A mindfulness intervention to reduce maternal distress in neonatal intensive care: a mixed methods pilot study

Adaptation of SafeCare, an evidence-based parenting program, for caregivers of infants in the neonatal intensive care unit

BACKGROUND

While there are several parenting programs for NICU caregivers, no studies, to our knowledge, have developed parenting programs aimed at preventing child maltreatment that specifically address these parental factors: parental stress, parental self-efficacy, and positive parent-infant interaction.

OBJECTIVES

The objectives of this study were to: 1) Identify adaptations and/or augmentations needed to optimize SafeCare® for NICU caregivers, and 2) Examine the acceptability and preliminary effects of the adapted SafeCare NICU (SCNC) program with NICU caregivers.

METHODS

This study consisted of two phases: formative (phase one) and pilot (phase two). For phase one, 5 NICU former caregivers and 5 NICU staff were interviewed to make relevant, NICU-specific adaptations for SCNC. Phase two consisted of a pilot study, where 13 current NICU caregivers were enrolled in the adapted SCNC program. Outcomes included acceptability and preliminary effects of parental stress, parental self-efficacy, and parent-infant interaction.

RESULTS

Adaptations to SafeCare consisted of adding a pre-session to discuss individualized experiences, incorporation of adjusted developmental milestones, a NICU-specific resource sheet, and individualized adaptations to activities based on relevant medical concerns. Out of the 13 participants, 8 completed SCNC (61.5 % retention rate). Participants indicated significant reductions in stress after SCNC (Parental stress index score = 61.7) compared to baseline (79.2, p = 0.02). Among participants who completed SCNC (n = 8), all stated they supported this program for implementation among NICU caregivers.

DISCUSSION

The adapted SCNC demonstrated acceptability among NICU caregivers.

Identifying outcomes and outcome measures in neonatal family-centered care trials: a systematic review

BACKGROUND

A wide range of outcomes for infants and parents has been reported in clinical trials testing FCC interventions. This systematic review aimed to identify outcomes, outcome measures, and time-points reported in experimental studies testing FCC interventions in neonatal care units.

METHODS

This review included experimental studies investigating FCC interventions in neonatal settings. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Cochrane, PsycINFO, Scopus, JBI, Lilacs, and SciELO, completed in December 2022 and updated in November 2023. Critical appraisal was performed using the JBI checklist for randomized controlled trials, and a narrative synthesis process was used. Outcomes were categorized into the Comet Taxonomy core areas.

RESULTS

The search identified 8787 papers; 42 studies were included in the analysis. Totally, 60 outcomes were identified: 42 infant and 18 parents' outcomes. Outcomes were clustered into 12 domains for infants and five domains for parents and measured by 97 outcome measures. The included studies reported 25 and 27 different time-points for infants and parents, respectively.

CONCLUSION

This review of studies testing FCC interventions identified heterogeneity and inconsistency of outcomes, outcome measures, and time-points measuring the outcomes. Developing a core outcome set for FCC studies is warranted to benchmark the evidence and identify best-practices.

IMPACT

This systematic review identified inconsistency of outcomes, outcome measures, and time-points reported in quantitative studies testing family-centered care interventions in neonatal care settings. The lack of standardized outcomes and outcome measures reported in clinical trials makes it difficult to synthesize data to provide conclusive recommendations. This systematic review will contribute to the development of a core outcome set for research testing family-centered care interventions in neonatal care settings.

Protocol for a pilot study assessing a virtual mindfulness intervention for postpartum African American women

