Neonatal Intensive Care Unit Experience Research Articles

Recruiting bereaved parents for research after infant death in the neonatal intensive care unit

Understanding parental experiences following infant death in the neonatal intensive care unit (NICU) is a high research priority and a necessary first step to improving health services. However, recruiting bereaved parents to discuss their experiences on such an extremely sensitive topic can be challenging and research procedures must be planned carefully in order to get an adequate sample. There is little published in the literature detailing specific strategies for recruiting bereaved parents for grief research, especially strategies for contacting parents and identifying factors that might affect participation. The purpose of this paper is to describe the process of recruiting bereaved parents into a qualitative research study exploring parental NICU experiences and grief responses following infant death. We describe a successful recruitment plan that led to the enrollment of difficult to recruit participants such as fathers, and individuals representing minorities and those from lower socioeconomic (SES) groups. Bereaved parents of infants after an NICU hospitalization should continue to be recruited for research studies for their unique perspectives and valuable insights about the devastating experience of infant death. Participants in this study reported more benefits than harm and the results addressed a critical gap in the literature.

Management of Supplemental Oxygen for Infants with Persistent Pulmonary Hypertension of Newborn: A Survey.

Objective To evaluate practice variations amongst neonatologists regarding oxygen management in neonates with persistent pulmonary hypertension of newborn (PPHN). Study Design An online survey was administered to neonatologists to assess goal oxygenation targets and oxygen titration practices in PPHN. Response variations were assessed and intergroup comparisons performed. Results Thirty-three percent (492) of neonatologists completed the survey. Twenty-eight percent reported using specific oxygen titration guidelines. Majority of respondents used a combination of oxygen saturation (SpO2) and arterial oxygen tension (PaO2) initially to titrate oxygen. Seventy percent of the respondents used higher goal SpO2 > 95% or 95 to 98% and thirty-eight percent of the respondents used PaO2 > 80 mm Hg. Physicians with extracorporeal membrane oxygenation experience and those with greater than ten years neonatal intensive care unit experience inclined toward use of SpO2 alone for oxygen titration and aimed for lower range of SpO2 and PaO2 targets. Greater proportion of neonatologists who employed specific oxygen titration guidelines used lower SpO2 targets. Conclusion Wide practice variations exist amongst neonatologists regarding optimal SpO2 and PaO2 targets and oxygen titration practices in the management of PPHN.

Infant Medical Trauma in the Neonatal Intensive Care Unit (IMTN): A Proposed Concept for Science and Practice.

Trauma is an innately subjective experience ensuing from a deeply distressing event. Research has demonstrated that while the environment of the neonatal intensive care unit (NICU) is capable of providing extraordinary lifesaving measures following birth, the experience may be disruptive to several key aspects of early development, placing infants at risk for adverse behavioral, cognitive, and emotional outcomes. This article provides rationale for the concept of Infant Medical Trauma in the NICU (IMTN) as a means of describing this unique stress experience. A triad of cumulative early life NICU experiences (stress, parental separation, and pain) is proposed to influence an infant's swinging neurodevelopmental pendulum amid the potential outcomes of risk and resilience. Creating language that describes the infant experience brings meaning and calls caregivers and parents to action to consider strategies that may improve long-term health. Actively seeking opportunities to decrease the allostatic load of at-risk infants may support an infant's pendulum to swing toward a path of resilience, thereby moderating his or her early life adverse experience.

Lived Experience of Caregivers of Family-Centered Care in the Neonatal Intensive Care Unit: "Evocation of Being at Home".

