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Sandnes R, Le Floch M, Riquin E, Nocus I, Müller JB, Bacro F. Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings. J Affect Disord 2024; 355:513-525. [PMID: 38556094 DOI: 10.1016/j.jad.2024.03.154] [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: 04/13/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND In recent years, there has been a wide array of research studies published on parental mental health and stress following very preterm birth. This review aims at reviewing the prevalence and risk factors of long-term parental depression, anxiety, post-traumatic stress symptoms and parenting stress following very preterm birth. METHODS We searched PubMed, PsychINFO and Web of Science for descriptive, cross-sectional and longitudinal studies published between January 2013 and August 2022. RESULTS 45 studies met our inclusion criteria. In the first two years, depression, anxiety, post-traumatic stress symptoms and parenting stress were present in ∼20 % of mothers of extreme and very low birth weight (E/VLBW) infants. Long-term psychological distress symptoms could be observed, although few studies have focused on symptoms into school age and longer. Fathers of VLBW infants might experience more psychological distress as well, however, they were only included in ten studies. We found that parental distress is more common when the co-parent is struggling with mental health symptoms. Many risk factors were identified such as social risk, history of mental illness, interpersonal factors (i.e. social support) and child-related factors (i.e. intraventricular hemorrhage, disability, use of medical equipment at home). LIMITATIONS Several studies have methodological issues, such as a lack of control of known confounders and there is a large variety of measures employed. CONCLUSION Important risk factors for stress and mental health symptoms were identified. More evidence is needed to determine if long-term symptoms persist into school age. Research should focus on taking a family-based approach in order to identify preventive strategies and resilience factors in parents of VLBW infants.
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Affiliation(s)
- Ramona Sandnes
- Faculty of Psychology, Centre de Recherche en Education de Nantes (CREN - UR 2661), Nantes University, Nantes, France.
| | - Marine Le Floch
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, France
| | - Elise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, France; Univ Angers, [CHU Angers], LPPL EA4638, F-49000 Angers, France; Fondation de Santé des Étudiants de France, clinique de Sablé sur Sarthe, Sablé sur Sarthe, France
| | - Isabelle Nocus
- Faculty of Psychology, Centre de Recherche en Education de Nantes (CREN - UR 2661), Nantes University, Nantes, France
| | - Jean Baptiste Müller
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France; Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Fabien Bacro
- Faculty of Psychology, Centre de Recherche en Education de Nantes (CREN - UR 2661), Nantes University, Nantes, France
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Ramirez JD, Sarik DA, Matsuda Y, Ortiz J. Best Practices to Support Maternal Mental Health During the Transition from Neonatal Intensive Care Unit to Home: A Scoping Review. Crit Care Nurs Clin North Am 2024; 36:261-280. [PMID: 38705693 DOI: 10.1016/j.cnc.2023.11.006] [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: 05/07/2024]
Abstract
Mothers with an infant hospitalized in the neonatal intensive care unit (NICU) are at an increased risk of mental health concerns, including depression and anxiety. Successful mental health support during the critical time of transition from hospital to home requires careful consideration of the mothers' mental health beginning during the NICU stay. Major themes from a scoping review to identify best practices to support maternal mental health include (1) comprehensive evaluation of needs and continuity of care, (2) key role of in-person support, and (3) the potential to use technology-based support to increase mental health support.
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Affiliation(s)
- Jazmin D Ramirez
- University of Miami School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, FL 33146, USA
| | | | - Yui Matsuda
- University of Miami School of Nursing and Health Studies, 5030 Brunson Drive, Coral Gables, FL 33146, USA
| | - Joy Ortiz
- Neonatal Intensive Care Unit, Nicklaus Children's Hospital, 3100 Southwest 62nd Avenue, Miami, FL 33155, USA
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3
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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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4
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Mira A, Coo S, Bastías R. Mother's mental health and the interaction with her moderate preterm baby in the NICU. J Reprod Infant Psychol 2024; 42:299-314. [PMID: 35635499 DOI: 10.1080/02646838.2022.2077921] [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: 02/09/2021] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Moderate preterm infants, born between 320/7 and 336/7 weeks, represent a significant number of preterm-born infants; however, they remain a poorly studied group despite their vulnerability. The objective of this correlational study is to describe the impact of having a moderate preterm infant hospitalised in the NICU on the mothers' mental health and how this relates to the interaction between the dyad. METHOD During the hospitalisation period, 85 moderate preterm mother-infant dyads participated in this study. The participants provided self-reports of depression, parental stress, and skin to skin and breastfeeding practices. Also, mother-infant interaction was assessed in the NICU with an observational scale. RESULTS Mothers evidenced high levels of stress and depressive symptoms during the hospitalization. The stress experienced by these women was significant, although weakly, associated with the interaction with their babies; and mothers of small for gestational age babies showed difficulties in this area. CONCLUSIONS The results of this study could represent a contribution to a better understanding of the relation between the characteristics of moderate preterm babies, maternal emotional wellbeing, and the quality of mother-infant interactions in NICU settings.
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Affiliation(s)
- Andrea Mira
- Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Santiago, Chile
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Soledad Coo
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Rodolfo Bastías
- Unidad de Neonatología, Hospital Luis Tisné T., Servicio de Salud Metropolitana Oriente, Santiago, Chile
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Jones L, Mariapun J, Tan AXQ, Kassim Z, Su TT. Maternal wellbeing of Malaysian mothers after the birth of a preterm infant. BMC Pregnancy Childbirth 2023; 23:510. [PMID: 37442958 DOI: 10.1186/s12884-023-05823-y] [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: 09/12/2022] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In Malaysia approximately 7% of births result in a preterm birth (< 37 weeks). Research in many other countries has found that mothers of preterm infants experience poorer psychological wellbeing. However, there has been limited research in Malaysia. We examined wellbeing, using the WHO Quality of Life brief version questionnaire (WHOQOL-BREF), in mothers who have preterm and full-term infants. METHODS Data was collected as part of the South East Asian Community Observatory MISS-P project. A total of 3221 mothers (7.9% with a preterm and 92.1 with a full-term birth) completed a survey, with a range of measures, including the WHOQoL-BREF and sociodemographic questions. RESULTS For the physical health, psychological wellbeing and quality of their environment WHOQOL-BREF domains, a lower gestational age, a lower education level, and having had an emergency caesarean delivery were significantly associated (p < 0.05) with a lower quality of life, and there was a weak effect for ethnicity for some domains. The effects were strongest for mothers' education level. CONCLUSIONS There is a weak but significant relationship between the gestational age of an infant and the mother's quality of life. Mothers in Malaysia with a preterm infant or a lower level of education may benefit from additional support.
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Affiliation(s)
- Liz Jones
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Malaysia), Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia.
| | - Jeevitha Mariapun
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Malaysia), Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - Abbey Xiao Qian Tan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Malaysia), Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - Zaid Kassim
- 2Segamat District Public Health Office, Ministry of Health, 85000, Segamat, Johor, Malaysia
| | - Tin Tin Su
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Malaysia), Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University (Malaysia), Jalan Lagoon, Selatan, Bandar Sunway, Selangor State, Malaysia
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6
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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 2023. [PMID: 37072014 DOI: 10.1055/s-0043-1768132] [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] [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
- 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
- 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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7
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Regalado D, Connolly ME, Krutsch K, Stark A, Kendall-Tackett K, Garner CD. Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199391. [PMID: 37746858 PMCID: PMC10521288 DOI: 10.1177/17455057231199391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population. OBJECTIVES This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns. DESIGN Anonymous, online cross-sectional survey. METHODS Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS. RESULTS The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns. CONCLUSION Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.
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Affiliation(s)
- Diego Regalado
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Meghan E. Connolly
- School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Kaytlin Krutsch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, TX, USA
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Amy Stark
- Department of Psychiatry, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | | | - Christine D. Garner
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, TX, USA
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, USA
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8
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Asaka Y, Mitani Y, Ohta H, Nakazawa T, Fukutomi R, Kobayashi K, Kumagai M, Shinohara H, Yoshida M, Ando A, Yoshimura Y, Nakagawa M, Oishi Y, Mizushima M, Adachi H, Kaneshi Y, Morioka K, Seto Y, Shimabukuro R, Hirata M, Ikeda T, Ozawa M, Takeshima M, Manabe A, Takahashi T, Mishima K, Kikuchi M, Yoda H, Kusakawa I, Cho K. Preterm toddlers have low nighttime sleep quality and high daytime activity. Sci Rep 2022; 12:20032. [PMID: 36414705 PMCID: PMC9681750 DOI: 10.1038/s41598-022-24338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
A number of studies have been made on the sleep characteristics of children born preterm in an attempt to develop methods to address the sleep problems commonly observed among such children. However, the reported sleep characteristics from these studies vary depending on the observation methods used, i.e., actigraphy, polysomnography and questionnaire. In the current study, to obtain reliable data on the sleep characteristics of preterm-born children, we investigated the difference in sleep properties between 97 preterm and 97 term toddlers of approximately 1.5 years of age using actigraphy. Actigraphy units were attached to the toddlers' waists with an adjustable elastic belt for 7 consecutive days, and a child sleep diary was completed by their parents. In the study, we found that preterm toddlers had more nocturnal awakenings and more daytime activity, suggesting that preterm-born children may have a different process of sleep development in their early development.