Elevated perinatal depressive symptoms are more common among disadvantaged African American women, and they are almost four times as likely to have postpartum posttraumatic stress compared to white women. For new mothers, depressive symptoms and posttraumatic stress can lead to negative parenting, poor mother-infant bonding, and delayed infant development. For African American women, a culturally adapted mindfulness-based intervention offers great potential as an acceptable approach to reduce psycho-behavioral symptoms and improve mother-infant interactions (i.e., bonding). Additionally, it is critical that mindfulness interventions consider time constraints of new mothers, provide accessible intervention delivery, address parenting, and consider the challenges of caring for an infant. Given these considerations, we describe a pilot research protocol in which we evaluate a culturally adapted mindfulness program: Mindfulness for African Americans Postpartum (MAAP). The intervention is based upon Kabat-Zinn's Mindfulness Based Stress Reduction program, but is adapted to include culturally relevant concepts of spirituality, inter-dependence, self-empowerment, and storytelling, which are salient to African American culture. To accommodate the needs of new mothers, a certified mindfulness interventionist delivers each session virtually using Zoom. The investigation uses a randomized controlled design in which African American women within 12 months of giving birth are randomized either to the MAAP intervention or to an Education Program. The primary aim is to determine the extent to which the MAAP intervention decreases maternal psycho-behavioral symptoms (perceived stress, depressive symptoms, anxiety, poor sleep, posttraumatic stress, and fatigue) and improves mother-infant bonding. A secondary aim is to explore the effects of MAAP on proinflammatory cytokines and oxytocin. Culturally adapted mindfulness interventions delivered virtually will make mindfulness more accessible and meaningful to populations, like African American new mothers, who are at higher risk for postpartum mood disorders and poor infant outcomes.

The Effect of Mindfulness on Posttraumatic Growth of Mothers of Premature Infants Admitted to Neonatal Intensive Care Unit

The purpose of this study was to determine the effect of Mindfulness-Based Stress Reduction (MBSR) on Posttraumatic Growth (PTG) in mothers of premature infants admitted to the Neonatal Intensive Care Unit (NICU) in Iran. Sixty mothers were selected by convenience sampling and assigned to the intervention and control groups. The intervention group received two MBSR sessions each week over the course of three weeks. The Posttraumatic Growth Inventory (PTGI) was used to collect data before, immediately after, and 1 month after the intervention. Based on repeated measures ANOVA, group-by-time interaction effect was significant and there was a statistically significant difference in the mean PTG scores of mothers in the two groups over time (p = 0.004). MBSR increased PTG in mothers. As a result, it is suggested that this approach be used in psychological support programs for mothers who have premature infants admitted to neonatal intensive care units.

A Reliability Generalization Meta-Analysis of the Mother-To-Infant Bonding Scale

The Mother-to-Infant Bonding Scale (MIBS) is among the most popular measurement tools to evaluate caregiver-infant attachment. We carried out a meta-analysis study to explore the generalizability of the reliability coefficients for the MIBS in different studies. The literature review yielded a total of 702 studies investigating caregiver-infant attachment. After removing duplicate studies, we also excluded compilations, meta-analyses, qualitative studies, those using different measurement tools, studies published in a language other than English, citations, and those whose full texts could not be accessed. Eventually, we considered a total of 26 studies with 33 Cronbach's alpha coefficients that satisfied the inclusion criteria. We normalized the alpha coefficients using Bonett's transformation, and the analyses were performed using a 95% confidence interval. The findings revealed a Cronbach's alpha (n = 33) coefficient of 0.73 (CI = 0.68-0.77); hence, the present reliability generalization study provides evidence that the reliability scores produced after measurements with the MIBS in previous studies are acceptable across samples. Overall, further studies may reliably utilize the MIBS to evaluate mother-infant attachment.

Transdiagnostic therapy compared to progressive muscle relaxation on the emotional health of mothers with premature infants: A randomized controlled trial

OBJECTIVE

The aim of this study was to compare the effects of transdiagnostic therapy compared to progressive muscle relaxation (PMR) on emotion regulation strategies, self-compassion, maternal role adaptation, and social and work adjustment in mothers of premature infants.

MATERIALS AND METHODS

This was a randomized controlled trial with two groups and pre-test, post-test, and a two-month follow-up assessment. Included were 27 mothers randomly assigned to either the transdiagnostic therapy group or the PMR group (13 in the transdiagnostic group and 14 in the PMR group). The experimental group received eight sessions of transdiagnostic therapy while the control group received eight sessions of PMR. The participants completed the following scales: Emotion Regulation Questionnaire, Self-Compassion Scale, Maternal Role Adaptation Scale, and Work and Social Adjustment Scale.

RESULTS

Transdiagnostic therapy was significantly more effective than PMR in improving emotion regulation strategies, self-compassion, maternal role adaptation, and social and work adjustment based on the between-group comparison conducted at post-test and follow-up (p < 0.01).

CONCLUSION

Transdiagnostic therapy was shown to be effective in improving the emotional health of mothers with premature infants and was more effective than PMR techniques.

