The Level and Sources of Stress in Mothers of Infants Admitted in Neonatal Intensive Care Unit

Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: Systematic review and meta-analysis evidence available from India

The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J-Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta-analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy.

The effect of empowerment counseling on stress and self-esteem of mothers with hospitalized premature infants

BACKGROUND

This study aimed to investigate the effect of counselling on stress and self-esteem of mothers with hospitalized premature infants.

MATERIALS AND METHODS

This parallel randomized clinical trial was conducted on 80 primigravida mothers aged 18-40 years, gestational age of 28-34 weeks in 2021 in Iran. The women were randomly assigned to two groups by blocked randomization. The data were collected using a demographic information questionnaire, Paternal Stress Scale and Rosenberg self-esteem questionnaire. Individual counselling based on the GATHER model was carried out within two consecutive weeks in four sessions. Data were analyzed with SPSS 24.

RESULTS

There was no significant difference between the two groups in demographic variables, stress, and self-esteem before the intervention (P>0.05). There was a substantial difference in the mean score of self - esteem 9.52±3.22 and 16.75±6.39 (P<0.001), stress 154.65±32.15and 61±10.98 (P<0.001) and different dimensions of stress between the control and intervention groups after the intervention. The most significant reduction occurred in the dimension of appearance and behaviour of the infant (cohen d=3.146).

CONCLUSIONS

The results show counselling with an empowerment approach based on the GATHER model is effective in reducing stress and increasing self-esteem of mothers of premature infants admitted to the intensive care unit.

The Stress Levels of Premature Infants' Parents and Related Factors in NICU

Introduction

Parental stress related to their infants' hospitalization is a significant concern that affects both parents and their infants. Fathers' experiences tend to be understudied compared to mothers. Further research on fathers' stress levels is necessary. While parental stress has been correlated with infant health severity, the specific causes and risk factors contributing to heightened stress levels in parents of neonatal intensive care unit (NICU) infants are not yet fully understood and require further investigation.

Objective

This study aimed to examine the stress levels experienced by parents of premature infants in the NICU and to explore the factors associated with parental stress in this specific context.

Methods

A cross-sectional observational design was used to accomplish this study, which was carried out on 743 parents from nine different NICUs located in governmental hospitals across various locations in Egypt. We used characteristics of parents and premature infants, and Parent Stress Scale was used for data collection.

Results

A majority of parents reported experiencing high stress in the following domains: sight and sound (80.3%), infants' appearance (69%), and the parent-infant relationship (81.4%). Additionally, about three-quarters (73.6%) of parents experienced high stress overall, with a mean score of 167.56 (21.3).

Conclusion

About three-quarters of the parents experienced high overall stress levels. Also, factors that were found to affect parents' stress levels included premature infants connected to mechanical ventilators, previous neonatal death, parents living far from hospitals, infants delivered through cesarean section, insufficient income, and prolonged hospitalization beyond 5 days.

Stress Levels in Mothers of Admitted Newborns in NICU and Effect of Counseling

OBJECTIVES

To examine the effect of counseling on stress levels in mothers of neonates admitted to the Neonatal Intensive Care Unit (NICU).

METHODS

This prospective research was carried out from January 2020 to December 2020 in a central India teaching hospital providing tertiary care. Parental Stressor Scale (PSS):NICU questionnaire was used to measure maternal stress among mothers of 540 admitted infants between 3 and 7 d of admission. Counseling was done at the time of recruitment and its effect was measured after 72 h and re-counseling was done. This cycle of stress assessment and counseling was repeated every 72 h till the baby was admitted in the NICU. Overall stress levels for each subscale were determined, and pre- and post-counseling stress was compared.

RESULTS

For the subscales of sight and sound, appearance and behavior, change in the parental role, and staff behavior and communication, the median scores were 1.5 (IQR-1.2-1.88), 2.5 (2.3-2.9), 3.3 (3.0-3.6) and 1.3 (1.1-1.62), respectively indicating high stress in the parental role alteration. Counseling was effective in reducing stress levels among all mothers irrespective of various maternal factors (p <0.01). Stress reduces more with increasing number of counseling, as suggested by higher change in the stress score with increased number of counseling.

CONCLUSIONS

This study shows that NICU mothers are under remarkable stress and repeated counseling sessions targeted at particular concerns might assist.

Prevalence of mental health problems in mothers of preterm infants admitted to NICU: A cross-sectional study

OBJECTIVE

To study the prevalence of mental health problems among mothers of preterm infants admitted to the neonatal intensive care unit (NICU).