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Affiliation(s)
- Yoko Asaka
- grid.260026.00000 0004 0372 555XDepartment of Maternal and Child Health Nursing, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, 514-8507 Japan
| | - Yusuke Mitani
- grid.9707.90000 0001 2308 3329Department of Pediatrics, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Hidenobu Ohta
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan ,grid.416859.70000 0000 9832 2227Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi-Cho, Kodaira, Tokyo 187-8553 Japan ,Department of Psychiatry, Asai Hospital, 38-1 Togane, Chiba, 283-0062 Japan ,grid.251924.90000 0001 0725 8504Department of Occupational Therapy, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Takayo Nakazawa
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Rika Fukutomi
- grid.419588.90000 0001 0318 6320Department of Pediatric Nursing, Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-0044 Japan
| | - Kyoko Kobayashi
- grid.419588.90000 0001 0318 6320Department of Pediatric Nursing, Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-0044 Japan
| | - Mayuko Kumagai
- grid.251924.90000 0001 0725 8504Department of Nursing, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Hitomi Shinohara
- grid.462295.e0000 0004 0370 9568Graduate School of Nursing, Hyogo University, 2301 Shinzaike, Hiraoka-Cho, Kakogawa, 675-0195 Japan
| | - Michiko Yoshida
- grid.39158.360000 0001 2173 7691Department of Nursing, Faculty of Health Sciences, Hokkaido University, N12, W5, Kita-Ku, Sapporo, 060-0812 Japan
| | - Akiko Ando
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Yuko Yoshimura
- grid.9707.90000 0001 2308 3329Institute of Human and Social Sciences, Kanazawa University, Kakuma-Machi, Kanazawa, 921-1192 Japan ,grid.9707.90000 0001 2308 3329Research Center for Child Mental Development, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Machiko Nakagawa
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan ,grid.452874.80000 0004 1771 2506Department of Neonatology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541 Japan
| | - Yoshihisa Oishi
- grid.414929.30000 0004 1763 7921Department of Pediatrics, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935 Japan
| | - Masato Mizushima
- Department of Neonatology, Sapporo City Hospital, N11, W13, Chuo-Ku, Sapporo, 060-8604 Japan
| | - Hiroyuki Adachi
- grid.251924.90000 0001 0725 8504Department of Pediatrics, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543 Japan
| | - Yosuke Kaneshi
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Keita Morioka
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Yoshitaka Seto
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Rinshu Shimabukuro
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan ,grid.63906.3a0000 0004 0377 2305Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Ohkura, Setagaya-Ku, Tokyo, 157-8535 Japan
| | - Michio Hirata
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan ,grid.411827.90000 0001 2230 656XDepartment of Child Studies, Faculty of Human Sciences and Design, Japan Women’s University, 2-8-1 Mejirodai, Bunkyo-Ku, Tokyo, 112-8681 Japan
| | - Takashi Ikeda
- grid.9707.90000 0001 2308 3329Research Center for Child Mental Development, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Miwa Ozawa
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
| | - Masahiro Takeshima
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Atsushi Manabe
- grid.39158.360000 0001 2173 7691Department of Pediatrics, Hokkaido University Graduate School of Medicine, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
| | - Tsutomu Takahashi
- grid.251924.90000 0001 0725 8504Department of Pediatrics, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543 Japan
| | - Kazuo Mishima
- grid.251924.90000 0001 0725 8504Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Mitsuru Kikuchi
- grid.9707.90000 0001 2308 3329Research Center for Child Mental Development, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan ,grid.9707.90000 0001 2308 3329Department of Psychiatry and Neurobiology, Kanazawa University, 13-1 Takara-Machi, Kanazawa, 920-8640 Japan
| | - Hitoshi Yoda
- grid.452874.80000 0004 1771 2506Department of Neonatology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541 Japan
| | - Isao Kusakawa
- grid.430395.8Department of Pediatrics, St. Luke’s International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560 Japan
| | - Kazutoshi Cho
- grid.412167.70000 0004 0378 6088Maternity and Perinatal Care Center, Hokkaido University Hospital, N15, W7, Kita-Ku, Sapporo, 060-8638 Japan
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9
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Meng L, Lingling Z, Haihong Z, Xiaobai Z, Dandan H, Shaoyan W. Readiness for Hospital Discharge and Its Correlation with the Quality of Discharge Teaching among the Parents of Premature Infants in NICU. Appl Bionics Biomech 2022; 2022:4924021. [PMID: 35874642 PMCID: PMC9300354 DOI: 10.1155/2022/4924021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess the extent of the readiness for hospital discharge and the correlation with discharge teaching quality among parents of premature infants' in the NICU. Background Low readiness for discharge from the hospital can lead to negative outcomes in healthcare for infants born prematurely and their parents. Discharge guidelines are a basic approach to ensure the readiness of the parents for discharge from the hospital. No investigation has ever been conducted into the sufficiency of hospital discharge guidelines for premature infants and their impact on parental readiness for hospital discharge. Design Data was collected from four hospitals in China using a correlational descriptive study. Methods Two hundred and eight parents of premature NICU-hospitalized infants of four tertiary hospitals in Henan Province from May to October 2020 were enrolled. The general information questionnaire, the readiness for hospital discharge scale- (RHDS-) parent form, and the quality of discharge teaching scale- (QDTS-) parent form were used for data collection. Spearman correlation analysis and descriptive statistics were used to analyze the data. Results The total score for hospital discharge readiness was high (8.05 ± 1.11). The total score of the quality of discharge guidelines was moderate (7.44 ± 1.44). Moreover, the discharge teaching quality was positively correlated with the parents' readiness. Positive correlations were found between PRHDS and QDTS subscales, including content received and delivery, physical-emotional status, knowledge, and expected support. Conclusion The quality of the discharge guidelines perceived by parents of premature infants was moderate, which may have reduced their readiness for hospital discharge. Relevance to Clinical Practice. This study furnishes basic information on the importance of readiness of discharge for the parents of premature infants. The teaching guides nurses to enhance the quality of discharge teaching and the readiness of parents for discharge from the hospital.
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Affiliation(s)
- Li Meng
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhang Lingling
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Zhang Haihong
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Zhang Xiaobai
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Huang Dandan
- The First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, 471003, China
| | - Wu Shaoyan
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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10
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Goodman SH, Muzik M, Simeonova DI, Kidd SA, Owen MT, Cooper B, Kim CY, Rosenblum KL, Weiss SJ. Maternal Interaction With Infants Among Women at Elevated Risk for Postpartum Depression. Front Psychol 2022; 13:737513. [PMID: 35310268 PMCID: PMC8929344 DOI: 10.3389/fpsyg.2022.737513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/27/2022] [Indexed: 12/03/2022] Open
Abstract
Ample research links mothers’ postpartum depression (PPD) to adverse interactions with their infants. However, most studies relied on general population samples, whereas a substantial number of women are at elevated depression risk. The purpose of this study was to describe mothers’ interactions with their 6- and 12-month-old infants among women at elevated risk, although with a range of symptom severity. We also identified higher-order factors that best characterized the interactions and tested longitudinal consistency of these factors from 6 to 12 months of infant age. We leveraged data from eight projects across the United States (n = 647), using standardized depression measures and an adaptation of the NICHD Mother-Infant Interaction Scales. Overall, these depression-vulnerable mothers showed high levels of sensitivity and positive regard and low levels of intrusiveness, detachment, and negative regard with their infants. Factor analyses of maternal behaviors identified two overarching factors—“positive engagement” and “negative intrusiveness” that were comparable at 6 and 12 months of infant age. Mothers’ ability to regulate depressed mood was a key behavior that defined “positive engagement” in factor loadings. An exceptionally strong loading of intrusiveness on the second factor suggested its central importance for women at elevated depression risk. Mothers with severe depressive symptoms had significantly more “negative intrusiveness” and less “positive engagement” with their 6-month-old infants than women with moderate or fewer depressive symptoms, suggesting a potential tipping point at which symptoms may interfere with the quality of care. Results provide the foundation for further research into predictors and moderators of women’s interactions with their infant among women at elevated risk for PPD. They also indicate a need for evidence-based interventions that can support more severely depressed women in providing optimal care.