Development and content validation of yoga module for the mental health of NICU mothers

BACKGROUND

Postnatal yoga has been found to be effective for maternal mental health management. But a validated yoga module for the mental health of early postpartum mothers with infants admitted to the Neonatal Intensive Care Unit (NICU) is lacking.

AIM

To design and validate a yoga module for the mental health of early postpartum mothers having infants admitted to the NICU.

MATERIALS AND METHODS

First phase: A yoga module was designed through a review of published research articles and yogic texts for NICU mothers. Second phase: thirty-eight yoga experts validated the yoga module. Lawshe's formula was used to calculate each item's content validity ratio (CVR). The intra-class correlation coefficient was determined for the validated yoga module. Third phase: The validated yoga module was pilot-tested with a sample size of 20 NICU mothers.

RESULTS

Thirty-eight yoga experts validated the yoga module for NICU mothers. Thirteen practices included in the module indicated good content validity (cutoff value: 0.316). The module's content validity index (CVI) and intra-class correlation coefficient were 0.672 and 0.924, respectively. Ten days of practicing the yoga module resulted in a significant reduction in maternal stress levels in the yoga group (p < 0.001) compared to the control group (p = 0.427).

CONCLUSION

The present study suggests good content validity of the yoga module for the mental health of NICU mothers. However, future randomized controlled trials must be carried out to determine both the feasibility and clinical efficacy of the Yoga Module for NICU mothers.

The Efficacy of Provider-Based Prenatal Interventions to Reduce Maternal Stress: A Systematic Review

PURPOSE

Exposure to stress during the prenatal period is often associated with adverse maternal and neonatal health outcomes and is increasing in prevalence in the United States. Health care providers play a crucial role in addressing and mitigating this stress, but there is a lack of consensus in effective interventions. This review evaluates the effectiveness of prenatal provider-based interventions that reduce stress for pregnant people, especially those who are disproportionately affected by stress.

METHODS

A search of relevant English-language literature was conducted using PubMed, CINAHL, Web of Science, Embase, and PyscInfo. Inclusion criteria were 1) the target population was pregnant people, 2) the intervention was delivered within the U.S. health care system, and 3) the study intervention had the goal of reducing stress (stress-reducing intervention).

RESULTS

A total of 3,562 records were identified in the search and 23 were included in analysis. The four identified categories for provider-led stress-reducing prenatal interventions included in the review are 1) skills-building, 2) mindfulness, 3) behavioral therapy, and 4) group support. Findings suggest an increased overall likelihood of mood and maternal stress improvement among pregnant people who complete provider-based stress-reducing interventions, especially group-based therapies that integrated resource allocation, skills-building, mindfulness, and/or behavioral therapy into an intersectional program. However, the efficacy of each type of intervention varies by category and type of maternal stress targeted.

CONCLUSIONS

Although few studies demonstrated a significant reduction in stress for pregnant people, this review highlights the critical need for increased research and attention to stress-reducing interventions in the prenatal period, especially as it pertains to minoritized populations.

Exploring the Influence of a Mindfulness Intervention on the Experiences of Mothers with Infants in Neonatal Intensive Care Units

Objectives

Mothers with infants in the neonatal intensive care unit (NICU) are at increased risk of psychological distress, which can have lasting negative impacts on both mother and infant. However, few interventions are available to promote these mothers' mental health and wellbeing. In the context of a pilot randomized controlled trial testing a mindfulness intervention for mothers with infants in the NICU, we explore the experiences of the mothers participating in the mindfulness-based intervention, with mothers in the control group as comparison, and the ways they felt it influenced their time in the NICU.

Method

Twenty-six participants (15 participants in the intervention arm and 11 participants in the control arm) recruited from two NICUs in an urban center in Eastern United States completed semi-structured interviews. Interviews explored the mothers' NICU experience as well as experience with the mindfulness and health education (control) programs. Data was analyzed using an iterative, thematic constant comparison process informed by grounded theory.

Results

Mothers reported that participation in the mindfulness intervention helped them to calm the chaos through recentering and fostering connections, find comfort through non-judgmental acceptance, gain perspective on the situation, and facilitate self-care. These were experienced only among the mothers in the intervention arm. These themes did not vary based on demographics of the mothers in the mindfulness study arm or their pre-study awareness of mindfulness.

Conclusions

Mindfulness interventions may foster new practices and perspectives for mothers with infants in the NICU, potentially leading to improved mental health wellbeing.

