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Evans D, Eatwell D, Hodson-Walker S, Pearce S, Reynolds V, Smith S, Whitehouse L, Butterworth R. Collaborative Recognition of Wellbeing Needs: A Novel Approach to Universal Psychosocial Screening on the Neonatal Unit. J Clin Psychol Med Settings 2024; 31:513-525. [PMID: 38684595 DOI: 10.1007/s10880-024-10016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 05/02/2024]
Abstract
Universal screening for the psychological needs of families in neonatal care is internationally recommended, but is not routinely practiced in the United Kingdom (UK). The present quality improvement project explores the clinical and operational feasibility of a novel approach to universal screening on a neonatal intensive care unit in the UK. The approach to screening taken adopts collaborative, strengths-based and dialogical methods for recognising the psychological needs of families whose baby is in hospital. A novel screening tool, developed through consultation with families, is described. Over one month, 42 out of 80 eligible families engaged with the screening protocol either at admission to the unit, transition to the special care nursery within the unit, or discharge home, with completion rates higher at admission than discharge. This led to an eightfold increase in the number of families accessing targeted or specialist psychological intervention compared to the period prior to this pilot. This project demonstrates the need for adequate capacity in the workforce to carry out a screening programme and to respond to the needs identified.
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Affiliation(s)
- Davy Evans
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- Health in Mind, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Daisy Eatwell
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Sarah Pearce
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Vicky Reynolds
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Shona Smith
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Leah Whitehouse
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ruth Butterworth
- North West Neonatal Operational Delivery Network, Manchester, UK
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Lagoski M, Soghier L, Lagata J, Shivers M, Sadler E, Fischer E, Borschuk A, House M. Mental Health Support and Screening for Mood Disorders for Caregivers in the Neonatal Intensive Care Unit: Is the Call to Arms Being Answered? Am J Perinatol 2024. [PMID: 38925161 DOI: 10.1055/a-2353-0993] [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: 06/28/2024]
Abstract
OBJECTIVE Perinatal mood and anxiety disorders (PMADs) affect many neonatal intensive care unit (NICU) parents and are a significant risk factor for maternal suicide. Lack of screening and treatment interferes with infant development and bonding, compounding risks in fragile infants. We aim to describe PMAD screening in level IV NICUs across the Children's Hospitals Neonatal Consortium (CHNC) and to determine the relationship between standardized screening and mental health professionals (MHPs) presence. STUDY DESIGN We surveyed experts at 44 CHNC NICUs about PMADs screening practices and presence of NICU-specific MHPs. Kruskal-Wallis test was used to examine relationships. RESULTS Of 44 centers, 34 (77%) responded. Fourteen centers (41%) perform screening with validated tools. Thirteen (38%) centers have NICU-dedicated psychologists. Formally screening centers tend to have higher cumulative MHPs (p = 0.089) than informally screening centers. Repeat screening practices were highly variable with no difference in the number of cumulative MHPs. CONCLUSION Screening practices for PMADs vary across CHNC centers; less than half have additional MHPs beyond social workers. Creating a sustainable model to detect PMADs likely requires more MHPs in NICUs. KEY POINTS · PMADs affect many NICU parents.. · Systematic screening for PMADs is limited in level IV children's hospital NICUs.. · Additional MHPs may contribute to enhanced screening and support of parents.. · Hospitals should prioritize funds for NICU-specific MHPs to optimize outcomes..
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Affiliation(s)
- Megan Lagoski
- Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University and the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lamia Soghier
- Division of Neonatology, Department of Pediatrics, George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia
| | - Joanne Lagata
- Division of Neonatology, Department of Pediatrics, Emory University, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Miller Shivers
- Division of Psychiatry and Behavioral Health, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Erin Sadler
- Division of Psychology & Behavioral Health, Department of Pediatrics, George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia
| | - Elizabeth Fischer
- Division of Pediatric Psychology and Behavioral Medicine, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Adrienne Borschuk
- Division of Psychiatry and Behavioral Sciences, Department of Pediatrics, SUNY Upstate Medical University Upstate Golisano Children's Hospital, Syracuse, New York
| | - Melissa House
- Division of Neonatology, Department of Pediatrics, Emory University of School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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Wilpers AB, Francis K, Powne AB, Somers L, Ren Y, Kohari K, Lorch SA. Differences in Person-Centered Care in Fetal Care Centers: Results from the U.S. Pilot Study of the PCC-FCC Scale. J Pers Med 2024; 14:772. [PMID: 39064026 PMCID: PMC11278169 DOI: 10.3390/jpm14070772] [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: 06/21/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE We report findings from a U.S. mixed-methods pilot study of the Person-Centered Care in Fetal Care Centers (PCC-FCC) Scale. METHODS Participants, who received care at a U.S. Fetal Care Center (FCC) between 2017 and 2021, completed an online questionnaire providing sociodemographic details, specifics about the care received, qualitative experiences, and scores from the PCC-FCC Scale. RESULTS Participants' (n = 247) PCC-FCC scores and qualitative feedback indicate high perceived person-centered care (PCC), particularly in areas of care coordination, respectful care, and patient education. However, 8% scored below the midpoint, and 38% of comments were negative, especially regarding expectation setting, preparation for post-intervention maternal health, and psychosocial support. Public insurance was associated with higher total PCC-FCC (p = 0.03) and Factor 2 scores (p = 0.02) compared to those with private insurance. The qualitative themes trust, clarity, comprehensive care, compassion, and belonging further elucidate the concept of PCC in FCCs. CONCLUSION The PCC-FCC Scale pilot study revealed strong overall PCC in FCCs, yet variability in patient experiences suggests areas needing improvement, including expectation setting, preparation for post-intervention maternal health, and psychosocial support. Future research must prioritize diverse samples and continued mixed methodologies to better understand the role of insurance and identify other potential disparities, ensuring comprehensive representation of the FCC patient population.
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Affiliation(s)
- Abigail B. Wilpers
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Fetal Therapy Nurse Network, Chicago, IL 60604, USA
- North American Fetal Therapy Network, Roseville, MN 55113, USA
- St. Louis Fetal Care Institute, SSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO 63104, USA
| | - Katie Francis
- Fetal Therapy Nurse Network, Chicago, IL 60604, USA
- North American Fetal Therapy Network, Roseville, MN 55113, USA
- St. Louis Fetal Care Institute, SSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO 63104, USA
| | - Amy B. Powne
- Fetal Therapy Nurse Network, Chicago, IL 60604, USA
- North American Fetal Therapy Network, Roseville, MN 55113, USA
- UC Davis Fetal Care and Treatment Center, UC Davis Health, Sacramento, CA 95817, USA
| | | | - Yunyi Ren
- Department of Public Health Sciences, School of Medicine, University of California-Davis, Sacramento, CA 95616, USA
| | - Katherine Kohari
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
- Fetal Care Center, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Scott A. Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Moreno-Sanz B, Alferink MT, O'Brien K, Franck LS. Family integrated care: State of art and future perspectives. Acta Paediatr 2024. [PMID: 38738866 DOI: 10.1111/apa.17272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
Family integrated care (FICare) represents a contemporary approach to health care that involves the active participation of families within the healthcare team. It empowers families to acquire knowledge about the specialised care required for their newborns admitted to neonatal intensive care unit (NICU) and positions them as primary caregivers. Healthcare professionals in this model act as mentors and facilitators during the hospitalisation period. This innovative model has exhibited notable enhancements in both short- and long-term health outcomes for neonates, alongside improved psychological well-being for families and heightened satisfaction among healthcare professionals. Initially designed for stable premature infants and their families, FICare has evolved to include critically ill premature and full-term infants. Findings from recent studies affirm the safety and feasibility of FICare as a NICU-wide model of care, benefiting all infants and families. The envisioned expansion of FICare focusses on sustainability and extending its implementation, recognising the necessity for tailored adaptations to suit varying diverse cultural and socio-economic contexts.
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Affiliation(s)
- Bárbara Moreno-Sanz
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research-IdIPAZ, Madrid, Spain
| | - Milène Tirza Alferink
- Division of Pediatrics/Neonatology, OLVG, Location East and West, Amsterdam, The Netherlands
| | - Karel O'Brien
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
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Willmeroth T. Nurses' and Parents' View on Neonatal Intensive Care Unit Diaries: A Qualitative Study and Framework Conceptualization. Am J Perinatol 2024; 41:e1800-e1812. [PMID: 37207660 DOI: 10.1055/s-0043-1768959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The birth of a premature or critically ill newborn can be a traumatic event for the entire family. In these situations, the neonatal intensive care unit (NICU) diary is a relevant coping intervention to support family members. However, a profound theoretical concept is lacking, and there is little evidence about how it is applied by nurses in clinical practice. Therefore, this study aims to investigate how NICU diaries are used by nurses to support family members cope with their experiences and to develop an evidence-guided and theory-based framework for conceptualizing diary usage in the NICU. STUDY DESIGN A qualitative study design containing 12 narrative interviews with nurses from six different hospitals and two focus group interviews with nine parents from two different hospitals was chosen. The qualitative data were analyzed via content analysis inductively and separately and brought together via graphical coding in a second step. RESULTS Four main categories emerged from the analyzed data to describe the NICU diary in nursing practice. Regarding diary (1) "usage," three different types of NICU diaries were identified, which seem to be established largely intuitive. The (2) "content" is constituted by the diary's title, introduction, textual, and nontextual components. Taking into account the diary (3) "function" for the parental coping process, three subcategories emerge: (a) strengthening the parental role, (b) supporting understanding of events, and (c) bringing joy and normality to the situation. (4) "Challenges" address an appropriate writing style, the reading of parental entries by nurses and limited resources. Based on these results and taking into account relevant literature, a framework for conceptualizing NICU diaries was developed. CONCLUSION NICU diaries show great potential to support the parental coping process. Nevertheless, diary conceptualization should be based on a theoretical framework to clarify its usage for nurses and parents. KEY POINTS · NICU diaries are an established intervention used by nurses to support parental coping.. · In nursing practice, different types of NICU diaries emerge.. · Writing styles, content, and reading of entries are reported heterogeneously.. · A conceptualizing framework for NICU diaries is needed..
