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Syed F, Mittal S, Thakur M, Kumar L, Yadav K. Addressing depression in parents of neonates: the critical need for integrated care in the NICU. J Matern Fetal Neonatal Med 2024; 37:2356033. [PMID: 39034157 DOI: 10.1080/14767058.2024.2356033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/11/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Major Depressive Disorder (MDD) during the perinatal period is a significant global health concern, ranking as the fourth-leading contributor to the global burden of disease and the second-leading cause of disability in individuals aged 15-44. This study investigates the association between perinatal MDD, poor nutrition, low prenatal care adherence, substance use and increased suicide risk. METHODOLOGY A comprehensive review of existing research studies examined the prevalence and consequences of perinatal MDD. Studies focusing on symptoms, risk factors, and associated outcomes in mothers and infants were analyzed to provide a comprehensive overview of the multifaceted impact of MDD during the perinatal period. CONCLUSION Approximately 10-15% of women experience postpartum depression, with over 60% reporting symptoms within the first 6 weeks postpartum. Postpartum MDD increases the likelihood of preterm birth, small-for-gestational-age newborns and developmental delay. These findings underscore the critical need for comprehensive screening, identification and intervention approaches to mitigate the short and long term consequences of perinatal MDD.
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MESH Headings
- Humans
- Infant, Newborn
- Female
- Depression, Postpartum/epidemiology
- Depression, Postpartum/therapy
- Depression, Postpartum/psychology
- Pregnancy
- Depressive Disorder, Major/therapy
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/psychology
- Depressive Disorder, Major/diagnosis
- Intensive Care Units, Neonatal
- Parents/psychology
- Delivery of Health Care, Integrated
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Affiliation(s)
- Farooq Syed
- Neonatal Transport, PaNDR-Cambridge University Hospitals, Cambridge, UK
| | - Sumit Mittal
- Leicester Neonatal Services, University Hospitals Leicester, Leicester, UK
| | | | | | - Kamini Yadav
- Leicester Neonatal Services, University Hospitals Leicester, Leicester, UK
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Evans D, Eatwell D, Hodson-Walker S, Pearce S, Reynolds V, Smith S, Whitehouse L, Butterworth R. Collaborative Recognition of Wellbeing Needs: A Novel Approach to Universal Psychosocial Screening on the Neonatal Unit. J Clin Psychol Med Settings 2024; 31:513-525. [PMID: 38684595 DOI: 10.1007/s10880-024-10016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 05/02/2024]
Abstract
Universal screening for the psychological needs of families in neonatal care is internationally recommended, but is not routinely practiced in the United Kingdom (UK). The present quality improvement project explores the clinical and operational feasibility of a novel approach to universal screening on a neonatal intensive care unit in the UK. The approach to screening taken adopts collaborative, strengths-based and dialogical methods for recognising the psychological needs of families whose baby is in hospital. A novel screening tool, developed through consultation with families, is described. Over one month, 42 out of 80 eligible families engaged with the screening protocol either at admission to the unit, transition to the special care nursery within the unit, or discharge home, with completion rates higher at admission than discharge. This led to an eightfold increase in the number of families accessing targeted or specialist psychological intervention compared to the period prior to this pilot. This project demonstrates the need for adequate capacity in the workforce to carry out a screening programme and to respond to the needs identified.
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Affiliation(s)
- Davy Evans
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- Health in Mind, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Daisy Eatwell
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Sarah Pearce
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Vicky Reynolds
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Shona Smith
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Leah Whitehouse
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ruth Butterworth
- North West Neonatal Operational Delivery Network, Manchester, UK
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3
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Wile B, Skowronski K, Shariati K, Olagunju AT. Promoting mental well-being among parents in the neonatal intensive care unit: a perspective on the role of Physician Associates. J Perinatol 2024; 44:1069-1072. [PMID: 38499755 DOI: 10.1038/s41372-024-01936-0] [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] [Received: 09/06/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Emotional disorders in parents of infants admitted to the neonatal intensive care unit (NICU) carry the potential for serious ramifications in neonatal and childhood outcomes. Despite this, current NICU mental health supports are less than optimum; postpartum mental health screening is limited, often missed in parents of inpatient infants, and may not be applicable to all family structures. Current evidence demonstrates improved outcomes in neonates and family members with early identification and multidisciplinary approaches to managing mental health problems. Physician Associates/Assistants (PAs) are a skilled group of advanced practice providers who are often a point of first contact for parents in the NICU, helping maintain continuity of care. In this perspective, we underscore leveraging the skills of PAs to promote the emotional wellbeing of parents in the NICU by way of practice and policy involvement. We also included a generic set of recommendations to equip PAs in this role.
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Affiliation(s)
- Brooke Wile
- Neonatal Intensive Care Unit, McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
- Physician Assistant Education Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Karolina Skowronski
- Neonatal Intensive Care Unit, McMaster Children's Hospital, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Khashayar Shariati
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia.
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Fladeboe KM, Stock NM, Heike CL, Evans KN, Junkins C, Stueckle L, O'Daffer A, Rosenberg AR, Yi-Frazier JP. Feasibility and Acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) Intervention for Caregivers of Children with Craniofacial Conditions. Cleft Palate Craniofac J 2024; 61:1125-1133. [PMID: 36802967 DOI: 10.1177/10556656231157449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Few evidence-based psychosocial programs exist within craniofacial care. This study (a) assessed feasibility and acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) intervention among caregivers of children with craniofacial conditions and (b) described barriers and facilitators of caregiver resilience to inform program adaptation. DESIGN In this single-arm cohort study, participants completed a baseline demographic questionnaire, the PRISM-P program, and an exit interview. PARTICIPANTS Eligible individuals were English-speaking legal guardians of a child <12-years-old with a craniofacial condition. INTERVENTION PRISM-P included 4 modules (stress-management, goal-setting, cognitive-restructuring, meaning-making) delivered in 2 one-on-one phone or videoconference sessions 1-2 weeks apart. MAIN OUTCOME MEASURES Feasibility was defined as >70% program completion among enrolled participants; acceptability was defined as >70% willingness to recommend PRISM-P. Intervention feedback and caregiver-perceived barriers and facilitators of resilience were summarized qualitatively. RESULTS Twenty caregivers were approached and 12 (60%) enrolled. The majority were mothers (67%) of a child <1-year-old diagnosed with a cleft lip and/or palate (83%) or craniofacial microsomia (17%). Of these, 8 (67%) completed PRISM-P and 7 (58%) completed interviews; 4 (33%) were lost-to-follow-up before PRISM-P and 1 (8%) before the interview. Feedback was highly positive, with 100% willing to recommend PRISM-P. Perceived barriers to resilience included uncertainty about their child's health; facilitators included social support, parental identity, knowledge, and control. CONCLUSIONS PRISM-P was acceptable among caregivers of children with craniofacial conditions but not feasible based on program completion rates. Barriers and facilitators of resilience support the appropriateness of PRISM-P for this population and inform adaptation.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Carrie L Heike
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Kelly N Evans
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Courtney Junkins
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Laura Stueckle
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Palliative Care, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
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Bokova E, Prasade N, Lewis WE, Feira CN, Lim IIP, Oyetunji TA, Rentea RM. Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management. J Pediatr Surg 2024; 59:1245-1249. [PMID: 38570262 DOI: 10.1016/j.jpedsurg.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Pull-through procedures for Hirschsprung disease (HD) can be performed during the Neonatal Intensive Care Unit (NICU) stay or delayed until discharge following home irrigations. This study assesses the safety of a delayed pull-through as an alternative to neonatal reconstruction in infants with successful abdomen decompression with home irrigations based on Hirschsprung-associated enterocolitis (HAEC) development. METHODS A single-institution retrospective review of neonates with HD who underwent delayed or neonatal pull-through from July 2018-July 2022. Endpoints included post-pull-through HAEC incidence, recurrence at an 18-month follow-up, time to the first HAEC episode, NICU length of stay (LOS), and HAEC-related LOS. RESULTS Twenty-four neonates were included. Eighteen were discharged from the NICU with home irrigations. Of these, 3 (28%) developed enterocolitis preoperatively, 12 (67%) underwent a delayed pull-through. NICU LOS in the delayed cohort was 3 times shorter than in the neonatal (6 vs. 18 days, p < 0.01). The incidence of enterocolitis (82% vs. 80%), time to the first episode (43 vs. 57 days), and HAEC-related LOS (median of 3 days) were similar. CONCLUSIONS Delayed HD pull-through is a viable neonatal reconstruction alternative that reduces NICU stay without increasing the risk of postoperative HAEC development. TYPE OF STUDY Original Research Article. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ninad Prasade
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Wendy E Lewis
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Christine N Feira
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Irene Isabel P Lim
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA.
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Hofheimer JA, McGowan EC, Smith LM, Meltzer-Brody S, Carter BS, Dansereau LM, Pastyrnak S, Helderman JB, Neal CR, DellaGrotta SA, O'Shea TMD, Lester BM. Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge. Am J Perinatol 2024; 41:1396-1408. [PMID: 37072014 PMCID: PMC11223892 DOI: 10.1055/s-0043-1768132] [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: 10/27/2022] [Accepted: 02/03/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. STUDY DESIGN We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. RESULTS Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. CONCLUSION Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. KEY POINTS · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..
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Affiliation(s)
- Julie A. Hofheimer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women and Infant's Hospital/Brown University, Providence, Rhode Island
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, California
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian S. Carter
- Department of Pediatrics, Department of Medical Humanities and Bioethics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Steven Pastyrnak
- Department of Pediatrics, Spectrum Health Helen DeVos Children's Hospital/Michigan State University, Grand Rapids, Michigan
| | - Jennifer B. Helderman
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Charles R. Neal
- Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children and Hawaii Pacific Medical Group, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Sheri A. DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Thomas Michael D. O'Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barry M. Lester
- Departments of Pediatrics, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
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Klawetter S, Gievers L, McEvoy CT, Nicolaidis C. NICU Parent and Staff Advocacy to Address Parental Mental Health. Clin Pediatr (Phila) 2024:99228241260167. [PMID: 38853718 DOI: 10.1177/00099228241260167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Parents of infants requiring neonatal intensive care unit (NICU) hospitalization often experience increased rates of distress, trauma, and perinatal mood disorders. Untreated parental mental health conditions have short- and long-term effects for infants and families. While some NICUs provide varying degrees of mental health supports for NICU families, these services are not universally or systematically integrated in US NICUs. Multiple factors contribute to this gap in care, including mental health stigma, funding constraints, and lack of staff training and capacity. In an effort to address this gap, we used a participatory action research approach, guided by a Patient and Stakeholder Engagement model, to partner with graduate NICU parents and patient-facing NICU staff to identify parental mental health needs and ideas to address them. Through efforts to mitigate power differentials and engage parents as research and program development partners, our work shaped NICU practices, programming, and subsequent research.
