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Malouf R, Harrison S, Pilkington V, Opondo C, Gale C, Stein A, Franck LS, Alderdice F. Factors associated with posttraumatic stress and anxiety among the parents of babies admitted to neonatal care: a systematic review. BMC Pregnancy Childbirth 2024; 24:352. [PMID: 38724899 PMCID: PMC11084127 DOI: 10.1186/s12884-024-06383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Posttraumatic stress (PTS) and anxiety are common mental health problems among parents of babies admitted to a neonatal unit (NNU). This review aimed to identify sociodemographic, pregnancy and birth, and psychological factors associated with PTS and anxiety in this population. METHOD Studies published up to December 2022 were retrieved by searching Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health electronic databases. The modified Newcastle-Ottawa Scale for cohort and cross-sectional studies was used to assess the methodological quality of included studies. This review was pre-registered in PROSPERO (CRD42021270526). RESULTS Forty-nine studies involving 8,447 parents were included; 18 studies examined factors for PTS, 24 for anxiety and 7 for both. Only one study of anxiety factors was deemed to be of good quality. Studies generally included a small sample size and were methodologically heterogeneous. Pooling of data was not feasible. Previous history of mental health problems (four studies) and parental perception of more severe infant illness (five studies) were associated with increased risk of PTS, and had the strongest evidence. Shorter gestational age (≤ 33 weeks) was associated with an increased risk of anxiety (three studies) and very low birth weight (< 1000g) was associated with an increased risk of both PTS and anxiety (one study). Stress related to the NNU environment was associated with both PTS (one study) and anxiety (two studies), and limited data suggested that early engagement in infant's care (one study), efficient parent-staff communication (one study), adequate social support (two studies) and positive coping mechanisms (one study) may be protective factors for both PTS and anxiety. Perinatal anxiety, depression and PTS were all highly comorbid conditions (as with the general population) and the existence of one mental health condition was a risk factor for others. CONCLUSION Heterogeneity limits the interpretation of findings. Until clearer evidence is available on which parents are most at risk, good communication with parents and universal screening of PTS and anxiety for all parents whose babies are admitted to NNU is needed to identify those parents who may benefit most from mental health interventions.
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Affiliation(s)
- Reem Malouf
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care National Perinatal Epidemiology Unit Nuffield Department of Population Health, University of Oxford Old Road Campus Headington, Oxford, OX3 7LF, UK
| | - Sian Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care National Perinatal Epidemiology Unit Nuffield Department of Population Health, University of Oxford Old Road Campus Headington, Oxford, OX3 7LF, UK
| | - Victoria Pilkington
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care National Perinatal Epidemiology Unit Nuffield Department of Population Health, University of Oxford Old Road Campus Headington, Oxford, OX3 7LF, UK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Gale
- School of Public Health, Faculty of Medicine, Neonatal Medicine, Imperial College London, Chelsea and Westminster Campus, 369 Fulham Road, London, SW10 9NH, UK
| | - Alan Stein
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Honorary Professor, African Health Research Institute, Johannesburg, KwaZulu Natal, South Africa
- African Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care National Perinatal Epidemiology Unit Nuffield Department of Population Health, University of Oxford Old Road Campus Headington, Oxford, OX3 7LF, UK.
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK.