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Affiliation(s)
- Tabea Willmeroth
- Fachbereich Gesundheit, FH Münster, University of Applied Sciences, Witten, Germany
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6
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Perazzo SI, Hoge MK, Shaw RJ, Gillispie-Bell V, Soghier L. Improving parental mental health in the perinatal period: A review and analysis of quality improvement initiatives. Semin Perinatol 2024; 48:151906. [PMID: 38664078 DOI: 10.1016/j.semperi.2024.151906] [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] [Indexed: 05/12/2024]
Abstract
Parental mental health is an essential sixth vital sign that, when taken into consideration, allows clinicians to improve clinical outcomes for both parents and infants. Although standards exist for screening, referral, and treatment for perinatal mood and anxiety disorders (PMADs), they are not reliably done in practice, and even when addressed, interventions are often minimal in scope. Quality improvement methodology can accelerate the implementation of interventions to address PMADs, but hurdles exist, and systems are not well designed, particularly in pediatric inpatient facilities. In this article, we review the effect of PMADs on parents and their infants and identify quality improvement interventions that can increase screening and referral to treatment of parents experiencing PMADs.
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Affiliation(s)
- Sofia I Perazzo
- Division of Neonatology, Children's National Hospital, Washington DC, USA; The George Washington University School of Medicine and Health Sciences, USA
| | - Margaret K Hoge
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Lamia Soghier
- Division of Neonatology, Children's National Hospital, Washington DC, USA; The George Washington University School of Medicine and Health Sciences, USA.
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Rodrigues SM, Shin SS, Pinto MD, Bounds DT, Terry J, Burton CW. Parenting Expectations, NICU Experiences, and Maternal Psychological Outcomes: An Exploratory Mixed-Methods Study. Adv Neonatal Care 2024; 24:195-207. [PMID: 38215024 DOI: 10.1097/anc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND Infant neonatal intensive care unit (NICU) hospitalization increases maternal risk for psychological distress. However, no universal screening standards exist and predicting maternal risk remains challenging. Reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences. PURPOSE This study explored parenting expectation-experience differences (EEDs) among NICU mothers and assessed correlations between EED scores and psychological outcomes 1 to 5 years post-NICU hospitalization. METHODS A 3-phase explanatory sequential mixed-methods design was used. Pearson's correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes. Reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores. RESULTS Most participants (92.9%) reported negative EED scores, indicating NICU experiences fell short of parenting expectations. Significant inverse correlations were found between EED scores and maternal outcomes, including depression ( r = -0.25, P < .01), anxiety ( r = -0.25, P < .01) and posttraumatic stress disorder symptoms ( r = -0.41, P < .001), and perceived parenting self-efficacy ( r = -0.28, P < .01). Major qualitative themes included unexpected versus prepared, lost parenting experiences, and surviving and thriving. Data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations. IMPLICATIONS FOR PRACTICE AND RESEARCH Preparing mothers for infant NICU hospitalization and creating a NICU parenting environment, which better supports mothers and their engagement in parenting tasks, may help to reduce differences between parenting expectations and NICU experiences. Further research is needed to elucidate the impacts of parenting EEDs in this population.
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Affiliation(s)
- Sarah M Rodrigues
- Author Affiliations: Sue & Bill Gross School of Nursing, University of California, Irvine (Drs Rodrigues, Shin, Pinto, and Bounds); Department of Gender & Sexuality Studies, University of California, Irvine (Dr Terry); and School of Nursing, University of Nevada, Las Vegas (Dr Burton)
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8
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Rodrigues SM, Bounds DT, Terry J, Pinto MD, Shin S, Burton CW. Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children. Issues Ment Health Nurs 2024; 45:142-151. [PMID: 37699105 DOI: 10.1080/01612840.2023.2250000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.
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Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Dawn T Bounds
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Jennifer Terry
- Department of Gender & Sexuality Studies, University of California, Irvine, California, USA
| | - Melissa D Pinto
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Sanghyuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
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Ismail L, Markowsky A, Adusei-Baah C, Gallizzi G, Hall M, Kalburgi S, McQuistion K, Morgan J, Tamaskar N, Parikh K. Variation in Length of Stay by Level of Neonatal Care Among Moderate and Late Preterm Infants. Hosp Pediatr 2024; 14:37-44. [PMID: 38058236 DOI: 10.1542/hpeds.2023-007252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Moderate and late preterm infants are a growing subgroup of neonates with increased care needs after birth, yet standard protocols are lacking. We aim to describe variation in length of stay (LOS) by gestational age (GA) across hospitals within the same level of neonatal care and between different levels of neonatal care. METHODS Retrospective cohort study of hospitalizations for moderate (32-33 weeks GA) and late (34-36 weeks GA) preterm infants in 2019 Kid's Inpatient Database. We compared adjusted LOS in this cohort and evaluated variation within hospitals of the same level and across different levels of neonatal care. RESULTS This study includes 217 051 moderate (26.2%) and late (73.8%) preterm infants from level II (19.7%), III (66.3%), and IV (11.1%) hospitals. Patient-level (race and ethnicity, primary payor, delivery type, multiple gestation, birth weight) and hospital-level (birth region, level of neonatal care) factors were significantly associated with LOS. Adjusted mean LOS varied for hospitals within the same level of neonatal care with level II hospitals showing the greatest variability among 34- to 36- week GA infants when compared with level III and IV hospitals (P < .01). LOS also varied significantly between levels of neonatal care with the greatest variation (0.9 days) seen in 32-week GA between level III and level IV hospitals. CONCLUSIONS For moderate and late preterm infants, the level of neonatal care was associated with variation in LOS after adjusting for clinical severity. Hospitals providing level II neonatal care showed the greatest variation and may provide an opportunity to standardize care.
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Affiliation(s)
- Lana Ismail
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Gina Gallizzi
- Children's National Hospital, Washington, District of Columbia
| | | | - Sonal Kalburgi
- Children's National Hospital, Washington, District of Columbia
| | | | - Joy Morgan
- Children's National Hospital, Washington, District of Columbia
| | - Nisha Tamaskar
- Children's National Hospital, Washington, District of Columbia
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
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Zhang R, Wang D, Zhu L, He Y, Cheng L, Ma J, Zhang T, Zhang J, Li L. Research trends in readiness for hospital discharge between 2002 and 2021: A bibliometric analysis. Nurs Open 2023; 10:7676-7693. [PMID: 37775985 PMCID: PMC10643845 DOI: 10.1002/nop2.2009] [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: 12/21/2022] [Revised: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023] Open
Abstract
AIM This study aimed to undertake a bibliometric analysis to provide comprehensive information in demonstrating the current status and outline the overall trends in the area of readiness for hospital discharge (RHD). DESIGN A bibliometric and visual analysis of RHD literature was undertaken. METHODS Articles were retrieved from the Web of Science network from 2002 to 2021. VOSviewer was used to identify the co-authorship network of countries/institutions, co-authorship and co-citation analysis of authors, and co-citation analysis of references and citation analysis of documents. CiteSpace was used to identify the keyword co-occurrence network and perform cluster analysis, detecting the keywords with citation bursts and speculated frontiers in this research field. RESULTS A total of 512 articles were included in the final analysis. Key findings are: (1) There has been a continuous but somewhat fluctuating rise in the number of publications. (2) 56.05% of publications come from the USA with Marquette University making the highest contribution. (3) Most publications (17, 3.32%) in RHD research were from the Journal of Clinical Nursing, and Anaesthesia and Analgesia had the highest number of citations (584 citations). (4) Weiss ME (25, 4.88%) was the most productive author whose articles have been the most highly cited (646 citations). (5) Cited references from Weiss ME (2007) also made the largest contribution to co-citations, and the most cited reference was from Jack BW (2009) (1022 citations). (6) The 20 most frequent keywords and keywords with the strongest citation bursts were retrieved. There were seven research hotspots, and three emerging research frontiers were explored. CONCLUSIONS The bibliometric analysis of material published in the last 20 years indicates that there have been statistically significant gains in comprehensive information on RHD, including the knowledge mapping of the countries, institutions, authors, references and keywords. The hotspots and frontiers, which have been explored can give guidance to researchers as to new angles and directions to take. IMPLICATIONS FOR NURSING MANAGEMENT The effects of the implementation of ERAS on RHD-related risk for adverse post-discharge outcomes in surgical patients will be of increasing concern for healthcare professionals. It is important for patients and their relatives to be confident that on discharge they are sufficiently ready for hospital discharge to enable them to safely and smoothly make the transition to home. Improving the level of RHD in discharged patients can help nurse managers and researchers measure the effectiveness of discharge planning services.
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Affiliation(s)
- Rong Zhang
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Dongmei Wang
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ling Zhu
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Yongdong He
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ling Cheng
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Jifen Ma
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ting Zhang
- Department of Thoracic, Cardiac, and Great Vascular Surgery, Taihe HospitalHubei University of MedicineShiyanChina
| | - Jun Zhang
- School of NursingWuhan UniversityWuhanChina
| | - Longti Li
- Nursing Department, Taihe HospitalHubei University of MedicineShiyanChina
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Pang EM, Liu J, Lu T, Joshi NS, Gould J, Lee HC. Evaluating Epidemiologic Trends and Variations in NICU Admissions in California, 2008 to 2018. Hosp Pediatr 2023; 13:976-983. [PMID: 37867440 PMCID: PMC10593864 DOI: 10.1542/hpeds.2023-007190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Previous research suggests increasing numbers of and variation in NICU admissions. We explored whether these trends were reflected in California by examining NICU admissions and birth data in aggregate and among patient and hospital subpopulations more susceptible to variations in care. METHODS In this retrospective cohort study, we evaluated NICU utilization between 2008 and 2018 for all live births at hospitals that provide data to the California Perinatal Quality Care Collaborative. We compared hospital- and admission-level data across birth weight (BW), gestational age (GA), and illness acuity categories. Trends were analyzed by using linear regression models. RESULTS We identified 472 402 inborn NICU admissions and 3 960 441 live births across 144 hospitals. Yearly trends in NICU admissions remained stable among all births and higher acuity births (mean admission rates 11.9% and 4.1%, respectively). However, analysis of the higher acuity births revealed significant increases in NICU admission rates for neonates with higher BW and GA (BW ≥ 2500g: 1.8% in 2008, 2.1% in 2018; GA ≥ 37 weeks: 1.5% in 2010, 1.8% in 2018). Kaiser hospitals had a decreasing trend of NICU admissions compared to non-Kaiser hospitals (Kaiser: 13.9% in 2008, 10.1% in 2018; non-Kaiser: 11.3% in 2008, 12.3% in 2018). CONCLUSIONS Overall NICU admission rates in California were stable from 2008-2018. However, trends similar to national patterns emerged when stratified by infant GA, BW, and illness acuity as well as Kaiser or non-Kaiser hospitals, with increasing admission rates for infants born at higher BW and GA and within non-Kaiser hospitals.