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Affiliation(s)
| | - Ladawna Gievers
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Cindy T McEvoy
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Aurora, CO, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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Ranu J, Hoffman KR, Sauers-Ford HS, Williams J, Rosenthal JL. A Qualitative Intervention Evaluation of Neonatal Virtual Family-Centered Rounds. Hosp Pediatr 2024; 14:463-473. [PMID: 38774983 PMCID: PMC11137623 DOI: 10.1542/hpeds.2023-007554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/06/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To conduct an implementation evaluation of the virtual family-centered rounds (FCR) intervention by exploring the perceptions and experiences of parents and care team providers. METHODS We conducted a qualitative descriptive study using a thematic analysis of unobtrusive observations of rounding encounters and semi-structured interviews with the parents of discharged infants and members of the neonatal care team. Eligible participants had used virtual FCR at least once. Five research team members independently performed focused coding and memo writing of transcripts and observation fieldnotes. The team met weekly to compare and refine codes, update the interview guide, develop tentative categories, and discuss the theoretical direction. RESULTS We conducted 406 minutes of unobtrusive observations and 21 interviews with parents, physicians, neonatal nurse practitioners, bedside nurses, dieticians, and pharmacists. Three themes and 13 subthemes emerged from the analysis: (1) virtual FCR improved perceived care delivery and clinical outcomes through increased opportunities for parent engagement, (2) the acceptance of virtual FCR by providers grew over time despite the persistent presence of technical challenges, and (3) the implementation of virtual FCR should be standardized and delivered by the care team to enhance usability, effectiveness, and sustainability. CONCLUSIONS Virtual FCR is perceived by NICU parents and care team providers to be a valuable intervention that can enhance family centered care. The identified virtual FCR implementation strategies should be tested in further studies.
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Affiliation(s)
- Jaskiran Ranu
- Mercy San Juan Medical Center, Carmichael, California
| | - Kristin R. Hoffman
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Hadley S. Sauers-Ford
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jacob Williams
- Graduate School of Biomedical Sciences & Professional Studies, Drexel University, Philadelphia, Pennsylvania
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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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Massa K, Ramireddy S, Ficenec S, Mank C, Josephsen J, Babbar S. A Randomized Control Trial of Meditation for Mothers Pumping Breastmilk for Preterm Infants. Am J Perinatol 2024; 41:842-852. [PMID: 35240703 DOI: 10.1055/a-1787-7576] [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: 11/01/2022]
Abstract
OBJECTIVE Mothers of preterm infants face unique challenges in establishing milk supply. We hypothesized that daily meditation practice while pumping would increase milk volume. STUDY DESIGN This was a randomized control trial examining the effect of meditation on the breastmilk supply of women delivering preterm infants. The meditation group engaged in daily use of a mindfulness-focused meditation app in addition to routine lactation support. The primary outcome was mean breastmilk volume on the infant's nineth day of life. Secondary outcomes included use of lactation-promoting behaviors, continuation of breastfeeding, and measures of mental health and breastfeeding self-efficacy by validated questionnaires. In addition to the intention to treat analysis, a per protocol analysis examined the association of frequent meditation with these breastfeeding and mental health outcomes. RESULTS A total of 60 women were analyzed. Mean milk volume was 647.1 ± 467.8 mL in the meditation group and 514.9 ± 393.5 mL in the routine care group (p = 0.27). Median number of pumping sessions was 7 (interquartile range [IQR] 5-8) in the meditation group, compared to 6 (IQR 4-7) in the routine care group (p = 0.11). Other lactation-promoting behaviors, breastfeeding continuation, and questionnaire scores were similar.Adjusting for confounders, we found an increase in breastmilk production of 223.2 mL (95% CI 98.8-347.5, p = 0.001) and in pumping episodes by 0.93 (95% CI 0.16-1.70, p = 0.020) associated with frequent meditation. Skin-to-skin contact was increased to 100% (p = 0.006) among women who meditated seven or more times. Adjusted odds of a clinically significant Edinburgh Postnatal Depression Scale score of >9 was 0.057 (95% CI 0.0014-0.711, p = 0.023) with frequent meditation. CONCLUSION Breastmilk production was similar in mothers practicing meditation compared to those receiving routine lactation support. For women engaging in frequent mediation, there may be an effect in establishing breastmilk supply and reduction of depression symptoms. KEY POINTS · Breastmilk is not increased for neonatal intensive care unit (NICU) moms asked to engage in meditation.. · Maternal mental health is not improved among NICU moms asked to meditate.. · However, higher-frequency meditation is associated with increased milk volume and lower odds of high scores on depression screening..
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Affiliation(s)
- Katherine Massa
- Department of Obstetrics and Gynecology, Washington University, Saint Louis, Missouri
| | - Soumya Ramireddy
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Sara Ficenec
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Carolyn Mank
- Department of Obstetrics and Gynecology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Justin Josephsen
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Shilpa Babbar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
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11
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Ginsberg KH, Alsweiler J, Rogers J, Cavadino A, Douglas M, Serlachius A. A digital Acceptance and Commitment Therapy and education intervention targeting stress of parents and caregivers with preterm babies in the neonatal intensive care unit: A randomised controlled cluster trial protocol. Contemp Clin Trials 2024; 140:107519. [PMID: 38547962 DOI: 10.1016/j.cct.2024.107519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Parents with babies in the neonatal intensive care unit (NICU) experience high levels of stress, anxiety, and depression. The NICU experience may also lead to impaired parenting and early childhood socio-emotional problems. Psychosocial interventions can reduce NICU parent distress. Yet many are time-intensive and costly to deliver. Acceptance and Commitment Therapy (ACT), an evidence-based psychological therapy, may address these needs. ACT has been shown to be effective in reducing distress of parents of children with chronic illnesses, particularly when combined with parent education. Therefore, the primary aim of this study is to determine if a digital intervention that uses a brief form of ACT plus parent education will reduce the stress of primary caregivers with preterm babies in the NICU more than a digital education-only intervention or standard care control group. METHODS In a randomised controlled cluster trial design, participants will be randomly assigned to one of three groups: ACT plus education; education-only; or standard care control. The primary outcome will be parental/caregiver stress levels, measured on the Parental Stress Scale: Neonatal Intensive Care Unit. Secondary outcomes include overall stress, anxiety, and depression. Outcome measures will be evaluated at baseline, two weeks after enrolment, discharge to home, and 3-months post-discharge. CONCLUSION This study will explore the efficacy of a digital ACT plus education intervention on parental stress levels. While position papers have advocated for the use of ACT with NICU parents, this study will be the first to test ACT as a stand-alone intervention with this population. TRIAL REGISTRATION This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry on 14 June 2023 (ACTRN12623000641695p).
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Affiliation(s)
- Kristin H Ginsberg
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jen Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Meihana Douglas
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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12
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Rodrigues SM, Shin SS, Pinto MD, Bounds DT, Terry J, Burton CW. Parenting Expectations, NICU Experiences, and Maternal Psychological Outcomes: An Exploratory Mixed-Methods Study. Adv Neonatal Care 2024; 24:195-207. [PMID: 38215024 DOI: 10.1097/anc.0000000000001139] [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: 01/14/2024]
Abstract
BACKGROUND Infant neonatal intensive care unit (NICU) hospitalization increases maternal risk for psychological distress. However, no universal screening standards exist and predicting maternal risk remains challenging. Reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences. PURPOSE This study explored parenting expectation-experience differences (EEDs) among NICU mothers and assessed correlations between EED scores and psychological outcomes 1 to 5 years post-NICU hospitalization. METHODS A 3-phase explanatory sequential mixed-methods design was used. Pearson's correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes. Reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores. RESULTS Most participants (92.9%) reported negative EED scores, indicating NICU experiences fell short of parenting expectations. Significant inverse correlations were found between EED scores and maternal outcomes, including depression ( r = -0.25, P < .01), anxiety ( r = -0.25, P < .01) and posttraumatic stress disorder symptoms ( r = -0.41, P < .001), and perceived parenting self-efficacy ( r = -0.28, P < .01). Major qualitative themes included unexpected versus prepared, lost parenting experiences, and surviving and thriving. Data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations. IMPLICATIONS FOR PRACTICE AND RESEARCH Preparing mothers for infant NICU hospitalization and creating a NICU parenting environment, which better supports mothers and their engagement in parenting tasks, may help to reduce differences between parenting expectations and NICU experiences. Further research is needed to elucidate the impacts of parenting EEDs in this population.
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Affiliation(s)
- Sarah M Rodrigues
- Author Affiliations: Sue & Bill Gross School of Nursing, University of California, Irvine (Drs Rodrigues, Shin, Pinto, and Bounds); Department of Gender & Sexuality Studies, University of California, Irvine (Dr Terry); and School of Nursing, University of Nevada, Las Vegas (Dr Burton)
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13
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Arkin N, Zhao T, Yang Y, Wang L. Development and validation of a novel risk classification tool for predicting long length of stay in NICU blood transfusion infants. Sci Rep 2024; 14:6877. [PMID: 38519538 PMCID: PMC10959994 DOI: 10.1038/s41598-024-57502-3] [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: 10/14/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
Newborns are as the primary recipients of blood transfusions. There is a possibility of an association between blood transfusion and unfavorable outcomes. Such complications not only imperil the lives of newborns but also cause long hospitalization. Our objective is to explore the predictor variables that may lead to extended hospital stays in neonatal intensive care unit (NICU) patients who have undergone blood transfusions and develop a predictive nomogram. A retrospective review of 539 neonates who underwent blood transfusion was conducted using median and interquartile ranges to describe their length of stay (LOS). Neonates with LOS above the 75th percentile (P75) were categorized as having a long LOS. The Least Absolute Shrinkage and Selection Operator (LASSO) regression method was employed to screen variables and construct a risk model for long LOS. A multiple logistic regression prediction model was then constructed using the selected variables from the LASSO regression model. The significance of the prediction model was evaluated by calculating the area under the ROC curve (AUC) and assessing the confidence interval around the AUC. The calibration curve is used to further validate the model's calibration and predictability. The model's clinical effectiveness was assessed through decision curve analysis. To evaluate the generalizability of the model, fivefold cross-validation was employed. Internal validation of the models was performed using bootstrap validation. Among the 539 infants who received blood transfusions, 398 infants (P75) had a length of stay (LOS) within the normal range of 34 days, according to the interquartile range. However, 141 infants (P75) experienced long LOS beyond the normal range. The predictive model included six variables: gestational age (GA) (< 28 weeks), birth weight (BW) (< 1000 g), type of respiratory support, umbilical venous catheter (UVC), sepsis, and resuscitation frequency. The area under the receiver operating characteristic (ROC) curve (AUC) for the training set was 0.851 (95% CI 0.805-0.891), and for the validation set, it was 0.859 (95% CI 0.789-0.920). Fivefold cross-validation indicates that the model has good generalization ability. The calibration curve demonstrated a strong correlation between the predicted risk and the observed actual risk, indicating good consistency. When the intervention threshold was set at 2%, the decision curve analysis indicated that the model had greater clinical utility. The results of our study have led to the development of a novel nomogram that can assist clinicians in predicting the probability of long hospitalization in blood transfused infants with reasonable accuracy. Our findings indicate that GA (< 28 weeks), BW(< 1000 g), type of respiratory support, UVC, sepsis, and resuscitation frequency are associated with a higher likelihood of extended hospital stays among newborns who have received blood transfusions.