METHODS

In this cross-sectional two-arm study, 130 mothers in each group, with either term infants not in NICU or preterm infants admitted to NICU, underwent mental health assessment using the Generalized Anxiety Disorder Scale, Centre for Epidemiologic Studies-Depression Scale, Stanford Acute Stress Reaction Questionnaire and Modified Parental Stress Scale-NICU. Their coping styles and quality of life were also assessed. Data were analyzed using SPSS IBM 25.0.

RESULTS

Anxiety (66.2% versus 46.9%) and depression (45.4% versus 23.1%) were more common among NICU mothers. Regarding subdomains of acute stress reaction, a higher number of NICU mothers showed symptoms of anxiety, re-experience and functional impairment. For mothers with infants in NICU, sight, sound, and parental role alterations were stressful. They had reduced quality of life scores in domains of physical health, psychological health, and social relationships. Also, a higher number of these mothers exhibited problem-solving and emotion-focused coping.

CONCLUSION

Preterm birth with NICU admission of the infant is more stressful for a mother than the term birth of a healthy neonate. It affects her mental health and quality of life. Both the obstetrician and the pediatrician should be mindful of this.

Evaluation of parental stress in neonatal intensive care unit in Iran: a national study

BACKGROUND

More attention is paid to the survival and treatment of the sick infant in the neonatal intensive care unit (NICU) and parental stress is not considered. The purpose of this study was to determine samples of the level of parental stress in the NICU.

METHOD

This study is a descriptive-analytical study in which Parental Stress and General Health were used in an analytical national survey in Iran. The research sample consists of 2456 parents of infants admitted to NICU. The sampling method was multi-stage random. We used 11- item parental stress questionnaire and 28-item general health questionnaire for the data collection.

RESULT

Baloch ethnicity with an average of 11.52 had the highest level of stress. The mean stress score of mothers was higher than fathers. The mean score of all dimensions of physical symptoms, anxiety, social functioning, depression, and total mental health score in mothers was higher than fathers. There was a statistically significant difference in the length of hospitalization in terms of different levels of parental stress scores (p < 0.002). Lack of decisive response to parents was one of the most stressful issues (8.1%).

CONCLUSION

Our result shows mothers' stress was higher than fathers. So that health policymakers should pay attention to stress risk factors to provide appropriate interventions according stress risk factors Future studies should design appropriate interventions to reduce parental stress, especially in high-risk mothers.

Frequency of maternal stress and psychic risk in newborns who have been hospitalized in a neonatal intensive care unit

Abstract Objectives: describe the frequency of maternal stress and psychic risk indicators in newborns who were exposed to the neonatal intensive care unit (NICU) after hospital discharge. Methods: observational, analytical, cohort study, sample of 26 participants (13 exposed and 13 not exposed to the NICU). Maternal stress was assessed by Inventário de Sintomas de Stress para Adultos de Lipp (ISSL) (Lipp’s Stress Symptoms Inventory for Adults) and psychological risk by Indicadores Clínicos de Risco para o Desenvolvimento Infantil (IRDI) (Clinical Risk Indicators for Child Development), 15 days after hospital discharge and at 4 months of corrected age. Results: the study found a frequency of stress of 23.1% in mothers of newborns who were exposed to NICUs and 38.5% of psychological risk in these newborns. The following associations were found: maternal stress and newborn exposure to the NICU (p=0.037); maternal stress and newborn exposure time to NICU (p=0.031); psychological risk and prematurity (p=0.014). There were no association between psychic risk and maternal stress; and there was no diference in the frequency of psychological risk between the groups of newborns. Conclusions: newborn hospitalization in the NICU is associated with maternal stress, but not with psychological risk. Prematurity can cause psychological risk. Maternal stress was not associated with psychological risk.

Maternal Stress Experience in the Neonatal Intensive Care Unit after Preterm Delivery

OBJECTIVE

 Preterm delivery with the admission of a child in the neonatal intensive care unit (NICU) is extremely challenging for parents. Being separated from the baby and seeing her infant feeling pain and being sick together with the complexity of the NICU environment, the mother experiences great anxiety, fear, and stress. The purpose of the study was to assess NICU-related stress and to identify maternal and infant factors associated with increased stress in mothers of preterm infants.

STUDY DESIGN

 The maternal stress level was assessed in 122 mothers of preterm infants using the Parental Stressor Scale: NICU (PSS: NICU) in which items were distributed in three subscales as follows: Sights and Sounds of NICU-subscale 1 (S1), Infant Appearance and Behavior-S2, and Parental Role Alteration-S3.