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Affiliation(s)
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | | | - Sharon A. Kidd
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States
| | - Margaret Tresch Owen
- Department of Psychology, The University of Texas at Dallas, Richardson, TX, United States
| | - Bruce Cooper
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States
| | - Christine Y. Kim
- Department of Psychology, Emory University, Atlanta, GA, United States
- The Pennsylvania State University (PSU), University Park, PA, United States
| | - Katherine L. Rosenblum
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Sandra J. Weiss
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Sandra J. Weiss,
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11
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Zubaidah Z, Rustina Y, Nurhaeni N, Hastono SP. Experience of Mother on Caring of Children with Low Birth Weight in an Urban Setting, Indonesia: A Descriptive Phenomenological Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2021.8260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Low birth weight is a major public health issue; it causes higher mortality rate among neonatal. Therefore, it is essential for caregivers to know how to save the baby’s life with evidence-based practices at home. The previous studies found that low birth weight mothers had poor awareness caring their babies at home care adequately.
AIM: The objective of the study was to explore experience of mothers on caring for children with low birth weight from an urban setting in a low-middle-income country.
METHODS: This was a descriptive phenomenological approach. This study was conducted in a rural setting in the Semarang region of Indonesia. Ten mothers whose babies with low birth weight had been discharged from the perinatology care unit in a secondary level hospital and resided in Semarang were interviewed in their homes using a semi-structured interview guide. Data were audiotaped, transcribed verbatim, and analyzed inductively by content analysis.
RESULTS: Twenty mothers aged 20–37 years were interviewed. Most of the babies were moderate to late preterm, and the gestational age at delivery ranged between 33 and 38 weeks gestation, and the birth weights of the babies ranged between 1.4 and 2 kg. Five major themes emerged, which included the psychological response of mothers, sharing information related to the care procedure, breastfeeding, social support, and health-seeking behavior.
CONCLUSIONS: The findings indicate that home management of low birth weight babies poses multiple needs and is associated with poor quality of care. Hence, extensive education and identification of other social support systems are needed to augment facility-based care for mothers and their babies.
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12
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Vohr BR, McGowan EC, Brumbaugh JE, Hintz SR. Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth. J Pediatr 2022; 241:12-21. [PMID: 34673090 DOI: 10.1016/j.jpeds.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI.
| | - Elisabeth C McGowan
- Department of Pediatrics, Alpert Medical School of Brown University and Women & Infants Hospital, Providence, RI
| | - Jane E Brumbaugh
- Children's Center of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Susan R Hintz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA
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13
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NICU discharge preparation and transition planning: editorial. J Perinatol 2022; 42:1-2. [PMID: 35165373 PMCID: PMC9010287 DOI: 10.1038/s41372-022-01310-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Mautner E, Stern C, Avian A, Deutsch M, Fluhr H, Greimel E. Maternal Resilience and Postpartum Depression at the Neonatal Intensive Care Unit. Front Pediatr 2022; 10:864373. [PMID: 35620147 PMCID: PMC9127378 DOI: 10.3389/fped.2022.864373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The neonatal intensive care unit causes maternal stress and postpartum depressive symptoms in preterm and term mothers. Personal resources like maternal resilience are usually not considered in counselling these women. OBJECTIVE This study aims to evaluate the resilience and differences in postpartum depression after admission of newborns at the neonatal intensive care unit. METHODS This prospective pilot study was conducted in a single teaching hospital in Austria from December 2016 until December 2018. Sixty women completed two internationally validated questionnaires, the Edinburgh Postnatal Depression Scale (EPDS) to evaluate depressive symptoms and the Resilience Scale RS-13 to measure maternal resilience during the postpartum period (3 to 10 days postpartum). Additionally, women answered two open questions about burdens and relief. RESULTS Twenty women (34%) showed lower resilience scores. The 39 high-resilient women (66%) showed significantly less depression (p = 0.005). Women reported social support from their partner (n = 15), health professionals and psychologists (n = 15), family and friends (n = 12), and child-specific relief, e.g., spending time with the newborn and involvement in care (n = 7) as the most helpful variable during the first postpartum period. CONCLUSION The experience of having a newborn at the neonatal intensive care unit is a challenging event for women. Women have different resilience parameters. Mothers with lower resilience will benefit from social support and emotional health-promoting activities.
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Affiliation(s)
- Eva Mautner
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.,Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Christina Stern
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Maria Deutsch
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.,Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Herbert Fluhr
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Elfriede Greimel
- Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.,Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
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15
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Malouf R, Harrison S, Burton HA, Gale C, Stein A, Franck LS, Alderdice F. Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: A systematic review and meta-analysis. EClinicalMedicine 2022; 43:101233. [PMID: 34993425 PMCID: PMC8713115 DOI: 10.1016/j.eclinm.2021.101233] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/09/2021] [Accepted: 11/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Parents of babies admitted to neonatal units (NNU) are exposed to a range of potentially distressing experiences, which can lead to mental health symptoms such as increased anxiety and post-traumatic stress (PTS). This review aimed to describe how anxiety and PTS are defined and assessed, and to estimate anxiety and PTS prevalence among parents of babies admitted to NNU. METHOD Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature were searched to identify studies published prior to April 14, 2021. Included studies were assessed using Hoy risk of bias tool. A random-effects model was used to estimate pooled prevalence with 95% CIs. Potential sources of variation were investigated using subgroup analyses and meta-regression. The review is registered with PROSPERO (CRD42020162935). FINDINGS Fifty six studies involving 6,036 parents met the review criteria; 21 studies assessed anxiety, 35 assessed PTS, and 8 assessed both. The pooled prevalence of anxiety was 41.9% (95%CI:30.9, 53.0) and the pooled prevalence of PTS was 39.9% (95%CI:30.8, 48.9) among parents up to one month after the birth. Anxiety prevalence decreased to 26.3% (95%CI:10.1, 42.5) and PTS prevalence to 24.5% (95%CI:17.4, 31.6) between one month and one year after birth. More than one year after birth PTS prevalence remained high 27.1% (95%CI:20.7, 33.6). Data on anxiety at this time point were limited. There was high heterogeneity between studies and some evidence from subgroup and meta-regression analyses that study characteristics contributed to the variation in prevalence estimates. INTERPRETATION The prevalence of anxiety and PTS was high among parents of babies admitted to NNU. The rates declined over time, although they remained higher than population prevalence estimates for women in the perinatal period. Implementing routine screening would enable early diagnosis and effective intervention. FUNDING This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Reem Malouf
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Sian Harrison
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Hollie A.L Burton
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster campus, 369 Fulham Road, London, SW10 9NH
| | - 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 Honorary Professor, African Health Research Institute, KwaZulu, Natal
| | - 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
- Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
- Corresponding author:-Fiona Alderdice, 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
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16
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Vriend E, Leemhuis A, Flierman M, Schie P, Nollet F, Jeukens‐Visser M. Mental health monitoring in parents after very preterm birth. Acta Paediatr 2021; 110:2984-2993. [PMID: 34375472 PMCID: PMC9291782 DOI: 10.1111/apa.16064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/09/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate parental mental health monitoring during follow-up care for very preterm (VPT) infants, describe symptoms of anxiety and depression and risk factors for mothers and fathers at 1 and 12 months of corrected age. METHODS Parents completed the Hospital Anxiety and Depression Scale (HADS). Psychological symptoms and risk factors were analysed within and between mothers and fathers. RESULTS In 4 years, the monitoring reached 1260 (48%) families. Of these, 693 mothers and 340 fathers (300 couples) completed the HADS twice. At 1 month, 22% and 15% of the mothers and 10% and 9% of the fathers, respectively, reported elevated symptoms of anxiety and depression. At 12 months, these rates were significantly reduced to 14% and 9% for mothers and 5% and 4% for fathers respectively. Within couples, anxiety and depression were positively associated. At 12 months, in 20% of the couples, one or both parents reported elevated symptoms. Risk factors were length of hospital stay, migration background, educational level and employment status. CONCLUSION The mental health of parents of VPT infants improved, but elevated symptoms were still observed in 17% of included families after one year. Acknowledging and remediating parental mental health remain essential during follow-up care.
