Auricular acupuncture as stress-relieving intervention for parents of infants in the neonatal intensive care unit: insights gained from a pilot study

Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial

Study Objectives The purpose of this study is to identify factors associated with Neonatal Intensive Care Unit (NICU) mothers’ quality of sleep as measured with the General Sleep Disturbance Scale (GSDS). Methods Recruitment took place in a level 3 NICU. At enrollment, mothers completed a socio-demographic questionnaire, described their presence in the unit and their breast milk expression behavior. They also completed online or paper questionnaires about NICU-related stress, symptoms of postpartum depression, family-centered care, perception of noise and light in the unit, and sleep disturbances. Data regarding the infant’s clinical condition were collected from their medical file. Pearson correlations were performed to identify associations between mothers’ quality of sleep and other study variables. Subsequently, to compare mothers with a clinically significant GSDS score to mothers with a non-significant score, a binary logistic regression model was conducted. Results 132 mothers participated. Sleep disturbances of mothers with an infant hospitalized in the NICU was positively correlated with stress (r = 0.40; p = .00), depressive symptoms (r = 0.51; p = .00), and breast milk expression (r = 0.23; p = .01). In addition, for mothers with significant levels of depressive symptoms (OR = 1.19; p = .00), with greater presence in the unit (OR = 1.36; p = .04), or with other children at home (OR = 3.12; p = .04), the likelihood of clinically significant sleep disturbances was increased. Conclusions These results improve our understanding of the factors influencing the quality of sleep of mothers whose premature infant is hospitalized for 2 weeks or more in the NICU. In addition, these results allow the identification of mothers having a higher possibility for sleep disturbance, which enables the implementation of targeted interventions to promote adequate sleep.

The Baby-Friendly Hospital Initiative (BFHI) has a positive effect on breastfeeding in maternity wards; however, few studies have examined to what degree it affects care in neonatal intensive care units (NICUs). Recently, the BFHI has been adapted to the NICUs (Neo-BFHI). This study aimed to compare breastfeeding support in Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited (group 1) with NICUs in hospitals that have not yet begun this initiative (group 2). A validated questionnaire on breastfeeding support was distributed to level II and III NICUs in Spanish public hospitals. A univariate analysis and an analysis adjusted for the number of beds in NICUs were conducted. The results of the analysis of 36 breastfeeding support measures are presented in accordance with the Ten Steps to Successful Breastfeeding adapted to NICUs. Of the 141 participating NICUs, 129 (91%) responded to the questionnaire: 38 NICUs from group 1 and 91 NICUs from group 2. Group 1 had implemented a higher number of breastfeeding support measures than group 2. There were significant differences in 18 measures related to steps 2, 4, 5, 7, and 8 of the Neo-BFHI. In addition, a comparison of NICUs in hospitals with full accreditation (7 of 129) with those in group 2 revealed significant differences in 7 measures pertaining to steps 2, 5, 8, and 9. The Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited have better implementation of practices to promote and support breastfeeding.

A neonatal intensive care unit (NICU) hospitalization can add significant stress to the postpartum period. Parents experience isolation and uncertainty, which can affect their capacity to bond with their new baby. Understanding how stress is shaped by and changes following a NICU experience will help in developing supports for these families. We examined patterns of parenting stress over the first year of life following a NICU stay to better understand changes in stress, differences in maternal and paternal stress, and how medical and developmental variables impact parent stress. Parents of infants (n = 51) who had experienced a NICU hospitalization and met criteria for California's High-Risk Infant Follow-Up program completed assessments at 6, 9, and 12 months. A comparison group (n = 38) from a historic dataset included parents of infants born full term without medical complications. NICU parents reported higher levels of parenting stress at 6 months, but not 12 months, with mothers and fathers reporting similar stress levels. Parenting-related stress was found to be relatively stable and consistent over this period. Among NICU parents, lower developmental level at 12 months was associated with more distress in interacting with their child. These findings highlight the importance of monitoring parenting stress following discharge from the NICU and developing interventions for supporting parents of NICU graduates showing developmental delays.