RESULTS

 Maternal total PSS: NICU score was 3.46 ± 0.71. Parenteral Role Alteration was the most stressful (4.20 ± 0.79) followed by Infant Appearance and Behavior (3.51 ± 0.91) and Sights and Sounds subscale (2.28 ± 0.95); p (S1-S2) < 0.001, p (S1-S3) < 0.001, and p (S2-S3) < 0.001. Total PSS: NICU and Infant Appearance and Behavior scores correlated positively with maternal age (r = 0.189; p = 0.040 and r = 0.204; p = 0.027, respectively) and duration of NICU treatment (r = 0.188; p = 0.044 and r = 0.190; p = 0.042). More visits in NICU by a mother were associated with a lower PSS: NICU score (p = 0.049) and neonatal seizures and invasive ventilation in infants were associated with higher stress scores (p = 0.007 and p = 0.042).

CONCLUSION

 Mothers of preterm infants admitted in the NICU experience significant stress which is correlated with maternal age and NICU treatment duration and is associated with frequency of NICU visits, presence of neonatal seizures, and need for ventilator support. Parental role alteration is the greatest stressor followed by Infant Appearance and Behavior and NICU-surrounding stressor factors which show the need for interventions and counseling focused on mothers' role, their involvement in infant's care, and thus, family-centered care implementation.

KEY POINTS

· Mothers of preterm infants experience significant stress.. · Parental role alteration is the greatest maternal stressor.. · Maternal stress is correlated with age and NICU duration, and is associated with the frequency of NICU visits and infant's health status.

Perceptions of Parent Stressors in the Neonatal Intensive Care Unit Among the General Public and Healthcare Professionals

OBJECTIVES

Intervention efforts to improve the psychosocial well-being of parents with an infant in the neonatal intensive care unit (NICU) are high priority. This study assessed public and healthcare professionals' perceptions of prominent NICU stressors to highlight areas where NICU parents are in need of further support. Relations with sample characteristics were also examined to establish the generalizability of known parent demographic/sociofamilial risk factors.

METHODS

A cross-sectional design was used to assess public (n = 96) and staff (n = 55) responses on the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU).

RESULTS

The public perceived parental stress as being low to moderate. This was significantly lower than the staff estimate and highly comparable with past parent reports. Staff communication was perceived as most stressful by the public with this influenced by gender and education. Staff with more NICU experience were more likely to overestimate parental stress, particularly those working at the highest care level.

CONCLUSIONS

Collectively, these findings highlight preconceived anxiety around staff communication and behaviors and indicate that education on the potential for traumatic unit experiences to influence staff-parent communication may be important.

Maternal-infant bonding for the opioid exposed dyad: A rodgers' evolutionary concept analysis

AIM

This concept analysis aimed to offer insight into how opioid exposure affects the quality and construction of the maternal-infant bond.

BACKGROUND

Maternal-infant bonding can be influenced by maternal opioid use disorder and the neonatal intensive care unit environment. Many interventions for mothers with opioid use disorder focus on enhancing parental skills, but often the emotional and relational features of the maternal-infant bond have been overlooked.

DATA SOURCE

Literature from Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and PsycINFO published from January 2011 to June 2021 using "attachment theory," "mother-infant attachment," "maternal-infant bonding," "neonatal opioid withdrawal syndrome," and "neonatal abstinence syndrome" as key terms.

REVIEW METHODS

Rodgers' method of concept analysis was used to determine the antecedents, attributes, and consequences of maternal-infant bonding.

RESULTS

The key attributes of bonding for the opioid-exposed mother-infant dyad are engaged mothering, recognition of risk, affection, and respectful maternity care. The antecedents are closeness, selflessness, and purposeful touch. The consequences are sobriety, custody, love, and security.

Health care staff support for mothers in NICU: a focused ethnography study

BACKGROUND

Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU.

METHODS

A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework.

RESULT

Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained.

CONCLUSION

The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU.

Prenatal Maternal Docosahexaenoic Acid (DHA) Supplementation and Newborn Anthropometry in India: Findings from DHANI

Long-chain omega-3 fatty acid status during pregnancy may influence newborn anthropometry and duration of gestation. Evidence from high-quality trials from low- and middle-income countries (LMICs) is limited. We conducted a double-blind, randomized, placebo-controlled trial among 957 pregnant women (singleton gestation, 14-20 weeks' gestation at enrollment) in India to test the effectiveness of 400 mg/day algal docosahexaenoic acid (DHA) compared to placebo provided from enrollment through delivery. Among 3379 women who were screened, 1171 were found eligible; 957 were enrolled and were randomized. The intervention was two microencapsulated algal DHA (200 × 2 = 400 mg/day) or two microencapsulated soy and corn oil placebo tablets to be consumed daily from enrollment (≤20 weeks) through delivery. The primary outcome was newborn anthropometry (birth weight, length, head circumference). Secondary outcomes were gestational age and 1 and 5 min Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score. The groups (DHA; n = 478 and placebo; n = 479) were well balanced at baseline. There were 902 live births. Compliance with the intervention was similar across groups (DHA: 88.5%; placebo: 87.1%). There were no significant differences between DHA and placebo groups for birth weight (2750.6 ± 421.5 vs. 2768.2 ± 436.6 g, p = 0.54), length (47.3 ± 2.0 vs. 47.5 ± 2.0 cm, p = 0.13), or head circumference (33.7 ± 1.4 vs. 33.8 ± 1.4 cm, p = 0.15). The mean gestational age at delivery was similar between groups (DHA: 38.8 ± 1.7 placebo: 38.8 ± 1.7 wk, p = 0.54) as were APGAR scores at 1 and 5 min. Supplementing mothers through pregnancy with 400 mg/day DHA did not impact the offspring's birthweight, length, or head circumference.