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Affiliation(s)
- Eline Vriend
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Aleid Leemhuis
- Department of Neonatology, Amsterdam Reproduction and Development Emma Children's Hospital Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Monique Flierman
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Petra Schie
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - Martine Jeukens‐Visser
- Department of Rehabilitation Medicine, Amsterdam Reproduction and Development Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
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17
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Kestler-Peleg M, Lavenda O. Optimism as a mediator of the association between social support and peripartum depression among mothers of neonatal intensive care unit hospitalized preterm infants. Stress Health 2021; 37:826-832. [PMID: 33565704 DOI: 10.1002/smi.3033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/25/2020] [Accepted: 02/04/2021] [Indexed: 02/05/2023]
Abstract
The birth of a preterm infant and the hospitalization in a neonatal intensive care unit (NICU) add extra functional and emotional demands to the typical transition to motherhood. Therefore, the prevalence of peripartum depression (PPD) among preterm mothers is especially high. As optimism was found to be a mediator of the association between social support and depression, the current study aimed to test this mediation in the population of NICU mothers. A sample of 128 Israeli mothers of 214 NICU hospitalized infants filled out self-report questionnaires regarding background variables, social support, optimism, and PPD symptoms. As hypothesized, optimism was found to partially mediate the association between social support and PPD symptoms among mother of preterm infants. The higher the perceived social support reported, the higher maternal optimism reported, and in turn, the lower PPD symptoms reported. In accordance with the Transactional Stress Theory, social support and optimism reflect maternal secondary appraisals that impact the way mothers of preterm infants cope with the challenging situation of a preterm birth and NICU hospitalization. Healthcare professionals should encourage preterm mothers' use of social support to increase optimism and reduce the risk of developing PPD.
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Affiliation(s)
- Miri Kestler-Peleg
- Faculty of Social Sciences, School of Social Work, Ariel University, Ariel, Israel
| | - Osnat Lavenda
- Faculty of Social Sciences, School of Social Work, Ariel University, Ariel, Israel
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18
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Truong C, Juhl A, Hwang SS. Risk factors for postpartum depressive symptoms among mothers of Colorado-born preterm infants. J Perinatol 2021; 41:2028-2037. [PMID: 34035446 DOI: 10.1038/s41372-021-01088-5] [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: 01/10/2021] [Revised: 04/08/2021] [Accepted: 04/29/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Identify risk factors of postpartum depressive symptoms (PDS) among preterm infants' mothers. STUDY DESIGN Retrospective cross-sectional analysis of Colorado's Pregnancy Risk Assessment Monitoring System from 2012 to 2018 included weighted n = 33,633 mothers of preterm infants. Multivariate regression models calculated adjusted risk factors of PDS. RESULTS PDS risk factors include history of maternal depression (adjusted risk ratio [aRR] 1.98, 95% confidence interval [CI] 1.28-3.05), early preterm birth <34wga (aRR 1.48, 95% CI 1.05-2.08), no prenatal care (aRR 3.19, 95% CI 1.52-6.71), non-Hispanic other (Asian/Pacific Islander, American Indian/Alaskan, or mixed) race/ethnicity (aRR 1.76, 95% CI 1.10-2.82), and pre-pregnancy public insurance (aRR 2.34, 95% CI 1.46-3.76). CONCLUSION PDS risk factors among Colorado mothers of preterm infants slightly differ from identified risk factors among mothers of term infants. These findings can improve PDS screening and diagnosis so effective therapies and support can be offered during and after NICU hospitalization.
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Affiliation(s)
- Connie Truong
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ashley Juhl
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Sunah S Hwang
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.,Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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19
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Garfield CF, Lee YS, Warner-Shifflett L, Christie R, Jackson KL, Miller E. Maternal and Paternal Depression Symptoms During NICU Stay and Transition Home. Pediatrics 2021; 148:peds.2020-042747. [PMID: 34341101 DOI: 10.1542/peds.2020-042747] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the trajectory and risk factors of depression symptoms among parents from NICU admission to 30 days postdischarge. We hypothesized depression symptom scores would decrease from admission and then increase from discharge to 30 days. METHODS Prospective longitudinal cohort study of premature infants in NICU. Parents completed the validated Edinburgh Postnatal Depression Scale (EPDS) at 4 time points: NICU admission, discharge, and 14 days and 30 days postdischarge. EPDS score change across time and probability of a positive screen (EPDS ≥10) were by assessed using mixed effect regression models. RESULTS Of 431 parents enrolled (mothers, n = 230 [53%]), 33% of mothers (n = 57) and 17% of fathers (n = 21) had a positive EPDS screening. Score change was 1.9 points different between mothers and fathers (confidence interval [CI]: 1.3-2.6; P < .0001), with mothers decreasing 2.9 points (CI: 2.1-3.7; P < .0001) and fathers decreasing 1.0 points (CI: 0.1-2.0; P = .04). Over time, mothers decreased 10.96 times (CI: 2.99-38.20; P = .0003); fathers decreased at a nonsignificant rate. Admission or discharge screening improved 30-day depressive symptom prediction (AUC 0.66 baseline demographics only versus 0.84+initial [P < .0001], and versus 0.80+discharge screening [P < .001]). CONCLUSIONS Mothers and fathers experience different depressive symptom trajectories from NICU to home. Screening parents for postpartum depression during the NICU stay is likely to result in improved identification of parents at risk for postpartum depression after discharge. Focused attention on fathers appears warranted.
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Affiliation(s)
- Craig F Garfield
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois .,Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Young S Lee
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Rebecca Christie
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathryn L Jackson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Miller
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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20
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Mothers' experiences of caring for preterm babies at home: qualitative insights from an urban setting in a middle-income country. BMC Pregnancy Childbirth 2021; 21:395. [PMID: 34016064 PMCID: PMC8136128 DOI: 10.1186/s12884-021-03872-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
Background Preterm delivery is the birth of a baby before 37 weeks of gestation. This global phenomenon is a critical issue of concern especially in developing countries that are resource-constrained when it comes to the management of preterm babies. Complications associated with prematurity contribute significantly to under-five mortality and are linked with feelings of despair, grief, and anxiety among mothers. Methods This was a qualitative descriptive study in an urban setting in the Greater Accra region of Ghana. Eleven mothers whose babies had been discharged from the neonatal intensive care unit in a major hospital and resided in Accra were interviewed in their homes using a semi-structured interview guide. Data were audiotaped, transcribed verbatim, and analyzed inductively by content analysis. Results All the mothers had formal education and the mean maternal age was 27.9 years. The majority of the mothers were multiparous. The gestational age at birth ranged from 32 to 34 weeks and the average birth weight of their babies was 1.61 kg. Four major themes emerged which included: Around the clock care; mothers’ self-perceptions and attitudes of significant others; mothers’ health and wellbeing; and support. Most of the mothers experienced physical exhaustion from the extra demands involved with care, had negative emotions, and unmet social needs. Conclusions The findings indicate that home management of preterm babies poses multiple stressors and is associated with poor psychological and physical wellbeing among mothers. Hence, the need for extensive education and identification of other social support systems to augment facility-based care for mothers and their preterm babies. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03872-9.
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Manickam S, Vivier PM, Rogers ML, McGowan EC, Smego R, Tucker R, Vohr BR. Neighborhood Inequality and Emergency Department Use in Neonatal Intensive Care Unit Graduates. J Pediatr 2020; 226:294-298.e1. [PMID: 32621816 DOI: 10.1016/j.jpeds.2020.06.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
Neonatal intensive care unit graduates residing in high-risk neighborhoods were at increased risk of emergency department use and had higher rates of social/environmental risk factors. Distances to primary care provider and emergency department did not contribute to emergency department use. Knowledge of neighborhood risk is important for preventative service reform.
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Affiliation(s)
- Surya Manickam
- The Warren Alpert Medical School of Brown University, Providence, RI; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Elisabeth C McGowan
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Women & Infants Hospital, Providence, RI
| | - Raul Smego
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | | | - Betty R Vohr
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI; Women & Infants Hospital, Providence, RI.
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Abdulla L, McGowan EC, Tucker RJ, Vohr BR. Disparities in Preterm Infant Emergency Room Utilization and Rehospitalization by Maternal Immigrant Status. J Pediatr 2020; 220:27-33. [PMID: 32111378 DOI: 10.1016/j.jpeds.2020.01.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effects of immigrant mother status and risk factors on the rates of emergency room (ER) visits and rehospitalizations of preterm infants within 90 days after discharge. STUDY DESIGN This was a retrospective cohort study of 732 mothers of 866 preterm infants (<37 weeks of gestational age) cared for in a neonatal intensive care unit (NICU) for >5 days. Medical and demographic data and number of ER visits and rehospitalizations were collected. The primary outcomes were the numbers of ER visits and rehospitalizations. Analysis included bivariate comparisons of immigrant and native mother-infant dyads. Regression models were run to estimate the effects of immigrant mother status and risk factors. RESULTS Compared with native mothers, immigrant mothers (176 of 732; 24%) were more likely to be older, to be gravida >1, to be nonwhite, to have a non-English primary language, to have less than a high school education, and to have Medicaid insurance but less likely to have child protective services, substance abuse, and a mental health disorder. Infants of immigrant mothers (203 of 866; 23%) had higher rates of ER visits and more days of hospitalization compared with infants of native mothers. Among immigrant mothers only, >5 years living in the US, non-English primary language, and bronchopulmonary dysplasia (BPD) were predictive of ER visits, whereas Medicaid and BPD were predictive of rehospitalization. For the total cohort, after an interaction between Medicaid and immigrant status was added to the model, immigrant status became nonsignificant and immigrant mothers with Medicaid emerged as a strong predictor of hospitalization and a borderline predictor for ER visits. CONCLUSIONS Among immigrant mothers, non-English primary language, >5 years living in the US, and BPD increased the odds of an ER visit. For the total cohort, however, the interaction of immigrant mother with Medicaid as a marker of poverty provided a significant modifying effect on increased rehospitalization and ER use.