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Affiliation(s)
- Nurbiya Arkin
- Department of Neonatal, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Ting Zhao
- Department of Neonatal, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yanqing Yang
- Department of Neonatal, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Le Wang
- Department of Neonatal, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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14
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Guittard C, Eutrope J, Caillies S, Loron G. Effect of tactile and/or kinesthetic stimulation therapy of preterm infants on their parents' anxiety and depressive symptoms: A systematic review. BMC Psychol 2024; 12:3. [PMID: 38167522 PMCID: PMC10759426 DOI: 10.1186/s40359-023-01510-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In the case of preterm birth, the idealized postnatal period is replaced by an anxious and even traumatic experience for parents. Higher prevalence of parental anxiety, postnatal depression, and posttraumatic stress disorder has been observed in mothers of preterm infants up to 18 months after childbirth. There is increasing evidence that proprioceptive stimulation has a beneficial effect on preterms' short-term outcomes. Could this care also have an impact on parental anxiety and depressive symptoms? We reviewed recent publications on the impact on parents' anxiety and depressive symptoms of delivering tactile and/or kinesthetic stimulation to their premature newborn. METHODS We conducted a systematic review by searching the PubMed, PsycInfo, Scopus, ScienceDirect and Google Scholar databases for English-language publications from the past 10 years. We focused on the mothers or fathers of infants born preterm (before 37 weeks of gestation) who provided tactile and/or kinesthetic stimulation to their premature newborn in the neonatal intensive care unit. Relevant outcomes were the parents' anxiety, stress, depressive symptoms, and symptoms of posttraumatic stress disorder, assessed with reliable standardized inventories. RESULTS Eleven articles were included in the systematic review. Results suggested a beneficial effect of parents' early tactile and kinesthetic stimulation of their preterm infants. CONCLUSIONS These interventions may act as protective factors against the occurrence of anxiety and depressive symptoms in parents and deserve to be studied further in this population.
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Affiliation(s)
| | - Julien Eutrope
- Université de Reims Champagne-Ardenne, C2S, CHU Reims, service de psychiatrie de l'enfant et de l'adolescent, F-51100, Reims, France
| | | | - Gauthier Loron
- Université de Reims Champagne-Ardenne, CReSTIC, CHU Reims, service de médecine néonatale et de réanimation pédiatrique, F-51100, Reims, France
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15
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Ciciolla L, Shreffler KM, Quigley AN, Price JR, Gold KP. The Protective Role of Maternal-Fetal Bonding for Postpartum Bonding Following a NICU Admission. Matern Child Health J 2024; 28:11-18. [PMID: 38165585 PMCID: PMC11195440 DOI: 10.1007/s10995-023-03873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Admission of a newborn to a neonatal intensive care unit (NICU) can be a highly stressful event that affects maternal psychological well-being and disrupts the early maternal-infant bonding relationship. Determining factors that promote maternal-infant bonding among those with a NICU admission is essential for the development of effective interventions. METHODS Using a longitudinal clinic-based sample of diverse and low-income pregnant women, we examined whether maternal-fetal bonding measured during the second trimester moderated the association between NICU admission and postpartum bonding measured at six months post birth, controlling for demographic characteristics. RESULTS Approximately 18% of the sample experienced a NICU admission at birth. NICU admission was associated with lower postpartum bonding (b = -8.74; p < .001, Model 1), whereas maternal-fetal bonding was associated with higher bonding reported at six months postpartum (b = 3.74, p < .001, Model 2). Results of the interaction revealed that women who reported higher maternal-fetal bonding reported higher postnatal bonding regardless of NICU admission status. DISCUSSION Because maternal-fetal bonding can be enhanced through intervention, it is a promising target for reducing the risks of NICU admission for the early maternal-infant relationship.
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Affiliation(s)
- Lucia Ciciolla
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Karina M Shreffler
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, 1100 N. Stonewall Ave., Oklahoma City, OK, 73117, USA.
| | - Ashley N Quigley
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Jameca R Price
- School of Community Medicine, University of Oklahoma Health Sciences Center, Tulsa, OK, USA
| | - Karen P Gold
- School of Community Medicine, University of Oklahoma Health Sciences Center, Tulsa, OK, USA
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16
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Chu X, Dai X, Yuan P, Qi G, Shi X. Epidemical trends and risk factors of PTSD in parents of critically ill children: Evidence from both meta-analysis and subgroup analysis. J Affect Disord 2024; 344:242-251. [PMID: 37832741 DOI: 10.1016/j.jad.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Post-Traumatic Stress Disorder (PTSD) in parents traumatized by a child's critical illness, while differences in prevalence and risk factors for parental PTSD in previous studies. This study aimed to assess trends in the prevalence and risk factors for PTSD in parents of critically ill children. METHODS Nine main databases were searched to extract the prevalence, sample size and risk factors from the published literature. Random effects model analysis, I2 statistic, quality assessment, subgroup analysis and sensitivity analysis were performed. RESULTS Twenty-five studies met the inclusion criteria, with pooled prevalence rates of 13.8 % (95 % CI: [confidence interval, CI] 10.0 %-17.7 %) in fathers and 20.2 % (95 % CI:16.1 %-24.3 %) in mothers. Mothers had a significantly higher prevalence of PTSD compared to fathers. The prevalence of PTSD generally increased after discharge, with the highest prevalence at 6 months, but then decreased (fathers: 18.0 %, CI: 6.1 %-29.9 %; mothers: 20.2 %, CI: 12.8 %-27.6 %), respectively. The results showed five risks, positive acute stress disorder (ASD) screening (OR [odds ratio, OR] =2.45), disease severity (OR = 3.78), perceived stress (OR = 1.44), unemployed status (OR = 2.52) and length of hospital stay (OR = 1.01). LIMITATIONS Due to the limitations of the original study, we could not explore trends in the prevalence of PTSD in this particular population over a more extended period after hospital discharge. CONCLUSION The prevalence of PTSD among parents of critically ill children is high and significantly different. Therefore, it is crucial to focus on this vulnerable group, providing them with essential psychological counseling and comprehensive social support to reduce the occurrence of PTSD.
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Affiliation(s)
- Xiangyuan Chu
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiu Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Ping Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Guojia Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China.
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17
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Pettinger KJ, Copper C, Boyle E, Blower S, Hewitt C, Fraser L. Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis. Pediatrics 2023; 152:e2023061878. [PMID: 37946609 PMCID: PMC10657778 DOI: 10.1542/peds.2023-061878] [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] [Accepted: 08/23/2023] [Indexed: 11/12/2023] Open
Abstract
CONTEXT Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk. OBJECTIVES To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks). DATA SOURCES Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature. STUDY SELECTION Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks. DATA EXTRACTION A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses. RESULTS Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58). LIMITATIONS Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies. CONCLUSIONS Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.
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Affiliation(s)
| | | | - Elaine Boyle
- University of Leicester, Leicester, United Kingdom
| | | | | | - Lorna Fraser
- University of York, York, United Kingdom
- King’s College London, London, United Kingdom
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18
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Eves R, Baumann N, Bilgin A, Schnitzlein D, Richter D, Wolke D, Lemola S. Parents' life satisfaction prior to and following preterm birth. Sci Rep 2023; 13:21233. [PMID: 38040950 PMCID: PMC10692203 DOI: 10.1038/s41598-023-48582-8] [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: 04/25/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023] Open
Abstract
The current study tested whether the reported lower wellbeing of parents after preterm birth, relative to term birth, is a continuation of a pre-existing difference before pregnancy. Parents from Germany (the German Socio-Economic Panel Study, N = 10,649) and the United Kingdom (British Household Panel Study and Understanding Society, N = 11,012) reported their new-born's birthweight and gestational age, subsequently categorised as very preterm or very low birthweight (VP/VLBW, < 32 weeks or < 1500 g), moderately/late preterm or low birthweight (MLP/LBW, ≥ 32 weeks and < 37 weeks/≥ 1500 g and < 2500 g), or term-born (≥ 37 weeks and ≥ 2500 g). Mixed models were used to analyse life satisfaction, an aspect of wellbeing, at four assessments-two years and six months before birth and six months and two years afterwards. Two years before birth, satisfaction of prospective term-born, MLP/LBW, or VP/VLBW mothers did not significantly differ. However, mothers of VP/VLBWs had lower satisfaction relative to mothers of term-borns at both assessments post-birth. Among fathers, satisfaction levels were similarly equivalent two years before birth. Subsequently, fathers of VP/VLBWs temporarily differed in satisfaction six months post-birth relative to fathers of term-borns. Results indicate that parents' lower life satisfaction after VP/VLBW birth is not a continuation of pre-existing life satisfaction differences.
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Affiliation(s)
- Robert Eves
- Fakultät Für Psychologie Und Sportwissenschaft, Abteilung Für Psychologie, Universität Bielefeld, 10 01 31, Bielefeld, Germany.
