support. This can be achieved by enabling the presence and involvement of family and friends at the level the parents desire.

IMPACT

This study addressed a knowledge gap regarding parents' support need from family and friends during their preterm infant's hospitalisation. This study's results will offer important knowledge to develop unit practices and comprehensive support systems for parents.

REPORTING METHOD

This study followed the relevant EQUATOR guidelines and COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Mother-newborn couplet care and the expectations, concerns and educational needs of healthcare professionals: a qualitative study

OBJECTIVES

Our aim was to explore healthcare professionals' (HCPs) expectations, concerns and educational needs regarding preparing for implementing the concept of couplet care, keeping newborns in need of intensive care together with their mothers in need of obstetrical care.

DESIGN

A qualitative focus group study based on semistructured interviews. We analysed the data using reflexive thematic analysis. This study is part of a comprehensive research project and pre-implementation based on curriculum development principles and implementation theory.

SETTING

We conducted four focus group interviews from May to June 2023 at a tertiary referral university hospital in Denmark.

PARTICIPANTS

Neonatologists, obstetricians, midwives and nurses (n=21) were recruited from neonatal and obstetric departments.

INCLUSION CRITERIA

Neonatologists, obstetricians, midwives and nurses with various levels of postgraduate experience.

RESULTS

We identified the overarching theme of building bridges in relation to HCPs' expectations, concerns and educational needs and five subthemes: Enhancing meaningfulness through increased teamwork; compromising or improving patient safety; challenging professional comfort zones; encountering other cultural and ethical values; and recognising educational requirements.

CONCLUSIONS

HCPs widely support mother-newborn couplet care and emphasise the need for closer collaboration between neonatal and obstetric departments. Implementing couplet care is seen as meaningful, potentially enhancing the well-being of mothers and newborns and positively impacting HCPs' job satisfaction. Key concerns include patient safety, quality of treatment and care and the well-being of HCPs navigating their skills, psychological safety and professional boundaries. While the importance of couplet care for early closeness and connection is acknowledged, challenges arise in meeting diverse maternal and neonatal needs. Additional research, especially in highly specialised settings, is necessary to understand the complexities associated with changing the care paradigm for newborns and mothers to be cared for together and in implementing couplet care. We found focus groups useful as a tool for needs assessment and uncovering and adapting practices to address challenges in implementing couplet care.

Optimal presence: enhancing parent integration to maximize neurodevelopmental outcomes in preterm infants

Preterm birth disrupts the natural progression of events in the parent-infant relationship and bestows many of the typical parent responsibilities to the clinical care team. In turn, the neonatal intensive care environment (NICU) introduces obstacles to parents that would not otherwise be encountered and forces parents to adapt to this artificial environment as they seek to bond with and care for their newborn. Facilitating parent presence at the bedside and incorporating them into the care of their preterm infant is critical for lessening the immediate burden to both the parent and offspring while also ensuring the best possible outcome for preterm infants. In this review, we explore the impact that parents exert on the neurodevelopmental outcome of preterm infants and identify several barriers and facilitators to parent presence.

Experiences and impacts of psychological support following adverse neonatal experiences or perinatal loss: a qualitative analysis

BACKGROUND

Poor parental mental health in the perinatal period has detrimental impacts on the lives and relationships of parents and their babies. Parents whose babies are born premature and/or sick and require neonatal care or those who experience perinatal loss are at increased risk of adverse mental health outcomes. In 2021 a North-West charity received funding to offer psychological support to service users of infants admitted to neonatal care or those who had experienced perinatal loss, named the Family Well-being Service (FWS). The FWS offered three different types of support - ad hoc support at the neonatal units or specialist clinics; one-to-one person-centred therapy; or group counselling. Here we report the qualitative findings from an independent evaluation of the FWS.

METHODS

Thirty-seven interviews took place online or over the phone with 16 service users (of whom two took part in a follow-up interview), eight FWS providers and 11 healthcare professionals. Interviews were coded and analysed using thematic analysis.

RESULTS

The analysis revealed two themes. 'Creating time and space for support' detailed the informational, contextual, and relational basis of the service. This theme describes the importance of tailoring communications and having a flexible and proactive approach to service user engagement. Service users valued being listened to without judgement and having the space to discuss their own needs with a therapist who was independent of healthcare. Communication, access, and service delivery barriers are also highlighted. The second theme - 'making a difference' - describes the cognitive, emotional, and interpersonal benefits for service users. These included service users being provided with tools for positive coping, and how the support had led to enhanced well-being, improved relationships, and confidence in returning to work.