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Affiliation(s)
- Layla Abdulla
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI
| | - Elisabeth C McGowan
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI; Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
| | - Richard J Tucker
- Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI; Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI.
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A pilot study demonstrating the impact of the supporting and enhancing NICU sensory experiences (SENSE) program on the mother and infant. Early Hum Dev 2020; 144:105000. [PMID: 32151905 PMCID: PMC7282956 DOI: 10.1016/j.earlhumdev.2020.105000] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
AIM To explore differences in maternal mental health and infant neurobehavioral outcome among infants who received and did not receive the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. STUDY DESIGN Eighty preterm infants (50 receiving standard-of-care and 30 receiving the SENSE program) born ≤32 weeks gestation were enrolled within the first week of life in a prospective quasi-experimental design, using a historical control group for comparison. Standard-of-care consisted of tactile (skin-to-skin, touch, holding) and olfactory (scent cloth, close maternal contact) interventions as determined to be appropriate by health care professionals and parents. The SENSE group received specific doses of tactile (skin-to-skin care, holding, massage, touch), auditory (human speech, music), olfactory (scent cloth, close maternal contact), kinesthetic/vestibular (movement, rocking/transfers), and visual (dim or cycled light) exposures, based on the infant's postmenstrual age and tailored to medical status and infant cues according to the SENSE program. The SENSE program includes the intentional delivery of positive, age-appropriate sensory exposures by parents (or a sensory support team, when parents are unavailable) each day of NICU hospitalization. Infant neurobehavioral outcome, as well as maternal mental health and confidence, were assessed prior to NICU discharge, using standardized measures. RESULTS Seventy-three infants were included in the final analysis. Mothers whose infants received the SENSE program demonstrated higher scores on the Maternal Confidence Questionnaire (p = 0.01). Infants who received the SENSE program demonstrated less asymmetry on the NICU Network Neurobehavioral Scale (p = 0.02; mean difference 0.9) and higher scores on the Hammersmith Neonatal Neurological Evaluation (p < 0.001; mean difference 4.8). DISCUSSION Preliminary evidence demonstrates improvements in maternal confidence and infant neurobehavioral performance following SENSE implementation.
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Levinson M, Parvez B, Aboudi D, Shah S. Impact of maternal stressors and neonatal clinical factors on post-partum depression screening scores. J Matern Fetal Neonatal Med 2020; 35:1328-1336. [PMID: 32316772 DOI: 10.1080/14767058.2020.1754394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Higher rates of postpartum depression (PPD) are reported in mothers of neonatal intensive care unit (NICU) hospitalized infants. The relationship of neonatal clinical risk factors and self-reported maternal stress levels to positive PPD screening is not well characterized.Objective: To determine the feasibility of postpartum depression screening in a regional perinatal center, and assess the association of NICU-specific comorbidities and maternal stress levels with PPD screening scores.Design/Methods: Prospective study of mothers of NICU-hospitalized infants conducted between 21and 30 days of their infant's life. Mothers completed the Edinburgh Postpartum Depression scale (EPDS) and the Parental Stressor Scale: NICU (PSS: NICU) in the environmental, infant behavior and parental domains. Total EPDS scores and positive PPD screening were correlated with NICU comorbidities, demographic factors and PSS: NICU scores.Results: The incidence of positive PPD screening was 19% (25/135). In bivariate analysis, positive PPD screen was associated with exclusive breastfeeding (67% vs, 35%, p < .05) and maternal age <35 years (32% vs. 12%, p < .05). No observed differences in maternal and infant demographic factors or neonatal comorbidities were seen in mothers with positive PPD screening. Mean PPD screening scores were higher in infants with intraventricular hemorrhage of any grade and necrotizing enterocolitis. In adjusted analysis, overall and domain-specific PSS: NICU scores were associated with positive PPD screening.Conclusion: Cumulatively and within each PSS: NICU domain, parental stress correlated with positive PPD screening but was unrelated to NICU comorbidities. Reducing modifiable factors which exacerbate parental stress may impact the incidence of positive PPD screening among NICU mothers.
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Affiliation(s)
- Michelle Levinson
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - Boriana Parvez
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - David Aboudi
- New York City Department of Health and Mental Hygiene, Division of Mental Health Statistics, New York, NY, USA
| | - Shetal Shah
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY, USA
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Vaughn AT, Hooper GL. Development and Implementation of a Postpartum Depression Screening Program in the NICU. Neonatal Netw 2020; 39:75-82. [PMID: 32317337 DOI: 10.1891/0730-0832.39.2.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 06/11/2023]
Abstract
Postpartum depression (PPD) is higher among NICU mothers compared to mothers without infants in the NICU. Routine screening improves early PPD identification and treatment for mothers. Key national women and infant organizations endorse facility-based policies that address PPD screening. In addition to PPD screening, the key national organizations recommend facilities providing care to women and infants develop a method of referral for maternal PPD evaluation, treatment, and follow-up. Due to the timing, onset, and maternal predisposition to PPD, the NICU is a prime setting for PPD screening. Despite recommendations, PPD screening is not routine in the NICU. This article describes the development and assessment of a PPD screening program implemented in the NICU. Data analysis of 30 NICU mothers evaluated the risk of PPD based on screening tool scores, maternal diagnostic evaluation compliance, and documentation of maternal follow-up with designated NICU staff.
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Meltzer-Brody S, Kanes SJ. Allopregnanolone in postpartum depression: Role in pathophysiology and treatment. Neurobiol Stress 2020; 12:100212. [PMID: 32435663 PMCID: PMC7231991 DOI: 10.1016/j.ynstr.2020.100212] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
Postpartum depression (PPD) is a unique subtype of major depressive disorder and a substantial contributor to maternal morbidity and mortality. In addition to affecting the mother, PPD can have short- and long-term consequences for the infant and partner. The precise etiology of PPD is unknown, but proposed mechanisms include altered regulation of stress response pathways, such as the hypothalamic-pituitary-adrenal axis, and dysfunctional gamma-aminobutyric acid (GABA) signaling, and functional linkages exist between these pathways. Current PPD pharmacotherapies are not directly related to these proposed pathophysiologies. In this review, we focus on the potential role of GABAergic signaling and the GABAA receptor positive allosteric modulator allopregnanolone in PPD. Data implicating GABAergic signaling and allopregnanolone in PPD are discussed in the context of the development of brexanolone injection, an intravenous formulation of allopregnanolone recently approved by the United States Food and Drug Administration for the treatment of adult women with PPD.
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Affiliation(s)
- Samantha Meltzer-Brody
- Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, USA
- Corresponding author.
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Rabiepoor S, Vatankhah-Alamdary N, Khalkhali HR. The Effect of Expressive Writing on Postpartum Depression and Stress of Mothers with a Preterm Infant in NICU. J Clin Psychol Med Settings 2019; 27:867-874. [DOI: 10.1007/s10880-019-09688-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Das A, Gordon-Ocejo G, Kumar M, Kumar N, Needlman R. Association of the previous history of maternal depression with post-partum depression, anxiety, and stress in the neonatal intensive care unit. J Matern Fetal Neonatal Med 2019; 34:1741-1746. [PMID: 31327298 DOI: 10.1080/14767058.2019.1647162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A history of depression in post-partum women who have infants admitted to the neonatal intensive care unit (NICU), is associated with higher risk for anxiety and stress. These conditions, which can be harmful to neonates, may be missed if maternal mental health screening is confined to depression. OBJECTIVE To determine if the history of a previously diagnosed depression would be associated with an increased risk of both postpartum depression and other stress-related disorders (i.e. anxiety and stress) among mothers with infants in the NICU. DESIGN Prospective survey questionnaire-based study conducted over a period of 9 months. SETTING Urban inpatient hospital-based setting, serving mainly low-income population. PARTICIPANTS A total of 118 mothers of newborns who had been in the NICU for 7-29 days were approached for enrollment. Out of 118, 96 mothers consented to be screened and were asked to fill out the 21-item Depression Anxiety and Stress Scale-21 (DASS-21) questionnaire. OUTCOME Primary outcome was to determine whether the history of a previously diagnosed depression is associated with an increased risk of both postpartum depression and other stress-related disorders (i.e. anxiety and stress). RESULTS Out of the 96 subjects, 36 (37.5%) had a previous history of depression before delivery (Group A) while 60/96 (62.5%) did not (Group B) and 46/96 (48%) of the mothers were positive for either depression, anxiety, or stress. This included 22/96 (22.9%) mothers who screened positive for depression; 37/96 (38.5%) who screened positive for anxiety; and 32/96 (33.3%) who screened positive for stress. After adjusting for maternal drug abuse, birth weight and maternal gravidity, the association between a previous history of depression and current depression scores were statistically significant (p = .04), as were the associations between previous depression and current anxiety and stress scores (p = .02 and p = .003, respectively). CONCLUSIONS AND RELEVANCE A history of depression, documented in the antepartum medical record, identifies post-partum women who are at higher risk for anxiety and stress. Screening for depression alone may lead to missing these mental health issues.