BackgroundIn recent decades, family-centered care (FCC) has come to be known, accepted, and reported as the best care strategy for admitted children and their families. However, in spite of the increasing application of this approach, the experiences of the caregivers have not yet been studied.ObjectivesThe present study aimed at the description and interpretation of the FCC experience in two neonatal intensive care units (NICU) at Shiraz University of Medical Sciences.MethodsThis study was conducted through the hermeneutic phenomenological approach. Semi-structured interviews were conducted with 17 professional and familial caregivers, and their interactions were observed in three work shifts. The interviews were audiotaped and transcribed verbatim. After observations, field notes were also written. Finally, the data were analyzed through van Manen’s methodology.ResultsOne of the essential themes that emerged in this study was the “evocation of being at home” among familial and even professional caregivers. This theme had three subthemes: i.e., “meta-family interaction,” “comprehensive support,” and “reconstruction of a normal family.” Accordingly, FCC eliminated borders between professional and non-professional caregivers and built close relationships among them in the NICU. It also provided for the needs of neonates, their families, and even professional caregivers through perceived and received support.ConclusionsParents of the neonates admitted to the NICU experience hard moments. They not only play the role of primary caregivers, but they also receive the care. Focusing on the different meanings of this care from the caregivers’ points of view and having managers provide certain requirements can guarantee the establishment of comprehensive care for clients and proper support for the staff in this unit.

Differences and similarities between mothers and fathers of premature children: a qualitative study of parents' coping experiences in a neonatal intensive care unit.

BackgroundThe aim of this study was to explore and describe the coping experiences of parents to children admitted to a neonatal unit.MethodsA qualitative research approach was chosen, using in-depth interviews with eight fathers and eight mothers.ResultsThe main findings were that parents with previous complicated births had more difficulties in coping compared to those parents with no experience with complications. Coping seemed easier where parents’ opinions were heard regarding their baby’s care and when both parents were present in the neonatal intensive care unit (NICU). The main similarities between mothers and fathers were the reluctance to speak their opinions on childcare, and both experienced a sense of alienation and problems in bonding with the baby. They also needed a limitation on the number of visitors in the NICU. Differences between mothers and fathers were that fathers tried hard to be the strong partner in the relationship, and were more concerned with the mother if she was seriously ill postpartum, while mothers were more concerned for their baby. Mothers’ postpartum period was felt as more stressful if the father was not present, but mothers were also better at welcoming support from the health personnel.ConclusionThis study highlights the parent’s coping experiences in NICUs. Coping seemed easier where parents’ opinions were heard. Nurses in the NICU should take the former experiences of the parents into consideration when nursing in the NICU and planning for discharge.

Impact of hands-on care on infant sleep in the neonatal intensive care unit.

Sleep disruption is increasingly recognized in hospitalized patients. Impaired sleep is associated with measureable alterations in neurodevelopment. The neonatal intensive care unit (NICU) environment has the potential to affect sleep quality and quantity. We aimed: (i) to determine the frequency and duration of hands-on care, and its impact on sleep, for NICU patients; and (ii) to assess the incidence of respiratory events associated with handling for a cohort of sick neonates. Term and near-term neonates admitted to the NICU and at risk for cerebral dysfunction due to severity of illness or clinical suspicion for seizures underwent attended, bedside polysomnography. Continuous polysomnogram segments were analyzed and data on handling, infant behavioral state, and associated respiratory events were recorded. Video and polysomnography data were evaluated for 25 infants (gestational age 39.4 ± 1.6 weeks). The maximum duration between handling episodes for each infant was 50.9 ± 26.2 min, with a median of 2.3 min between contacts. Handling occurred across all behavioral states (active sleep 29.5%; quiet sleep 23.1%; awake 29.9%; indeterminate 17.4%; P = 0.99). Arousals or awakenings occurred in 57% of contacts with a sleeping infant. Hypopnea, apnea, and oxygen desaturation occurred with 16%, 8%, and 19.5% of contacts, respectively. Hypopnea was most likely to occur following contact with infants in active sleep (28%; P < 0.001). Infants in the NICU experience frequent hands-on care, associated with disturbances of sleep and respiration. The potential health and developmental impact of these disturbances merits study, as strategies to monitor sleep and minimize sleep-disordered breathing might then improve NICU outcomes. Pediatr Pulmonol. 2017;52:84-90 © 2016 Wiley Periodicals, Inc.