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Torbert N, Taladay C, Kauer T, Hackenburg L, Weaver MS, Kellas JK. Providing "Compassionate Care" in the Neonatal Intensive Care Unit Through Infant and Family Needs-Based Care. Am J Perinatol 2024; 41:e863-e869. [PMID: 36451625 DOI: 10.1055/s-0042-1758725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Provision of compassionate care to infants and their families in the neonatal intensive care unit (NICU) is a key component of competent critical care. Although recognized as an essential aspect of NICU care, compassionate care for infants and families in a NICU setting has been underexplored. This study defined and described compassionate care according to NICU staff. STUDY DESIGN Voice-recorded, face-to-face individual interviews occurred with NICU nurses (n = 45), NICU nurse practitioners (n = 15), and neonatologists (n = 9) from two NICUs in the midwestern United States. Semantic content analysis was used. Consolidated criteria for Reporting Qualitative research guidelines were followed. RESULTS Three dynamic and interactive qualitative themes emerged: excellent standard of intensive care, commitment, and engaged family communication. A conceptual framework entitled patient and family needs-based care was developed from the qualitative interviews. CONCLUSION The framework developed from this study supports the therapeutic journey of NICU infants and families by integrating a focus on compassionate personalized care within the context of keen clinical and communication skillsets that staff have gained throughout their NICU careers. KEY POINTS · While clinical competence is emphasized as a practice standard, compassion remains a core care value.. · A working definition of compassionate care and the description of its defining pillars has been underexplored.. · This study describes the perspectives of NICU staff on the actionable components of compassionate care for ill infant and their families..
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Affiliation(s)
- Nicholas Torbert
- Division of Neonatology, Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital Medical Center, Omaha, Nebraska
| | - Cassidy Taladay
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Trevor Kauer
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Lucas Hackenburg
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Meaghann S Weaver
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Nebraska Medical Center and Children's Hospital Medical Center, Omaha, Nebraska
| | - Jody Koenig Kellas
- Department of Communication Studies, University of Nebraska-Lincoln, Lincoln, Nebraska
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Barnes J, Vance AJ. Perspectives on Parenting in the NICU: Advocacy, Support, and Partnership. Adv Neonatal Care 2024; 24:1-3. [PMID: 38271290 DOI: 10.1097/anc.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Jessica Barnes
- Trauma Informed Professional Grady Memorial Hospital, Atlanta, Georgia
| | - Ashlee J Vance
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
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Gopalan P, Spada ML, Shenai N, Kratzer I, Nichols N, Kucherer S, Chou S, Hovis E, Beck S, Glance J. An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:35-43. [PMID: 38694157 PMCID: PMC11058915 DOI: 10.1176/appi.focus.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.
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Affiliation(s)
- Priya Gopalan
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Meredith L Spada
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Isabella Kratzer
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Nona Nichols
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Shelly Kucherer
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Shinnyi Chou
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Elizabeth Hovis
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Stacy Beck
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
| | - Jody Glance
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital (Gopalan, Spada, Kratzer, Kucherer, Chou, Glance); Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio (Nichols); Department of Obstetrics, Gynecology, and Reproductive Services, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh (Beck); Department of Psychiatry, University of Wisconsin-Madison (Shenai); Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee (Hovis)
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Malin KJ, Kruschel K, Gondwe K, Lagatta J, Carter CS, Nazarloo HP, Conley Y, White-Traut R. Feasibility of Stress Research in Premature Infant-Maternal Dyads During and After Neonatal Intensive Care Unit Hospitalization. Adv Neonatal Care 2023; 23:583-595. [PMID: 37948632 PMCID: PMC10786239 DOI: 10.1097/anc.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Stress from preterm infant admission to the neonatal intensive care unit (NICU) is associated with infant and maternal physiologic changes, including endocrine and epigenetic alterations. Little is known about the mechanisms connecting NICU stress to biologic changes, and whether preterm infant and maternal stress are reciprocal. As a preliminary step, feasibility and acceptability of measuring indicators of stress are required. PURPOSE This study evaluated the feasibility and acceptability of research examining perceptions and biologic markers of stress in premature infant-maternal dyads during and after NICU hospitalization. METHODS We evaluated study feasibility using a longitudinal descriptive design. Acceptability was measured via a maternal questionnaire. Exploratory data regarding hospitalization, perceptions of stress, social support and social determinants of health, and biologic markers of stress were collected during the first week of life and again 3 months after NICU. RESULTS Forty-eight mothers were eligible for the study, 36 mothers were approached, 20 mothers consented to participate, and 14 mothers completed data collection. Mothers reported high levels of study acceptability despite also voicing concern about the sharing of genetic data. Exploration of DNA methylation of SLC6A4 in preterm infants was significant for a strong correlation with perception of total chronic stress. IMPLICATIONS FOR PRACTICE AND RESEARCH Clinical practice at the bedside in the NICU should include standardized screening for and early interventions to minimize stress. Complex research of stress is feasible and acceptable. Future research should focus on linking early life stress with epigenetic alterations and evaluation of the dyad for reciprocity.