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Affiliation(s)
- Anirudha Das
- Department of Neonatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | - Robert Needlman
- Department of Neonatology, Cleveland Clinic Foundation, Cleveland, OH, USA
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29
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Lakshmanan A, Kubicek K, Williams R, Robles M, Vanderbilt DL, Mirzaian CB, Friedlich PS, Kipke M. Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study. BMC Pediatr 2019; 19:223. [PMID: 31277630 PMCID: PMC6610911 DOI: 10.1186/s12887-019-1604-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background We have limited information on families’ experiences during transition and after discharge from the neonatal intensive care unit. Methods Open-ended semi-structured interviews were conducted with English or Spanish- speaking families enrolled in Medicaid in an urban high-risk infant follow up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. Results Twenty-one participants completed the study. The infant’s median (IQR) birth weight was 1750 (1305, 2641) grams; 71% were Hispanic and 10% were Black non-Hispanic; 62% reported living in a neighborhood with 3-4th quartile economic hardship. All were classified as having chronic disease per the Pediatric Medical Complexity Algorithm and 67% had medical complexity. A conceptual model was constructed and the analysis revealed major themes describing families’ challenges and ideas to support transition centered on the parent-child role and parent self-efficacy. The challenges were: (1) comparison to normal babies, (2) caregiver mental health, (3) need for information. Ideas to support transition included, (1) support systems, (2) interventions using mobile health technology (3) improved communication to the primary care provider and (4) information regarding financial assistance programs. Specific subthemes differed in frequency counts between infants with and without medical complexity. Conclusions Families often compare their preterm or high-risk infant to their peers and mothers feel great anxiety and stress. However, families often found hope and resilience in peer support and cited that in addition to information needs, interventions using mobile health technology and transition and financial systems could better support families after discharge. Electronic supplementary material The online version of this article (10.1186/s12887-019-1604-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Katrina Kubicek
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Roberta Williams
- Division of Cardiology, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marisela Robles
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Douglas L Vanderbilt
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA
| | - Michele Kipke
- USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Validation of the Arabic Version of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU). J Clin Psychol Med Settings 2019; 27:593-602. [DOI: 10.1007/s10880-019-09643-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hollen R, Smith AG, Smith-Gagen J. Breastmilk Pumping for the Mental Health of the NICU Mother. CLINICAL LACTATION 2019. [DOI: 10.1891/2158-0782.10.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ObjectiveWhile much is known about breastfeeding and postpartum depression, little is known about breast milk pumping's impact on postpartum depression among mothers with infants in the neonatal intensive care unit (NICU).MethodsThirty-two mothers of infants admitted to a Level III NICU between February and July 2017 were screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). They were also surveyed for current breastmilk pumping activities and demographic factors. Multivariable logistic regression was used to assess the associations between postpartum depression and breast milk pumping, adjusting for confounding variables.ResultsAfter controlling for confounding variables, mothers who did not pump breast milk (relative to mothers who did) were 11 times more likely to have lower EPDS depression scores indicative of probable postpartum depression (OR = 11.7, p-value .05).ConclusionsOur results suggest a significant reduction in probable postpartum depression among NICU mothers who express breastmilk.
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McGowan EC, Abdulla LS, Hawes KK, Tucker R, Vohr BR. Maternal Immigrant Status and Readiness to Transition to Home From the NICU. Pediatrics 2019; 143:peds.2018-2657. [PMID: 31036673 PMCID: PMC6564064 DOI: 10.1542/peds.2018-2657] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evaluate effects of immigrant status on perceptions of discharge readiness in mothers of preterm infants <37 weeks' gestation and identify the impact of primary language and years in the United States. METHODS Immigrant (n = 176) and native (n = 556) mothers of preterm infants cared for in the NICU for >5 days between 2012 and 2015 completed the Fragile Infant Parental Readiness Evaluation (FIPRE), a NICU-discharge readiness questionnaire. Group comparisons were made on the basis of immigrant status. Regression models examined effects of immigrant status, primary language, and years in the United States on discharge readiness. RESULTS Immigrant mothers were more likely to be older, gravida >1, multiracial or people of color, and non-English speaking; have less than a high school education; and receive Medicaid but less likely to have child protective services involvement, substance abuse, and mental health disorder (MHD). Whereas rates of non-English primary language, low education, and Medicaid decreased, rates of MHDs increased with years in the United States. At NICU discharge, immigrant mothers had poorer perceptions of infant well-being, maternal well-being, maternal comfort, and time impact. In adjusted analyses, immigrant status, non-English primary language, and MHD predicted unfavorable scores. Among immigrant mothers, increased years in the United States and MHD predicted unfavorable scores. CONCLUSIONS Although findings suggest acculturation with increased years in the United States, immigrant mothers perceived less discharge readiness in multiple domains, highlighting the need for culturally competent care and discharge services specifically tailored to help this vulnerable population.
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Affiliation(s)
- Elisabeth C. McGowan
- Warren Alpert Medical School,,Division of Neonatology, Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island; and
| | | | - Katheleen K. Hawes
- Warren Alpert Medical School,,Division of Neonatology, Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island; and,College of Nursing, The University of Rhode Island, Kingston, Rhode Island
| | - Richard Tucker
- Division of Neonatology, Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island; and
| | - Betty R. Vohr
- Warren Alpert Medical School,,Division of Neonatology, Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island; and
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Abstract
There is increasing evidence of ongoing changes occurring in short-term and long-term motor and language outcomes in former premature infants. As rates of moderate to severe cerebral palsy (CP) have decreased, there has been increased awareness of the impact of mild CP and of developmental coordination disorder on the preterm population. Language delays and disorders continue to be among the most common outcomes. In conjunction with medical morbidities, there is increased awareness of the negative impact of family psycho-socioeconomic adversities on preterm outcomes and of the importance of intervention for these adversities beginning in the neonatal ICU.
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González-Hernández A, González-Hernandez D, Fortuny-Falconi CM, Tovilla-Zárate CA, Fresan A, Nolasco-Rosales GA, Juárez-Rojop IE, López-Narváez ML, Gonzalez-Castro TB, Escobar Chan YM. Prevalence and Associated Factors to Depression and Anxiety in Women with Premature Babies Hospitalized in a Neonatal Intensive-Care Unit in a Mexican Population. J Pediatr Nurs 2019; 45:e53-e56. [PMID: 30655115 DOI: 10.1016/j.pedn.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE The aims of this study were to investigate the frequency of depression and anxiety in mothers of children hospitalized in a neonatal intensive care unit, and to determine the characteristics associated with depression and anxiety in a sample of Mexican mothers. METHOD We studied 188 mothers who had premature babies in a neonatal intensive-care. Sociodemographic and clinical characteristics were collected through a face to face interview performed by professional staff. We assessed depression using the Beck Depression Inventory (BDI) and clinical anxiety using the Hamilton Anxiety Rating Scale (HAM-A). RESULTS Clinical anxiety was reported in more than one-third of women (34.0%, n = 64) followed by depression (19.7%, n = 37), while twenty-six women reported both significant depression and anxiety (13.8%). Women with both clinical symptoms were younger, they were more frequently students and were living within extended families. Women who presented only symptoms of depression reported lower educational level (elementary school 29.7%, n = 11). CONCLUSION Our results show a high incidence of anxiety, depression, and both emotional disorders in Mexican mothers of premature babies hospitalized in a neonatal intensive care unit. Demographic features such as occupation or age may impact the occurrence and severity of joint symptoms of depression and anxiety which should be monitored by the health team and referred to a mental health service.