Parents of infants in the neonatal intensive care unit (NICU) are at increased risk of developing perinatal post-traumatic stress disorder (PPTSD), a mental health condition known to interfere with healthy parental and infant attachment. Feelings of uncertainty about illness have been theorized as an antecedent to post-traumatic stress, however the relationship has not been explored in parents of infants requiring care in the NICU. The purpose of this prospective study was to explore parental uncertainty during and after NICU discharge and the relationship between uncertainty and PPTSD. The sample consisted of 319 parents during NICU hospitalization and 245 parents at 3 months postdischarge. Parents who screened positive for PPTSD 3 months after hospital discharge reported more uncertainty both while in the NICU and 3 months after hospital discharge (p < 0.001). In parents with a personal or family history of mental illness, the moderated/mediating structural probit analysis showed no direct or indirect effect of uncertainty during hospitalization or at 3 months after hospital discharge on screening positive for PPTSD. In parents who did not report personal or family history of mental illness, uncertainty at 3 months after hospital discharge had a direct effect (b = 0.678, p < 0.001) and indirect mediating effect (b = 0.276, p < 0.001) on screening positive for PPTSD. The results provide actionable implications for mental health and NICU providers: (1) routine screening for uncertainty and risk factors including previous personal and family history of mental illness, and (2) the development of NICU follow-up support services to mitigate risk for PPTSD.

Assess postpartum care attendance among parents of infants in a large, urban, children's hospital level IV NICU with an on-site delivery unit. 86 postpartum parents of infants continuously hospitalized ≥six weeks and <one year postpartum in a level IV NICU between 4/24/23 and 2/16/24 completed surveys. We compared postpartum visit attendance by six weeks between parents of infants transferred into the NICU to parents of infants born in the hospital's delivery unit (inborn). 26 (30%) did not attend a postpartum visit by six weeks, significantly more common among parents of transferred (41%) than parents of (10%) inborn infants (aRR 4.5, 95% CI: 1.3-15.6). Health concerns were common in both groups. Parents of transferred infants had a higher risk of not attending a postpartum visit by six weeks compared to parents of inborn infants, highlighting the need for children's hospitals to measure and address postpartum healthcare gaps.

Many infants (7-15%) spend time in a Neonatal Intensive Care Unit (NICU) and continue to experience ongoing medical issues and neurodevelopmental impairments after discharge. Parents of medically complex children report higher levels of psychological distress (e.g., depression, PTSD), exhibit more intrusive parenting styles, and report greater family burden compared to parents of healthy children. Additionally, greater family burden is associated with lower child developmental quotient. NICU infants impact the relationship and cooperation between parents, which has implications for children's' social-emotional development. Current literature highlights that infant medical issues and parental psychosocial functioning influence infant development. However, the direct and indirect relationships among relevant infant and family biopsychosocial variables remain unclear, particularly among infants with a variety of complex medical conditions within the first two years following NICU hospitalization. The current study assessed hypothesized relationships among infant medical risk, parental psychological distress, parenting style, couple functioning, parenting alliance, family burden, and access to resources, and assess whether and to what extent they contribute to infant cognitive and socio-emotional development. Eligible participants included parents of singleton infants who are 1.5 - 2.5 years old (adjusted gestational age) and seen at The Children's Hospital of Philadelphia (CHOP) Neonatal Follow-Up Program (NFUP) at Buerger. Participants were at least 18 years old, speak and read English, and were in an intimate relationship with their partner at the time of the child's NICU admission and cohabitating with partner and child since discharge. Eligible parents were contacted by phone to inquire about interest. Interested parents arrived at CHOP NFUP at Buerger 30 minutes prior to their infant's appointment to provide informed consent and complete self-report measures. Infant medical risk, cognitive development, and socio-emotional development were gleaned from medical records and developmental assessments from the medical chart. Structural equation comparative models were tested to best capture the data, as informed by current literature. Findings revealed that increased infant medical severity at discharge was directly associated with greater family impact and infant social-cognitive development two years later. Greater family resources had a direct effect with less family impact, less parental trauma, better couple functioning, better parenting alliance, and better infant social-cognitive development. More parental trauma was associated with more negative parenting styles and poorer couple functioning, which in turn, negatively impacted parenting alliance and then positive parenting styles. Together, findings provide greater insight into how family factors, including availability of basic needs, money, and time, directly impact parental mental health, parent-child interactions, and child development. This work suggests that medical providers, clinicians, and researchers should consider targeting parental trauma and access to resources, including time, to optimize family and infant outcomes.