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Affiliation(s)
- Kathryn J Malin
- Marquette University, College of Nursing, Milwaukee, Wisconsin (Dr Malin); Children's Wisconsin, Milwaukee (Drs Malin and White-Traut); Medical College of Wisconsin, Milwaukee (Ms Kruschel and Dr Lagatta); University of Washington, The Department of Child, Family, and Population Health Nursing, Seattle, Washington (Dr Gondwe); The Kinsey Institute at Indiana University, Bloomington, Indiana (Drs Carter and Nazarloo); and University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania (Dr Conley)
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Rambod M, Pasyar N, Mazarei Z, Soltanian M. The predictive roles of parental stress and intolerance of uncertainty on psychological well-being of parents with a newborn in neonatal intensive care unit: a hierarchical linear regression analysis. BMC Pediatr 2023; 23:607. [PMID: 38037025 PMCID: PMC10691133 DOI: 10.1186/s12887-023-04420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Hospitalization of newborns in neonatal intensive care units (NICU) exposes parents to considerable stress. This study aimed to determine the predictive role of parental stress and intolerance of uncertainty on the psychological well-being of parents with a newborn in NICU using hierarchical linear regression analysis. METHODS This cross-sectional study included 130 parents of newborns hospitalized in the NICU. Data were collected using Parental Stress Scale, Intolerance of Uncertainty Scale, and Psychological Wellbeing Scale. The data were analyzed in SPSS v.26 using hierarchical linear regression analysis. RESULTS The mean scores of the parents' psychological well-being, parental stress, and intolerance of uncertainty were 79.08 (SD = 11.70), 63.06 (SD = 26.71), and 75.38 (SD = 19.40), respectively. The result of the hierarchical linear regression analysis revealed that, in step 1, academic education had a significant proportion of the variance of parents' psychological well-being (β = 0.26, P = 0.005). In step 2, it was shown that academic education (β=-0.25, P = 0.006) and parental stress (β=-0.25, P = 0.006) had a significant proportion of the variance of parents' psychological well-being. According to step 2, education levels, parental stress, and intolerance of uncertainty explained 22% of the changes in parents' psychological well-being. CONCLUSION There was a significant association between the parents' psychological well-being and education levels, intolerance of uncertainty, and parental stress. Academic education and parental stress were the predictors of parents' psychological well-being. Based on these findings, early detection of parents' education and stress are important for their psychological well-being.
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Affiliation(s)
- Masoume Rambod
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nilofar Pasyar
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zeinab Mazarei
- Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Soltanian
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran
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Gorsky KG, Butala S, House M, Moon C, Calvetti S, Khando T, Kipke M, Lakshmanan A. Uncertainty and the NICU Experience: A Qualitative Evaluation of Family and Provider Perspectives. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1745. [PMID: 38002836 PMCID: PMC10670907 DOI: 10.3390/children10111745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
There is limited information regarding caregiver and provider perspectives on uncertainty across the continuum of the neonatal intensive care unit (NICU) experience. Open-ended semi-structured interviews were conducted with providers and English- and Spanish-speaking caregivers of infants with a history of admission to a quaternary safety-net NICU. Major themes were generated using inductive-deductive thematic analysis. Seventy-six individuals participated in the study: 47 caregivers and 29 providers. The median gestational age of the infants was 29 weeks and 85% were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm. Most providers were neonatologists (37%) and nurses (27%) and more than half had over ten years of experience. A conceptual model of caregiver uncertainty was developed and key domains included drivers of uncertainty and its impact, and factors influencing coping and adaptation. Our analysis found a positive association between caregiver information gathering, clinical continuity, support systems, maternal mental health supports, and witnessing a child's progress and the development of adjustment to chronic uncertainty. These results suggest key areas for intervention that can promote parental adaptation to the uncertainty inherent in the NICU experience.