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Affiliation(s)
| | | | - Carlos Mario Fortuny-Falconi
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico.
| | - Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, Mexico.
| | | | - Isela Esther Juárez-Rojop
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, Mexico
| | | | - Thelma Beatriz Gonzalez-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, Mexico
| | - Yudy Merady Escobar Chan
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
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Supporting caregivers during hematopoietic cell transplantation for children with primary immunodeficiency disorders. J Allergy Clin Immunol 2018; 143:2271-2278. [PMID: 31178019 DOI: 10.1016/j.jaci.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/23/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Caregivers of children with primary immunodeficiency disorders (PIDs) experience significant psychological distress during their child's hematopoietic cell transplantation (HCT) process. OBJECTIVES This study aims to understand caregiver challenges and identify areas for health care system-level improvements to enhance caregiver well-being. METHODS In this mixed-methods study caregivers of children with PIDs were contacted in August to November 2017 through online and electronic mailing lists of rare disease consortiums and foundations. Caregivers were invited to participate in an online survey assessing sociodemographic variables, the child's medical characteristics, psychosocial support use, and the World Health Organization-5 Well-Being Index. Open-ended questions about health care system improvements were included. Descriptive statistics and linear multivariate regression analyses were conducted. A modified content analysis method was used to code responses and identify emergent themes. RESULTS Among the 80 caregiver respondents, caregivers had a median age of 34 years (range, 23-62 years) and were predominantly female, white, and married with male children given a diagnosis of severe combined immune deficiency. In the adjusted regression model lower caregiver well-being was significantly associated with lower household income and medical complications. Challenges during HCT include maintaining relationships with partners and the child's healthy sibling or siblings, managing self-care, and coping with feelings of uncertainty. Caregivers suggested several organizational-level solutions to enhance psychosocial support, including respite services, online connections to other PID caregivers, and bedside mental health services. CONCLUSIONS Certain high-risk subpopulations of caregivers might need more targeted psychosocial support to reduce the long-term effect of the HCT experience on their well-being. Caregivers suggested several organizational-level solutions for provision of this support.
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Liu Y, McGowan E, Tucker R, Glasgow L, Kluckman M, Vohr B. Transition Home Plus Program Reduces Medicaid Spending and Health Care Use for High-Risk Infants Admitted to the Neonatal Intensive Care Unit for 5 or More Days. J Pediatr 2018; 200:91-97.e3. [PMID: 29793871 DOI: 10.1016/j.jpeds.2018.04.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/27/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effects of a transition home intervention on total Medicaid spending, emergency department visits, and unplanned readmissions for preterm infants born at ≤366/7 weeks gestation and high-risk full-term infants. STUDY DESIGN The Transition Home Plus (THP) program incorporated enhanced support services before and after discharge from the neonatal intensive care unit (NICU) provided by social workers and family resource specialists (trained peers) working with the medical team from October 2012 to October 2014. Rhode Island Medicaid claims data were used to study the 321 infants cared for in the NICU for ≥5 days, who were enrolled in the THP program. THP infants were compared with a historical comparison group of 365 high-risk infants born and admitted to the same NICU in 2011 before the full launch of the THP program. Intervention and comparison group outcomes were compared in the eight 3-month quarters after the infant's birth. Propensity score weights were applied in regression models to balance demographic characteristics between groups. RESULTS Infants in the intervention group had significantly lower total Medicaid spending, fewer emergency department visits, and fewer readmissions than the comparison group. Medicaid spending savings for the intervention group were $4591 per infant per quarter in our study period. CONCLUSIONS Transition home support services for high-risk infants provided both in the NICU and for 90 days after discharge by social workers and family resource specialists working with the medical team can reduce Medicaid spending and health care use.
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Affiliation(s)
| | - Elisabeth McGowan
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
| | - Richard Tucker
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | | | | | - Betty Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
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Winter L, Colditz PB, Sanders MR, Boyd RN, Pritchard M, Gray PH, Whittingham K, Forrest K, Leeks R, Webb L, Marquart L, Taylor K, Macey J. Depression, posttraumatic stress and relationship distress in parents of very preterm infants. Arch Womens Ment Health 2018; 21:445-451. [PMID: 29502280 DOI: 10.1007/s00737-018-0821-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
To determine the prevalence, associated factors, and relationships between symptoms of depression, symptoms of posttraumatic stress (PTS), and relationship distress in mothers and fathers of very preterm (VPT) infants (< 32 weeks). Mothers (n = 323) and fathers (n = 237) completed self-report measures on demographic and outcome variables at 38 days (SD = 23.1, range 9-116) postpartum while their infants were still hospitalised. Of mothers, 46.7% had a moderate to high likelihood of depression, 38.1% had moderate to severe symptoms of PTS, and 25.1% were in higher than average relationship distress. The corresponding percentages in fathers were 16.9, 23.7, and 27%. Depression was positively associated with having previous children (p = 0.01), speaking little or no English at home (p = 0.01), financial stress (p = 0.03), and recently accessing mental health services (p = 0.003) for mothers, and financial stress (p = 0.005) and not being the primary income earner (p = 0.04) for fathers. Similar associations were found for symptoms of PTS and relationship distress. Being in higher relationship distress increased the risk of depression in both mothers (p < .001) and fathers (p = 0.03), and PTS symptoms in mothers (p = 0.001). For both mothers and fathers, depression was associated with more severe PTS symptoms (p < .001). Fathers of VPT infants should be screened for mental health problems alongside mothers, and postpartum parent support programs for VPT infants should include strategies to improve the couple relationship.
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Affiliation(s)
- Leanne Winter
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia. .,The Parenting and Family Support Centre, School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
| | - Paul B Colditz
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Matthew R Sanders
- The Parenting and Family Support Centre, School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Roslyn N Boyd
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia
| | - Margo Pritchard
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Mater Mothers' Hospital, Brisbane, Australia.,Australian Catholic University, Brisbane, Australia
| | - Peter H Gray
- Mater Mothers' Hospital, Brisbane, Australia.,Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Koa Whittingham
- Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Australia
| | - Kylee Forrest
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Mater Mothers' Hospital, Brisbane, Australia
| | - Rebecca Leeks
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Lachlan Webb
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Louise Marquart
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Karen Taylor
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
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Hollen R, Smith-Gagen J, Olguin S. Case Report of the Incidence of Maternal Depression at a Community Level III, 39-Bed NICU. CLINICAL LACTATION 2018. [DOI: 10.1891/2158-0782.9.3.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postpartum depression (PPD) is a vastly undetected, underdiagnosed, and untreated mental health concern for all mothers with infants. Having an infant in the neonatal intensive care unit (NICU) has an even higher impact on mothers’ mental health, predisposing them to a higher rate of PPD. The aim of this project was to identify the incidence of PPD in a Level III NICU to determine appropriate intervention strategies. All mothers with NICU infants 14 to 20 days were invited to complete the 10-question Edinburgh Postnatal Depression Screening (EPDS). The EPDS was scored, and a NICU social worker discussed the results and offered resources for those with scores of ≥10. The incidence of positive screens at our institution was 71.9% for an EPDS score with a cutoff ≥10, and 50% for an EPDS score with a cutoff ≥13. Simple strategies, including routine screening, PPD groups, and NICU support groups, were implemented. All NICUs should know the incidence of mothers’ PPD. Acting on this information flows downstream to improving the health of the infant and family.
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McCarter DE, Demidenko E, Hegel MT. Measuring outcomes of digital technology-assisted nursing postpartum: A randomized controlled trial. J Adv Nurs 2018; 74:10.1111/jan.13716. [PMID: 29772609 PMCID: PMC6240405 DOI: 10.1111/jan.13716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 11/30/2022]
Abstract
AIM To determine if delivering electronic messages from nurses during the first 6 months postpartum is feasible, acceptable and effective in improving mood and decreasing parenting stress. BACKGROUND Competing demands during the postpartum hospitalization make focused time for nurses to provide education and support difficult. Unmet needs following discharge may increase the incidence of postpartum depression. Untreated depression negatively affects families, especially for vulnerable women with limited access to health care. DESIGN This is a longitudinal cohort study in three phases. Feasibility and acceptability were assessed during Phases 1 & 2. Phase 3 is a randomized controlled trial (RCT) with three conditions. METHODS This protocol was approved by the Institutional Review Board of the maternity hospital on 12 May 2015 and reviewed annually. Women are enrolled during the maternity hospitalization, after which randomization occurs. The control group receives usual care. Intervention I participants receive a standardized electronic message four times/week for 6 months postpartum. Intervention II participants receive the messages and the option to request a call from a nurse. Electronic surveys at 3 weeks, 3 months and 6 months postpartum measure depressive symptoms using the Edinburgh Postnatal Depression Scale and parenting stress using the Parenting Stress Index-Short form. Patient satisfaction, nursing time and expertise required are also measured. DISCUSSION Phase 1 and 2 have demonstrated the intervention is feasible and acceptable to women. Phase 3 enrolment is completed, and the last follow-up surveys were emailed to participants in February 2018. Results will help inform efforts to continue nursing care after hospital discharge.