Types, Evidence, and Resources of Interventions Focused on Improving the Psychosocial Well-being of Parents of Premature/Sick Infants: A Scoping Review

BACKGROUND

Parents of infants born premature and/or sick and who require neonatal care are at risk of poor mental health. Currently, there is no comprehensive knowledge about interventions (ie, types, evidence, resources) that have been exclusively designed to improve the psychosocial well-being of this population group.

PURPOSE

To undertake a systematic scoping review of interventions focused on improving the psychosocial well-being of parents of sick/premature infants who required neonatal care to identify the ( a ) types of interventions, ( b ) evidence of the interventions, and ( c ) level of resources required to deliver the interventions.

SEARCH STRATEGY

e searched 7 databases (MEDLINE, CINAHL, PsycINFO, Cochrane, EMBASE, Web of Science, and Global Index), reviewed references, and followed up key authors.

RESULTS

From 10,516 hits, 38 articles met the inclusion criteria (36 different studies/interventions). Studies included creative oriented (n = 11), group/peer support (n = 4), relaxation/mindfulness (n = 3), spiritual/religious (n = 4), psychotherapeutic-based (n = 11), and "other" (n = 3) (eg, sleep, acupuncture). Most had been undertaken in high-income settings with mothers and required varying levels of resources within and between the different intervention types. While some interventions were effective, there was high heterogeneity with similar interventions using different designs, protocols, and outcomes. Most intervention types included studies that highlighted what parents valued (eg, self-care, relaxation, social opportunities).

IMPLICATIONS FOR RESEARCH

Evidence highlights a wide range of potential interventions for nursing and other specialist staff to consider and offers insights into potential mechanisms of effectiveness to underpin future intervention design.

A scoping review of non-pharmacological perinatal interventions impacting maternal sleep and maternal mental health

Background

A woman’s vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered.

Methods

Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings.

Results

Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological (n = 9), educational (n = 15), lifestyle (n = 10), chronotherapeutic (n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation.

Conclusions

Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.

Mindfulness and Relaxation-Based Interventions to Reduce Parental Stress, Anxiety and/or Depressive Symptoms in the Neonatal Intensive Care Unit: A Systematic Review

Parents with infants in the neonatal intensive care unit (NICU) experience high levels of stress, anxiety, and depression. Mindfulness and relaxation-based interventions are effective in reducing distress in the general postpartum population. The aim of this systematic review was to evaluate whether mindfulness and/or relaxation-based interventions reduce stress, anxiety, and depression in NICU parents. A total of five studies met the inclusion criteria and were assessed for quality using the Downs & Black Checklist. The most consistent results in this review suggest that mindfulness and/or relaxation-based interventions may be effective at reducing anxiety symptoms in NICU parents, with moderate to large effect sizes, and show promise in reducing depressive symptoms. The findings show limited potential benefits on parental stress. Methodological weaknesses, heterogeneous intervention factors (including format and length), and varying participant adherence hinder the ability to make strong conclusions. Directions for future research are discussed.

The Effect of Mindfulness-Based Stress Reduction on Posttraumatic Stress of Mothers With Premature Neonates Admitted to a Neonatal Intensive Care Unit

Mothers experience posttraumatic stress disorder with the birth of a premature neonate. The purpose of this study was to determine the effect of mindfulness-based stress reduction on posttraumatic stress of mothers with premature neonates in Iran. Sixty mothers with premature neonates were selected by using convenience sampling and stratified random allocation. Mindfulness-based stress reduction was trained and mean posttraumatic stress disorder was measured. Mean posttraumatic stress scores of the 2 groups were statistically significant immediately and 1 month after the intervention (independent t test, P < .05). Posttraumatic stress of both groups reduced over time, but this reduction was more significant in the intervention group (repeated-measures analysis of variance, P < .05). Concerning the positive role of mindfulness-based stress reduction in posttraumatic stress disorder of mothers, it is recommended to use this approach in care programs of mothers with premature neonates.