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Affiliation(s)
- Katharine Griffin Gorsky
- Division of Neonatology, San Francisco School of Medicine, University of California, San Francisco, CA 94158, USA;
| | - Saloni Butala
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- School of Medicine, WesternU College of Osteopathic Medicine of the Pacific, Pomona, CA 91766, USA
| | - Madison House
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- School of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Chelsea Moon
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- School of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Sam Calvetti
- Community Health Outcome Intervention Research, Children’s Hospital, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Tenzin Khando
- Life Course Intervention Research Network, University of California, Los Angeles, CA 94158, USA;
| | - Michele Kipke
- School of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- Department of Health Systems Science, Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
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Boss RD. Palliative care for NICU survivors with chronic critical illness. Semin Fetal Neonatal Med 2023; 28:101446. [PMID: 37100723 DOI: 10.1016/j.siny.2023.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The sickest of NICU survivors develop chronic critical illness (CCI). Most infants with CCI will leave the NICU using chronic medical technology and will experience repeated rehospitalizations. The unique issues for these NICU graduates- escalating chronic medical technologies, fractured post-NICU healthcare, gaps in home health services, and family strain-are common and predictable. This means that raising family and NICU team awareness of these issues, and putting plans in place to address them, should occur for every NICU infant with CCI. Pediatric palliative care is one resource that can be engaged within the NICU to support the child and family through NICU discharge and beyond. This review examines what is known about the unique needs of infants who leave the NICU with CCI and the role that NICU-initiated palliative care involvement can play for these patients, families, clinicians, and the health care system.
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Affiliation(s)
- Renee D Boss
- Pediatric Palliative Care, Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Berman Institute of Bioethics, 200 N. Wolfe St, Baltimore, MD, 21287, USA.
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McKeown L, Burke K, Cobham VE, Kimball H, Foxcroft K, Callaway L. The Prevalence of PTSD of Mothers and Fathers of High-Risk Infants Admitted to NICU: A Systematic Review. Clin Child Fam Psychol Rev 2023; 26:33-49. [PMID: 36564614 DOI: 10.1007/s10567-022-00421-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/25/2022]
Abstract
Admission of a preterm or sick full-term infant to the neonatal intensive care unit (NICU) is a stressful experience for parents. Indeed, the 'NICU experience' may constitute a traumatic event for parents, distinct from other birth-related trauma, leading to significant and ongoing posttraumatic stress disorder (PTSD) symptoms. However, the rates at which this outcome occurs are not well understood. This review aimed to identify the prevalence of PTSD in mothers and fathers of high-risk infants admitted to the NICU, specifically focusing on the NICU experience as the index trauma. The PRISMA-P: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols were used to conduct this review. We searched PsycINFO, PubMed, Scopus, EMBASE, Web of Science, ProQuest Dissertations and Theses databases, and reference lists of included articles (1980-2021). Two independent reviewers screened titles and abstracts and conducted the full-text screening assessment. Of the 707 records identified, seven studies met the inclusion criteria. In this systematic review, PTSD symptomatology was assessed by self-report measures rather than a clinical interview. We identified significant variations in the methodologies and quality between studies, with a wide variation of reported prevalence rates of PTSD of 4.5-30% in mothers and 0-33% in fathers. Overall, the findings indicate that up to one-third of parents experience PTSD symptomatology related to the NICU experience. These results emphasize the importance of universal routine antenatal and postnatal screening for symptoms of PTSD to identify parents at risk of distress during the NICU experience and after discharge.Trial registration: The study protocol was registered with Prospero registration number CRD42020154548 on 28 April 2020.
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Affiliation(s)
- Lisa McKeown
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia.
| | - Kylie Burke
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, Brisbane, Australia
- Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Hayley Kimball
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Katie Foxcroft
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Leonie Callaway
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
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