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Affiliation(s)
- Emily M. Pang
- Stanford University School of Medicine, Stanford, California
| | - Jessica Liu
- Division of Neonatology, Department of Pediatrics
- California Perinatal Quality Care Collaborative (CPQCC)
| | - Tianyao Lu
- Division of Neonatology, Department of Pediatrics
- California Perinatal Quality Care Collaborative (CPQCC)
| | - Neha S. Joshi
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Jeffrey Gould
- Division of Neonatology, Department of Pediatrics
- California Perinatal Quality Care Collaborative (CPQCC)
| | - Henry C. Lee
- California Perinatal Quality Care Collaborative (CPQCC)
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, California
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Boutillier B, Ethier G, Boucoiran I, Reichherzer M, Luu TM, Morin L, Pearce R, Janvier A. Prenatal Workshops and Support Groups for Prospective Parents Whose Children Will Need Neonatal Care at Birth: A Feasibility and Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1570. [PMID: 37761531 PMCID: PMC10529479 DOI: 10.3390/children10091570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Introduction: Support groups in neonatal intensive care units (NICUs) are beneficial to parents. The usefulness of prenatal support groups for prospective parents who will have a newborn requiring admission to the NICU has never been investigated. Methods: We assessed the needs of NICU parents regarding topics they would have wished to discuss prenatally and developed the content of a prenatal support workshop. A standardized survey prospectively evaluated the perspectives of pregnant women admitted to a high-risk pregnancy unit who participated in the resulting workshops. Results: During needs assessment, 295 parents invoked themes they would have wished to discuss antenatally: parental guilt, future parental role, normalizing their experience/emotions, coping with many losses, adapting to their new reality, control and trust, information about the NICU, technology around the baby, common neonatal interventions, the NICU clinical team, and the role of parents in the team. These findings were used to develop the workshop, including a moderator checklist and a visual presentation. Practical aspects of the meetings were tested/finalized during a pre-pilot phase. Among 21 pregnant women who answered the survey (average gestational age 29.3 weeks), all agreed that the workshop was useful, that it made them feel less lonely (95%), that exchanges with other women were beneficial (95%) and gave them a certain amount of control over their situation (89%). All answers to open-ended questions were positive. Conclusion: Prenatal educational/support workshops provide a unique and useful means to support future NICU parents. Future investigations will explore whether these prenatal interventions improve clinical outcomes.
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Affiliation(s)
- Béatrice Boutillier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Guillaume Ethier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Martin Reichherzer
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Thuy Mai Luu
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Lucie Morin
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Rebecca Pearce
- Parent Representative, Collaborates with Canadian Premature Babies Foundation, Etobicoke, ON M8X 1Y3, Canada;
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
- Bureau de L’éthique Clinique (BEC), Université de Montréal, Montréal, QC H3C 3J7, Canada
- Unité de Soins Palliatifs, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
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13
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Ginsberg KH, Serlachius A, Rogers J, Alsweiler J. Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey. J Pediatr 2023; 259:113456. [PMID: 37172808 DOI: 10.1016/j.jpeds.2023.113456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand. STUDY DESIGN A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices. RESULTS Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P < .001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents. CONCLUSIONS Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.
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Affiliation(s)
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jen Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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14
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Ahn HY, Jo HJ, Ko HJ. Effects of a Noncontact Visit Program in the NICU for the Prevention of COVID-19. Healthcare (Basel) 2023; 11:2152. [PMID: 37570392 PMCID: PMC10419116 DOI: 10.3390/healthcare11152152] [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: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND With the spread of COVID-19, neonatal intensive care units restricted visiting hours to prevent infection. As a result, mothers of high-risk newborns were restricted from making contact with their children. Various problems could be encountered for hospitalized children and mothers of high-risk newborns due to restrictions on visits in the neonatal intensive care unit. Therefore, during the pandemic, continuous nursing support for mothers of high-risk newborns was needed. METHODS In this study, a nonequivalent control group non-synchronized design was employed. The subjects of the study were 36 mothers of high-risk neonates (20 in the experimental group and 16 in the control group) in E University Hospital, D Metropolitan City, from July to September 2022. The experimental group received a 10 min program performed by a nurse from 7:00 p.m. to 9:00 p.m. three times per week. RESULTS There were significant differences in nurses' support between the experimental and control groups (F = 25.594, p < 0.001), changes over time (F = 16.178, p < 0.001), and time-group interactions (F = 9.663, p = 0.003). CONCLUSIONS It was interpreted that the real-time noncontact visitation program could transcend time and space for many mothers of high-risk newborn babies, who suffered psychologically due to restrictions and bans on visitations during the COVID-19 pandemic.
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Affiliation(s)
- Hye Young Ahn
- College of Nursing, Eulji University, Uijeongbu 11759, Republic of Korea
| | | | - Hyun Jeong Ko
- College of Nursing, Eulji University, Uijeongbu 11759, Republic of Korea
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15
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Lastrucci E, Daniotti M, Procopio E, Scaturro G, Tubili F, Martin R, la Marca G. Communicating a Positive Result at Newborn Screening and Parental Distress. Int J Neonatal Screen 2023; 9:38. [PMID: 37489491 PMCID: PMC10366888 DOI: 10.3390/ijns9030038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
The assumption of this study is strictly connected to the need to focus and to know more about the impact on the psychological state of the parents whose newborn babies get a positive result at Expanded Newborn Screening (ENS). As clinical experience shows us, this aspect seems to have a potentially lasting resonance on the way the disease will be managed and handled in the family, leading to potential negative effects and repercussions on the child's wellbeing and on the quality of life within the family. On the basis of this and on the evidence emerging from a review of the literature, this study aims to investigate and objectify possible distress indicators elicited at the moment of the communication of a positive result at ENS. Questionnaires containing the Beck Depression Inventory-II, the State-Trait Anxiety Inventory-Y, and the Short Form 36 Health Survey tests were administered to the parents of 87 newborns who received positive results at ENS. The parents of 32 babies expressed the presence of discomfort potentially related to the communication of a positive result at ENS.
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Affiliation(s)
- Elisa Lastrucci
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50019 Florence, Italy;
| | - Marta Daniotti
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Elena Procopio
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Giusi Scaturro
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Flavia Tubili
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Rosanna Martin
- Psychology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy;
| | - Giancarlo la Marca
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50019 Florence, Italy;
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
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16
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Sadler EM, Okito O, Soghier L. Addressing caregiver mental health in the neonatal ICU. Curr Opin Pediatr 2023; 35:390-397. [PMID: 36974450 DOI: 10.1097/mop.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals. RECENT FINDINGS Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes. SUMMARY To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU. VIDEO ABSTRACT http://links.lww.com/MOP/A70.
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Affiliation(s)
- Erin M Sadler
- Division of Psychology and Behavioral Health
- Department of Pediatrics
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Ololade Okito
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
| | - Lamia Soghier
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
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17
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Joshi NS, Congdon JL, Phillipi CA. Rethinking Admission Location for Low Acuity Infants of 35 Weeks' Gestation. Pediatrics 2023; 151:e2022059996. [PMID: 36994640 PMCID: PMC10071420 DOI: 10.1542/peds.2022-059996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Neha S. Joshi
- Department of Pediatrics, Stanford University, Stanford, California
| | - Jayme L. Congdon
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Carrie A. Phillipi
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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18
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Younge T, Jacobs M, Tuchman L, Streisand R, Soghier L, Fratantoni K. Sociodemographic risk factors, parental stress and social support in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2023; 108:165-169. [PMID: 36805477 DOI: 10.1136/archdischild-2022-324119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Investigate relationships among neonatal intensive care unit (NICU) parent demographics, reported stress and social support. DESIGN Cross-sectional observation. SETTING Tertiary referral NICU in Mid-Atlantic USA. PATIENTS Parents (n=300) in the Giving Parents Support trial at enrolment. MEASURES Psychometric scales measured general stress, parental stress, NICU stress and social support. Demographic variables included education level, health insurance type, race, relationship status, age and gender. Length of stay was used to control for illness severity. Associations and potential modifying effects were evaluated using linear regression. RESULTS Having less than a college degree (b=-2.52, SE=0.91) and female parent gender (b=-3.42, SE=1.47) were associated with lower parental stress scores. Older age in years was associated with higher parental stress scores (b=0.21, SE=0.07) but lower NICU stress scores (b=-0.01, SE=0.01). Greater social support scores were associated with lower scores of general (b=-2.76, SE=0.39) and parental stress (b=-1.71, SE=0.47). Less than a college degree (b=-0.26, SE=0.11), Medicaid insurance (b=-0.43, SE=0.11) and black race (b=-0.56, SE=0.12) were associated with decreased social support scores. Level of social support modified the relationship between education and parental stress, with higher social support decreasing education-based differences in parental stress scores (p=0.049). CONCLUSION Sociodemographic risk factors may not infer stress or risk in the anticipated direction. Practice and future research should focus on identifying and supporting NICU families at high risk for stress and low support. TRIAL REGISTRATION NUMBER NCT02643472.
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Affiliation(s)
- Tamiko Younge
- Division of Neonatology, Children's National Hospital, Washington, DC, USA
| | - Marni Jacobs
- Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, USA.,Department of OBGYN & Reproductive Sciences, UCSD, La Jolla, California, USA
| | - Lisa Tuchman
- Division of Adolescent and Young Adult Medicine, Children's National Hospital, Washington, DC, USA
| | - Randi Streisand
- Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC, USA
| | - Lamia Soghier
- Division of Neonatology, Children's National Hospital, Washington, DC, USA
| | - Karen Fratantoni
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA
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19
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McKeown L, Burke K, Cobham VE, Kimball H, Foxcroft K, Callaway L. The Prevalence of PTSD of Mothers and Fathers of High-Risk Infants Admitted to NICU: A Systematic Review. Clin Child Fam Psychol Rev 2023; 26:33-49. [PMID: 36564614 DOI: 10.1007/s10567-022-00421-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/25/2022]
Abstract
Admission of a preterm or sick full-term infant to the neonatal intensive care unit (NICU) is a stressful experience for parents. Indeed, the 'NICU experience' may constitute a traumatic event for parents, distinct from other birth-related trauma, leading to significant and ongoing posttraumatic stress disorder (PTSD) symptoms. However, the rates at which this outcome occurs are not well understood. This review aimed to identify the prevalence of PTSD in mothers and fathers of high-risk infants admitted to the NICU, specifically focusing on the NICU experience as the index trauma. The PRISMA-P: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols were used to conduct this review. We searched PsycINFO, PubMed, Scopus, EMBASE, Web of Science, ProQuest Dissertations and Theses databases, and reference lists of included articles (1980-2021). Two independent reviewers screened titles and abstracts and conducted the full-text screening assessment. Of the 707 records identified, seven studies met the inclusion criteria. In this systematic review, PTSD symptomatology was assessed by self-report measures rather than a clinical interview. We identified significant variations in the methodologies and quality between studies, with a wide variation of reported prevalence rates of PTSD of 4.5-30% in mothers and 0-33% in fathers. Overall, the findings indicate that up to one-third of parents experience PTSD symptomatology related to the NICU experience. These results emphasize the importance of universal routine antenatal and postnatal screening for symptoms of PTSD to identify parents at risk of distress during the NICU experience and after discharge.Trial registration: The study protocol was registered with Prospero registration number CRD42020154548 on 28 April 2020.