Psychiatric Symptoms, Posttraumatic Growth, and Life Satisfaction Among Parents of Seriously Ill Infants: A Prospective Case-Controlled Study

We evaluated psychiatric symptoms, posttraumatic growth, and life satisfaction among the parents (n = 34) of newborns (n = 17) requiring therapeutic hypothermia or urgent surgery (interest group). Our control group included 60 parents of healthy newborns (n = 30). The first surveys were completed soon after diagnosis or delivery and the follow-up surveys 1 year later (participation rate 88% in the interest group and 70% in the control group). General stress was common in both groups but was more prevalent in the interest group as were depressive symptoms, too. Anxiety was more common in the interest group, although it showed a decrease from the baseline in both groups. Life satisfaction had an inverse correlation with all measures of psychiatric symptoms, and it was lower in the interest group in the early stage, but similar at 12 months due to the slight decline in the control group. Mothers in the interest group had more anxiety and depressive symptoms than fathers in the early stage. Mothers had more traumatic distress than fathers at both time points. Half of the parents experienced substantial posttraumatic growth at 12 months. In conclusion, the serious illness of an infant substantially affects the well-being of the parents in the early stages of illness and one year after the illness.

Mindful Kangaroo Care: mindfulness intervention for mothers during skin-to-skin care: a randomized control pilot study

Background

Parents of babies admitted to the Newborn Intensive Care Unit (NICU) undergo considerable stress. There is evidence that mindfulness reduces stress in these parents. Kangaroo Care (KC) is practiced in NICUs across the world and is stress-relieving. Whether mindfulness practiced during KC in the NICU reduces parental distress has not yet been studied. The objective was to explore the feasibility and acceptability of teaching and practicing mindfulness during KC for mothers of premature babies. The objective was also to document preliminary outcomes of Mindful Kangaroo Care (MKC) on maternal stress, anxiety, depression, and mindful awareness.

Methods

In this pilot randomized controlled study, mothers of premature babies who were expected to stay in the NICU for at least four weeks were taught two mindfulness exercises to practice during KC and compared to mothers who received standard care with no mindfulness teaching. Mothers filled out stress, anxiety, depression and mindful awareness scales at recruitment and after four weeks. Acceptability and feasibility questionnaires were also completed.

Results

Fifteen mothers per group completed the study. The MKC group demonstrated a significant within-group reduction in anxiety (p = 0.003), depression (p = 0.02) and stress (p = 0.002), and a significant increase in both the curiosity (p = 0.008) and decentering (p = 0.01) scores of the Toronto Mindfulness Scale, all of which had medium to large effect sizes. Only the increases in curiosity and decentering were significant between groups. Fourteen mothers found the intervention acceptable, one neutral.

Conclusion

MKC was acceptable, feasible and led to a reduction in stress, anxiety and depression in mothers who practiced mindfulness exercises during KC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04336-w.

Treatment of severe extravasation injury in a newborn by using tilapia fish skin: A case report

Introduction and importance

Peripheral venous catheterizations in newborns are associated with complications such as infections, phlebitis, vessel rupture and drug leaks or serum. Extravasation injury refers to the leakage of injected drugs from blood vessels causing damage to the surrounding tissues, skin necrosis, and sometimes amputation. Using tilapia fish skin (TFS) is one of the new strategies that have been used in wound management.

Case presentation

This case is a 36-week- and 4-day-old male fetus with a birth weight of 1600 g, height of 40 cm, and head circumference of 31 cm who was born to a 25-year-old mother by cesarean section at Mahzad Obstetrics and Gynecology Hospital, Urmia, Iran. On the third day of hospitalization at neonatal intensive care unit (NICU), an extravasation injury occurred in the infant's left hand in size approximately 1 × 1 cm by peripheral catheter. Despite extensive intravenous antibiotic therapy and rinsing with normal saline, wound healing was not achieved. The necrotic area was bandaged by using of the tilapia skin. For this purpose, the area was first washed with normal saline for 5 min and then the tilapia skin was placed on the damaged skin for 10 days. After a month, the newborn's wound had completely healed.

Clinical discussion

Infants are more prone to extravasation injury than adults due to being more sensitive and thinner peripheral vessel walls.

Conclusion

This case illustrates that tilapia fish skin may be a suitable alternative to other temporary skin cover dressings in premature newborns suffering from extravasation injury.

•

Peripheral venous catheterizations are associated with complications such as extravasation.

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Tilapia fish dressing is one of the new strategies that have been used in wound management.