Special Issue

Every once in a while, a cluster of manuscripts arrive that create a naturally occurring Special Issue. This was the case for this issue. We have six articles addressing parental and neonatal concerns. This issue has articles covering gestational diabetes, neonatal intensive care unit (NICU) experiences experiences, newborn resuscitation, and parent’s experiences when a baby stops breathing. This mix of manuscripts came from five different countries: China, Iran, Sweden, United States of America, and Jordon. Methodologies include both quantitative and qualitative but each article either addresses Mothers, Fathers, Infants, or Children. The first article addressing developmental care provided by NICU nurses in China (Zhang, Lee, Chen, & Liu, 2016) highlights that not only nurse factors influence the nurses’ ability to provide important developmental care in the NICU but staffing and hospital system factors also play a role. In the article by Segre, Orengo-Aguayo, and Siewert (2016), this team investigated the attitudes of mothers of newborns in the NICU toward being screened for depression and receiving counseling by nurses. This team was particularly interested in whether mothers would be willing to receive a nurse-delivered intervention to address depression in mothers of infants in the NICU. These important studies address important clinical and system issues in the NICU setting. Women experiencing gestational diabetes are at risk for increased worry and anxiety. The article from Iran Bastani (2016) tested a complementary and alternative approach to treating anxiety in women with gestational diabetes,

Does she think she’s supported? Maternal perceptions of their experiences in the neonatal intensive care unit

Parents’ involvement in the care of their infants in the neonatal intensive care unit (NICU) is critically important, leading many NICUs to implement policies and practices of family-centered care (FCC). Analyzing narrative interviews, we examined whether mothers of premature infants who participated in an intervention to help reduce anxiety, stress, and depression felt that their NICU experience reflected four key nursing behaviors previously identified as being necessary to achieving FCC. Fifty-six narratives derived from semi-structured interviews with the mothers were analyzed qualitatively and quantitatively to examine whether the women experienced emotional support, parent empowerment, welcoming environment, and parent education, as well as whether differences in reported experiences were related to sociodemographic factors or maternal coping styles. Overall, the mothers reported more negative than positive experiences with respect to the four behaviors, and those who had negative interactions with the hospital staff felt a sense of disenfranchisement and failure as mothers. Sociodemographic factors and coping styles were significantly associated with the mothers’ perceptions of their experiences, although these relationships were not consistent. Achieving actual FCC in the NICU may require parent-informed evidence-based changes in NICU personnel training and infrastructure.

A Qualitative Study: NICU Nurses as NICU Parents.

The neonatal intensive care unit (NICU) nurse who has become a NICU mother is in a unique position to evaluate the NICU experience. Because of her professional experience, she has an understanding of the NICU and healthcare environment. This study examines the lived experiences of these women, how they coped with their roles as professionals and parents, and how their responses differed from those of NICU mothers without professional NICU experience. A narrative qualitative design was utilized to examine the lived experiences of study participants. Face-to-face taped interviews were conducted. Responses were transcribed, then analyzed using both computer-assisted data analysis and manual analysis. Six nurses participated. Their responses were grouped into 6 categories on the basis of previous research. These participants experienced many of the same issues as NICU mothers without professional experience. However, there were meaningful differences. NICU nurses were vocal advocates from the first day of admission. They were also knowledgeable about how to negotiate and work around the system. NICU nurses who have had the experience of having an infant in the NICU have seen the healthcare system from both sides and can be advocates for family-centered care, helping their coworkers understand what works and what does not work for NICU families. Qualitative research focused on the experiences of healthcare team members who utilize the healthcare system as patients or family members can provide an articulate and educated insight into the experiences of all who use the healthcare system.

Care of the Family of an Infant With a Congenital Heart Defect During the NICU Hospitalization.

The family of an infant born with a congenital heart defect is challenged by both the short- and long-term implications of the diagnosis and the neonatal intensive care unit (NICU) hospitalization. Nurses are in a key position to support these families as they deal with the psychological, emotional, and financial impact of the NICU experience. Understanding how families perceive the NICU environment and their grief in losing the desired healthy baby provides the NICU nurse with the knowledge to engage in self-reflection on her or his interpersonal style and caregiving attitudes. Utilizing the concepts and principles of family-centered care and relationship-based practice, nurses can work together with the families to determine how to best meet the families' needs and to find the resources to support them. Families and colleagues appreciate nurses who demonstrate expertise in this approach to family-centered care. This appreciation leads to greater job satisfaction and decreased job-related stress.