CONCLUSION

The findings complement and extend the existing literature by offering new insights into therapeutic support for service users experiencing adverse neonatal experiences or perinatal loss. Key mechanisms of effective support, irrespective of whether it is provided on a one-to-one or group basis were identified. These mechanisms include clear information, flexibility (in access or delivery), being independent of statutory provision, focused on individual needs, active listening, the use of therapeutic tools, and positive relationships with the therapist. Further opportunities to engage with those less willing to take up mental health support should be developed.

Prevalence of anxiety, depression, and stress among parents of neonates admitted to neonatal intensive care unit: a systematic review and meta-analysis

BACKGROUND

Neonatal intensive care unit (NICU) admission causes significant distress that can hinder the successful transition into parenthood, child-parent relations, and child development.

PURPOSE

This systematic review and meta-analysis aimed to understand parental psychological phenomena. Here we assessed the emotional response of parents of newborns during NICU admission.

METHODS

Two authors independently searched the PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Clinical Key, and Google Scholar databases for studies published between January 01, 2004, and December 31, 2021. The review followed Cochrane collaboration guidelines and the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) statement. The quality of the included studies was assessed using the modified Newcastle-Ottawa Scale. Stata software (version 16) was used to compute the results.

RESULTS

This review comprised 6,822 parents (5,083 mothers, 1,788 fathers; age range, 18-37 years) of NICU patients. The gestational ages and neonatal weights were 25.5-42 weeks and 750-2,920 g, respectively. The pooled prevalence of anxiety was higher among mothers (effect size [ES], 0.51; 95% confidence interval [CI], 0.41-0.61; and heterogeneity [I2]=97.1%; P<0.001) than among fathers (ES, 0.26; 95% CI, 0.11-0.42; I2=96.6%; P<0.001). Further, the pooled prevalence of depression was higher among mothers (ES, 0.31; 95% CI, 0.24-0.38; I2=91.5%; P<0.001) than among fathers (ES, 0.12; 95% CI, 0.03-0.22; I2=85.6%; P<0.001). Similarly, the pooled prevalence of stress was higher among mothers (ES, 0.41; 95% CI, 0.31-0.51; I2= 93.9%; P<0.001) than among fathers (ES, 0.22; 95% CI, 0.09-0.34; I2=85.2%; P<0.001).

CONCLUSION

NICU admission is more stressful for mothers than fathers and can affect mental health and quality of life. Mothers reported a higher pooled prevalence of stress, anxiety, and depression than fathers, possibly attributable to their feelings about birthing a sick child.

Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs

BACKGROUND

Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms.

METHOD

This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches.

RESULTS

178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes.

CONCLUSION

Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.

Being parents of extremely preterm children, from a long-term perspective: A qualitative study of parents' experiences

BACKGROUND

In recent decades, modern neonatal intensive care has improved, increasing the survival of extremely preterm children. Few studies have examined the experiences of parents of extremely preterm children from a long-term perspective.

AIM

To describe parents' experiences of parenting extremely preterm children during their childhood and transition to adulthood.

STUDY DESIGN

A qualitative interview study with a descriptive design.

SUBJECTS

Thirteen parents of eleven children born at 24 gestational weeks in Sweden, 1990-1992, participated in individual semi-structured interviews.

OUTCOME MEASURES

Data were analyzed using qualitative reflexive thematic analysis.

RESULT

Five themes forming a timeline were created in the analytic process: parenthood, at the NICU, young childhood, adolescence, and adulthood. Various aspects affecting parenthood were described throughout the timeline, and occasionally the parents experienced difficulties dealing with their children's special physical and/or mental needs. Today, some families have established a functioning situation despite their children's physical and/or mental difficulties, while some still struggle with their children's everyday life.

CONCLUSION

Having an extremely preterm family member profoundly affects the whole family for various lengths of time. Parents expressed a need for support from both healthcare and school throughout their children's childhood and in their transition to adulthood, although the need varies between parent-child pairs. By studying the parents' experiences, their need for support can be further recognized and understood, and developed and improved accordingly.

Addressing caregiver mental health in the neonatal ICU

PURPOSE OF REVIEW

The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals.

RECENT FINDINGS

Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes.

SUMMARY

To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU.

VIDEO ABSTRACT

http://links.lww.com/MOP/A70.

Improving Neonatal Intensive Care Unit Quality and Safety with Family-Centered Care

There is strong evidence that family-centered care (FCC) improves the health and safety of infants and families in neonatal settings. In this review, we highlight the importance of common, evidence-based quality improvement (QI) methodology applied to FCC and the imperative to engage in partnership with neonatal intensive care unit (NICU) families. To further optimize NICU care, families should be included as essential team members in all NICU QI activities, not only FCC QI activities. Recommendations are provided for building inclusive FCC QI teams, assessing FCC, creating culture change, supporting health-care practitioners and working with parent-led organizations.