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Tilapia fish dressing may be used as a suitable alternative method for routine dressings, even in premature neonates

Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study

BACKGROUND

Anxiety disorders and depression during pregnancy are highly prevalent. Hospitalized pregnant women with high maternal or fetal risk represent a particularly vulnerable population often excluded from research samples. Screening for mental health disorders is not routinely offered for this particular patient group. Electronic mindfulness-based interventions constitute an accessible, convenient, and cost-effective mental health resource but have not yet been evaluated for acceptance in inpatient settings. To date, little is known about the needs and perceptions of this group of women.

OBJECTIVE

The aim of this study was to examine whether a brief electronic mindfulness-based intervention (eMBI) is accepted among hospitalized high-risk pregnant women. We assessed personal motivation and barriers, experiences, usability requirements, and overall acceptance of the eMBI, as well the specific needs and demands of patients with high-risk pregnancies regarding mental health services.

METHODS

An exploratory pilot study with a mixed-methods study design was carried out among 30 women hospitalized with a high obstetric risk. The study participants were given access to an eMBI with a 1-week mindfulness program on how to deal with stress, anxiety, and depressive symptoms. Semi-structured interviews were conducted with the 30 participants and analyzed using systematic content analysis. In addition, acceptance and usability were assessed via questionnaires.

RESULTS

Study findings showed a high level of acceptance of the eMBI. Most of the respondents were satisfied with the usability and considered the eMBI program to be helpful. The greatest barriers to using the eMBI were a general negative attitude toward using apps, preference for personal contact, or no current need for psychotherapy. Participants criticized the lack of awareness of mental health issues during pregnancy and expressed a need for low-threshold treatment offers, especially during hospitalization.

CONCLUSIONS

There is a strong need for mental health services in pregnancy care, especially for pregnant women with risk profiles. An eMBI offers an acceptable means of providing mental health support for hospitalized women with a severe obstetric risk.

Relationship between mindfulness and maternal stress and mother - Infant bonding in neonatal intensive care unit

BACKGROUND

Having a baby admitted to a neonatal intensive care unit (NICU) is so stressful, has a negative impact on mother well-being, and also disrupts mother-infant bonding process because the infant spend the first several weeks or months in the NICU. Previous studies have shown the positive association of the mindfulness and various health conditions. This study investigated the relationship between mothers' dispositional mindfulness and level of stress and bonding in mothers with infants in the NICU.

MATERIALS AND METHODS

A cross-sectional study was performed during 2019 on 140 mothers with newborns admitted to the NICUs in two hospitals in Qom city in Iran. The self-report measures of dispositional mindfulness, Parental Stressor Scale: NICU, and the Postpartum Bonding Questionnaire were administered to mothers on the 2^nd-5^th day after birth. The data analysis was carried out by using a stepwise multiple regression model.

RESULTS

The mean scores of mindfulness, stress, and bonding were 3.32 ± 0.52, 2.32 ± 0.77, and 0.47 ± 0.37, respectively. There was a statistically significant inverse relationship between total mindfulness score and stress (P < 0.001). Furthermore, high scores of mindfulness were associated with better bonding (P = 0.04).

CONCLUSIONS

Improvement in mindfulness helps mothers to reduce stress and make better bonding with infants. It is recommended that mindfulness interventions use during pregnancy also after birth, especially for mothers that their infants admitted to in the NICUs.

Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative

Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.

Mindfulness and Acceptance Interventions for Parents of Children and Adolescents Diagnosed with Chronic Medical Conditions: A Systematic Review

Background: Mindfulness and acceptance interventions (MAIs) have been identified as potentially beneficial for parents of children and adolescents diagnosed with chronic medical conditions. Objective: The objective of this review was to provide a descriptive summary of the existing literature on MAIs delivered to parents of children and adolescents diagnosed with chronic medical conditions. Data sources: Electronic searches were conducted by a Library Information Specialist familiar with the field by using EMBASE, MEDLINE, PsycINFO, EBM Reviews Databases, and Cochrane Database of Systematic Reviews. Study eligibility, participants, and interventions: Peer-reviewed journal articles of MAIs delivered to parents of children and adolescents (birth to 18 years of age) diagnosed with a chronic medical condition were eligible for inclusion. Study appraisal and synthesis methods: A total of 18 studies involving 793 parents met inclusion criteria and thus were included in this review. The majority of studies were either pre/post design (n = 8) or randomized controlled trials (n = 6). Most interventions were delivered within a group (n = 6) or individually (n = 5). Nearly all studies (n = 14) reported statistically significant outcomes following the MAI intervention. Conclusions and implications of key findings: Descriptive information yielded from this review provides promising evidence that MAIs are being delivered to parents across the world and many researchers are using similar outcome measures when assessing the psychological flexibility, acceptance, and mindfulness skills following participation in MAIs among this population of parents.