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Affiliation(s)
- Lisa McKeown
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia.
| | - Kylie Burke
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, Brisbane, Australia
- Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Hayley Kimball
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Katie Foxcroft
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Leonie Callaway
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
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20
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Ataş N, Kılıçaslan F. The Effect of Hopelessness on Depressive Symptoms in Mothers of Infants Hospitalized at Neonatal Intensive Care Unit: The Mediating Role of Anxiety. Psychiatry 2023; 86:187-199. [PMID: 36688831 DOI: 10.1080/00332747.2022.2161260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: Mothers of infants admitted to the neonatal intensive care unit (NICU) are at high risk for depressive symptoms. This study investigated whether anxiety symptoms mediate the relationships between hopelessness and depressive symptoms in mothers with newborn infants admitted to the NICU.Methods: This cross-sectional descriptive study was conducted in the NICU of a university hospital in Turkey between October 2021 and March 2022. A total of 100 mothers whose infants were hospitalized in the NICU participated in the study. The data were collected using the Sociodemographic Data Form, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Beck Hopelessness Scale (BHS). Linear regression analysis was used to examine the effect of demographic characteristics on scale scores. In order to test whether the anxiety score has a mediating role in the relationship between hopelessness and depression, the analysis was made based on the bootstrap method and the Maximum Likelihood method.Results: Levels of the depression, anxiety and hopelessness levels of the NICU mothers were not affected by the demographic variables of the parent and the infant. Hopelessness was found to predict depressive symptoms (β = 0.476; p < .050). In addition, according to the mediator variable analysis results, it was found that anxiety had a mediating role between the level of hopelessness and depressive symptoms (β = 0.596; p < .050). Accordingly, hopelessness explains 52.5% of the change in depression along with anxiety.Conclusion: Our study detailed the specific process of depressive symptoms caused by hopelessness in NICU mothers.
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21
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Scala M, Marchman VA, Dowtin LL, Givrad S, Nguyen T, Thomson A, Gao C, Sorrells K, Hall S. Evaluation of a course for neonatal fellows on providing psychosocial support to NICU families. PEC INNOVATION 2022; 1:100053. [PMID: 37213727 PMCID: PMC10194397 DOI: 10.1016/j.pecinn.2022.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 05/23/2023]
Abstract
Objectives Families in the Neonatal Intensive Care Unit (NICU) experience significant psychological distress. Fellowship training requires education on mental health issues. No standardized program exists. We evaluated the impact of an online course, combining research with family perspectives, on neonatology fellow knowledge and self-efficacy when emotionally supporting NICU families. Methods Fellows from 20 programs completed a course covering: (1) Parent Mental Health, (2) Infant Mental Health, (3) Communication, and (4) Comprehensive Mental Health (e.g., discharge, bereavement) with pre- and post-course knowledge and self-efficacy assessments. Results Fellows (n=91) completed the course and assessments. Pre-course knowledge was similar by year of training (1st: 66.9%; 2nd: 67.2%; 3rd: 67.4%). Mean knowledge and self-efficacy improved between pre- and post-course assessments regardless of training year or prior education for knowledge (d=1.2) (67.1% vs. 79.4%) and for self-efficacy (d=1.2) (4.7 vs 5.2 on 6-point Likert scale). Fellows who gained more knowledge had higher self-efficacy scores at post-test (r = .37). Conclusions Current neonatal fellowship training under-educates on mental health. An online course improved fellow knowledge and self-efficacy. Our course may be an exemplar for others creating similar curricula. Innovation An online course enriched by patient perspectives is an effective method of disseminating education around mental health.
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Affiliation(s)
- Melissa Scala
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
- Corresponding author at: Division of Neonatal and Developmental Medicine, Stanford University, MC5660, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | | | | | - Soudabeh Givrad
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Tuan Nguyen
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Alexa Thomson
- Human Biology, Stanford University, Stanford, CA, USA
| | - Courtney Gao
- Human Biology, Stanford University, Stanford, CA, USA
| | | | - Sue Hall
- St John’s Regional Medical Center (retired), Oxnard, CA, USA
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22
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Swenson SA, Paulsen ME. EBNEO commentary: Elevated depression and anxiety symptoms in parents of very preterm infants while hospitalised and post-discharge. Acta Paediatr 2022; 111:1648-1649. [PMID: 35650173 PMCID: PMC9544086 DOI: 10.1111/apa.16414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah A. Swenson
- Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Megan E. Paulsen
- Department of Pediatrics, Division of NeonatologyUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
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23
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Implementation Outcomes and Challenges of Partnerships between Resource Parents and Parents with Sick Infants in Intensive Neonatal Care Units: A Scoping Review. CHILDREN 2022; 9:children9081112. [PMID: 35892615 PMCID: PMC9331213 DOI: 10.3390/children9081112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Parents with a sick child in a neonatal intensive care unit (NICU) usually experience stress, anxiety, and vulnerability. These precarious feelings can affect early parent–child interactions and have consequences for the child’s neurodevelopment. Parents who have had a sick child in an NICU (veteran parents) can offer helpful interventions for these vulnerable families. This article is a scoping review of parental interventions used with the families of NICU infants, and an overview of French perspectives. Two independent reviewers studied the scientific literature published in English between 2001 to 2021 using Covidence software. The databases used were MEDLINE, ISI Web of Science, the Cochrane Database, and Google Scholar. Themes were identified from the articles’ results using an open coding approach. The data are presented in a narrative format. Ten articles were included, and four major themes addressed: (1) description of activities, (2) recommendations, (3) impact, and (4) barriers (resulting from recruitment, training, remuneration, and organization). Activities were very diverse, and a step-by-step implementation was recommended by all authors. Peer-support interventions might be a potential resource for those anxious parents and improve their NICU experiences. These challenges are described by SOS Préma in France. This article brings together recent studies on partnership in the NICU. It is an innovative topic in neonatology with vast issues to explore.
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Weimer KED, Bidegain M, Shaikh SK, Couchet P, Tanaka DT, Athavale K. Comparison of short-term outcomes of 35-weeks' gestation infants cared for in a level II NICU vs mother-baby, a retrospective study. J Neonatal Perinatal Med 2022; 15:643-651. [PMID: 35661024 DOI: 10.3233/npm-221015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late preterm infants are at high risk for medical complications and represent a growing NICU population. While 34-weeks' gestation infants are generally admitted to the NICU and 36-weeks'gestation infants stay in mother-baby, there is wide practice variation for 35-weeks'gestation infants. The objective of this study was to compare short-term outcomes of 35-weeks' gestation infants born at two hospitals within the same health system (DUHS), where one (DRH) admits all 35-weeks' gestation infants to their level II NICU and the other (DUH) admits all 35-weeks' gestation infants to mother-baby, unless clinical concern. METHODS We conducted a retrospective cohort analysis of 35-weeks' gestation infants born at DUHS from 2014-2019. Infant specific data were collected for birth, demographics, medications, medical therapies, LOS, ED visits and readmissions. 35-weeks' gestation infants at each hospital (DRH vs DUH) that met inclusion criteria were compared, regardless of unit(s) of care. RESULTS 726 infants of 35-weeks' gestation were identified, 591 met our inclusion criteria (DUH -462, DRH -129). Infants discharged from DRH were more likely to receive medical therapies (caffeine, antibiotics, blood culture, phototherapy, NGT), had a 4 day longer LOS, but were more likely to feed exclusively MBM at discharge. There were no differences in ED visits; however, more infants from DUH were readmitted within 30 days of discharge. CONCLUSIONS Our findings suggest admitting 35-weeks' gestation infants directly to the NICU increases medical interventions and LOS, but might reduce hospital readmissions.
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Affiliation(s)
- K E D Weimer
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - M Bidegain
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - S K Shaikh
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - P Couchet
- Department of Pediatrics, Duke University, Durham, NC, USA.,Hospital de Clínicas, Departamento de Neonatología, UDELAR, Montevideo, Uruguay
| | - D T Tanaka
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - K Athavale
- Department of Pediatrics, Duke University, Durham, NC, USA
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Bloyd C, Murthy S, Song C, Franck LS, Mangurian C. National Cross-Sectional Study of Mental Health Screening Practices for Primary Caregivers of NICU Infants. CHILDREN 2022; 9:children9060793. [PMID: 35740730 PMCID: PMC9221644 DOI: 10.3390/children9060793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022]
Abstract
Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The objective of this study was to determine the prevalence of mental health screening and treatment programs for parents or other primary caregivers in NICUs across the country. In this cross-sectional study, US NICU medical directors were invited to complete an online survey about current practices in mental health education, screening, and treatment for primary caregivers of preterm and ill infants in the NICU. Comparative analyses using Fisher’s exact test were performed to evaluate differences in practices among various NICU practice settings. Survey responses were obtained from 75 out of 700 potential sites (10.7%). Of participating NICUs, less than half routinely provided caregivers with psychoeducation about mental health self-care (n = 35, 47%) or routinely screened caregivers for PPD or other mental health disorders (n = 33, 44%). Nearly one-quarter of the NICUs did not provide any PMAD screening (n = 17, 23%). Despite consensus that postpartum psychosocial care is essential, routine mental health care of primary caregivers in the NICU remains inadequate.