Çekin B, Turan T. The stress levels of parents of premature infants and related factors in Nenoatal Intensive Care Units. Turk J Pediatr 2018; 60: 117-125. The aim of this study is to determine the stress levels of parents whose premature baby are hospitalized in the neonatal intensive care unit (NICU) and to determine the factors affecting their stress. The study sample included 101 parents of premature babies in the NICU of a university hospital. Interviews were conducted with the parents. Additionally, the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) was administered. When the stress levels of parents in the NICU were analyzed, it was found that their scores on the infant`s appearance and behaviors subscale of the PSS:NICU reflected the highest rate of stress. The mean score on the parental role alterations subscale was higher among mothers than fathers (p < 0.05). Additionally, high stress levels were found among parents who had children other than their baby in the NICU, parents whose baby had a young gestation age and a low birthweight, parents whose baby was on a respiration device, and parents who had experienced a stressful event in the past year. The stress levels of parents whose premature baby was hospitalized in the NICU were also high. The family-centred approach is recommended to identify and meet all the needs of all such parents.

Human milk from the biologic mother (HM) reduces disease burden and associated costs of care during and after neonatal intensive care unit (NICU) hospitalization for very low birth weight (VLBW; birth weight < 1500 g) infants, when compared to feedings of donor human milk (DHM) or commercial formula (CF). However, compared to DHM and CF, little is known about the institutional cost to acquire HM from the biologic mother. This study aimed to determine the institutional cost of acquiring HM for VLBW infant feedings during the NICU hospitalization. This analysis examined 157 maternal pumping records from a prospective cohort study evaluating health outcomes and cost of HM feedings for VLBW infants. The costs for the breast pump rental fee, 1-time pump kit purchase, and disposable food-grade containers for storing expressed HM were evaluated using standard cost analysis techniques. The median cost of acquiring 100 mL of HM varied from $0.51 when mothers pumped ≥ 700 mL daily to $7.93 for those who pumped < 100 mL daily. Mothers who pumped ≥ 100 mL daily had lower acquisition cost compared to both DHM ($14.84/100 mL) and CF ($3.18/100 mL). For mothers who pumped > 100 mL daily, the exact day of pumping where the cost of HM was less expensive than DHM or CF was 4 to 7 days and 6 to 19 days, respectively. Human milk from the biologic mother has lower acquisition cost than DHM and CF when mothers provided ≥ 100 mL daily and pumped for a sufficient number of days (range, 4-19). Neonatal intensive care units should prioritize resources to ensure that mothers achieve this daily milk volume.

This study was planned for the purpose of determining the effect of stress-reducing nursing interventions on the stress levels of mothers and fathers of premature infants in a Neonatal Intensive Care Unit (NICU). Randomised intervention. The physical and psychosocial environment of the NICU is a major factor in the stress experienced by the family. Interviews were conducted with the parents of premature infants who agreed to participate in the research. An approximately 30-minute educational programme about their infant and the intensive care unit was held for the mothers and fathers in the intervention group within the first week after their infant was admitted to the intensive care unit. Then they were introduced to the unit and personnel. They were given the information they requested and their questions were responded to. The parents in the control group received nothing in addition to the routine unit procedures. The mothers and fathers' stress scores were measured for both groups after their infants' 10th day in the NICU with the Parental Stress Scale: NICU (PSS:NICU). The difference between the intervention group and the control group mothers' mean stress score was found to be statistically significant (t = 4.05, p < 0.05). It was determined that the stress scores for the fathers in the treatment group in this research were lower, but the difference between the two groups was not found to be statistically significant (p > 0.05). It has been determined that parents experience very high stress levels when their infants are admitted to an NICU and that there are nursing interventions which can be implemented to decrease their levels of stress. Determining the sources of stress experienced by parents can help NICU nurses use appropriate interventions in cooperation with other members of the team to decrease the stress that parents experience.

Identifying Depression in Neonatal Intensive Care Unit Parents: Then What?

Having an infant in the Neonatal Intensive Care Unit (NICU) can disrupt parent well-being, the transition to parenthood, and the typical trajectories of infant and child health. For lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority identity (LGBTQ+) parents, this stress may be compounded by health disparities and fear of stigma and discrimination; however, research is lacking about LGBTQ+ parents of infants in the NICU. The purpose of this integrative review was to better understand the experiences of LGBTQ+ parents of NICU infants, with a focus on experiences of stigma and discrimination, sources of strength and resilience, and provision of family-centered care. We searched EBSCOHost, ProQuest, Web of Science, and Google Scholar between 30 May 2023 and 18 September 2023 for empirical studies published in English in peer-reviewed scholarly journals in which LGBTQ+ parents shared their experiences with having infants admitted to the NICU. We identified six articles that met inclusion criteria, all of which were qualitative studies that included 12-14 LGBTQ+ parents of NICU infants. LGBTQ+ parents in all studies reported instances of perceived stigma and discrimination while their infants were in the NICU, whereas parents in two studies mentioned strength and resilience, and parents in three studies described elements of family-centered care. There is a need for rigorous research on family-centered NICU care that includes questions about sources of strength and resilience in addition to challenges. We propose that future researchers use community engaged methods to center perspectives of LGBTQ+ parents.