Historical Perspectives: Unsilencing Suffering: Promoting Maternal Mental Health in Neonatal Intensive Care Units

Mothers of infants in the NICU suffer higher rates of psychological distress, anxiety, and depression compared with the general population. Often, their mental health concerns remain underidentified and undertreated, which can have deleterious effects on the offspring, both in short-term outcomes while in the NICU as well as long-term neurodevelopmental and behavioral outcomes. In this review, we present an overview of existing empirical evidence about how maternal mental health affects the health of infants, special considerations regarding the mental health needs of NICU mothers, and the findings about existing and developing interventions to address mental health concerns in this vulnerable population.

Unplanned postdischarge healthcare utilisation, discharge readiness, and perceived quality of teaching in mothers of neonates hospitalized in a neonatal intensive care unit: A descriptive and correlational study

BACKGROUND

Discharge teaching has been positively associated with discharge readiness in various care settings and patient types. Association of discharge readiness with unplanned use of health services has not received as much attention in the neonatal intensive care unit (NICU) population, but has been negatively associated in parents of older children.

OBJECTIVES

The objective of the study was to describe and assess relationships between maternal readiness for neonates' discharge, discharge teaching, and unplanned use of health services after discharge from an NICU.

METHODS

Mothers from an NICU of a tertiary referral hospital in Switzerland completed the "Readiness for Hospital Discharge Scale" and the "Quality of Discharge Teaching Scale parental forms" in the 24 h preceding discharge. Telephone interviews evaluating the unplanned use of health services were conducted 28 days after discharge. Simple linear regressions and multiple regressions were used to explore the links between the readiness, perceived quality of discharge, and unplanned use of health services.

RESULTS

Of the 71 participants, 75% (n = 53%) felt ready for discharge when asked directly, and for 60% (n = 42) of them, the amount of discharge teaching received was equal to or higher than that needed, but with high heterogeneity in scores. For 38% of mothers (n = 27), the expected support from the medical care of their child after discharge was deemed insufficient. In the month after discharge, unplanned use of health services occurred in 46% of the participants (n = 32). Perceived quality of teaching positively predicted readiness for discharge (R² = 0.24, p = 0.0004). Unplanned use of health services correlated neither with readiness nor with perceived teaching quality.

CONCLUSIONS

At discharge, mothers felt mostly ready and well prepared to go home. In the month after discharge, almost half used health services in an unplanned manner. Further exploration of reasons leading to this high rate of postdischarge healthcare utilisation is warranted.

Maternal Distress in the Neonatal Intensive Care Unit: A Concept Analysis

BACKGROUND

The neonatal intensive care unit (NICU) can cause significant psychological distress in a mother. There is no common definition of maternal distress in the NICU currently in use.

PURPOSE

To develop a clear conceptual understanding of maternal distress in the NICU using conceptual definitions and empirical findings.

METHODS/SEARCH STRATEGY

A literature search was conducted using EBSCOhost, MEDLINE, CINAHL, PsychINFO, and Google Scholar. The concept analysis was guided by Walker and Avant's (2011) guide.

FINDINGS/RESULTS

Maternal distress in the NICU consists of a combination of depressive, anxiety, trauma, and posttraumatic stress symptoms. The symptoms occur together on a spectrum and present differently in each mother. The antecedents to maternal distress are a NICU hospitalization and a perceived interruption to the transition to motherhood. Consequences of maternal distress in the NICU are issues with developing a healthy maternal-infant bond, adverse infant development, and decreased maternal quality of life.

IMPLICATIONS FOR PRACTICE

A complete understanding of maternal distress in the NICU will lead to increased awareness of adverse mental health states in this population.

IMPLICATIONS FOR RESEARCH

Identification of mothers at risk for maternal distress in the NICU, as well as the identification of antecedents and consequences related to the mother and the infant from maternal distress in the NICU. Using a single, clear definition of maternal distress in the NICU population will lead to a more cohesive body of literature.