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Affiliation(s)
- Cooper Bloyd
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
- Department of Pediatrics, University of California, San Francisco, CA 94143, USA
| | - Snehal Murthy
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
| | - Clara Song
- Southern California Permanente Medical Group, Pasadena, CA 91188, USA;
| | - Linda S. Franck
- School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Christina Mangurian
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-415-206-5925; Fax: +1-415-206-8942
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Schuetz Haemmerli N, Stoffel L, Schmitt KU, Khan J, Humpl T, Nelle M, Cignacco E. Enhancing Parents' Well-Being after Preterm Birth-A Qualitative Evaluation of the "Transition to Home" Model of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074309. [PMID: 35409993 PMCID: PMC8998674 DOI: 10.3390/ijerph19074309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 01/03/2023]
Abstract
There are few programs available aimed at preventing short- and long-term negative consequences after preterm birth and covering the entire care continuum. The “Transition to Home (TtH)” model is such a program, offering structured, individual support for families with preterm infants before and after hospital discharge. This study gathers and examines the parents’ views of receiving support from an interprofessional team under the TtH model of care during hospitalization and after discharge. Using a qualitative explorative design, 39 semi-structured interviews with parents were analyzed thematically. From this analysis, three main themes were identified: (1) TtH and the relevance of continuity of care; (2) Enhancement of parents’ autonomy and self-confidence; (3) Perception of interprofessional collaboration. Within these themes, the most relevant aspects identified were continuity of care and the appointment of a designated health care professional to anchor the entire care continuum. Emotional support complemented by non-medical approaches, along with strength-based and family resource-oriented communication, also emerged as key aspects. Continuous, family-centered care and well-organized interprofessional collaboration promote the well-being of the family after a premature birth. If the aspects identified in this study are applied, the transition from hospital to home will be smoothened for the benefit of affected families.
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Affiliation(s)
- Natascha Schuetz Haemmerli
- Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland; (K.-U.S.); (E.C.)
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Correspondence:
| | - Liliane Stoffel
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Kai-Uwe Schmitt
- Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland; (K.-U.S.); (E.C.)
- Insel Gruppe, Bern University Hospital, 3010 Bern, Switzerland
| | - Jeannine Khan
- Kantonale Schule für Berufsbildung, 5001 Aarau, Switzerland;
| | - Tilman Humpl
- Tilman Humpl, Department of Paediatrics, St. Elisabethen-Krankenhaus, Kliniken des Landeskreises Lörrach, 79539 Lörrach, Germany;
| | - Mathias Nelle
- Mathias Nelle, Children’s Hospital, Kreiskliniken Böblingen, 71302 Böblingen, Germany;
| | - Eva Cignacco
- Department of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland; (K.-U.S.); (E.C.)
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Dahan S, Bourque CJ, Reichherzer M, Prince J, Mantha G, Savaria M, Janvier A. Community, Hope, and Resilience: Parental Perspectives on Peer Support in Neonatology. J Pediatr 2022; 243:85-90.e2. [PMID: 34843711 DOI: 10.1016/j.jpeds.2021.11.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To describe the perspective of parents who participated in peer-to-peer support meetings with parents of children in a neonatal intensive care unit (NICU) and veteran resource parents with previous NICU experience. STUDY DESIGN During a longitudinal evaluation in a tertiary care NICU, participating parents were asked to evaluate meetings; with open-ended questions, they were asked about their perspectives. Results were analyzed using mixed methods. RESULTS Forty-five NICU parents participated over a 10-week study period. They were followed longitudinally after attending at least 1 of the 10 meetings offered; 95% of parents (43 of 45) reported that the meeting was useful to them and gave an overall evaluation of 8.7 out of 10 (average). For each meeting, all the subjects on the checklist of the moderators (veteran resource parents) were discussed with new parents. When describing why and how the meetings were useful to them in their answers to open-ended questions, NICU parents reported 3 major themes: (1) decreasing isolation and being a community (73%), (2) hope and resilience (63%), and (3) getting practical "parent" information (32%). Sharing stories with parents who also had experienced loss, sadness, and grief, NICU parents trusted that it was possible to adapt and thrive. The meetings normalized parents' emotions (92%), decreased negative emotions (eg, anger, sadness, guilt), empowered them in their parental role, and helped them communicate with loved ones and providers. CONCLUSIONS Peer support meetings are a unique and useful means to support parents. Future investigations will investigate whether and how this type of intervention can improve clinical outcomes.
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Affiliation(s)
- Sonia Dahan
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Espace Éthique Méditerranéen, Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Marseille, France
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | - Melissa Savaria
- Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Préma-Québec, Quebec, Quebec, Canada; Bureau de l'Éthique Clinique, University of Montreal, Montreal, Quebec, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montreal, Quebec, Canada.
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Dubowitz H, Finkelhor D, Zolotor A, Kleven J, Davis N. Addressing Adverse Childhood Experiences in Primary Care: Challenges and Considerations. Pediatrics 2022; 149:185395. [PMID: 35362065 PMCID: PMC9405315 DOI: 10.1542/peds.2021-052641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/24/2022] Open
Abstract
This article draws attention to the overlapping literature on social determinants of health and adverse childhood experiences, and the growing clinical interest in addressing them to promote children's and parents' health and well-being. We address important considerations and suggest solutions for leaders and practitioners in primary care to address social determinants of health/adverse childhood experiences. Priorities include: begin with a few prevalent conditions for which there are helpful resources; focus on conditions that are current or recent and where parents may be more apt to engage in services; focus initially on families with children aged <6 given the frequency of well-child visits and the especially strong relationships between primary care professionals and parents during this period; ensure training of primary care professionals and staff to help them play this role competently and comfortably; and have good referral processes to facilitate additional evaluation or help.
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Affiliation(s)
- Howard Dubowitz
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland,Address correspondence to Howard Dubowitz, MD, MS, Department of Pediatrics, University of Maryland School of Medicine, 520 W Lombard St, Baltimore, MD 21201. E-mail:
| | - David Finkelhor
- Department of Sociology, University of New Hampshire, Durham, New Hampshire
| | - Adam Zolotor
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jennifer Kleven
- Department of Pediatrics, Gundersen Health System, La Crosse, Wisconsin
| | - Neal Davis
- Pediatric Community Based Care, Intermountain Primary Children’s Hospital, Salt Lake City, Utah
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Curren LC, Borba CPC, Henderson DC, Tompson MC. "Making Room": A Thematic Analysis Study of the Process of Postpartum Maternal Adjustment. Matern Child Health J 2022; 26:1142-1152. [PMID: 35298743 DOI: 10.1007/s10995-022-03393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Mothers are especially vulnerable to the onset or recurrence of psychological symptoms during the postpartum period. However, protective psychosocial factors may provide a stress buffering effect and promote a positive adjustment trajectory. Previous research has demonstrated the importance of positive maternal adjustment for maternal mental health and child outcome. However, research is needed that explores (1) the psychosocial components of maternal adjustment, (2) the process of maternal adjustment as subjectively experienced by mothers, and (3) clinical targets that can help postpartum healthcare teams to facilitate positive adjustment during the perinatal period. METHODS This qualitative study utilized thematic analysis in order to understand the dimensions and properties of themes related to maternal adjustment. Through narrative interviews, this study investigated processes associated with maternal adjustment in a sample of n = 23 mothers receiving obstetric care. RESULTS Thematic analysis uncovered three key developmental processes: (1) "Stretching Identity; Transitioning Roles", (2) "Navigating Stressors; Approaching Self-Efficacy", and (3) "Changing Relationships; Strengthening Support." Negative maternal self-attributions emerged as a key target for supportive intervention. Each process is complex and susceptible to both downward and upward spirals, consistent with the broaden-and-build theory of positive emotion. CONCLUSIONS FOR PRACTICE Negative maternal attributions of self are discussed as a key target precipitating postpartum adjustment trajectories. Given this, parenting interventions that teach cognitive reappraisal or mindfulness strategies may be especially beneficial for mothers in the perinatal period.
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Affiliation(s)
- Laura C Curren
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Martha C Tompson
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Parental mental health screening in the NICU: a psychosocial team initiative. J Perinatol 2022; 42:401-409. [PMID: 34580422 PMCID: PMC9145720 DOI: 10.1038/s41372-021-01217-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/28/2021] [Accepted: 09/10/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE About 40-50% of parents with children admitted to Neonatal Intensive Care Units (NICU) experience clinically significant levels of depression, anxiety, and trauma. Poor parental mental health can negatively influence parent-child interactions and child development. Therefore, early identification of parents at-risk for clinical distress is of paramount importance. METHODS To address this need, the psychosocial team, including psychology and psychiatry, at a large, level 4 Neonatal Intensive Care Unit (NICU) developed a quality-improvement initiative to assess the feasibility of screening parents and to determine rates of depression and trauma in the unit. RESULTS About 40% of mothers and 20% of fathers were screened between 2 weeks of their child's hospitalization. About 40-45% of those parents endorsed clinically significant levels of depression and anxiety symptoms. CONCLUSIONS Recommendations for enhancing the feasibility and effectiveness of this process are discussed and considerations for future clinical and research endeavors are introduced.
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Martín-Ancel A, Pérez-Muñuzuri A, González-Pacheco N, Boix H, Espinosa Fernández MG, Sánchez-Redondo MD, Cernada M, Couce ML. Cuidados paliativos perinatales. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Johnson Rolfes J, Paulsen M. Protecting the infant-parent relationship: special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents. J Perinatol 2022; 42:815-818. [PMID: 34711936 PMCID: PMC8552434 DOI: 10.1038/s41372-021-01256-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022]
Abstract
Perinatal mood and anxiety disorders (PMADs) are common, particularly among parents of infants requiring admission to the neonatal intensive care unit (NICU), yet remain underdiagnosed and undertreated. Undertreated parental mental health disorders can interfere with healthy infant development, compounding abnormal neurodevelopment and psychosocial development that preterm or ill newborns may already face. Interdisciplinary efforts to increase PMAD awareness, screening, and referral uptake may improve family-infant health and developmental outcomes in high-risk infants requiring NICU admission. Therefore, special emphasis on PMAD screening and treatment in NICU parents aligns with the American Academy of Pediatrics mission and should be a focus in neonatal care and included in education, quality improvement, and outcome-based research initiatives.