Psychological distress in mothers of infants admitted in neonatal intensive care unit (NICU)

Introduction: Mothers whose infants are admitted to NICU undergo significant distress which can interfere with mother infant bonding. Materials & Methods: Mothers belonging to two groups: Group 1 –(clinical) 30 mothers of infants admitted in NICU of IGICH. Group 2-(control) 30 mothers of normal infants from Jayanagar General Hospital (JGH) were included. Period Of Study: July 14 to Dec 14. All mothers cooperative for interview, mothers from intact families were included. Mothers of infants having major illness were excluded. Results: Qualitative analysis of clinical sample indicates 90% mothers in “extremely stressful” severity rating and 10% “very stressful” rating. Urban families experience more stress (p=0.012). Previous NICU experience showed higher stress levels as compared to no previous experience (p=0.052). Coping styles like praying to god about infant well being(100%), reading books(26%), always thinking about baby(100%), expressing emotions to husband and families (85%), blaming themselves(56%) and others like in laws(10%), meditating(12%), keeping feelings and emotions to themselves (43%), sitting and crying(10%). Control group used praying and talking to themselves (43%), sitting and crying (10%). Control group used praying and talking to family and coped better. Statistically significant difference indicating higher distress in mothers of clinical group.100% felt bad, lonely, hurt and sad, 50% felt hopeless about future and 25% expressed anger mostly directed towards their mother/husband. 70% mothers in clinical group were not allowed to breastfeed thus causing emotional distress to the mother. Conclusion: Mothers are at immense stress when separated from their infants hence measures to reduce the same must be considered.

Religious and Spiritual Journeys: Brief Reflections from Mothers and Fathers in a Neonatal Intensive Care Unit (NICU).

The birth of a child is often accompanied by elation and celebration, but when a birth results in admittance to the Neonatal Intensive Care Unit (NICU), the typical emotions of joy and celebration may be tempered with anxiety and fear. Parents with a religious and spiritual worldview may find their faith and spiritual lens is an important aspect of coping with their NICU experience. There is a dearth of literature on this issue, and thus a pilot study was implemented that included eight mothers and fathers of babies admitted to the NICU. Parents responded to a brief interview 4 to 6 weeks after discharge that focused on how their religious or spiritual worldview changed as a result of their NICU experience, how they coped with their premature newborn after discharge, and the perceived impact on their spousal/partner relation-ship. Results indicated that parents who presented to the NICU with a religious or spiritual background indicated their faith grew as a result of their experience in the NICU. Parents without a religious or spiritual worldview also reported being able to adequately manage their NICU experience and reported little to no change in their religious or spiritual lives. Further, parents reported they coped well after their babies' discharge from the NICU and had supportive spousal relationships. This pilot study supported assessment of religious and spiritual experiences as a salient aspect in NICU parents' lives. Further study is necessary to elucidate how religiosity and spirituality can be strengthened for families during this challenging time.

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

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. 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 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. 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). 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.

Guilt, shame and fear of death predict neonatal intensive care unit-related parental distress

Objective: To explore the relationship between parents’ personality proneness to negative self-conscious emotions (guilt, shame and fear of death) and the stressfulness associated with their newborn’s hospitalisation in a neonatal intensive care unit (NICU). Background: Parents commonly blame themselves for their newborn’s hospitalisation and this self-blame may be characterological (shame-based) and/or behavioural (guilt-based) in type. The NICU experience may threaten parents’ cultural worldviews and self-worth, thereby making it mortality-salient. Method: Self-report questionnaires were used to measure NICU-related parental distress, guilt, shame and fear of death in 88 mother–father dyads. The Actor–Partner Interdependence Model method of dyadic analysis was used to measure actor (intrapersonal) and partner (interpersonal) self-conscious emotion effects with parental distress. A mediation analysis was performed to determine if fear of death mediated the relationship of guilt and shame with parental distress. Results: Shame and fear of death had significant actor effects with mothers’ and fathers’ distress, whereas chronic guilt had a significant actor effect with mothers’ distress. None of the partner effects was statistically significant. Overall, these self-conscious emotion predispositions explained 21% of the variance in mothers’ distress and 28% of the variance in fathers’ distress. Fear of death partially mediated the relationship of chronic guilt and shame with parental distress. Conclusion: Personality proneness to chronic guilt, shame and especially fear of death predicted NICU-related parental distress. These self-conscious emotions are aversive and parents may be reluctant to disclose them, yet emotional disclosure may benefit parents’ short- and long-term physical and psychological health.