Comparing prenatal and postpartum stress among women with previous adverse pregnancy outcomes and normal obstetric histories: A longitudinal cohort study

OBJECTIVE

The aim of this study was to compare subjectively and objectively measured stress during pregnancy and the three months postpartum in women with previous adverse pregnancy outcomes and women with normal obstetric histories.

METHODS

We recruited two cohorts in southwestern Finland for this longitudinal study: (1) pregnant women (n = 32) with histories of preterm births or late miscarriages January-December 2019 and (2) pregnant women (n = 30) with histories of full-term births October 2019-March 2020. We continuously measured heart rate variability (HRV) using a smartwatch from 12 to 15 weeks of pregnancy until three months postpartum, and subjective stress was assessed with a smartphone application.

RESULTS

We recruited the women in both cohorts at a median of 14.2 weeks of pregnancy. The women with previous adverse pregnancy outcomes delivered earlier and more often through Caesarean section compared with the women with normal obstetric histories. We found differences in subjective stress between the cohorts in pregnancy weeks 29 and 34. The cohort of women with previous adverse pregnancy outcomes had a higher root mean square of successive differences between normal heartbeats (RMSSD), a well-known HRV parameter, compared with the other cohort in pregnancy weeks 26 (64.9 vs 55.0, p = 0.04) and 32 (63.0 vs 52.3, p = 0.04). Subjective stress did not correlate with HRV parameters.

CONCLUSIONS

Women with previous adverse pregnancy outcomes do not suffer from stress in subsequent pregnancies more than women with normal obstetric histories. Healthcare professionals need to be aware that interindividual variation in stress during pregnancy is considerable.

NICU parents' mental health: A comparative study with parents of term and healthy infants

AIM

To compare mental health in parents of preterm/ill infants and parents of term and healthy infants before birth and 1 month after hospital discharge.

METHODS

A comparative cohort design was used. In total 439 parents from six neonatal intensive care units (NICUs) and 484 parents from four maternity units (MUs) in Sweden answered a survey 1 month after discharge.

RESULTS

Parents in neonatal units experienced significantly more psychologically traumatic births and rated their health and the health of their infants less favourably the first week after delivery than parents in MUs. In the neonatal units, both parents had better possibilities to stay together with the infant during hospital stay. There was no difference between the NICU and MU groups in postpartum depressive symptoms 1 month after discharge. Experiencing a traumatic birth was not related to an increased risk of perinatal depressive symptoms (Edinburgh Postnatal Depression Scale ≥13) for mothers in NICUs. In contrast, the risk of depression increased for mothers in MUs.

CONCLUSION

Family togetherness, parent-infant closeness and emotional support at NICUs may contribute to the positive outcome. Further studies are needed to assess the long-term effects of how family togetherness and closeness influence families long term.

Understanding factors associated with emotional closeness in parents with a preterm infant in the neonatal intensive care unit

BACKGROUND

There is a dearth of knowledge regarding the specific factors associated with emotional closeness in parents with an infant in the NICU.

AIM

To determine if parental presence, involvement in infant care, holding, skin-to-skin contact (SSC), perceived family-centered care, depression symptoms, and sociodemographic characteristics are associated with the emotional closeness of parents with an infant hospitalized at the NICU.

STUDY DESIGN

This longitudinal descriptive study was conducted in two Canadian level-three NICUs. A sociodemographic questionnaire was completed by parents at enrolment. A closeness diary was completed by each parent for 14 days to measure parental presence, involvement in infant care, holding, SSC, and emotional closeness. One question from the DigiFCC tool was sent daily via text message to the parents' cellphones to measure their perception of the quality of family-centered care they experienced. Parent depression symptoms were measured using the Edinburgh Postnatal Depression Scale at discharge.

RESULTS

A total of 60 families were involved in the study. Increased parental presence (B = 0.21, p < 0.001), increased time involved in infant care (B = 0.14, p < 0.001), increased holding time (B = 0.53, p < 0.001), and greater time in SSC (B = 0.27, p = 0.01) were associated with greater parental emotional closeness.

CONCLUSION

Several factors may enhance parents' emotional closeness when their infant is in the NICU. Care providers need to be aware and adapt their clinical practices accordingly to promote emotional closeness by encouraging parental presence, involvement in infant care, holding, and skin-to-skin contact.

Parent-infant closeness after preterm birth and depressive symptoms: A longitudinal study

Background

Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents.