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Affiliation(s)
- Julie Johnson Rolfes
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Megan Paulsen
- grid.17635.360000000419368657Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN USA
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Martín-Ancel A, Pérez-Muñuzuri A, González-Pacheco N, Boix H, Espinosa Fernández MG, Sánchez-Redondo MD, Cernada M, Couce ML. Perinatal palliative care. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 96:60.e1-60.e7. [DOI: 10.1016/j.anpede.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
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Giving parents support: a randomized trial of peer support for parents after NICU discharge. J Perinatol 2022; 42:730-737. [PMID: 35260824 PMCID: PMC9184279 DOI: 10.1038/s41372-022-01341-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/01/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peer support during inpatient hospitalization has been recommended for NICU parents and can improve maternal mental health. Less is known about the impact of peer support after NICU discharge on parental mental health and infant healthcare utilization. METHODS Three hundred families of infants approaching discharge from a Level IV NICU were randomized to receive a care notebook (control) or care notebook plus peer support for 12 months (intervention). Participants reported on measures of stress, depression, anxiety, self-efficacy, and infant healthcare utilization. Analysis compared outcomes between control and treatment groups. RESULTS Parental depression, anxiety, stress, and self-efficacy improved significantly for all participants, yet there were no differences between control and intervention groups. Infant ED visits, hospitalizations, immunization status, and developmental status at 12 months did not differ between groups. CONCLUSIONS Peer support after NICU discharge did not improve self-reported parental mental health measures or infant healthcare utilization. CLINICAL TRIAL REGISTRATION NCT02643472.
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Lemmon ME, Wusthoff CJ, Boss RD, Rasmussen LA. Ethical considerations in the care of encephalopathic neonates treated with therapeutic hypothermia. Semin Fetal Neonatal Med 2021; 26:101258. [PMID: 34176763 PMCID: PMC8627487 DOI: 10.1016/j.siny.2021.101258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Engaging with ethical issues is central to the management of neonatal encephalopathy (NE). As treatment for these neonates evolves, new ethical issues will arise and many existing challenges will remain. We highlight three key ethical issues that arise in the care of neonates with NE treated with therapeutic hypothermia: facilitating shared decision making, understanding futility, and defining the boundaries between standard of care and research. Awareness of these issues will help clinicians counsel families in light of evolving treatments and outcomes.
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Affiliation(s)
- Monica E. Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, DUMC 3936, Durham, NC, 27710, USA,Corresponding author. (M.E. Lemmon)
| | - Courtney J. Wusthoff
- Departments of Neurology and Pediatrics, Stanford University, Stanford, 750 Welch Road, Suite 317, Palo Alto, CA, 94304, USA
| | - Renee D. Boss
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Berman Institute of Bioethics, 200 N. Wolfe St, Suite 2019, Baltimore, MD, 21287, United States
| | - Lisa Anne Rasmussen
- Division of Palliative Care, Department of Family Medicine, Department of Neurology, Department of Pediatrics, Larner College of Medicine, University of Vermont, UVM Medical Center Palliative Care, 111 Colchester Avenue, Main Campus, Smith 262, Burlington, VT, 05401-1473, USA.
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Loewenstein K, Barroso J, Phillips S. The Experiences of Parent Dyads in the Neonatal Intensive Care Unit: A Qualitative Description. J Pediatr Nurs 2021; 60:1-10. [PMID: 33567394 DOI: 10.1016/j.pedn.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
Background The hospitalization of an infant in the neonatal intensive care unit (NICU) is a distressing and often unexpected event for parents. Parents have risk for depression, anxiety, and posttraumatic stress, which can adversely impact them and their relationship. The hospitalization and subsequent stress may affect parents' capability to connect with and parent their child. Purpose Describe parents' experiences and ability to cope with the NICU; identify experiential and coping differences between mothers and fathers; examine the effect of the NICU hospitalization on the parent dyad relationship. Methods A qualitative descriptive design with dyadic interviews examined parents' experiences and coping skills, and subsequent effects on the parental relationship. Data collection continued until saturation was achieved and no new themes emerged. Through content analysis, an accurate description of parents' experiences in the NICU was rendered. Findings Nine themes from eight dyad interviews emerged and were categorized within the six domains of the transactional theory of stress and coping. The major themes were: Deeply Distressing, Unexpected and Unprepared, Expecting to Hear and Be Heard, Becoming Parents, Stronger Together, Support is Key, Parents Want Better Communication, and Adjusting to the NICU. Implications for practice Support from professionals and family, and clear and consistent communication from the treatment team helped alleviate parents' anxiety about their infant. Implications for research Research regarding the impact of a NICU hospitalization on the relationship between parent dyad members, specifically longitudinal studies, may lead to a better understanding of the long-term effects of this specific stressor on parents.
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Affiliation(s)
| | - Julie Barroso
- Zucker Hillside Hospital, NY, United States of America
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Bernardo J, Rent S, Arias-Shah A, Hoge MK, Shaw RJ. Parental Stress and Mental Health Symptoms in the NICU: Recognition and Interventions. Neoreviews 2021; 22:e496-e505. [PMID: 34341157 DOI: 10.1542/neo.22-8-e496] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Parental experiences in the NICU are often characterized by psychological stress and anxiety following the birth of a critically ill or premature infant. Such stress can have a negative impact on parents and their vulnerable infants during NICU hospitalization as well as after discharge. These infants are also at increased risk for adverse developmental, cognitive, academic, and mental health outcomes. Identifying parents at risk for psychological distress is important and feasible with the use of well-validated screening instruments. Screening for psychological distress is essential for identifying families in need of referral for psychological support and resources. Numerous interventions have been implemented in the NICU to support parents. These include staff-based support such as wellness rounds and education in developmental care as well as parental-based support that includes cognitive behavioral therapy and home visitation programs. Comprehensive interventions should use a multidisciplinary approach that involves not only NICU staff but also key stakeholders such as social workers, spiritual/religious representatives, specialists in developmental care, and psychiatrists/psychologists to help support families and facilitate the transition to the home. Future efforts should include raising awareness of the psychological stresses of NICU parents and encouraging the development of programs to provide parents with psychological support.
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Affiliation(s)
- Janine Bernardo
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sharla Rent
- Division of Neonatal Medicine, Department of Pediatrics, Duke University, Durham, NC
| | - AnnaMarie Arias-Shah
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA
| | - Margaret K Hoge
- Department of Developmental and Behavioral Pediatrics, UT Southwestern Dallas, Dallas, TX
| | - Richard J Shaw
- Division of Child Psychiatry, Stanford University School of Medicine, Palo Alto, CA
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Murthy S, Haeusslein L, Bent S, Fitelson E, Franck LS, Mangurian C. Feasibility of universal screening for postpartum mood and anxiety disorders among caregivers of infants hospitalized in NICUs: a systematic review. J Perinatol 2021; 41:1811-1824. [PMID: 33692474 PMCID: PMC8349842 DOI: 10.1038/s41372-021-01005-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 01/31/2023]
Abstract
This systematic review evaluated the feasibility of implementing universal screening programs for postpartum mood and anxiety disorder (PMAD) among caregivers of infants hospitalized in the neonatal intensive care unit (NICU). Four moderate quality post-implementation cohort studies satisfied inclusion criteria (n = 2752 total participants). All studies included mothers; one study included fathers or partners. Screening included measures of depression and post-traumatic stress. Screening rates ranged from 48.5% to 96.2%. The incidence of depression in mothers ranged from 18% to 43.3% and was 9.5% in fathers. Common facilitators included engaging multidisciplinary staff in program development and implementation, partnering with program champions, and incorporating screening into routine clinical practice. Referral to mental health treatment was the most significant barrier. This systematic review suggests that universal PMAD screening in NICUs may be feasible. Further research comparing a wider range of PMAD screening tools and protocols is critical to address these prevalent conditions with significant consequences for parents and infants.
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Affiliation(s)
- Snehal Murthy
- School of Medicine, University of California, San Francisco, CA, USA
| | - Laurel Haeusslein
- Benioff Children's Hospital Oakland, University of California, San Francisco, CA, USA
| | - Stephen Bent
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Elizabeth Fitelson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Linda S Franck
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
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Williams AB, Hendricks-Muñoz KD, Parlier-Ahmad AB, Griffin S, Wallace R, Perrin PB, Rybarczyk B, Ward A. Posttraumatic stress in NICU mothers: modeling the roles of childhood trauma and infant health. J Perinatol 2021; 41:2009-2018. [PMID: 34168287 DOI: 10.1038/s41372-021-01103-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/10/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate acute stress disorder (ASD) symptoms and their predictors in Neonatal Intensive Care Unit (NICU) mothers. STUDY DESIGN In this cross-sectional study, 119 mothers (~72% Medicaid) completed surveys during the first month of their infants' hospitalizations. Correlations and structural equation models (SEMs) evaluated relations among mothers' childhood trauma history, infant health appraisals, objective infant health, and ASD. RESULT ASD symptoms (~55%) and childhood trauma (~33%) were prevalent. ASD was correlated with childhood trauma, infant health, and infant health appraisals. All SEMs had good fit, indicating that (a) infant health appraisals partially mediated relations between childhood trauma and ASD, and (b) infant health appraisals fully mediated relations between objective infant health and ASD. CONCLUSION ASD symptoms are prevalent among NICU mothers regardless of infant health severity. Recognition of childhood trauma history and appraisals of infant health is critical for trauma-informed care.