The objective of this study is to investigate the impact of early life experiences and gut microbiota on neurobehavioral development in preterm infants during neonatal intensive care unit (NICU) hospitalization. Preterm infants were followed from NICU admission until their 28th postnatal day or until discharge. Daily stool samples, painful/stressful experiences, feeding patterns, and other clinical and demographic data were collected. Gut microbiota was profiled using 16S rRNA sequencing, and operational taxonomic units (OTUs) were selected to predict the neurobehaviors. The neurobehavioral development was assessed by the Neonatal Neurobehavioral Scale (NNNS) at 36 to 38 weeks of post-menstrual age (PMA). Fifty-five infants who had NNNS measurements were included in the sparse log-contrast regression analysis. Preterm infants who experienced a high level of pain/stress during the NICU hospitalization had higher NNNS stress/abstinence scores. Eight operational taxonomic units (OTUs) were identified to be associated with NNNS subscales after controlling demographic and clinical features, feeding patterns, and painful/stressful experiences. These OTUs and taxa belonging to seven genera, i.e., Enterobacteriaceae_unclassified, Escherichia-Shigella, Incertae_Sedis, Veillonella, Enterococcus, Clostridium_sensu_stricto_1, and Streptococcus with five belonging to Firmicutes and two belonging to Proteobacteria phylum. The enriched abundance of Enterobacteriaceae_unclassified (OTU17) and Streptococcus (OTU28) were consistently associated with less optimal neurobehavioral outcomes. The other six OTUs were also associated with infant neurobehavioral responses depending on days at NICU stay. This study explored the dynamic impact of specific OTUs on neurobehavioral development in preterm infants after controlling for early life experiences, i.e., acute and chronic pain/stress and feeding in the NICU. The gut microbiota and acute pain/stressful experiences dynamically impact the neurobehavioral development in preterm infants during their NICU hospitalization.

Maternal mental health (MH) conditions represent a leading cause of preventable maternal death in the US. Neonatal Intensive Care Unit (NICU) hospitalization influences MH symptoms among postpartum women, but a paucity of research uses national samples to explore this relationship. Using national administrative data, we examined the rates of MH diagnoses of anxiety and/or depression among those with and without an infant admitted to a NICU between 2010 and 2018. Using generalized estimating equation models, we explored the relationship between NICU admission and MH diagnoses of anxiety and/or depression, secondarily examining the association of NICU length of stay and race/ethnicity with MH diagnoses of anxiety and/or depression post NICU admission. Women whose infants became hospitalized in the NICU for <2 weeks had 19% higher odds of maternal MH diagnoses (aOR: 1.19, 95% CI: 1.14%–1.24%) and those whose infants became hospitalized for >2 weeks had 37% higher odds of maternal MH diagnoses (aOR: 1.37 95% CI: 1.128%–1.47%) compared to those whose infants did not have a NICU hospitalization. In adjusted analyses, compared to white women, all other race/ethnicities had significantly lower odds of receiving a maternal MH condition diagnosis [Black (aOR = 0.76, 0.73–0.08), Hispanic (aOR = 0.69, 0.67–0.72), and Asian (aOR: 0.32, 0.30–0.34)], despite higher rates of NICU hospitalization. These findings suggest a need to target the NICU to improve maternal MH screening, services, and support while acknowledging the influence of social determinants, including race and ethnicity, on health outcomes.

The experience of hospitalization of a newborn in the Neonatal Intensive Care Unit (NICU) may become distressing both for the baby and parent. The study aimed to assess the degree of parental stress and coping strategies in parents giving KMC to their babies hospitalized in NICU compared to the control group parents not giving KMC. The prospective observational study enrolled a cohort of 337 parents of premature babies hospitalized in NICU in 2016 in Eastern Poland. The Parental Stressor Scale: Neonatal Intensive Care Unit, Coping Inventory for Stressful Situations were used. The level of stress in parents giving KMC was defined as low or moderate. Analysis confirmed its greater presence in the group of parents initiating KMC late (2–3 weeks) compared to those starting this initiative in week 1 of a child’s life. An additional predictor of a higher level of stress in parents initiating KMC “late” was the hospital environment of a premature baby. Task oriented coping was the most common coping strategy in the study group. KMC and direct skin-to-skin contact of the parent with the baby was associated with a higher level of parental stress only initially and decreased with time and KMC frequency.