- Department of Psychology, Lifespan Health and Wellbeing Group, University of Warwick, Coventry, UK.
| | - Nicole Baumann
- Department of Health Sciences, University of Leicester, Leicester, UK
- Turner Institute for Brain and Mental Health, School of Psychology Sciences, Monash University, Melbourne, Australia
| | - Ayten Bilgin
- Department of Psychology, University of Essex, Colchester, Essex, UK
| | - Daniel Schnitzlein
- Leibniz University of Hannover, Hannover, Germany
- IZA Bonn, Bonn, Germany
| | - David Richter
- German Institute for Economic Research, (DIW Berlin, Deutsches Institut Für Wirtschaftsforschung E.V.), Berlin, Germany
| | - Dieter Wolke
- Department of Psychology, Lifespan Health and Wellbeing Group, University of Warwick, Coventry, UK
| | - Sakari Lemola
- Fakultät Für Psychologie Und Sportwissenschaft, Abteilung Für Psychologie, Universität Bielefeld, 10 01 31, Bielefeld, Germany
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19
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Bansal S, Willis R, Barks MC, Pollak KI, Brandon D, Kaye EC, Lemmon ME. Supporting Disclosure of Unmet Mental Health Needs among Parents of Critically Ill Infants. J Pediatr 2023; 262:113596. [PMID: 37399922 PMCID: PMC10757990 DOI: 10.1016/j.jpeds.2023.113596] [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: 02/10/2023] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To characterize (1) the prevalence of mental health discussion and (2) facilitators of and barriers to parent disclosure of mental health needs to clinicians. STUDY DESIGN Parents of infants with neurologic conditions in neonatal and pediatric intensive care units participated in a longitudinal decision-making study from 2018 through 2020. Parents completed semi-structured interviews upon enrollment, within 1 week after a conference with providers, at discharge, and 6 months post-discharge. We used a conventional content analysis approach and NVIVO 12 to analyze data related to mental health. RESULTS We enrolled 61 parents (n = 40 mothers, n = 21 fathers) of 40 infants with neurologic conditions in the intensive care unit. In total, 123 interviews were conducted with 52 of these parents (n = 37 mothers, n = 15 fathers). Over two-thirds of parents (n = 35/52, 67%) discussed their mental health in a total of 61 interviews. We identified two key domains when approaching the data through the lens of mental health: (1) self-reported barriers to communicating mental health needs: parents shared uncertainty about the presence or benefit of support, a perceived lack of mental health resources and emotional support, and concerns about trust; (2) self-reported facilitators and benefits of communicating mental health needs: parents described the value of supportive team members, connecting to peer support, and speaking to a mental health professional or neutral third party. CONCLUSIONS Parents of critically ill infants are at high risk of unmet mental health needs. Our results highlight modifiable barriers and actionable facilitators to inform interventions to improve mental health support for parents of critically ill infants.
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Affiliation(s)
- Simran Bansal
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rheaya Willis
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Mary C Barks
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Debra Brandon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke University School of Nursing, Durham, NC
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
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20
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Cuervo S, Creaghead N, Vannest J, Hunter L, Ionio C, Altaye M, Parikh NA. Language Outcomes of Children Born Very Preterm in Relation to Early Maternal Depression and Anxiety. Brain Sci 2023; 13:1355. [PMID: 37891724 PMCID: PMC10605035 DOI: 10.3390/brainsci13101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Unaddressed maternal psychological distress within the first year postpartum is known to have numerous negative consequences on the child's developmental outcomes, including language acquisition. This study examined the relationship between early maternal psychosocial factors and the language outcomes of children born very preterm (VPT; ≤32 weeks gestational age). It used data from the Cincinnati Infant Neurodevelopment Early Prediction Study, an ongoing National-Institutes-of-Health-funded prospective, multicenter cohort investigation of VPT infants. A total of 243 (125 boys; 118 girls) children born VPT (M = 29.03 weeks of gestation; SD = 2.47) and their corresponding 207 mothers (34 with multiple infants) were included in this study. We did not find an association between maternal depression or anxiety and Bayley-III (M = 92.3, SD = 18.9) language scores. Additionally, maternal grit and self-efficacy did not modify the relationship between depression and anxiety and language scores. A higher level of maternal education and infant female sex were significantly associated with higher language scores. While preterm birth typically results in higher rates of depression and anxiety for parents, the findings suggest that maternal depression, anxiety, and grit and the self-efficacy of the mothers in this sample did not relate to the language development of their children, independent of maternal education and infant female sex.
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Affiliation(s)
- Sisan Cuervo
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nancy Creaghead
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
| | - Lisa Hunter
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
| | - Chiara Ionio
- Department of Psychology, Catholic University of the Sacred Heart, 00168 Milano, Italy;
| | - Mekibib Altaye
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nehal A. Parikh
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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21
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Traino KA, Fisher RS, Basile NL, Dattilo TM, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Kolon TF, Lakshmanan Y, Palmer BW, Mullins LL, Ciciolla LM, Wisniewski AB. Adverse Birth Experiences and Parent Adjustment Associated With Atypical Genital Appearance Due to Differences of Sex Development. J Pediatr Psychol 2023; 48:759-767. [PMID: 37500595 PMCID: PMC10516460 DOI: 10.1093/jpepsy/jsad042] [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: 03/20/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Differences/disorders of sex development (DSDs) are rare, congenital conditions involving discordance between chromosomes, gonads, and phenotypic sex and are often diagnosed in infancy. A key subset of parents of children newly diagnosed with a DSD experience clinically elevated distress. The present study examines the relationship between perinatal factors (i.e., gestational age, delivery method) and trajectories of parental adjustment. METHODS Parent participants (mothers = 37; fathers = 27) completed measures at baseline, 6- and 12-month follow-up. Multilevel linear regression controlled for clustering of the data at three levels (i.e., time point, parent, and family) and examined the relationship between perinatal factors and trajectories of depressive and anxious symptoms. Two-way interactions between perinatal factors and parent type were evaluated. RESULTS Overall depressive and anxious symptoms decreased over time. There were significant interactions between gestational age and parent type for depressive and anxious symptoms, with younger gestational age having a stronger negative effect on mothers vs. fathers. There was a significant interaction between time and gestational age for depressive symptoms, with 36 weeks' gestational age demonstrating a higher overall trajectory of depressive symptoms across time compared to 38 and 40 weeks. Findings for the delivery method were not significant. CONCLUSIONS Findings uniquely demonstrated younger gestational age was associated with increased depressive symptoms, particularly for mothers compared to fathers. Thus, a more premature birth may predispose parents of infants with DSD to distress. Psychosocial providers should contextualize early diagnosis-related discussions within stressful birth experiences when providing support.
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Affiliation(s)
- Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Yee-Ming Chan
- Division of Endocrinology, and Harvard Medical School, Boston Children’s Hospital, USA
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Douglas E Coplen
- Division of Urologic Surgery, St. Louis Children’s Hospital, USA
| | - Thomas F Kolon
- Division of Urology, Children’s Hospital of Philadelphia, USA
| | | | - Blake W Palmer
- Department of Pediatric Urology, Cook Children’s Medical Center, USA
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Lucia M Ciciolla
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
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Shaw RJ, Givrad S, Poe C, Loi EC, Hoge MK, Scala M. Neurodevelopmental, Mental Health, and Parenting Issues in Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1565. [PMID: 37761526 PMCID: PMC10528009 DOI: 10.3390/children10091565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
The World Health Organization in its recommendations for the care of preterm infants has drawn attention to the need to address issues related to family involvement and support, including education, counseling, discharge preparation, and peer support. A failure to address these issues may translate into poor outcomes that extend across the lifespan. In this paper, we review the often far-reaching impact of preterm birth on the health and wellbeing of the parents and highlight the ways in which psychological stress may have a negative long-term impact on the parent-child interaction, attachment, and the styles of parenting. This paper addresses the following topics: (1) neurodevelopmental outcomes in preterm infants, including cognitive, sensory, and motor difficulties, (2) long-term mental health issues in premature infants that include elevated rates of anxiety and depressive disorders, autism, and somatization, which may affect social relationships and quality of life, (3) adverse mental health outcomes for parents that include elevated rates of depression, anxiety, and symptoms of post-traumatic stress, as well as increased rates of substance abuse, and relationship strain, (4) negative impacts on the parent-infant relationship, potentially mediated by maternal sensitivity, parent child-interactions, and attachment, and (5) impact on the parenting behaviors, including patterns of overprotective parenting, and development of Vulnerable Child Syndrome. Greater awareness of these issues has led to the development of programs in neonatal mental health and developmental care with some data suggesting benefits in terms of shorter lengths of stay and decreased health care costs.
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Affiliation(s)
- Richard J. Shaw
- Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; (E.C.L.); (C.P.)
| | - Soudabeh Givrad
- Division of Child and Adolescent Psychiatry, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065, USA;
| | - Celeste Poe
- Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; (E.C.L.); (C.P.)
| | - Elizabeth C. Loi
- Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; (E.C.L.); (C.P.)
| | - Margaret K. Hoge
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Melissa Scala
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA;
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Handley SC, Formanowski B, Passarella M, Kozhimannil KB, Leonard SA, Main EK, Phibbs CS, Lorch SA. Perinatal Care Measures Are Incomplete If They Do Not Assess The Birth Parent-Infant Dyad As A Whole. Health Aff (Millwood) 2023; 42:1266-1274. [PMID: 37669487 PMCID: PMC10901240 DOI: 10.1377/hlthaff.2023.00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Measures of perinatal care quality and outcomes often focus on either the birth parent or the infant. We used linked vital statistics and hospital discharge data to describe a dyadic measure (including both the birth parent and the infant) for perinatal care during the birth hospitalization. In this five-state cohort of 2010-18 births, 21.6 percent of birth parent-infant dyads experienced at least one complication, and 9.6 percent experienced a severe complication. Severe infant complications were eight times more prevalent than severe birth parent complications. Among birth parents with a severe complication, the co-occurrence of a severe infant complication ranged from 2 percent to 51 percent, whereas among infants with a severe complication, the co-occurrence of a severe birth parent complication was rare, ranging from 0.04 percent to 5 percent. These data suggest that measures, clinical interventions, public reporting, and policies focused on either the birth parent or the infant are incomplete in their assessment of a healthy dyad. Thus, clinicians, administrators, and policy makers should evaluate dyadic measures, incentivize positive outcomes for both patients (parent and infant), and create policies that support the health of the dyad.