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Affiliation(s)
- Allison Baylor Williams
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA. .,Department of Psychology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.
| | - Karen D Hendricks-Muñoz
- Department of Pediatrics, Division of Neonatal Medicine, Virginia Commonwealth University School of Medicine and Children's Hospital of Richmond, Richmond, USA.,Virginia Commonwealth Center on Health Disparities, Richmond, VA, USA
| | | | - Sarah Griffin
- MIRECC Research Fellowship, Durham Veteran Affairs Medical Center, Durham, NC, USA
| | - Rachel Wallace
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Bruce Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Alyssa Ward
- Department of Pediatrics, Division of Neonatal Medicine, Virginia Commonwealth University School of Medicine and Children's Hospital of Richmond, Richmond, USA.,Behavioral Health Division, Department of Medical Assistance Services, Richmond, VA, USA
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Schuetz Haemmerli N, von Gunten G, Khan J, Stoffel L, Humpl T, Cignacco E. Interprofessional Collaboration in a New Model of Transitional Care for Families with Preterm Infants - The Health Care Professional's Perspective. J Multidiscip Healthc 2021; 14:897-908. [PMID: 33935499 PMCID: PMC8079346 DOI: 10.2147/jmdh.s303988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background Families with preterm infants find life after hospital discharge challenging and need tailored support to thrive. The “Transition to Home (TtH)”-model offers structured, individual support for families with preterm infants before and after hospital discharge. TtH improves parental mental health and competence, promotes child development and fosters interprofessional collaboration (IPC). Aim Evaluate the TtH-models’ structure and implementation process and its associated interprofessional collaboration from the healthcare professional’s (HCP) perspective. Methods This qualitative explorative study thematically analyzed four focus group interviews (n=28 HCP) and an open-ended questionnaire with general pediatricians (n=8). Results The main themes of the thematic analysis were the benefits of the TtH-model, tailored parental support, the challenges of changing interprofessional collaboration, facilitators and barriers to successfully implementing the model, and feasibility and health economic limits. HCP acknowledge that continuous family-centered care led by an advanced practice nurse (APN) supports, strengthens, and relieves families with preterm infants in the transition from hospital to home. Families in complex situations benefit most. The TtH-model incorporates key aspects of integrated care like shared decision-making, considering family preferences, and defining the APN as the family’s main contact. HCP want network collaboration but found communication, cooperation, and reorganization challenging in the new IPC process. IPC challenges and involving many HCP in family care can create parental oversupply, negatively affect treatment outcomes, and raise health care costs. Conclusion These challenges need to be addressed to ensure sustainable implementation of the model. The roles and tasks of HCP should be clearly distinguished from each other, and HCP must have time to learn this new form of IPC. Learning requires time, effective communication strategies, and leadership support. Political action is also required to implement new models of care, including regulating advanced practice roles and developing new financing models.
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Affiliation(s)
- Natascha Schuetz Haemmerli
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Inselspital, University Children's Hospital, Neonatology, Bern, Switzerland
| | - Geraldine von Gunten
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Inselspital, University Children's Hospital, Neonatology, Bern, Switzerland
| | - Jeannine Khan
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Liliane Stoffel
- Inselspital, University Children's Hospital, Neonatology, Bern, Switzerland
| | - Tilman Humpl
- Inselspital, University Children's Hospital, Neonatology, Bern, Switzerland
| | - Eva Cignacco
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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41
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Bevilacqua F, Morini F, Ragni B, Braguglia A, Gentile S, Zaccara A, Bagolan P, Aite L. Pediatric medical traumatic stress (PMTS) in parents of newborns with a congenital anomaly requiring surgery at birth. J Pediatr Surg 2021; 56:471-475. [PMID: 32862997 DOI: 10.1016/j.jpedsurg.2020.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pediatric medical traumatic stress (PMTS) is a psychological and physiological response of children and their families to pain, serious illness, and invasive medical procedures. We aimed to apply the PMTS model to parents of newborns operated at birth for a congenital malformation and to identify clinical and sociodemographic risk factors associated with PMTS symptoms at 6 months. METHODS We designed a cross-sectional study to assess PMTS symptoms (avoidance, arousal, reexperiencing) in parents of six months children operated on for a congenital anomaly, with the Italian version of the Impact of Event Scale - Revised (IES-R). RESULTS One-hundred-seventy parents form the object of the study. Eighty-two parents (48.2%) fell over the clinical cut-off. Ventilatory time (p = 0.0001), length of hospital stay (p = 0.0001), associated anomalies (p = 0.0002), medical devices at discharge (p = 0.0001) and Bayley motor scale (p = 0.0002) were significantly correlated with IES-R Total and Subscale Scores. Multivariate linear regression showed length of hospital stay and number of associated anomalies as significant predictors of IES-R Scores. CONCLUSIONS Regardless the type of anomaly and sociodemographic factors, it is the clinical history of the child which seems to predict the severity of PMTS symptoms in this population of parents. PMTS represents a useful model to describe the psychological reactions of parents of newborns operated at birth for a congenital malformation. NICU and outpatient pediatric staff should be aware of risk factors to identify families who may request early multidisciplinary interventions since the first admission. LEVEL OF EVIDENCE Prognosis study, level II.
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Affiliation(s)
- Francesca Bevilacqua
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Francesco Morini
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Annabella Braguglia
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Simonetta Gentile
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Zaccara
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucia Aite
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
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Dicky O, Kuhn P, Akrich M, Reynaud A, Caeymaex L, Tscherning C. Emotional responses of parents participating for the first time in caregiving for their baby in a neonatal unit. Paediatr Perinat Epidemiol 2021; 35:227-235. [PMID: 33029809 DOI: 10.1111/ppe.12718] [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: 01/10/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents of term and preterm infants hospitalised at birth experience a stressful situation. They are considered as primary caregivers in neonatal units and are encouraged to participate in their child's care. OBJECTIVES The aim of our study was to analyse the feelings of parents participating for the first time in caregiving for their baby admitted at birth in a neonatal unit in France and to compare the feelings reported by parents of term and preterm infants. METHODS An online survey was created in 2014 for parents who had a baby hospitalised at birth. We analysed parents' responses to this open-ended question: "How did you feel when you participated in caregiving for your baby for the first time?" using a qualitative discourse analysis by two analysts. Themes were identified and coded. RESULTS Between February 2014 and March 2018, 1603 parents of preterm infants and 239 parents of term infants responded to this open-ended question. Twenty-five per cent of parents expressed positive feelings exclusively (confidence, ease, joy, pride, feeling supported by healthcare professionals, by their family and feeling of being a parent), 41% expressed negative feelings exclusively (stress, fear, feeling of being judged, frustration, anger, uselessness and clumsiness) and 34% expressed mixed feelings (both positive and negative). Parents of term infants expressed less frequent feelings of stress and fear than parents of preterm infants: with a relative risk (RR) of 0.69, 95% confidence interval (CI) 0.56, 0.87. Parents of term babies more frequently expressed feelings of frustration: RR 2.40 (95% CI 1.33, 4.32). CONCLUSIONS Infant- and Family-Centred Developmental Care supportive programmes are recommended within neonatal units in order to improve the experience of parents participating in caregiving for their baby hospitalised at birth.
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Affiliation(s)
- Odile Dicky
- NICU, University Hospital, Toulouse, France.,U1027 INSERM, Paul Sabatier University, Toulouse, France
| | - Pierre Kuhn
- NICU, University Hospital, Strasbourg, France.,Cellular and Integrative Neuroscience Institute, CNRS, Paris, France
| | - Madeleine Akrich
- Collectif inter-associatif autour de la naissance (CIANE), Paris, France
| | | | - Laurence Caeymaex
- NICU, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Centre d'Etudes Discours Images Textes Ecrits Communication (CEDITEC), Paris Est Créteil University, Créteil, France
| | - Charlotte Tscherning
- NICU, University Hospital, Toulouse, France.,U1027 INSERM, Paul Sabatier University, Toulouse, France.,NICU, Sidra Medecine Hospital, Well Cornell University Hospital, Doha, Qatar.,Center for Pathophysiology Toulouse-Purpan (CPTP), Inserm Unviversity of Toulouse, Toulouse, France
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43
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Moreyra A, Dowtin LL, Ocampo M, Perez E, Borkovi TC, Wharton E, Simon S, Armer EG, Shaw RJ. Implementing a standardized screening protocol for parental depression, anxiety, and PTSD symptoms in the Neonatal Intensive Care Unit. Early Hum Dev 2021; 154:105279. [PMID: 33339676 DOI: 10.1016/j.earlhumdev.2020.105279] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to describe the development of a standardized screening program for parents of infants in the Neonatal Intensive Care Unit (NICU) and to assess its implementation. The standardized screening protocol assessed parental mental health symptoms including depression, anxiety and trauma. Screening began at 14 days post NICU admission and was implemented as part of routine medical care for all caregivers with infants admitted to the NICU at two weeks of age. Screenings were facilitated by pediatric social workers and psychology postdoctoral fellows and included review of critical self-harm items. A total of 158 parents ages 18-42 years (mean = 31.04) were eligible for screening, with 150 completed screenings. Positive screens on any of the three measures resulted in a mental health referral. Approximately 27% of parents had a positive screen that resulted in a mental health referral. The standardized screening protocol was found to be feasible, widely accepted, and effective in establishing referrals for in house mental health services. This model can be used as an example to help other NICUs implement their own universal screening protocols.
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Affiliation(s)
- Angelica Moreyra
- Children's Hospital Los Angeles, Los Angeles, CA, USA; Stanford University School of Medicine, Palo Alto, CA, USA.
| | - LaTrice L Dowtin
- Stanford University School of Medicine, Palo Alto, CA, USA; PlayfulLeigh Psyched, LLC, Hyattsville, MD, USA.
| | - Maria Ocampo
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA.
| | - Emily Perez
- Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | | | - Emily Wharton
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA.
| | - Stephanie Simon
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA.
| | - Erin G Armer
- Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Richard J Shaw
- Stanford University School of Medicine, Palo Alto, CA, USA.
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Gateau K, Song A, Vanderbilt DL, Gong C, Friedlich P, Kipke M, Lakshmanan A. Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:48. [PMID: 33435907 PMCID: PMC7802207 DOI: 10.1186/s12884-020-03536-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background Having a preterm newborn and the experience of staying in the neonatal intensive care unit (NICU) has the potential to impact a mother’s mental health and overall quality of life. However, currently there are few studies that have examined the association of acute post-traumatic stress (PTS) and depression symptoms and infant and maternal outcomes in low-income populations. Design/ methods In a cross-sectional study, we examined adjusted associations between positive screens for PTS and depression using the Perinatal Post-traumatic stress Questionnaire (PPQ) and the Patient Health-Questionnaire 2 (PHQ-2) with outcomes using unconditional logistic and linear regression models. Results One hundred sixty-nine parents answered the questionnaire with 150 complete responses. The majority of our sample was Hispanic (68%), non-English speaking (67%) and reported an annual income of <$20,000 (58%). 33% of the participants had a positive PPQ screen and 34% a positive PHQ-2 screen. After adjusting for confounders, we identified that a positive PHQ-2 depression score was associated with a negative unit (95% CI) change on the infant’s Vineland Adaptive Behavior Scales, second edition of − 9.08 (− 15.6, − 2.6) (p < 0.01). There were no significant associations between maternal stress and depression scores and infant Bayley Scales of Infant Development III scores or re-hospitalizations or emergency room visits. However, positive PPQ and screening score were associated with a negative unit (95% CI) unit change on the maternal Multicultural Quality of Life Index score of − 8.1 (− 12, − 3.9)(p < 0.01) and − 7.7 (− 12, − 3) (p = 0.01) respectively. Conclusions More than one-third of the mothers in this sample screened positively for PTS and depression symptoms. Screening scores positive for stress and depression symptoms were associated with a negative change in some infant development scores and maternal quality of life scores. Thoughtful screening programs for maternal stress and depression symptoms should be instituted. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03536-0.