The lived experience of fathers of preterm infants in the Neonatal Intensive Care Unit: a systematic review of qualitative studies.

To systematically review the experience of fathers of preterm infants hospitalised in the Neonatal Intensive Care Unit. Family-centred care is more and more acknowledged in Neonatal Intensive Care Units, advocating for active engagement of both parents in the care journey. Nonetheless, fathers' Neonatal Intensive Care Unit experience has received limited research attention. Systematic review of qualitative studies. Four electronic databases (CINHAL, ISI Web of Science, PubMed, Scopus) were explored and studies published between 2000-2014 were included. Preferred Reporting Item for Systematic Reviews and Meta-analysis (PRISMA) and Joanna Briggs Institute (JBI) Critical Appraisal Tool for Qualitative Studies guidelines were adopted. Key themes were extracted and synthesised. Five main themes resuming fathers' experience of preterm birth and Neonatal Intensive Care Unit stay were identified from 14 studies. Themes were: emotional roller-coaster, paternal needs, coping strategies, self-representation and caregiving engagement. These dimensions were found to be dynamically shaped across three critical turning points: preterm birth, Neonatal Intensive Care Unit stay and at home. Neonatal Intensive Care Unit fathers of preterm infants experience ambivalence, a set of different needs and coping strategies. They modify their self-representations along the Neonatal Intensive Care Unit journey and needs specific nursing support and intervention to sustain caregiving engagement and transition to parenthood. A systematic and deepened understanding of preterms' fathers lived experience in Neonatal Intensive Care Unit would be helpful to inform nursing practice. Specific action priorities are suggested within the frame of family-centred care.

Posttraumatic growth in mothers after infant admission to neonatal intensive care unit

Hospitalization in neonatal intensive care units (NICUs) is stressful and traumatic for mothers (1), even in the absence of clinical or pathological concerns (2). Several studies involving mothers of infants hospitalized in NICU identifi ed diff erent sources of parental stress, defi ned as the physical and psychological aspects of a situation that impose demands on individuals (1, 3, 4). High stress is an important risk factor for poor parent-infant relationships during early childhood and has long-term negative outcomes (5). Research indicates that parents whose infants have been admitted to NICU experience emotional reactions such as guilt, depression, fear, anxiety, acute stress disorder, etc. (6-9).

Development of Program Standards for Psychosocial Support of Parents of Infants Admitted to a Neonatal Intensive Care Unit: A National Interdisciplinary Consensus Model

Parents of infants admitted to a neonatal intensive care unit (NICU) experience stress and psychological distress. They need psychosocial support. While survival of even micropreemies has dramatically improved in the last decade, few best practices have developed for parental support. This article will describe an interdisciplinary team approach to achieving consensus around best practices and recommendations for psychosocial parental support programs designed to meet the needs of parents during their journey from the perinatal/intrapartum period, through the NICU stay, and home to primary care settings.