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Affiliation(s)
- Sara C Handley
- Sara C. Handley , Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Ciaran S Phibbs
- Ciaran S. Phibbs, Palo Alto Veterans Affairs Medical Center, Menlo Park, California; and Stanford University
| | - Scott A Lorch
- Scott A. Lorch, Children's Hospital of Philadelphia and University of Pennsylvania
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24
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Madsen KB, Liu X, Albiñana C, Vilhjálmsson BJ, Agerbo E, Mortensen PB, Hougaard DM, Nordentoft M, Werge T, Mors O, Børglum AD, Munk-Olsen T. Genetic liability to posttraumatic stress disorder and its association with postpartum depression. Psychol Med 2023; 53:5052-5059. [PMID: 35811373 PMCID: PMC10782827 DOI: 10.1017/s0033291722002045] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childbirth may be a traumatic experience and vulnerability to posttraumatic stress disorder (PTSD) may increase the risk of postpartum depression (PPD). We investigated whether genetic vulnerability to PTSD as measured by polygenic score (PGS) increases the risk of PPD and whether a predisposition to PTSD in PPD cases exceeds that of major depressive disorder (MDD) outside the postpartum period. METHODS This case-control study included participants from the iPSYCH2015, a case-cohort of all singletons born in Denmark between 1981 and 2008. Restricting to women born between 1981 and 1997 and excluding women with a first diagnosis other than depression (N = 22 613), 333 were identified with PPD. For each PPD case, 999 representing the background population and 993 with MDD outside the postpartum were matched by calendar year at birth, cohort selection, and age. PTSD PGS was calculated from summary statistics from the Psychiatric Genomics Consortium with LDpred2-auto. Odds ratios (ORs) were estimated using conditional logistic regression adjusted for parental psychiatric history and country of origin, PGS for MDD and age at first birth, and the first 10 principal components. RESULTS The PTSD PGS was significantly associated with PPD (OR 1.42, 95% CI 1.20-1.68 per standard deviation increase in PTSD PGS) compared to healthy female controls. Genetic PTSD vulnerability in PPD cases did not exceed that of matched female depression cases outside the postpartum period (OR 1.10, 95% CI 0.94-1.30 per standard deviation increase). CONCLUSIONS Genetic vulnerability to PTSD increased the risk of PPD but did not differ between PPD cases and women with depression at other times.
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Affiliation(s)
- Kathrine Bang Madsen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Xiaoqin Liu
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Clara Albiñana
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Bjarni Jóhann Vilhjálmsson
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - David Michael Hougaard
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Merete Nordentoft
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Werge
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Lundbeck Foundation Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
| | - Anders D. Børglum
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Biomedicine and the iSEQ Center, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, CGPM, Aarhus, Denmark
| | - Trine Munk-Olsen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Research Unit of Psychiatry, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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Ozdil M. Postpartum Depression Among Mothers of Infants Hospitalized in the Neonatal Intensive Care Unit During the COVID-19 Pandemic. Cureus 2023; 15:e44380. [PMID: 37779733 PMCID: PMC10540708 DOI: 10.7759/cureus.44380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background Neonatal intensive care unit (NICU) hospitalization of newborn babies has been shown to have a negative impact on the mental health of postpartum women. The mental health of new mothers may be further burdened by the effects of the coronavirus disease 2019 (COVID-19) pandemic on social, economic, and psychological dimensions. This study aimed to evaluate postpartum depression and related factors in mothers of infants hospitalized in NICU during two distinct COVID-19 pandemic periods and examine any additional effects of the pandemic on the mental health of postpartum women. Methodology The Edinburgh Postpartum Depression Scale (EPDS) was applied to 250 NICU mothers during the COVID-19 pandemic. The first 125 women's children were hospitalized during a period of high number of cases and deaths when restrictions were in place for NICU parental visits (November 2021 to February 2022, the early group). The remaining 125 women completed the scale when there was a lower number of cases and restrictions had been eased (March to June 2022, the late group). Results In the early group, the EPDS scores were statistically higher (7.53.9 vs. 5.63.4; p < 0.001), smoking and NICU stay duration were significantly higher (p = 0.01), whereas the duration of marriage was significantly lower (p = 0.01). Women in the late group with EPDS scores ≥13 were statistically less educated (p = 0.01). EPDS scores ≥13 were significantly associated with depression during pregnancy and with a history of abortion/stillbirth/neonatal death (odds ratio (OR) = 5.240, 95% confidence interval (CI) 1.114 to 27.967, p = 0.03 and OR = 1.641, 95% CI = 1.009 to 2.669, p = 0.04, respectively). Conclusions NICU admission is a significant maternal risk factor for postpartum depression due to the disruption of maternal-infant bonding, and this risk may be exacerbated during times of global public health crises such as the COVID-19 pandemic. Depression during pregnancy and the presence of a perinatal loss may also contribute to worse postpartum mental outcomes in NICU mothers.
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Affiliation(s)
- Mine Ozdil
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Balıkesir Atatürk City Hospital, Balıkesir, TUR
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26
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Hwang SS, Weikel BW, Palau MA, Greenfield JC, Klawetter S, Neu M, Roybal KL, Scott J, Shah P, Bourque SL. NICU Visitation Time and Adherence to Safe Sleep Practices Among Mothers of Very Preterm Infants. Adv Neonatal Care 2023; 23:365-376. [PMID: 37036938 PMCID: PMC10524197 DOI: 10.1097/anc.0000000000001066] [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: 04/12/2023]
Abstract
BACKGROUND Sleep-associated infant death is the leading cause of postneonatal mortality in the United States. Preterm infants are at higher risk for sleep-associated death, but maternal adherence to safe sleep practices is lower than for mothers of full-term infants. Data are lacking on whether maternal neonatal intensive care unit (NICU) visitation time impacts safe sleep compliance after hospital discharge. PURPOSE For mothers of preterm infants, to investigate the association of time days per week spent in the NICU and adherence to safe sleep practices after discharge. METHODS A prospective observational study of 109 mothers with infants born at less than 32 weeks from 4 Colorado NICUs who completed a survey at 6 weeks after discharge about infant sleep practices. Maternal time spent in the NICU was defined as the average number of days spent in the NICU per week of infant hospitalization, as documented in the electronic medical record. Multivariable logistic regression models assessed the relationship between time in the NICU and safe sleep adherence. Covariates included maternal/infant characteristics significant at P < .2 level in bivariate analysis. RESULTS Predictors of compliance with all safe infant sleep practices included public/no insurance compared with private insurance (adjusted odds ratio [AOR] 0.29; 95% confidence interval [CI] 0.09-0.96), some college/associate-level education versus bachelor's degree (AOR 5.88; 95% CI 1.21-28.67), and depression/anxiety symptoms (AOR 0.37; 95% CI 0.14-0.97). NICU visitation days was not associated with adherence to safe sleep practices. IMPLICATIONS FOR PRACTICE AND RESEARCH Maternal visitation days was not associated with adherence to safe infant sleep practices after discharge, highlighting the need to identify barriers and facilitators to engaging families about SUID risk-reducing behaviors.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora (Drs Hwang, Palau, and Bourque and Mss Weikel and Scott); Graduate School of Social Work, University of Denver, Denver, Colorado (Dr Greenfield and Mss Roybal and Shah); School of Social Work, Portland State University, Portland, Oregon (Dr Klawetter); and College of Nursing, University of Colorado, Aurora (Dr Neu)
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27
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Ginsberg KH, Serlachius A, Rogers J, Alsweiler J. Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey. J Pediatr 2023; 259:113456. [PMID: 37172808 DOI: 10.1016/j.jpeds.2023.113456] [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] [Received: 12/04/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand. STUDY DESIGN A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices. RESULTS Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P < .001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents. CONCLUSIONS Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.
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Affiliation(s)
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jen Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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28
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Pierce SK, Reynolds KA, Jakobson LS, Ricci MF, Roos LE. Unmet Parental Mental Health Service Needs in Neonatal Follow-Up Programs: Parent and Service Provider Perspectives. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1174. [PMID: 37508670 PMCID: PMC10378703 DOI: 10.3390/children10071174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Parental mental health services in neonatal follow-up programs (NFUPs) are lacking though needed. This study aimed to determine (1) the unmet mental health needs of parents and (2) the parent and provider perspectives on barriers and opportunities to increase mental health service access. Study 1: Parents in a central Canadian NFUP (N = 49) completed a mixed-method online survey (analyzed descriptively and by content analysis) to elucidate their mental health, related service use, barriers to service use, and service preferences. Study 2: Virtual focus groups with NFUP service providers (N = 5) were run to inform service improvements (analyzed by reflexive thematic analysis). The results show that parents endorsed a 2-4 times higher prevalence of clinically significant depression (59.2%), anxiety (51.0%), and PTSD (26.5%) than the general postpartum population. Most parents were not using mental health services (55.1%) due to resource insecurity among parents (e.g., time, cost) and the organization (e.g., staffing, training, referrals). Consolidating parents' and service providers' perspectives revealed four opportunities for service improvements: bridging services, mental health screening, online psychoeducation, and peer support. Findings clarify how a central Canadian NFUP can address parental mental health in ways that are desired by parents and feasible for service providers.
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Affiliation(s)
- Shayna K Pierce
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Kristin A Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB R3E 3N4, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Lorna S Jakobson
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - M Florencia Ricci
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Manitoba Neonatal Follow-Up Program, Winnipeg, MB R3E 3G1, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
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Dubner SE, Morales MC, Marchman VA, Shaw RJ, Travis KE, Scala M. Maternal mental health and engagement in developmental care activities with preterm infants in the NICU. J Perinatol 2023; 43:871-876. [PMID: 37046070 PMCID: PMC10096104 DOI: 10.1038/s41372-023-01661-0] [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: 12/13/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To examine associations between maternal mental health and involvement in developmental care in the NICU. STUDY DESIGN Mothers of infants born <32 weeks gestation (n = 135) were approached to complete mental health screening questionnaires at two weeks after admission. Mothers who completed screening (n = 55) were further classified as with (n = 19) and without (n = 36) elevated scores. Mothers' frequency, rate, and duration of developmental care activities were documented in the electronic health record. RESULTS 35% of screened mothers scored above the cutoff for clinical concern on ≥1 measure. No significant differences between the 3 groups were identified for rates, frequency, or amount of all developmental care, kangaroo care, and swaddled holding. CONCLUSION Elevated scores on maternal mental health questionnaires did not relate to developmental care. Maternal developmental care engagement may not indicate mental health status. Universal screening for psychological distress is required to accurately detect symptoms in mothers of hospitalized preterm infants.