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Affiliation(s)
- Kameelah Gateau
- Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,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
| | - Ashley Song
- 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, Johns Hopkins University, Baltimore, MD, USA
| | - Douglas L Vanderbilt
- Section of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Cynthia Gong
- 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.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Philippe 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
- Division of Research on Children, Youth and Families, Children's Hospital, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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45
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Kim P. How stress can influence brain adaptations to motherhood. Front Neuroendocrinol 2021; 60:100875. [PMID: 33038383 PMCID: PMC7539902 DOI: 10.1016/j.yfrne.2020.100875] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Research shows that a woman's brain and body undergo drastic changes to support her transition to parenthood during the perinatal period. The presence of this plasticity suggests that mothers' brains may be changed by their experiences. Exposure to severe stress may disrupt adaptive changes in the maternal brain and further impact the neural circuits of stress regulation and maternal motivation. Emerging literature of human mothers provides evidence that stressful experience, whether from the past or present environment, is associated with altered responses to infant cues in brain circuits that support maternal motivation, emotion regulation, and empathy. Interventions that reduce stress levels in mothers may reverse the negative impact of stress exposure on the maternal brain. Finally, outstanding questions regarding the timing, chronicity, types, and severity of stress exposure, as well as study design to identify the causal impact of stress, and the role of race/ethnicity are discussed.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, CO, United States.
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Infant-Family Mental Health in the NICU: A Mixed-Methods Study Exploring Referral Pathways and Family Engagement. J Perinat Neonatal Nurs 2021; 35:68-78. [PMID: 33528190 DOI: 10.1097/jpn.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parents and infants in the neonatal intensive care unit (NICU) are exposed to considerable stress, and infant-family mental health (IFMH) services foster emotional well-being in the context of the parent-infant relationship. This mixed-methods study examined the role of an IFMH program introduced in a level 4 NICU. The study included (1) retrospective medical record review of NICU patients who were referred to the IFMH program and (2) qualitative interviews with NICU nurse managers, neonatologists, and medical social workers to explore their understanding of the IFMH program, explore the referral pathways and factors that supported family engagement, and identify specific recommendations for program improvement. Of the 311 infant-parent dyads referred to the IFMH program, 62% had at least one session and Spanish-speaking families were more likely to engage. Of those families receiving services, about one-third had brief intervention, one-third had 4 to 10 sessions, and one-third had long-term services, including in-home after-discharge services. Qualitative interviews with health providers identified unique qualities of the IFMH program and why families were and were not referred to the program. Recommendations centered on adding a full-time IFMH mental health provider to the NICU and increasing communication and integration between the IFMH program and the medical team.
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Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category. J Perinatol 2021; 41:468-477. [PMID: 32801351 PMCID: PMC7427695 DOI: 10.1038/s41372-020-00775-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine interhospital variation in admissions to neonatal intensive care units (NICU) and reasons for the variation. STUDY DESIGN 2010-2012 linked birth certificate and hospital discharge data from 35 hospitals in California on live births at 35-42 weeks gestation and ≥1500 g birth weight were used. Hospital variation in NICU admission rates was assessed by coefficient of variation. Patient/hospital characteristics associated with NICU admissions were identified by multivariable regression. RESULTS Among 276,489 newborns, 6.3% were admitted to NICU with 34.5% of them having mild diagnoses. There was high interhospital variation in overall risk-adjusted rate of NICU admission (coefficient of variation = 26.2) and NICU admission rates for mild diagnoses (coefficient of variation: 46.4-74.0), but lower variation for moderate/severe diagnoses (coefficient of variation: 8.8-14.1). Births at hospitals with more NICU beds had a higher likelihood of NICU admission. CONCLUSION Interhospital variation in NICU admissions is mostly driven by admissions for mild diagnoses, suggesting potential overuse.
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Fang JL, Chuo J. Using telehealth to support pediatricians in newborn care. Curr Probl Pediatr Adolesc Health Care 2021; 51:100952. [PMID: 33531258 PMCID: PMC8693894 DOI: 10.1016/j.cppeds.2021.100952] [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: 10/22/2022]
Abstract
This clinical scenario-based review will discuss how telehealth programs improve access to specialty care for neonates, their caregivers, and primary care pediatricians. Tele-resuscitation supports pediatricians during complex, high-risk newborn resuscitations, improves the quality of delivery room care, and reduces odds of transfer to a higher level of care. Neonatologists and other pediatric specialists use telehealth to provide more effective consultations that positively influence management decisions and patient outcomes. When neonatologists provide video visits to home and meet virtually with primary care pediatricians, infants discharged from the NICU experience fewer emergency room visits and hospital re-admissions. With further implementation and dissemination of neonatal telemedicine programs, it is important that these programs continue to be thoughtfully designed to achieve measurable value that is relevant to patients and caregivers, providers, healthcare systems, and payers.
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Affiliation(s)
- Jennifer L Fang
- Division of Neonatal Medicine, Mayo Clinic, 200 First St. SW, Rochester MN, 55905, United States.
| | - John Chuo
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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Moreno-Sanz B, Montes MT, Antón M, Serrada MT, Cabrera M, Pellicer A. Scaling Up the Family Integrated Care Model in a Level IIIC Neonatal Intensive Care Unit: A Systematic Approach to the Methods and Effort Taken for Implementation. Front Pediatr 2021; 9:682097. [PMID: 34178899 PMCID: PMC8219911 DOI: 10.3389/fped.2021.682097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Family Integrated Care (FICare) integrates parents in the direct care of their child while the healthcare personnel act as teachers and guides. To this date, most reports on the feasibility of this model refer to stable preterm infants admitted to Neonatal Intensive Care Units (NICUs). Objectives: To scale up and adapt FICare to make it suitable in level IIIC NICUs, which care for extreme prematurity and other complex medical or surgical neonatal conditions. Materials and Methods: Step 1 was the creation of the FICare implementation team (FICare-IT) and baseline analysis of current procedures for critical care to identify needs, wishes, and requirements; we aimed for protocol elaboration tailored to our cultural, architectural, and clinical context (March 2017 to April 2018). Step 2 as a dissemination strategy by FICare-IT acting as primary trainers and mentors to ensure the education of 90% of nursing staff (May 2018 to July 2018). Step 3 involved piloting and evaluation with the aim to refine the procedure (July 2018 to December 2020). Results: A rigorous but flexible protocol was edited. The FICare educational manual included two curricula: for healthcare professionals/staff (Training the trainers) and for families (Education of caregivers), the latter being categorized in two intervention levels (basic and advanced), depending on the infant care needs and parent's decision. In total, 76 families and 91 infants (74.7% preterm; 18.7% complex surgery; 6.6% others) were enrolled in the pilot. No differences in acceptance rate (overall 86.4%) or in the number of infant-family dyads in the program per month were observed when considering the pre- and post-Covid-19 pandemic periods. All families, except for one who dropped out of the program, completed the agreed individualized training. Mothers spent more time in NICU than fathers (p < 0.05); uninterrupted time spent by mothers in NICU was longer during the pre-pandemic period (p < 0.01). Observed time to reach proficiency by task was within the expected time in 70% of the program contents. The parents revealed educational manuals, workshops, and cot-side teaching sessions as essential for their training, and 100% said they would accept entry into the FICare program again. Conclusions: The principles of the FICare model are suitable for all levels of care in NICUs. Leadership and continuous evaluation/refinement of implementation procedures are essential components to achieve the objectives.
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Affiliation(s)
- Bárbara Moreno-Sanz
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
| | - María Teresa Montes
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
| | - Marta Antón
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | | | - Marta Cabrera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain
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Soghier LM, Kritikos KI, Carty CL, Glass P, Tuchman LK, Streisand R, Fratantoni KR. Parental Depression Symptoms at Neonatal Intensive Care Unit Discharge and Associated Risk Factors. J Pediatr 2020; 227:163-169.e1. [PMID: 32681990 DOI: 10.1016/j.jpeds.2020.07.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the prevalence and risk factors associated with parental depressive symptoms at neonatal intensive care unit (NICU) discharge and determine the relationships among depressive symptoms, stress, and social support. STUDY DESIGN Parents participating in the Giving Parents Support trial (n = 300) were surveyed before NICU discharge. Depressive symptoms, stress, and social support were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10), Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support (MSPSS). Regression analyses examined relationships among depressive symptoms, stress, social support, and parent/infant factors. RESULTS At NICU discharge, 45% of parents reported depressive symptoms and 43% reported elevated perceived stress. Increased odds of elevated depressive symptoms were associated with older gestational age (P = .02), female infant (P = .02), and longer length of stay (P = .045). Odds of depression were 7.87 (95% CI, 2.15-28.75) for parents of infants with gestational age ≥37 weeks compared with gestational age <28 weeks. Parental NICU stress was higher in younger parents (P < .01). Depressive symptoms were positively associated with parental stress. Each 1-point increase in PSS:NICU score was associated with a 2.1-point (95% CI, 1.6-2.9; P < .001) increase in CESD-10 score. Social support was inversely associated with depressive symptoms. CONCLUSION The prevalence of depressive symptoms in parents at NICU discharge was high, even among parents of term infants. Older gestational age, greater parental stress, and lower levels of social support were strong correlates of depressive symptoms. Strategies to support parents, including depression screening, stress reduction strategies, and mental health referrals, are needed.
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Affiliation(s)
- Lamia M Soghier
- Department of Neonatology, Children's National Hospital, Washington, DC; Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC.
| | - Katherine I Kritikos
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC
| | - Cara L Carty
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC
| | - Penny Glass
- Department of Neonatology, Children's National Hospital, Washington, DC; Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Department of Psychology and Behavioral Health, Children's National Hospital, Washington, DC
| | - Lisa K Tuchman
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Department of Adolescent and Young Adult Medicine, Children's National Hospital, Washington, DC
| | - Randi Streisand
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Department of Psychology and Behavioral Health, Children's National Hospital, Washington, DC
| | - Karen R Fratantoni
- Center for Translational Science, Children's Research Institute, Children's National Hospital, Washington, DC; Division of General and Community Pediatrics, Children's National Hospital, Washington, DC
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