A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study

OBJECTIVES

The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) is a well-validated tool to assess different sources of stress in parents during the NICU hospitalization of their infant. The present meta-analytic study assessed the relative impact of different NICU-related sources of parental stress in a pool of studies conducted in a wide set of different countries. Also, differences in stress levels by parent gender and country, as well as the impact of infants' neonatal characteristics and clinical conditions were explored.

METHODS

Records were searched on PubMed, Scopus, and Web of Science (January 1993-December 2019). A purposive open search string was adopted: ["PSS:NICU"] OR ["PSS-NICU"] OR ["Parental Stressor Scale"]. A multiple random-effect meta-analysis was conducted on data from 53 studies extracted by independent coders.

RESULTS

Parental role alteration emerged as the greatest source of stress for both mothers and fathers. Mothers reported higher stress levels compared to fathers. A significant difference emerged only for the subscale related to sights and sounds physical stimuli. No significant effects of infants' neonatal characteristics (gestational age, birth weight) and clinical conditions (comorbidities) emerged. A marginal positive effect of NICU length of stay emerged on the global level of parents' stress.

CONCLUSIONS

The current meta-analysis underlines that parental stress related to NICU admission is a worldwide healthcare issue. Immediate and tailored support to parents after the birth of their at-risk infant should be prioritized to reduce parental stress and to promote mothers and fathers' emotional well-being and new-born neurodevelopmental outcomes.

Impact of a Parent Video Viewing Program in the Neonatal Intensive Care Unit

Purpose: Video visits, or televisits, have become increasingly popular across various medical subspecialties. Within the University of California, Davis, Neonatal Intensive Care Unit, a video visitation program known as FamilyLink allows families to remotely view their babies when they are otherwise unable to visit. This study aimed to explore parents' perceived effects of video camera use as well as the relationship of video visit use with rates of breast milk feedings at hospital discharge. Materials and Methods: Families enrolled in this study completed a series of two identical surveys that gathered self-reported data on their experiences during their infant's hospitalization. Comparisons were made considering whether the FamilyLink program was utilized during the admission as well as changes in self-reported experiences over the time course of the hospital admission. The type of enteral feeding at discharge was recorded and reviewed for each baby. Results: Of 100 families enrolled in the study, 30 were found to have used FamilyLink to visit with their baby. The use of FamilyLink was associated with survey findings of sustained intention to breastfeed or provide breast milk to the baby, as well as increased perceived parental involvement in the baby's care. Improved rates of breast milk feedings at the time of discharge were also found among babies whose families conducted televisits using FamilyLink. Conclusions: Video viewing in the NICU has effected a positive impact on breast milk feedings and parents' feelings of involvement during the admission, with the potential to further improve on families' experiences with a hospitalized baby.

Pain profile of premature infants during routine procedures in neonatal intensive care: An observational study

Background:

Premature neonates receive a large number of painful procedures during their stay in the neonatal intensive care unit (NICU). However, there are many other processes that happen in the NICU, which may not be considered painful but can cause discomfort and/or stress to the neonate.

Method:

Pain profile during routine procedures in NICU was assessed using the premature infant pain profile (PIPP) score. Neonates of gestational age >26 weeks, less than 7 days old and admitted for less than 7 days in the NICU were included.

Results:

A total of 662 procedures were observed in 132 (78 M, 54 F) neonates. The mean (SD) age of the neonates was 2.4 (1.8) days and the mean (SD) birth weight was 2.3 (0.6) kg. 63 (54.5%) were of low birth weight (LBW), 85 (64.39%) were full term. High PIPP score was noted in blood sampling, heel prick, suction, and weight measurement. Significant differences were observed in the PIPP score during blood sampling and suction across gender. Some ordinary and non-stressful procedures also scored very high on the PIPP scale.

Conclusions:

The validity of PIPP needs to be reexamined. Our understanding of pain during routine procedures may need to be revisited.