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Affiliation(s)
- Sarah E Dubner
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Maya Chan Morales
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Virginia A Marchman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Richard J Shaw
- Division of Child Psychiatry, Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine E Travis
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa Scala
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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30
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Brady S, Steinwurtzel R, Kim R, Abascal E, Lane M, Brachio S. Improving Postpartum Depression Screening in the NICU: Partnering with Students to Improve Outreach. Pediatr Qual Saf 2023; 8:e674. [PMID: 37434597 PMCID: PMC10332827 DOI: 10.1097/pq9.0000000000000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Infants born to mothers with postpartum depression (PPD) are at risk for adverse developmental outcomes. Mothers of premature infants are 40% more likely to develop PPD when compared with the general population. Current published studies on implementing PPD screening in the Neonatal Intensive Care Unit (NICU) do not comply with the American Academy of Pediatrics (AAP) guideline, which recommends multiple screening points in the first year postpartum and includes partner screening. Our team implemented PPD screening that follows the AAP guideline and includes partner screening for all parents of infants admitted to our NICU beyond 2 weeks of age. Methods The Institute For Healthcare Improvement Model for Improvement was the framework for this project. Our initial intervention bundle included provider education, standardized identification of parents to be screened, and bedside screening performed by the nurse with social work follow-up. This intervention transitioned to weekly screening by phone by health professional students and the use of the electronic medical record for notification of team members of screening results. Results Under the current process, 53% of qualifying parents are screened appropriately. Of the parents screened, 23% had a positive Patient Health Questionnaire-9 requiring referral for mental health services. Conclusions Implementing a PPD screening program that complies with the AAP standard is feasible within a Level 4 NICU. Partnering with health professional students greatly improved our ability to screen parents consistently. Given the high percentage of parents with PPD uncovered with appropriate screening, this type of program has a clear need within the NICU.
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Affiliation(s)
- Sinead Brady
- From the Division of Neonatal and Perinatal Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, N.Y
| | - Rochelle Steinwurtzel
- From the Division of Neonatal and Perinatal Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, N.Y
| | - Rachel Kim
- Mailman School of Public Health, Columbia University, New York, N.Y
| | | | - Mariellen Lane
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, N.Y
| | - Sandhya Brachio
- From the Division of Neonatal and Perinatal Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, N.Y
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Orovou E, Eskitzis P, Mrvoljak-Theodoropoulou I, Tzitiridou-Hatzopoulou M, Dagla M, Arampatzi C, Iliadou M, Antoniou E. The Relation between Neonatal Intensive Care Units and Postpartum Post-Traumatic Stress Disorder after Cesarean Section. Healthcare (Basel) 2023; 11:1877. [PMID: 37444711 DOI: 10.3390/healthcare11131877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The experience of a neonate hospitalized in the NICU is an understandably traumatic experience for parents, especially for the mothers of neonates. This mental distress resulting from preterm birth and/or NICU hospitalization can be understood as post-traumatic symptomatology, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 version). The aim of this study is to investigate the impact of the admission of a neonate to the NICU (forany reason) on the development of postpartum PTSD in a sample of women after cesarean section. METHODS A total of 469 women who gave birth with cesarean section from July 2019 to June 2020 participated in this study out of the original sample of 490 women who consented to participate. Data were obtained from the researcher's socio-demographic questionnaire and the post-traumatic stress checklist (PCL-5) from the Diagnostic and Statistical Manual of Mental Disorders DCM-5 version. RESULTS In total,11.7% of the sample experienced postpartum PTSD. There is a strong relationship between the inclusion of a neonate to the NICU due to perinatal stress, breathing difficulties, infections, and IUGR with postpartum PTSD (37.7%) in relation to the perinatal stress Criterion A (fear for the life of the neonate), the first criterion of postpartum PTSD. CONCLUSIONS Additional measures must be taken for mothers of children who have been admitted to the neonatal intensive care unit with psychological support interventions and a reassessment of their mental state.
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Affiliation(s)
- Eirini Orovou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Christiana Arampatzi
- Department of Midwifery, University of Western Macedonia, Keptse, 50200 Ptolemaida, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, Agioy Spyridonos 28, 12243 Egaleo, Greece
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Spence CM, Stuyvenberg CL, Kane AE, Burnsed J, Dusing SC. Parent Experiences in the NICU and Transition to Home. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6050. [PMID: 37297654 PMCID: PMC10252259 DOI: 10.3390/ijerph20116050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6-8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.
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Affiliation(s)
- Christine M. Spence
- Department of Counseling and Special Education, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Corri L. Stuyvenberg
- Rehabilitation Science Graduate Program, Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Audrey E. Kane
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Jennifer Burnsed
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, USA;
| | - Stacey C. Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90033, USA;
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Sadler EM, Okito O, Soghier L. Addressing caregiver mental health in the neonatal ICU. Curr Opin Pediatr 2023; 35:390-397. [PMID: 36974450 DOI: 10.1097/mop.0000000000001242] [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: 03/29/2023]
Abstract
PURPOSE OF REVIEW The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals. RECENT FINDINGS Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes. SUMMARY To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU. VIDEO ABSTRACT http://links.lww.com/MOP/A70.
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Affiliation(s)
- Erin M Sadler
- Division of Psychology and Behavioral Health
- Department of Pediatrics
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Ololade Okito
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
| | - Lamia Soghier
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
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Klawetter S, Weikel B, Roybal K, Cetin N, Uretsky MC, Bourque SL, Hall A, Hwang SS, Neu M, Palau MA, Scott J, Shah P, Greenfield JC. Social Determinants of Health and Parenting Self-Efficacy Among Mothers of Preterm Infants. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2023; 14:411-429. [PMID: 37441191 PMCID: PMC10336838 DOI: 10.1086/716303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Objective To explore the relationships between social and environmental factors and parenting self-efficacy (PSE) among mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) using a social determinants of health (SDoH) framework. Method We analyzed data from a prospective cohort study that included 187 mother-infant dyads admitted to four NICUs in the Mountain West region between June 2017 and December 2019. We used multivariable linear regression models to assess the independent associations between maternal and infant characteristics and PSE. Results Our final multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant (F(12,160) = 3.17, p = .0004, adjusted R¬2 = .131). Significant predictors of PSE were race/ethnicity (β= 3.3, p = .022), having another child/children (β= 4.2, p = .005), and depression (β= -4.2, p = .004). Conclusions Findings suggest that social workers and medical practitioners should consider SDoH, such as insurance type, household income, and employment, along with traditional clinical indicators when assessing families' infant care needs. Social workers, medical practitioners, and researchers should be mindful of how implicit bias may influence the allocation of care and parental supports.
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Affiliation(s)
- Susanne Klawetter
- Portland State University, School of Social Work, PO Box 751-SSW, Portland, OR 97207
| | - Blair Weikel
- University of Colorado, School of Medicine, 13121 East 17 Avenue, Education 2 South, Mailstop 8402, Aurora, CO 80045
| | - Kristi Roybal
- University of Denver Graduate School of Social Work, 2148 S. High St., Denver, CO 80208
| | - Nazan Cetin
- Portland State University, School of Social Work, PO Box 751-SSW, Portland, OR 97207
| | - Mathew C Uretsky
- Portland State University, School of Social Work, PO Box 751-SSW, Portland, OR 97207
| | - Stephanie L Bourque
- University of Colorado, School of Medicine, 13121 East 17 Avenue, Education 2 South, Mailstop 8402, Aurora, CO 80045
| | - Anne Hall
- University of Colorado, School of Medicine, 13121 East 17 Avenue, Education 2 South, Mailstop 8402, Aurora, CO 80045
| | - Sunah S Hwang
- University of Colorado, School of Medicine, 13121 East 17 Avenue, Education 2 South, Mailstop 8402, Aurora, CO 80045
| | - Madalynn Neu
- University of Colorado, College of Nursing, 13120 E. 19 Ave, C-288-18, Aurora, CO 80045
| | - Mauricio A Palau
- University of Colorado, School of Medicine, 13121 East 17 Avenue, Education 2 South, Mailstop 8402, Aurora, CO 80045
| | - Jessica Scott
- University of Colorado, School of Medicine, 13121 East 17 Avenue, Education 2 South, Mailstop 8402, Aurora, CO 80045
| | - Pari Shah
- University of Denver Graduate School of Social Work, 2148 S. High St., Denver, CO 80208
| | - Jennifer C Greenfield
- University of Denver Graduate School of Social Work, 2148 S. High St., Denver, CO 80208
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Gong J, Fellmeth G, Quigley MA, Gale C, Stein A, Alderdice F, Harrison S. Prevalence and risk factors for postnatal mental health problems in mothers of infants admitted to neonatal care: analysis of two population-based surveys in England. BMC Pregnancy Childbirth 2023; 23:370. [PMID: 37217846 PMCID: PMC10201804 DOI: 10.1186/s12884-023-05684-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Previous research suggests that mothers whose infants are admitted to neonatal units (NNU) experience higher rates of mental health problems compared to the general perinatal population. This study examined the prevalence and factors associated with postnatal depression, anxiety, post-traumatic stress (PTS), and comorbidity of these mental health problems for mothers of infants admitted to NNU, six months after childbirth. METHODS This was a secondary analysis of two cross-sectional, population-based National Maternity Surveys in England in 2018 and 2020. Postnatal depression, anxiety, and PTS were assessed using standardised measures. Associations between sociodemographic, pregnancy- and birth-related factors and postnatal depression, anxiety, PTS, and comorbidity of these mental health problems were explored using modified Poisson regression and multinomial logistic regression. RESULTS Eight thousand five hundred thirty-nine women were included in the analysis, of whom 935 were mothers of infants admitted to NNU. Prevalence of postnatal mental health problems among mothers of infants admitted to NNU was 23.7% (95%CI: 20.6-27.2) for depression, 16.0% (95%CI: 13.4-19.0) for anxiety, 14.6% (95%CI: 12.2-17.5) for PTS, 8.2% (95%CI: 6.5-10.3) for two comorbid mental health problems, and 7.5% (95%CI: 5.7-10.0) for three comorbid mental health problems six months after giving birth. These rates were consistently higher compared to mothers whose infants were not admitted to NNU (19.3% (95%CI: 18.3-20.4) for depression, 14.0% (95%CI: 13.1-15.0) for anxiety, 10.3% (95%CI: 9.5-11.1) for PTS, 8.5% (95%CI: 7.8-9.3) for two comorbid mental health problems, and 4.2% (95%CI: 3.6-4.8) for three comorbid mental health problems six months after giving birth. Among mothers of infants admitted to NNU (N = 935), the strongest risk factors for mental health problems were having a long-term mental health problem and antenatal anxiety, while social support and satisfaction with birth were protective. CONCLUSIONS Prevalence of postnatal mental health problems was higher in mothers of infants admitted to NNU, compared to mothers of infants not admitted to NNU six months after giving birth. Experiencing previous mental health problems increased the risk of postnatal depression, anxiety, and PTS whereas social support and satisfaction with birth were protective. The findings highlight the importance of routine and repeated mental health assessments and ongoing support for mothers of infants admitted to NNU.