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Affiliation(s)
- Deborah E McCarter
- Professor of Nursing, Saint Anselm College, Manchester, New Hampshire
- Staff Nurse, Catholic Medical Center, Manchester, New Hampshire
| | - Eugene Demidenko
- Professor of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Mark T Hegel
- Professor in Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Vohr B, McGowan E, Keszler L, O'Donnell M, Hawes K, Tucker R. Effects of a transition home program on preterm infant emergency room visits within 90 days of discharge. J Perinatol 2018; 38:185-190. [PMID: 28906495 DOI: 10.1038/jp.2017.136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate effects of a transition home program (THP) and risk factors on emergency room (ER) use within 90 days of discharge for preterm (PT) infants <37 weeks gestation. STUDY DESIGN This is a prospective 3-year cohort study of 804 mothers and 954 PT infants. Mothers received enhanced neonatal intensive care unit transition support services until 90 days postdischarge. Regression models were run to identify the effects of THP implementation year and risk factors on ER visits. RESULTS Of the 954 infants, 181 (19%) had ER visits and 83/181 (46%) had an admission. In regression analysis, THP year 3 vs year 1 and human milk at discharge were associated with decreased risk of ER visits, whereas increased odds was associated with non-English speaking, maternal mental health disorders and bronchopulmonary dysplasia. CONCLUSION Enhanced THP services were associated with a 33% decreased risk of all ER visits by year 3. Social and environmental risk factors contribute to preventable ER visits.
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Affiliation(s)
- B Vohr
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA
| | - E McGowan
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA
| | - L Keszler
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA
| | - M O'Donnell
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - K Hawes
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA.,Alpert School of Medicine, Brown University, Providence, RI, USA.,College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - R Tucker
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
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Loewenstein K. Parent Psychological Distress in the Neonatal Intensive Care Unit Within the Context of the Social Ecological Model: A Scoping Review. J Am Psychiatr Nurses Assoc 2018; 24:495-509. [PMID: 29577790 DOI: 10.1177/1078390318765205] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neonatal intensive care unit (NICU) parents are at risk for psychological distress and impaired mental health, and statistics related to parent psychological distress vary. OBJECTIVE To determine the scope of literature regarding the mental health and psychosocial well-being of parents in the NICU. DESIGN A scoping review within the Arksey and O'Malley framework and the SEM was undertaken to answer, "What factors contribute to parent's mental health in the NICU?" A systematic review of the literature was performed using the PRISMA methodology. RESULTS Common socioeconomic factors and infant and parent characteristics may place parents at a greater risk for developing distress. History of mental illness, family cohesion, birth trauma, altered parenting role, gestational age, birth weight, and severity of prematurity/illness emerged as themes. CONCLUSION Further research is required to provide a standard for the screening and assessment of parents' mental health and psychosocial well-being during a NICU hospitalization. The experiences of nonbirth parents in the NICU should be explored to examine the effects of the hospitalization on all types of parents.
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Affiliation(s)
- Kristy Loewenstein
- 1 Kristy Loewenstein, MSN, RN-BC, PMHNP-BC, Medical University of South Carolina College of Nursing, Charleston, SC, USA; Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
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Vohr B, McGowan E, McKinley L, Tucker R, Keszler L, Alksninis B. Differential Effects of the Single-Family Room Neonatal Intensive Care Unit on 18- to 24-Month Bayley Scores of Preterm Infants. J Pediatr 2017; 185:42-48.e1. [PMID: 28238479 DOI: 10.1016/j.jpeds.2017.01.056] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the effects of human milk and social/environmental disparities on developmental outcomes of infants born preterm cared for in a single-family room (SFR) neonatal intensive care unit (NICU). STUDY DESIGN Outcomes were compared between infants weighing ?1250 g cared for in an open-bay NICU (1/2007-8/2009) (n?=?394) and an SFR NICU (1/2010-12/2011) (n?=?297). Human milk provision at 1 week, 4 weeks and discharge, and 4 week volume (mL/kg/day) were analyzed. At 18-24 months of age, the Bayley III was administered. Group differences were evaluated and multiple linear regression analyses were run. RESULTS Infants cared for in the SFR NICU had higher Bayley III cognitive and language scores, higher rates of human milk provision at 1 and 4 weeks, and higher human milk volume at 4 weeks. In adjusted regression models, the SFR NICU was associated with a 2.55-point increase in Bayley cognitive scores and 3.70-point increase in language scores. Every 10?mL/kg/day increase of human milk at 4 weeks was independently associated with increases in Bayley cognitive, language, and motor scores (0.29, 0.34, and 0.24, respectively). Medicaid was associated with decreased cognitive (?4.11) and language (?3.26) scores, and low maternal education and non-white race with decreased language scores (?4.7 and ?5.8, respectively). Separate models by insurance status suggest there are differential benefits from SFR NICU and human milk between infants with Medicaid and private insurance. CONCLUSIONS Infants born preterm cared for in the SFR NICU have higher Bayley language and cognitive scores and receive more human milk. Independent effects on outcomes were derived from SFR NICU, provision of human milk, and social and environmental factors.
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Affiliation(s)
- Betty Vohr
- Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI.
| | - Elisabeth McGowan
- Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
| | | | - Richard Tucker
- Women & Infants Hospital of Rhode Island, Providence, RI
| | - Lenore Keszler
- Women & Infants Hospital of Rhode Island, Providence, RI; Alpert School of Medicine, Brown University, Providence, RI
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McGowan EC, Du N, Hawes K, Tucker R, O'Donnell M, Vohr B. Maternal Mental Health and Neonatal Intensive Care Unit Discharge Readiness in Mothers of Preterm Infants. J Pediatr 2017; 184:68-74. [PMID: 28237375 DOI: 10.1016/j.jpeds.2017.01.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/14/2016] [Accepted: 01/20/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate associations between maternal mental health disorders (MHDs) and discharge readiness for mothers of infants born preterm (<37 weeks). We hypothesized that mothers with a history of MHDs would report decreased perceptions of neonatal intensive care unit (NICU) discharge readiness compared with mothers without a history. STUDY DESIGN Mothers of infants born preterm in the NICU >5 days between 2012 and 2015 and participating in a transition home program completed a discharge readiness questionnaire measuring perceptions of staff support, infant well-being (medical stability), maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant). Greater scores are more optimal (range 0-100). Social workers obtained a history of MHDs. Group comparisons and regression analyses were run to predict decreased scores and maternal discharge readiness. RESULTS A total of 37% (315/850) of mothers reported a MHD. They were more likely to be white (64% vs 55% P = .05), single (64% vs 45% P ≤ .001), on Medicaid (61% vs 50% P = .002), and less likely to be non-English speaking (10% vs 22%, P ≤ .001). Mothers with MHD perceived less NICU support (92 ± 13 vs 94 ± 12, P = .005), less emotional readiness for discharge (78 ± 17 vs 81 ± 14, P = .04), and lower family cohesion (81 ± 24 vs 86 ± 19, P = .02) compared with mothers without MHD. Regression modeling (OR; CI) indicated that maternal history of MHDs predicted mother's decreased perception of infant well-being (1.56; 1.05-2.33) and her own well-being (1.99; 1.45-2.8) at discharge. CONCLUSION One-third of mothers reported a history of MHDs. This vulnerable group perceive themselves as less ready for discharge home with their infant, indicating an unmet need for provision of enhanced transition services.
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Affiliation(s)
- Elisabeth C McGowan
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI.
| | - Nan Du
- Yale New Haven Children's Hospital, New Haven, CT
| | - Katheleen Hawes
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI; College of Nursing, University of Rhode Island, Kingston, RI
| | - Richard Tucker
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI
| | - Melissa O'Donnell
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI
| | - Betty Vohr
- Division of Neonatology, Department of Pediatrics, Women & Infants Hospital, Providence, RI
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Bogen DL, Fisher SD, Wisner KL. Identifying Depression in Neonatal Intensive Care Unit Parents: Then What? J Pediatr 2016; 179:13-15. [PMID: 27697325 DOI: 10.1016/j.jpeds.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Debra L Bogen
- Department of Pediatrics University of Pittsburgh School of Medicine Division of General Academic Pediatrics Children's Hospital of Pittsburgh; Department of Psychiatry Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania.
| | - Sheehan D Fisher
- Department of Psychiatry Northwestern University Feinberg School of Medicine
| | - Katherine L Wisner
- Department of Psychiatry Northwestern University Feinberg School of Medicine; Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago, Illinois
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