The Parents' Perception of Nursing Support in their Neonatal Intensive Care Unit (NICU) Experience

NICU is an environment that has many challenges in information receiving and understanding. The infants that are cared for might have serious and complex medical problems. For Parents the NICU experience is filled with stress, fear, sadness, guilt and shock of having a sick baby in NICU. The aim of this research was to explore and describe parents' experience when their infant is admitted to the NICU. And assess their perception of nursing support of information provision and according to their emotional feelings. This study was undertaken at Neonatal Intensive Care Unit in King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia which is part of National Guard Health Affairs (NGHA) organization in the kingdom. The study utilized a self-report questionnaire with likert scale measurement and telephone interview with closed questions. One hundred and four parents agree to be the part of study and provided their consent to include their children in the study. The majority of respondents were mothers (76%), the remaining (24%) from the total sample were Fathers. All their infants have been admitted to the NICU at 2014. Many parents did not able to receive enough information easily from the unit; most of them found the information by nurses was difficult to understand. The majority of parent's perceived high stress and anxiety level according to this information. Also, Most Parents was not agreed about the nurses' support towards their emotional feeling and care. Additional finding indicate that a decrease in support level being associated with an increase in stress and anxiety level. In order to provide a high level of support and decrease the level of stress, there is a need for developing support strategies. One strategy is through a technology to develop an automatic daily summary for parent.

Operating Room Within the Neonatal Intensive Care Unit—Experience of a Medical Center in Taiwan

Most neonates who reside in the neonatal intensive care unit (NICU) and require surgery are transferred to the operating room (OR) or undergo bedside surgery. However, critically ill neonates who are transferred often encounter the risk of complications. An OR in our NICU was therefore launched in 2009. This study was to appraise the surgeries performed in the NICU OR and compare results with the traditional main OR outside the NICU. This was a retrospective study in the NICU of a tertiary center. Retrospective chart review was conducted for all neonates who underwent surgical procedures in the NICU OR and the main OR. The information regarding baseline characteristics, surgical procedures and duration, ventilator use, hypothermia, hyperglycemia, instrument dislocations, surgically related infection or complications, and outcomes was obtained. There were a total of 65 patients in this study, 37 in the NCIU OR group and 28 in the main OR group. The presurgical mean airway pressure and the fraction of inspired oxygen (FiO2) were comparable between the two groups, but the postsurgical FiO2 was significantly lower in the NICU OR group (31.0%) than in the main OR group (40.9%; p = 0.027). Furthermore, the NICU OR group required a significantly shorter preoperation waiting time (34.4 minutes vs. 63.6 minutes, p = 0.001) and had a lower incidence of hypothermia than the main OR group (8.1% vs. 39.3%, p = 0.008). However, surgically related complications were similar between groups. The OR within the NICU may reduce the risk of complications during transportation and provide continuity of care to critically ill neonates. It also decreases the disturbance to other NICU patients during operation.

Variation between residents and attending staff interpreting radiographs to verify placement of nutrition access devices in the neonatal intensive care unit.

Although radiography is considered the standard for confirming the position of nutrition access devices, it is sometimes difficult to visualize their tips. The purpose of this study was to evaluate how well pediatric residents could confirm placement via radiography of feeding tubes and intravenous (IV) nutrition catheter support in a neonatal intensive care unit (NICU). Seventy radiographs in a NICU during May 2013 were retrospectively evaluated. Eight pediatric residents (mean NICU experience, 5 months; range, 0-12 months) recorded the location of feeding tubes and IV nutrition catheters and marked their tips on computerized radiographs. Consensus review of radiographs by a radiologist and a NICU expert using a picture archiving communication system monitor in a reading room served as the reference standard. Detection rates and correct tip localization percentages were evaluated. Of the 70 neonates, 38 had nutrition access devices: orogastric tube (n = 36), oroduodenal tube (n = 4), or central venous catheter (CVC) (n = 8). Detection rates were 89.6% for orogastric tubes (range, 75.0%-100%), 90.6% for oroduodenal tubes (range, 50.0%-100%), and 46.9% for CVCs (range, 12.5%-75.0%). Percentage of correct tip localizations was 85.7% for orogastric tubes (range, 74.1%-100%), 86.2% for oroduodenal tubes (range, 25.0%-100%), and 70% for CVCs (range, 50.0%-100%). It is not easy for pediatrician residents to confirm the position of nutrition access devices in neonates by using radiographs. Reinforcement of radiology teaching, second opinions from radiologists or NICU experts, and other methods for verifying the positions of nutrition access devices are needed to minimize complications.