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Affiliation(s)
- Jenny Gong
- 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, UK
| | - Gracia Fellmeth
- 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, UK
| | - Maria A Quigley
- 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, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Campus, 369 Fulham Road, London, 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, Johannesburg, South Africa
- African Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - 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, UK
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Siân 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, UK.
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Segre LS, McCabe JE, Davila RC, Carter C, O'Hara MW, Arndt S. A Randomized Controlled Trial of Listening Visits for Mothers of Hospitalized Newborns. Nurs Res 2023; 72:229-235. [PMID: 36920154 PMCID: PMC10329483 DOI: 10.1097/nnr.0000000000000650] [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: 03/16/2023]
Abstract
BACKGROUND Emotional distress is frequently experienced by mothers whose newborns are hospitalized in a neonatal intensive care unit (NICU). Among these women, there is a critical need for emotional support conveniently delivered at the newborn's point of care by a trusted and medically knowledgeable professional: a NICU nurse. One promising way to enhance in situ delivery of emotional care is to have a NICU nurse provide Listening Visits (LVs), a brief support intervention developed expressly for delivery by nurses to depressed postpartum women. OBJECTIVES This trial assessed the feasibility of having NICU nurses deliver LVs to emotionally distressed mothers of hospitalized newborns and compared depression outcomes in a small sample of participants randomized to LVs or usual care (UC). METHODS In this pilot randomized controlled trial, emotionally distressed mothers of hospitalized newborns were randomized to receive up to six LVs from a NICU nurse or UC from a NICU social worker. To assess change in depression symptoms, women were invited to complete the Inventory of Depression and Anxiety Symptoms-General Depression Scale at enrollment and 4 and 8 weeks post-enrollment. RESULTS Depression symptoms declined over time for both groups, with no difference between the two groups. A post hoc analysis of reliable change found higher rates of improvement at the 4-week assessment among recipients of LVs than UC. DISCUSSION NICU nurses successfully implemented LVs during this trial. Depression symptom scores did not significantly differ in the two groups posttreatment or at follow-up. Nevertheless, post hoc analyses indicated comparatively higher rates of clinical improvement immediately after LVs, suggesting the intervention can reduce maternal depression early on when women are most distressed.
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Nance N, Badon SE, Ridout K, Ahern J, Li DK, Quesenberry C, Avalos LA. Associations between antidepressant use patterns during pregnancy and birth outcomes among periconception antidepressant users. Pharmacotherapy 2023; 43:372-380. [PMID: 36872575 PMCID: PMC10857746 DOI: 10.1002/phar.2790] [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: 11/03/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Little is known about antidepressant medication use patterns during pregnancy among periconception (before and immediately following conception) users. Additionally, the associations between these patterns and birth outcomes is unclear, after taking into account underlying depression severity. OBJECTIVE This study describes patterns of antidepressant use among periconception users and examines associations between usage patterns and birth outcomes. STUDY DESIGN This retrospective cohort study included pregnant Kaiser Permanente Northern California (KPNC) members with a live birth between 2014 and 2017 and an antidepressant medication fill that overlapped the 8th week of pregnancy. Outcomes were preterm birth and neonatal intensive care unit (NICU) admission. Data were extracted from KPNC's electronic health records. Modified Poisson regression was conducted. RESULTS Of the 3637 pregnancies meeting inclusion criteria, 33% (n = 1204) continued antidepressant use throughout the pregnancy (refilled throughout pregnancy), 47% (n = 1721) discontinued use (no refills), and 20% (n = 712) stopped and reinitiated use (refill after 30+ day gap in supply). Women who continued use had 1.86 (95% confidence interval (CI) 1.53, 2.27) times the risk of preterm birth and 1.76 (95% CI: 1.42, 2.19) times the risk of NICU admission, compared to women who discontinued use during pregnancy. Similarly, women with continued use had 1.66 (95% CI: 1.27, 2.18) times the risk of preterm birth and 1.85 (95% CI: 1.39, 2.46) times the risk of NICU admission, compared to women who stopped and reinitiated use. This relationship held when examining continuous exposure; the relationship between continuous exposure and preterm delivery was stronger in later trimesters. CONCLUSIONS Periconception antidepressant users who continue use during pregnancy, particularly into the second and third trimesters, may be at higher risk of adverse birth outcomes. This evidence should be considered alongside the risks associated with depression relapse.
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Affiliation(s)
- Nerissa Nance
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- University of California, Berkeley, Berkeley, California, USA
| | - Sylvia E Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Jennifer Ahern
- University of California, Berkeley, Berkeley, California, USA
| | - De-Kun Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Charles Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Laccetta G, Di Chiara M, De Nardo MC, Terrin G. Symptoms of post-traumatic stress disorder in parents of preterm newborns: A systematic review of interventions and prevention strategies. Front Psychiatry 2023; 14:998995. [PMID: 36970259 PMCID: PMC10032332 DOI: 10.3389/fpsyt.2023.998995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/07/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundPreterm birth and subsequent NICU admission can be a traumatic experience for parents who may subsequently develop post-traumatic stress (PTS) disorder (PTSD). Given that developmental issues are common among children of parents with PTSD, interventions for prevention and treatment are essential.ObjectiveTo assess the most effective non-pharmacological interventions to prevent and/or treat PTS symptoms in parents of preterm newborns.MethodsSystematic review performed in accordance with the PRISMA statements. Eligible articles in English language were searched in MEDLINE, Scopus, and ISI Web of Science databases using the following medical subject headings and terms: “stress disorder, post-traumatic,” “parents,” “mothers,” “fathers,” “infant, newborn,” “intensive care units, neonatal,” and “premature birth.” The terms “preterm birth” and “preterm delivery” were also used. Unpublished data were searched in ClinicalTrials.gov website. All intervention studies published until September 9th, 2022 and including parents of newborns with gestational age at birth (GAb) <37 weeks which underwent ≥1 non-pharmaceutical interventions for prevention and/or treatment of PTS symptoms related to preterm birth were included. Subgroup analyses were conducted by type of intervention. The quality assessment was performed according to the criteria from the RoB-2 and the “NIH Quality Assessment Tool for Before-After studies.”ResultsSixteen thousand six hundred twenty-eight records were identified; finally, 15 articles (1,009 mothers, 44 fathers of infants with GAb ≤ 366/7 weeks) were included for review. A good standard of NICU care (effective as sole intervention: 2/3 studies) and education about PTSD (effective in association with other interventions: 7/8 studies) could be offered to all parents of preterm newborns. The 6-session Treatment Manual is a complex intervention which revealed itself to be effective in one study with low risk of bias. However, the effectiveness of interventions still remains to be definitively established. Interventions could start within 4 weeks after birth and last 2–4 weeks.ConclusionThere is a wide range of interventions targeting PTS symptoms after preterm birth. However, further studies of good quality are needed to better define the effectiveness of each intervention.
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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: 7] [Impact Index Per Article: 7.0] [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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Community health workers as change agents in improving equity in birth outcomes in Detroit. PLoS One 2023; 18:e0281450. [PMID: 36787290 PMCID: PMC9928129 DOI: 10.1371/journal.pone.0281450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
We examined whether pairing pregnant women with community health workers improved pregnancy outcomes among 254 Black women with singleton pregnancies participating in the Women-Inspired Neighborhood (WIN) Network: Detroit using a case-control design. A subset (N = 63) of women were recontacted and asked about program satisfaction, opportunities, and health behaviors. Michigan Vital Statistics records were used to ascertain controls (N = 12,030) and pregnancy and infant health outcomes. Logistic and linear regression were used to examine the association between WIN Network participation and pregnancy and infant health outcomes. The WIN Network participants were less likely than controls to be admitted to the neonatal intensive care unit (odds ratio = 0.55, 95% CI 0.33-0.93) and had a longer gestational length (mean difference = 0.42, 95% CI 0.02-0.81). Community health workers also shaped participants' view of opportunities to thrive. This study demonstrates that community health workers can improve pregnancy outcomes for Black women.
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Oxytocin Levels Increase and Anxiety Decreases in Mothers Who Sing and Talk to Their Premature Infants during a Painful Procedure. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020334. [PMID: 36832462 PMCID: PMC9955880 DOI: 10.3390/children10020334] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
(1) Background: Preterm infants spend their first weeks of life in the hospital partially separated from their parents and subjected to frequent potentially painful clinical procedures. Previous research has found that early vocal contact reduces infant pain perception while simultaneously increasing oxytocin (OXT) levels. The current study aims to assess the effect of maternal singing and speaking on mothers. (2) Methods: During a painful procedure over two days, twenty preterm infants were randomly exposed to their mother's live voice (speaking or singing). Maternal OXT levels were measured twice: before and after singing, as well as before and after speaking. The anxiety and resilience responses of mothers were studied before and after the two-day interventions, regardless of the speaking/singing condition. OXT levels in mothers increased in response to both singing and speech. Concurrently, anxiety levels decreased, but no significant effects on maternal resilience were found. (3) Conclusions: OXT could be identified as a key mechanism for anxiety regulation in parents, even in sensitive care situations, such as when their infant is in pain. Active involvement of parents in the care of their preterm infants can have a positive effect on their anxiety as well as potential benefits to their sensitivity and care abilities through OXT.
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Sakonidou S, Kotzamanis S, Tallett A, Poots AJ, Modi N, Bell D, Gale C. Parents' Experiences of Communication in Neonatal Care (PEC): a neonatal survey refined for real-time parent feedback. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324548. [PMID: 36717224 DOI: 10.1136/archdischild-2022-324548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/03/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Assessing parent experiences of neonatal services can help improve quality of care; however, there is no formally evaluated UK instrument available to assess this prospectively. Our objective was to refine an existing retrospective survey for 'real-time' feedback. METHODS Co-led by a parent representative, we recruited a convenience sample of parents of infants in a London tertiary neonatal unit. Our steering group selected questions from the existing retrospective 61-question Picker survey (2014), added and revised questions assessing communication and parent involvement. We established face validity, ensuring questions adequately captured the topic, conducted parent cognitive interviews to evaluate parental understanding of questions,and adapted the survey in three revision cycles. We evaluated survey performance. RESULTS The revised Parents' Experiences of Communication in Neonatal Care (PEC) survey contains 28 questions (10 new) focusing on communication and parent involvement. We cognitively interviewed six parents, and 67 parents completed 197 PEC surveys in the survey performance evaluation. Missing entries exceeded 5% for nine questions; we removed one and format-adjusted the rest as they had performed well during cognitive testing. There was strong inter-item correlation between two question pairs; however, all were retained as they individually assessed important concepts. CONCLUSION Revised from the original 61-question Picker survey, the 28-question PEC survey is the first UK instrument formally evaluated to assess parent experience while infants are still receiving neonatal care. Developed with parents, it focuses on communication and parent involvement, enabling continuous assessment and iterative improvement of family-centred interventions in neonatal care.