Methods

This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents’ presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14  days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4  months corrected age of the infant.

Results

The study included 684 mothers and 574 fathers. The median presence was 469   min (Q1 258 and Q3 1,087) per 24   h for the mothers and 259   min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4  months, respectively. Parents’ presence and depressive symptoms varied greatly between the units. Parents’ presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted).

Conclusion

No association was found between the duration of parent-infant closeness in the neonatal unit and parents’ depressive symptoms. The beneficial effects of family-centered care on parents’ depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents’ depression after NICU stay.

Psychometric Properties of an Instrument to Measure the Quality of Family-Centered Care in NICUs

OBJECTIVE

To examine the psychometric properties of the Digi Family-Centered Care-Parent Version (DigiFCC-P), which was developed to measure parents' perceptions of family-centered care (FCC) in NICUs.

DESIGN

Cross-sectional psychometric study.

SETTING

Twenty-three NICUs in 15 countries in Europe, Canada, and Australia.

PARTICIPANTS

Mothers (n = 565) and fathers (n = 406) of preterm infants hospitalized in NICUs.

METHODS

Participants reported their perceptions of the quality of FCC during their infants' hospitalizations by answering one DigiFCC-P question delivered to their mobile phones every evening. Nine questions rotated in random order. Participants responded on a 7-point Likert scale. We evaluated the instrument's internal consistency, construct and concurrent validity, and sensitivity.

RESULTS

The internal consistency of the DigiFCC-P was satisfactory; the Cronbach's alpha coefficient was .74 (95% confidence interval [.71, .77]), and all the corrected item-total correlations were greater than .30. We identified that the items formed two factors, support from staff and the parent's active participation, and observed no strong item cross-loadings on the two factors. We discovered some items with weak interitem correlations, and the two factors explained 35.2% of the variance. Scores on the DigiFCC-P and Family-Centered Care Questionnaire were significantly correlated (r = .59, p < .001) and supported the convergent validity of the instrument. In addition, changes were discovered in the participants' ratings over time, which indicated that the instrument was sensitive to detect changes in their evaluations.

CONCLUSION

The psychometric testing of the DigiFCC-P provided initial support for the convergent validity and reliability of the instrument. The instrument was also sensitive in detecting changes in the evaluations of FCC over time. However, there is a need for further development of the content validity of the instrument.

Ten Years of Neonatal Intensive Care Adaption to the Infants' Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway

Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support. Our paper describes how we managed to systematically reorganize the nurse's workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants' needs by providing neonatal intensive care with parents as equal partners.

Validation of the Chinese Empowerment of Parents in the Intensive Care (EMPATHIC-30) Questionnaire Among Parents in Neonatal Intensive Care Units: A Prospective Cross-Sectional Study

BACKGROUND

There are no specific validated questionnaires assessing satisfaction of family-centered care experienced by parents of infants hospitalized in Chinese Neonatal Intensive Care Units (NICU).

AIM

To adapt and test the reliability and validity of the Chinese version of the EMPATHIC-30 questionnaire in NICU settings.

METHODS

A prospective, cross-sectional design was adopted. The EMPATHIC-30 questionnaires were completed by parents of infants admitted to one of the four NICUs at Hunan Children's Hospital, China, between November 2018 and 2019. Inclusion criteria were parents whose infants were admitted to the NICU for at least 5 days. Exclusion criteria were parents whose children were discharged within 5 days after admission or whose infants died in the NICU. Reliability was tested with Cronbach's alpha. The congruent validity was tested using Spearman's Rank correlation analysis, and the non-differential validity was tested using Cohen's d.

RESULTS

Parents of 619 infants discharged from the NICUs completed and returned the questionnaire. Most infants were male (n = 337, 54.4%) and infants' length of stay was a median of 21 days (IQR = 14-37). Mostly, mothers completed the questionnaire (n = 523, 84.5%). The Cronbach's alpha values of the five individual domains were between 0.67 and 0.95, and the alpha of the total questionnaire was.90, providing an adequate internal consistency. Congruent validity was measured by correlating the five domains with four standard satisfaction scales, documenting a weak correlation (r _s -0.025-0.327). Non-differential validity showed some significant effect size between four binary variables (mechanical ventilation, unplanned admission, admission after surgery, length of stay) four of the five domains.

CONCLUSION

The Chinese version of EMPATHIC-30 questionnaire showed acceptable psychometric properties. This instrument might be considered a suitable instrument to measure parent satisfaction among Chinese parents whose infants are admitted to an NICU. Measuring parent satisfaction with this instrument might contribute to improving family-centered care initiatives in NICUs with Chinese parents.