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Affiliation(s)
- Susanna Sakonidou
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Sophia Kotzamanis
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | | | | | - Neena Modi
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Derek Bell
- NIHR CLAHRC for Northwest London, London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
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Collette K, Feeley N, Galipeau R, Lebel V. Acceptability and feasibility of a digital educational intervention designed to improve the psychological well-being of parents with a preterm infant at the neonatal intensive care unit: A pilot project. Early Hum Dev 2023; 176:105717. [PMID: 36724661 DOI: 10.1016/j.earlhumdev.2023.105717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Families experience psychological distress when their preterm infant is in the Neonatal Intensive Care Unit. A tailored educational intervention may be beneficial for their psychological well-being. Unfortunately, existing websites have moderate to low information quality and there is no educational website for French-speaking parents. AIM To measure the acceptability and feasibility of a digital educational intervention designed to improve the psychological well-being of parents with a preterm infant, as well as the acceptability and feasibility of the study methods used. METHODS A pilot randomized controlled trial was conducted. Participants were randomized to have access to either an educational website or information pamphlet. They were invited to complete an online questionnaire about stress and depressive symptoms 2 and 4 weeks after recruitment. An online questionnaire regarding the acceptability of the intervention and the data collection process was completed 5 weeks after recruitment. RESULTS Twenty parents participated. All participants with access to the website considered it was acceptable in terms of the appropriateness, convenience, and efficiency to meet their informational needs. 85 % of participants assigned to the website viewed it 1 to 3 times per day during the data collection period and 69.4 % consulted the website for 5 to 20 min each time. The data collection process was acceptable for 85 % to 95 % of participants. DISCUSSION The educational website was an acceptable and feasible intervention and the data collection process used was acceptable according to participants.
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Affiliation(s)
- Kimberley Collette
- Université du Québec en Outaouais, Nursing Department, 5 rue St-Joseph, St-Jérôme, Québec J7Z 0B7, Canada.
| | - Nancy Feeley
- Ingram School of Nursing at McGill University, Montreal, Québec, Canada; Jewish General Hospital Centre for Nursing Research, Lady Davis Institute, Montreal, Québec, Canada
| | - Roseline Galipeau
- Université du Québec en Outaouais, Nursing Department, 5 rue St-Joseph, St-Jérôme, Québec J7Z 0B7, Canada
| | - Valérie Lebel
- Université du Québec en Outaouais, Nursing Department, 5 rue St-Joseph, St-Jérôme, Québec J7Z 0B7, Canada.
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Fu M, Song W, Yu G, Yu Y, Yang Q. Risk factors for length of NICU stay of newborns: A systematic review. Front Pediatr 2023; 11:1121406. [PMID: 36994438 PMCID: PMC10040659 DOI: 10.3389/fped.2023.1121406] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023] Open
Abstract
Background The improvement in survival of preterm infants is accompanied by an increase in neonatal intensive care unit (NICU) admissions. Prolonged length of stay in the NICU (LOS-NICU) increases the incidence of neonatal complications and even mortality and places a significant economic burden on families and strain on healthcare systems. This review aims to identify risk factors influencing LOS-NICU of newborns and to provide a basis for interventions to shorten LOS-NICU and avoid prolonged LOS-NICU. Methods A systematic literature search was conducted in PubMed, Web of Science, Embase, and Cochrane library for studies that were published in English from January 1994 to October 2022. The PRISMA guidelines were followed in all phases of this systematic review. The Quality in Prognostic Studies (QUIPS) tool was used to assess methodological quality. Results Twenty-three studies were included, 5 of which were of high quality and 18 of moderate quality, with no low-quality literature. The studies reported 58 possible risk factors in six broad categories (inherent factors; antenatal treatment and maternal factors; diseases and adverse conditions of the newborn; treatment of the newborn; clinical scores and laboratory indicators; organizational factors). Conclusions We identified several of the most critical risk factors affecting LOS-NICU, including birth weight, gestational age, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. As only a few high-quality studies are available at present, well-designed and more extensive prospective studies investigating the risk factors affecting LOS-NICU are still needed in the future.
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Affiliation(s)
- Maoling Fu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenshuai Song
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Genzhen Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Genzhen Yu
| | - Yaqi Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoyue Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Parental resilience and psychological distress in the neonatal intensive care unit. J Perinatol 2022; 42:1504-1511. [PMID: 35927487 DOI: 10.1038/s41372-022-01478-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the associations between parental resilience and psychological distress during the neonatal intensive care unit (NICU) hospitalization. STUDY DESIGN Observational cohort study of parents of preterm infants (n = 45) admitted to a NICU between December 2017-October 2019. Data on resilience and psychological distress were collected using validated scales. Regression analysis was used to evaluate associations. RESULT One-third of NICU parents screened positive for depression or anxiety. There were no identified sociodemographic factors or parental engagement activities associated with resilience. Parents with higher resilience had lower scores on depression and anxiety screens. However, resilience alone was not a predictor for a positive depression or anxiety screen (aOR 0.93, CI 0.86-1.00; aOR 0.95, CI 0.89-1.02, respectively). CONCLUSION Resilience may be associated with lower scores on depression and anxiety screens but is not an independent predictor for a positive screen during the early NICU hospitalization.
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The Association between NICU Admission and Mental Health Diagnoses among Commercially Insured Postpartum Women in the US, 2010-2018. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101550. [PMID: 36291486 PMCID: PMC9600206 DOI: 10.3390/children9101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
Maternal mental health (MH) conditions represent a leading cause of preventable maternal death in the US. Neonatal Intensive Care Unit (NICU) hospitalization influences MH symptoms among postpartum women, but a paucity of research uses national samples to explore this relationship. Using national administrative data, we examined the rates of MH diagnoses of anxiety and/or depression among those with and without an infant admitted to a NICU between 2010 and 2018. Using generalized estimating equation models, we explored the relationship between NICU admission and MH diagnoses of anxiety and/or depression, secondarily examining the association of NICU length of stay and race/ethnicity with MH diagnoses of anxiety and/or depression post NICU admission. Women whose infants became hospitalized in the NICU for <2 weeks had 19% higher odds of maternal MH diagnoses (aOR: 1.19, 95% CI: 1.14%−1.24%) and those whose infants became hospitalized for >2 weeks had 37% higher odds of maternal MH diagnoses (aOR: 1.37 95% CI: 1.128%−1.47%) compared to those whose infants did not have a NICU hospitalization. In adjusted analyses, compared to white women, all other race/ethnicities had significantly lower odds of receiving a maternal MH condition diagnosis [Black (aOR = 0.76, 0.73−0.08), Hispanic (aOR = 0.69, 0.67−0.72), and Asian (aOR: 0.32, 0.30−0.34)], despite higher rates of NICU hospitalization. These findings suggest a need to target the NICU to improve maternal MH screening, services, and support while acknowledging the influence of social determinants, including race and ethnicity, on health outcomes.
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Types, Evidence, and Resources of Interventions Focused on Improving the Psychosocial Well-being of Parents of Premature/Sick Infants: A Scoping Review. Adv Neonatal Care 2022; 22:E138-E151. [PMID: 34224480 DOI: 10.1097/anc.0000000000000913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Torr C. Culturally competent care in the neonatal intensive care unit, strategies to address outcome disparities. J Perinatol 2022; 42:1424-1427. [PMID: 35241768 DOI: 10.1038/s41372-022-01360-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Abstract
In the past two years, we have witnessed social unrest, the unequal effects of a pandemic across our society, and a focus on how systems in the United States produce unequal outcomes along racial and cultural divides. With increased national awareness, there has also been a call for change in healthcare, specifically racial inequities in Neonatal Intensive Care Unit (NICU) outcomes (1). While race may be a data point used to classify outcomes, it has no basis in biology, and merely identifying it does not make it simple to address. To address these inequities we need to look past the social construct of race and to the social aspects of our care in the NICU. Focusing on small and large changes that we can make as individuals, units, and as a specialty that can improve the care and outcomes of this at-risk patient population. This perspective focuses on culturally congruent care, trauma-informed care, and other approaches to reduce disparities in neonatal outcomes.
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Affiliation(s)
- Carrie Torr
- University of Utah School of Medicine, Salt Lake City, UT, USA.
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O'Toole S, Suarez C, Adair P, McAleese A, Willis S, McCormack D. A Systematic Review of the Factors Associated with Post-Traumatic Growth in Parents Following Admission of Their Child to the Intensive Care Unit. J Clin Psychol Med Settings 2022; 29:509-537. [PMID: 35526209 PMCID: PMC9399044 DOI: 10.1007/s10880-022-09880-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
This systematic review aims to identify the demographic, clinical and psychological factors associated with post-traumatic growth (PTG) in parents following their child's admission to the intensive care unit (ICU). Papers published up to September 2021 were identified following a search of electronic databases (PubMed, Medline, Web of Science, PsycINFO, CINAHL, PTSDpubs and EMBASE). Studies were included if they involved a sample of parents whose children were previously admitted to ICU and reported correlational data. 1777 papers were reviewed. Fourteen studies were eligible for inclusion; four were deemed to be of good methodological quality, two were poor, and the remaining eight studies were fair. Factors associated with PTG were identified. Mothers, and parents of older children, experienced greater PTG. Parents who perceived their child's illness as more severe had greater PTG. Strong associations were uncovered between PTG and post-traumatic stress, psychological well-being and coping. PTG is commonly experienced by this population. Psychological factors are more commonly associated with PTG in comparison with demographic and clinical factors, suggesting that parents' subjective ICU experience may be greater associated with PTG than the objective reality.
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Affiliation(s)
- S O'Toole
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK.
| | - C Suarez
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - P Adair
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - A McAleese
- Clinical Psychology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - S Willis
- Clinical Psychology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - D McCormack
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
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Mindfulness and Relaxation-Based Interventions to Reduce Parental Stress, Anxiety and/or Depressive Symptoms in the Neonatal Intensive Care Unit: A Systematic Review. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09902-8. [PMID: 35984549 PMCID: PMC9388971 DOI: 10.1007/s10880-022-09902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Abstract
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.
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